Chyi H. Lin

The role of pulmonary inflammation in the development of pulmonary hypertension in newborn with meconium aspiration syndrome (MAS)

1. There was no clear correlation between the tracheal aspirate cytokines and the elevation of pulmonary arterial pressure in newborn piglets with MAS. The use of dexamethasone significantly suppressed tracheal aspirate cytokines but did not significantly alter pulmonary arterial pressure. Dexamethasone significantly increased the cardiac stroke volume and blood pressure. 2. Early dexamethasone therapy (< 12 hrs) for one week in infants with MAS significantly improved pulmonary ventilation and facilitated weaning from mechanical ventilation. 3. The mechanisms for the improvement in cardiopulmonary status following early dexamethasone therapy in MAS remain unclear. An overall improvement in cardiac hemodynamics, along with a significant decrease in lung inflammation may be responsible for the improvement.

Fatao coxsackievirus B infection in early infancy characterized by fulminant hepatitis

OBJECTIVES to clarify the major features of fatal coxsackievirus B infection characterized by fulminant hepatitis in early infancy. METHODS clinical manifestations and laboratory investigations concerning five consecutive young infants with overwhelming coxsackievirus B fulminant hepatitis between 1994 and 1997 were retrospectively reviewed. Aetiological diagnosis was made by viral cultures and confirmed by a neutralization test with a type-specific antiserum. RESULTS all five had a deteriorating clinical course of severe hepatitis complicated by disseminated intravascular coagulopathy (DIC). Coxsackievirus B1 infection was established in four patients and coxsackievirus B3 in one. The pathological findings of the two cases illustrated extensive hepatocellular necrosis. Fulminant hepatitis can occur as a leading presentation of disseminated coxsackievirus B infections and dominant the clinical features in neonates and young infants. CONCLUSIONS the liver was the target organ of fatal coxsackievirus B infection in our patients. Hepatic involvement progressed rapidly to jaundice and coagulopathy, and was considered to be indicative of poor prognosis. Coxsackievirus B hepatitis may be serious in early infancy.

Prevention of chronic lung disease in preterm infants by early postnatal dexamethasone therapy

Recent studies suggest that early dexamethasone therapy may lessen the pulmonary inflammation in preterm infants with respiratory distress syndrome (RDS). To investigate whether early (<12 hr) postnatal dexamethasone therapy would reduce the incidence of chronic lung disease (CLD), a randomized, double‐blind, controlled trial was conducted in 40 infants (birth weights from 500 to 1,999 gm) who had severe RDS and required mechanical ventilation within 6 hr of birth. All infants received one dose of Survanta® before they were randomly assigned to control (saline placebo) or dexamethasone‐treated groups (0.5 mg/kg/d for 1 week, then tapered over 3 weeks). Sequential analysis was performed with the end point of assessment being the presence or absence of CLD on postnatal Day 28.

Risk for respiratory distress syndrome in preterm infants born to mothers complicated by placenta previa

This study examined the risk factors for respiratory distress syndrome (RDS) in preterm infants from pregnancies complicated by placenta previa. Forty preterm infants born to mothers with placenta previa between January 1989 and December 1995 in a medical center were enrolled. Each of these patients was matched in gestational age and gender with an infant born immediately after to a mother without placenta previa. Obstetric and neonatal outcome variables were collected. The mean+/-S.D. gestational age for both groups was 33.0+/-3.1 weeks. There was no difference in mean birthweight between the placenta previa and control groups (2129+/-598 vs. 2136+/-493 g). All the patients in the former and 11 (28%) in the latter were born by cesarean section. About a half of the mothers in both groups received antenatal steroids. Infants from placenta previa pregnancies had a higher incidence (21/40 vs. 10/40, P<0.01) and more severe RDS than controls. Stratified by the status of treatment with antenatal steroid, we found that gestational age was a significant risk factor for RDS in both treated and untreated groups (P<0.01), but placenta previa was an independent risk factor (odds ratio 32; CI 1-4182) by multiple exact logistic regression in antenatal steroid-treated group. We conclude that preterm infants born to mothers with placenta previa had a higher risk for RDS than controls. It played an independent role, in addition to gestational age, only in infants treated with antenatal steroid. We speculate that placenta previa was not directly contributing to RDS, but through other associated risk factors for RDS.

