Shih-Hui Huang

Assessment of Growth From Foot Length in Taiwanese Neonates

BACKGROUND Previous studies have demonstrated a positive correlation between foot length (FL) and birth body weight (BBW), birth body length (BBL), and head circumference (HC). However, there is no data on birth FL in Taiwan. The aim of this study was to evaluate FL measurement in Taiwanese neonates as a method of estimating other anthropometric indices. METHODS In this retrospective study, we enrolled 256 babies born at our hospital and Kaohsiung Veterans General Hospital from 2003-2005. Medical records were reviewed for sex, BBW, BBL, HC, gestational age, and birth FL. Ill newborns, small-for-gestational-age babies, or those with poor birth footprints were excluded. FL at birth was measured from the center of the back of the heel to the tip of the big toe. Linear regression analysis was used to investigate the relation of FL to BBW and BBL. The intraclass correlation coefficient was used to assess inter-rater reliability. RESULTS A total of 256 babies were reviewed. There were 136 male and 120 female neonates. The gestational age was 38.5+/-1.3 (mean+/-standard deviation) weeks, ranging from 35-42 weeks. The BBW was 3137+/-396g. The BBL was 51.1+/-2.1 cm. The HC was 33.5+/-1.7 cm. The FL was 7.4+/-0.46 cm. The regression equation for BBW (y) on FL (x) was as follows: y=486.2+360.4x (p<0.001, r=0.421). The regression equation for BBL (y) on FL (x) was as follows: y=40.1+1.45x (p<0.001, r= 0.305). The regression equation for HC (y) on FL (x) was as follows: y=14.8+2.53x (p<0.001, r=0.423). FL showed excellent reliability, with an intraclass correlation coefficient of 0.965 (p<0.001). CONCLUSION Our study demonstrated a significant degree of correlation between FL and BBW, BBL and HC. However, it did not reliably estimate BBW, BBL, or HC-the three anthropometric indices were weakly correlated (r<0.5) with FL.

Clinical relevance of the risk factors for coronary artery lesions in Kawasaki disease

We aimed to investigate which factors are associated with coronary artery lesions (CALs) during the acute and chronic stages in Taiwanese children with Kawasaki disease (KD). A total of 216 children with KD were enrolled. Clinical and laboratory data were obtained for each child within 7 days of illness. The patients were classified into KD children without acute CALs (n = 135) and those with acute CALs (n = 81) according to echocardiography data at Week 2 after treatment. Then, KD children with acute CALs were further divided into those without chronic CALs (n = 55) and with chronic CALs (n = 26) according to annual echocardiography data. During acute stage of KD, neutrophil count (<54%) [odds ratio (OR) = 0.44, p = 0.041]; second dose of intravenous immunoglobulin (IVIG) treatment (OR = 5.01, p = 0.009); and platelet count (≤400,000) (OR = 0.42, p = 0.006) were correlated with the risk of acute CALs. During chronic stage of KD, age (12–60 months) (OR = 0.25, p = 0.042); first dose of IVIG treatment (OR = 0.12, p = 0.005); and band count (≥3%) (OR = 3.51, p = 0.032) were correlated with the risk of chronic CALs. Our results suggest that the effects of neutrophil count, doses of IVIG treatment, and platelet count on CALs in acute KD are important. Age, doses of IVIG treatment, and band count are related to the persistence of CALs in chronic stage of KD.

Interleukin-18 and coronary artery lesions in patients with Kawasaki disease

Background: Interleukin‐18 (IL‐18) plays an important role in mediating cytokine cascade leading to coronary artery lesions (CALs) in Kawasaki disease (KD). However, our research suggested that the literature regarding IL‐18 and KD is limited. Consequently, this study aimed to evaluate the correlation between IL‐18 and CALs in patients with KD. Methods: In this prospective study of 14 children with KD (seven without and seven with CALs in the acute phase), we obtained patient measurements of a series of serum IL‐18 levels in the acute, subacute, and convalescent phases. Serum IL‐18 levels were measured with a Bio‐Plex cytokine assay. Control samples were obtained from 18 febrile children with viral infection. Results: Compared with febrile controls, patients with acute‐stage CALs [postintravenous immunoglobulin (post‐IVIG) period] had a significantly higher IL‐18 level (88.4 ± 20.7 vs 56.0 ± 35.0 pg/mL, p = 0.006). However, those without acute‐stage CALs (post‐IVIG period) lacked similarly elevated IL‐18 level readings (62.0 ± 40.6 vs 56.0 ± 35.0 pg/mL, p = 0.762). The IL‐18 level of patients with acute‐stage CALs did not decrease significantly until the convalescent phase (97.4 ± 55.8 vs 38.7 ± 22.6 pg/mL, p = 0.018), but for those without CALs, it decreased significantly in the subacute phase (60.2 ± 37.4 vs 23.6 ± 13.8 pg/mL, p = 0.018). In the subacute stage, there was a significant difference of IL‐18 level between patients with and without acute‐stage CALs (p = 0.048). Conclusion: Our data show that IL‐18 levels were elevated in the acute phase of KD and might be related to the formation of CALs.

