Hsing-I Tseng

B-Type Natriuretic Peptide Predicts Responses to Indomethacin in Premature Neonates with Patent Ductus Arteriosus

OBJECTIVES To determine whether B-type natriuretic peptide (BNP) predicts indomethacin responsiveness in premature neonates with patent ductus arteriosus (PDA). STUDY DESIGN Premature neonates receiving indomethacin for an echocardiograhically large (diameter>1.5 mm) and clinically significant PDA were prospectively studied. All neonates underwent paired echocardiography and BNP measurements at baseline and 24 hours after each dose of indomethacin. After treatment, neonates who responded (with closed or insignificant PDA) and neonates who did not respond (with persistent significant PDA requiring surgical ligation) were compared. RESULTS Thirty-one premature neonates (mean gestational age, 30 weeks) underwent 119 paired echocardiography and BNP determinations. Mean BNP levels (1286+/-986 pg/mL) associated with significant PDA (n=96) were higher than those associated with closed or insignificant PDA (n=23; 118+/-124 pg/mL; P<.001). Twenty-three neonates responded and 8 neonates did not respond to indomethacin. Mean baseline BNP levels were higher in neonates who were non-responders (2234+/-991 pg/mL) than neonates who were responders (983+/-814 pg/mL; P=.001). A baseline BNP level>1805 pg/mL had a sensitivity rate of 88% and a specificity rate of 87% for predicting indomethacin non-responsiveness (P=.003). CONCLUSIONS High baseline BNP levels predict poor responses to indomethacin and the need for surgery in premature neonates with PDA.

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.

Assisted exercise improves bone strength in very low birthweight infants by bone quantitative ultrasound

Aim:  To evaluate whether assisted exercise could prevent the development of osteopenia of prematurity, we performed assisted exercise in the study group of very low birthweight (VLBW) premature infants.

The Natural Flavonoid Apigenin Suppresses Th1- and Th2-Related Chemokine Production by Human Monocyte THP-1 Cells Through Mitogen-Activated Protein Kinase Pathways

Dietary flavonoids have various biological functions, and there is increasing evidence that reduced prevalence and severity of allergic reactions are associated with the intake of flavonoids. Among natural flavonoids, apigenin is a potent anti-inflammatory agent. However, the mechanisms of apigenins effect remain uncertain. Monocyte-derived chemokine (MDC) plays a pivotal role in recruiting T-helper (Th) 2 cells in the allergic inflammation process. In the late phase of allergic inflammation, the Th1 chemokine interferon-inducible protein 10 (IP-10) has also been found in elevated levels in the bronchial alveolar fluid of asthmatic children. We used human THP-1 monocyte cells, pretreated with or without apigenin, prior to lipopolysaccharide stimulation. By means of enzyme-linked immunosorbent assay, we found that apigenin inhibited production of both MDC and IP-10 by THP-1 cells and that the suppressive effect of apigenin was not reversed by the estrogen receptor antagonist ICI182780. The p65 phosphorylation of nuclear factor kappaB remained unaffected, but the phosphorylation of p38, c-Jun N-terminal kinase, and extracellular signal-regulated kinase mitogen-activated protein kinase pathways were all blocked. We found that inhibition of c-raf phosphorylation might be the target of apigenins anti-inflammation property.

Bone status and associated factors measured by quantitative ultrasound in preterm and full-term newborn infants☆

