Fatal Pseudomonas aeruginosa Bronchopneumonia in a Children's Hospital

Barson, A J

doi:10.1136/adc.46.245.55

Cited by 16 publications

(2 citation statements)

References 14 publications

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“…The association of otitis media with ventilation may help explain the relatively large number of cases with Ps. aeruginosa infections (Barson, 1971). It can be argued that stagnant, degenerating organic material could provide a fertile medium for the growth of a secondarily introduced organism.…”

Section: Discussionmentioning

confidence: 99%

Infection and amniotic aspiration of middle ear in stillbirths and neonatal deaths.

De¹

1973

Archives of Disease in Childhood

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Aspirated debris in the middle ear was seen commonly in infants of over 28 weeks' gestation who bad suffered from intrapartum asphyxia, and was usually associated with evidence of pulmonary aspiration of amniotic squames. Most of these infants were stillborn or had died in the first 2 days of postnatal life, but amniotic debris persisted for a longer period in some, and in 8 cases it had excited a foreign body histiocyte reaction.The 17 cases with otitis media could be divided into two groups on the basis of middle ear findings: 11 cases with an admixture of amniotic debris and purulent exudate (P/A group) and 6 with purulent exudate only. The P/A group showed many clinical features in common with the infants of the aspiration group, with a high incidence of pregnancy complications and of need for prolonged ventilation.All 17 cases with otitis media had evidence of infection elsewhere, including pneumonia (12) and meningitis (6). In 13 of the 14 cases with positive bacteriology, the organisms cultured were Gram-negative (Esch. coli or Pseudomonas aeruginosa).It is argued that amniotic debris may be aspirated into the middle ear in asphyxiated babies and this may explain some of the unusual metaplastic changes noted in the epithelium of the middle ear cavities. Furthermore, stagnant amniotic debris may become secondarily infected by organisms, particularly if the infant requires ventilation.While infections of the middle ear are known to be common in older children, relatively little attention has been paid to similar infections occurring in newborn infants. This is surprising since it has been shown by many writers that middle ear infections are common in this age group (Benner, 1940;Allen, Morison, and Rutherford, 1946;McLellan et al., 1962 The left middle ear cavity was examined using the procedure described by Morison (1970). Smears of any fluid or exudate present were taken, and whenever purulent exudate was present bacteriological samples were taken for culture. The petrous temporal bone on the right side was dissected away from the skull so as to include the terminal portion of the extemal auditory canal and the tympanic membrane in continuity with the 872 on 11 May 2018 by guest. Protected by copyright.

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Section: Discussionmentioning

confidence: 99%

Infection and amniotic aspiration of middle ear in stillbirths and neonatal deaths.

De¹

1973

Archives of Disease in Childhood

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“…Infections caused by Ps. aeruginosa are almost always a complication of other diseases, particularly in prematures with RDS who have been mechanically ventilated (Barson, 1971). Thus, the pseudomonas septicaemia may not have been related to the catheterization.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic antibiotics in chronic umbilical artery catheterization in respiratory distress syndrome.

Bard¹,

Albert²,

Teasdale³

et al. 1973

Archives of Disease in Childhood

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(1973). Archives of Disease in Childhood, 48, 630. Prophylactic antibiotics in chronic umbilical artery catheterization in respiratory distress syndrome. The use of prophylactic antibiotics with indwelling umbilical artery catheters under continuous perfusion in 75 high risk newborns with respiratory distress syndrome (RDS) was evaluated. These infants were divided alternatively into 'treated' and 'nontreated' groups. The incidence of bacteraemia during chronic catheterization was 1 -3 %, and the incidence of septic complications probably related to the catheterization was 2 6%. There was a total of 11 7% colonization of catheter tips with pathogens, with no significant difference between the nontreated and the treated group. There was no difference in mortality or morbidity between the two groups. One nontreated infant showed a bacteraemia while an indwelling catheter was present, and a second was found to be septicaemic two days after removal. 2 infants, 1 from each group, developed a localized skin infection, probably related to catheterization. Antibiotic coverage during chronic umbilical artery catheterization in infants with RDS has dubious prophylactic value.

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Acute Lesions Induced by Endotracheal Intubation

Joshi¹,

Mandavia²,

Stern³

et al. 1972

Am J Dis Child

118

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Clinical charts, autopsy records, and slides of the larynx, trachea, and bronchi in 172 cases of newborn infants with respiratory distress syndrome (RDS) were reviewed for acute lesions induced by endotracheal intubation. Mild lesions (mucosal or submucosal necrosis) were seen in 63.3% and relatively severe lesions showing inflammatory changes in 15.8% of the cases. No lesions were seen in the remaining cases. Vocal cords with or without the subglottic region of larynx and trachea were the commonest lesion sites. Lesion severity was directly related to duration of intubation and subsequent bacterial infection. In seven (4.3%) cases Pseudomonas pneumonia with or without septicemia extending from acute diffuse laryngotracheobronchitis was a major factor in infant death. Comparable focal lesions in RDS survivors may result in residual permanent damage to upper respiratory tract. Endotracheal intubation with posi¬ tive pressure mechanical venti¬ lation is now frequently used in the management of severe cases of res¬ piratory distress syndrome (RDS).1 The pathological features of lesions induced by endotracheal intubation in adults.-' and in experimental ani¬ mals4 has been adequately described. However, only brief descriptions of acute lesions of the larynx, trachea, and bronchi in intubated newborn in¬ fants are available in the literature.59It is the purpose of this paper to de¬ scribe and analyze these lesions seen at autopsy on RDS patients who died within seven days of birth and to dis¬ cuss their role in the mortality of some patients with RDS and their possible implications for future mor¬ bidity in the survivors. Materials and MethodsClinical charts, autopsy protocols, and slides from all patients dying of RDS dur¬ ing the period 1961 to 1970 were reviewed. A total of 1,250 cases of patients whose conditions were clinically diagnosed as Hospital during this period. Out of 220 pa¬ tients dying within seven days with defi¬ nite histologie evidence of RDS, 48 cases were excluded because of inadequacy of data, leaving a total of 172 cases for the present study. At least one slide each of a longitudinal section of the larynx and cross sections of the trachea and mainstem bronchi were available in these cases.Types of Lesions.-The lesions noted in the slides of larynx, trachea, and bronchi were classified as follows in increasing or¬ der of severity: type 1, mucosal necrosis (Fig 1); type 2, mucosal and submucosal necrosis (Fig 2); and type 3, mucosal and submucosal necrosis with mild to moderate inflammation (3m) (Fig 3) or severe in¬ flammation (3s) (Fig 4 and 5). Other changes, such as edema, vascular engorge¬ ment, and hemorrhage, were also noted. In assigning cases to various types described above, the severest lesion in each case, seen in either the larynx, trachea, or bronchi, was considered. The distribution of the lesions, ie, whether focal or diffuse, was also assessed. Reports of bacterial cul¬ tures taken at autopsy from the trachea, lungs, and heart blood or spleen were ob¬ tained from the autopsy prot...

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Fatal Pseudomonas aeruginosa Bronchopneumonia in a Children's Hospital

Cited by 16 publications

References 14 publications

Infection and amniotic aspiration of middle ear in stillbirths and neonatal deaths.

Infection and amniotic aspiration of middle ear in stillbirths and neonatal deaths.

Prophylactic antibiotics in chronic umbilical artery catheterization in respiratory distress syndrome.

Acute Lesions Induced by Endotracheal Intubation

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