Effectiveness and safety of intravenous iloprost for severe persistent pulmonary hypertension of the newborn.

OBJECTIVE: The aims of this study were to determine the effectiveness (oxygenation), safety (hemodynamic status) and short term outcomes of intravenous iloprost (IVI) administration as a rescue therapy in severe persistent pulmonary hypertension of the newborn (PPHN). DESIGN: Retrospective medical records review. SETTING: Tertiary neonatal intensive care unit at Songklanagarind Hospital, Songkhla Province, Hat Yai, Thailand. PARTICIPANTS: Newborns who received IVI as an adjunctive therapy for treatment of severe PPHN, as defined by an oxygen index (OI) of >20 and without response to conventional therapies. MAIN OUTCOME MEASURES: The change of OI and alveolar-arterial oxygen difference before and after commencement of IVI. RESULTS: 33 neonates with severe PPHN at a median gestation of 39 weeks and a baseline OI of 40 (range, 21-101) received IVI. The median OI and alveolar-arterial oxygen difference had a statistically significant decrease after 2 hours of treatment and continued to decline thereafter (P<0.05). All infants received one or more inotropic medications and volume expanders to provide blood pressure support with no statistically significant difference of blood pressure and heart rate before and after IVI treatment. The mortality rate was 15.2%, all of them had initially severe hypoxemia with a median OI of 53.6. CONCLUSION: Triglyceride and non-high-density lipoprotein cholesterol are better than low-density lipoprotein cholesterol as predictors of cardiovascular disease risk factors in Chinese Han children and adolescents.

Risk factors and outcomes of carbapenem-resistant Acinetobacter baumannii bacteremia in neonatal intensive care unit: a case-case-control study.

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a serious threat among critically ill neonates. METHODS: We performed a case-case-control study in a Thai neonatal intensive care unit to identify risk factors and outcomes for CRAB bacteremia. Case group (CG) I was defined as cases with CRAB (n = 14), and CG II was defined as cases with carbapenem-susceptible A. baumannii (n = 38) bacteremia. The control group (n = 44) was selected from all patients admitted before and after 3 days that CG I was identified, but had no infection. RESULTS: The mean gestational age and birth weight of CG I, II and control were 33.5, 35.2 and 35.2 weeks and 1856.5, 2273.9 and 2309.5 g, respectively. By multivariate analysis, CG I was more likely to have had an umbilical artery catheter (adjusted odds ratio = 29.30; P = 0.019) whereas CG II was more likely exposed to ceftazidime (adjusted odds ratio = 5.19; P = 0.046) and aminoglycosides (adjusted odds ratio = 35.59; P = 0.002). There was a significant difference in history of cefoperazone/sulbactam (21.4% versus 0%; P = 0.01) and imipenem use (35.7% versus 0%; P < 0.001) among CG I compared with control. Crude mortality in CG I was higher than CG II (42.9% versus 13.2%; odds ratio = 5.0; P = 0.02). CONCLUSION: Our cohort of neonatal CRAB bacteremia is characterized by a very high mortality. Infection-control interventions inclusive of strict adherence to infection-control process for central vascular line placement and maintenance as well as antimicrobial stewardship program are essential to help reduce CRAB bacteremia.

Early onset neonatal bacterial meningitis caused by Streptococcus gallolyticus subsp. paste urianus.

We report a case of neonatal meningitis due to Streptococcus gallolyticus subsp. pasteurianus born to a mother with an asymptomatic urinary tract infection due to Streptococcus group D and Escherichia coli. In the past, this organism may have been reported as Streptococcus bovis or S. bovis biotype II/2. Accurate identification of this organism is necessary to determine the etiology of infection and give correct treatment of neonatal meningitis, caused by this organism.

Congenital hepatic arteriovenous malformation presenting with severe persistent pulmonary hypertension.

Congenital hepatic arteriovenous malformation is a rarely seen vascular malformation with persistent pulmonary hypertension in neonates. The authors report a full-term female newborn presenting with intractable heart failure and respiratory distress soon after birth. Investigation by echocardiography showed severe persistent pulmonary hypertension of the newborn and patent ductus arteriosus. The hepatic angiogram revealed congenital hepatic arteriovenous malformation; therefore, secondary pulmonary artery hypertension complicated with 'steal' phenomenon was conclusively diagnosed.

