Neonates In Taiwan Research Articles

Prevalence of cytomegalovirus DNAemia and genotypic distribution among childbearing mothers and neonates in Taiwan

BackgroundCongenital cytomegalovirus (CMV) infection is the leading cause of neurologic disabilities and sensorineural hearing loss in children. However, in Taiwan, there is limited information on the genotypic diversity and prevalence of perinatal CMV infection in both mothers and neonates. The aim of this study was to screen samples from both mothers and umbilical cord blood for CMV at the time of delivery and to determine the CMV genotypic distribution. MethodsBetween June 2012 and July 2015, residual maternal and umbilical cord blood samples were collected from consenting participants admitted to the Chang Bing Show Chwan Memorial Hospital in central Taiwan. The blood samples were screened for CMV DNA using real-time PCR assay, and the genotypic classification of the CMV UL55, UL144, and US28 genes was determined by sequencing and phylogenetic analysis. ResultsA total of 1282 mother-neonate paired samples were enrolled in the study, 95.3% of whom were Taiwanese. CMV DNA was detectable in 6.2% of the maternal blood samples, with a significantly higher rate noted in non-Taiwanese mothers (11.7%,p=0.027). For the 1,282 umbilical cord blood samples, CMV DNA was detectable in 5.3% of the samples. The presence of CMV DNA in maternal blood was positively associated with the presence of CMV DNA in umbilical cord blood (p=0.01). In addition, the UL55, UL144, and US28 genotypic distribution was similar between mothers and neonates. ConclusionThe prevalence of CMV DNAemia in childbearing mothers and neonates is similar and their genotypic distribution implies potential CMV infection during pregnancy.

Characterization of group B Streptococcus colonization in full-term and Late-Preterm neonates in Taiwan

Group B streptococcus (GBS) infections can be life-threatening in newborns. This study aimed to analyze GBS carriage status and genotypic diversity in healthy neonates after implementation of intrapartum antibiotic prophylaxis (IAP) in Taiwan. Newborns carrying GBS were identified from a screen of 500 newborns and followed up until their cultures turned negative. Their mothers' GBS screening data were reviewed. Molecular methods, including capsular serotyping, multilocus sequence typing and pulsed-field gel electrophoresis (PFGE), were used to analyze GBS isolates. GBS colonization was detected at either the nose or anus in 11 of 500 healthy neonates (2.2%). In this group of 11 neonates, 4 had GBS serotypes II and III for 4-6 months, 1 had serotype V for 2 months, 6 had serotypes Ia, II, V, and VI for less than 1 month, and 1 had 2 different serotypes (serotypes V and II) at different times. The most prevalent serotype was II (33.3%), followed by Ia (25.0%), III (16.7%), V (16.7%), and VI (8.3%). The main sequence type was ST1 (50.0%), followed by ST19 (16.7%), ST23 (8.3%), ST24 (8.3%), ST103 (8.3%), and ST 231 (8.3%). All isolates were grouped into 5 PFGE clusters F, G, J, X, and Y, and all were susceptible to β-lactam antimicrobial agents. GBS was carried in 2.2% (11/500) healthy newborns and persisted for 6 months in 3 neonates. This study makes clearer our understanding of GBS colonization, serotype distribution, and genotype distribution in healthy neonates.

Reexamining the ideal depth of endotracheal tube in neonates

The appropriate endotracheal tube (ET) depth for the newborn with respiratory failure is important. Inappropriate ET depth increases the risk of uneven lung expansion and collapse. This retrospective study aimed to compare the final ideal ET depth with Tochen's formula in Taiwanese intubated neonates, and to determine the correlation between neonatal factors and final ideal ET depth, and to devise an accurate predictive formula for use in Taiwan. Data were collected from neonates who required endotracheal intubation and who were admitted to the Neonatal Intensive Care Unit from 2011 to 2015. Correlations between the final ideal ET depth, GA, and BW were assessed using the Pearson correlation test. Multiple regression analysis was used to produce a formula to predict appropriate ET depth from mouth angle to midtracheal position of neonates. A total of 139 neonates were enrolled in this study. The final ideal ET depth was in concordance with Tochen's formula only in 19 neonates (13.7%); relatively deeper in 30 (21.6%) neonates; and shallower than the values from Tochen's formula in 90 (64.7%) neonates. Multiple regression analysis showed that the BW and GA together produced best prediction for final ideal ET depth in our study population. SGA and gender were shown to be insignificantly related to final ideal ET depth. Our study showed the final ideal ET depth was shallower than Tochen's formula in 64.7% of neonates. Tochen's formula might not be suitable to predict ET depth for neonates in Taiwan. In our study, the new formula: 4.0+1.0 BW (kg)+0.05 GA (weeks) provides a more accurate value and alternative method for evaluating the final ideal ET depth in Taiwan. A practical guideline for Asian neonates should be validated by prospective studies with large sample sizes.

