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

Coagulase-negative staphylococci (C-NS) are a frequent cause of bacteraemia in premature neonates. It is likely that the strains of C-NS causing bacterial sepsis in premature neonates have their origin on the patient's skin surface. We have studied the quantitative development of the skin microflora at eight sites on premature neonates. A swab wash method was used to sample and enumerate the cutaneous microflora of premature neonates admitted to an intensive care unit with respiratory distress syndrome. The numbers of bacteria present on the skin increased rapidly by 100-fold in the first week of life. The species of C-NS found on neonatal skin were similar to those found on adult skin. However, the bacterial population was 10(3) lower by comparison. There was considerable variation in numbers of bacteria and in the proportion resistant to antibiotics from day to day. There appeared to be no association between antibiotic usage and the proportion of isolates resistant to antibiotics, although the resident bacteria were in many cases resistant to a variety of antibiotics. C-NS were isolated from 92% of samples from which bacteria were isolated. Staphylococcus epidermidis was found at all sites and accounted for 82% of each colonial type of staphylococcus isolated. Other organisms isolated included Propionibacterium sp, alpha-haemolytic streptococci, aerobic spore-bearing bacilli, aerobic coryneforms, Candida albicans, Klebsiella oxytoca, Pityrosporum sp, Klebsiella pneumoniae, and Escherichia coli. The results of this study suggest that the skin of premature neonates is colonised with antibiotic resistant C-NS during the first week of life and that the chance of contamination of an intravascular catheter at insertion increases during this period.
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PMID:Development of cutaneous microflora in premature neonates. 151 78

A comparative study of bowel colonisation and incidence of necrotising enterocolitis in neonates admitted to an intensive care unit is reported. Neonates of less than 33 weeks gestational age requiring mechanical ventilation for respiratory distress syndrome were randomised during the first week of life to receive either vancomycin and aztreonam or vancomycin and gentamicin for episodes of suspected sepsis after the first week of life. A higher proportion of neonates who received vancomycin and gentamicin had faecal colonisation with enterobacteriaceae at the end of the second, third, and fourth weeks of life. Treatment with vancomycin and aztreonam was associated with a rapid quantitative reduction in faecal colonisation with enterobacteriaceae, whereas there was no quantitative reduction in colonisation with enterobacteriaceae associated with treatment with vancomycin and gentamicin. There were no differences between the two groups in faecal colonisation with anaerobes, Enterococcus sp, Staphylococcus sp, or yeasts. Six (14.6%) of 41 who received vancomycin and gentamicin compared with 0 of 40 who received vancomycin and aztreonam subsequently developed necrotising enterocolitis.
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PMID:Enterobacteriaceae and neonatal necrotising enterocolitis. 153 88

Over a 4 year period, nine of 180 (5%) infants weighing less than 2000 G, admitted to the Aga Khan University Hospital (AKUH) developed necrotizing enterocolitis (NEC). An outbreak of NEC occurred in 1989, during which six infants developed the clinical illness. Overall incidence was 1.1%. Thirty-one birth weight and gestation matched controls were selected for comparison. Risk factors usually considered as predisposing factors, i.e., low 5 min Apgar score, rate of maternal complications, respiratory distress syndrome, mechanical ventilation, umbilical catheterisation, patient ductus arteriosus, use of antibiotics and feeding practices were found with equal frequency in both cases and controls. Six infants had positive blood and/or peritoneal fluid cultures (66%) compared to only five (16%) in the control group (P less than 0.01). Our data suggests that prematurity and sepsis are important predisposing factors for development of NEC.
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PMID:Necrotizing enterocolitis in infants weighing less than 2000 G. 157 65

Streptococcus pneumoniae is an unusual pathogen during the neonatal period. Two cases of neonatal early-onset sepsis, one of them associated with meningitis, are reported. Positive cultures for Strep. pneumoniae were obtained from both newborns and their mothers. Both newborns were full term with birth weights in the normal range. In one of them, amniorrexis occurred 18 hours before the delivery and the amniotic fluid was meconium stained. Significant clinical findings consisted in fever and respiratory distress. There was leucopenia and in one case the chest radiography was abnormal. Both neonates had an uneventful recovery after starting antibiotic treatment and no long term sequellae were detected. The incidence of neonatal sepsis caused by Strep. pneumoniae and its pathogenesis are reviewed.
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PMID:[Neonatal sepsis caused by Streptococcus pneumoniae. Report of two cases]. 157 5