Neonatal acute kidney injury in a tertiary center in a developing country.

BACKGROUND: Acute kidney injury (AKI) is a common contributor to morbidity and mortality in newborns, with prevalences varying by population and hospital. A study of AKI in newborns in tertiary care centers in Thailand, a developing country with limited resources, has not been conducted yet. METHODS: The aim of this study was to determine the prevalence of AKI in newborns in a tertiary care hospital in southern Thailand and to investigate the etiology, mortality and risk factors of mortality. The records of patients aged <30 days with high serum creatinine, admitted from 1984 to 2007, were retrospectively reviewed. RESULTS: Eighty-eight boys and 51 girls were enrolled; 61.4% were premature and 56.5% had a birth weight <2500 g. The prevalence of newborn AKI increased from 0.9 to 6.3% during the 24-year study period. Thirty-nine and 65% had renal failure within 2 and 7 days post-birth, respectively. Sepsis was the most common cause of AKI (30.9%) followed by hypovolemia (18.7%), kidney, ureter and bladder (KUB) anomalies (12.2%), congestive heart failure (12.2%) and birth asphyxia (11.5%). Indomethacin caused AKI in 24.4% with gestational age <32 weeks. Sepsis-induced AKI had the highest mortality rate (65.1%) with an overall mortality rate of 38.8% and nearly 14 times the risk of death compared to hypovolemia-induced AKI. CONCLUSIONS: The prevalence of newborn AKI in our Thai tertiary center over 24 years was 6.3% of admitted newborns. Sepsis was the most common cause of AKI and sepsis-induced AKI is the most common cause of death. Disease etiology was the only risk factor for mortality.

Outcomes of very low birth weight infants in Songklanagarind Hospital.

OBJECTIVE: To determine the mortality and morbidity rates of very low birth weight (VLBW) infants in Songklanagarind Hospital. MATERIAL AND METHOD: A retrospective study of all infants with birth weight < 1,500 g admitted to the neonatal intensive care unit between January 2003 and December 2006. RESULTS: A total of 178 VLBW infants, met the enrollment criteria, with mean (+/- standard deviation-SD) birth weight and gestational age of 1,123 +/- 273 g and 29 +/- 3 weeks, respectively. Forty-two (23.6%) were referred from other hospitals. The overall mortality rate was 27.0%. Perinatal risk factors of mortality were birth weight < 1,000 g (p < 0.01), congenital anomalies (p < 0.01), and Apgar score at 1 minute < or = 5 (p < 0.01). Among the 130 (73.0%) survivors to discharge, 92 (70.8%) survived without major morbidity. The major morbidities were moderate/severe bronchopulmonary dysplasia, retinopathy of prematurity stage 3, necrotizing enterocolitis stage > or = 2 and intraventricular hemorrhage grade > or = III in 31 (23.8%), 12 (9.2%), 4 (3.1%) and 2 (1.5%) infants, respectively. CONCLUSION: The mortality rate of VLBW infants in Songklanagarind Hospital was similar to other developing countries, although greater than in developed countries. Among survivors, the major morbidity rates were acceptable.

Influence of maternal nutrient intake and weight gain on neonatal birth weight: a prospective cohort study in southern Thailand.

OBJECTIVES: To assess the nutritional intake and gestational weight gain of pregnant women and the relationship between nutritional intake, gestational weight gain, and neonatal birth weight. METHODS: A prospective cohort study was carried out in three districts of Songkhla Province in southern Thailand. Nutritional intakes were calculated based on a 24-h food record and a food frequency checklist. The women were followed until delivery and the neonatal birth weight recorded. RESULTS: Two hundred and thirty-six pregnant women with a mean age of 27.2 +/- 6.2 years were recruited. The average daily energy intake was 1806 +/- 482 kcal. The average gestational weight gain was 12.2 +/- 4.6 kg and the average neonatal birth weight was 3054 +/- 474 g. Micronutrient intakes were overall inadequate averaging only 50-80% of recommended levels. Neonatal birth weight was significantly positively correlated with gestational weight gain (r = 0.17, p = 0.01), but was not correlated with maternal nutritional intakes. CONCLUSIONS: Pregnant women in rural areas of Songkhla Province consume adequate macronutrients with appropriate gestational weight gain, but generally consume inadequate micronutrients. A nutritional education program explaining the importance of micronutrients should be a focus of a public education program.