The impact of prenatal group B streptococcus screening as a national health policy in Taiwan

ObjectiveThere was no national data on group B streptococcus (GBS) infections in Taiwan. Until 2012, when prenatal GBS screening was introduced to obstetric practices as a national health policy aimed at reducing neonatal GBS infections. The purpose of this study was to examine the impact of this national health policy on the incidence of maternal GBS colonization and neonatal GBS infection rate. Relatedly, the clinical characteristics of neonatal GBS infection were investigated to determine the correlations between the incidence of maternal GBS colonization and the neonatal GBS infection rate. Materials and methodsThis population-based nationwide study used data for 2012–2013 from the National Health Insurance Research Database of Taiwan. A total of 789 newly diagnosed pregnant women with genital GBS infection were recruited. ResultsThe maternal GBS screening rate was 93.2%. The maternal colonization rate of GBS was around 8.2%, and the incidence of neonatal GBS infection was 22.6%. The data indicate that no sepsis was developed in any of the cases, while fever was found in 3 cases (3/179, 1.7%) and UTI was found in 1 case (1/179, 0.6%). ConclusionsWe conclude that a policy calling for universal maternal rectovaginal cultures for GBS with intrapartum antibiotic prophylaxis is a good national policy for reducing morbidity due to GBS infections in neonates in Taiwan.

Urinary Neutrophil Gelatinase-Associated Lipocalin Levels in Neonates

Acute kidney injury (AKI) is common in preterm infants and is associated with high mortality and morbidity. New biomarkers for the early detection of AKI have been identified. Specifically, urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a new and powerful biomarker for AKI and sepsis. Our study evaluated the reference range of uNGAL in healthy neonates in Taiwan. This study examined 24 preterm and 38 term infants without clinical complications. Urine samples were collected and the uNGAL values were measured at postnatal age (PNA) 3 days, 7 days, 14 days, and 21 days in the preterm infants and at PNA 3 days in the term infants. The uNGAL values were tested using enzyme-linked immunosorbent assay. The median uNGAL values in the preterm infants at PNA 3 days, 7 days, 14 days, and 21 days were 41.52ng/mL, 35.82ng/mL, 43.79ng/mL, and 30.85ng/mL, respectively. The median value at PNA 3 days in the term infants was 88.1ng/mL. No significant differences associated with gestational age, birth body weight, or PNA were observed among the preterm infants. However, the uNGAL values in the female term infants were higher than those in the male term infants (p=0.003). This study presents preliminary data on uNGAL levels in neonates in Taiwan. A large-scale study investigating the correlations between uNGAL and with gestational age, birth body weight, sex, and PNA is recommended.

Nationwide Twin Birth Weight Percentiles by Gestational Age in Taiwan

Nationwide birth weight norms for twins have been reported in several countries across different ethnicities, but such data have not been established in Taiwan. The purpose of this study was to develop reference growth charts that are population-based and contain the information of birth weight percentiles by gestational age for twin neonates in Taiwan. In this study, we collected nationwide birth weight data for twins by sex and gestational age through the Taiwan Birth Registry. Percentiles, means, and standard deviations of birth weight for each 1-week increment of gestational age from 21 weeks of gestation were estimated and smoothed using weighted polynomial models. The 10(th), 50(th), and 90(th) percentiles of birth weight born at the 37(th) gestational week were 2174 g, 2580 g, and 3125 g for male twins, respectively, and they were 2100 g, 2500 g, and 3000 g for female twins, respectively. The 10(th), 50(th), and 90(th) percentiles of birth weight born at the 40(th) gestational week were 2326, 3285, and 3790 g for male twins, respectively, and they were 2200 g, 2770 g, and 3690 g for female twins, respectively. This is the first nationwide birth weight norm for twins in Taiwan, which is particularly useful for investigation into the predictors and outcomes of altered fetal growth through twin studies in the Taiwanese population.

