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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The case records of all neonates admitted to the neonatal unit at Aga Khan University Hospital (Karachi) in a 30 month period (Nov. 86-April 89) were analysed. Of 60 neonates with confirmed sepsis, 33 (55%) had non-nosocomial infection (NNC) whereas 27 (45%) had nosocomial sepsis (NC). The most common organisms causing early-onset NNC sepsis were Klebsiella species (53%) and Escherichia coli (10%), whereas the organisms causing late-onset NNC sepsis included Salmonella parathypi (21%), Group A Streptococcus (21%), Escherichia coli (14%) and Pseudomonas species (14%). Klebsiella was the most common organism causing NC sepsis, others being Staphylococcus aureus (15%) and Serratia species (15%). The mortality in NC sepsis, early-onset and late onset NNC sepsis was 44%, 26% and 43%, respectively. Risk factors associated with NNC sepsis included low birthweight, prematurity and prolonged and complicated deliveries. There was a high incidence of drug resistance to ampicillin and gentamicin among gram-negative organisms causing sepsis (mean 67%).
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PMID:Neonatal sepsis in Pakistan. Presentation and pathogens. 186 74

Babies, on admission into a neonatal ward at the Lagos University Teaching Hospital, had their rectal swab specimens examined bacteriologically and screened for enteric bacterial pathogens over a one-year-period at two-week intervals. It was found that on the average there were 3 (9.68%) enteric bacterial pathogens out of an average of 31 admissions at each screening period. The enteric bacterial pathogens isolated included: non-typhoid salmonellae, which accounted for 55 (80.88%) isolates out of the 68 enteric bacterial pathogens, Salmonella typhi 2.94%, Shigella dysenteriae 2.94%, Shigella flexneri 4.41%, S. boydii 1.47%, S. sonnei 1.47%, Campylobacter jejuni 1.47% and Enteropathogenic Escherichia coli (EPEC) 2.94%. The main clinical conditions associated with those babies in whom the enteric pathogens were isolated included sepsis, prematurity, neonatal jaundice and tetanus. It is concluded that the enteric bacterial pathogens, even though they were not directly associated with diarrhoeal disease in the newborns in this study, might have contributed to other illnesses like sepsis and meningitis. It is also noteworthy that the enteric bacterial pathogens isolated sporadically from the babies could have been over-looked in view of the fact that it is not conventional to search for enteric bacterial pathogens in babies without diarrhoea on admission. Rectal swab investigations could provide additional information which might be of epidemiological importance in ill neonates in the clinical settings that prevail in developing countries.
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PMID:Screening of children for enteric bacterial pathogens in the outborn neonatal ward in Lagos, Nigeria. 191 94

The purpose of this cohort study was to determine the incidence of and risk factors for major neurodevelopmental impairments among survivors of extreme prematurity. The study cohort comprised 100 infants born between 24 and 28 weeks of gestational age at one tertiary center from 1983 to 1984. Twenty-five infants (25%) died; 75 (75%) survived until follow-up (mean, 60 months). Standardized neurodevelopmental and psychometric assessments were performed in blind fashion on 68 of the 75 surviving children (91% follow-up). Informal assessments (parent, teacher, and physician reports) were obtained instead for seven (9%) children who had relocated outside of the area. Overall, 19 children (25%) had one or more major impairments: mental retardation, 9; cerebral palsy, 4; multiple impairments, 5; and blindness, 1. Despite a high prevalence of impairments, 95% of children (n = 71) were functionally independent [corrected]. Special educational resources were definitely necessary for seven (9%) and possibly needed for 36 (48%) additional children. Univariate analyses revealed four significant risk factors for cerebral palsy: hydrocephalus (relative risk = 12.2), grades III and IV intraventricular hemorrhage (relative risk = 5.8), 5-minute Apgar score lower than 7 (relative risk = 5.7), and bronchopulmonary dysplasia (relative risk = 5.5). Hydrocephalus was the only significant risk factor observed for mental retardation (relative risk = 5.4). Risk factors predicting a need for special education resources included sepsis (relative risk = 24.9), low socioeconomic status (relative risk = 16.3), and nonwhite race (relative risk = 3.0). Thus our data suggest that biomedical factors appear to confer the greatest risk of major impairments; sociodemographic factors appear to have a significant impact on educational risk in extremely premature infants who do not die. Continued follow-up with biomedical and developmental-social interventions appears warranted to decrease the risk of educational underachievement in this population.
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PMID:Risk factors for major neurodevelopmental impairments and need for special education resources in extremely premature infants. 191 94

