Bilateral agenesis of the diaphragm is a rare, life-threatening malformation. Infants with this d... more Bilateral agenesis of the diaphragm is a rare, life-threatening malformation. Infants with this defect rarely survive to have surgical intervention. We report a 32-week premature female infant who was born to a 36-year-old mother via vaginal delivery. The pregnancy course was complicated by hypertension and polyhydramnios. Cytogenetic study showed a normal 46 XX female karyotype. She had cyanosis, respiratory distress and scaphoid abdomen at birth. A roentgenograph confirmed the diagnosis of diaphragmatic hernia. Surgery was performed at 21 h of age. Bilateral agenesis of diaphragm, herniation of abdominal organs and oesophagus and pulmonary hypoplasia were noted. Furthermore, stomach and spleen were adherent to the mediastinum and vertebrae. The patient developed hypotension and persistent hypoxaemia and expired at age of 26 h. Autopsy revealed bilateral agenesis of diaphragm, hypoplasia of lungs, and pancreas fibrosis with mild hypoplasia of islets of Langerhans. Bilateral agenesis of diaphragm associated with pancreas fibrosis is a rare entity, and its clinical significance needs further investigation.
Bronchopulmonary dysplasia (BPD) has been a critical morbidity in preterm infants. To improve our... more Bronchopulmonary dysplasia (BPD) has been a critical morbidity in preterm infants. To improve our definition and prediction of BPD is challenging yet indispensable. We aimed to apply machine learning (ML) to investigate effective models by using the recently-proposed and data-driven definition to predict late respiratory support modalities at 36 weeks' post menstrual age (PMA). We collected data on very-low-birth-weight infants born between 2016 and 2019 from the Taiwan Neonatal Network database. Twenty-four attributes associated with their early life and seven ML algorithms were used in our analysis. The target outcomes were overall mortality, death before 36 weeks' PMA, and severity of BPD under the new definition, which served as a proxy for respiratory support modalities. Of the 4103 infants initially considered, 3200 were deemed eligible. The logistic regression algorithm yielded the highest area under the receiver operating characteristic curve (AUROC). After attribute selection, the AUROC of the simplified models remain favorable (e.g., 0.801 when predicting no BPD, 0.850 when predicting grade 3 BPD or death before 36 weeks' PMA, and 0.881 when predicting overall mortality). By using ML, we developed models to predict late respiratory support. Estimators were developed for clinical application after being simplified through attribute selection.
Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui, 1995
Very low birth weights (VLBW) remain the major factor contributing to neonatal mortality and morb... more Very low birth weights (VLBW) remain the major factor contributing to neonatal mortality and morbidity. The development of Neonatal Intensive Care Units (NICU) has improved the outcome for the VLBW infants. However, outborn VLBW infants may have different outcomes, and different medical costs than those born intramurally. This study compared the mortality, morbidity and costs of inborn and outborn VLBW infants cared in the NICU of a tertiary care center. A total of 176 VLBW infants (inborn 83, outborn 93) were examined over the three years period June 1990 to May 1993. The birth weights (1131 +/- 244 g vs 1133 +/- 255 g) and gestational ages (29.0 +/- 4.0 wk vs 28.9 +/- 3.0 wk) were not different between the two groups. However, the age of admission to our wards was significantly different between the inborn infants (5.0 +/- 3.2 hr.) and outborn infants (53.6 +/- 26.8 hr.). There was no difference in mortality rates between the outborn infants (35.7%) and the inborn infants (32.9%),...
Invasive interventions have been conducted in preterm infants with significant patent ductus arte... more Invasive interventions have been conducted in preterm infants with significant patent ductus arteriosus (PDA) when medical treatment has failed, and methods of invasive intervention have been reported. Surgical ligation via lateral thoracotomy has been a well-established procedure for decades. Recently, transcatheter occlusion has been safely and feasibly applied to the premature population. However, little research has been conducted on the benefits of transcatheter occlusion in very-low-birth-weight (VLBW) infants compared to surgical ligation. This study compared transcatheter and surgical techniques in VLBW infants in terms of short-term respiratory outcomes. The medical records of 401 VLBW infants admitted to a tertiary hospital between September 2014 and January 2019 were retrospectively reviewed. Patients who were diagnosed with a congenital anomaly, a chromosomal anomaly, or congenital heart disease, except for an inter-atrial shunt, were excluded. The perinatal conditions, ...
