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Background and Purpose: To study the epidemiology, presentation and laboratory findings of Chlamydia trachomatis pneumonia in hospitalized infants younger than 6 months., Methods: Between January 2001 and December 2005, infants younger than 6 months admitted to the children's medical center of Taipei Veterans General Hospital with the diagnosis of acute bronchiolitis, bronchopneumonia or pneumonia were prospectively studied. Chest radiograph findings were reviewed in all patients. Basic laboratory examinations performed included white blood cell count and eosinophil count. C. trachomatis was detected via enzyme-linked immunosorbent assay antigen test and the titers of immunoglobulin G and immunoglobulin M by indirect immunoperoxidase assay., Results: A total of 60 infants, 32 males and 28 females, were included. C. trachomatis infection was detected in 30% of patients (18/60). The median age was 2.5 months (range, birth to 6 months). Fever was not detected in 72% of patients (13/18). Only 22% (4/18) of these patients had the characteristic staccato cough. The mean duration of symptoms before admission was 8 days (range, 1 day to 2 months). Rhinorrhea was a prodromal symptom in 67% (12/18) of patients, with a mean pre-onset duration of 7 days (range, 1 to 14 days). Eighty three percent (15/18) of the patients had tachypnea, with a mean duration of 3.2 days (range, 1 to 7 days). Conjunctivitis was noted before admission in 6 patients (33%). Only peripheral eosinophils showed statistically significant difference between Chlamydia-positive and -negative disease (p=0.046), and may be clinically useful in cases of suspected C. trachomatis infection. Mixed infection with other pathogens including adenovirus, respiratory syncytial virus, Mycoplasma pneumoniae, cytomegalovirus and Streptococcus pneumoniae was found in 27% (5/18) of patients., Conclusions: C. trachomatis is not infrequent and plays an important role in infants younger than 6 months old hospitalized due to lower respiratory tract infection.

Background and Purpose: To assess the etiologic agents, presentation, laboratory findings, treatment, clinical outcome and prognostic factors of pyogenic arthritis in pediatric patients., Methods: We reviewed the medical records of patients under 18 years of age with a diagnosis of septic arthritis from January 1971 to July 2004. Information collected included clinical characteristics, laboratory data, response to therapy and outcome. An unsatisfactory clinical outcome was defined as the development of sequelae including ambulatory disability, limb-length discrepancy, chronic osteomyelitis, and abnormalities of bone growth., Results: A total of 60 children who met the criteria for diagnosis of septic arthritis were included. The etiologic agent was identified in 71.7% of the patients. Staphylococcus aureus was the most common etiologic agent in all age groups (59.0%). The erythrocyte sedimentation rate was higher than 20 mm/h in 89% of patients and soft tissue swelling was the most common radiographic finding (16.7%). Lower extremity involvement was found in 90.8% of patients and the knee joint was most commonly involved. The clinical outcome was unsatisfactory in 28.3% of patients. The duration of symptoms before the initiation of treatment was significantly longer in patients with sequelae (4.2 vs 13.1 days, p<0.01), and the neutrophil percentage in peripheral blood was also significantly higher in this group (81.5% vs 65.7%, p=0.027)., Conclusions: Delayed treatment and increased neutrophil ratio in peripheral blood were significantly associated with an increased risk of sequelae.

