Pediatrics & Neonatology RSS feed: Current Issue. Pediatrics and Neonatology is the official peer-reviewed publication of the Taiwan Pediatric Association and The Society of Neonatology ROC, and is indexed in EMBASE and SCOPUS. Articles on clinical and laboratory research in pediatrics and related fields are eligible for consideration. http://www.pediatr-neonatol.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. Pediatrics & Neonatology1875-9572526December 2011 © 2011 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.pediatr-neonatol.com/article/PIIS1875957211001306/abstract?rss=yesUltrasonography and computed tomography are the initial imaging methods of choice for evaluating the pediatric pancreaticobiliary diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is often performed when they fail to provide an accurate diagnosis. Percutaneous transhepatic cholangiography (PTC) is preferred when ERCP is unsuccessful or in patients with biliary-enteric anastomoses where ERCP is not technically feasible. However, both ERCP and PTC are invasive procedures and have a risk of complications, such as pancreatitis.Magnetic Resonance Cholangiopancreatography in the Evaluation of Pediatric Pancreaticobiliary DiseasesHsun-Chin Chao10.1016/j.pedneo.2011.10.002Pediatrics & Neonatology 52, 6 (2011)2011-11-17Pediatrics & Neonatology2011-11-17526S1875-9572(11)X0007-4Editorials305306http://www.pediatr-neonatol.com/article/PIIS187595721100129X/abstract?rss=yesAsthma is one of the most common chronic disorders in childhood, which imposes a growing burden on society in terms of morbidity, quality of life, and health care costs. In addition to current medications, such as bronchodilator, inhalation of corticosteroid, leukotriene modifier, and anti-immunoglobulin E (IgE) antibody, some traditional medicines have also shown the therapeutic effect on asthma. Propolis, a natural resinous product collected by honeybees, has exhibited various biological activities. In an ovalbumin-sensitized airway inflammatory animal model, propolis extracts could suppress the serum levels of ovalbumin-specific IgE and immunoglobulin G1 (IgG1) and airway hyperresponsiveness. Moreover, propolis was used as an adjuvant to treat patients with mild to moderate asthma in a clinical trial. The results showed that the number of nocturnal asthma attacks significantly decreased and the lung function improved in patients receiving propolis.Caffeic Acid Phenethyl Ester Possessing Various Immunomodulatory Effects Is a Potentially Effective Therapy for AsthmaYao-Hsu Yang10.1016/j.pedneo.2011.10.001Pediatrics & Neonatology 52, 6 (2011)2011-11-21Pediatrics & Neonatology2011-11-21526S1875-9572(11)X0007-4Editorials307308http://www.pediatr-neonatol.com/article/PIIS1875957211001185/abstract?rss=yesRett syndrome (RTT), a neurodevelopmental condition characterized by delayed-onset loss of spoken language and the development of distinctive hand stereotypies, affects approximately 1 in 10,000 live female births. Clinical diagnosis has been based on symptoms such as loss of acquired purposeful hand skills, autistic behaviors, motor dysfunctions, seizure disorders, and gait abnormalities. RTT is a genetic disease and is caused almost exclusively by mutations in the X-linked gene, MECP2, to produce a phenotype that is thought to be primarily of neurological origin. Clinical reports show RTT patients to have a smaller brain volume, especially in the cerebral hemispheres, and alterations in various neurotransmitter systems, including acetylcholine, dopamine, serotonin, glutamate, substance P, and various trophic factors. Because of its monogenetic characteristic, disruption of Mecp2 is readily recapitulated in mice to produce a prominent RTT-like phenotype and provide an excellent platform for understanding the pathogenesis of RTT. As shown in human studies, Mecp2 mutants also display subtle alterations in neuronal morphology, including smaller cortical neurons with a higher-packing density and reduced dendritic complexity. Neurophysiological studies in Mecp2-mutant mice consistently report alterations in synaptic function, notably, defects in synaptic plasticity. These data suggest that RTT might be regarded as a synaptopathy (disease of the synapse) and thus potentially amenable to rational therapeutic intervention.Rett Syndrome: From Bed to BenchShih-Ming Weng, Mark E.S. Bailey, Stuart R. Cobb10.1016/j.pedneo.2011.08.002Pediatrics & Neonatology 52, 6 (2011)2011-11-07Pediatrics & Neonatology2011-11-07526S1875-9572(11)X0007-4Review Article309316http://www.pediatr-neonatol.com/article/PIIS1875957211001197/abstract?rss=yesObjective: The increasing incidence of pediatric Crohn’s disease (CD) is well known in Western countries in the last two decades. This study was conducted to delineate the trends of incidence during this period and clinical patterns of pediatric CD in Taiwan.Methods: All children admitted to National Taiwan University Hospital between 1990 and 2009 who met the Porto Criteria for CD were included. Annual enrollment and clinical characteristics were retrospectively reviewed. The incidence was calculated by dividing the number of index cases by total hospitalized pediatric cases to minimize the bias caused by the growing number of hospitalized patients there. We quoted data and statistics from the Department of Health, Executive Yuan, Taiwan, and Accounting and Statistics, Executive Yuan, Taiwan, to present the social-economic changes in Taiwan in the recent decades.Results: The cumulative hospital-based incidence of CD rose from 13.2 per 100,000 to 25.4 per 100,000 children admitted to this hospital in the past two decades. The median age of diagnosis in the first decade of this study was less than that of the second decade. The other study parameters, including gender, disease activity at diagnosis, duration from disease onset to diagnosis, anatomic location and disease behavior, and symptoms at diagnosis, were not different.Conclusions: This study showed that the hospital-based incidence of pediatric CD has been increasing in Taiwan in recent decades. Factors contributing to such an increase could be physicians’ awareness of the disease, easier access to health care, and environmental factors.Characteristics and Incidences of Pediatric Crohn’s Disease in the Decades Before and After 2000Yu-Mei Shen, Jia-Feng Wu, Huey-Ling Chen, Hong-Yuan Hsu, Mei-Hwei Chang, Te-Kuei Hsieh, Yen-Hsuan Ni10.1016/j.pedneo.2011.08.003Pediatrics & Neonatology 52, 6 (2011)2011-11-07Pediatrics & Neonatology2011-11-07526S1875-9572(11)X0007-4Original Articles317320http://www.pediatr-neonatol.com/article/PIIS1875957211001203/abstract?rss=yesBackground: Although significant advances have been made in perinatal care, retinopathy of prematurity (ROP) remains a serious complication in prematurely born individuals. There have been limited studies on ROP in Taiwan, and most of those existing reports are outdated.Methods: This retrospective study included 252 very-low-birth-weight (VLBW) infants admitted to the neonatal intensive care unit of Chang Gung Children’s Hospital over a 2-year period between July 2005 and June 2007. All infants were examined for ROP according to the guidelines published by the American Academy of Pediatrics. The relationship between clinical risk factors and the development of ROP was analyzed.Results: Of the 252 VLBW infants, 216 met the screening criteria. Of the 216, 99 (45.8%) had ROP. Compared with neonates born at 29 weeks of gestational age (GA) or later, those very premature infants of ≤25weeks’ and 26–28 weeks’ GA had increased odds ratios (OR) of 8.49 and 3.19, respectively, for the development of severe ROP. No ROP was detected in infants of greater than 33 weeks’ GA. The simultaneous presence of a low GA, low birth weight (LBW), lower Apgar scores, hypotension, patent ductus arteriosus, septicemia, intraventricular hemorrhage, ventilator dependence, and use of postnatal steroids was associated with severe ROP. Using multiple logistic regression analyses for ROP, only maternal preeclampsia [OR, 2.52; confidence interval (CI), 1.32–4.7]; duration of mechanical ventilation (OR, 1.06; CI, 1.04–1.08); and LBW (OR, 2.62; CI, 1.370–3.375) predicted the development of threshold ROP.Conclusion: The incidence of ROP among VLBW infants was 45.8%; 19.0% had severe ROP. Infants of lower GAs and/or with LBW, whose mother had preeclampsia or who had a long duration of mechanical ventilation are at risk for the development of threshold ROP.Analysis of Incidence and Risk Factors of Retinopathy of Prematurity Among Very-low-birth-weight Infants in North TaiwanChang-Yo Yang, Reyin Lien, Peng-Hong Yang, Shih-Ming Chu, Jen-Fu Hsu, Ren-Huei Fu, Ming-Chou Chiang10.1016/j.pedneo.2011.08.004Pediatrics & Neonatology 52, 6 (2011)2011-11-14Pediatrics & Neonatology2011-11-14526S1875-9572(11)X0007-4Original Articles321326http://www.pediatr-neonatol.com/article/PIIS1875957211001215/abstract?rss=yesBackground: Asthma is a chronic inflammatory disease of the airways for which current treatments are mainly based on pharmacological interventions, such as glucocorticoid therapy. Our objective was to study the immunoregulatory effects of caffeic acid phenethyl ester (CAPE, a phytochemical synthesized from propolis) on cytokine secretion of peripheral blood mononuclear cells (PBMCs) from asthmatic children.Methods: PBMCs from asthmatic children (5.5±3.3 years old, n=28) and healthy children (5.6±2.8 years old, n=23) were co-cultured with CAPE in vitro with and without phorbol-12-myristate-13-acetate-ionomycin.Results: Our results show that predominant interleukin 4 (IL-4) and interferon-gamma secretion of cultured supernatant were detected in healthy donors compared with asthmatics. In the presence of phorbol-12-myristate-13-acetate-ionomycin, with or without CAPE treatment, the asthmatic children showed significantly decreased levels of IL-10 secretion compared with the healthy controls. However, CAPE significantly decreased IL-10 and interferon-gamma in healthy donors. There was a slight but not statistically significant reduction of IL-4 secretion in CAPE-treated PBMCs compared with untreated control PBMCs from the healthy children. Our data also shows that CAPE significantly enhanced transforming growth factor-beta 1 production from PBMCs from asthmatic children.Conclusion: The immunoregulatory effects of CAPE on human PBMCs may be through the induction of regulatory T cells, as evidenced by the enhanced transforming growth factor-beta 1 production from PBMCs from asthmatic children in our study.The Immunoregulatory Effects of Caffeic Acid Phenethyl Ester on the Cytokine Secretion of Peripheral Blood Mononuclear Cells From Asthmatic ChildrenLeticia Bautista Sy, Li-King Yang, Chiau-Juno Chiu, Wen-Mein Wu10.1016/j.pedneo.2011.08.005Pediatrics & Neonatology 52, 6 (2011)2011-11-14Pediatrics & Neonatology2011-11-14526S1875-9572(11)X0007-4Original Articles327331http://www.pediatr-neonatol.com/article/PIIS1875957211001227/abstract?rss=yesBackground: Magnetic resonance cholangiopancreatography (MRCP) is an innovative and noninvasive technique for evaluating the biliary tree and pancreatic duct in children. The aim of this study was to assess the usefulness of MRCP as a noninvasive method to evaluate the biliary system in children.Methods: We retrospectively reviewed the records of patients undergoing MRCP between October 2002 and May 2007 for suspected biliary system abnormalities. MRCP findings were compared with other imaging modalities, operative findings, and clinical endpoints.Results: Complete data were available for 60 patients (35 girls, 25 boys; mean age 2 years, 33 children less than 1 year old). Ultrasound was performed in all 60 patients. Twenty-two patients had choledochal cyst, and 19 had a thin or invisible gall bladder. Endoscopic retrograde cholangiopancreatography was done in two patients. The sensitivities and specificities of MRCP for diagnosing choledochal cyst and biliary atresia were 100.0% and 100.0% and 86.7% and 100.0%, respectively. Surgery was performed in 37 patients, including 21 with a choledochal cyst, 14 with biliary atresia, and 1 with a pancreatic duct stone.Conclusion: MRCP is useful method for evaluation of the pancreaticobiliary system in pediatric patients. It yields a high degree of accuracy in the diagnosis of biliary atresia and choledochal cyst.Usefulness of Magnetic Resonance Cholangiopancreatography in Pancreatobiliary Abnormalities in Pediatric PatientsChang-Ting Huang, Hung-Chang Lee, Wai-Tao Chen, Chuen-Bin Jiang, Shin-Lin Shih, Chun-Yan Yeung10.1016/j.pedneo.2011.08.006Pediatrics & Neonatology 52, 6 (2011)2011-11-07Pediatrics & Neonatology2011-11-07526S1875-9572(11)X0007-4Original Articles332336http://www.pediatr-neonatol.com/article/PIIS1875957211001239/abstract?rss=yesBackground: The use of thoracostomy tube for drainage of parapneumonic effusion is an important therapeutic measure. In this study, we compared the effectiveness and complications between chest tube and pigtail catheter thoracostomy for drainage of parapneumonic pleural effusion in children.Methods: We retrospectively reviewed the medical records of children with parapneumonic effusion during the period of July 2001 through December 2003. Patients who received thoracostomy with either chest tube or pigtail catheter were enrolled into this study. Medical records, such as