Journal of the Chinese Medical Association : JCMA, Jan 19, 2016
Laryngotracheobronchial anomalies (LTBAs) may cause respiratory problems during early childhood, ... more Laryngotracheobronchial anomalies (LTBAs) may cause respiratory problems during early childhood, and increase the risk of hospitalization or mortality in diseased children. This study investigated the initial hospitalization age and risk factors for in-hospital mortality in infants diagnosed with LTBAs during their first 5 years of life. Hospitalized infants diagnosed with LTBAs were retrieved from Taiwan's National Health Insurance Research Database from 2003 to 2005. Their medical claim data were traced up to 59 months of age. The age distribution of all LTBA cases was analyzed, and then the enrolled infants were grouped into two age groups. Hospitalization-related comorbidities and risk factors for in-hospital mortality were also analyzed. A total of 1272 LTBA cases were retrieved. Most of them (976, 76.7%) were initially hospitalized at an age of 0-3 months, and 47 infants (3.7%) died. These enrolled cases were grouped into early and late LTBA groups, with ages of 0-3 months...
The mortality risk associated with congenital airway anomalies (CAA) in children with congenital ... more The mortality risk associated with congenital airway anomalies (CAA) in children with congenital heart disease (CHD) is unclear. This study aimed to investigate the factors associated with CAA, and the associated mortality risk, among children with CHD. This nationwide, population-based study evaluated 39,652 children with CHD aged 0-5 years between 2000 and 2011, using the Taiwan National Health Insurance Research Database (NHIRD). We performed descriptive, logistic regression, Kaplan-Meier, and Cox regression analyses of the data. Among the children with CHD, 1,591 (4.0%) had concomitant CAA. Children with CHD had an increased likelihood of CAA if they were boys (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.33-1.64), infants (OR, 5.42; 95%CI, 4.06-7.24), or had a congenital musculoskeletal anomaly (OR, 3.19; 95%CI, 2.67-3.81), and were typically identified 0-3 years after CHD diagnosis (OR, 1.33; 95%CI 1.17-1.51). The mortality risk was increased in children with CHD and...
Although necrotizing enterocolitis (NEC) is a primary disease of prematurity, full-term infants a... more Although necrotizing enterocolitis (NEC) is a primary disease of prematurity, full-term infants account for approximately 10% of cases. We retrospectively reviewed the medical records of infants with perforated NEC at two tertiary medical centers over the past fifteen years. Nine full-term and 29 pre-term infants with perforated NEC were enrolled in our study. Among the full-term cases, 4 were older than one month. Perforated NEC was male predominant in pre-term cases and female predominant in full-term cases. Abdominal distention, abdominal wall discoloration and muscle guarding were the most common manifestations in preterm cases, and abdominal distension and bloody stool were most common in full-term cases. The most common abnormal laboratory findings were anemia and metabolic acidosis in preterm cases, and leucocytosis and metabolic acidosis in full-term cases. In pre-term infants, the most common related factors were prenatal problems and maternal disease (19/29, 65.5%), patent ductus arteriosus with indomethacin use (14/29, 48.3%), and sepsis (11/29, 37.9%). In full-term cases, congenital anomaly (5/9, 55.6%) and sepsis (3/9, 33.3%) were the most common related factors, especially in full-term infants older than 1 month. The most common pathogen cultured from patients' blood or ascites was Klebsiella pneumoniae, followed by E. coli, in both pre-term and full-term infants. In conclusion, perforated NEC should be considered in both preterm and full-term babies if infants present with signs of surgical abdomen. To reduce NEC mortality and morbidity in both preterm and full-term infants, early diagnosis and treatment are vitally important, especially in cases with predisposing factors. (Clinical Neonatology 2007;14:75-80)
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
The optimal management of thoracic empyema in children is still controversial. In this retrospect... more The optimal management of thoracic empyema in children is still controversial. In this retrospective study, we analyze our six-year experience in the management of empyema. From April 1995 to December 2001, 39 patients under age 6 years were admitted with the diagnosis of empyema. These patients were assigned by the method of empyema management to one of two groups (either the conservatively treated or surgically treated group). The surgical patients were divided on the basis of the timing of surgical intervention into either the early (within 8 hospital days) or late (beyond 8 hospital days) surgical group. There was no difference in total hospital stay between those treated conservatively (24.3 +/- 11.6 days) and surgically (24.5 +/- 7.9 days). Among the surgically treated patients, recipients of early surgical intervention had significantly shorter hospital stay (20.2 +/- 5.9 days) than those receiving late surgical intervention (30.1 +/- 6.5 days). Early surgical intervention in cases of thoracic empyema in young children can shorten hospitalization. These children should undergo surgery if their clinical course does not improve within one week.
