Rate of breastfeeding for 4 months and promoting factors: A cohort study of mothers of preterm infants at Siriraj Hospital.

Background: Breast milk is widely accepted as the best nutrition for all newborn infants. Preterm infants probably gain more benefits from breast milk than term infants because they are at higher risk for having several morbidities. Objective: To determine the rate of 4-month exclusive or predominant breastfeeding and partial breastfeeding in preterm infants, and to determine the promoting factors of successful breastfeeding. Methods: This was a cohort study in mothers of preterm infants with gestational age ≤ 34 weeks and birth weight ≤ 2000 grams. The mother-infant dyads were followed until 4 months of age. Results: The study period was between 1 March 2009 and 28 February 2010. There were 90 mothers recruited. Data of 74 mothers with complete follow up were analyzed. The mean maternal age was 29.67 ± 7.43 years old. The median gestational age at delivery was 31 (interquartile range 4) weeks. Mean infants birth weight was 1412.71 ± 339.18 grams. The rates of exclusive or predominant and partial breastfeeding were 32.4% and 29.7%, respectively. Mother works at home, maternity leave, mothers stay with infants during hospitalization and exclusive breastfeeding in the last 24 hours before discharge were associated with 4-month exclusive or predominant breastfeeding. After multiple logistic regression analysis, factors significantly associated with successful exclusive breastfeeding were mothers work at home (adjusted OR 6.77, 95%CI 1.80-25.55), previous breastfeeding experience (5.09, 95%CI 1.39-18.65), mothers stay with infants during hospitalization (4.22, 1.17-15.22) and exclusive breastfeeding in the last 24 hours before discharge (4.70, 1.17-18.89). Conclusion: Exclusive breastfeeding in preterm infants is possible. Mothers stay with their infants during long hospitalization and exclusive breastfeeding during the last 24 hours before discharge are significant promoting factors that should be supported by health personnel. Mother works at home is the other significant promoting factor of successful 4-months exclusive or predominant breastfeeding.

Cryptococcus neoformans septicemia in an immunocompetent neonate: first case report in Thailand.

Neonatal infection due to Cryptococcus neoformans is extremely rare. We report a case of a 21-day-old neonate diagnosed with cryptococcal septicemia who was successfully treated with amphotericin B. He was born to a human immunodeficiency virus (HIV) seronegative mother. This report alerts general pediatricians and neonatologists to consider Cryptococcus neoformans infection as a possible cause of sepsis in newborn infants.

Fetal neck myofibroma.

Magnetic resonance imaging (MRI), as an adjunct to ultrasonography, has become a promising tool in prenatal diagnosis and therapy. In this report, the authors described a case of giant solid mass arising in the fetal neck region diagnosed by prenatal sonographic examination at the gestational age of 33 weeks'. MRI was used to confirm the diagnosis, and to assist fetal airway assessment. Due to the concern of fetal airway compromise, the ex utero intrapartum treatment (EXIT) was strategically planned with help from specialists in the according fields. This allowed the authors to secure the fetal airway before fetomaternal circulation was disconnected. It was performed successfully through Cesarean section at the time of birth. Histopathology revealed infantile myofibroma, which is a rare form of such a tumor arising on the fetal head and neck region diagnosed prenatally.

Risk factors of pneumothorax during the first 24 hours of life.

BACKGROUND: Pneumothorax is one of the air leak syndrome and is more common in the newborn period than in any other childhood periods. It can be divided into spontaneous pneumothorax and secondary pneumothorax from underlying lung pathology or assisted ventilation. Pneumothorax results in longer hospital stays and even deaths in some cases. To date, there are few studies that focus on identifying risk factors of pneumothorax. We conducted this study to ascertain risk factors for pneumothorax, in order to create a guideline to prevent this condition. MATERIAL AND METHOD: This is a retrospective case-control study. Cases were infants with the diagnosis of pneumothorax (P25.1 Pneumothorax originating in the perinatal period) between January 2001 and December 2004. Controls were those whose birth times followed in the immediate chronology to the cases. Case: control ratio was 1:2. Univariate analysis was used to compare the two groups. Odds ratio and 95% confidence interval were used to identify possible risk factors. Statistical significance was considered as p < 0.05. RESULTS: There are 44 cases and 88 controls. Risk factors are shown as Odds ratio and 95% confidence interval. Infant factors associated with higher risk of pneumothorax are male (2.6; 1.2, 5.6), low birth weight (19.3; 2.3, 160.2), vacuum extraction (20.9; 1.1, 403.4), meconium-stained amniotic fluid (4.5; 1.8, 11.0), low 1-minute Apgar score (78.3; 4.5, 1357.8), and the administration of bag and mask positive-pressure ventilation (29.0; 3.6, 233.5). Maternal factor associated with higher risk of pneumothorax is poor antenatal care (3.5; 1.04, 11.9). CONCLUSION: All pregnant women should be encouraged to have good antenatal care. Mother who has complication(s) during pregnancy and delivery should receive special care to prevent perinatal depression. For mothers with meconium-stained amniotic fluid, close fetal monitoring and tracheal suction for meconium after delivery should be appropriately considered to prevent meconium aspiration. Finally, neonatal resuscitation, when needed, should be done very carefully by following the American Heart Association and the American Academy of Pediatrics guidelines, especially for bag and mask positive-pressure ventilation.

High-risk neonatal hearing screening program using automated screening device performed by trained nursing personnel at Siriraj Hospital: yield and feasibility.

OBJECTIVES: To determine the prevalence and significant risk factors for pathologic hearing screening test results in high-risk neonates and the feasibility of implementing hearing screening program using automated otoacoustic emission (OAE)/ auditory brain stem response (ABR) device performed by trained nursing staffs. STUDY DESIGN: Single-center prospective, descriptive study. MATERIAL AND METHOD: All neonates admitted to the Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, who met the high-risk criteria according to Joint Committee of Infant Hearing 1994, American Academy of Pediatrics, were screened with one-step protocol using an automated OAE/ABR device (AccuScreen, GN Otometrics, Denmark). Infants who failed 2 consecutive OAE tests were reconfirmed by ABR prior to discharge. Descriptive analysis was used for the prevalence of pathologic hearing test results, age at screening, duration of procedure, number of risk factors per infant. Univariate analysis using Chi-square test and multiple logistic regression analysis were used for identification of significant risk factors. RESULTS: Five hundred and seven infants were identified to be at-risk in an 18-month study period. The prevalence of pathologic hearing screening test was 6.7% with unilateral and bilateral pathologic results in 13 and 21 infants (2.6% and 4.1%). Only craniofacial anomalies and mechanical ventilation > 5 days were shown to be independent significant risk factors (42-fold and 4-fold increased risk). Median age at screening test performed was 19 days (range 1-149 days) and almost all infants (97.3%) were screened within 3-month postnatal age. The mean time for hearing screening procedure was 10.7 +/- 8.0 minutes (range 2-60 minutes), 98.1% of procedure was accomplished within 30 minutes. CONCLUSION: Hearing screening using automated OAE/ABR devices in high-risk neonates revealed approximately 7% of pathologic results with almost two-thirds having bilateral affected. The significant independent risk factors in this study population were craniofacial anomalies and mechnical ventilation > 5 days. The protocol of having trained nursing staffs to perform the screening yielded good results, i.e., the coverage of screened infants within 3 months of age (97%), feasible duration of procedure.