Background: Total anomalous pulmonary venous return (TAPVR) is an uncommon congenital cardiovascular anomaly with poor natural prognosis. It has been detected more frequently in recent year due to the advent of echocardiography and cardiovascular magnetic resonance imaging (MRI). The aim of this study was to evaluate the clinical manifestations and outcomes in TAPVR patients with or without pulmonary venous obstruction (PVO)., Methods: From January 1985 to December 2002, a total of 27 cases with TAPVR at our institution were reviewed. Accurding to the preseace or assence of PVO, patients were divided into PVO group and non-PVO group. Patients' sex, age at diagnosis, types of TAPVR, clinical manifestations, surgical treatment and outcomes were evaluated., Results: All of them had received 2-dimensional (2-D) and color Doppler echocardiography examination. Cardiac catheterization was performed in all but 1 patient who died at the first day of birth. In addition, 10 of 27 cases had cardiovascular MRI for further study. The number of cases in PVO group and non-PVO group were 15 (56%) and 12 (44%), respectively. There was no significant difference in sex or pulmonary venous drainage sites between both groups. Cyanosis was more prevalent in the PVO group (80% vs. 30%, p = 0.038). Four (27%) cases PVO group and 3 (25%) cases of the non-PVO group had of the non-isolated cardiac lesions. Pulmonary hypertension was present in 18 (69%) of 26 cases who had received cardiac catheterization. Among them, 10 had PVO and 5 had systemic level of pulmonary arterial pressure. Seven (30%) of 23 patients who had received operation died; in contrast, 3 of 4 patients without operation expired. The remaining 1 did not had surgery because of complex heart disease. There was no significant difference in surgical mortality between PVO and non-PVO groups (33% vs. 27%)., Conclusions: Cyanosis is an obvious clinical symptom of obstructed TAPVR. Surgical mortality made no significant difference between obstructed and non-obstructed groups. Early detection and surgical treatment for TAPVR are important. Although cardiac catheterization and angiocardiography is the golden standard for the diagnosis, 2-D and color Doppler echocardiography can also provide quick and accurate diagnostic images of TAPVR.

Background: Infections cause significant mortality and morbidity in neonates, especially the premature ones. Although there are various antibiotics can be used to combat neonatal infection, resistant strains have subsequently emerged. In an epidemiological survey, we analyzed bacterial isolates and their antibiotic susceptibilities for cases of bacteremia in a neonatal intensive care unit (NICU) of a teaching hospital., Methods: From November 1999 to October 2001, 623 neonates admitted to the NICU were enrolled. The incidence and incidence density of bacteremia, morbidity and mortality of sepsis, as well as antibiotic susceptibility, were investigated., Results: Totally, 754 blood cultures were done on 623 patients. Fifty-eight patients experienced 85 episodes of bacteremia, with 87 isolates cultured. The incidence of bacteremia in our NICU was 9.31% (58/623) with an incidence density of 10.98/1000 patient-days. The overall mortality rate was 7.22%. The case fatality rate of bacteremia was 20.7% (12/58). The bacterial pathogens encountered, in order of frequency, were coagulase-negative Staphylococcus (29%), Staphylococcus aureus (22%), and Enterobacter cloacae (17%). All of the gram-positive bacteria were susceptible to vancomycin, while the gram-negative bacteria were susceptible to imipenem, amikacin and ciprofloxacin. Oxacillin-resistant S. epidermidis, oxacillin-resistant S. aureus, and multi-drug resistant enterobacteriae were the leading microorganisms causing bacteremia in our NICU., Conclusions: It is an endless struggle to combat neonatal infection. Periodic evaluation of bacterial antibiotic susceptibility is necessary. More judicious selection of antibiotics and rotating antibiotic regimens should be kept in mind to reduce the resurgence of multidrug resistant strains.

Plasma electrolyte concentrations in premature infants are unstable, and hyperkalemia may induce significant, even life-threatening, symptoms in tiny infants. The medical records of 95 premature infants were retrospectively reviewed. Patients with a major congenital anomaly or mortality within 24 h after birth were excluded. Plasma electrolytes, blood urea nitrogen, creatinine, blood pH, urine output, and related clinical conditions during first 96 h of life were analyzed. Plasma potassium concentrations had significant negative correlations with gestational age and birth weight (p < 0.05). Infants with a gestational age of less than 29 weeks had significantly higher potassium concentrations (average 5.9 +/- 0.3 mEq/L, peak 7.8 +/- 0.4 mEq/L, p < 0.05) than other gestational age groups, and their plasma potassium levels were significantly higher at 24 and 48 h of age (p < 0.05). Forty-two infants (42/95, 44%) had peak plasma potassium concentrations greater than or equal to 6 mEq/L. With statistical analysis, the hyperkalemic infants comprised of significantly (p < 0.05) fewer males (31% vs. 55%), they had more-severe respiratory distress syndrome (RDS) (grades 2 +/- 0 vs. 1 +/- 0, p < 0.05), and needed more frequent use of inotropics (52% vs. 23%, p < 0.05) compared to normokalemic infants. In conclusion, hyperkalemia during the first 2 days of life is common in extremely premature infants. Small gestational age, very low birth weight, female gender, high RDS grade, need of exogenous surfactant and inotropic agents, delayed feeding, and a high mortality rate were observed in hyperkalemic infants.