BACKGROUND To study the distribution of the birthplaces of very-low-birth-weight (VLBW) infants a... more BACKGROUND To study the distribution of the birthplaces of very-low-birth-weight (VLBW) infants and examine whether delivery at different levels of hospital affects neonatal and infant mortality. METHODS This population-based cohort study was retrieved from Taiwan Maternal and Child Health Database. Livebirth singleton VLBW infants born between 2011 and 2014, with BW between 500 and 1499 g and gestational age ≥22 weeks were enrolled. The main outcomes were risk-adjusted odds ratios (aOR) of neonatal and infant mortality by birthplace, which was categorized as medical center (MC), regional hospital (RH), district hospital (DH), and clinic (C) based on Taiwan's hospital accreditation system. RESULTS Of 4560 VLBW infants enrolled, 3005 (66%) were born in MCs, 1181 (26%) in RHs, 213 (5%) in DHs, and 161 (4%) in Cs. Neonatal mortality rates were 10%, 15%, 16%, 17%, and infant mortality rates were 13%, 17%, 18%, 21%, if born in MCs, RHs, DHs and Cs, respectively. The aORs for neonatal and infant mortality were 1.94 (95% CI 1.53-2.48) and 1.67 (1.34-2.08) for those born in RHs, 2.26 (1.38-3.70) and 1.82 (1.16-2.86) for infants born in DHs/Cs, as compared to those born in MCs. For VLBW infants born in RHs, DHs, and Cs and postnatally transferred to MCs, the aORs of neonatal and infant mortality were lower than those who were not transferred. CONCLUSION VLBW infants born outside of MCs had higher neonatal and infant mortality and a two-fold higher risk of mortality than those born in MCs. When possible, VLBW infants should be born in MCs.
Background: Very-low-birth weight (VLBW) infants, defined as those with a birth body weight (BBW)... more Background: Very-low-birth weight (VLBW) infants, defined as those with a birth body weight (BBW) ＜1,501g, are at high risk for mortality. Compared to the traditional survival rate, which simply reflects the overall survival rate, the conditional survival rate provides the future life expectancy at a given postnatal age and is more practical clinically. This study explores and compares the conditional survival rate and traditional survival rate of VLBW infants in a tertiary medical center. Methods: Two-hundred and eighty-eight VLBW infants admitted to the neonatal intensive care unit (NICU) of a tertiary medical center were enrolled. Patients were stratified by BBW in 100g intervals and gestational age (GA) in weekly intervals. The conditional survival rate and traditional survival rate were calculated for both stratification methods. Results: The overall survival rate was 80.6%. More than half of all deaths (53.5%) occurred in the first week of life. The conditional survival rate i...
Bronchopulmonary dysplasia (BPD) has been a critical morbidity in preterm infants. To improve our... more Bronchopulmonary dysplasia (BPD) has been a critical morbidity in preterm infants. To improve our definition and prediction of BPD is challenging yet indispensable. We aimed to apply machine learning (ML) to investigate effective models by using the recently-proposed and data-driven definition to predict late respiratory support modalities at 36 weeks’ post menstrual age (PMA). We collected data on very-low-birth-weight infants born between 2016 and 2019 from the Taiwan Neonatal Network database. Twenty-four attributes associated with their early life and seven ML algorithms were used in our analysis. The target outcomes were overall mortality, death before 36 weeks’ PMA, and severity of BPD under the new definition, which served as a proxy for respiratory support modalities. Of the 4103 infants initially considered, 3200 were deemed eligible. The logistic regression algorithm yielded the highest area under the receiver operating characteristic curve (AUROC). After attribute selecti...