Sepsis may initiate acute respiratory distress syndrome which may be accompanied by an increased pulmonary epithelial-endothelial permeability. In this study, sepsis was induced by an intraperitoneal implantation of gelatine capsules containing Escherichia coli/Bacteroides fragilis/adjuvant substance. The importance of bacteria in sepsis-related lung injury was studied in rats given an intraperitoneal injection of E. coli or in rats given the adjuvant substance alone in capsules intraperitoneally. Rats with empty capsules were used as controls. The rats were intratracheally instilled with bovine serum albumin (BSA) directly after the capsule implantation or the injection of E. coli, and the passage over the lower respiratory tract was assessed as blood plasma levels of immunoreactive BSA. The plasma BSA levels in the control rats increased continuously up to 24 h after intratracheal instillation. This increase was significantly augmented already 1 h after the septic challenge, i.e. before any clinical symptoms were observed, in both the septic rats and the rats with the E. coli injected intraperitoneally. Furthermore, the time required to obtain maximal plasma BSA levels was shorter in septic, adjuvant-exposed and in E. coli-injected rats than in the controls. The plasma levels and the total BSA passage over the lower respiratory tract was significantly higher (p less than 0.001) in the septic and in the E. coli-injected rats than in the adjuvant-exposed and the control rats.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Increased passage of bovine serum albumin over the respiratory tract after intratracheal instillation during septic shock in rats. 158 99

Gram-negative sepsis has dramatically increased in frequency throughout the twentieth century in the United States. Currently, approximately 200,000 patients develop gram-negative sepsis each year in this country. Of these, about one-quarter develop the adult respiratory distress syndrome (ARDS). Among these critically ill patients, mortality is estimated at 60%-90%. In the complex series of events leading to acute lung injury in gram-negative sepsis, endotoxin is the proximal mediator. Although endotoxin may be capable of causing direct injury to the pulmonary endothelium, its primary role is as a trigger activating inflammatory agents, including complement, neutrophils, and platelets, and inducing the production of cytokines and arachidonic acid metabolites. The end results are impairment of the endothelial barrier, diffusely increased capillary permeability, and adherence of neutrophils to the endothelium with subsequent migration into the tissues. The consequent clinical syndrome is one of acute respiratory distress with pulmonary edema, poorly compliant lungs, and refractory hypoxemia. Endothelial injury often becomes widespread, leading to the failure of multiple organs, including the kidneys, brain, intestine, and liver. Conventional therapy consists of supplemental oxygen, positive end-expiratory pressure, inotropic agents, fluid management, and antibiotics aimed at the offending pathogen. Recent discoveries regarding the mediators of sepsis as well as the expansion of the biotechnological armamentarium have provided clinicians with a plethora of new tools with which to manipulate the host's inflammatory response. The challenge for the next decade will be to ensure the safety, efficacy, and cost-effective use of these expensive but potentially lifesaving immunomodulators, singly or in combination, as adjuvant therapy.
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PMID:Gram-negative sepsis and the adult respiratory distress syndrome. 162 78

A total of 1509 singleton neonates (849 males and 660 females) were admitted into the Special Care Baby Unit at the University of Port Harcourt Teaching Hospital in Nigeria between January 1984 and December 1987. Of these, 29 (1.9%) were extreme low birth weight (ELBW); 86 (5.7%) were very low birth weight (VLBW), 40 of whom survived; 406 (26.9%) were low birth weight (LBW); and 988 (65.5%) were normal birth weight (NBW) babies. Survival rates in the 4 groups were 10.3%, 46.5%, 89.2%, and 94.7%, respectively. Higher mean birth weight (p .01), longer mean gestation (p .001), and lower incidence of birth asphyxia (p .02 with Yates's correction) significantly more mature for their gestational age (p = .008, Fisher's exact probability test) than those who died. Among infants who survived, one each had idiopathic respiratory distress syndrome (RDS) and septicemia. Among the infants who died there were 2 cases of RDS and 1 each of aspiration pneumonia and septicemia. Survival of babies with birth weights under 1000 gm improved very little over the 4-year period, while the survival rates stayed constant at 90% in babies with birth weights of 1500 gm and above. The overall survival rate in the Unit improved from 86.1% in 1984 to 91.4% in 1987. There were relatively fewer cases of birth asphyxia in the VLBW category than in the rest of the babies resulting in better survival. The survival of LBW infants was distinctly reflected by that of VLBW infants whose survival could be improved by instituting measures such as prompt resuscitation of the asphyxiated neonate and prevention of sepsis.
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PMID:Survival in very low birthweight infants at the University of Port-Harcourt Teaching Hospital, Nigeria. 163 36

