Neurodevelopmental Outcomes in Very Low Birth Weight Infants Using Aminophylline for the Treatment of Apnea.

BACKGROUND: Aminophylline has been widely used in the treatment of apneic episodes in premature infants. Animal models suggest caution in the use of aminophylline as it may increase the cerebral metabolic rate and decrease the rate of anoxic survival in neonates. This study aimed to evaluate the neurological outcomes in very low birth weight (VLBW) infants treated with aminophylline for apnea in our neonatal intensive care unit. METHODS: All VLBW infants (body birth weight < 1500 g) admitted to our neonatal intensive care unit between January 2000 and December 2011 were enrolled in this retrospective study. Clinical characteristics and outcomes of these infants were reviewed and recorded. Scores on the Bayley Scales of Infant Development at 6 months, 12 months, and 18 months of corrected age were also recorded. The controls (who did not receive aminophylline) were matched for gestational age with the aminophylline group. RESULTS: The baseline characteristics of the aminophylline group and the control group were similar. The neurodevelopmental outcomes as well as rates of patent ductus arteriosus, brain injury, severe retinopathy of prematurity, and necrotizing enterocolitis were not significantly different between the two groups. Only bronchopulmonary dysplasia remained significantly higher in the aminophylline group after adjusting for risk factors (48.08% vs. 21.15%; adjusted odds ratio: 12.50; p < 0.001). CONCLUSION: Aminophylline therapy for apnea of prematurity had no apparent and additional risk on the neurodevelopmental outcomes of VLBW infants at a corrected age of 18 months. Further studies with a larger sample size are needed to confirm the adverse neurological effects of aminophylline treatment.

A strategy for reduction of antibiotic use in new patients admitted to a neonatal intensive care unit.

BACKGROUND: In order to reduce the unnecessary use of and provide appropriate guidance for the administration of antibiotics, the neonatal bacterial infections screening score (NBISS) was developed to assess each new patient that is admitted to the neonatal intensive care unit (NICU). METHODS: NBISS was designed based on maternal risk factors, clinical presentations, and laboratory data. The total score of each new patient is calculated at the time of admission. The first period of this study was an observational survey. Receiver operating characteristic (ROC) curves were used to determine the best cut-off NBISS for the diagnosis of bacterial infection (BI) and guide the use of antibiotics during the second period of this study. RESULTS: Of 250 neonates who were admitted to the NICU, 237 (94.8%) received antibiotics during the first period of study. The initial total scores were not statistically different between the BI and non-BI groups (p = 0.155). We weighted C-reaction protein (CRP) (by 8×), the presence of a bulging fontanelle, pus from the ear canal, redness around the umbilicus, reduced movement, and being unable to feed (each by 5×) as significantly different between the BI and non-BI groups (p = 0.015). Weighted scores >8 points demonstrated the best diagnostic accuracy for indicating BI. After introducing NBISS for predicting BI in new patients admitted to NICU, the rate of antibiotic use significantly decreased from 94.8% to 60.3% between the two periods. CONCLUSION: Using this simple screening strategy, we were able to clinically reduce the use of unnecessary antibiotics.

Effects of antenatal corticosteroids on neonatal outcomes in very-low-birth-weight preterm newborns: a 10-year retrospective study in a medical center.

OBJECTIVE: To evaluate the effects on neonatal outcomes between very-low-birth-weight (VLBW) preterm newborns with and without maternal use of antenatal corticosteroids (ACS). METHODS: We retrospectively reviewed medical records of VLBW premature infants who were admitted to Kaohsiung Medical University Hospital between 1999 and 2008. A total of 256 infants were enrolled in this study. A total of 174 neonates did not receive any ACS, and 82 neonates received ACS. A total of 37 neonates received one dose of ACS, and 45 neonates received more than one dose of ACS, referred to as "multiple-dose ACS." In addition, these 82 infants were divided to betamethasone group (n=8) and dexamethasone group (n=50) with 24 infants excluded because of inadequate information. RESULTS: Neonates with multiple-dose ACS had lower incidence of surfactant use and lower rate of intubation than neonates without ACS. There were no differences in the occurrences of intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, sepsis, and chronic lung disease with one-dose vs. multiple-dose ACS and in the betamethasone group vs. the dexamethasone group. CONCLUSIONS: ACS reduces the need for exogenous surfactant, and the need for endotracheal tube insertion at birth in VLBW premature infants.

