Tseng-Chen Sung

Impact on Neonatal Outcome and Anthropometric Growth in Very Low Birth Weight Infants with Histological Chorioamnionitis

BACKGROUND/PURPOSE Chorioamnionitis (CAM) is one of the main causes of preterm labor. The specific aim of our study was to evaluate neonatal outcome and anthropometric growth at the corrected age of 2 years after exposure to an adverse intrauterine event of CAM in very low birth weight (VLBW, less than 1500 g) infants. METHODS One hundred and nineteen VLBW infants had adequate placental histological data available for the study. Maternal and perinatal characteristics and neonatal morbidity were determined. The infants were followed up prospectively and their anthropometric growth was recorded in the neonatal follow-up clinic for 2 years. RESULTS Histological CAM was evident in 64 cases (53.8%, CAM group). Patients with histological CAM delivered earlier (27.8 +/- 2.9 vs. 29.6 +/- 3.6 weeks, p = 0.003), and they had higher incidence of preterm premature rupture of membranes (PPROM, p less than 0.001) and longer ventilation days (p = 0.001). After adjusting for gestational age, sepsis (aOR, 3.355), bronchopulmonary dysplasia (aOR, 3.018) and mechanical ventilation (aOR, 4.094) had a higher incidence in the CAM group. At the corrected ages of 6, 12, 18 and 24 months, anthropometric measurements, including body weight, body height and head circumference, were similar for the study and control infants. CONCLUSION Histological CAM was associated with a higher incidence of PPROM, sepsis, bronchopulmonary dysplasia, more mechanical ventilation and longer ventilation days. However, at the age of 2 years, CAM had no impact on anthropometric growth.

Generalized Lymphangiomatosis Presenting as Cardiomegaly

Lymphangioma refers to the local proliferation of well-differentiated lymphatic tissue. Generalized lymphangiomatosis is rare. We report a previously healthy 8-month-old infant who suffered from tachypnea with mild fever for 2 weeks. Imaging studies revealed a well-defined, large mass occupying the mediastinum, which presented as cardiomegaly. The disseminated mass extended to the thymus, lung, and spleen. Lymphangiomatosis was diagnosed by biopsy. Drainage of the pericardial fluid and total parenteral nutrition did not result in improvement of chylopericardium. Secondary hypogammaglobulinemia and septic shock developed sequentially. Surgical removal of the mediastinal mass and spleen were performed. Daily subcutaneous injection of interferon (IFN) alpha-2b was then given for 3 months. No recurrence was noted during 2 years of follow-up. IFN alpha-2b may be considered as an alternative for the treatment of generalized lymphangiomatosis.

Fatal Community-Acquired Pneumonia: 18 Years in a Medical Center

BACKGROUND Community-acquired pneumonia (CAP) remains a significant cause of childhood morbidity worldwide. We analyzed the etiologies and the clinical characteristics of children who died from CAP. This study aimed at early identification of the poor prognostic factors in order to improve the efficiency of pneumonia management and prevent deaths. METHODS A retrospective chart review was performed for children younger than 18 years admitted to Shin Kong Wu Ho-Su Memorial Hospital between September 1992 and August 2010 with a diagnosis of pneumonia on admission. Twenty-one patients who died with the diagnosis of pneumonia and its complications were included in the study, along with 63 age- and year-matched survival controls. RESULTS Twelve patients (57.1%) were younger than 2 years. Gram-negative bacteria (7 patients) were the most frequently identified pathogen, followed by Mycoplasma pneumoniae (6 patients). Four of these six M. pneumoniae infected patients were co-infected with other pathogens. Among the clinical characteristics, fatal CAP was associated mainly with initial presentations of anemia, lymphopenia, thrombocytopenia, bandemia, hyponatremia, sepsis, meningitis, metabolic acidosis, disseminated intravenous coagulopathy, and underlying congenital diseases. In multivariate logistic regression analysis, metabolic acidosis (odds ratio = 8.50; 95% confidence interval = 2.82-25.60; p < 0.001) was a prognostic risk factor for fatality. CONCLUSION For patients with CAP, blood gas should be included in the routine blood test on admission. Once the initial blood test associated with the aforementioned poor prognostic factors has been identified, an immediate treatment including Gram-negative bacilli antibiotics should be started aggressively in order to prevent deaths.