A noninvasive sizing method to choose fitted Amplatzer septal occluder by transthoracic echocardiography in patients with secundum atrial septal defects

To simplify the conventional procedure, we developed a technique for transcatheter closure of atrial septal defects (ASDs) under transthoracic echocardiographic (TTE) sizing without balloon sizing. At present, device closure of interatrial communication has become a well-established technique to adequately treat severe left-to-right shunt associated with ASDs. During the traditional procedure, fluoroscopy with the waist of a compliant balloon is used to determine the appropriate size of the closure device and defect sizing. Choice of adequate closure device using transthoracic echocardiography (TTE) has been hitherto unreported. Between December 2002 and August 2004, 40 patients (15 males, 25 females, mean age 11.7 ± 7.8 years) with secundum ASDs underwent transcatheter closure at our institution. In group 1, 30 patients had the procedure by balloon sizing and TTE sizing. In 10 patients (group 2), TTE sizing was used as the sole tool for selecting device size and the device size was chosen to be based on the Amplatzer septal occluder (ASO) size and TTE size ratio in group 1. The procedure was performed under continuous transesophageal echocardiographic monitoring with general anesthesia. A correlation was found between TTE and stretched balloon sizing diameter SBD (y = 1.2645x − 1.4465; R2 = 0.9861), and between TTE size and ASO size (y = 1.3412x − 1.2864; R2 = 0.9929) in group 1. In group 2, a statistical correlation between TTE and ASO (y = 1.3419x − 0.1172; R2 = 0.9934) was also found. Good linear regression between TTE size and ASO chosen size was noted in group 1 and group 2 (R2 = 0.99). In group 2, successful device implantation was accomplished in all patients whose device size was chosen to be based on the ASO and TTE ratio in group 1. Transthoracic echocardiographic sizing is a safe and ideal method to measure interatrial defect and choose the occluding device, respectively. With our experience, the sizing based on TTE is generally easier than measurement from the balloon sizing.

Oscillometric Ambulatory Blood Pressure Values in Healthy Children

To assess the feasibility of ambulatory blood pressure monitoring (ABPM) and establish reference values for ABPM in normal children and adolescents, 24-hour ABPM was performed in 120 normotensive, nonobese subjects, aged from 6 to 14 years (58 males, age 10.1 +/- 2.8 years; 62 females, age 9.7 +/- 3.1 years; mean +/- SD). The subjects were classified into three age groups: group A (6-8 years, n=40, 23 males, 17 females), group B (9-11 years, n=40, 21 males, 19 females), and group C (11-14 years, n=40, 18 males, 22 females). ABPM was carried out using an oscillometric device with appropriate cuff size. The monitor was programmed to measure BP every 15 min during the day (6 a.m. to 10 p.m.) and every 30 min during the night (10 p.m. to 6 a.m.). Successful rates (recording time=24 hours and > 40 recordings) were 83%, 88%, and 93% in groups A, B, and C, respectively. The recordings of 15 subjects (7 in group A, 5 in group B, 3 in group C) were not analyzed because of incomplete readings. The 24-hour mean systolic/diastolic blood pressure (SBP/DBP) for males and females were 106 +/- 7/65 +/- 5 and 105 +/- 6/64 +/- 5, 110 +/- 6/66 +/- 5 and 109 +/- 5/65 +/- 4, and 115 +/- 7/67 +/- 6 and 113 +/- 6/66 +/- 4 mmHg in groups A, B, and C, respectively. The daytime mean SBP/DBPfor males and females were 110 +/- 7/73 +/- 4 and 109 +/- 8/72 +/- 5, 117 +/- 5/75 +/- 4 and 115 +/- 8/74 +/- 6, and 122 +/- 6/76 +/- 4 and 120 +/- 7/75 +/- 6 mmHg in groups A, B, and C, respectively. The nighttime mean SBP/DBP for the corresponding sex and age groups were 97 +/- 8/58 +/- 5 and 95 +/- 7/57 +/- 6, 101 +/- 8/59 +/- 6 and 99 +/- 7/57 +/- 5, and 105 +/- 7/58 +/- 5 and 103 +/- 6/56 +/- 4 mmHg, respectively. The first fall in BP appeared after lunch (approximately 1:00 pm) and the second fall appeared during the night hours (11:00 pm to 6:00 am). There was a significant correlation between 24-hour mean ambulatory SBP and age (r=0.48, P < 0.001). In contrast, ambulatory DBP and age were not significantly correlated. A nocturnal fall of SBP/DBP was observed in all age- and sex-subgroups. This study showed that ABPM was reproducible and accurate. The normal ambulatory blood pressure (ABP) values in the pediatric age group have not been reported in Taiwan. The distribution of ABP observed in this study could serve as a preliminary reference. A multicenter study may be done to provide normal ranges of ABP in Taiwan for clinical purposes. Further studies are necessary to elucidate the role of ABPM in children.

