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

Primary tissue closure of gastroschisis remains controversial. Some surgeons routinely place a silicone rubber sheet silo over the exposed bowel, planning a staged closure. In the past 14 1/2 years, we have cared for 106 newborns with gastroschisis, closing the defect primarily in 80%. The success of this technique depends on enlarging the abdominal cavity and decreasing the volume of bowel that must be replaced in the peritoneal cavity. Thorough preoperative rectal irrigation should evacuate all meconium. After undermining the skin around the abdominal wall defect for only 1 cm, a midline subcutaneous fasciotomy is created from the xiphoid to the pubis. The abdominal wall is then stretched in all quadrants beginning at the flanks. The eviscerated small bowel can often be returned without enlarging the initial skin defect. The skin is closed with subcuticular absorbable sutures reinforced by long skin tapes. The small ventral hernia that results is closed at about 1 year of age. Fascia could be closed primarily in 28% of these patients, and 17% required a prosthetic pouch. The duration of postoperative ileus and length of hospital stay were statistically significantly shorter in the infants who underwent primary closure. Even though more complicated patients were included in the primary closure group, the incidence of mortality and morbidity was not higher than in patients treated with silicone rubber pouches. Deaths were inevitable in five infants with gangrenous bowel, multiple anomalies, and extreme prematurity. Deaths were related to sepsis in three infants and were the result of operative or anesthetic technique in four. Only two preoperative factors were prognostic of morbidity and mortality: gestational age (but not birth weight) and the presence of intestinal ischemia or atresia.
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PMID:Gastroschisis in 106 consecutive newborn infants. 293 43

Intestinal stenosis or stricture occurs in approximately one third of medically treated infants surviving the acute phase of necrotizing enterocolitis (NEC). Identification of these lesions by the use of routine contrast enemas has been advocated as a means of decreasing potential morbidity from delayed diagnosis. However, the significant incidence of spontaneous resolution and reluctance to submit asymptomatic infants to contrast enema have led recent researchers to reserve these studies for patients developing symptoms of obstruction during a period of close observation. From July 1984 to July 1986, symptomatic strictures developed in five infants (15%) responding to medical management at our institution. Contrast enemas were not routinely performed and four (80%) of these patients presented with life-threatening sepsis or perforation associated with intestinal obstruction. Two infants developed complete colonic obstruction 4 and 6 weeks after discharge from the Intensive Care Nursery, having initially tolerated oral feedings. Both infants were critically ill due to perforation or sepsis and underwent emergency colostomy at community hospitals. Two other infants developed abdominal distension with sepsis and cardiopulmonary decompensation while remaining hospitalized for prematurity and pulmonary insufficiency. These patients became symptomatic 5 and 7 weeks after cautious refeeding while closely monitored in the Intensive Care Nursery. The occurrence of such life-threatening complications suggests that clinical observation alone is not adequate in the management of many of these infants. Contrast enemas should be performed to identify those patients at risk of such potential morbidity or mortality, especially those infants not residing near pediatric surgical facilities.
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PMID:Post-necrotizing enterocolitis strictures presenting with sepsis or perforation: risk of clinical observation. 304 59

When sought by light microscopy in formalin-fixed tissue, fusobacteria are apparent in 7-18% of chorioamnionitis cases. Brown and Hopps bacterial staining characteristically visualizes their long, slender and filamentous forms. Fusobacteria-like organisms in placentae have previously been associated with prematurity. Our findings indicate that perinatal infection with fusobacteria may cause neonatal death from prematurity, rather than from sepsis. In a study of 586 placentae, 14 specimens with chorioamnionitis and fusobacteria-like organisms were found. On the five occasions when microbiologic tests were made, fusobacteria were isolated. Prematurity of the newborns was associated with twelve of those placentae. Immunofluorescent labelling of the organisms is a helpful but incomplete means of diagnosis. Because fusobacteria antibodies are highly specific, they do not cross-react with other members of the genus Fusobacterium. A typical case is reported, in detail.
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PMID:Clinicopathologic considerations of fusobacteria chorioamnionitis. 307 Oct 72

The neonatal outcomes of 30 pregnancies that were complicated by premature and prolonged rupture of the membranes that had started in the second trimester of pregnancy, were reviewed. The neonatal mortality was 11 (36%), the main cause of death being pulmonary hypoplasia. Two infants died of sepsis, but these were the only proved episodes of maternal or fetal infection. Of the survivors, 27% developed compressive limb abnormalities, all of which responded to passive physiotherapy. Pulmonary hypoplasia was significantly associated with earlier onset of rupture of the membranes, and the absence of fetal breathing movements. Compressive limb abnormalities were significantly associated with longer periods of oligohydramnios. We conclude that premature rupture of the membranes, even with onset in the second trimester, may be associated with a favourable outcome and this may be predicted by the persistence of fetal breathing movements. We therefore, recommend expectant management of such pregnancies, but suggest elective delivery at 34 weeks to limit fetal exposure to uterine compression and minimise the risks of prematurity.
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PMID:Neonatal outcome after prolonged rupture of the membranes starting in the second trimester. 319 69