Neurodevelopmental Outcome of Very-Low-Birth-Weight Infants with Chorioamnionitis

BACKGROUND Chorioamnionitis (CAM) is one of the main causes of preterm labor and has been associated with an adverse perinatal outcome in preterm infants. OBJECTIVE The specific aim of our study was to evaluate whether there is significant difference in the Bayley developmental index scores at 6, 12, 18 and 24 months of corrected age for very-low-birthweight (birth body weight <1500 gm, VLBW) infants with or without placental CAM. METHODS Ninety-five cases (54 in CAM and 41 in non-CAM groups) available for the study were all VLBW infants with adequate histologic placental material for analysis. Neonatal characteristics and morbidities were recorded. The infants were followed up prospectively with Bayley Scales of Infant Development in the Neonatal Follow-up Clinic for 2 years. RESULTS We found that 56.8% of placentas presented a picture of CAM. In comparison of the neonatal characteristics, VLBW infants with CAM had shorter gestational age (27.9 +/- 2.8 vs. 30.0 +/- 3.7 weeks, p = 0.003), lower Cesarean delivery rate (48.1% vs. 73.2%, p = 0.011), more maternal steroid use (44.4% vs. 12.2%, p = 0.004) and higher incidence of preterm premature rupture of membrane (PPROM, 37.0% vs. 12.2%, p = 0.009). In comparison of neonatal outcomes, the CAM group had higher incidence of bronchopulmonary dysplasia (BPD, 40.7% vs. 19.5%, p = 0.044), more mechanical ventilation (87.0% vs. 27/41, p = 0.023) and intubation (68.5% vs. 46.3%, p = 0.049), and more median days of ventilation (23.1 +/- 29.1 vs. 7.8. +/- 13.7 days, p = 0.001). As for the follow-up, at any test age, either the mean (Mental Development Index (MDI) / (Psychomotor Development Index (PDI) scores of Bayley test or the incidence of score below 85, there was no significant difference in both groups. CONCLUSIONS The VLBW infants with histologic chorioamnionitis were not associated with an increased risk of lower MDI or PDI scores at the corrected ages of 6, 12, 18 and 24 months compared with the non-CAM control group.

Association of Plasma Leptin Levels With Maternal Body Weight and Body Mass Index in Premature and Term Newborns

BACKGROUND Leptin plays an important role in the regulation of body weight and energy metabolism in adults; its role in neonates also needs to be explored. The current study aims to determine the correlation between serum leptin concentrations and anthropometric variables in newborns and their mothers, and to examine the effects of sex, gestational age and antenatal steroid use on neonatal leptin levels. METHODS This was a retrospective study. Blood samples were collected from 55 newborns within 24 hours of birth. Plasma leptin levels were measured by immunometric assay. The relationship between neonatal leptin levels and anthropometric parameters was determined using Pearsons correlation and further evaluated by linear regression analysis. RESULTS Neonatal leptin was significantly correlated with maternal body weight (p < 0.002) and maternal body mass index (BMI) (p < 0.001). However, it was not correlated with gestational age (p = 0.130), birth weight (p = 0.097), or birth BMI (p = 0.336). The leptin levels in premature newborns (gestational age < 37 weeks; 0.69 +/- 1.82ng/mL) were significantly less than those in term newborns (gestational age > or = 37 weeks; 2.09 +/- 2.30 ng/mL, p = 0.031). There were no significant differences between sexes (p = 0.277) or in relation to antenatal steroid use (p = 0.611). CONCLUSION Neonatal serum leptin concentrations within 24 hours of birth correlated with maternal body weight and BMI, especially in premature newborns. Premature newborns had significantly lower leptin levels than full-term newborns.