BACKGROUND A clear understanding of the factors associated with bone status in newborn infants is essential for devising strategies for preventing osteoporotic fracture in future generations. OBJECTIVE The aims of this study were to perform bone speed of sound (SOS) to assess the status of the tibia in preterm and full-term newborns, and to evaluate factors associated with bone status at birth. STUDY DESIGNS Bone SOS was measured by quantitative ultrasonography on the left tibia in full-term and preterm newborn infants immediately after birth. A birth chart and maternal history were recorded. Univariate and multivariate analyses were performed to identify factors affecting bone SOS at birth. SUBJECTS The study analyzed 667 infants, including 370 males and 297 females, during study period. RESULTS Univariate analysis revealed that gender, gestational age (GA) and birth anthropometrics significantly affected tibial bone SOS at birth whereas maternal factors did not. Multivariate multiple regression analysis revealed that gender (male-to-female coefficient of 45.71 and 32.52 in premature and full-term infants, respectively), GA (coefficient of 32.55 and 31.27 in premature and full-term infants, respectively, for every 1-week increase), and birth weight (coefficient of -0.11 and -0.103 in premature and full-term infants, respectively, for every 1-gram increase) were important factors affecting tibial bone SOS in both preterm and full-term newborn infants at birth. CONCLUSIONS Male gender and advanced GA have a positive effect on increasing tibial bone SOS at birth, while birth weight had a negative effect on increasing tibial bone SOS. Tibial bone SOS is higher in small-for-gestational-age infants than in those of appropriate-for-gestational-age infants.

Neonatal intensive care unit-specific screening criteria for retinopathy of prematurity

This study investigated the incidence of retinopathy of prematurity (ROP) and its risk factors in a tertiary referral hospital in Taiwan to evaluate the applicability of the ROP screening guidelines published by the American Academy of Pediatrics, American Academy of Ophthalmology, and American Association for Pediatric Ophthalmology and Strabismus in 2006 (2006 guidelines). A pediatric ophthalmologist applied the 2006 guidelines to screen for ROP and to treat with laser photocoagulation in each case. We retrieved all records of premature infants referred for ROP screening at the hospital during 2004 to 2008. Univariate logistic regression analysis was applied firstly to identify factors correlating with stage 3 ROP or with laser treatment, and then those significant (p < 0.05) risk factors were analyzed by multivariate logistic regression. In the 138 male and 118 female premature infants in this study, mean gestation age was 30.8 ± 2.8 weeks, and mean birth weight was 1464.7 ± 434.2 g. The percentage of infants with ROP in at least one eye was 38.7%. Thirty two (12.5%) had ROP stage 3 or higher in at least one eye. Multivariate logistic regression analysis showed that the best predictors of type 1 pre‐threshold ROP (requiring laser treatment) were young gestational age, low birth weight and male gender. As medical care of extremely premature infants improves, timely identification and treatment of conditions such as ROP are essential. Although the incidence of ROP in this institute was comparable to that in developing countries and higher than that in developed countries, the 2006 guidelines originally developed for a United States population were still applicable. However, the 2006 guidelines should be modified for a Taiwan population by considering gender.

Effects of Budesonide and Fluticasone Propionate in Pediatric Asthma Patients

BACKGROUND Cytokines and chemokines play important roles in asthma. However, little information exists on the effects of inhaled corticosteroids on cytokine and chemokine plasma levels in childhood asthma. We compared the pharmaceutical effects of two inhaled corticosteroids used in pediatric patients with mild-to-moderate asthma, budesonide and fluticasone propionate. METHODS Pediatric patients aged 5-18 years old were enrolled in this randomized, open-label, observer-blinded study and received 3 months of treatment with either inhaled budesonide (200 microg/puff) or fluticasone propionate (250 microg/puff), at two puffs per day. Peak expiratory flow (PEF), exhaled nitric oxide, Asthma Control Test (ACT), plasma Levels of tumor necrosis factor-alpha, thymus and activation-regulated chemokine, and interferon-inducible protein 10 were measured before treatment and monthly for 3 months after treatment. RESULTS There were six patients in the budesonide group, and eight in the fluticasone group. After 3 months, both groups showed improved PEF. In the first month, PEF improved more in the budesonide group than in the fluticasone group, though the difference was not significant. After treatment, ACT scores in both groups were well controlled, except for one patient in the fluticasone group. The fluticasone group had a more significant reduction in exhaled nitric oxide than the budesonide group in the first month. CONCLUSION Improvements in lung function were more rapid in the budesonide group than the fluticasone group. However, patients in the fluticasone group had better anti-inflammatory responses than those in the budesonide group. We conclude that each inhaled corticosteroids have its own clinical and laboratory effects.

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.