age, sex, clinical presentation, subsequent therapies, hospital stay, laboratory data, and complications, were collected and compared between these two methods of intervention.Results: A total of 32 patients (17 boys and 15 girls; age range, 2–17 years; mean age, 14 years) were enrolled into the study. Twenty patients were treated with traditional chest tubes, whereas 12 patients were treated with pigtail catheters. In the chest tube group, drainage failure occurred in one patient and pneumothorax occurred in two patients. In the pigtail catheter group, drainage failure occurred in two patients, but no case was complicated with pneumothorax. There were no significant differences in either drainage days or hospitalization days between the chest tube group and pigtail catheter group (6.0±2.6 vs. 5.9±3.8, p=0.66; 12.5±5.6 vs. 17.3±8.5, p=0.13).Conclusion: The effectiveness and complications of the pigtail catheter were comparable to those of the chest tubes.Comparison of Pigtail Catheter With Chest Tube for Drainage of Parapneumonic Effusion in ChildrenChien-Heng Lin, Wei-Ching Lin, Jeng-Sheng Chang10.1016/j.pedneo.2011.08.007Pediatrics & Neonatology 52, 6 (2011)2011-11-14Pediatrics & Neonatology2011-11-14526S1875-9572(11)X0007-4Original Articles337341http://www.pediatr-neonatol.com/article/PIIS1875957211001240/abstract?rss=yesBackground/Purpose: The outcome of extremely low birth weight (ELBW, ≤1000g) infants has recently been improved in Taiwan. However, their postdischarge anthropometry and development have seldom been explored. We report these results for ELBW infants at corrected age of 2 years in a tertiary care center.Methods: This descriptive and retrospective study enrolled ELBW infants discharged alive from a tertiary care center from January 2004 to December 2007. A scheduled follow-up program up to 2-year corrected age was tightly controlled by a case manager. Bayley Scales of Infant Development-Second Edition, representing the mean±1 standard deviation as 100±15 in normal population, was used to assess infants’ development. An index less than 70 was regarded as abnormal. Anthropometry, including body weight (BW), body length (BL), and head circumference (HC), against the growth standard from the World Health Organization was assessed. Growth delay was defined as growth parameters below the 10th percentile values.Results: One hundred ELBW infants were enrolled. Eighty of them were discharged alive (80% surviving), and their follow-up rates were 91% at 6 months, 90% at 12 months, and 83% at 24 months corrected ages. The 2-year survival rate was 75%. The percentages of delayed growth in BW/BL/HC, presented as (male vs. female), were (33/41/37 vs. 38/25/45) at 6 months, (31/31/50 vs. 41/22/37) at 12 months, and (39/36/54 vs. 26/29/38) at 24 months. The negative means of the Z score for BW/BL/HC in both genders indicated ELBW infants had significant growth delay compared with those of the normal population. The index of Bayley scales was significantly lower in ELBW infants than that in normal population at each age. Male infants had lower mental development index and psychomotor development index at 2 years than females. About 61% of those with BW less than 750g died or had neurodevelopmental impairment.Conclusion: ELBW infants have a high incidence of growth and developmental delay at corrected age of 2 years, particularly in male infants or those with BW less than 750g. This study reveals that ELBW infants require well predischarge planning and postdischarge follow-up.Growth and Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants: A Single Center’s ExperienceYung-Chieh Lin, Yuh-Jyh Lin, Chyi-Her Lin10.1016/j.pedneo.2011.08.008Pediatrics & Neonatology 52, 6 (2011)2011-11-07Pediatrics & Neonatology2011-11-07526S1875-9572(11)X0007-4Original Articles342348http://www.pediatr-neonatol.com/article/PIIS1875957211001252/abstract?rss=yesHenoch-Schönlein purpura (HSP) or hepatitis C virus (HCV) infection was reported in association with malignancies. However, HSP and HCV infection rarely present in pediatric patients with non-Hodgkin’s lymphoma. We describe an 8-year-old girl with Stage-IV diffuse large B-cell lymphoma who presented with HSP and elevated HCV antibody titer at diagnosis and at relapse. After treatment, purpura disappeared and HCV antibody titer returned to normal range. There was no recurrence of HSP or elevated HCV antibody during a follow-up of 2 years.Henoch-Schönlein Purpura and Elevated Hepatitis