Journal of Autism and Developmental Disorders, 2022
Autism spectrum disorder (ASD) is reportedly more prevalent in urban areas partly because of bett... more Autism spectrum disorder (ASD) is reportedly more prevalent in urban areas partly because of better accessibility and affordability to healthcare. With universal health insurance coverage in Taiwan, a previous study has shown no urban-rural disparity in the utilization rate of a child's preventive healthcare. Under this circumstance, we followed a birth cohort of 176,273 live births from 2006 to 2015 to detect the differences in ASD incidence between urbanicities. After adjusting for socioeconomic factors, children were 1.28 (95% confidence interval (CI): 1.13-1.44) and 1.54 (95% CI: 1.36-1.75) more likely to acquire ASD in satellite and urban areas compared with those in rural areas, respectively. A gradient association between parental educational attainment and ASD incidence was also noted. Greater ASD incidences in more urbanized areas and more advanced educated parents' children were detected under a circumstance with low barriers to healthcare.
We studied the outcomes at school age in children who had participated in a doubleblind, placebo-... more We studied the outcomes at school age in children who had participated in a doubleblind, placebo-controlled trial of early postnatal dexamethasone therapy (initiated within 12 hours after birth) for the prevention of chronic lung disease of prematurity. methods Of the 262 children included in the initial study, 159 lived to school age. Of these children, 146 (72 in the dexamethasone group and 74 in the control group) were included in our study. All the infants had had severe respiratory distress syndrome requiring mechanical ventilation shortly after birth. In the dexamethasone group, 0.25 mg of dexamethasone per kilogram of body weight was given intravenously every 12 hours for one week, and then the dose was tapered. We evaluated the children's growth, neurologic and motor function, cognition, and school performance. results Children in the dexamethasone group were significantly shorter than the controls (P=0.03 for boys, P=0.01 for girls, and P=0.03 for all children) and had a significantly smaller head circumference (P=0.04). Children in the dexamethasone group had significantly poorer motor skills (P<0.001), motor coordination (P<0.001), and visualmotor integration (P=0.02). As compared with the controls, children in the dexamethasone group also had significantly lower full IQ scores (mean [±SD], 78.2±15.0 vs. 84.4±12.6; P=0.008), verbal IQ scores (84.1±13.2 vs. 88.4±11.8, P=0.04), and performance IQ scores (76.5±14.6 vs. 84.5±12.7, P=0.001). The frequency of clinically significant disabilities was higher among children in the dexamethasone group than among controls (28 of 72 [39 percent] vs. 16 of 74 [22 percent], P=0.04). conclusions Early postnatal dexamethasone therapy should not be recommended for the routine prevention or treatment of chronic lung disease, because it leads to substantial adverse effects on neuromotor and cognitive function at school age.
Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui, 1995
Fetal tachycardia sometimes is quite difficult to treat, especially when the fetus has congestive... more Fetal tachycardia sometimes is quite difficult to treat, especially when the fetus has congestive heart failure. Sustained supraventricular tachycardia and hydrops had been diagnosed in a fetus as early as the 27th week of gestational age. A variety of antiarrhythmic agents, including digoxin, digoxin in combination with quinidine or propranolol or verapamil, have been prescribed for the mother, always in a vain effort of conversion of the tachycardia. A baby was born via vaginal delivery at 35 weeks' gestation because of premature labor. The tachycardia disappeared immediately after birth, but several episodes of tachycardia occurred during the neonatal period, and were converted only by electric cardioversion or intravenous amiodarone. Oral amiodarone was then prescribed for three months to prevent recurrence. The baby has lived well without attacks during a one-and-a-half-year follow-up.
Long-time average spectrum (LTAS) was used to analyze the cry phonations of 26 infants under four... more Long-time average spectrum (LTAS) was used to analyze the cry phonations of 26 infants under four months old; 16 of them are full-term and the other 10 infants are preterm. The results of first spectral peak, mean spectral energy, spectral tilt, high frequency energy were used to compare the cry phonatory between full-term and preterm infants. In addition, cry duration and percent phonation is also compared. According to previous studies, full-term and preterm infants’ crying behavior show significant differences because immature neurological development of preterm infants. Major findings in this study are: (1) There was no significant difference in unedited cry phonation across groups; (2) There was no significant difference in percent phonation across groups; (3) There was no significant difference in first spectral peak across groups, and no significant difference within groups could be found. However, full-term infants have higher first spectral peak than that of preterm infants...