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
To determine the relationship of placental weight and birth characteristics of healthy Chinese si... more To determine the relationship of placental weight and birth characteristics of healthy Chinese singleton newborns, 552 consecutive singleton near-term and uncomplicated pregnancies were enrolled in a retrospective study from October 2000 to April 2001. Maternal age, infants' gender, gestational age, placental weight (PW), birth weight (BW), birth length (BL), cord length, ponderal index, and appearance of meconium-stained amniotic fluid or a nuchal cord were recorded and analyzed. Our results show that the mean value of BW was 3235 +/- 17 g, birth length was 48.8 +/- 0.1 cm, PW was 646.2 +/- 0.3 g, BW/BL was 66.2 +/- 0.3, BW/PW was 5.1 +/- 0.1, and ponderal index was 2.8 +/- 0.0, respectively. Male neonates had significantly larger BWs (p<0.05) and BLs (p<0.01) than did female neonates. However, there was no significant difference in PW between male and female neonates. PW was positively correlated with BW (r=0.413, p<0.01), BL (r=0.305, p<0.01), BW/BL (r=0.397, p<0.01), and cord length (r=0.264, p<0.01). The PW of studied infants showed no significant difference when grouped by gestational age, maternal age, presence of meconium stained amniotic fluid, or presence of a nuchal cord. Of the studied healthy neonate, 81.9% and 69.4% had no meconium-stained amniotic fluid or nuchal cord, respectively. There were no significant differences in PW or BW/PW between neonates with the presence or absence of meconium-stained amniotic fluid or a nuchal cord. These results indicate that PW has a significant role in fetal growth in terms of weight, body length, and cord length. Furthermore, it has no significant role in the presence of meconium-stained fluid or a nuchal cord in healthy neonates.
Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui
A 13-year-old boy with an intradural extramedullary enterogenous cyst is presented. He presented ... more A 13-year-old boy with an intradural extramedullary enterogenous cyst is presented. He presented with progressive weakness of lower limbs. The myelography and computed tomography scan of spinal cord demonstrated an intradural, extramedullary lesion at the spinal level of T 7-9. A cystic lesion was discovered during operation. The cyst caused the spinal cord compression and was related to neurological deficit. Histologically, it was confirmed by Periodic Acid-Schiff and Alcian Blue stain to contain mucin. He recovered very well after surgical removal of the cyst.
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
Respiratory syncytial virus (RSV) is the most frequent pathogen found in hospitalized young child... more Respiratory syncytial virus (RSV) is the most frequent pathogen found in hospitalized young children with lower respiratory tract infection, and the virus is distributed worldwide. Respiratory distress and respiratory failure are caused by RSV in some severe cases. Its appearance always varies every year and depends on differences of latitudes, altitudes and climates. The purpose of this study was to investigate the epidemiology of hospitalized children from a hospital located in northern Taiwan with RSV induced lower respiratory tract infection. , and the selected patients were children aged under five and diagnosed with lower respiratory tract infection. The means adopted in this study were analyses of clinical presentations and laboratory tests (including viral identification with either virus culture or RSV antigen rapid test from the nasopharyngeal aspirate). The results showed that 153 children were positive with RSV identification. These cases were diagnosed in clinical practice all year round, and its peak was in spring, especially in March and April. Thirteen percent of all RSV-infected children in this study presented as severe form with respiratory distress and a need of respiratory support. However, none of these cases died from this disease, and all cases recovered without long-ferm respiratory complication.
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
Background: Acute lung injury, such as meconium aspiration syndrome in neonates, may present with... more Background: Acute lung injury, such as meconium aspiration syndrome in neonates, may present with exacerbated ventilation and perfusion abnormalities. This can impair the efficacy of intravenous antibiotic therapy in treating pulmonary infection. Intrapulmonary administration via perfluorochemical as a vehicle may adequately deliver drugs, such as the poorly pulmonary-penetrative antibiotic vancomycin, to affect lung regions while maintaining gas exchange and non-toxic serum level.
Background: To evaluate the influence of hyperoxia on neurotransmitters in the developing brain o... more Background: To evaluate the influence of hyperoxia on neurotransmitters in the developing brain of newborn piglets. Methods: Ten newborn piglets were randomly assigned to hyperoxia (inhaled 100% oxygen) or control (inhaled room air) groups and ventilated for 4 hours. Blood samples were obtained at 0, 15, 30, and then every 30 minutes for 4 hours. Extracts of whole brain tissue were assayed for dopamine, serotonin, and their metabolites using high-performance liquid chromatography. Results: In comparison with the control group, there was a general trend of lower neurotransmitter content in the brains of the hyperoxia group. In addition, the levels of dopamine and 3,4-dihydroxyphenylacetic acid in the left frontal lobe, and serotonin in the right occipital lobe and left frontal lobe, of the hyperoxia group were significantly lower compared with the control group ( p < 0.05).