Parenteral nutrition-associated cholestasis in premature babies: risk factors and predictors.

BACKGROUND: One of the most common complications in infants under parenteral nutrition treatment is parenteral nutrition-associated cholestasis (PNAC). The etiology of PNAC is thought to be multifactorial. The aims of this study were to evaluate the risk factors for PNAC in our neonatal intensive care unit and determine useful predictors. METHODS: This study enrolled premature infants (gestational age <36 weeks) who were admitted to our neonatal intensive care unit and treated with parenteral nutrition infusion for at least 2 weeks between January 2004 and January 2007. Multiple possible risk factors were analyzed by a retrospective review study design. PNAC was defined as direct bilirubin greater than 1.5 mg/dL during parenteral nutrition. RESULTS: A total of 62 premature infants with prolonged course of parenteral nutrition were eligible for this study; 11 (17.74%) of the infants developed PNAC. There were significant differences in terms of gestational age, birth body weight, duration of parenteral nutrition, septic episodes, and average energy intake during the 2nd and 3rd weeks of life between infants with cholestasis and those without cholestasis. Of these risk factors, the duration of parenteral nutrition was most significant after multivariate logistic regression analysis. CONCLUSION: Young gestational age, low birth body weight, more sepsis episodes, and long duration of parenteral nutrition were significant risk factors for PNAC in our study. Low energy intake during the 2nd and 3rd weeks of life is a predictor for PNAC.

Effect of blood transfusions on the outcome of very low body weight preterm infants under two different transfusion criteria.

BACKGROUND: Multiple packed red blood cell (PRBC) transfusions in very low birth weight (VLBW) prematurity have been suggested to be a risk factor for the development of retinopathy of prematurity (ROP) or for chronic lung disease (CLD). The purpose of this study was to examine the effect of PRBC transfusions on the outcome of VLBW prematurity. METHODS: In total, between July 2005 and June 2006, 36 VLBW preterm babies were admitted to our neonatal intensive care unit and were randomly allocated to the "restrictive" (n= 19) or "liberal" (n= 17) criteria for PRBC transfusion. Complete blood count (CBC) was examined at admission and 30 days later. Reticulocyte counts, serum iron and ferritin were examined and compared with the clinical outcomes. RESULTS: Infants in the liberal group received a larger PRBC transfusion volume compared with the restrictive group over 30 days (41.7+/-20.1 vs. 27.2+/-15.9mL, p=0.029). There were no significant differences in the proportion of patients with respiratory distress syndrome, patent ductus arteriosus, severe intraventricular hemorrhage, ROP or CLD between the two groups. The laboratory data, except reticulocyte count, showed no significant difference on day 30. Further analysis of premature babies with and without CLD showed that total transfused blood volume greater than 30mL over 30 days was a risk factor for developing CLD in VLBW infants. CONCLUSION: Both criteria of PRBC transfusion had similar clinical outcomes, although liberal transfusion resulted in a greater amount of blood transfused and a low reticulocyte count at 30 days of age. We suggest restrictive criteria for minimizing the overall amount of transfusion to less than 30 mL may be a better way of preventing CLD in VLBW infants.

Ectopic pancreatic tissue presenting as an umbilcal mass in a newborn: a case report.

The case of an ectopic pancreatic mass at the umbilicus in an 8-day-old male neonate is reported, the youngest patient with this condition ever reported in an English-language journal. The patient was healthy except for a protruding mass with intermittent mucous discharge at the base of the umbilical stump. Surgical intervention was performed under the impression of the umbilical mass. Pathology diagnosed an ectopic pancreas with acute hemorrhage. To the best of our knowledge, only one case of ectopic pancreas presenting as an umbilical mass with intermittent mucous discharge has previously been reported.

Neonatal readmission within 2 weeks after birth.

To examine the causes of neonatal readmission within two weeks of discharge and identify the factors associated with neonatal readmission, newborns readmitted to Kaohsiung Municipal Hsiao-Kang (KMHK) Hospital within two weeks of discharge from our nursery between October 2001 and November 2003 were studied retrospectively. Of the 1099 deliveries during the study period, there were 63 newborns readmitted to KMHK Hospital within 14 days of discharge, with a rate of 5.7%. The control group consisted of a systematic sampling of newborns delivered over the same period that were not readmitted (n=74). The diagnoses of readmission included jaundice (73.0%), fever and suspected sepsis (19.0%), enteritis (4.8%), and others (3.2%). Factors associated with readmission included length of stay in nursery less than 72 hours, exclusive breast feeding, more body weight loss, and higher bilirubin level at discharge from nursery. After multiple logistic regression analysis, length of stay in nursery less than 72 hours, exclusive breast feeding and higher bilirubin level at discharge from nursery were the significant risk factors for neonatal readmission.

