Mei-Yung Chung

Colistin inhalation monotherapy for ventilator-associated pneumonia of Acinetobacter baumannii in prematurity

Ventilator‐associated pneumonia (VAP) caused by Acinetobacter baumannii is increasing. It has a high mortality rate but experience in using inhaled colistin as monotherapy for VAP in children, especially pre‐term infants, is limited. This study presents experiences using aerosolized colistin as monotherapy for VAP due to A. baumannii infection in pre‐term infants.

Clinical Manifestations of Symptomatic Intracranial Hemorrhage in Term Neonates: 18 Years of Experience in a Medical Center

BACKGROUND Intracranial hemorrhage (ICH) is an uncommon but important cause of morbidity and mortality in term neonates. We conducted a retrospective analysis of the clinical characteristics and developmental outcomes of symptomatic ICH in term neonates. METHODS A retrospective chart review was conducted of all term neonates (less than 1 month old) diagnosed with ICH and admitted to the neonatal intensive care unit of Kaohsiung Chang Gung Hospital from December 1991 to December 2008. Demographic characteristics, mode of delivery, laboratory data, clinical presentation, and developmental status were recorded. RESULTS Data for 24 term neonates (17 boys and 7 girls) with a diagnosis of ICH were collected for analysis. The clinical manifestations of ICH included anemia (13/24, 54%), seizure (11/24, 46%), cyanosis (7/24, 29%), tachypnea (5/24, 21%), fever (1/24, 4%), hypothermia (1/24, 4%), and poor feeding (1/24, 4%). Age at symptom onset ranged from 2 hours to 11 days following birth. The most common type of ICH was subdural hemorrhage. All ICHs resolved, except in one infant, who died from hypoxicischemic encephalopathy at 25 days. Ten children with symptomatic ICH were reported to have normal development, while the remainder (13/23, 57%) showed developmental delays or disabilities. CONCLUSION Unexplained anemia, seizure, and cyanosis were the major presenting signs in infants with symptomatic ICH. A diagnosis of ICH should be considered in term neonates who present with one or more of these signs. Although the mortality in term infants with symptomatic ICH was low, more than half.

Applications of flexible bronchoscopy in infants with congenital vocal cord paralysis: a 12-year experience.

BACKGROUND Congenital vocal cord paralysis (VCP) is a common cause of congenital stridor. Before the widespread application of flexible bronchoscopy (FB) by pediatricians, congenital stridor in infants was usually attributed to laryngomalacia. Prompt recognition and careful follow-up is crucial for the management of congenital VCP. METHODS We performed a retrospective chart review of newborn infants with congenital VCP diagnosed by FB over a 12-year period. RESULTS During the 12-year period, FB was performed on a total of 356 infants. Fifteen (4%) infants were diagnosed with congenital VCP. There were eight males and seven females and the mean age at diagnosis was 76.6 days. Stridor with respiratory distress was the most prominent presenting symptom. The majority (93%, 14/15) demonstrated bilateral VCP, while one patient (7%) had unilateral VCP. Seven of the 15 (46%) patients had idiopathic VCP, while eight (54%) had VCP associated with neuromuscular disorders. Tracheotomy was necessary in four patients (26%). None of them underwent further surgical interventions. Spontaneous recovery occurred in 10 patients (71%), and of these, 90% (9/10) were treated without tracheotomy. CONCLUSION In order to allow prompt diagnosis of congenital VCP, FB should be performed in every newborn infant with stridor. Patients with congenital VCP should undergo additional imaging studies to detect any associated neurological abnormalities and intrathoracic comorbidities. The majority of patients can be managed conservatively and monitored carefully using serial FB. Corrective surgery should be reserved for those with a lack of resolution at prolonged follow-up, and those with significant comorbidities.

Severe bronchopulmonary dysplasia is associated with higher fluid intake in very low-birth-weight infants: a retrospective study.

OBJECTIVE This study aims to investigate the association between fluid intake in the first 4 days of life and the subsequent severity of bronchopulmonary dysplasia (BPD) in very low-birth-weight infants (VLBWI). STUDY DESIGN A retrospective chart review of 75 infants with a gestational age of less than 32 weeks and a birth weight of < 1,500 g was performed. Demographic, clinical data, associated maternal risk factors, and amount of fluid received in the first 4 days of life were analyzed. RESULTS Severe BPD was associated with a lower gestational age (27.04 ± 2.073 wks vs. 28.70 ± 1.706 wks, p=0.001), lower birth weight (981.44 ± 244.54 vs. 1,199.63 ± 165.39 g, p < 0.001), use of surfactant (91.7 vs. 63%, p=0.002), patent ductus arteriousus (PDA) (70.8 vs. 37%, p=0.004), pulmonary hemorrhage (14.6 vs. 0%, p=0.045), and more fluids received from the 2nd to 4th days of life (346.44 ± 42.38 mL/kg vs. 323.91 ± 27.62 mL/kg, p=0.007). A cut off point of 345 mL/kg of fluids from the 2nd to 4th days of life was selected using receiver operating characteristic curve analysis, and remained a significant risk factor even after multiple logistic regression analysis. CONCLUSION Our findings demonstrate that VLBWI who received higher fluid intake from the 2nd to 4th days of life are at an increased risk of developing severe BPD.