C Virus Antibody in a Girl With Nasopharyngeal Diffuse Large B-Cell LymphomaJen-Yin Hou, Hsi-Che Liu, Der-Cherng Liang, Yin-Sum Choi, Chia-Ying Lin, Ting-Chi Yeh10.1016/j.pedneo.2011.08.009Pediatrics & Neonatology 52, 6 (2011)2011-11-14Pediatrics & Neonatology2011-11-14526S1875-9572(11)X0007-4Case Reports349352http://www.pediatr-neonatol.com/article/PIIS1875957211001264/abstract?rss=yesPyomyositis is a pyogenic muscular tissue infection mainly occurring in immunocompromised patients. Chronic myeloid leukemia (CML) accounts for only 2–3% of cases of childhood leukemia. Herein, we report on a 17-year-old male with bilateral hip pain caused by adductor pyomyositis before beginning the treatment course of CML. CML was diagnosed by bone marrow chromosome study and was treated initially with imatinib but switched to hydroxyurea 5 days later because of poor cytoreduction response. Subsequently, white blood cell counts decreased gradually; however, the hyperleukocytosis condition resolved very slowly again until we switched back to imatinib use on the 40th day of hospitalization. Pyomyositis was diagnosed by magnetic resonance imaging. Oxacillin was administered to cover Staphylococcus aureus, the most common pathogen of pyomyositis. Bilateral hip pain improved within 72 hours after antibiotic usage, but follow-up magnetic resonance imaging after 15 days of treatment revealed well-defined abscess and osteomyelitis of both femoral heads. Abscess incision and drainage were performed, and cultures of the drained pus grew no microorganisms. The patient completed 5 weeks of oxacillin treatment after the operation and recovered with a full range of motion of both hips. There was no residual disability. This is the first report of bilateral hip pain caused by pyomyositis as the initial presentation of CML. Pyomyositis needs to be considered in the differential diagnosis of hip pain in pediatric patients.Bilateral Hip Pain Caused by Adductor Pyomyositis as the Initial Presentation of Chronic Myeloid Leukemia in a 17-Year-Old ChildMing-Chun Chen, Shang-Hsien Yang, Ting-Kuo Yao, Pau-Nyen Chong, Shu-Huey Chen10.1016/j.pedneo.2011.08.010Pediatrics & Neonatology 52, 6 (2011)2011-11-14Pediatrics & Neonatology2011-11-14526S1875-9572(11)X0007-4Case Reports353357http://www.pediatr-neonatol.com/article/PIIS1875957211001276/abstract?rss=yesAsymmetrical form of conjoined twinning (heteropagus) is an extremely rare event with an incidence of 1–2 million live births. The incomplete component of heteropagus, namely, parasite, usually consists of rudimentary organs. Therefore, the autosite component of heteropagus can be separated successfully. A wide spectrum of associated congenital cardiac malformations, which are usually minor, has been described in autosites. However, a single-ventricle heart anomaly in the autosite has been reported in a very few cases. We report an unusual case of heteropagus with a complex cardiac malformation. To the best of our knowledge, this is the third heteropagus case in the literature with a single-ventricle heart in the autosite.An Unusual Case of Heteropagus: Autosite With a Complex Cardiac MalformationHulya Ozkan-Ulu, Yavuz Yilmaz, Fatma Nur Sari, Nahide Altug, Nurdan Uras, Ugur Dilmen10.1016/j.pedneo.2011.08.011Pediatrics & Neonatology 52, 6 (2011)2011-11-07Pediatrics & Neonatology2011-11-07526S1875-9572(11)X0007-4Case Reports358360http://www.pediatr-neonatol.com/article/PIIS1875957211001288/abstract?rss=yesAnti-N-methyl-d-aspartate (NMDA) receptor encephalitis is a treatment-responsive encephalitis associated with anti-NMDA receptor antibodies, which bind to the NR1/NR2 heteromers of the NMDA receptors. It is a highly characteristic syndrome evolving in five stages: the prodromal phase (viral infection-like symptoms), psychotic phase, unresponsive phase, hyperkinetic phase, and gradual recovery phase. It has been considered as a paraneoplastic syndrome usually affecting childbearing-age female with ovarian tumors; however, recent reports suggest a much higher incidence of nonparaneoplastic cases in children. We report a 14-year-old girl with anti-NMDA receptor encephalitis without a detectable tumor who showed a nearly complete recovery after intensive immunotherapy.Anti-N-Methyl-d-Aspartate Receptor EncephalitisTe-Yu Hung, Ning-Hui Foo, Ming-Chi Lai10.1016/j.pedneo.2011.08.012Pediatrics & Neonatology 52, 6 (2011)2011-11-07Pediatrics & Neonatology2011-11-07526S1875-9572(11)X0007-4Case Reports361364