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

TPN-associated cholestasis (TPNAC) is a common problem in neonatal surgical patients. Of the 222 infants admitted to the neonatal surgical intensive care unit between January 1982 and June 1983, 46 patients received parenteral nutrition for over 14 days. Cholestasis occurred in 16 of these patients (35%), while 30 patients remained jaundice-free. Clinical characteristics associated with the development of TPNAC, included primary diagnosis, low birth weight, duration of TPN administration, the interval before enteral feeding was initiated, sepsis, central venous catheter infection, and the number of operative procedures. Factors which did not appear significant in the development of conjugated hyperbilirubinemia were prematurity, sex, gestational age, average daily weight gain, and the specific components of the nutritional intake. Mortality was high in the children with cholestasis (31%) as compared to the "normal" neonates (3%) and two of the five deaths were directly related to progressive hepatic dysfunction. This report confirms the high incidence of TPNAC in the newborn surgical population and discusses the critical risk factors associated with development of the syndrome.
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PMID:TPN-associated hyperbilirubinemia: a common problem in newborn surgical patients. 393 Jun 93

A set of xiphopagus conjoined twins with prematurity, exomphalos, and intestinal obstruction was separated successfully. Preoperative evaluation included computerised axial tomography, 99mTc-HIDA scan, and barium enema. Major hepatobiliary and gastrointestinal anomalies were encountered. One twin is alive and well today. The other twin died one week postoperatively from sepsis. Postmortem studies showed she had a severe cardiac anomaly incompatible with normal life.
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PMID:Management of xiphopagus conjoined twins with small bowel obstruction. 394 59

A previous prospective study of neonatal mortality in babies receiving special care at the University College Hospital, Ibadan, revealed that respiratory failure associated with prematurity, perinatal asphyxia, sepsis, and congenital malformations were the major causes of high neonatal mortality. To improve survival, selective measures were taken to improve care of low-birth-weight infants and prevent or treat intrapartum and postnatal hypoxia, metabolic acidosis, hypoglycemia, and hypothermia. A change in the initial antibiotic management of suspected septicemia to the use of cloxacillin and an aminoglycoside was also introduced, based on the current knowledge of etiologic agents and their antimicrobial sensitivities. In the 5-year period (1976 to 1980), the neonatal mortality in babies weighing 2,500 g and more at birth dropped significantly from 1.2% to 0.7% (P less than .02). The case fatality rates from birth asphyxia and neonatal sepsis dropped by 48% and 32%, respectively. Despite therapeutic interventions, however, the neonatal mortality in babies with birth weight of 1,000 g or less, 1,001 to 1,500 g, 1,501 to 2,000 g, and 2,001 to 2,499 g remained unchanged at about 82%, 25%, 9%, and 3%, respectively. These results suggest that early identification of infants at risk of developing birth asphyxia or neonatal septicemia and institution of prompt and appropriate management could produce a significant reduction in mortality in infants of normal birth weight. Survival of low-birth-weight infants requires additional high technical, financial, and manpower resources, which most centers in developing countries cannot afford at the present time. Therefore, efforts are probably better concentrated on decreasing the incidence of low birth weight.
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PMID:Neonatal mortality: effects of selective pediatric interventions. 396 46

This study was undertaken to determine the effects of clinical amniotic fluid infection on the neonate in terms of bacterial infection, hyaline membrane disease, asphyxia, and mortality. A retrospective chart review was made of 107 mothers with clinical amniotic fluid infection and their infants at this institution over a 3-year period. The next live-born infant with a birth weight within 100 gm and gestational age within 2 weeks was chosen as a control for each study patient. The rate of prematurity in the study group was 71%. When prematurity was controlled for, there was no significant difference in regard to asphyxia, hyaline membrane disease, bacterial sepsis, and death between the study and control groups. These findings suggest that the adverse outcome for infants delivered to mothers with clinical amniotic fluid infection at this institution was related primarily to their prematurity.
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PMID:Clinical amniotic fluid infection and its effect on the neonate. 398 66

The relationship of acute urinary tract infection occurring during pregnancy and the incidence of adverse fetal outcomes was examined with the use of birth certificate data from Washington state for the years 1980 and 1981. The two-year fetal mortality rate among urinary tract infection-associated pregnancies was found to be 17.9 per thousand livebirths, 2.4 times the rate for the state as a whole. Low birth weight newborns and small for gestational age newborns were, respectively, 2.04 and 1.57 times more frequent in urinary tract infection-associated pregnancies compared to controls. These estimates of risk were unchanged when adjusted for maternal age, race, and past obstetric history. The risk of prematurity in women with urinary tract infection and no history of fetal loss was 2.4 times the control risk. Sepsis was rare in both the urinary tract infection and control groups. These results add to the evidence implicating maternal urinary tract infection as a threat to fetal well-being.
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PMID:Maternal urinary tract infection and adverse fetal outcomes. 401 27

We have reviewed 107 cases of staphylococcal bacteraemia in order to assess the current clinical spectrum of serious staphylococcal sepsis in Zimbabwe, where staphylococcal bacteraemia is common. Infection was hospital-acquired in 35 cases and community-acquired in 72 cases. The mortality rate was 28%. Most patients were young, with predisposing conditions such as prematurity, protein-caloric malnutrition and measles. The length of the prodromal illness tended to be short and a primary site of infection, usually the lungs or skin, was obvious in 66% of patients. In 30% there was evidence of metastatic spread, usually to meninges, bone, joint and muscle, but endocarditis was uncommon. Metastatic infection was rare when infection was acquired in hospital. Death appeared to be associated with measles, protein-caloric malnutrition, acquisition of infection in hospital, absence of an obvious focus of infection and with inappropriate antibiotic therapy. Aggressive treatment with antibiotics intravenously was the rule. A combination of penicillin and an aminoglycoside was favoured until the nature of the infecting organism was established. Of those patients who died, 38% had received less than 72 h antibiotic therapy. Multiple antibiotic resistance is now widespread in Zimbabwe.
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PMID:Staphylococcal bacteraemia in Zimbabwe 1983. 403 14