This prospective study was designed to determine the value of a daily modified biophysical profile in detecting infection in patients with preterm premature rupture of the membranes who were managed expectantly. Ninety-nine patients received daily nonstress tests and biophysical profile scores. Results of the last predelivery study were related to subsequent development of amnionitis or fetal sepsis. Infection was present in 16 patients. When the biophysical profile score was 0/8, infection was uniformly present. When fetal breathing was absent (biophysical profile score, less than or equal to 4/8) and nonstress test was nonreactive, infection was present in 75% of cases (sensitivity, 75%; specificity, 95%). Because a nonreactive nonstress test could be secondary to prematurity instead of infection, these results were analyzed over time. Those who initially had a reactive nonstress test that subsequently became nonreactive were more likely to be infected. We conclude that a daily biophysical profile score and nonstress test can detect infection and propose delivery of patients with a biophysical profile score of 0/8 and nonreactive nonstress test. Patients with absent fetal breathing and a nonstress test that changes from reactive to nonreactive also should be considered for delivery. Absent fetal breathing with a reactive nonstress test or a consistently nonreactive nonstress test should have further testing to rule out infection.
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PMID:Preterm premature rupture of membranes: detection of infection. 195 22

A retrospective case-control study was designed to assess risk factors for neonatal infection. Nonprivate patients (8,215) who delivered in a period from January 1, 1983 to June 30, 1988 were studied. Ninety three cases of conjunctivitis (incidence 2.4/1,000), 104 cases of pneumonia (incidence 2.8/1,000), and 50 cases of sepsis (incidence 1.3/1,000) were identified. Group B streptococcus was cultured from septic neonates in 46%. Calculated Odds ratio's indicated prematurity/low birth-weight (OR 6.9) and antepartum fetal tachycardia (OR 6.3) as important risk factors for pneumonia/sepsis. Prematurity/low birth-weight (OR 3.0) and an abnormal presentation in the birth canal (OR 2.8) were identified as risk factors for conjunctivitis. After testing all the risk factors found by univariate analysis in a logistic regression model tachycardia (chi 2 35.21, p less than 0.001) remained an independent predictor for neonatal pneumonia/sepsis and abnormal vaginal presentation (chi 2 7.58, p 0.006) for conjunctivitis.
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PMID:Risk factors for neonatal infection. 208 89

A 93% survival rate was achieved in 80 neonates treated for gastroschisis between 1979 and 1986. Uncomplicated gastroschisis occurred in 70 infants (88%); 51% underwent staged silo reduction and 49% had primary fascial closure. Gastroschisis associated with intestinal atresia or volvulus was present in 10 neonates (12%), half of whom had a residual jejunoileum between 10 and 55 cm. Major postoperative complications included gastrointestinal problems (infarction, obstruction, and prolonged dysfunction), wound infection, and catheter-associated difficulties (sepsis, infiltration, and malposition). Three of the six deaths were related to associated conditions (extreme prematurity, trisomy 13, and multiple anomalies) and three were caused by intraoperative hemorrhage, necrotizing enterocolitis, and extensive short-bowel syndrome. No statistical difference in morbidity, mortality, and length of hospitalization was demonstrated between infants treated by silo reduction and primary closure. Safe management of gastroschisis should include an individualized assessment of visceroabdominal disproportion and degree of intraabdominal tension. Vigilant expectation of potentially life-threatening complications is required to decrease postoperative morbidity, irrespective of the technique of abdominal wall closure.
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PMID:An individualized approach to the management of gastroschisis. 213 18

