ABSTRACT
BACKGROUND: Septicemia is a major antecedent of morbidity and mortality in very low birth weight (501- to 1500-g) infants. Our purpose was to determine prospectively the incidence, clinical presentation, laboratory features, risk factors, morbidity and mortality associated with late onset septicemia in infants 501 to 1500 g. METHODS: Clinical data were prospectively collected for 2416 infants enrolled in a multicenter trial to determine the efficacy of intravenous immunoglobulin in preventing nosocomial infections. Septicemia was confirmed by positive blood culture in 395 symptomatic infants. Multivariate analyses of factors associated with septicemia were performed. RESULTS: Sixteen percent of VLBW infants developed septicemia at a median age of 17 days. Factors associated with septicemia by logistic regression included male gender, lower gestational age and birth weight and decreased baseline serum IgG concentrations. Increasing apnea (55%), feeding intolerance, abdominal distension or guaiac-positive stools (43%), increased respiratory support (29%), lethargy and hypotonia (23%) were the dominant presenting features of septicemia. An abnormal white blood cell count (46%), unexplained metabolic acidosis (11%) and hyperglycemia (10%) were the most common laboratory indicators. Septicemic infants, compared with nonsepticemic infants, had significantly increased mortality (21% vs. 9%), longer hospital stay (98 vs. 58 days) and more serious morbidity, including severe intraventricular hemorrhage, bronchopulmonary dysplasia and increased ventilator days (P < 0.001). CONCLUSIONS: Late onset septicemia is common in very low birth weight infants, and the rate is inversely proportional to gestational age and birth weight. Septicemia is more common in males and those with low initial serum IgG values. A set of clinical signs (apnea, bradycardia, etc.) and laboratory values (leukocytosis, immature white blood cells and neutropenia) increase the probability of late onset sepsis, but they have poor positive predictive value.
Subject(s)
Infant, Very Low Birth Weight , Sepsis/diagnosis , Sepsis/epidemiology , Female , Gestational Age , Humans , Incidence , Infant Mortality , Infant, Newborn , Logistic Models , Male , Multivariate Analysis , Prospective Studies , Risk FactorsSubject(s)
Placenta/physiology , Adaptation, Physiological , Female , Humans , Placentation , PregnancyABSTRACT
Protein-calorie malnutrition in experimental animals resulted in a complex picture of changes in various drug-metabolic pathways. The need for these studies is discussed in the context that undernutrition is prevalent in many countries and coincides with many intercurrent illnesses in the affected populations. The need of these affected populations for appropriate therapies is recognized, and these therapies should be based on scientific principles rather than on empiricism.
Subject(s)
Animals, Newborn/metabolism , Fetus/metabolism , Pharmaceutical Preparations/metabolism , Protein-Energy Malnutrition/metabolism , Animals , Female , Fetal Growth Retardation/etiology , Liver/metabolism , Maternal-Fetal Exchange , Mice , Pregnancy , Protein-Energy Malnutrition/complications , RatsSubject(s)
Breast Feeding , Drug Therapy , Milk, Human , Female , Humans , Information Systems , Pharmacokinetics , Risk FactorsABSTRACT
Mechanisms of transport of environmental pollutants and ingested drugs in breast milk and their absorption in newborn nurslings are outlined. The authors urgently call for additional research to determine which maternal medications are safe for nursing infants.
