Chao-Huei Chen

The Effect of Breast-and Bottle-Feeding on Oxygen Saturation and Body Temperature in Preterm Infants

From July 1997 to June 1998, 25 preterm infants (birth weight < 1800 g) were included in a prospective study to compare the clinical effects of breast-and bottle-feeding. Oxygen saturation, heart rate, respiratory rate, and body temperature were recorded every minute for 20 minutes during feeding periods. Eighty pairs of breast-and bottle-feeding sessions were observed at the chronological age of 9.3 ± 4.3 (range=2.1-25.3) weeks. Oxygen saturation and body temperature of the preterm infants were significantly higher when they were directly breastfed. There were 2 episodes of apnea (breath pause more than 20 seconds) and 20 episodes of oxygen desaturation (PaO 2< 90%) during bottle-feeding and none during breastfeeding. We conclude that breastfeeding is a more physiological feeding method for the preterm infant and bottle-feeding may be more stressful.

Oral glucose lactate stimulation test in mitochondrial diseases

We selected 23 patients with neurologic diseases, including 15 boys and 8 girls from 1 month to 10 years of age, who were divided into mitochondrial and nonmitochondrial disease groups. All patients were required to fast and rest for at least 4-10 hours before the test. Glucose was administered orally using a 50% glucose:water solution at a dose of 1.75 mg/kg. Blood samples then were drawn from a retained heparinized venous line at 0, 30, 60, 120, and 180 min and tested for lactate and glucose levels. Of the mitochondrial disease group, 10 of 11 patients had an upward sloping curve of lactate metabolism; the one who had a flat line response was a patient who suffered from a free-fatty-acid metabolic defect presenting with a recurrent Reye-like syndrome. There was a relatively flat line response in the nonmitochondrial disease group except in a patient with alternating hemiplegia whose symptoms responded well to flunarizine therapy. A significant increase in blood lactate content at 60 min after glucose loading occurred in the mitochondrial disease group, in contrast to that of the nonmitochondrial group. Sensitivity and specificity of a 5 mg/dl increase in blood lactate concentration at 60 min was 72.7% vs. 91.7% Moreover, all 4 patients whose blood lactate increased by 13 mg/dl at 60 min were in the mitochondrial disease group.

An outbreak of enterovirus 71 in a nursery

Abstract In this article we report a nosocomial outbreak of enterovirus 71 (EV71) in a newborn nursery and describe the clinical presentations of infected infants. Community outbreaks of EV71 are quite common in epidemic areas, but a nosocomial outbreak of EV71 is a rare occurrence. A total of 7 out of 19 infants (37%) had symptoms. All infants had poor activity, 6 (86%) had fever, 4 (57%) had drowsiness, 3 (43%) had diarrhoea, and 2 (29%) had oral ulcers. Four infants (57%) suffered from encephalitis. There were no deaths. EV71 was isolated from 3 (43%) of the young infants, while all were positive when tested for EV71 using a reverse transcription polymerase chain reaction. A sequence analysis of the EV71 partial gene revealed a 98.6–100% nucleotide similarity. Control measures included staff hand washing, disinfecting all materials exposed to potentially infected biological fluid, increasing staff hygiene precautions in the kitchen, and using a different basin for bathing each baby. We conclude that it is difficult to diagnose EV71 infection in young infants by clinical presentation alone and, similar to other enteroviruses, EV71 can spread efficiently amongst young infants in a nursery unit.

PHACE Syndrome: Report of One Case

PHACE syndrome indicates a neurocutaneous syndrome including Posterior fossa malformation, large facial Hemangioma, Arterial malformation, Coarctation of the aorta and/or other Cardiac anomalies, and Eye abnormalities. We here report a female infant who presented a giant facial hemangioma. Dandy-Walker malformations with hydrocephalus was found subsequently. We treated the hemangioma with prednisolone, methylprednisolone, interferon-alpha, and local injections of corticosteroid. Encephalomalacia was found later and it was attributed to carotid artery anomalies. Brain image studies, thorough ophthalmologic and cardiac examinations are strongly recommended in infants with large, plaquelike facial hemangiomas. Carotid angiography should also be considered if carotid artery anomalies are suspected.

Infants of Twin Pregnancies with One Twin Demise in the Uterus: A Retrospective Study

Many papers have reported that twin pregnancies with one twin demise in the uterus can cause complications in the surviving twin. We retrospectively reviewed charts from 1988 to 1997 at our hospital and found 17 of 302 twin deliveries with one twin intrauterine fetal death. The incidence of intrauterine death of a single twin was 5.7%. Six of the surviving twin (35.3%) had renal function impairment. One died due to acute renal failure. The other five patients recovered normal serum creatinine level. Five patients (29.4%) had abnormal brain imaging findings. One had multicystic encephalomalacia and microcephaly. Three of the five patients were complicated with cerebral palsy. After dividing the patients into complicated (n = 8, 47.1%) and non-complicated (n = 9, 52.9%) groups, we found that the patients with complication had lower Apgar score at 5 minutes and those with monochorionic diamniotic placenta had higher incidences of complication (62.5% vs 12.5%). We conclude that twin pregnancies with one fetal demise in the uterus do result in a higher incidence of complication in the surviving twin, especially if placentation type is monochorionic diamniotic. In managing the surviving twin of the monozygous twin pregnancies with one fetal demise in the uterus, we must be careful to monitor these patients. If complication was suspected, we should arrange the brain and kidney ultrasonography and manage these patients appropriately to decrease the complication risk.