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is a very rare congenital disease characterized by abdominal distension due to a dilated urinary bladder, microcolon and decreased or absent intestinal peristalsis. Most patients die at an early age. We report on a female baby with this syndrome which was associated with duodenal web and tracheobronchial malacia. The literature on this syndrome is also reviewed.

We report a case of congenital biliary atresia and liver cirrhosis who developed hepatopulmonary syndrome thirteen years after Kasai operation. This 15-yea-old girl suffered from hyperbilirubinemia and acholic stool since birth. Congenital biliary atresia was diagnosed at 6 weeks of age and she received Kasai operation when liver cirrhosis was also found during the surgery. Dyspnea and cyanosis insidiously occurred since the age of 13 and she had been admitted to our hospital due to episodes of esophageal varices bleeding where esophageal varices ligation was performed. Serial examinations showed PaO2: 71 mmHg despite of 100% oxygen supplement. Pulmonary catheterization showed multiple arteriovenous shunts and macroaggregated albumin test revealed significant shunting. Contrast-enhanced echocardiogram showed microbubbles in the left heart. Thus, hepatopulmonary syndrome type II was diagnosed. Treatment is a dilemma although liver transplantation with concomitant lung transplantation is a possible choice.

Forty-eight cases of adenovirus pneumonia in children were treated in the Department of Pediatrics of Taipei Veterans General Hospital from January 1998 through December 2000. The clinical characteristics of these patients were compared with those of a control group of 70 patients with non-adenovirus pneumonia mostly caused by Mycoplasma pneumoniae and other viruses during the same period. No difference was found between the adenovirus and non-adenovirus groups in age, sex, duration of fever, and hospitalization days. Chest retraction and extrapulmonary manifestations were significantly more common in the adenovirus group, especially conjunctivitis, gastroenteritis, lymphadenopathy, bleeding diathesis, and exanthema. C-reactive protein levels were significantly higher in the study group than in the control group. In the adenovirus group, 2 patients died and 5 had permanent lung damage after adenovirus infections. No mortality or long-term sequelae were found in the non-adenovirus group. Adenovirus may cause diseases manifesting predominantly as fever and lower respiratory tract infection that may require hospitalization. Extrapulmonary manifestations were observed in more than half of children with adenovirus infections. Adenoviral pneumonia can be fatal and permanent lung damage may be noted during the follow-up period.

Background: Obesity impairs performance in most athletic events. The prevalence of obesity in Taiwan has increased over the past decades. It is important to understand any alterations in cardiopulmonary responses to exercise in obese children. The purpose of this study is to evaluate the cardiorespiratory response to graded treadmill exercise testing protocol in obese children., Methods: Twenty obese and 10 control children between 8 to 12 years of age were recruited among patients at Pediatric Clinics. The treadmill was set at a grade of 10% to perform continuous treadmill walking. Measures of cardiopulmonary responses were recorded. Height, weight and body mass index were determined before testing., Results: Cardiopulmonary responses including heart rate (HR), systolic pressure (SP), rate-pressure product (RPP) and forced vital capacity (FVC) were significantly different between obese children and normal children during and after exercise. The correlations of cardiopulmonary function to age, sex, height, body weight, triceps and biceps skinfold thickness were assessed, and a significant correlation was found between HR and age (r = 0.5, p < 0.05), as well as biceps skinfold thickness (r = 0.5, p < 0.05). There was also a good correlation between predicted values of FVC and age (r = -0.5, p < 0.05). The HR (r = 0.79, p < 0.05) was in correlation with tricep skinfold thickness in normal healthy children., Conclusions: In conclusion, there appears to show a relatively less efficient cardiopulmonary response in obese children. Regular exercise that improves fitness and body composition should have a favorable effect on obese children.