Amniocentesis to guide the management of preterm pregnancies complicated by premature rupture of the membranes (PROM) has been adopted at several centers. The purpose of this study was to evaluate this practice prospectively among comparable groups of patients, which has not previously been reported. Forty-seven patients with PROM at 26 to 34 weeks of gestation and an accessible pocket of amniotic fluid by ultrasound examination were randomly assigned to an "amniocentesis group" (N = 25) or to a "no amniocentesis group" (N = 22). Amniocentesis results were utilized when making management decisions in the amniocentesis group, whereas a clinical basis alone was used in the no amniocentesis group. Demographic variables were similar between the two study populations at the time of randomization. There were no antepartum fetal deaths and one neonatal death in each group. Fetal distress, as judged by the fetal monitor tracing, was more frequent in the no amniocentesis group (P less than .05). The number of days the infant remained in the hospital was significantly less in the amniocentesis group (median = 8.5 days, range 2 to 88 days) than in the no amniocentesis group (median = 22 days, range 2 to 110 days, P less than .01). This difference in neonatal hospital days appeared to be mainly due to a slower resolution of the multiple problems of prematurity. No significant differences in these complications were demonstrated individually. No differences in antepartum hospital days, postpartum hospital days, postpartum endometritis, or sepsis were apparent between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Conservative versus aggressive management of preterm rupture of membranes. A randomized trial of amniocentesis. 639 20

A review is presented of jaundiced newborn infants during the 10-year period to 1980. Included are those whose serum bilirubin level was 154 mumol/l or more. Of 41,057 live births, 4,406 (10.7%) infants had hyperbilirubinaemia. The most common (19.9;%) aetiological factor was prematurity, followed by ABO erythroblastosis 7.1%; sepsis 3.4%; Rhesus erythroblastosis 2.7%; bruising 2.2%; multifactorial 1.0% and glucose-6-phosphate dehydrogenase deficiency 0.5%. Treatment was not undertaken in 2,855 (64.7%) infants, but 1,419 (32.2%) received phototherapy alone, 122 (2.7%) infants received both exchange transfusion and phototherapy and 10 (0.2%) infants received exchange transfusion alone. Of the infants requiring exchange transfusion 50.0% had Rhesus erythroblastosis, 28.0% ABO erythroblastosis, 10.6% jaundice of prematurity and the remainder were due to a variety of causes. Sixty-three (1.4%) infants died, with two deaths being related to the hyperbilirubinaemia, as their death was due to necrotizing enterocolitis following exchange transfusion. Phototherapy proved safe with no deaths directly attributable to its use.
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PMID:Jaundice: a 10 year review of 41,000 live born infants. 641 49

Fifty (13%) of 375 infants who weighed 1500 g or less at birth had necrotizing enterocolitis (NEC). Haematological changes suggestive of sepsis occurred in 83% and positive bacteriological cultures were found in 38%, the most common organism isolated being Clostridium perfringens. Complications included intestinal perforation in six patients and recurrence of NEC in five, of whom one subsequently developed an intestinal stricture. Five of the eight nursery deaths were secondary to peritonitis and overwhelming sepsis from NEC. In spite of the discontinuation of milk feeds for prolonged periods, satisfactory caloric intake and weight gain were achieved with parenteral nutrition in the survivors. Of the 41 long-term survivors, six (15%) were found to have a disability at 2 years of age, corrected for prematurity, compared with 48 (20%) of 241 very low birthweight survivors from the same study period who did not have NEC. None had evidence of gastrointestinal dysfunction. Six (15%) children remained below the 10th percentile for both weight and height. This study showed that early diagnosis and therapy for NEC in very low birthweight infants were associated with a favourable short- and long-term outcome.
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PMID:Necrotizing enterocolitis in very low birthweight infants: a four-year experience. 646 13

This report concerns 60 children with documented Staphylococcus epidermidis sepsis. There were 34 boys and 26 girls, ages 2 weeks to 15 years. The primary diagnosis included malignancy (13), congenital (13) or acquired (11) gastrointestinal disorders, prematurity (7), cardiac defect (5), hydrocephalus (2) and miscellaneous (9). Clinical presentation included fever (54), tachycardia (15), lethargy (20), hypotension (8), irritability (6), increased gastric residuals (6) and apnea/bradycardia (3). A documented source of sepsis was noted in 56 patients, including percutaneous central venous catheters (23), Broviac catheters (17), umbilical arterial catheters (6), wound (3), V-P shunt (2), cardiac defect (2), cholangitis (1), chest tube (1) and peripheral arterial line (1). There were six sepsis-related deaths, four in premature infants. Two of six infected subclavian catheters were treated successfully with vancomycin. Infection was successfully cleared in 20 of 23 infected Broviac catheters with vancomycin through the line. However, six were eventually removed for tract infection (1), persistent fever (2), and Candida sp. infection (3). Although once considered a non-pathogenic skin contaminant, S. epidermidis has emerged as a serious pathogen in hospitalized, immunosuppressed, premature and malnourished pediatric patients. Indwelling catheters enhance the likelihood of infection in these patients. Aggressive antimicrobial therapy is vital in this potentially lethal infection. Vancomycin proved efficacious in this series.
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PMID:Staphylococcus epidermidis sepsis in pediatric patients: clinical and therapeutic considerations. 648 77


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