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PubMed2002

Pain management in French neonatal intensive care units.

UNLABELLED: The aim of this study was to investigate pain management in neonatal intensive care units (NICUs) in France and to identify factors associated with variability across units. A questionnaire sent to 143 heads of level II or III NICUs investigated the use of pain scores, pain management organization and pharmacological treatment in five clinical situations (endotracheal intubation, prolonged mechanical ventilation, acute stage of necrotizing enterocolitis, central venous catheter insertion and cephalhaematoma). The response rate was 81%. Among the 35 (30%) units that used no pain scores, 40% ascribed this to lack of knowledge. Factors associated with failure to use pain scores were level II status, no university affiliation, no surgical patients and neonatal patients only. Among the units that scored pain, 78% used valid scores for acute pain and 73% for prolonged pain. Written guidelines were available for acute pain in 65% of units and for prolonged pain in 36%. The rate of pharmacotherapy use varied widely across the five clinical situations studied (from 16 to 77%) and across units for a given clinical situation. Also extremely variable were the regimens used in each situation and the dosages of analgesics and sedatives. Only 11% of units adjusted dosages to gestational age. CONCLUSION: Pain assessment was performed in the most French NICUs, but a strong heterogeneity for pain treatment was observed. Reference to recently published pain management guidelines and new randomized trials could be useful to optimize pain treatment in NICUs.

Analgesics↗
PubMed2000

Nursing the preterm surgical neonate.

The preterm neonate's response to surgery manifests in all body systems. Necrotising Enterocolitis (NEC) is an acute gastro-intestinal emergency requiring surgical intervention. Severe NEC may require the removal of infarcted bowel. Examining the response to surgery in the preterm neonate with NEC offers nurses a rationale for their post-operative care. Both physiological and psychological responses need to be understood in the light of family centred care.

Breast Feeding↗
PubMed2005

Neutrophil transepithelial migration: role of toll-like receptors in mucosal inflammation.

The symptomatic phases of many inflammatory diseases are characterized by migration of large numbers of neutrophils (PMN) across a polarized epithelium and accumulation within a lumen. For example, acute PMN influx is common in diseases of the gastrointestinal system (ulcerative colitis, Crohn's disease, bacterial enterocolitis, gastritis), hepatobiliary system (cholangitis, acute cholecystitis), respiratory tract (bronchial pneumonia, bronchitis, cystic fibrosis, bronchiectasis), and urinary tract (pyelonephritis, cystitis). Despite these observations, the molecular basis of leukocyte interactions with epithelial cells is incompletely understood. In vitro models of PMN transepithelial migration typically use N-formylated bacterial peptides such as fMLP in isolation to drive human PMNs across epithelial monolayers. However, other microbial products such as lipopolysaccharide (LPS) are major constituents of the intestinal lumen and have potent effects on the immune system. In the absence of LPS, we have shown that transepithelial migration requires sequential adhesive interactions between the PMN beta2 integrin CD11b/CD18 and JAM protein family members. Other epithelial ligands appear to be abundantly represented as fucosylated proteoglycans. Further studies indicate that the rate of PMN migration across mucosal surfaces can be regulated by the ubiquitously expressed transmembrane protein CD47 and microbial-derived factors, although many of the details remain unclear. Current data suggests that Toll-like receptors (TLR), which recognize specific pathogen-associated molecular patterns (PAMPs), are differentially expressed on both leukocytes and mucosal epithelial cells while serving to modulate leukocyte-epithelial interactions. Exposure of epithelial TLRs to microbial ligands has been shown to result in transcriptional upregulation of inflammatory mediators whereas ligation of leukocyte TLRs modulate specific antimicrobial responses. A better understanding of these events will hopefully provide new insights into the mechanisms of epithelial responses to microorganisms and ideas for therapies aimed at inhibiting the deleterious consequences of mucosal inflammation.

Cell Movement↗
PubMed1991

Yersinia species isolated from sheep with enterocolitis.

In 40 submissions to the Regional Veterinary Laboratory (RVL) Wagga Wagga from sheep in southern New South Wales from 1981 to 1989, 53 isolates of Yersinia sp were recovered from 45 sheep in 37 flocks. Of 53 isolates, 26 were identified as Y. pseudotuberculosis, 20 as Y. enterocolitica, 5 as Y. intermedia and 2 as Y. frederiksenii. Twelve isolates of Y. pseudotuberculosis tested in the slide agglutination test all belonged to serotype III. The 20 Y. enterocolitica isolates were categorised biochemically as biotype 5 strains and, of 6 isolates serotyped, all belonged to serogroup 2,3. Outbreaks of yersiniosis were most common in late winter and early spring and affected flocks often had experienced a change in husbandry. Infection with Yersinia sp was associated with diarrhoea, illthrift and mortality. At necropsy, congestion and occasionally thickening of the intestinal mucosa were observed in affected sheep. Gastrointestinal nematodiasis and coccidiosis often were concurrent findings. The characteristic histological lesion in sheep infected with Y. pseudotuberculosis was acute segmental suppurative erosive enterocolitis. There were no lesions consistently associated with Y. enterocolitica, Y. intermedia or Y. frederiksenii.