Hyperbilirubinaemia in newborn infants is generally regarded as a problem, and bilirubin itself as toxic metabolic waste, but the high frequency in newborn infants suggests that the excess of neonatal bilirubin may have a positive function. To investigate the hypothesis that bilirubin has a role as a free-radical scavenger, the rate of rise in serum bilirubin in the first few days of life was measured in 44 infants with five illnesses thought to enhance free-radical production and in 58 control infants. The infants were selected from 2700 consecutive births by exclusion of those with factors known to affect bilirubin metabolism, including enteral feeding. The control infants were those who seemed to be ill and received treatment, including restriction of enteral feeds, but in whom no illness, or disorders not related to free-radical production, were found. The mean serum bilirubin rise was significantly lower in the combined illness group than in the control group (36.1 [95% Cl 26.9-45.3] vs 66.7 [55.9-77.5] mumol.l-1.day-1; p less than 0.0001). In subgroup analyses the mean rises in infants with circulatory failure, neonatal depression/asphyxia, aspiration syndromes, and proven sepsis were significantly lower than in controls matched for gestational age and birthweight, but rises in infants with respiratory distress and their matched controls did not differ. These findings are consistent with the hypothesis that bilirubin is consumed in vivo as an antioxidant. Such consumption may operate in vivo in addition to the standard pathways for bilirubin metabolism (production, isomerisation, and excretion).
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PMID:Variation of initial serum bilirubin rise in newborn infants with type of illness. 167 69

Continuous positive airway pressure (CPAP) administered as a mixture of oxygen and compressed air via nasal prongs has dramatically improved survival rates and lessened the frequency of barotrauma and bronchopulmonary dysplasia in the premature infant with respiratory distress syndrome. Associated with the increased use of nasal CPAP has been the development of marked bowel distension (CPAP belly syndrome), which occurs as the infant's respiratory status improves and the baby becomes more vigorous. To identify contributing factors, we prospectively compared 25 premature infants treated with nasal CPAP with 29 premature infants not treated with nasal CPAP. Infants were followed up for development of distension, defined clinically as bulging flanks, increased abdominal girth, and visibly dilated intestinal loops. We evaluated birth weight, weight at time of distension, method of feeding (oral, orogastric tube), and treatment with nasal CPAP and correlated these factors with radiologic findings. Of the infants who received nasal CPAP therapy, gaseous bowel distension developed in 83% (10/12) of infants weighing less than 1000 g, but in only 14% (2/14) of those weighing at least 1000 g. Only 10% (3/29) of infants not treated with nasal CPAP had distension, and all three weighed less than 1000 g. Presence of sepsis and method of feeding did not correlate with occurrence of distension. Neither necrotizing enterocolitis nor bowel obstruction developed in any of the patients with a diagnosis of CPAP belly syndrome. Our study shows that nasal CPAP, aerophagia, and immaturity of bowel motility in very small infants were the major contributors to the development of benign gaseous bowel distension.
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PMID:Benign gaseous distension of the bowel in premature infants treated with nasal continuous airway pressure: a study of contributing factors. 172 37

Neonatal mortality rate is perhaps the most reliable indicator of perinatal outcome. An assessment of perinatal outcome can be made through knowledge of causes of death. This study was undertaken to evaluate the neonatal deaths in the Neonatal Division, Lady Hardinge Medical College. Livebirths (n=7309) and deaths (n=328) during a 6-month period were retrospectively analyzed. These were grouped into nonpreventable and potentially preventable causes of death. The single most important factor contributing to mortality was respiratory distress (29.3%), followed by sepsis (24.4%), and birth asphyxia (16.2%). The nonpreventable causes of mortality (e.g., lethal congenital malformations, extremely low birthweight) accounted for 10.4% of the total mortality. The idealized neonatal mortality rate was 4.6/1000 livebirths, while the salvageable death rate was 40.2/1000 livebirths. Mortality increased significantly if the birthweight fell below 2 kg. The salvageable deaths could perhaps be prevented through better antenatal and intranatal care, ventilatory support, and sepsis prevention.
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PMID:Neonatal mortality patterns in an urban hospital. 180 Mar 43


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