To Explore the Neonatal Nurses’ Beliefs and Attitudes Towards Caring for Dying Neonates in Taiwan

(1) To explore attitudes and beliefs of neonatal nurses toward nursing care for dying neonates; (2) to estimate the influence of neonatal nurses' personal and professional characteristics on their attitudes towards end-of life care for dying infants. A cross-sectional design was used. A questionnaire was used to collect data from 80 neonatal nurses. Research setting was four level III NICUs at four medical centers around the central region of Taiwan. Research participants were neonatal nurses who had worked for at least 1 year in one of level III NICUs and had been directly involved with the care of dying infants. Research participants were 80 neonatal nurses (response rate 100 %). Research findings identified eight barriers hindering neonatal palliative care practice. These barriers were insufficient communication due to the lack of an in-service educational program; the lack of available counseling help for neonatal clinicians; inability to express personal opinions, values and beliefs towards neonatal palliative care; insufficient staffing; the lack of unit policies/guidelines for supporting palliative care; the technological imperative; parental demands and personal beliefs about death and previous experience caring for dying infants. Further studies are needed to explore each barrier and to provide in-service neonatal palliative care educational programs that are needed to decrease these barriers.

Group B Streptococcal Infection in Taiwan: Maternal Colonization and Neonatal Infection

There is no national data on group B streptococcus (GBS) infection in Taiwan. We investigated incidence of maternal GBS colonization and neonatal GBS infection rate and clinical pictures of neonatal GBS infection to estimate the value of intrapartum chemoprophylactic strategy in Taiwan. From January 2004 to June 2005, a prospective study to estimate maternal colonization rate by maternal rectovaginal culture at six hospitals was conducted. Neonatal GBS infection rate based on inborn infants was calculated retrospectively from January 2001 to June 2005; clinical pictures of infants diagnosed with invasive GBS disease were reviewed. Maternal colonization rate of GBS was around 20% at hospital base, incidence of neonatal GBS infection was 1 per 1000 live births of infants born at hospitals. There were 221 infants with GBS infection: in 142, the disease occurred within 7 days of birth (early-onset disease, EOD), and in 79, it developed later (late-onset disease). Infantile EOD was more often seen in mothers with premature rupture of membrane, often accompanied by respiratory failure necessitating ventilator support. Infants with late-onset disease often manifested fever, leukopenia, thrombocytopenia, and meningitis. Fifteen infants died, mostly of EOD type (12 of 15). Risk factors of mortality included rescue at delivery room, leukopenia, thrombocytopenia, sepsis, respiratory distress, persistent hypertension of newborn, respiratory failure needing intensive respiratory support (intermittent mandatory ventilator and high frequency oscillatory ventilator), surfactant use, shock, and congenital heart diseases. We concluded that universal maternal rectovaginal culture of GBS with intrapartum antibiotic prophylaxis is an urgent call to reduce EOD and mortality because of GBS infection in neonates in Taiwan.

Utilizing Nasal-Tragus Length to Estimate Optimal Endotracheal Tube Depth for Neonates in Taiwan

To assess the application of the nasal-tragus length (NTL) to predict the proper endotracheal tube (ETT) depth; also, as relatively thinner size of Asian than Caucasian, the fitness of using the NTL to estimate the optimal ETT depth for neonates in Taiwan was examined. The newborn infants who do need intubation orally were included. Those with midface dysmorphism, craniofacial anomalies, head trauma and/or facial injury in whom it was unable to measure NTL, were excluded. The data were collected after a satisfactory ETT tip position was confirmed on chest roentgenogram. Equations were established via the polynomial and the linear regression of the NTL and the actual ETT; simplified formulae as NTL+0.5 and NTL+1 were assumed accordingly. Paired t test was used to assess the coefficients. The 63 neonates, weighing 410 through 4,196 g and with gestation 21 through 41 weeks, were enrolled. No statistical difference was found between the actual ETT depth and the estimated ETT depth via the NTL+1 cm in neonates weighing ≤ 2,500 g (n=41, p=0.06), and also between the actual ETT depth and the estimated ETT depth via the NTL+0.5 cm in group weighing >2,500 g (n=22, p=0.171). Using the NTL to predict the optimal ETT depth with the formula, NTL plus 1 cm, was clinically practical for newborn infants in Taiwan weighing ≤ 2,500 g, and a modified formula, NTL plus 0.5 cm, was more suitable for neonates weighing >2,500 g.