Effects of early postnatal dexamethasone therapy on calcium homeostasis and bone growth in preterm infants with respiratory distress syndrome

The effects of dexamethasone therapy on calcium homeostasis and bone growth were evaluated in 49 infants (24 placebo and 25 dexamethasone) who participated in a double‐blind trial of early dexamethasone therapy for the prevention of chronic lung disease. Dexamethasone (0.25 mg kg‐1 b.i.d. on d 1–7; 0.12 mg kg‐1 b.i.d. on d 8‐14; 0.05mg kg‐1 b.i.d. on d 15‐21; 0.02mg kg‐1 b.i.d. on d 22‐28) or saline placebo was given i.v. Serum calcium (Ca), phosphorus (P) and parathyroid hormone (PTH), and the corresponding urinary excretion of calcium (FECa) and phosphorus (FEP) were measured on d 2, 3, 7, 10, 14, 21 and 28 after starting the study. Radiographic evaluations of bone growth were also evaluated. Infants in the dexamethasone group had significantly higher PTH on d 2 (p < 0:01), 7 and 14 (p < 0:05) than infants in the placebo group. The dexamethasone‐treated infants also had significantly higher FEP on d 2,7 and 14 (p < 0:05) and lower FECa on d 7 and 14 (p < 0:05) than control infants. There was no significant difference between the groups in bone growth during the study. It was concluded that early dexamethasone therapy causes a transient elevation in PTH without apparent change in bone growth. The long‐term effect remains to be evaluated further.

Congenital bilateral agenesis of diaphragm : report of a case

Abstract Bilateral agenesis of the diaphragm is a rare, life-threatening malformation. Infants with this defect rarely survive to have surgical intervention. We report a 32-week premature female infant who was born to a 36-year-old mother via vaginal delivery. The pregnancy course was complicated by hypertension and polyhydramnios. Cytogenetic study showed a normal 46 XX female karyotype. She had cyanosis, respiratory distress and scaphoid abdomen at birth. A roentgenograph confirmed the diagnosis of diaphragmatic hernia. Surgery was performed at 21 h of age. Bilateral agenesis of diaphragm, herniation of abdominal organs and oesophagus and pulmonary hypoplasia were noted. Furthermore, stomach and spleen were adherent to the mediastinum and vertebrae. The patient developed hypotension and persistent hypoxaemia and expired at age of 26 h. Autopsy revealed bilateral agenesis of diaphragm, hypoplasia of lungs, and pancreas fibrosis with mild hypoplasia of islets of Langerhans. Conclusion Bilateral agenesis of diaphragm associated with pancreas fibrosis is a rare entity, and its clinical significance needs further investigation.

Interactive multimedia synchronisation in the distributed environment using the formal approach

Several synchronisation problems should be solved in order to develop interactive multimedia applications in the distributed environment. These problems include intra-medium synchronisation, inter-media synchronisation, and interactive synchronisation. The dynamic extended finite state machine (DEFSM) model, and the corresponding control schemes to handle four VCR-like user interactions, i.e. reverse, skip, freeze-restart, and scale, in distributed interactive multimedia presentations are proposed. The development of a distributed interactive multimedia synchronization specification and execution system is also described. The synchronisation specification and execution system is based on the proposed DEFSM model and the corresponding synchronisation control schemes. The DEFSM model and the control schemes can be incorporated as the synchronisation control kernel of distributed interactive multimedia systems. In this way, system developers do not need to deal with the details of multimedia synchronisation.

Oil recovery from a fluctuating water table

ABSTRACT Oil recovery in an unconfined aquifer was affected by precipitation and a fluctuating water table at the 322.5 K site in Taiwan. An immiscible displacement model was applied to quantify the effect of precipitation on oil recovery. This study also investigated a method to determine the field-average residual oil saturation by simulating the observed cumulative oil recovery with time.

PO-0694 Risk-adjusted Mortality Of Vlbw In Taiwan- A Population-based Study

Background and aims Preterm babies have higher mortality than terms. Risk-adjusted mortality (RAM) is useful for making comparisons among different NICUs. GA, BBW, sex, singleton birth and antenatal steroid have been used to estimate mortality (M) of preterm. The aims of this study are 1. To compare the performance of GA, BW, and Logistic Regression (LR) in predicting M of VLBW infants. 2. To compare the RAM in different areas and periods. Methods Cohort data from 2000 to 2011 were used. M is defined as death prior to discharge. Exclusion criteria included 1) Transferred after 24 h of age; 2) Death within 24 h of admission and 3) Lethal malformation. We developed a LR model to predict M [expected probability (Pro)]. ROC curves were used for assessing performance of predicting M. To compare the RAM, we calculated (O-E) Pro (observed Pro – expected Pro) values in each patient and used these values for comparisons. Results 9207 VLBWs were enrolled. The calculated probability of death by LR model was: P = 1/(1+e-Z), where e= natural logarithms and z = (-0.62•[prenatal steroid]) -(0.219•GA)- (0.004•BBW)- (0.327•[singleton]) + (0.286•[male]) + 8.438. Area under ROC were 0.858 for LR (95% CI: 0.847–0.869), 0.841 for BBW (95% CI: 0.829–0.853) and 0.827 for GA (95% CI: 0.815–0.839). Abstract PO-0694 Figure 1 There were significant differences of RAM in different locations and years (Figure 1). Conclusions The use of LR is better than GA and BW in predicting M of VLBWs. RAM can be used as a tool for quality improvement.