Chu-Chong Lu

Neonatal readmission within 2 weeks after birth.

To examine the causes of neonatal readmission within two weeks of discharge and identify the factors associated with neonatal readmission, newborns readmitted to Kaohsiung Municipal Hsiao-Kang (KMHK) Hospital within two weeks of discharge from our nursery between October 2001 and November 2003 were studied retrospectively. Of the 1099 deliveries during the study period, there were 63 newborns readmitted to KMHK Hospital within 14 days of discharge, with a rate of 5.7%. The control group consisted of a systematic sampling of newborns delivered over the same period that were not readmitted (n=74). The diagnoses of readmission included jaundice (73.0%), fever and suspected sepsis (19.0%), enteritis (4.8%), and others (3.2%). Factors associated with readmission included length of stay in nursery less than 72 hours, exclusive breast feeding, more body weight loss, and higher bilirubin level at discharge from nursery. After multiple logistic regression analysis, length of stay in nursery less than 72 hours, exclusive breast feeding and higher bilirubin level at discharge from nursery were the significant risk factors for neonatal readmission.

Parenteral nutrition-associated cholestasis in premature babies: risk factors and predictors.

BACKGROUND One of the most common complications in infants under parenteral nutrition treatment is parenteral nutrition-associated cholestasis (PNAC). The etiology of PNAC is thought to be multifactorial. The aims of this study were to evaluate the risk factors for PNAC in our neonatal intensive care unit and determine useful predictors. METHODS This study enrolled premature infants (gestational age <36 weeks) who were admitted to our neonatal intensive care unit and treated with parenteral nutrition infusion for at least 2 weeks between January 2004 and January 2007. Multiple possible risk factors were analyzed by a retrospective review study design. PNAC was defined as direct bilirubin greater than 1.5 mg/dL during parenteral nutrition. RESULTS A total of 62 premature infants with prolonged course of parenteral nutrition were eligible for this study; 11 (17.74%) of the infants developed PNAC. There were significant differences in terms of gestational age, birth body weight, duration of parenteral nutrition, septic episodes, and average energy intake during the 2nd and 3rd weeks of life between infants with cholestasis and those without cholestasis. Of these risk factors, the duration of parenteral nutrition was most significant after multivariate logistic regression analysis. CONCLUSION Young gestational age, low birth body weight, more sepsis episodes, and long duration of parenteral nutrition were significant risk factors for PNAC in our study. Low energy intake during the 2nd and 3rd weeks of life is a predictor for PNAC.

Eosinophilia in Hospitalized Newborn Infants

To evaluate the incidence of and conditions associated with eosinophilia (absolute eosinophil count (AEC)≥ 1000×10^6/L) in hospitalized newborn infants, the medical records of patients presenting with eosinophilia during hospitalization were retrospectively studied. There were 270 cases enrolled and 69 patients (34 boys and 35 girls) had eosinophilia during hospitalization, for an incidence rate of 25.6%. Conditions associated with eosinophilia included infectious disease (39.1%), establishment of an anabolic state (24.6%), congenital heart disease (10.1%), and others (26.2%). Peak eosinophil counts in 62 of the 69 patients ranged from 1,000 to 2,000×10^6/L. A higher peak AEC was noted in patients with establishment of an anabolic state. In this group, a highly significant positive correlation (r=0.593, p＜0.05) was found between the time at which peak eosinophilia occurred and the time at which birth weight was regained. The AEC returned to normal (＜700×10^6/L) from the peak count within 9.11±9.92 (mean±standard deviation, SD) days. A significant negative correlation (r=-0.42, p＜0.05) was found between birth weight and the time at which peak AEC returned to normal. None of the infants received bone marrow aspiration, and no specific treatment was given. In conclusion, eosinophilia is a frequent finding in hospitalized newborn infants. Eosinophilia is sometimes clinically unimportant with regard to morbidity and requires no specific treatment.

