Teh-Ming Wang

Treatment With Propranolol for Infantile Hemangioma in 13 Taiwanese Newborns and Young Infants

BACKGROUND Hemangioma in infants has a benign self-limited course, but the 10% of cases with complications need further treatment. Successful treatment with propranolol in western countries has been reported over the past few years. We evaluated the efficacy of propranolol for treating infantile hemangioma in Taiwanese newborns and young infants. METHODS Patients below 1 year of age treated with propanolol between November 2009 and March 2011 were enrolled. Demographic data, clinical features, imaging findings, treatment regimens of propranolol, and outcome were investigated. RESULTS Thirteen patients were treated with propranolol at a dose of 2-3 mg/kg/day. Seven (53.8%) patients had solitary hemangioma and six had multiple ones. The indications for treatment were risk of local event in nine patients, functional risk in four, local complication in one, and life-threatening complication in one. The median age for starting propranolol was 4 months (range: 1-11 months). Responses to propranolol, such as decolorization, regression in tumor size, or improvement of hemangioma-associated complications were observed in all patients within 1-2 weeks after treatment. Propranolol-associated adverse effects occurred in two patients. One infant had occasional tachypnea, and the other had occasional pale-looking appearance. The symptoms resolved after dosage tapering. CONCLUSION Propranolol may be a promising therapeutic modality for infantile hemangioma. Therapeutic strategies are needed to evaluate the optimal treatment protocol and long-term adverse effects.

Acute immune thrombocytopenic purpura in infants: associated factors, clinical features, treatment and long-term outcome.

Abstract:  The natural course of acute immune thrombocytopenic purpura (ITP) in infants is poorly described in the literature. A retrospective study of 17 consecutive patients <1 yr of age admitted and treated for acute ITP between 1996 and 2005 was conducted. We investigated their demographics, vaccination history, clinical features, laboratory examinations, response to treatment and long‐term outcome. There were 11 male and six female infants. Their ages ranged from 24 d to 12 months with a median of 3 months. All infants presented with petechiae and/or ecchymoses. Fourteen cases had platelet counts below 20 × 109/L at the time of admission. They all had good response to a single course of treatment (14/17) or multiple courses of treatment (3/17). None had progressed into chronic ITP. Seven infants had a causal relationship with immunization, five associated with hepatitis B, one diphtheria–pertussis–tetanus, one diphtheria–tetanus–acellular pertussis‐inactivated poliovirus vaccine‐conjugated Haemophilus influenza vaccines. These seven infants responded to treatment within 3–9 d after therapy with intravenous immunoglobulin, high‐dose methylprednisolone or oral steroids. Re‐boosters with vaccines revealed no recurrence of the disease in all of these seven patients. The study suggests that further immunization is not contraindicated in infants experiencing acute ITP associated with vaccines.

Changes in Preterm Breast Milk Nutrient Content in the First Month

BACKGROUND The primary aim of the study was to investigate the changes in composition of breast milk from mothers with preterm infants (gestation age < 35 weeks) during the first 4-6 weeks of lactation. METHODS Breast milk from 17 mothers who had delivered preterm infants was collected longitudinally for 4-6 weeks. Breast milk from 15 mothers of full-term infants was also collected at the 1(st) week and 4(th) week. Fat, protein, lactose, energy, minerals (calcium and phosphate), and immune components [secretory immunoglobulin A (IgA), leptin, lysozyme, and lactoferrin] content were measured weekly in each participant. A mid-infrared human milk analyzer was used to measure the protein, fat, and lactose contents. Calcium and phosphate components were checked via spectrophotometry. The concentrations of major immune components (secretory IgA, lactoferrin, lysozyme, and leptin) were quantified using enzyme-linked immunosorbent assay kits. RESULTS Eighty samples from 17 preterm mothers were collected. The mean gestational age was 29.88 ± 2.39 weeks. There were significant changes in nutrient components during these periods, with increases in lactose (p < 0.001), lipid (p = 0.001), calorie (p = 0.012), and phosphate (p = 0.022) concentration and decreases in protein (p < 0.001) and secretory IgA (p < 0.001) concentration. There were no differences in calcium (p = 0.919), lactoferrin (p = 0.841), leptin (p = 0.092), and lysozyme (p = 0.561) levels. Furthermore, there were no significant differences in most components of breast milk between full-term and preterm mothers. CONCLUSION The longitudinal study revealed significant changes in macronutrient contents and secretory IgA concentration in preterm milk over the 4-6 week period, which is compatible with the results of previous studies. The quantification of phosphate in preterm breast milk was lower than the normal range, suggesting that close monitoring of body bone mass may be indicated. More studies are warranted to evaluate the clinical significance of alterations of major milk components during the postnatal stage.