The outcome of neonatal care was studied in 3 subdistricted rural areas in Yogyakarta Province with a total population of 112,075 people. All pregnancies and deliveries between May 1983-April 1984 were registered and seen twice during pregnancy, on delivery, and 5 days and 1 month postpartum by trained health personnel. There were 1819 singleton liveborn infants with a neonatal mortality rate of 25.3% in which 82.6% of the deaths occurred in the early neonatal period. 91.5% of the women delivered in their own homes and 83.9% were assisted by a traditional birth attendant (TBA) who was either trained or untrained. There were still 27.1% of the pregnancies which did not receive any antenatal care. 75.2% received tetanus immunizations and there was a 1.1% incidence of tetanus. The incidence of lowbirth infants was 8.1% among these, 19.7% died prior to 1 month of age and represented 63% of neonatal mortality. The causes of neonatal mortality were: birth asphyxia and hypoxia--56.5%; prematurity/low birthweight--13%; infection/sepsis--13% diarrhea--8.7%, tetanus neonatorum--4.4%, and other unknown causes--4.4%. In rural areas, TBAs play a key role in labor and in caring for mothers and their newborns up to 1 month of age. Clearly there is much needed improvement in health service delivery at all levels of the healthcare system, especially in the areas of resuscitation of newborns and in problems of low birthweight.
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PMID:Neonatal mortality in Yogyakarta rural areas. 327 Aug

Group B streptococcal infection may result in significant morbidity and mortality in both infants and adults. The experience with group B streptococcal disease was analyzed at one medical center over a ten-year period from 1975 to 1984. Streptococcus agalactiae bacteremia was observed in 29 adults and 26 infants, with an attack rate of 0.2 cases per 1000 adult admissions and 3.2 cases per 1000 live births, respectively. The majority of adult infections apparently occurred as a result of nosocomial acquisition and was associated with a high mortality rate of 38%. Risk factors for group B streptococcal sepsis in adults include diabetes mellitus, malignancy, and hepatic failure. The majority (73%) of neonatal cases occurred within seven days of birth and occurred in a setting of maternal fever, prolonged rupture of membranes, or prematurity. The mortality rate in infants was remarkably low at only 15%. Fatalities occurred in both adults and infants, despite appropriate antimicrobial therapy. Infection control strategies against group B streptococcus must address potential nosocomial dissemination in adults as well as vertical transmission in infants.
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PMID:Group B streptococcal sepsis in adults and infants. Contrasts and comparisons. 327 72

Malassezia furfur, a lipophilic yeast, has become recognized as a cause of sepsis in infants receiving parenteral fat emulsions via indwelling deep venous catheters. Colonization of infants' skin may be a prerequisite to colonization of the intravascular catheter and subsequent infection with M furfur. Three hundred ninety-three surveillance cultures were performed on 146 infants during their first 12 weeks of hospitalization in the intensive care unit (ICU) or the neonatal transitional unit (NTU). In addition, 47 full-term newborn infants and 38 healthy infants in the well-baby clinic were cultured. Colonization rates were greatest (48%) during the second month of hospitalization for the infants in the ICU/NTU group. In contrast, 0 of 47 newborn infants and 2 of 38 healthy infants were colonized. Prematurity and a prolonged length of stay were identified as risk factors for colonization.
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PMID:Malassezia furfur skin colonization in infancy. 328 20

Authors have studied 45 babies born during past five years to drug-addicted mothers. Increase in number han been remarkable: from 0.095 per thousand live births in 1980 to 1.57 in 1984. There was and 16.3% incidence for preterm infants, 34.8% for low birth weight and 18.6% were small for gestational age. One third (30.2%) suffered infections, mostly sepsis. Morbidity was high in these babies, caused mainly by prematurity. Drug withdrawal syndrome appeared in 26 babies (60.4%) at an age of 13 +/- 10 hours. Fifteen of these babies (57.6%) required pharmacological treatment during 10 +/- 7.3 days, with a good response, and only two cases needed treatment for more than a month. There were no deaths in the neonatal period. In our experience children of heroin addicted mothers form a group difficult to study because their parents give not reliable data, they have high morbidity and true problems begin when they leave hospital.
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PMID:[Newborn infants of mothers addicted to heroin. Study of 45 cases]. 334 60

The sonograms of 12 infants aged 2 days to 7 months were evaluated to determine if the torcular Herophili could be demonstrated routinely on cranial sonography. Sonography, which was performed for a variety of indications (prematurity, seizures, hydrocephalus, sepsis, congenital anomalies, and subarachnoid hemorrhage) demonstrated the torcular Herophili in all cases. It appeared as a variable-sized, anechoic, and triangular or elongated structure inferior to the occipital lobes, posterior to the cerebellum, and just inside the cranial vault. Correlation with computed tomographic scans was available in four patients. A detailed description of the normal anatomy of the torcular Herophili is provided. Knowledge of the variable sonographic appearance of the torcular Herophili is important to distinguish it from a pathologic entity.
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PMID:Sonographic appearance of the torcular Herophili. 351 38

The number of cases of neonatal Haemophilus influenzae sepsis reported in the literature has increased. The predominant serotypes (80%) involved in neonates appear to be non-type b whereas in older infants type b is responsible for the great majority of cases. It appears that most cases of neonatal H. influenzae sepsis begin before or at the time of delivery, as the disease is strongly associated with early postnatal onset (83%), prematurity (83%), and a variety of maternal complications (44%). The mortality rate is 55.5% overall but 90% among babies born at less than or equal to 30 weeks of gestation.
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PMID:Characteristic features of neonatal sepsis due to Haemophilus influenzae. 353 17


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