Background: Ultrasonography is a non-invasive diagnostic technique, and it has been used to detec... more Background: Ultrasonography is a non-invasive diagnostic technique, and it has been used to detect intracranial lesions in neonates for a long time. Correspondingly, screening tests using cranial ultrasonography have been applied for early detection of intracranial lesions in full-term neonates during the past decade. Methods: We retrospectively reviewed the findings of cranial ultrasonographic screening tests in healthy full-term neonates between September 2004 and August 2009. The ultrasonographic findings were divided into the following categories: (a) nonsignificant (NS) group, including normal and normal variations, (b) minor anomaly group, including tiny cystic lesions, mild hemorrhage, or mild ventricular anomaly, and (c) major anomaly group, including significant anomaly of any intracranial pathology. The participants with major anomalies were further reviewed, and the following medical records of all enrolled patients were reviewed until they were 24 months of age. Results: There were a total of 3186 neonates who received cranial ultrasonographic screening examination during the 5-year period, and most of them (2982 cases, 93.6%) were assigned to the NS group. The most common normal variation was the presence of cavum septum pellucidum (1979 cases, 62.1%). Minor anomalies were found in 202 (6.3%) neonates, including 119 (3.7%) neonates with tiny cysts, and 59 (1.9%) neonates with mild intraventricular hemorrhage. Major anomalies were found in two (0.06%) neonates, including obstructive hydrocephalus and agenesis of the corpus callosum. Two other infants (0.06%) initially presented with minor anomaly or normal variation, but they were diagnosed as Moyamoya disease and neonatal seizure some months later. Conclusion: The incidence of minor and major anomalies detected by cranial ultrasonographic screening examinations in healthy full-term neonates is 6.3% and 0.06%, respectively. Thus, cranial ultrasonographic screening testing may play a role in the early diagnosis of intracranial anomalies of otherwise healthy neonates. However, this examination cannot exclude or detect all cranial abnormalities, including many potential neurologic diseases of neonates, so continuing clinical diligence is still important for all infants.
International Journal of Pediatric Otorhinolaryngology, 2015
Aspirated pen cap (APC) is a clinical challenging issue in children because of the difficulty in ... more Aspirated pen cap (APC) is a clinical challenging issue in children because of the difficulty in both making diagnosis and performing extraction. In case of failed retrieval by rigid endoscopy (RE), more invasive surgical approaches are recommended. The objective of this study is to introduce a new retrieval technique of APC by using laser and balloon catheter (BC) guided with flexible endoscopy (FE) and supported by a novel non-invasive ventilation (NIV) in the intensive care unit (ICU) setting. We retrospectively review the charts and FE video records of our pediatric cases with the diagnosis of APC in the past decade, 2004-2014. Four consecutive cases with bronchial APC which had failed extraction with RE were transferred to our hospital. All of them were under procedural sedation, topical anesthesia, NIV support and ICU monitoring. After FE confirmed the diagnosis and location, a BC parallel to the endoscope was manipulated to pass through the cap hole of the APC. Two APCs required laser pretreatment before retrieval: one debulked the entrenched granulation whereas another enlarged the size of cap hole. Guide wires also were required in three cases to assist the BC to pass through the cap hole. All four APCs were successfully retrieved on their first attempts with no significant complications. FE assisted by laser, guide wire and BC, with this NIV support and ICU monitoring is a feasible, safe and effective modality for retrieving those difficult bronchial APCs in pediatric cases.
Acute airway infections, including bronchiolitis, are common causes of early childhood hospitaliz... more Acute airway infections, including bronchiolitis, are common causes of early childhood hospitalization. The development of later asthma may be related to early airway infections in young children. This study is to investigate the relationship between hospitalized airway infections (HAI) in young children (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 3 years old) and later childhood asthma. Hospitalized children (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 3 years old) with bronchiolitis or other acute airway infections (other HAI group) from 1997-2000 were retrieved from the National Health Insurance Research Database of Taiwan, and compared to age- and gender-matched subjects with regards to asthma until 10 years of age; and potential comorbidities and medical care conditions. In total, 3,264 children (1,981 with bronchiolitis; 1,283 with other HAIs) were compared to 18,527 controls. The incidence of childhood asthma was higher in the study (16.2%) than the control (11.7%) group, and most cases were diagnosed between 3-5 years old. The hazard ratios were 1.583 (95% CI: 1.414-1.772) and 1.226 (95% CI: 1.053-1.428) for the bronchiolitis and other HAI subgroups, respectively, compared to the control group, and 1.228 (95% CI: 1.075-1.542) in the bronchiolitis subgroup compared to the other HAIs subgroup. A significantly higher odds ratio (1.973, 95% CI: 1.193-3.263) for the children with congenital heart disease (CHD) in the bronchiolitis subgroup was found at an age of 3-5 years compared to the control group. Young children (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 3 years old) hospitalized due to acute HAIs are at a higher risk of developing childhood asthma at age 3 to 10 years. The parents of children with HAIs at age 0 to 2 years should be informed for the higher risk of developing childhood asthma, especially in children with CHD and bronchiolitis.
Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui
Povidone-iodine (PV-I) are commonly used for disinfection in hospitals. Previous investigators ha... more Povidone-iodine (PV-I) are commonly used for disinfection in hospitals. Previous investigators had proved that iodine can be absorbed from the skin. In an attempt to determine the effect of single treatment of various PV-I preparations on thyroid function in fullterm newborns, serial measurements of serum thyroxine (T4) and Thyroid stimulating hormone (TSH) were done in 48 neonates treated with one dose antiseptics (tincture PV-I, aqueous PV-I, tincture PV-I followed with 75% alcohol and no treatment in control group). The results revealed no significant change of thyroid function in any study group. In conclusion, PV-I with different preparations, aqueous or tincture, did not significantly influence neonatal thyroid function if they were used to a fullterm neonate only once and even to a wide skin surface.