Differential changes in endothelin-1 and endothelial nitric oxide synthase gene expression in rats with a chronic high pulmonary flow.

The expressions of endothelin-1 (ET-1) and endothelial nitric oxide synthase were assessed in the lung of adult Wistar rats (n = 6/group) undergoing an abdominal aortocaval shunt to increase pulmonary blood flow for 4, 8 or 12 weeks. The shunt resulted in significant medial hypertrophy of the pulmonary artery without significant increases in pulmonary and systemic arterial pressure. A competitive reverse transcriptase-polymerase chain reaction demonstrated significant increases in pulmonary preproET-1 mRNA at 12 weeks (mean +/- standard error of the mean; shunt, 1.82 +/- 0.12; sham, 1.00 +/- 0.15; P < 0.05) and in pulmonary endothelial nitric oxide synthase mRNA at both 8 weeks (shunt, 1.57 +/- 0.12; sham, 1.00 +/- 0.18; P < 0.05) and 12 weeks (shunt, 1.89 +/- 0.18; sham, 1.00 +/- 0.13; P < 0.05). In addition, western blot analysis showed increases in pulmonary endothelial nitric oxide synthase protein by 126% and 164% at 8 and 12 weeks, respectively, in the shunt animals. However, the plasma ET-1 concentrations and the lung ET-1 contents were unchanged. These results indicate that endothelial nitric oxide synthase gene expression was upregulated, prior to that of ET-1, at the transcriptional level during pulmonary vascular remodeling in this chronic shunt model.

Synergistic effect of multiple indoor allergen sources on atopic symptoms in primary school children.

Accumulating data show that the complex modern indoor environment contributes to increasing prevalence of atopic diseases. However, the dose-response relationship between allergic symptoms and complexity of indoor environmental allergen sources (IEAS) has not been clearly evaluated before. Therefore, we designed this study to investigate the overall effect of multiple IEAS on appearance of asthma (AS), allergic rhinitis (AR), and eczema (EC) symptoms in 1472 primary school children. Among various IEAS analyzed, only stuffed toys, cockroaches, and mold patches fit the model of 'more IEAS, higher odds ratio (OR) of association'. The association of IEAS and AR increased stepwise as more IEAS appeared in the environment (1.71, 2.47, to 2.86). In AS and EC, the association was significant only when all three IEAS were present (1.42, 1.98, to 4.11 in AS; 1.40, 1.76, to 2.95 in EC). These results showed that different IEAS had a synergistic effect on their association with atopic symptoms and also suggest that there is a dose-response relationship between kinds of IEAS and risk of appearance of atopic diseases.

Nonsurgical percutaneous retrieval of dislodged Port-A catheters from pulmonary artery in children.

A total of 110 central venous access procedures using Port-A catheters were performed in our center for pediatric patients with oncologic or hematologic diseases over a period of 6 years from November 1994 to June 2000. Spontaneous dislodgement of the outlet catheters was noted in two cases. Both dislodged catheters were located in the left pulmonary artery and were successfully retrieved via the right femoral vein by nonsurgical transvenous snares. Awareness of the possibility of spontaneous catheter dislodgement and embolization of Port-A catheters is important as prompt retrieval will prevent further serious complications. When the procedure is performed by an open surgical method, to reduce the possibility of spontaneous catheter dislodgement, the use of a guidewire is recommended while a Port-A catheter is being inserted into the subclavian vein.

Hypertriglyceridemia in a 5-day-old newborn--a case report.

Neonatal hypertriglyceridaemia is extremely rare in pediatrics. We narrowed down the possibilities to a case of lipoprotein lipase (LPL) deficiency through a designed process of elimination with this particular patient. The biochemical hallmark of the disease is the presence of hyperchylomicronemia in fasting plasma. The patient responded well to a special formula containing median chain triglyceride (MCT). This was one of the youngest cases of hyperlipidemia and hyperlipoproteinemia to be reported during the neonatal period. Therefore the approach is mainly through the process of elimination because of inadequate laboratory facilities.