Serum HDL Level at Acute Stage of Kawasaki Disease

Kawasaki disease is a disease of acute vascular inflammation of unknown etiology and HDL is a known risk factor of vascular damage. So far, there is no specific serum marker for KD. The previous study has shown a remarkable change of serum HDL in the patients with KD. To find whether changes in serum HDL level is a specific serum marker for early diagnosis of KD, we measured the concentration of HDL, LDL, TC, TG and CRP immediately after admission and one week later in three groups of patients (56 patients with KD, 38 patients with clinical viral infection, and 42 patients with bacterial infection). There was a significant decrease of HDL and increase of TG immediately after admission in three groups of patients. HDL and TG did not return to normal one week later. HDL level is more adversely affected in severe diseases than in mild diseases. Our results indicated that low HDL level is noted in various acute infection and is not a specific serum marker in the early stage of Kawasaki disease. It is interesting that low HDL is a universal phenomenon in this series. Further research is needed to explain the mechanism of lipid alterations and its consequences.

Effects of Flow Rate on Delivery of Bubble Continuous Positive Airway Pressure in an In Vitro Model

BACKGROUND There has been concern over the effect of vigorous bubbling on the delivery pressure during the operation of the bubble nasal continuous positive airway pressure (CPAP) system. We investigated the relationship between intra-tubing pressure changes and flow rates in a closed bubble CPAP system in vitro. METHODS Using an experimental (in vitro) model, the distal connecting tube of the CPAP system was immersed under the water seal to a depth of 5 cm. Sixteen different flow rates, ranging from 2 L/min to 20 L/min, were tested. The procedure was repeated 10 times at each flow rate, and the intra-tubing pressure was recorded. RESULTS The intra-tubing pressure within the model increased as the air flow rates were adjusted from 2 L/min to 20 L/min. The relationship was represented by the following equation, pressure (cmH(2)O) = 5.37 + 0.15 x flow rate (L/min) (R(2) = 0.826, p < 0.001). CONCLUSION These results demonstrated that the intra-tubing pressure in a bubble CPAP system was highly correlated with flow rate in vitro.

Abnormal biventricular performance in asymptomatic adolescents late after repaired Tetralogy of Fallot: Combined two-dimensional speckle tracking and three-dimensional echocardiography study

Background: The aim of this prospective study was to assess biventricular performance in asymptomatic adolescents with repaired tetralogy of Fallot (TOF) using 2D speckle tracking and real time 3D echocardiography simultaneously. Methods: We studied 31 patients with repaired TOF (M/F: 22/9, age: 16.1 ± 6.1 yrs) who had history of cardiac surgery with mean follow‐up duration of 12.8 years, and 32 age‐ and sex‐matched normal individuals (M/F: 23/9, age: 16.6 ± 5.1 yrs). All subjects underwent speckle tracking and 3D echocardiography, electrocardiogram, treadmill, and blood sampling for measurement of brain natriuretic peptide (BNP). Results: Compared to the control group, the TOF group had higher BNP level (31.8 ± 21.4 vs 14.1 ± 12.4 pg/ml, p < 0.01), lower peak oxygen consumption (8.4 ± 1.7 vs 9.9 ± 1.6 ml/kg/min, p < 0.05), and longer QRS duration (126 ± 30 vs 82 ± 9 ms, p < 0.01). Patients with repaired TOF had significantly impaired right ventricle (RV) global and all six regional longitudinal strain and strain rate than normal controls. Left ventricle (LV) global and mainly apical regional longitudinal strain and strain rate were reduced in patients with repaired TOF. There was a significant correlation of global longitudinal strain (r = 0.456, p = 0.01) and global time to peak longitudinal strain (r = 0.484, p < 0.01) between LV and RV in patients with repaired TOF. In terms of 3D echo cardiographic volume data, patients with repaired TOF had lower LV stroke volume index (p < 0.05), but higher RV end diastolic volume index (p < 0.01), RV end systolic volume index (p < 0.01), RV stroke volume index (p < 0.01), and pulmonary regurgitation fraction (p < 0.01) than normal controls. Conclusion: Our results suggest asymptomatic adolescents with repaired TOF had abnormal biventricular myocardial performance, as demonstrated by combined 2D speckle‐tracking and 3D echocardiography. The implications of these findings for management of adolescents late after repaired TOF remain to be determined.

Secondary erythrocytosis in distal renal tubular acidosis: report of one case.

The wide spectrum of distal renal tubular acidosis (RTA) has been reported. Children with distal RTA can present with failure to thrive, gastrointestinal symptoms, nephrocalcinosis, and renal failure, etc. So far, secondary erythrocytosis in pediatric patients with distal RTA has not been reported. Here we report a case of distal RTA with failure to thrive and nephrocalcinosis accompanied by secondary erythrocytosis in a 3-year-old boy. He has been followed up for 2 years and is under treatment with NaHCO3 and potassium citrate. The treatment contributes to the improvement of metabolic acidosis and his growth. There is normal renal function and constant erythrocytosis during the follow-up period. Further studies are needed to clarify the relationship between erythrocytosis and distal RTA.