Vascular Ring Due to Double Aortic Arch with Atretic Left Arch and Left Ligamentum Arteriosum: Report of one Case

A 1-day-old female infant presented with vomiting immediately after feeding and shortness of breath after birth. Esophagography revealed external compression of the esophagus. Echocardiography showed a right aortic arch with mirror image branching of brachiocephalic vessels without intracardiac anomalies. Left ventriculography confirmed the echocardiography findings and revealed a tenting of the proximal part of the left subclavian artery and a blind pouch of Kommerell diverticulum at the descending aorta. The patient underwent surgery, which revealed a complete vascular ring compressing the trachea and the esophagus. The ring was formed by a right aortic arch, atretic left arch and left ligamentum arteriosum. Following surgical division of the ligamentum arteriosum and the atretic left arch, the symptoms subsequently improved.

Individualized developmental care in the newborn intensive care unit.

With recent advances on newborn intensive care, the survival rate of very low birth weight preterm infants has been improved. The consequently new morbidities such as learning disabilities, behavioral problems, lower mean IQ and motor clumsiness have become more frequent. Neonatal individualized developmental care seeks to read the behavior of premature infants, and pace our procedures and caregiving according to individual infants cues. Studies have shown that with implementation of developmental care, the time spent on ventilator and hospitalization was decreased, and infants started oral feeding earlier. The short and long-term neurobehavioral outcomes were improved. Developmental care focuses not only on changing the environment to provide a calming and soothing environment for the infants and family, but also provides a chance for all the staff members to read the behavior of the infants, think and reflect before doing something to the infants.

Management of Acute Decompensation of Neonatal Maple Syrup Urine Disease with Continuous Arteriovenous Haemofiltration: Report of One Case

A 22-day-old female infant was referred to our hospital due to unusual urine odor suspecting inborn error of metabolism. Physical examination revealed a stuporous and hypotonic infant with poor reflexes. Intravenous thiamine and high glucose along with appropriate protein were given under the suspicion of maple syrup urine disease (MSUD), which was confirmed by blood and cerebrospinal fluid amino acid assays, and urinary organic acid assay. Progressive neurological deterioration was observed despite the non-invasive treatment. So, we performed pump assisted continuous arteriovenous haemofiltration (CAVHF). Dramatic improvement in neurological function was observed hours after initiation of CAVHF, along with decrease in the level of isoleucine, leucine and valine. In our experience, CAVHF is a well-tolerated procedure for managing the acute phase of neonatal MSUD. Further study on indications, duration of treatment, and preventing complications is needed.

Noise Distribution in Closed and Open Spaces in the Neonatal Intensive Care Unit

Introduction: Premature babies with immature organ systems are very fragile. Noise in a neonatal intensive care unit (NICU) has been known to cause many adverse effects such as hearing impairment, sleep disturbance, somatic effects and hindrance of emotional development. The aim of this study was to survey noise levels and time distribution of noise in two different spaces in our NICU Materials and Methods: We performed a noise distribution survey in our NICU at the Veterans General Hospital Taichung using two electronic sound-level meters (RION NL 21, Japan) with a central site measurement. There were two rectangular adjacent spaces (6×5 meters each) with six beds in each space. One space (room A) was a closed space with a controllable door and the other space (room B) was next to an open area without a wall between it and the nurse station. All measurements were made using the A filter and slow response time (1-second averaging) and expressed in decibels (dBA). The sound levels were presented as hourly L(subscript eq), L(subscript max) and L10. Data were analyzed using SPSS 10.0 software for Windows. Results: The hourly L(subscript eq( was 54.59 dBA in room A and 52.29 dBA in room B. The difference in the hourly L(subscript eq) was 2.3 dBA (p＜0.05). The hourly L(subscript max) was 73.54 dBA in room A and 71.56 dBA in room B. The difference in the hourly L(subscript max was 1.98 dBA (p＜0.05). The hourly L10 was 56.67 dBA in room A and 54.81 dBA in room B. The difference in the hourly L10 was 1.86 dBA (p＜0.05). In our study, hourly L(subscript eq), L(subscript max) and L10 all exceeded the recommended levels. Conclusion: The closed space (room A) had higher noise levels than the open space (room B). The controllable doors cement walls, glass windows and incubators inside a closed space might contribute to this higher noise level. Continuous sound level monitoring of the intensive care unit is important to provide a safe environment for premature infants.

Nosocomial infection in a neonatal intensive care unit--from a viewpoint of national health insurance.

In order to survey both the epidemiology of nosocomial infection in our neonatal intensive care unit (NICU) and the changing face of nosocomial infection after the introduction of National Health Insurance (NHI) in Taiwan, we retrospectively reviewed the nosocomial infections which occurred in our NICU from March 1, 1991, to February 28, 1999. We also compared the nosocomial infections from the viewpoint of NHI. The mean rate of nosocomial infections in our NICU during these 8 years was 13.6%, and it had significantly increased after the NHI plan was implemented (from 7.9% to 19.0%). The most common type of nosocomial infection was blood stream infection (53.8%, 120 of 223 infections). Coagulase-negative Staphylococci and fungi were the two most common pathogens of nosocomial blood stream infection in our NICU, accounting for 28.1% and 24.2% of the infections, respectively. The survival rate of very low birth weight (VLBW) infants increased from 76.3% to 78.4% after the implementation of NHI. However, the nosocomial infection rate of the VLBW infants had markedly increased from 22.6% to 41.9%. The total number of hospitalization days of the patients with nosocomial infection was significantly greater than that of those without nosocomial infections (p < 0.05), and the patients with the lower birth weights had longer hospital stays. The risk factors for nosocomial infection including invasive procedures, multiple and empirical antibiotics, and extremely low birth weight premature infants, remained the same, but the prevalence of nosocomial infection in the neonatal intensive care unit has changed markedly since the NHI plan began. Further investigation to determine strategies for preventing nosocomial infection in very low birth weight infants is warranted.