Age Factors↗
PubMed1989

Surgical management of neutropenic enterocolitis.

Three cases of histologically confirmed neutropenic enterocolitis, each presenting as an acute abdomen in patients with leukaemia are presented. All three patients presented with fever and abdominal pain within 14 days of completing a course of chemotherapy. Signs of peritonitis localized to the right iliac fossa developed in each patient, in spite of aggressive antibiotic therapy and bowel rest. All three patients were found to have non-viable caecum at laparotomy and were treated by right hemicolectomy. Primary ileocolic anastomosis was performed in one patient, who recovered following a stormy postoperative course owing to sepsis. Two patients underwent formation of an ileostomy with distal mucous fistula and each recovered with minimal postoperative complications; secondary anastomosis was performed electively in both cases. The difficulty in diagnosing neutropenic enterocolitis preoperatively is discussed and the place of non-operative management is reviewed but we recommend surgical intervention as a means of ensuring removal of a localized septic focus until marrow regeneration occurs.

Abdomen, Acute↗
PubMedDate not supplied

[Distribution of capsular serotypes in Klebsieela strains of enteral origin].

The significant proportion of microorganisms belonging to the Klebsiella genus among the causative agents isolated and subdifferentiation of the genus for epidemiological survey of infantile Klebsiella infections are dealt with in the present paper. The 28 Klebsiella strains isolated from cases of enteritis confirms the enteral tropism of these enterobacteria, especially among the infantile population. A proportion of 13.3% strains were identified in pure cultures obtained from feces and were considered as certainly enteropathogenic. The biochemical behaviour of the strains studied pointed to the ubiquity of the aerogenes biotype (76.9%) followed by the pneumoniae biotype (12.4%) and indol-positive Klebsiella strains (10.7%). Of the total 308 Klebsiella strains typed serologically with 80 OK capsular sera, 284 (92.2%) were listed in 63 serotypes, 13 of which (K7, K35, K47, K9, 530, K16, K1, K11, K18, K20, K37, K80, K i.e. 47.5%) were frequently identified in acute infantile cases of enterocolitis syndrome. Most of these serotypes are also considered endemo-epidemic by authors. Worthy of note among the Klebsiella types isolated in pure cultures from cases of infantile enteritis, was the prevalence of the aerogenes biotype, with a higher incidence of K1, K2, K16, K26, K44 serotypes, and of the indol-positive strains, with serotypes K13, K16, K65, K80.

Enteritis↗
PubMed1987

Diagnosis of pseudomembranous colitis by computed tomography: a report of two patients.

In patients with pseudomembranous colitis, the colonic wall has a characteristic appearance on computed tomographic scans of the abdomen: it is diffusely thickened and the ascending or descending colon viewed on end has a donut-like appearance. It is important to recognize the possible association of such findings with pseudomembranous colitis in order to make an accurate diagnosis in patients experiencing an acute abdominal catastrophe.

Abdomen, Acute↗
PubMed1977

[Etiologic role of bacteria of the genus Providencia in acute intestinal diseases].

A study was made of morphological, cultural, biochemical properties and antigenic structure (by O-antigen) of 59 strains isolated in group acute intestinal affection of children at the pioneer camp. By the combination of biochemical properties (31 tests) all the cultures isolated were referred to Providencia alcalifaciens of biotype 7. Serological typing with the aid of experimental diagnostic agglutinating O-sera showed these strains to be referred to serological group O2. Identity of the O-antigen of the isolated cultures to the standard O2 strain was confirmed by the results of cross reactions of agglutinin absorption. The results of bacteriological and clinico-epidemiological studies offered a possibility of regarding the isolated Providencia alcalifaciens of serological group O2 as the causative agents of the group intestinal disease in children.

Acute Disease↗
PubMed1995

Pathologic changes of gut in non-01 Vibrio cholerae infection.