Vascular Ring Due to Double Aortic Arch with Atretic Left Arch and Left Ligamentum Arteriosum: Report of one Case

A 1-day-old female infant presented with vomiting immediately after feeding and shortness of breath after birth. Esophagography revealed external compression of the esophagus. Echocardiography showed a right aortic arch with mirror image branching of brachiocephalic vessels without intracardiac anomalies. Left ventriculography confirmed the echocardiography findings and revealed a tenting of the proximal part of the left subclavian artery and a blind pouch of Kommerell diverticulum at the descending aorta. The patient underwent surgery, which revealed a complete vascular ring compressing the trachea and the esophagus. The ring was formed by a right aortic arch, atretic left arch and left ligamentum arteriosum. Following surgical division of the ligamentum arteriosum and the atretic left arch, the symptoms subsequently improved.

Congenital chylothorax associated with isolated congenital hypoplastic superior caval vein: a case report.

UNLABELLED Congenital absence, or hypoplasia, of the superior vena cava (SVC) with situs solitus is quite uncommon. Most cases have been found incidentally and concomitant with left persistent SVC or other cardiac disorders. Congenital chylothorax may be associated with cardiac anomalies, various syndromes, thoracic ductal or venous thrombosis, birth trauma or local compression of the thoracic duct, but it is rarely caused directly by congenital SVC anomalies. CONCLUSION We report a rare case of congenital chylothorax associated with isolated congenital hypoplastic SVC and underdeveloped collateral circulation.

Nosocomial infection in a neonatal intensive care unit--from a viewpoint of national health insurance.

In order to survey both the epidemiology of nosocomial infection in our neonatal intensive care unit (NICU) and the changing face of nosocomial infection after the introduction of National Health Insurance (NHI) in Taiwan, we retrospectively reviewed the nosocomial infections which occurred in our NICU from March 1, 1991, to February 28, 1999. We also compared the nosocomial infections from the viewpoint of NHI. The mean rate of nosocomial infections in our NICU during these 8 years was 13.6%, and it had significantly increased after the NHI plan was implemented (from 7.9% to 19.0%). The most common type of nosocomial infection was blood stream infection (53.8%, 120 of 223 infections). Coagulase-negative Staphylococci and fungi were the two most common pathogens of nosocomial blood stream infection in our NICU, accounting for 28.1% and 24.2% of the infections, respectively. The survival rate of very low birth weight (VLBW) infants increased from 76.3% to 78.4% after the implementation of NHI. However, the nosocomial infection rate of the VLBW infants had markedly increased from 22.6% to 41.9%. The total number of hospitalization days of the patients with nosocomial infection was significantly greater than that of those without nosocomial infections (p < 0.05), and the patients with the lower birth weights had longer hospital stays. The risk factors for nosocomial infection including invasive procedures, multiple and empirical antibiotics, and extremely low birth weight premature infants, remained the same, but the prevalence of nosocomial infection in the neonatal intensive care unit has changed markedly since the NHI plan began. Further investigation to determine strategies for preventing nosocomial infection in very low birth weight infants is warranted.