Neonatal transport is an integral part of perinatal regionalization and the pattern could be affe... more Neonatal transport is an integral part of perinatal regionalization and the pattern could be affected by the policy of payment. This study evaluated the impact of National Health Insurance on the results of neonatal transport in the Tainan area. We collected regional data on the transported neonates obtained over two time periods. The first group (n=260) was collected between July 1991 and May 1992, and the second group (n=473) was collected between August 1997 and March 1999, three years after the implementation of National Health Insurance. The percentage of low-birth weight neonates transported was not different between the two periods (59.6% vs 59.1%). The frequency of endotracheal tube intubation performed by the transport team (41.3% vs 21%, p<0.01) was lower in the latter group. The incidence of hypothermia was similar between the two groups (20.7% vs 19.8%). The incidence of hypoglycemia (26.8% vs 13%, p<0.01), acidemia (35.3% vs 26%, p<0.01), infant mortality (19.7...
Objectives: To investigate the course of prolonged hypoglycemia in full-term, small for gestation... more Objectives: To investigate the course of prolonged hypoglycemia in full-term, small for gestational age (SGA) newborns and their neurologic outcomes. Materials and Methods: We retrospectively reviewed the medical records of full-term SGA newborns born in National Cheng Kung University Hospital between November 1, 1991 and December 31, 2001. They were routinely screened for hypoglycemia at the ages of 1, 2, 4, 6, 12, 24, and 48 hours by dextrostix testing. Hypoglycemia was defined as a glucose value lower than 35 mg/dL within 3 hours, lower than 40 mg/dL between 3 and 24 hours, and lower than 45 mg/dL at more than 24 hours of age. Serum cortisol and insulin levels were determined when the duration of hypoglycemia was exceeded 7 days. Data on risk factors and neurologic outcomes were collected and analyzed. Results: Thirty- five full-term SGA newborns developed hypoglycemia after birth. Eight (23%) of them had hypoglycemia for longer than 48 hours and recovered within 7 days of age; 8...
Background. Family-centered care for preterm infants in Western societies has yielded short-to me... more Background. Family-centered care for preterm infants in Western societies has yielded short-to medium-term benefits. However, the intervention effects have rarely been validated in Eastern societies. Objective. The aim of this study was to examine whether a family-centered intervention program (FCIP) could improve the short-term medical and neurobehavioral outcomes in preterm infants with very low birth weight (VLBW; a birth weight of <1,500 g) in Taiwan over the outcomes seen with a usual care program (UCP). Design. This was a multicenter, single-blind, randomized controlled trial study. Setting. Three medical centers in northern and southern Taiwan were the locations for the study. Participants. The participants were 251 VLBW preterm infants without severe perinatal complications. Intervention. The infants were randomly assigned to receive the FCIP or the UCP during hospitalization. Measurements. Infant morbidities, feeding, growth, and neurobehavioral performance were evaluated during the neonatal period. Parental adherence to interventions was measured in the FCIP group. Results. The FCIP promoted earlier full enteral feeding (β =-1.1 weeks; 95% CI =-1.9 to-0.2 weeks) and hospital discharge (β =-0.6 week; 95% CI =-1.1 to-0.1 weeks), greater weight gain (β = 3.3 g/d; 95% CI = 0.1 to 6.6 g/d), and better neurobehavioral performance than the UCP (β = 1.2 points; 95% CI = 0.2 to 2.3 points). Furthermore, a higher degree of parental motivation in interventions, goal attainment, and comprehensiveness of home activities was significantly associated with greater effects in infants' neurobehavioral performance and weight gain (r = .20-.31; all Ps < .05). Limitations. The findings may not be generalized to preterm infants with severe perinatal diseases and parents with a low level of interest in interventions. Conclusions. Family-centered care facilitated short-term medical and neurobehavioral outcomes in VLBW preterm infants in Taiwan; the effects were likely achieved through Post a comment for this article at: https://academic.oup.com/ptj
RSV is the most common cause of viral bronchiolitis. This review presents recent literature on th... more RSV is the most common cause of viral bronchiolitis. This review presents recent literature on the epidemiology, risk factors, pathophysiology, diagnosis, later sequels, therapeutic options and prevention of RSV infection in infants and children.