A 14-year-old girl who had beta-thalassemia hemoglobin E disease was infected by bacteriologically proven non-01 Vibrio cholerae at 2 months postsplenectomy and died 37 hours after onset of the malady. Postmortem examination disclosed congestion, edema, and hemorrhagic foci of the mucosa of the small and large intestines. The gut mucosa was focally eroded. The gut wall was infiltrated by leucocytes, especially neutrophils, in all coats representing acute purulent and hemorrhagic enterocolitis. There was hyperplasia of lymphoid follicles in the gut mucosa and lymph nodes. It is suggested that morphologic change of the gut in non-01 Vibrio cholerae infection is more severe than in infection caused by Vibrio cholerae.

Adolescent↗
PubMed1997

Clostridium difficile colitis presenting as an acute abdomen: case report and review of the literature.

Pseudomembranous colitis associated with Clostridium difficile rarely manifests as an acute abdomen and even more rarely as an acute abdomen without abnormal radiologic studies. The following is a case report of a 52-year-old white man who had an acute abdomen without abnormal radiologic studies, and was given a final diagnosis of C difficile colitis. Surgery was averted only by the ability to do an expeditious flexible sigmoidoscopy with the visualization of pseudomembranes. Diagnosis was later confirmed by a positive toxin assay and culture of C difficile. Treatment for C difficile colitis is usually medical, with oral vancomycin the preferred agent. Surgery may be needed when there is an acute abdomen with other systemic signs (fever or leukocytosis) or abnormal radiologic studies.

Abdomen, Acute↗
PubMedDate not supplied

[Appendicitis in the premature newborn]

OBJECTIVE: To present a case of acute appendicitis in a premature infant. METHODS: Retrospective review of the literature using Medline and Lilacs databases, as well as the necropsy report. CLINICAL REPORT: A white male preterm infant born at 34 weeks of gestation weighing 1,750g to a primiparous mother. The Apgar score was 4 and 8 at 1st and 5th minutes, respectively. The physical exam was normal until the 9th day of life when the child developed clinical features suggestive of acute abdomen, possibly due to necrotizing enterocolitis with perforation. He was submitted to exploratory laparotomy, which leaded to the diagnostic of acute appendicitis. CONCLUSION: Acute appendicitis must be discarded on the differential diagnostic when there is a suspicion of necrotizing enterocolitis with perforation, and risk factors are not present.

Journal Article↗
PubMed1999

Pediatric parenteral nutrition in India.

Nutritional support to patients in neonatal and pediatric intensive care units is critical not only to minimize negative nitrogen balance but also to promote growth and development. Continuous technological and logistical advances in the Western countries have improved the efficacy and reduced the complications of parenteral nutrition (PN) to the extent that despite the constraints of cost and infrastructure, PN is now fast growing in India. Although widespread availability is very much desired, it is important that the technique is developed with considerable expertise and used judiciously with full knowledge of its indications, limitations, dangers and benefits. Indications for PN include surgical conditions (short gut syndrome), very low birth weight infants (particularly with necrotizing enterocolitis and surgical anomalies), malabsorption syndromes, conditions requiring bowel rest (acute pancreatitis, severe ulcerative colitis and necrotizing enterocolitis) and several non-gastrointestinal indications (end stage liver disease, renal failure, multiple trauma and extensive burns). Provision of PN is associated with significant and sometimes life threatening complications. The possible complications are technical (thrombosis, perforation of vein, thrombophlebitis), infections, metabolic disturbances, hepatobiliary stenosis, cholestasis, fibrosis, cirrhosis or cholelithiasis and bone related complications like osteopenia and fractures. Meticulous monitoring is necessary not only to detect complications but also to document clinical benefit.

Adolescent↗
PubMedDate not supplied

Naturally occurring anti-Kell stimulated by E. coli enterocolitis in a 20-day-old child.

Anti-A and anti-K have been found in the serum of a 20-day-old child who had not been transfused but who was acutely ill with E. coli enterocolitis. Both antibodies are IgM proteins. The mother's serum does not contain either antibody and the anti-A and anti-K in the infant's serum are not of maternal origin. Both parents and the child are of the Kell phenotype K-k+. Stool cultures made from the child yielded E. coli O 125:B15, an uncommon B-variant pathogenic coliform. Cell-free preparations made from broth cultures of this organism have strong specific inhibitory activity against IgM anti-A and anti-K, and both antigens have been identified on the bacterial cells. At age 3 months the child had made a clinical recovery, stool cultures showed no pathogenic coliforms, and anti-A and anti-K were no longer detectable in her serum. These data indicate that absorption of metabolites with A-like and K-like activity produced by a pathogenic coliform in the intestinal tract were responsible for the appearance of apparent naturally occurring anti-A and anti-K in the child's serum.

ABO Blood-Group System↗