Abstract
We observed an unexpectedly high incidence of late sepsis in infants with bowel resection. To define the epidemiology of sepsis, we reviewed the records of all infants with bowel resection from 1978-83. 50 infants had resection for: NEC-38, Gastroschisis-3, Hirschsprung-3, atresia-4, other-2. 19(38%) had 27 episodes of late sepsis, as defined by clinical deterioration plus positive blood cultures. Onset of sepsis was 17 wks. (range 1-71) after surgery. In 3 episodes, cultures(S.epidermidis, enterococcus, and streptococcus) from a central venous line(CVL) were positive, with negative peripheral blood cultures. In the remaining 24 episodes Enterobacteriacea-12, Candida-4, S.epidermidus-2, S.aureus-2, enterococcus-2, S.pneumonia-1, and alpha-streptococcus-1 were recovered. Sex, race, birth wt. (1.9v2.1kg),primary diagnosis, age at resection, cms. resected (26.8v18.4), presence of ileocecal valve (37v47%), or enterostomy (89v75%) were similar in septic and nonseptic infants. However, septic infants had a CVL more frequently than those without sepsis (89v63%). (p 0.05). 21 of 27 episodes(77%) occurred with a CVL in place. 4 (21%) in the septic group died: 2 with gram negative sepsis, 2 from complications of long-term ventilator therapy. We conclude that infants with bowel resection are at increased risk for sepsis, particularly gram negative sepsis. A CVL may increase this risk. In these patients, a high index of suspicion of sepsis, meticulous catheter care, and early catheter removal is prudent.
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Walsh, M., Simpser, E. & Speck, S. 597 Late Onset Sepsis in Infants with Bowel Resection. Pediatr Res 19, 210 (1985). https://doi.org/10.1203/00006450-198504000-00627
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DOI: https://doi.org/10.1203/00006450-198504000-00627