Bilateral agenesis of the diaphragm is a rare, life-threatening malformation. Infants with this d... more Bilateral agenesis of the diaphragm is a rare, life-threatening malformation. Infants with this defect rarely survive to have surgical intervention. We report a 32-week premature female infant who was born to a 36-year-old mother via vaginal delivery. The pregnancy course was complicated by hypertension and polyhydramnios. Cytogenetic study showed a normal 46 XX female karyotype. She had cyanosis, respiratory distress and scaphoid abdomen at birth. A roentgenograph confirmed the diagnosis of diaphragmatic hernia. Surgery was performed at 21 h of age. Bilateral agenesis of diaphragm, herniation of abdominal organs and oesophagus and pulmonary hypoplasia were noted. Furthermore, stomach and spleen were adherent to the mediastinum and vertebrae. The patient developed hypotension and persistent hypoxaemia and expired at age of 26 h. Autopsy revealed bilateral agenesis of diaphragm, hypoplasia of lungs, and pancreas fibrosis with mild hypoplasia of islets of Langerhans. Bilateral agenesis of diaphragm associated with pancreas fibrosis is a rare entity, and its clinical significance needs further investigation.
Bronchopulmonary dysplasia (BPD) has been a critical morbidity in preterm infants. To improve our... more Bronchopulmonary dysplasia (BPD) has been a critical morbidity in preterm infants. To improve our definition and prediction of BPD is challenging yet indispensable. We aimed to apply machine learning (ML) to investigate effective models by using the recently-proposed and data-driven definition to predict late respiratory support modalities at 36 weeks' post menstrual age (PMA). We collected data on very-low-birth-weight infants born between 2016 and 2019 from the Taiwan Neonatal Network database. Twenty-four attributes associated with their early life and seven ML algorithms were used in our analysis. The target outcomes were overall mortality, death before 36 weeks' PMA, and severity of BPD under the new definition, which served as a proxy for respiratory support modalities. Of the 4103 infants initially considered, 3200 were deemed eligible. The logistic regression algorithm yielded the highest area under the receiver operating characteristic curve (AUROC). After attribute selection, the AUROC of the simplified models remain favorable (e.g., 0.801 when predicting no BPD, 0.850 when predicting grade 3 BPD or death before 36 weeks' PMA, and 0.881 when predicting overall mortality). By using ML, we developed models to predict late respiratory support. Estimators were developed for clinical application after being simplified through attribute selection.
Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui, 1995
Very low birth weights (VLBW) remain the major factor contributing to neonatal mortality and morb... more Very low birth weights (VLBW) remain the major factor contributing to neonatal mortality and morbidity. The development of Neonatal Intensive Care Units (NICU) has improved the outcome for the VLBW infants. However, outborn VLBW infants may have different outcomes, and different medical costs than those born intramurally. This study compared the mortality, morbidity and costs of inborn and outborn VLBW infants cared in the NICU of a tertiary care center. A total of 176 VLBW infants (inborn 83, outborn 93) were examined over the three years period June 1990 to May 1993. The birth weights (1131 +/- 244 g vs 1133 +/- 255 g) and gestational ages (29.0 +/- 4.0 wk vs 28.9 +/- 3.0 wk) were not different between the two groups. However, the age of admission to our wards was significantly different between the inborn infants (5.0 +/- 3.2 hr.) and outborn infants (53.6 +/- 26.8 hr.). There was no difference in mortality rates between the outborn infants (35.7%) and the inborn infants (32.9%),...
Invasive interventions have been conducted in preterm infants with significant patent ductus arte... more Invasive interventions have been conducted in preterm infants with significant patent ductus arteriosus (PDA) when medical treatment has failed, and methods of invasive intervention have been reported. Surgical ligation via lateral thoracotomy has been a well-established procedure for decades. Recently, transcatheter occlusion has been safely and feasibly applied to the premature population. However, little research has been conducted on the benefits of transcatheter occlusion in very-low-birth-weight (VLBW) infants compared to surgical ligation. This study compared transcatheter and surgical techniques in VLBW infants in terms of short-term respiratory outcomes. The medical records of 401 VLBW infants admitted to a tertiary hospital between September 2014 and January 2019 were retrospectively reviewed. Patients who were diagnosed with a congenital anomaly, a chromosomal anomaly, or congenital heart disease, except for an inter-atrial shunt, were excluded. The perinatal conditions, ...
