Neonatal mortality pattern in rural based medical college hospital

The present study was undertaken to establish priorities in neonatal care and to find out neonatal mortality pattern in a rural based medical college hospital. One hundred and twentythree neonatal deaths out of 1461 live births constituted the study material. The neonatal mortality rate was 84.2/1000 live births. The mortality in preterm, full term and post term infants was 43.13,4.02,7.02 percent respectively (p<0.001). The mortality in relation to birth weight was 100 percent (<1000 g); 71.43 percent (1000–1499 g); 37.14 percent (1500–1999 g); 7.63 percent (2000–2499 g) and 2.94 percent (>2500 g). Almost 70 percent of all deaths were because of severe birth anoxia and septicemia (including meningitis) either alone or in combination.     

新生儿败血症及败血症休克时血清IL-6、IL-6mRNA表达水平的研究

为探讨血清IL－6水平变化在新生儿败血症中的意义，采用酶免疫吸附法（ELISA）检测正常与严重感染新生儿血清IL－6值，用逆转录聚合酶链反应（RT－PCR）技术测定外周血单个核细胞（PBMC）IL－6mRNA表达情况。结果：血清IL－6水平以败血症休克组最高，败血症组次之，恢复期迅速下降，检测5例败血症新生儿PBMC均见IL－6mRNA表达，而6例对照新生儿中仅3例有IL－6mRNA表达；按百分位数法初步确定血清IL－6≥23ng/L为诊断新生儿血症的参考指标，此批标敏感性为81％，特异性为83％。提示新生儿败血及败血症休克早期血清IL－6水平升高，IL－6mRNA表达增强，与病情，预后有关，早期检测意义较大。     

Exchange transfusion in neutropenic septicemic neonates: effect on granulocyte functions

Depletion neutropenia caused by overwhelming bacterial infection is associated with fatal outcome and is an objective indicator of the severity of sepsis. Studies on controlled evaluation of exchange transfusion in the management of severe neonatal sepsis have not considered neutropenia as an inclusion critcrion, and randomized, controlled trials on evaluation of ncutrophil functions after exchange transfusion are scarce. This prompted us to carry out the present study. Septicemic neonates were enrolled if they had neutropenia and were randomized to undergo exchange transfusion (study group, n = 20) or not (controls, n= 10). Granulocyte functions were assessed using the nitro blue tetrazolium (NBT) reduction test and the staphylococcicidal index. Blood was drawn for granulocyte function tests once from controls and donors, and before, immediately after and 6 h after exchange transfusion in the study group. Mortality was 35% in the study group and 70% in controls. Gram-negative organisms accounted for 80%, in the study group and 90% in controls. Mean total leukocyte count and neutrophil count increased significantly immediately after exchange transfusion and 6 h later. Absolute band count decreased significantly immediately after exchange transfusion and incrcased 6 h later. NBT reduction in septicemic neonates in the study group, as wclras in controls. was significantly decreascd as compared to donor cells. NBT reduction improved significantly immediately after exchange transfusion and 6 h later. The valucs of the perccntage of viable staphylococci recovered from neutrophils also improved significantly immediately after exchange transfusion and 6 h later. We conclude that exchange transfusion with fresh whole blood in severe neonatal septicemia with neutropenia improves survival, increases the neutrophil count and cnhances neutrophil function.     

Outbreak of neonatal septicemia with multidrug resistantKlebsiella Pneumoniae

A nosocomial outbreak of neonatal septicemia due toK. pneumoniae occurred in nursery during June–July, 1991.Klebsiella pneumoniae (Klebocin type 314) was recovered from blood of 33(70.2%) of 47 neonates with septicemia. Multiple drug resistance was observed in all the cases. The same strain ofK. pneumoniae was recovered from the neonates and environment of nursery and labour room as well. The outbreak was attributable to environmental dissemination.     

Chromogenic endotoxin determination in blood — clinical relevance

Summary In a pilot study in 400 patients LPS-quantification in blood using chromogenic substrates, bacterial cultures and bacterial quantification were performed. Decreased plasma levels of antithrombin III and plasminogen were early predictors of gram-negative septicemia, which already were apparant 3 days prior to the first positive LPS-test. It is concluded that daily determinations of LPS may reduce the delay in proper antibiotic therapy.     

Severe sepsis epidemiology: sampling,selection, and society

Three new articles in Critical Care add to an expanding body of information on the epidemiology of severe sepsis. Although there have been a range of approaches to estimate the incidence of severe sepsis, most studies report severe sepsis in about 10 ± 4% of ICU patients with a population incidence of 1 ± 0.5 cases per 1000. Importantly, the availability of ICU services may well determine the number of treated cases of severe sepsis, and it seems clear that these studies are reporting the treated incidence, not the incidence, of severe sepsis. In the future, we must focus on whether all severe sepsis should be treated, and, consequently, what level of ICU services is optimal.     

NEONATAL SEPTICEMIA IN RIYADH, SAUDI ARABIA

Abstract. Ohlsson, A. and Serenius, F. (Division of Perinatology, Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia). Neonatal septicemia in Riyadh, Saudi Arabia). Neonatal septicemia in Riyadh, Saudi Arabia. Acta Paediatr Scand, 70: 825, 1981.-Twenty-nine cases of neonatal septicemia from Saudi Arabia are described. A high incidence of prematurity (45 %) and congenital malformations (45 %) were found as predisposing factors. The mortality was 45 %, mainly due to severe malformations and late referrals. Thirty-one percent of the cases grew Salmonella enteritidis species and one case of Bacteroides fragilis septicemia and meningitis is reported. Only two of the organisms isolated were sensitive to ampicillin. The importance of doing studies on neonatal septicemia on a local basis is stressed.     

糖尿病并发败血症16例临床分析

本文报道糖尿病并发的败血症16例,均经血培养证实。致病菌13例为革兰阴性杆菌占81.25％,另3例分别为金黄色葡萄球菌(金葡菌)、表皮葡萄球菌与白色念珠菌。起病均急骤,伴畏寒发热,严重者有神志改变、休克、酮症酸中毒或肺与肝脏迁徒性病灶、血管栓塞性病变、多脏器功能衰竭,病情凶险。病死率高达43.75％。     

新生儿败血症49例临床分析

49例新生儿败血症的临床分析结果显示:足月儿和早产儿首发症状各异。经多因素分析围产期危险因素与本病的关系,发现产科异常与败血症关系密切。并观察到混合感染率高(17.6％)。本文对血培养阴性、确有化脓性迁徒病灶的败血症提出诊断意见并浅谈先锋必治疗的体会。     

Recurrent systemic bacterial infections in homozygous C2 deficiency

Homozygous deficiency of the second component of complement (C2) occurs in one in 10, 000 individuals. Its clinical manifestations range from essentially no symptoms to recurrent infections or evidence of collagen-vascular disease. We present here a case report and a review of the literature focusing on recurrent systemic infections in C2-deficient individuals. Thirteen of 20 patients vi'ith C2 deficiency and a history of invasive bacterial infections have had recurrent episodes of bacteremia or meningitis. Most of these patients were children, and Streptococcus pneumoniae was the most common pathogen reported. The use of prophylactic antibiotics. Haemophilus influenzae type b and pneumococcal vaccines, and prompt medical attention for any febrile illness should be encouraged in children with documented C2 deficiency. Although there are no studies to date to document their efficacy, the above measures may serve to diminish the frequency of recurrent systemic bacterial disease in these children.