The BDS is easy to use and provides good levels of sensitivity and specificity.

After prolonged parenteral nutrition a 12 month old infant died with pulmonary hypertension and granulomatous pulmonary arteritis. A review of necropsy findings in 41 infants who had been fed parenterally showed that two of these also had pulmonary artery granulomata, while none of 32 control patients who died from sudden infant death syndrome had similar findings. Particulate contaminants have been implicated in the pathogenesis of such lesions and these were quantified in amino acid/dextrose solutions and fat emulsions using automated particle counting and optical microscope counting respectively. Parenteral feed infusions compounded for a 3000 g infant according to standard nutritional regimens were found to include approximately 37 000 particles between 2 and 100 pm in size in one day's feed, of which 80% were derived from the fat emulsion. In-line end filtration of intravenous infusions may reduce the risk of particle associated complications. A A 1000 g female infant born at 27 weeks' gestation developed necrotising enterocolitis after a period of respiratory distress and hypoglycaemia. Perforation of the terminal ileum led to laparotomy and formation of an ileostomy, which was closed five months later. Subsequently, an anastomotic stricture and adhesions caused small bowel obstruction requiring further surgery. Septicaemia, recurrent rotavirus infection, and protracted diarrhoea precluded full enteral feeding. She died suddenly and unexpectedly at 12 months of age, having been parenterally fed for much of her life. Striking features at postmortem examination were a granulomatous pulmonary arteritis with some of the arteries being occluded by fibrin, together with dilatation and hypertrophy of the right ventricle secondary to pulmonary hypertension.Identical lesions in drug offenders are thought to be related to intravenous injection of magnesium trisilicate dust used as a lubricant in drugs intended for oral administration.' 2 Granulomata have also been described in patients who have received large volumes of intravenous fluids,3 and they can be reproduced experimentally in rabbits by injection of saline containing particulate matter. 4 The aims of this study were, therefore, to establish how often pulmonary granulomata could be found at postmortem examination in both patients who had and those who had not received parenteral nutrition, and to determine the number and size of particles in parenteral feeding solutions. Subjects and methods NECROPSY STUDY SubjectsPostmortem material from all parenterally fed infants from a regional neonatal intensive care unit who had died between 1980 and 1989 were reviewed. Forty one such patients were identified, with a median (range) gestational age of 28 weeks (25-40) and weight 880 g (450-2820). The most common indication for parenteral nutrition was prematurity and failure to tolerate enteral feeding in association with respiratory distress requiring ventilatory support (n=38); indications in the three remaining patients were necrotising enterocolitis, isch...

Bacterial contamination of blood components remains a significant problem in transfusion medicine. The Pall enhanced bacterial detection system (Pall eBDS) detects the presence of bacteria in leucodepleted platelet concentrates by measuring the reduction of oxygen in the sample, due to aerobic bacterial growth. Pooled platelet concentrates were spiked at 10 cfu mL(-1) with 10 organisms (one species per bag). Pall eBDS pouches were inoculated with the spiked platelet concentrates. After 24 and 30 h of incubation, the oxygen level was measured. A further set of pouches were taken from the inoculated platelet concentrates at 24 h. Incubation and reading intervals were as for the initial set of pouches. A sensitivity study was also performed comparing the Pall eBDS with the BacT/ALERT system. Spiking at 10 cfu mL(-1) and immediately sampling into Pall eBDS pouches resulted in 97.6 and 100% detection after an incubation period of 24 and 30 h, respectively. After 24 h of incubation of the spiked platelet concentrates and then sampling into Pall eBDS pouches, 99.1% detection was obtained after incubation for both 24 and 30 h. The sensitivity of the Pall eBDS and BacT/ALERT is similar and in the order of 1 cfu mL(-1). Implementation of either BacT/ALERT or Pall eBDS for routine screening of platelet concentrates has the potential to further increase the safety of the blood supply.