Neonatal Drug Withdrawal Syndrome: Experience in a Medical Center in Southern Taiwan

Background: The purpose of this study was to describe the clinical manifestations of infants born to mothers who used morphine and/or amphetamines during pregnancy and the treatment given to these infants. Patients and Methods: From November 2003 to November 2006 we collected data on infants of mothers who had used morphine and/or amphetamines during pregnancy and were admitted to our neonatal intensive care unit (NICU). Clinical manifestations and management were analyzed. Results: Data were collected on 13 babies (8 girls and 5 boys) exposed to morphine and/or amphetamine. Three infants had a congenital anomaly, three were premature, and two were of unknown gestational age. Five infants were small for gestational age. Eleven infants were born to divorced mothers. Twelve mothers were unemployed. Two babies with congenital anomalies expired in our hospital. Most of the infants suffered from respiratory distress, feeding intolerance, and excessive irritability. The majority of infants were adopted and lost to follow-up. Conclusions: Morphine and/or amphetamine abuse by women during pregnancy had adverse and immediate effects on infants after delivery. In our study, 5 of the 13 infants (38%) received morphine treatment. There was no consistent choice of a pharmacologic agent for treatment these infants, even when there was a high urine level of an illicit drug. Additional assessment of infants of drug abusing mothers is important to determine the increased risks associated with other diseases such as sexually transmitted diseases, hepatitis C, and HIV infection. The long-term developmental outcome of the children in this study is unknown because most of the infants were lost to follow-up.

Conservative Treatment with High-frequency Oscillatory Ventilation and Corticosteroids in Infantile Lobar Emphysema

Infantile lobar emphysema (ILE) is a disease with a wide spectrum of etiology. The typical clinical pictures may vary from no symptoms, to mild or severe respiratory distress. Surgical lobectomy is the treatment of choice in most studies. Recent evidence demonstrates that its clinical course may be reversible or progressive. Not all cases deserve surgical lobectomy. We report our experience of treating five infants by combining high-frequency oscillatory ventilation (HFOV) and corticosteroids. The lobar emphysema of three infants resulting from prolonged mechanical ventilation resorbed, but the other two infants with cardiovascular anomalies expired. We observe that conservative management combining HFOV and corticosteroids deserves a place in treating ILE.

Clinical Manifestations and Outcomes of Symptomatic Infants Born to Diabetic Mothers

Background: The purpose of this study is to present the clinical manifestations and outcomes of infants born to mothers with insulin-dependent diabetes mellitus (IDDM) or gestational diabetes mellitus (GDM). Methods: From 1996 to 2003, we collected infants born to IDDM or GDM mothers who required admission to our neonatal intensive care unit. Their clinical manifestations and outcomes were described and analyzed. Results: The prevalence of infants born to diabetic mothers (IDM) was 1.3% of all live births, and the frequency of symptomatic IDMs was 0.4% (84 cases) of all live births. The male to female ratio of these symptomatic IDMs was about 2/1. The mean birth weight was 3506 ± 844 g compared to 3134 ± 530 g in the control group. Fifty-six percent of these IDMs were large for gestational age, 40.5% were appropriate for gestational age, and only 3.5% were small for gestational age. The frequency of macrosomia was 28.6% compared to 3.2% in the control group. Hypoglycemia (glucose level ＜ 40 mg/dl) was documented in 46.4% (39/84) of the infants. Other neonatal morbidities were hyper-bilirubinemia (52 cases), hyponatremia (2), hyperkalemia (15), hypocalcemia (17), polycythemia (1), gastrointestinal (GI) problems (14), respiratory distress (48), cardiac abnormalities (33), and brachial plexus injury (2). There was one neonatal death. Three infants with profound and persistent hypoglycemia had seizures during hospitalization. They all had mixed developmental delays and abnormal EEGs on follow-up. Conclusions: Infants born to diabetic mothers are at risk of macrosomia, hypoglycemia and other neonatal morbidities. Profound and persistent neonatal hypoglycemia in IDMs is associated with long-term neurological dysfunction.