Han-Yang Hung

High cytomegalovirus load and prolonged virus excretion in breast milk increase risk for viral acquisition by very low birth weight infants.

Background: Breast milk is the main source of postnatal human cytomegalovirus (HCMV) infection. The aim of this study was to assess the relationship between HCMV load in breast milk and viral transmission to very low birth weight (VLBW) infants. Methods: Breast-fed VLBW infants who were born to HCMV-seropositive mothers and who were managed in a neonatal intensive care unit were enrolled in the study. Blood from mothers and infants was tested for HCMV antibodies after birth. Breast milk was collected for viral culture and HCMV load measurement. Urine from the babies was obtained for HCMV-DNA detection. Symptoms of HCMV infection were recorded and evaluated by neonatologists. Results: Of the 23 evaluated mothers during a 1-year period, 19 were HCMV seropositive; 17 of the women had detectable HCMV-DNA in their breast milk whey. Of the 23 infants born to the 19 seropositive mothers, 8 infants of 8 mothers had HCMV-DNA detected in the urine, indicating that they were infected, even though the breast milk was always frozen prior to feeding. Three infected infants had symptoms. At 4 weeks after delivery, the median viral load in breast milk from mothers of the 8 infected infants was significantly higher than that from mothers of the 15 noninfected infants (P = 0.04). HCMV was detectable in breast milk for a significantly longer period in mothers of infected infants (7.5 vs. 2.6 weeks P = 0.03). Conclusions: High HCMV load and prolonged virus excretion in breast milk are maternal risk factors for viral transmission to VLBW infants.

Outcome of preterm infants with postnatal cytomegalovirus infection via breast milk: A two-year prospective follow-up study

AbstractApproximately 15% of preterm infants may develop postnatal cytomegalovirus (CMV) infection from seropositive mothers via breast milk and are at risk for neurological sequelae in childhood. The aims of this study were to assess the effects and outcomes on growth, neurodevelopmental status, and hearing in very low birth weight (VLBW) premature infants with postnatal CMV infection via breast milk at the corrected age of 12 and 24 months.The prospective follow-up study population comprised all living preterm children (nu200a=u200a55) with a birth weight ⩽1500u200ag and gestational age of ⩽35 weeks, who had been participated in our “postnatal CMV infection via breast milk” studies in 2000 and 2009, respectively. The cohort of children was assessed at 12 and 24 months. Clinical outcomes were documented during hospitalization and after discharge. Long-term outcomes included anthropometry, audiologic tests, gross motor quotient, Infant International Battery, and neurodevelopmental outcomes; all were assessed at postcorrected age in 12 and 24 months during follow-up visits.Of the 55 infants enrolled in the study (4 noninfected infants were excluded because their parents did not join this follow-up program later), 14 infants postnatally acquired CMV infection through breast-feeding (infected group) and were compared with 41 infants without CMV infection (control group). No significant differences were observed between the groups with regard to baseline characteristics, clinical outcomes, anthropometry, or psychomotor and mental development on the Bayley scale of infant development. None of the infants had CMV-related death or permanent sensorineural hearing loss.Transmission of CMV from seropositive mother via breast milk to preterm infants does not appear at this time to have major adverse effects on clinical outcomes, growth, neurodevelopmental status, and hearing function at 12 and 24 months corrected age.

Prader-Willi syndrome in Taiwan

Background: Prader–Willi syndrome (PWS) is a congenital disorder caused by absent expression of paternal genes in 15q11‐13 affecting multiple systems. The information concerning the clinical features of this genetic disorder is incomplete in Taiwan.

CONGENITAL RICKETS : A PATIENT REPORT

We present a premature newborn with congenital rickets, born to a mother with untreated chronic renal insufficiency. X-ray films showed blurred metaphyseal ends and decreased bone density in the femurs and ribs. With treatment including calcium, phosphate, and vitamin D, her rickets healed and she grew normally.

Small Versus Large Volume Dilute Surfactant Lavage for Meconium Aspiration Syndrome

BACKGROUNDnSurfactant lavage has been used to treat neonatal meconium aspiration syndrome (MAS).nnnOBJECTIVEnTo assess the effects of lavage with a small volume of dilute surfactant in neonates with MAS, and compare the results with those of historical controls treated with larger volumes.nnnMETHODSnFrom August 2002 to June 2005, we treated 11 newborns with MAS using 20 ml of dilute surfactant at a phospholipid concentration of 10 mg/ml (SVL group). We compared the results with those of 9 infants previously treated with large-volume lavage (LVL group), using 40 ml of dilute surfactant, 5 mg/ml.nnnRESULTSnBoth groups were similar at baseline except for a higher mean birth weight in the LVL group (3.29+/-0.36 vs 2.92+/-0.4 kg, P = 0.04). The lavage procedure was longer in the LVL than the SVL group (48.89 +/-7.41 vs. 30.91+/-5.83 mins, P <0.001). Measures of oxygenation, including mean PaO2, oxygenation index, and arterial/alveolar 02 ratio, showed no significant difference between the two groups. Adverse events in the LVL group included transient hypoxemia in 3 infants and white- out on chest x-ray in 5 cases. None of the patients in the SVL group had these findings. The peak mean airway pressure in.the LVL group was higher than that in the SVL group (16.0+/-2. 65 vs 13.3+/-3.01 cmH2O, P = 0.046).nnnCONCLUSIONSnSVL has the same benefits in neonatal MAS as LVL. However, SVL appears to be associated with fewer adverse events.