Chronic lung disease continues to be a major complication in premature infants with severe respir... more Chronic lung disease continues to be a major complication in premature infants with severe respiratory distress syndrome (RDS). This is despite having advanced ventilatory care, prenatal corticosteroids, and postnatal surfactant therapies. The combined use of intratracheal corticosteroids and surfactant may not only recruit the lungs, but also alleviate pulmonary inflammation in severe RDS. Fifteen newborn piglets received repeated pulmonary saline lavage to induce surfactant-depleted lungs, mimicking neonatal RDS. They were randomly divided into three groups: control group receiving no treatment; surfactant (Surf) group, treated with standard intratracheally instilled surfactant (100 mg/kg); and Budesonide plus surfactant (Bude + Surf) group, treated with intratracheally administered mixed suspension of budesonide (0.5 mg/kg) and surfactant (100 mg/kg). Blood samples were taken every 30 minutes for 4 hours. Lung tissue was examined after the experiment. Significantly better oxygena...
Journal of Microbiology, Immunology and Infection, 2014
K.-G. Wu). d These two authors contributed equally to this work. + MODEL Please cite this article... more K.-G. Wu). d These two authors contributed equally to this work. + MODEL Please cite this article in press as: Lee M-L, et al., Recent trends in antibiotic prescriptions for acute respiratory tract infections in pediatric ambulatory care in Taiwan, 2000e2009: A nationwide population-based study, Journal of Microbiology, Immunology and Infection (2014), http://dx.
Pediatrics international : official journal of the Japan Pediatric Society, 2006
The physical-chemical properties of perfluorochemical (PFC) liquids have been shown to influence ... more The physical-chemical properties of perfluorochemical (PFC) liquids have been shown to influence physiological and cellular responses during partial liquid ventilation (PLV). The aim of this study is to compare the relationship between patho-physiological endpoints and the physical properties of three PFC liquids used in treating acute lung injury. A total of 18 juvenile rabbits were randomized into conventional mechanical ventilation or PLV groups after lung saline lavages. Three PFC liquids, including Flutec perfluoro-1,3,5-trimethylcyclohexane (PP4; vapor pressure, 28.8 mmHg at 37 degrees C), Perfluorodecalin (PFD; vapor pressure, 13.6 mmHg at 37 degrees C), and Perflubron (PFB; vapor pressure, 10.4 mmHg at 37 degrees C) were used for PLV with no replacement for 4 h. A thermal detector was used to measure PFC loss rate. Physiological measurements and evaporative loss rate of PFC were done every 30 min, and lung histology was examined. The mean evaporative loss rate was significan...
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
Plasma electrolyte concentrations in premature infants are unstable, and hyperkalemia may induce ... more Plasma electrolyte concentrations in premature infants are unstable, and hyperkalemia may induce significant, even life-threatening, symptoms in tiny infants. The medical records of 95 premature infants were retrospectively reviewed. Patients with a major congenital anomaly or mortality within 24 h after birth were excluded. Plasma electrolytes, blood urea nitrogen, creatinine, blood pH, urine output, and related clinical conditions during first 96 h of life were analyzed. Plasma potassium concentrations had significant negative correlations with gestational age and birth weight (p < 0.05). Infants with a gestational age of less than 29 weeks had significantly higher potassium concentrations (average 5.9 +/- 0.3 mEq/L, peak 7.8 +/- 0.4 mEq/L, p < 0.05) than other gestational age groups, and their plasma potassium levels were significantly higher at 24 and 48 h of age (p < 0.05). Forty-two infants (42/95, 44%) had peak plasma potassium concentrations greater than or equal to...
To investigate the beneficial effects of exogenous surfactant supplementation (ESS) and partial l... more To investigate the beneficial effects of exogenous surfactant supplementation (ESS) and partial liquid ventilation (PLV) in treating acute lung injury induced by wood smoke inhalation. A prospective, randomized, controlled, multigroup study. An animal research laboratory at a medical center. Newborn piglets (n = 29; 1.80 +/- 0.06 kg) of either sex. Animals were ventilated with a tidal volume of 15 mL/kg, a rate of 30 breaths/min, a positive end-expiratory pressure of 5 cm H(2)O, and an Fio(2) of 1.0. After the induction of acute lung injury by wood smoke inhalation, animals were randomly assigned to receive either conventional mechanical ventilation (CMV) or PLV with or without ESS pretreatment. Animals were grouped as CMV, ESS-CMV, PLV, and ESS-PLV. Arterial blood gases, cardiovascular hemodynamics, dynamic lung compliance, and total lung injury scores were measured. After smoke inhalation, all four groups displayed similar high arterial carboxyhemoglobin levels, low Pao(2) (<15...
Zhonghua yi xue za zhi = Chinese medical journal; Free China ed, 1999
Although assisted ventilation has reduced the mortality rate of premature infants, pulmonary dise... more Although assisted ventilation has reduced the mortality rate of premature infants, pulmonary disease is still the major cause of morbidity and mortality in very low birth weight infants. We designed this study to evaluate the efficacy and safety of high-frequency oscillatory ventilation (HFOV) in premature infants and to compare the outcome for early intervention with HFOV versus conventional ventilation (CV). From January, 1997, to June, 1998, we analyzed premature infants with respiratory failure who required mechanical ventilation and supplemental oxygen to support adequate gas exchange in our neonatal intensive care unit. Patients were eligible if their gestational age was less than 35 weeks or their birth weight was less than 1,751 g. A total of 35 neonates were enrolled in the study. Eighteen infants were treated with HFOV, and 17 infants were treated with CV. They were treated with early intervention of HFOV or CV, within 24 hours-of-age. Patients were excluded if a lethal co...