Correlation of troponin I with perinatal and neonatal outcomes in neonates with respiratory distress

Background:   The specific aims of the present study were to evaluate the associations between cardiac troponin I (Tn I) and perinatal events and whether Tn I serves as a predictor to evaluate neonatal outcomes.

Holocord Intramedullary Spinal Cord Astrocytoma: Report of One Case

Intramedullary spinal cord astrocytoma in infants is relatively uncommon. Its occurrence is usually confined to the cervical and cervicothoracic regions. In this paper, we report on the case of a 4-month old male infant with low grade holocord intramedullary spinal cord astrocytoma. He had developed progressive weakness of the lower extremities over a month period. Neurological examination revealed flaccid paraplegia as well as complete loss of all modalities of sensation below the T10 level. MRI revealed a large intramedullary mass which was found to be an intramedullary astrocytoma at surgery. This case report presents the clinical features, radiographic findings, and treatment and outcome for this patient together with a review of relevant literature.

Calcinosis cutis following extravasation of calcium gluconate in neonates

Neonatal hypocalcemia is not an uncommon condition, especially in the premature neonate. It is effectively treated by intravenous infusion with calcium gluconate. We treated nine neonates with subcutaneous calcium deposition following calcium replacement with calcium gluconate from Jan. 1997 to Dec. 1997. Three of the infants were born to diabetic mothers, two had perinatal asphyxia and four were born prematurity. The average dosing number was 7.4 (5 to 9 doses). The onset of calcinosis cutis was 5 to 11 days after the first dose. The replacement of calcium gluconate caused amorphous masses at the site of extravasation and contracture of joint movement. A radiographic study was performed to determine the extent and course of extravasation, and areas remote from the infusion site also showed calcification. There is no specific mode of treatment except supportive management and a skin graft. The patient could functionally recover with cosmetic residue. In our follow-up clinics, all infants completely recovered without functional limitations.

Early Detection of Peripapillary Astrocytic Harmatoma in a 3 Day-Old Newborn with Tuberous Sclerosis Complex

Background and purpose: To report an atypical finding of peripapillary astrocytic harmatoma to establish the diagnosis of tuberous sclerosis complex in a 3 day-old newborn. Methods: Retrospective observational case report. Results: A 3-day-old newborn with multiple intracardiac vegetations were found by cardiac echo accidentally. After pupil dilation, the existence of a round, elevated and semitranslucent tumor without calcification was demonstrated in the right eye optic disc. This appearance was an unusual finding of the astrocystic harmatoma. Then the diagnosis of tuberous sclerosis complex was established by the late identified findings of cranial subependymal nodules and hypomelanotic macules. Conclusions: Tuberous sclerosis complex is a multi-system disease that causes non-neoplastic tumors and skin abnormalities. Photographic documentation of unusual findings of peripapillary astrocytic harmatoma is rare to demonstrate in a 3-day-old newborn with tuberous sclerosis complex.

Factors Influencing Nucleated Red Blood Cell Counts in Very Low Birth Weight Neonates

Objective: Nucleated red blood cells (NRBCs) are immature erythrocytes, the number of which varies widely at birth. Common causes of increased erythropoiesis include hypoxia or acute stress events. We intend to understand whether small for gestational age (SGA) status, which is usually interpreted as reflecting chronic intrauterine hypoxia, correlates with elevated NRBCs. Methods: We conducted a retrospective study to review the medical records of very-low-birth-weight infants born at Shin Kong WHS Memorial Hospital during a six-year period. Results: Compared with non-SGA infants, SGA babies had higher hemoglobin levels, hematocrits, and nucleated red blood cell counts, and lower white blood cell and platelet counts; elevated erythroblastosis can imply an intrauterine hypoxic effect. SGA was an important determinant among perinatal factors affecting the absolute NRBC count. In addition, a high absolute NRBC counts was associated with a high mortality rate. Conclusion: SGA infants have higher absolute NRBC counts at birth than non-SGA babies and this predicts a poor outcome.