Comparisons of the Clinical Manifestation and Prognosis of Air Leak Syndrome between Transferred Neonates and Inborn Infants

Objective: The aim of this study was to compare the clinical characteristics, management and outcomes between transferred and inborn neonates with air leak syndrome. Methods: The records of a total of 62 neonates with air leak syndrome admitted to our neonatal intensive care unit from January 2001 through July 2006 were retrospectively analyzed. There were 44 transferred patients (Group A) and 18 inborn cases (Group B) included in this study. Results: The gestational ages (36.35 ± 3.8 vs. 32.78 ± 5.5 weeks; P＜0.05), birth weights (2708.2 ± 761.4 vs. 1904.4 ± 1032.2 g; P＜0.01) and 1(superscript st) min Apgar scores (6.57 ± 2.3 vs. 5.06 ± 2.4; P＜0.05) were significantly higher in Group A, while the need of resuscitation at birth (27% vs. 67%; P＜0.01), presence of respiratory distress syndrome (31.8% vs. 61.1%; P＜0.05), need of surfactant replacement therapy (20% vs. 50%; P＜0.05) and death associated with pneumothorax (14% vs. 39%; P＜0.05) turned out significantly higher in Group B. As for the respiratory treatments before diagnosis, the definitive management, and the length of hospital stay, no significant differences were found between the two groups. Stratified comparison was made with the dividing line set at the gestational age of 34 weeks. In these two subpopulations, there were no differences detected in the clinical characteristics and outcomes between the transferred and inborn neonates. Conclusions: The transferred and inborn infants with air leak syndrome tended to have different clinical features and prognoses. Inborn cases were most likely to be premature with severe respiratory distress syndrome. The need for resuscitation at birth and death associated with pneumothorax were greater in the inborn cases. However, after adjusting for gestational age, there were no significant differences in the clinical features and prognoses between these two groups. This indicated that there were similar outcomes between the transferred and inborn neonates with air leak syndrome in our hospital.

Ambiguous Genitalia during Neonatal Period: A 15-Year Experience at a Medical Center

This study is a 15-year retrospective review of the newborns with ambiguous genitalia at the Department of Pediatrics, Chung-Ho Memorial Hospital, Kaohsiung Medical University. From 1991 through 2005, 30 newborns aged less than 1 month old with the initial diagnosis of ambiguous genitalia were enrolled in this study. Among these patients, 13 patients (43%, n=13/30) had congenital adrenal hyperplasia (CAH), 15 patients (50%, n=15/30) had penoscrotal (14 penoscrotal type and one perineal type) hypospadia and six of them also had associated anomalies in other organs. The remaining two patients (7%, n=2/30) had other anomalies of the genital organ (scrotum bifida and urogenital sinus). There were two patients with abnormal chromosome study results in the hypospadia group. Surgical correction by clitoroplasty or vaginoplasty was performed for the female patients with CAH. Orchiopexy, repair of urethrocutaneous fistula and hypospadia were performed for the cases of hypospadia. In our study, the etiologies of ambiguous genitalia were CAH, severe hypospadia, and other anomalies of the genital organs and the proportions were 43%, 50%, and 7%, respectively. The percentage of chromosomal anomaly was found to be approximately 10%.

Enteral Indomethacin Therapy for Patent Ductus Arteriosus in Premature Infants: An Experience in One Medical Center in Southern Taiwan

Introduction: Patent ductus arteriosus (PDA) is a common disease in preterm infants. Indomethacin has been used for closure of symptomatic PDA (sPDA). We report on enterally administered indomethacin treatment for preterm infants with sPDA to determine the closure rate, the potential risk factors associated with failed closure of sPDA and the prevalence of associated complications of oral indomethacin treatment. Materials and Methods: This retrospective study included 58 infants with gestational ages of less than 37 weeks and birth weights of less than 2,400 g. The diagnosis of sPDA was confirmed by clinical symptoms and echocardiography. All the infants had received at least one course of enteral indomethacin treatment. The contents of an indomethacin capsule were mixed with water and made into a suspension. These infants received 0.2 mg/kg/dose every 12 hours 3 times enterally via a nasogastric tube. Ductal closure was confirmed by follow-up echocardiography between 12 and 36 hours after completion of a course of treatment. Side effects to indomethacin were monitored during treatment. Results: The total sPDA closure rate was 77.8% (n=45). The significant predictor of failed PDA closure after one course of indomethacin treatment was larger PDA size (p＜0.05). Forty (62.5%) infants developed adverse side effects after indomethacin therapy. The most common side effect in our study was transient renal insufficiency (43.8%). Conclusion: For sPDA in prematurity, enteral indomethacin is still an acceptable alternative if the intravenous form is not available.