Journal of the Chinese Medical Association : JCMA, Jan 19, 2016
Laryngotracheobronchial anomalies (LTBAs) may cause respiratory problems during early childhood, ... more Laryngotracheobronchial anomalies (LTBAs) may cause respiratory problems during early childhood, and increase the risk of hospitalization or mortality in diseased children. This study investigated the initial hospitalization age and risk factors for in-hospital mortality in infants diagnosed with LTBAs during their first 5 years of life. Hospitalized infants diagnosed with LTBAs were retrieved from Taiwan's National Health Insurance Research Database from 2003 to 2005. Their medical claim data were traced up to 59 months of age. The age distribution of all LTBA cases was analyzed, and then the enrolled infants were grouped into two age groups. Hospitalization-related comorbidities and risk factors for in-hospital mortality were also analyzed. A total of 1272 LTBA cases were retrieved. Most of them (976, 76.7%) were initially hospitalized at an age of 0-3 months, and 47 infants (3.7%) died. These enrolled cases were grouped into early and late LTBA groups, with ages of 0-3 months...
The mortality risk associated with congenital airway anomalies (CAA) in children with congenital ... more The mortality risk associated with congenital airway anomalies (CAA) in children with congenital heart disease (CHD) is unclear. This study aimed to investigate the factors associated with CAA, and the associated mortality risk, among children with CHD. This nationwide, population-based study evaluated 39,652 children with CHD aged 0-5 years between 2000 and 2011, using the Taiwan National Health Insurance Research Database (NHIRD). We performed descriptive, logistic regression, Kaplan-Meier, and Cox regression analyses of the data. Among the children with CHD, 1,591 (4.0%) had concomitant CAA. Children with CHD had an increased likelihood of CAA if they were boys (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.33-1.64), infants (OR, 5.42; 95%CI, 4.06-7.24), or had a congenital musculoskeletal anomaly (OR, 3.19; 95%CI, 2.67-3.81), and were typically identified 0-3 years after CHD diagnosis (OR, 1.33; 95%CI 1.17-1.51). The mortality risk was increased in children with CHD and...
Although necrotizing enterocolitis (NEC) is a primary disease of prematurity, full-term infants a... more Although necrotizing enterocolitis (NEC) is a primary disease of prematurity, full-term infants account for approximately 10% of cases. We retrospectively reviewed the medical records of infants with perforated NEC at two tertiary medical centers over the past fifteen years. Nine full-term and 29 pre-term infants with perforated NEC were enrolled in our study. Among the full-term cases, 4 were older than one month. Perforated NEC was male predominant in pre-term cases and female predominant in full-term cases. Abdominal distention, abdominal wall discoloration and muscle guarding were the most common manifestations in preterm cases, and abdominal distension and bloody stool were most common in full-term cases. The most common abnormal laboratory findings were anemia and metabolic acidosis in preterm cases, and leucocytosis and metabolic acidosis in full-term cases. In pre-term infants, the most common related factors were prenatal problems and maternal disease (19/29, 65.5%), patent ductus arteriosus with indomethacin use (14/29, 48.3%), and sepsis (11/29, 37.9%). In full-term cases, congenital anomaly (5/9, 55.6%) and sepsis (3/9, 33.3%) were the most common related factors, especially in full-term infants older than 1 month. The most common pathogen cultured from patients' blood or ascites was Klebsiella pneumoniae, followed by E. coli, in both pre-term and full-term infants. In conclusion, perforated NEC should be considered in both preterm and full-term babies if infants present with signs of surgical abdomen. To reduce NEC mortality and morbidity in both preterm and full-term infants, early diagnosis and treatment are vitally important, especially in cases with predisposing factors. (Clinical Neonatology 2007;14:75-80)
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
The optimal management of thoracic empyema in children is still controversial. In this retrospect... more The optimal management of thoracic empyema in children is still controversial. In this retrospective study, we analyze our six-year experience in the management of empyema. From April 1995 to December 2001, 39 patients under age 6 years were admitted with the diagnosis of empyema. These patients were assigned by the method of empyema management to one of two groups (either the conservatively treated or surgically treated group). The surgical patients were divided on the basis of the timing of surgical intervention into either the early (within 8 hospital days) or late (beyond 8 hospital days) surgical group. There was no difference in total hospital stay between those treated conservatively (24.3 +/- 11.6 days) and surgically (24.5 +/- 7.9 days). Among the surgically treated patients, recipients of early surgical intervention had significantly shorter hospital stay (20.2 +/- 5.9 days) than those receiving late surgical intervention (30.1 +/- 6.5 days). Early surgical intervention in cases of thoracic empyema in young children can shorten hospitalization. These children should undergo surgery if their clinical course does not improve within one week.