Neonatal jaundice and molecular mutations in glucose-6-phosphate dehydrogenase deficient newborn infants

Molecular mutations of the glucose-6-phosphate dehydrogenase (G6PD) gene and clinical manifestations of neonatal jaundice in 112 male and 50 female Chinese neonates with G6PD deficiency were studied. In the 112 males, the nucleotide (nt) 1376 (G-->T) mutation was the dominant type (50.0%), followed by nt 1388 (G-->A) (16.1%), nt 493 (A-->G) (8.0%), nt 1024 (C-->T) (6.2%), nt 95 (A-->G) (5.4%), nt 392 (G-->T) (1.8%), nt 487 (G-->A) (1.8%), nt 871 (G-->A) (0.9%), and nt 1360 (C-->T) (0.9%). The nt 871 variant has not been reported in Taiwan before. The occurrence rates for nt 1376, nt 1388, nt 493, nt 95, and nt 1024 mutations in the 50 females were 44.0%, 18.0%, 12.0%, 6.0%, and 6.0%, respectively. The type of G6PD mutation in 10 male and 7 female neonates has not been identified yet. Although G6PD deficient neonates had higher frequency of phototherapy than G6PD normal neonates in both sexes, a significant difference in the prevalence of hyperbilirubinemia (peak bilirubin > or = 15.0 mg/dl) between G6PD deficient and normal neonates was found only in males. Further analysis showed that duration of phototherapy was longer in G6PD deficient male neonates than in the control group, while the outcome of phototherapy was better in subjects with non-nt 1376 mutations than subjects with the nt 1376 mutation. Most (78.3%) of the 23 G6PD deficient neonates who subsequently suffered from neonatal hyperbilirubinemia carried the nt 1376 mutation. The results of this study indicate that the nucleotide substitution at 1376 is the most common and important mutation for G6PD deficiency in Chinese neonates in Taiwan.

Precocious synthesis of adult haemoglobin in Chinese neonates in Taiwan.

Vox SanguinisVolume 20, Issue 4 p. 381-383 Precocious Synthesis of Adult Haemoglobin in Chinese Neonates in Taiwan1 R. Q. Blackwell, Corresponding Author R. Q. Blackwell Biochemistry Department, US Naval Medical Research Unit No. 2, Taipei, Taiwan and Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan US Naval Medical Research Unit No. 2, Box 14, APO San Francisco, CA 96263 (USA) Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (Republic of China)Search for more papers by this authorJ. T.-H. Huang, Corresponding Author J. T.-H. Huang Biochemistry Department, US Naval Medical Research Unit No. 2, Taipei, Taiwan and Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan US Naval Medical Research Unit No. 2, Box 14, APO San Francisco, CA 96263 (USA) Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (Republic of China)Search for more papers by this authorC.-S. Liu, Corresponding Author C.-S. Liu Biochemistry Department, US Naval Medical Research Unit No. 2, Taipei, Taiwan and Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan US Naval Medical Research Unit No. 2, Box 14, APO San Francisco, CA 96263 (USA) Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (Republic of China)Search for more papers by this authorWen-Tsuo Chiang, Corresponding Author Wen-Tsuo Chiang Biochemistry Department, US Naval Medical Research Unit No. 2, Taipei, Taiwan and Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan US Naval Medical Research Unit No. 2, Box 14, APO San Francisco, CA 96263 (USA) Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (Republic of China)Search for more papers by this author R. Q. Blackwell, Corresponding Author R. Q. Blackwell Biochemistry Department, US Naval Medical Research Unit No. 2, Taipei, Taiwan and Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan US Naval Medical Research Unit No. 2, Box 14, APO San Francisco, CA 96263 (USA) Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (Republic of China)Search for more papers by this authorJ. T.-H. Huang, Corresponding Author J. T.-H. Huang Biochemistry Department, US Naval Medical Research Unit No. 2, Taipei, Taiwan and Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan US Naval Medical Research Unit No. 2, Box 14, APO San Francisco, CA 96263 (USA) Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (Republic of China)Search for more papers by this authorC.-S. Liu, Corresponding Author C.-S. Liu Biochemistry Department, US Naval Medical Research Unit No. 2, Taipei, Taiwan and Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan US Naval Medical Research Unit No. 2, Box 14, APO San Francisco, CA 96263 (USA) Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (Republic of China)Search for more papers by this authorWen-Tsuo Chiang, Corresponding Author Wen-Tsuo Chiang Biochemistry Department, US Naval Medical Research Unit No. 2, Taipei, Taiwan and Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan US Naval Medical Research Unit No. 2, Box 14, APO San Francisco, CA 96263 (USA) Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (Republic of China)Search for more papers by this author First published: April 1971 https://doi.org/10.1111/j.1423-0410.1971.tb00457.x 1 This work was supported by the Bureau of Medicine and Surgery, Work Unit MR005.20–0099, Accepted: November 17, 1970. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume20, Issue4April 1971Pages 381-383 RelatedInformation

Precocious Synthesis of Adult Haemoglobin in Chinese Neonates in Taiwan

Precocious Synthesis of Adult Haemoglobin in Chinese Neonates in Taiwan