BACKGROUND To study the distribution of the birthplaces of very-low-birth-weight (VLBW) infants a... more BACKGROUND To study the distribution of the birthplaces of very-low-birth-weight (VLBW) infants and examine whether delivery at different levels of hospital affects neonatal and infant mortality. METHODS This population-based cohort study was retrieved from Taiwan Maternal and Child Health Database. Livebirth singleton VLBW infants born between 2011 and 2014, with BW between 500 and 1499 g and gestational age ≥22 weeks were enrolled. The main outcomes were risk-adjusted odds ratios (aOR) of neonatal and infant mortality by birthplace, which was categorized as medical center (MC), regional hospital (RH), district hospital (DH), and clinic (C) based on Taiwan's hospital accreditation system. RESULTS Of 4560 VLBW infants enrolled, 3005 (66%) were born in MCs, 1181 (26%) in RHs, 213 (5%) in DHs, and 161 (4%) in Cs. Neonatal mortality rates were 10%, 15%, 16%, 17%, and infant mortality rates were 13%, 17%, 18%, 21%, if born in MCs, RHs, DHs and Cs, respectively. The aORs for neonatal and infant mortality were 1.94 (95% CI 1.53-2.48) and 1.67 (1.34-2.08) for those born in RHs, 2.26 (1.38-3.70) and 1.82 (1.16-2.86) for infants born in DHs/Cs, as compared to those born in MCs. For VLBW infants born in RHs, DHs, and Cs and postnatally transferred to MCs, the aORs of neonatal and infant mortality were lower than those who were not transferred. CONCLUSION VLBW infants born outside of MCs had higher neonatal and infant mortality and a two-fold higher risk of mortality than those born in MCs. When possible, VLBW infants should be born in MCs.
Background: Very-low-birth weight (VLBW) infants, defined as those with a birth body weight (BBW)... more Background: Very-low-birth weight (VLBW) infants, defined as those with a birth body weight (BBW) ＜1,501g, are at high risk for mortality. Compared to the traditional survival rate, which simply reflects the overall survival rate, the conditional survival rate provides the future life expectancy at a given postnatal age and is more practical clinically. This study explores and compares the conditional survival rate and traditional survival rate of VLBW infants in a tertiary medical center. Methods: Two-hundred and eighty-eight VLBW infants admitted to the neonatal intensive care unit (NICU) of a tertiary medical center were enrolled. Patients were stratified by BBW in 100g intervals and gestational age (GA) in weekly intervals. The conditional survival rate and traditional survival rate were calculated for both stratification methods. Results: The overall survival rate was 80.6%. More than half of all deaths (53.5%) occurred in the first week of life. The conditional survival rate i...
Bronchopulmonary dysplasia (BPD) has been a critical morbidity in preterm infants. To improve our... more Bronchopulmonary dysplasia (BPD) has been a critical morbidity in preterm infants. To improve our definition and prediction of BPD is challenging yet indispensable. We aimed to apply machine learning (ML) to investigate effective models by using the recently-proposed and data-driven definition to predict late respiratory support modalities at 36 weeks’ post menstrual age (PMA). We collected data on very-low-birth-weight infants born between 2016 and 2019 from the Taiwan Neonatal Network database. Twenty-four attributes associated with their early life and seven ML algorithms were used in our analysis. The target outcomes were overall mortality, death before 36 weeks’ PMA, and severity of BPD under the new definition, which served as a proxy for respiratory support modalities. Of the 4103 infants initially considered, 3200 were deemed eligible. The logistic regression algorithm yielded the highest area under the receiver operating characteristic curve (AUROC). After attribute selecti...
