Biomedical subjects

C H Lin

Publications and source records attributed to C H Lin.

442 records · Page 25Linked to original sources

PubMedDate not supplied

Outcome and cost of intensive care for very low birth weight infants.

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%), nor in the incidence of intraventricular hemorrhage, respiratory distress syndrome, sepsis, necrotizing enterocolitis, retinopathy of prematurity or abnormal auditory brainstem response. However the incidence of patent ductus arteriosus and chronic lung disease of the outborn infants was higher than those of the inborn (47% vs 32%, 51% vs 29% respectively). The mean duration of hospitalization and cost seemed to be longer and higher in the outborn VLBW infants. It was concluded that outborn VLBW infants have higher rates of morbidity, longer hospitalization and cost more than inborn infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Care Costs↗

PubMedDate not supplied

Refractory fetal supraventricular tachycardia with hydrops: report of one case.

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.

Adult↗

PubMedDate not supplied

Renal effects and urinary excretion of prostaglandin following indomethacin therapy in premature infants with patent ductus arteriosus.

Renal side effects and urinary prostaglandin were evaluated in 10 premature infants (Mean +/- SD: BW 1245 +/- 290 gm, GA 32 +/- 2.2 wks, Postnatal age 7.7 +/- 3.8 days) with significant PDA who were given one dose of indomethacin (0.3 mg/kg intravenously). There was a significant decrease in urinary output, osmolal and free water clearance after therapy. The fractional excretion of sodium, chloride, potassium, glomerular filtration rate and urinary prostaglandin E2 also decreased but were not statistically different from the baseline values. In infants who responded to indomethacin with ductus closure, their renal functions appeared to be preserved even though they had higher plasma indomethacin levels than the non-responders in whom significant changes in renal function were observed following indomethacin therapy. This observation suggested that the improved renal hemodynamics following the closure of the ductus may minimize or attenuate the renal side effects of indomethacin.

Ductus Arteriosus, Patent↗

PubMedDate not supplied

Investigation and elimination of epidemic methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit.

A recent outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in neonatal intensive care unit (NICU) in a teaching hospital was investigated. A total of 25 MRSA isolates, 16 from the patients and nine from the staffs (carriers), was collected for the study. The possible relationship among the isolates was investigated by using antibiograms and restriction enzyme analysis of plasmid DNA. Control strategy of the MRSA nosocomial infection was proposed after the study of antibiograms and plasmid profile. There were four plasmid patterns (I-IV), each containing 7, 8, 2, and 8 isolates. Six of the 16 isolates from the patients had identical plasmid patterns as the carriers (I and II). Person to person transfer via hand contact by medical personnel was found to be the most frequent mode of transmission identified in the outbreak of MRSA nosocomial infection in the NICU. Our strategy for control of the outbreak and elimination of the MRSA from all patients and carriers was successful after intensive surveillance and control measures. These included (a) strict isolation and cohorting; (b) hand washing between patient contacts to prevent transmission; (c) treatment of the carrier state in health care workers and patients with safe and effective topical agents such as mupirocin.

Cross Infection↗

PubMedDate not supplied

The clinical application of transcutaneous bilirubinometry in full-term Chinese infants.

The pattern of jaundice in Chinese full-term newborns has seldom been explored. This study was to 1) investigate the correlation between transcutaneous bilirubin indices (TcB) and serum bilirubin levels; 2) use TcB to follow the pattern of jaundice in Chinese full-term newborns; and 3) compare the sensitivity and specificity of TcB measured from the forehead (TcB1), and mid-sternum (TcB2) by receiver operating characteristic curves (ROC curves). From April 1 to August 31, 1989, a total of 3217 TcB were obtained from 305 inborn full-term newborns (male 175, female 130) during their first 6 days of life. The correlation between serum bilirubin levels and TcB measured from the forehead (TcB1) and from the mid-sternum (TcB2) was good (r = 0.82 and 0.86 respectively). For formula-fed infants, both TcB1 (16.3 +/- 3.0) and TcB2 (16.6 +/- 2.7) reached peak levels at 78-84 hours of age, while in mixed-fed infants, peak levels were noted at 54-60 and 84-90 hours for TcB1 (17.2 +/- 2.2) and TcB2 (16.6 +/- 2.6) respectively. The incidence of hyperbilirubinemia was 5.9 per cent. There were no differences in peak TcB levels between formula-fed and mixed-fed infants. The ROC curves suggested that TcB2 is better than TcB1 in sensitivity and specificity. It is concluded that TcB is a reliable device for monitoring jaundice in Chinese full-term newborns. Peak level of jaundice occurred at the third to fourth day of age. The incidence of hyperbilirubinemia in Chinese infants has decreased, for reasons which need further investigation.

Bilirubin↗

PubMedDate not supplied

Systemic fungal infection in very low-birth-weight infants.

