Mei-Mei Ho

Intrauterine Growth of Twins in Taiwan

During the period between January 1, 1980 and December 31, 1991, there was a total of 21,348 live born neonates delivered in our hospital. Among them, there were 368 pairs of twins and 18 sets of triplets. The incidences of twin and triplet pregnancy were 1.76% (one pair in every 57.8 live deliveries) and 0.086% (one set in every 1,164 live deliveries), respectively. The mode of gestational age for all twins in this study was 36.6 +/- 3.2 weeks (36.6 +/- 3.6 weeks for vaginal delivery and 36.7 +/- 2.8 weeks for cesarean section, respectively). Among twins delivered by cesarean section, the birth weight of the first born twin was significantly heavier than the second born twin; however, this difference was not observed for those twins delivered vaginally. Also, the birth weight between male and female was not significantly different. However, for those twin pairs of different sexes, the birth weight for the male twin was significantly heavier than the female co-twin. In those cases the mean birth weight increased steadily as the gestational age increased and plateaued at about the 40th week. Compared to the intrauterine growth curve of the Chinese singleton, the difference started from the 33rd gestational week and reached a significant level at about the 37th gestational week. This may indicate the incipient of the placental insufficiency for multiple pregnancies. The intrauterine growth curve for twin pregnancies may serve as guide for studying the mortality and morbidity of twins in the future.

Human Herpesvirus-6 Associated Hemophagocytic Syndrome in β-Tha1assemia: Report of One Case

An 8-month-old male infant with severe anemia and thrombocytopenia was brought to our hospital due to fever and pallor. The physical examination on admission showed pale conjunctivae, skin rash, lymphadenopathy and hepatosplenomegaly. Subsequent laboratory studies showed pancytopenia, impaired liver function, elevated lactate dehydrogenase level but without evidence of disseminated intravascular coagulation. Bone marrow aspiration demonstrated increased macrophages and prominent hemophagocytosis. The serological studies revealed a recent infection of human herpesvirus-6 which was confirmed by blood mononuclear cell culture and polymerase chain reaction. This infant was also found to have beta-thalassemia which was confirmed by hemoglobin electrophoresis performed before first transfusion. After treatment with intravenous immunoglobulin and other supportive therapies, the bone marrow abnormalities has completely recovered after 5 days, and the hemogram improved. This report demonstrates the human herpesvirus-6 as the etiology of hemophagocytic syndrome.

Trismus-Pseudocamptodctyly Syndrome: Report of One Case

Trismus-pseudocamptodactyly syndrome is a rare neuromuscular disorder that manifests as a combination of hand, foot, and mouth anomalies. Limited range of motion for hands, feet, and mouth are typical presentations. A male term newborn baby was noted to have trismus, ulnar deviation of both wrist joints, limited stretch of digits during hand dorsiflexion but with full digital extension during volarflexion, and talipes equinovarus of the right foot. These anomalies were not seen in his parents. Hecht syndrome, or trismus-pseudocamptodactyly syndrome, was diagnosed with a negative result of electromyographic study.

Transient Leukemoid Reaction in an Extremely Premature Neonate

A female newborn was delivered prematurely at gestational age of 26 weeks with birth weight of 1,000 grams. Her initial white blood cell count was 68,900/mm3, which increased to 207,000/mm3 on the fifth day of life with a remarkable shift-to-left pattern. The most immature myeloid series in the peripheral blood smear was promyelocyte; and the promyelocyte, myelocyte and meta-myelocyte accounted for 38% of the peripheral white blood cells. Neither hepatosplenomegaly nor skin rash was noted, but the platelet count dropped to 86,000/mm3 transiently on Day 8. Cytogenetic study for the bone marrow aspiration revealed normal results. The leukemoid reaction recovered within three weeks without specific treatment. Antenatal usage of steroid to promote lung maturation was considered to be one possible cause of the transient leukemoid reaction.

Neonatal Asphyxia in Term and Preterm Neonates – Analysis of Prognostic Factors

Neonatal asphyxia may make an acute systemic organ injury with a wide variety of clinical and biochemical changes in either term or preterm infants. We conducted a retrospective study to identify the correlation between the prognosis and these parameters from June, 1, 1989 and May, 1, 1991. Thirty term and 45 preterm babies were enrolled in this study. Multiple regression analysis revealed that oliguria, bradyarrhythmia, hepatomegaly, female infants, no prenatal complication, and hyperkalemia were associated with earlybmortality for asphyxial term neonates. For preterm ones, asphyxia-induced bradyarrhythmia, low pH value, elevated serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), pulmonary hemorrhage, low gestational age, and low bicarbonate level correlated well with the mortality. Beside of these, univariate analysis discovered that seizure, persistent hypotonia or hypertonia, multiple organ damage, low pH value and less base excess were associated with chronic handicapping disability in term asphyxial infants. Seizure, elevated level of serum AST and ATL, and multiple organ injury with a mean of 4 organs involved were shown to be associated significantly with late morbidity in preterm infants. Our study served as an alternative method to help us to assess the asphyxial infants and predict their outcome.