Journal of Autism and Developmental Disorders, 2022
Autism spectrum disorder (ASD) is reportedly more prevalent in urban areas partly because of bett... more Autism spectrum disorder (ASD) is reportedly more prevalent in urban areas partly because of better accessibility and affordability to healthcare. With universal health insurance coverage in Taiwan, a previous study has shown no urban-rural disparity in the utilization rate of a child's preventive healthcare. Under this circumstance, we followed a birth cohort of 176,273 live births from 2006 to 2015 to detect the differences in ASD incidence between urbanicities. After adjusting for socioeconomic factors, children were 1.28 (95% confidence interval (CI): 1.13-1.44) and 1.54 (95% CI: 1.36-1.75) more likely to acquire ASD in satellite and urban areas compared with those in rural areas, respectively. A gradient association between parental educational attainment and ASD incidence was also noted. Greater ASD incidences in more urbanized areas and more advanced educated parents' children were detected under a circumstance with low barriers to healthcare.
We studied the outcomes at school age in children who had participated in a doubleblind, placebo-... more We studied the outcomes at school age in children who had participated in a doubleblind, placebo-controlled trial of early postnatal dexamethasone therapy (initiated within 12 hours after birth) for the prevention of chronic lung disease of prematurity. methods Of the 262 children included in the initial study, 159 lived to school age. Of these children, 146 (72 in the dexamethasone group and 74 in the control group) were included in our study. All the infants had had severe respiratory distress syndrome requiring mechanical ventilation shortly after birth. In the dexamethasone group, 0.25 mg of dexamethasone per kilogram of body weight was given intravenously every 12 hours for one week, and then the dose was tapered. We evaluated the children's growth, neurologic and motor function, cognition, and school performance. results Children in the dexamethasone group were significantly shorter than the controls (P=0.03 for boys, P=0.01 for girls, and P=0.03 for all children) and had a significantly smaller head circumference (P=0.04). Children in the dexamethasone group had significantly poorer motor skills (P<0.001), motor coordination (P<0.001), and visualmotor integration (P=0.02). As compared with the controls, children in the dexamethasone group also had significantly lower full IQ scores (mean [±SD], 78.2±15.0 vs. 84.4±12.6; P=0.008), verbal IQ scores (84.1±13.2 vs. 88.4±11.8, P=0.04), and performance IQ scores (76.5±14.6 vs. 84.5±12.7, P=0.001). The frequency of clinically significant disabilities was higher among children in the dexamethasone group than among controls (28 of 72 [39 percent] vs. 16 of 74 [22 percent], P=0.04). conclusions Early postnatal dexamethasone therapy should not be recommended for the routine prevention or treatment of chronic lung disease, because it leads to substantial adverse effects on neuromotor and cognitive function at school age.
Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui, 1995
Fetal tachycardia sometimes is quite difficult to treat, especially when the fetus has congestive... more Fetal tachycardia sometimes is quite difficult to treat, especially when the fetus has congestive heart failure. Sustained supraventricular tachycardia and hydrops had been diagnosed in a fetus as early as the 27th week of gestational age. A variety of antiarrhythmic agents, including digoxin, digoxin in combination with quinidine or propranolol or verapamil, have been prescribed for the mother, always in a vain effort of conversion of the tachycardia. A baby was born via vaginal delivery at 35 weeks' gestation because of premature labor. The tachycardia disappeared immediately after birth, but several episodes of tachycardia occurred during the neonatal period, and were converted only by electric cardioversion or intravenous amiodarone. Oral amiodarone was then prescribed for three months to prevent recurrence. The baby has lived well without attacks during a one-and-a-half-year follow-up.
Long-time average spectrum (LTAS) was used to analyze the cry phonations of 26 infants under four... more Long-time average spectrum (LTAS) was used to analyze the cry phonations of 26 infants under four months old; 16 of them are full-term and the other 10 infants are preterm. The results of first spectral peak, mean spectral energy, spectral tilt, high frequency energy were used to compare the cry phonatory between full-term and preterm infants. In addition, cry duration and percent phonation is also compared. According to previous studies, full-term and preterm infants’ crying behavior show significant differences because immature neurological development of preterm infants. Major findings in this study are: (1) There was no significant difference in unedited cry phonation across groups; (2) There was no significant difference in percent phonation across groups; (3) There was no significant difference in first spectral peak across groups, and no significant difference within groups could be found. However, full-term infants have higher first spectral peak than that of preterm infants...