Perinatal death pattern in the four districts of Thailand: findings from the Prospective Cohort Study of Thai Children (PCTC).

OBJECTIVE: To determine the magnitude and investigate causes of perinatal deaths of a cohort of the Prospective Cohort Study of Thai Children. MATERIAL AND METHOD: A semi-structured verbal autopsy questionnaire and review of medical records were used to ascertain the causes of deaths during the perinatal period in four districts of Thailand. RESULTS: The total numbers of 3,522 babies (with 28 pairs of twins) were born from 3,494 pregnant women. The perinatal mortality rate was 10.69 per 1,000 total births, the stillbirth rate was 6.75 per 1,000 births, and the early neonatal mortality rate was 3.97 per 1,000 live-births. About 37.8% of the perinatal deaths were agreed to by two pediatricians and a neonatologist as preventable. About 90% of the preventable stillbirths occurred in the antepartum period. CONCLUSION: Findings from the present study indicates that to further reduce the perinatal death rate, attention should be focused on reducing the stillbirths by a quality antenatal care.

Maternal iodine status and neonatal thyroid-stimulating hormone concentration: a community survey in Songkhla, southern Thailand.

OBJECTIVE: To determine iodine intake and urinary iodine excretion (UIE) in a group of pregnant Thai women and the concentration of thyroid-stimulating hormone (TSH) in their neonates. DESIGN: A prospective cohort study. SETTING: Three districts of Songkhla, southern Thailand. SUBJECTS: Two hundred and thirty-six pregnant women. RESULTS: A quarter of the participants lacked knowledge of iodine and the prevention of iodine deficiency, although 70 % used iodized salt. Those who did not use iodized salt stated that they had no knowledge about iodine (57 %) and no iodized salt was sold in their village (36 %). The median iodine intake in the three districts was 205-240 microg/d, with 53-74 % of pregnant women having iodine intake <250 microg/d. The median UIE in the three districts was 51-106 microg/l, with 24-35 % having UIE < 50 microg/l. The mean neonatal TSH was 2.40 (sd 1.56) mU/l, with 8.9 % of neonates having TSH > 5 mU/l. CONCLUSIONS: The studied women and their fetuses were at risk of mild iodine deficiency. About a quarter of the participants lacked knowledge of the importance of iodine. Education regarding the importance of iodine supplements and the promotion of iodized salt should be added to national health-care policies in order to prevent iodine-deficiency disorders, diseases that are subclinical but have long-term sequelae.

Infectious complications in infants with gastroschisis: an 11-year review from a referral hospital in southern Thailand.

UNLABELLED: MAIN PURPOSES: The study aimed to (1) examine the incidence of infectious complications (ICs) in our referral hospital in southern Thailand in infants with gastroschisis, with analysis of the impact of these complications on outcomes, and (2) identify associated factors to improve the practice at our institution for dealing with this condition. METHODS: A retrospective review of consecutive gastroschisis cases at the major teaching and referral hospital in southern Thailand was conducted for an 11-year period (1996-2006). Cases referred after a primary operation at other hospitals were excluded. The study focused on postoperative nosocomial infections as identified by Centers for Disease Control and Prevention criteria. RESULTS: Sixty-eight patients with gastroschisis were operated on. Twenty-seven patients (39.71%) underwent primary closure. Mortality was 4 of 68 patients (5.9%). Infectious complication occurred in 43 patients (63.2%). The complications significantly increased mechanical ventilation days (10.8 vs 3.8 days in noncomplicated cases), need for parenteral nutrition (25.3 vs 14.5 days), and postoperative stay (33.7 vs 21.1 days). Common ICs were wound infection (32.35%), isolated septicemia (19.1%), and pneumonia (13.24%). Univariate analysis identified an association between the occurrence of IC and birth order (multigravida), time from birth until arrival at our center (5 hours or more), hypoalbuminemia, hypoglycemia, type of operation (staged closure), use of central venous line, and prolonged use of ventilator. On multiple logistic regression, prolonged referral time, use of a central venous line, multigravida, and staged closure independently predicted the risk of IC. CONCLUSION: Infectious complication was significantly related to outcome in gastroschisis cases and should not be overlooked. Our data suggest that prompt referral, limiting central line practice on a selective basis, and an attempt to reduce wound infection in cases that require a temporary silo may improve the overall outcomes.