Feeding with Premature or Infant Formula in Premature Infants after Discharge: Comparison of Growth and Nutrition Status

We designed this prospective randomized controlled study to evaluate the effects of premature and standard term formula on growth, nutrient intake and biochemical response in premature infants from hospital discharge to 6 months of corrected age. Premature infants with a gestational age of < or =35 weeks and a birth weight < or =1850 gm were assigned to receive premature infant formula (n = 19) or a standard term infant formula (n = 15). No differences were found between the two groups in weight, length, or head circumference at baseline or on follow-up. Infants fed premature formula had higher blood urea nitrogen and phosphorus at 3 months of corrected age. Those on the premature formula also had higher energy intake at 1 month of corrected age. We suggest that premature infants, especially very low birth weight infants, fed preterm infant formula after discharge until 6 months of corrected age tolerate the formula well and may benefit over those standard term formula.

Congenital varicella syndrome as an unusual cause of congenital malformation: report of one case.

Intrauterine infections with varicella-zoster virus following maternal varicella in early pregnancy and resulting in congenital malformations are rare. Herein we report a child with congenital varicella syndrome characterized by low birth weight, cicatricial scarring, hypoplasia of both lower extremities with joint contracture, congenital hip dislocation, corneal opacity, atresia of the sigmoid colon and a rarely associated cloaca anomaly. The varicella IgG remained positive after she was seven months old. Her mother developed chickenpox at the 14th week of gestation. The purpose of this article is to raise pediatricians index of suspicion for congenital varicella syndrome when an infant is born with multiple congenital malformations with an apparent history of maternal varicella infection.

Meconium Obstruction in Very Low Birth Weight Premature Infants

Objective: The aim of this study was to identify the clinical signs and symptoms, clinical diagnosis and management of meconium obstruction in preterm and very low birth weight (VLBW) infants. We also wanted to identify the risk factors associated with meconium obstruction in prematurity. Methods: The medical records of premature infants with a diagnosis of meconium obstruction during a 5-year period were admitted to the neonatal intensive care unit (NICU) at the Mackay Memorial Hospital, Taipei, Taiwan were investigated. Infants with the diagnosis of gastroschisis, intestinal atresia, Hirschsprung’s disease, microcolon, malrotation, motility disorder, volvulus, sepsis, hypothyroidism and congenital anomalies were excluded. Results: Twelve infants were included in our study. Maternal hypertension was seen in five cases and four received MgSO4. The average time of first stool passage was 2.75 days. Abdominal distension developed between the ages of 3 to 14 days with a mean of 6.58 days of life. Forty-two percent of the symptomatic infants experienced resolution of obstruction using warm isotonic sodium chloride solution or diluted Gastrograffin enema alone. Four infants complicated with intestinal perforation. Conclusion: The risk factors include maternal history of hypertension with or without magnesium sulfate therapy. These premature infants with meconium obstruction are not clinically sick. Isotonic sodium chloride solution enemas are safe and effective intervention. Delayed diagnosis was associated with perforation and postponement in attaining adequate enteral feeding.

Thyroid Function in the Sick Very Low-Birth-Weight Infants

This study was undertaken to determine postnatal changes in thyroid function in very low-birth-weight (VLBW) infants. A total of one-hundred VLBW infants participated. Serial examination of serum levels of thyroxine (T4), free T4, triiodothyronine (T3), and thyroid-stimulating hormone (TSH) was performed in the neonatal period. A total of eighty-nine infants survived to discharge, while eleven died during hospitalization. Transient hypothyroxinemia was found in forty-one (46.1 percent) of the survivors. One of the surviving infants had primary hypothyroidism. His data was excluded from the analysis. In the other eighty-eight surviving infants, TSH levels were within normal limits throughout the six-week study period. T4 and free T4 values decreased after the first day of life, reaching a nadir at one week of age, followed by progressive increases. The mean cord blood T3 level was very low; the serum T3 value increased progressively in the postnatal period. We found a correlation between low T4 and free T4 values and mortality and neonatal illness. Hypothyroxinemia was associated with critical illness. In conclusion, the postnatal changes in thyroid function in VLBW infants were characteristic, with transient hypothyroxinemia being common in these infants. Further investigation of the relationship between thyroid function, death, neonatal illness, and developmental outcome is warranted.

Risk Factors for Chronic Lung Disease in Very Low Birth Weight Infants: A Five-Year Multicenter Study in Taiwan

Objective: To identify risk factors for chronic lung disease (CLD) in very low birth weight infants in Taiwan. Methods: This multicenter study enrolled 1763 infants with birth weights less than 1501 grams admitted to 8 participating neonatal intensive care units in Taiwan from 1996 through 2000. The outcome of interest was chronic lung disease (CLD), defined as dependence on supplemental oxygen at 36 weeks postmenstrual age (PMA). The association of CLD with demographic, prenatal and illness attributes, and postnatal interventions was analyzed by the chi-square and Students t tests. Multivariate logistic regression was used to further analyze risk factors, and odds ratios (OR) and 95% confidence intervals (CI) were estimated. Results: Among the 1763 survivors to 36 weeks postmenstrual age, 538 (31%) had CLD. CLD was associated with lower birth weight, lower gestational age, patent ductus arteriosus (FDA), and sepsis. When adjusted for birth weight, small for gestational age (SGA) associated with a significantly reduced risk of CLD, but when adjusted for gestational age, SGA was associated with a slightly increased, but statistically non-significant, OR for CLD. Conclusion: Low birth weight, low gestational age, FDA and sepsis were associated with an increased risk of CLD.