Neonatal transport is an integral part of perinatal regionalization and the pattern could be affe... more Neonatal transport is an integral part of perinatal regionalization and the pattern could be affected by the policy of payment. This study evaluated the impact of National Health Insurance on the results of neonatal transport in the Tainan area. We collected regional data on the transported neonates obtained over two time periods. The first group (n=260) was collected between July 1991 and May 1992, and the second group (n=473) was collected between August 1997 and March 1999, three years after the implementation of National Health Insurance. The percentage of low-birth weight neonates transported was not different between the two periods (59.6% vs 59.1%). The frequency of endotracheal tube intubation performed by the transport team (41.3% vs 21%, p<0.01) was lower in the latter group. The incidence of hypothermia was similar between the two groups (20.7% vs 19.8%). The incidence of hypoglycemia (26.8% vs 13%, p<0.01), acidemia (35.3% vs 26%, p<0.01), infant mortality (19.7...
Objectives: To investigate the course of prolonged hypoglycemia in full-term, small for gestation... more Objectives: To investigate the course of prolonged hypoglycemia in full-term, small for gestational age (SGA) newborns and their neurologic outcomes. Materials and Methods: We retrospectively reviewed the medical records of full-term SGA newborns born in National Cheng Kung University Hospital between November 1, 1991 and December 31, 2001. They were routinely screened for hypoglycemia at the ages of 1, 2, 4, 6, 12, 24, and 48 hours by dextrostix testing. Hypoglycemia was defined as a glucose value lower than 35 mg/dL within 3 hours, lower than 40 mg/dL between 3 and 24 hours, and lower than 45 mg/dL at more than 24 hours of age. Serum cortisol and insulin levels were determined when the duration of hypoglycemia was exceeded 7 days. Data on risk factors and neurologic outcomes were collected and analyzed. Results: Thirty- five full-term SGA newborns developed hypoglycemia after birth. Eight (23%) of them had hypoglycemia for longer than 48 hours and recovered within 7 days of age; 8...
Background. Family-centered care for preterm infants in Western societies has yielded short-to me... more Background. Family-centered care for preterm infants in Western societies has yielded short-to medium-term benefits. However, the intervention effects have rarely been validated in Eastern societies. Objective. The aim of this study was to examine whether a family-centered intervention program (FCIP) could improve the short-term medical and neurobehavioral outcomes in preterm infants with very low birth weight (VLBW; a birth weight of <1,500 g) in Taiwan over the outcomes seen with a usual care program (UCP). Design. This was a multicenter, single-blind, randomized controlled trial study. Setting. Three medical centers in northern and southern Taiwan were the locations for the study. Participants. The participants were 251 VLBW preterm infants without severe perinatal complications. Intervention. The infants were randomly assigned to receive the FCIP or the UCP during hospitalization. Measurements. Infant morbidities, feeding, growth, and neurobehavioral performance were evaluated during the neonatal period. Parental adherence to interventions was measured in the FCIP group. Results. The FCIP promoted earlier full enteral feeding (β =-1.1 weeks; 95% CI =-1.9 to-0.2 weeks) and hospital discharge (β =-0.6 week; 95% CI =-1.1 to-0.1 weeks), greater weight gain (β = 3.3 g/d; 95% CI = 0.1 to 6.6 g/d), and better neurobehavioral performance than the UCP (β = 1.2 points; 95% CI = 0.2 to 2.3 points). Furthermore, a higher degree of parental motivation in interventions, goal attainment, and comprehensiveness of home activities was significantly associated with greater effects in infants' neurobehavioral performance and weight gain (r = .20-.31; all Ps < .05). Limitations. The findings may not be generalized to preterm infants with severe perinatal diseases and parents with a low level of interest in interventions. Conclusions. Family-centered care facilitated short-term medical and neurobehavioral outcomes in VLBW preterm infants in Taiwan; the effects were likely achieved through Post a comment for this article at: https://academic.oup.com/ptj
RSV is the most common cause of viral bronchiolitis. This review presents recent literature on th... more RSV is the most common cause of viral bronchiolitis. This review presents recent literature on the epidemiology, risk factors, pathophysiology, diagnosis, later sequels, therapeutic options and prevention of RSV infection in infants and children.
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