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
To determine the relationship of placental weight and birth characteristics of healthy Chinese si... more To determine the relationship of placental weight and birth characteristics of healthy Chinese singleton newborns, 552 consecutive singleton near-term and uncomplicated pregnancies were enrolled in a retrospective study from October 2000 to April 2001. Maternal age, infants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gender, gestational age, placental weight (PW), birth weight (BW), birth length (BL), cord length, ponderal index, and appearance of meconium-stained amniotic fluid or a nuchal cord were recorded and analyzed. Our results show that the mean value of BW was 3235 +/- 17 g, birth length was 48.8 +/- 0.1 cm, PW was 646.2 +/- 0.3 g, BW/BL was 66.2 +/- 0.3, BW/PW was 5.1 +/- 0.1, and ponderal index was 2.8 +/- 0.0, respectively. Male neonates had significantly larger BWs (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) and BLs (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) than did female neonates. However, there was no significant difference in PW between male and female neonates. PW was positively correlated with BW (r=0.413, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), BL (r=0.305, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), BW/BL (r=0.397, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), and cord length (r=0.264, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). The PW of studied infants showed no significant difference when grouped by gestational age, maternal age, presence of meconium stained amniotic fluid, or presence of a nuchal cord. Of the studied healthy neonate, 81.9% and 69.4% had no meconium-stained amniotic fluid or nuchal cord, respectively. There were no significant differences in PW or BW/PW between neonates with the presence or absence of meconium-stained amniotic fluid or a nuchal cord. These results indicate that PW has a significant role in fetal growth in terms of weight, body length, and cord length. Furthermore, it has no significant role in the presence of meconium-stained fluid or a nuchal cord in healthy neonates.
Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui
A 13-year-old boy with an intradural extramedullary enterogenous cyst is presented. He presented ... more A 13-year-old boy with an intradural extramedullary enterogenous cyst is presented. He presented with progressive weakness of lower limbs. The myelography and computed tomography scan of spinal cord demonstrated an intradural, extramedullary lesion at the spinal level of T 7-9. A cystic lesion was discovered during operation. The cyst caused the spinal cord compression and was related to neurological deficit. Histologically, it was confirmed by Periodic Acid-Schiff and Alcian Blue stain to contain mucin. He recovered very well after surgical removal of the cyst.
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
Respiratory syncytial virus (RSV) is the most frequent pathogen found in hospitalized young child... more Respiratory syncytial virus (RSV) is the most frequent pathogen found in hospitalized young children with lower respiratory tract infection, and the virus is distributed worldwide. Respiratory distress and respiratory failure are caused by RSV in some severe cases. Its appearance always varies every year and depends on differences of latitudes, altitudes and climates. The purpose of this study was to investigate the epidemiology of hospitalized children from a hospital located in northern Taiwan with RSV induced lower respiratory tract infection. , and the selected patients were children aged under five and diagnosed with lower respiratory tract infection. The means adopted in this study were analyses of clinical presentations and laboratory tests (including viral identification with either virus culture or RSV antigen rapid test from the nasopharyngeal aspirate). The results showed that 153 children were positive with RSV identification. These cases were diagnosed in clinical practice all year round, and its peak was in spring, especially in March and April. Thirteen percent of all RSV-infected children in this study presented as severe form with respiratory distress and a need of respiratory support. However, none of these cases died from this disease, and all cases recovered without long-ferm respiratory complication.
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
Background: Acute lung injury, such as meconium aspiration syndrome in neonates, may present with... more Background: Acute lung injury, such as meconium aspiration syndrome in neonates, may present with exacerbated ventilation and perfusion abnormalities. This can impair the efficacy of intravenous antibiotic therapy in treating pulmonary infection. Intrapulmonary administration via perfluorochemical as a vehicle may adequately deliver drugs, such as the poorly pulmonary-penetrative antibiotic vancomycin, to affect lung regions while maintaining gas exchange and non-toxic serum level.
Background: To evaluate the influence of hyperoxia on neurotransmitters in the developing brain o... more Background: To evaluate the influence of hyperoxia on neurotransmitters in the developing brain of newborn piglets. Methods: Ten newborn piglets were randomly assigned to hyperoxia (inhaled 100% oxygen) or control (inhaled room air) groups and ventilated for 4 hours. Blood samples were obtained at 0, 15, 30, and then every 30 minutes for 4 hours. Extracts of whole brain tissue were assayed for dopamine, serotonin, and their metabolites using high-performance liquid chromatography. Results: In comparison with the control group, there was a general trend of lower neurotransmitter content in the brains of the hyperoxia group. In addition, the levels of dopamine and 3,4-dihydroxyphenylacetic acid in the left frontal lobe, and serotonin in the right occipital lobe and left frontal lobe, of the hyperoxia group were significantly lower compared with the control group ( p < 0.05).
Background: Ultrasonography is a non-invasive diagnostic technique, and it has been used to detec... more Background: Ultrasonography is a non-invasive diagnostic technique, and it has been used to detect intracranial lesions in neonates for a long time. Correspondingly, screening tests using cranial ultrasonography have been applied for early detection of intracranial lesions in full-term neonates during the past decade. Methods: We retrospectively reviewed the findings of cranial ultrasonographic screening tests in healthy full-term neonates between September 2004 and August 2009. The ultrasonographic findings were divided into the following categories: (a) nonsignificant (NS) group, including normal and normal variations, (b) minor anomaly group, including tiny cystic lesions, mild hemorrhage, or mild ventricular anomaly, and (c) major anomaly group, including significant anomaly of any intracranial pathology. The participants with major anomalies were further reviewed, and the following medical records of all enrolled patients were reviewed until they were 24 months of age. Results: There were a total of 3186 neonates who received cranial ultrasonographic screening examination during the 5-year period, and most of them (2982 cases, 93.6%) were assigned to the NS group. The most common normal variation was the presence of cavum septum pellucidum (1979 cases, 62.1%). Minor anomalies were found in 202 (6.3%) neonates, including 119 (3.7%) neonates with tiny cysts, and 59 (1.9%) neonates with mild intraventricular hemorrhage. Major anomalies were found in two (0.06%) neonates, including obstructive hydrocephalus and agenesis of the corpus callosum. Two other infants (0.06%) initially presented with minor anomaly or normal variation, but they were diagnosed as Moyamoya disease and neonatal seizure some months later. Conclusion: The incidence of minor and major anomalies detected by cranial ultrasonographic screening examinations in healthy full-term neonates is 6.3% and 0.06%, respectively. Thus, cranial ultrasonographic screening testing may play a role in the early diagnosis of intracranial anomalies of otherwise healthy neonates. However, this examination cannot exclude or detect all cranial abnormalities, including many potential neurologic diseases of neonates, so continuing clinical diligence is still important for all infants.