This retrospective study was designed to investigate the related factors and outcome of systemic fungal infection in very low-birth-weight (VLBW) infants. Medical records of infants admitted to the neonatal intensive care unit of National Cheng Kung University Hospital between January 1990 and June 1994 were reviewed. Of the 262 VLBW infants, 15 (5.7%) had fungemia (14 Candida 1 Cryptococcus) during the study period. Among the fungemic infants, 60% also had urinary tract infection; 18% had central nervous system infection. Their mean birth weight was 1079 +/- 78 g (504-1474 g), and the gestational age was 28.6 +/- 0.6 weeks (23-32 weeks). Thirteen of them (87%) had respiratory distress syndrome and patent ductus arteriosus, while 60% had chronic lung disease. The percentage of antibiotic usage, parenteral hyperalimentation, endotracheal intubation, placement of central venous line and steroid therapy were 100%, 100%, 73%, 67% and 36% respectively. The mean age at diagnosis of fungemia was 40.5 +/- 4.8 days (10-76 days). Common clinical manifestations were respiratory deterioration (93%), poor feeding (58%) and fever (53%). The frequency of side effects of amphotericin B in decreasing order were: hypokalemia (54%), hyponatremia (31%) and decreased urine amount (23%). The mortality rate was 40%. It was concluded that systemic fungal infection in VLBW infants might result in high mortality and the side effects were high in the treated infants.

Amphotericin B↗

PubMedDate not supplied

Upper airway obstruction caused by vascular anomalies in children.

Vascular ring or sling is one of the important etiologies for congenital upper airway obstruction in children. Between July 1988 and July 1995, a total of 92 children with stridor were initially evaluated by an esophagogram and two-dimensional echocardiogram. Seven children (7.7%) with variable types of vascular anomalies were diagnosed including pulmonary artery sling (2 cases), double aortic arch (1 case), right arch with left aberrant subclavian artery and ligamentum ductus (1 case), double aortic arch with one atretic arch (2 cases), and innominate artery compression of the trachea (1 case). The age at diagnosis ranged from 18 days to 3 years old. Only one patient was associated with an intracardiac anomaly. Five of the 7 patients were diagnosed as having laryngomalacia previously. Six patients had esophageal indentation on their esophagograms. Besides external airway compression, three patients also had intrinsic tracheal stenosis. Six patients received surgery because of severe respiratory distress. The patients' symptoms improved after surgery, but a premature baby died after a second operation for intrinsic tracheal stenosis at the age of 8 months.

Airway Obstruction↗

PubMedDate not supplied

Conversion disorders in childhood and adolescence: a psychiatric consultation study in a general hospital.

From March 1986 to April 1995, 418 consecutive psychiatric consultations for patients aged 18 or below were completed. Ten of these patients met the Diagnostic and Statistical Manual of Mental Disorders, 4th. edition (DSM-IV) diagnostic criteria for a conversion disorder. The medical and psychiatric consultation records of these patients were reviewed. Chief conversion symptoms included pseudoseizure (four cases), gait disturbance (two cases), abnormal movement (one case), four limbs weakness (one case), aphonia (one case) and tunnel vision (one case). The psychosocial problems of the patients included family problems (seven cases), interpersonal problems (two case) and concurrent physical illness (one case). Six patients (60%) manifested complete remission and others showed improvement of the symptoms.

Adolescent↗

PubMedDate not supplied

Vital statistics of premature and low birthweight infants in Tainan area.

UNLABELLED: Birth weight and gestational age are strongly associated with perinatal mortality and morbidity. This study was conducted to survey the vital statistics of premature and low birthweight infants in the Tainan area. Between July 1991 and April 1992, fifteen medical institutions were included on a voluntary basis: eight from level I (obstetric specialty clinic), six from level II (regional hospital), and one from level III (tertiary care center). A total of 14,307 deliveries were enrolled, accounting for about 60% of the total delivery for that year in the area. The proportions of delivery among level I, II and III were 52%, 41% and 7%, respectively. The incidence of premature singleton live birth was 4.6%, and the percentages of gestation between 20-27 weeks, 28-31 weeks and 32-37 weeks were 0.2%, 0.6% and 3.8%, respectively. The premature births accounted for 3.5%, 4.8% and 11.3% of live births at the level I, II and III hospitals, respectively. The incidence of low birthweight and very low birthweight singleton live births was 4.4% and 0.5%, respectively. The low birthweight births accounted for 3.5%, 4.5% and 11.1% of live births at the level I, II and III hospitals, respectively. The data revealed that the higher the level of hospital, the higher incidences of premature and low birthweight infant. Teenage mothers (< 20 year of age) had higher low birthweight rate. The risk of having low birthweight infants decreased progressively in mothers of age < 20 (6.3%), 20-24 (5.4%), 25-29 (4.1%) and 30-34 (3.8%), whereas it became higher in mothers older than 35 (4.8%). CONCLUSION: The incidence of premature and low birthweight births in the Tainan area was low. Teenager or those with maternal age older than 35 year were high risk groups for producing these infants.

Adolescent↗

PubMedDate not supplied

Pseudomonas aeruginosa endophthalmitis in prematurity: report of two cases.

Invasive bacterial eye infections in the neonate range from perforating keratitis to endophthalmitis. Endophthalmitis secondary to Pseudomonas aeruginosa has gained clinical and therapeutic importance since mortality rates are high and prognosis concerning preservation of vision is poor, especially in premature infants. We presented two cases with meningitis, septicemia and P. aeruginosa endophthalmitis. If premature infants develop a sepsis-like picture with cloudy cornea and purulent conjunctivitis, we have to consider the possibility of endophthalmitis and do a full ophthalmologic evaluation. Treatment should be started early and consists of systemic antibiotic therapy, as in septicemia. As P. aeruginosa spreads easily, prompt isolation and strict handwashing are indicated.

Anti-Bacterial Agents↗