Neonatal septicemia due to Pasteurella multocida: the first case report in Thailand.

Neonatal septicemia acquired by vertical transmission of Pasteurella multocida is very rare. The authors report a case of Pasteurella multocida septicemia in a 2-day-old male infant. His mother had a history of prolonged premature rupture of membranes and subsequently developed fever. The patient had fever and lethargy at 36 hours of age, then developed severe pneumonia, sepsis, persistent pulmonary hypertension, renal failure and liver failure. Although the appropriate antibiotics were given, he continued to deteriorate and eventually died.

The relationship of maternal iodine status and neonatal thyrotropin concentration: a study in Southern Thailand.

Iodine deficiency disorder (IDD) is a global health problem. Previous studies in Southern Thailand have shown that the prevalence of goiter in schoolchildren is 3-5%, indicating that Southern Thailand is an iodine sufficient area. We conducted a study in pregnant women to determine their iodine status and whether there was an association between maternal urinary iodine excretion (UIE) and the neonatal thyrotropin (TSH) concentration. We recruited 244 pregnant women attending the antenatal clinic at Songklanagarind Hospital. Their mean age was 28.5 +/- 5.3 years (range 15-42) with a mean gestation age of 9.4 +/- 2.7 weeks (range 6-15). Ten ml urine was collected for UIE measurement. All women were delivered at Songklanagarind Hospital. The mean gestational age at delivery was 38.2 +/- 2.1 weeks (range 28-41). The median maternal UIE was 139.5 microg/l with 78 (32%) women having UIE below 100 microg/l. The median TSH of the infants was 4.14 mIU/l (range 0.30-17.89) with 88 (36.1%) of infants having TSH concentration above 5 mIU/l. Logistic regression analysis revealed that the odds ratio of pregnant women with UIE below 100 microg/l giving birth to infants with neonatal TSH above 5 mIU/l was 2.04 (95% confidence interval 1.17-3.66, p = 0.012). In conclusion, our findings demonstrate that 32% of pregnant women have UIE below 100 microg/l, and that UIE below 100 microg/l in pregnant women is associated with neonatal TSH concentration above 5 mIU/l. These findings suggest that iodine deficiency is prevalent in pregnant women in Southern Thailand.

Clinical abnormalities, intervention program, and school attendance of Down syndrome children in southern Thailand.

BACKGROUND: Down syndrome is the most common chromosomal abnormality with an incidence of 1:700 livebirths. In southern Thailand, most Down syndrome patients are referred to Songklanagarind Hospital for surgical, medical treatment and/or stimulation intervention. OBJECTIVE: To study the clinical features and school attendance of Down syndrome children. MATERIAL AND METHOD: A total of 295 Down syndrome children attended Songklanagarind Hospital. The clinical features of Down syndrome, percentage of children receiving the stimulation intervention program, and attending school were studied. RESULTS: Congenital heart disease was found in 38.6%, gastrointestinal anomalies 16.9%, hematologic malignancy 6.1%, and thyroid disorders 11.4%. The mortality rate of Down syndrome children was 13.2%. Most children (65.6%) received the early stimulation, but only 38.9% attended the speech intervention program within the first 2 years of life. Of the total 109 Down syndrome children aged over 5 years that are still being followed, only 74 (67.9%) attended school. The school attendance was correlated with the family income, but not correlated with the level of maternal or paternal education. CONCLUSION: Congenital heart disease and gastrointestinal anomalies are commonly found in Down syndrome children. Most children received an early intervention program, but only 38.9% received speech intervention. In children aged >5 years, only 68% attended school, and school attendance was correlated with the family income.