International Journal of Pediatric Otorhinolaryngology, 2015
Aspirated pen cap (APC) is a clinical challenging issue in children because of the difficulty in ... more Aspirated pen cap (APC) is a clinical challenging issue in children because of the difficulty in both making diagnosis and performing extraction. In case of failed retrieval by rigid endoscopy (RE), more invasive surgical approaches are recommended. The objective of this study is to introduce a new retrieval technique of APC by using laser and balloon catheter (BC) guided with flexible endoscopy (FE) and supported by a novel non-invasive ventilation (NIV) in the intensive care unit (ICU) setting. We retrospectively review the charts and FE video records of our pediatric cases with the diagnosis of APC in the past decade, 2004-2014. Four consecutive cases with bronchial APC which had failed extraction with RE were transferred to our hospital. All of them were under procedural sedation, topical anesthesia, NIV support and ICU monitoring. After FE confirmed the diagnosis and location, a BC parallel to the endoscope was manipulated to pass through the cap hole of the APC. Two APCs required laser pretreatment before retrieval: one debulked the entrenched granulation whereas another enlarged the size of cap hole. Guide wires also were required in three cases to assist the BC to pass through the cap hole. All four APCs were successfully retrieved on their first attempts with no significant complications. FE assisted by laser, guide wire and BC, with this NIV support and ICU monitoring is a feasible, safe and effective modality for retrieving those difficult bronchial APCs in pediatric cases.
Acute airway infections, including bronchiolitis, are common causes of early childhood hospitaliz... more Acute airway infections, including bronchiolitis, are common causes of early childhood hospitalization. The development of later asthma may be related to early airway infections in young children. This study is to investigate the relationship between hospitalized airway infections (HAI) in young children (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 3 years old) and later childhood asthma. Hospitalized children (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 3 years old) with bronchiolitis or other acute airway infections (other HAI group) from 1997-2000 were retrieved from the National Health Insurance Research Database of Taiwan, and compared to age- and gender-matched subjects with regards to asthma until 10 years of age; and potential comorbidities and medical care conditions. In total, 3,264 children (1,981 with bronchiolitis; 1,283 with other HAIs) were compared to 18,527 controls. The incidence of childhood asthma was higher in the study (16.2%) than the control (11.7%) group, and most cases were diagnosed between 3-5 years old. The hazard ratios were 1.583 (95% CI: 1.414-1.772) and 1.226 (95% CI: 1.053-1.428) for the bronchiolitis and other HAI subgroups, respectively, compared to the control group, and 1.228 (95% CI: 1.075-1.542) in the bronchiolitis subgroup compared to the other HAIs subgroup. A significantly higher odds ratio (1.973, 95% CI: 1.193-3.263) for the children with congenital heart disease (CHD) in the bronchiolitis subgroup was found at an age of 3-5 years compared to the control group. Young children (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 3 years old) hospitalized due to acute HAIs are at a higher risk of developing childhood asthma at age 3 to 10 years. The parents of children with HAIs at age 0 to 2 years should be informed for the higher risk of developing childhood asthma, especially in children with CHD and bronchiolitis.
Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui
Povidone-iodine (PV-I) are commonly used for disinfection in hospitals. Previous investigators ha... more Povidone-iodine (PV-I) are commonly used for disinfection in hospitals. Previous investigators had proved that iodine can be absorbed from the skin. In an attempt to determine the effect of single treatment of various PV-I preparations on thyroid function in fullterm newborns, serial measurements of serum thyroxine (T4) and Thyroid stimulating hormone (TSH) were done in 48 neonates treated with one dose antiseptics (tincture PV-I, aqueous PV-I, tincture PV-I followed with 75% alcohol and no treatment in control group). The results revealed no significant change of thyroid function in any study group. In conclusion, PV-I with different preparations, aqueous or tincture, did not significantly influence neonatal thyroid function if they were used to a fullterm neonate only once and even to a wide skin surface.