Advantages of primary fascial closure of abdominal wall defects are mainly in reducing the number of staged procedures with related complications and the need of multiple operation. Nevertheless correction of large defects still remains a challenge to pediatric surgeon. Postoperative paralysis and mechanical ventilation after intraoperative milking of intestinal content and abdominal muscles stretching have been reported to reduce the risks of "forced" primary closure. A series of 64 Omphalocele and Gastroschisis has been reviewed. Associated anomalies are still the main cause of mortality among Omphalocele. Prematurity plays a secondary role on survival of Gastroschisis cases; deaths were mainly due to sepsis. Primary respiratory insufficiency affected a large number of Giant Omphalocele cases (larger than 5 cm with herniated liver) and was associated to a restricted chest structure. All these cases died in the first weeks of life. Primary closure with or without postoperative paralysis and mechanical ventilation showed to reduce in a significant way the postoperative complication rate compared to staged procedures. Mortality and hospital stay were not significantly influenced by different kinds of surgical treatment among Omphalocele. Associated anomalies are an unavoidable limiting factor to survival. Among Giant Omphalocele the use of aggressive primary fascial closure with ventilatory support showed in our hands to be a safe procedure provided that a preoperative selection of cases on the basis of chest X-ray and blood gases has been made.
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PMID:[One-stage "forced" closure of large congenital defects of the abdominal wall with mechanical ventilation and curarization. Clinical evaluation]. 214 95

Listeria monocytogenes can cause sepsis and meningitis during the neonatal period. Six cases of early onset neonatal sepsis caused by Listeria monocytogenes are reported here. These cases were diagnosed in a private hospital at Santiago, Chile from December 1984 throughout November 1986. The incidence rate was 1.4 x 1,000 liveborns. Clinical findings included prematurity (6), meconium stained amniotic fluid (6), hepatomegaly (6), splenomegaly (6), maculopapular exanthem (4), anal prolapse (3) and meningitis (1). Additionally 5 patients developed respiratory distress and 4 required ventilatory support. Overall mortality was 50% (3/6). All deaths were related to respiratory failure and occurred during the first week of disease. All patients received ampicillin and amikacin early in the course of their infection. Listeriosis of the newborn infant might be preventable by prompt recognition and treatment of maternal infections. Since Listeria infection in pregnancy is usually mild and symptoms and signs are nonspecific, prevention may be difficult. Pregnant women with fever of no clear origin or with an influenza like syndrome should be screened for listeriosis with cultures from blood, vagina and cervix samples.
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PMID:[Early onset neonatal septicemia caused by Listeria monocytogenes]. 215 19

We present a prospective study about 100 intravascular catheters inserted into 88 newborns. 35 positive blood cultures were obtained; 19 with clinical signs of sepsis and 16 in asymptomatic newborns. Coagulase-negative Staphylococci were the most common isolated organisms -84.2% in the symptomatic cases, 100% in the asymptomatic ones. A comparative study was realized between cases of catheter-related sepsis with positive blood culture of coagulase-negative Staphylococcus (n = 14) versus asymptomatic cases with positive blood culture (n = 16). Risk factors in the appearance of symptoms are: prematurity, newborns old age when catheters are inserted and days of catheter placement.
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PMID:[Staphylococcus coagulase negative infection in neonates caused by intravascular catheters. Prospective study]. 222 28

Campylobacter infections occurring during pregnancy have been associated with spontaneous abortion, stillbirth, prematurity and neonatal sepsis, all ten Campylobacter jejuni infections diagnosed in the approximately 24,000 pregnant women attending a 520-bed hospital between January 1984 and December 1988 were reviewed. Nine women delivered healthy babies at term. In one case, Campylobacter infection at 28 weeks of gestation was associated with premature labour and delivery with subsequent neonatal sepsis and death. One other infant developed Campylobacter jejuni enterocolitis at 3 days of age. Although maternal Campylobacter jejuni infection tends to be mild and self-limited, there may be more serious complications for the fetus or neonate, especially if infection occurs before the third trimester of pregnancy.
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PMID:Campylobacter jejuni infection occurring during pregnancy. 231 19


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