Reduced nosocomial infection rate in a neonatal intensive care unit during a 4-year surveillance period

Background Hospital‐acquired infections are a leading cause of morbidity and mortality in neonatal intensive care units (NICU). The aim of the study was to investigate the change of nosocomial infection rate in a NICU during a 4‐year surveillance period. Methods We investigated the changes in nosocomial infection rates, infection sites, and microorganism species in a NICU before and after the unit was moved to a new location, extending from November 2008 to October 2012.The new facility was opened on November 1, 2010 and the old NICU was closed on the same day. In the meantime, three catheter‐based bundles were implemented in the new NICU and all intensive care units in our hospital due to the new policy. Data collection was performed by independent, experienced infection control nurses. Results A total of 512 neonates were admitted to the NICU and enrolled in this study. There were 242 infants who were admitted to the old NICU, and 270 infants in the new facility. During the study period, the rate of infection episodes decreased from 19.0% to 11.1% (P = 0.01). Additionally, the average hospital‐acquired infection rate decreased from 6.26 cases per 1000 patient‐days to 4.09 cases per 1000 patient‐days (P = 0.03). The most common infection site was blood stream infection, which decreased from 8.3% to 3.7% (P = 0.03). The total catheter‐related infection rates of the blood stream, lower respiratory tract, and urinary tract decreased from 13.6% to 5.9% (P = 0.003). Klebsiella pneumonia, E. coli, Methicillin‐resistant Staphylococcus aureus (MRSA), and Coagulase‐negative Staphylococci (CoNS) were the most frequently found pathogens in the old NICU, whereas MRSA, CoNS, E. faecalis, and A. baumannii were the most frequently found pathogens in the new NICU. Conclusion The change in the environment and implementation of device bundles in the NICU might be associated with the nosocomial infection rate.

Post-discharge body weight and neurodevelopmental outcomes among very low birth weight infants in Taiwan: A nationwide cohort study.

Background Premature infants are at high risk for developmental delay and cognitive dysfunction. Besides medical conditions, growth restriction is regarded as an important risk factor for cognitive and neurodevelopmental dysfunction throughout childhood and adolescence and even into adulthood. In this study, we analyzed the relationship between post-discharge body weight and psychomotor development using a nationwide dataset. Materials and methods This was a nationwide cohort study conducted in Taiwan. Total of 1791 premature infants born between 2007 and 2011 with a birth weight of less than 1500 g were enrolled into this multi-center study. The data were obtained from the Taiwan Premature Infant Developmental Collaborative Study Group. The growth and neurodevelopmental evaluations were performed at corrected ages of 6, 12 and 24 months. Post-discharge failure to thrive was defined as a body weight below the 3rd percentile of the standard growth curve for Taiwanese children by the corrected age. Results The prevalence of failure to thrive was 15.8%, 16.9%, and 12.0% at corrected ages of 6, 12, and 24 months, respectively. At corrected ages of 24 months, 12.9% had low Mental Developmental Index (MDI) scores (MDI<70), 17.8% had low Psychomotor Developmental Index (PDI) scores (PDI<70), 12.7% had cerebral palsy, and 29.5% had neurodevelopmental impairment. Post-discharge failure to thrive was significantly associated with poor neurodevelopmental outcomes. After controlling for potential confounding factors (small for gestational age, extra-uterine growth retardation at discharge, cerebral palsy, gender, mild intraventricular hemorrhage, persistent pulmonary hypertension of newborn, respiratory distress syndrome, chronic lung disease, hemodynamic significant patent ductus arteriosus, necrotizing enterocolitis, surfactant use and indomethacin use), post-discharge failure to thrive remained a risk factor. Conclusion This observational study observed the association between lower body weight at corrected age of 6, 12, and 24 months and poor neurodevelopmental outcomes among VLBW premature infants. There are many adverse factors which can influence the neurodevelopment in NICU care. More studies are needed to elucidate the causal relationship.

Congenital chylothorax associated with isolated congenital hypoplastic superior caval vein: A case report: Clinical observations

Congenital absence, or hypoplasia, of the superior vena cava (SVC) with situs solitus is quite uncommon. Most cases have been found incidentally and concomitant with left persistent SVC or other cardiac disorders. Congenital chylothorax may be associated with cardiac anomalies, various syndromes, thoracic ductal or venous thrombosis, birth trauma or local compression of the thoracic duct, but it is rarely caused directly by congenital SVC anomalies.