Chronic lung disease continues to be a major complication in premature infants with severe respir... more Chronic lung disease continues to be a major complication in premature infants with severe respiratory distress syndrome (RDS). This is despite having advanced ventilatory care, prenatal corticosteroids, and postnatal surfactant therapies. The combined use of intratracheal corticosteroids and surfactant may not only recruit the lungs, but also alleviate pulmonary inflammation in severe RDS. Fifteen newborn piglets received repeated pulmonary saline lavage to induce surfactant-depleted lungs, mimicking neonatal RDS. They were randomly divided into three groups: control group receiving no treatment; surfactant (Surf) group, treated with standard intratracheally instilled surfactant (100 mg/kg); and Budesonide plus surfactant (Bude + Surf) group, treated with intratracheally administered mixed suspension of budesonide (0.5 mg/kg) and surfactant (100 mg/kg). Blood samples were taken every 30 minutes for 4 hours. Lung tissue was examined after the experiment. Significantly better oxygena...
Journal of Microbiology, Immunology and Infection, 2014
K.-G. Wu). d These two authors contributed equally to this work. + MODEL Please cite this article... more K.-G. Wu). d These two authors contributed equally to this work. + MODEL Please cite this article in press as: Lee M-L, et al., Recent trends in antibiotic prescriptions for acute respiratory tract infections in pediatric ambulatory care in Taiwan, 2000e2009: A nationwide population-based study, Journal of Microbiology, Immunology and Infection (2014), http://dx.
Pediatrics international : official journal of the Japan Pediatric Society, 2006
The physical-chemical properties of perfluorochemical (PFC) liquids have been shown to influence ... more The physical-chemical properties of perfluorochemical (PFC) liquids have been shown to influence physiological and cellular responses during partial liquid ventilation (PLV). The aim of this study is to compare the relationship between patho-physiological endpoints and the physical properties of three PFC liquids used in treating acute lung injury. A total of 18 juvenile rabbits were randomized into conventional mechanical ventilation or PLV groups after lung saline lavages. Three PFC liquids, including Flutec perfluoro-1,3,5-trimethylcyclohexane (PP4; vapor pressure, 28.8 mmHg at 37 degrees C), Perfluorodecalin (PFD; vapor pressure, 13.6 mmHg at 37 degrees C), and Perflubron (PFB; vapor pressure, 10.4 mmHg at 37 degrees C) were used for PLV with no replacement for 4 h. A thermal detector was used to measure PFC loss rate. Physiological measurements and evaporative loss rate of PFC were done every 30 min, and lung histology was examined. The mean evaporative loss rate was significan...
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
Plasma electrolyte concentrations in premature infants are unstable, and hyperkalemia may induce ... more Plasma electrolyte concentrations in premature infants are unstable, and hyperkalemia may induce significant, even life-threatening, symptoms in tiny infants. The medical records of 95 premature infants were retrospectively reviewed. Patients with a major congenital anomaly or mortality within 24 h after birth were excluded. Plasma electrolytes, blood urea nitrogen, creatinine, blood pH, urine output, and related clinical conditions during first 96 h of life were analyzed. Plasma potassium concentrations had significant negative correlations with gestational age and birth weight (p < 0.05). Infants with a gestational age of less than 29 weeks had significantly higher potassium concentrations (average 5.9 +/- 0.3 mEq/L, peak 7.8 +/- 0.4 mEq/L, p < 0.05) than other gestational age groups, and their plasma potassium levels were significantly higher at 24 and 48 h of age (p < 0.05). Forty-two infants (42/95, 44%) had peak plasma potassium concentrations greater than or equal to...
To investigate the beneficial effects of exogenous surfactant supplementation (ESS) and partial l... more To investigate the beneficial effects of exogenous surfactant supplementation (ESS) and partial liquid ventilation (PLV) in treating acute lung injury induced by wood smoke inhalation. A prospective, randomized, controlled, multigroup study. An animal research laboratory at a medical center. Newborn piglets (n = 29; 1.80 +/- 0.06 kg) of either sex. Animals were ventilated with a tidal volume of 15 mL/kg, a rate of 30 breaths/min, a positive end-expiratory pressure of 5 cm H(2)O, and an Fio(2) of 1.0. After the induction of acute lung injury by wood smoke inhalation, animals were randomly assigned to receive either conventional mechanical ventilation (CMV) or PLV with or without ESS pretreatment. Animals were grouped as CMV, ESS-CMV, PLV, and ESS-PLV. Arterial blood gases, cardiovascular hemodynamics, dynamic lung compliance, and total lung injury scores were measured. After smoke inhalation, all four groups displayed similar high arterial carboxyhemoglobin levels, low Pao(2) (<15...
Zhonghua yi xue za zhi = Chinese medical journal; Free China ed, 1999
Although assisted ventilation has reduced the mortality rate of premature infants, pulmonary dise... more Although assisted ventilation has reduced the mortality rate of premature infants, pulmonary disease is still the major cause of morbidity and mortality in very low birth weight infants. We designed this study to evaluate the efficacy and safety of high-frequency oscillatory ventilation (HFOV) in premature infants and to compare the outcome for early intervention with HFOV versus conventional ventilation (CV). From January, 1997, to June, 1998, we analyzed premature infants with respiratory failure who required mechanical ventilation and supplemental oxygen to support adequate gas exchange in our neonatal intensive care unit. Patients were eligible if their gestational age was less than 35 weeks or their birth weight was less than 1,751 g. A total of 35 neonates were enrolled in the study. Eighteen infants were treated with HFOV, and 17 infants were treated with CV. They were treated with early intervention of HFOV or CV, within 24 hours-of-age. Patients were excluded if a lethal co...
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