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ABSTRACT: OBJECTIVE: To compare the fat content and contamination of expressed breast milk (EBM) before and after storage (30 d) in hard polypropylene containers (HC) and soft polyethylene bags (SB) containers. METHODS: Ninety specimens of EBM were collected into HC and separated into two HC and two SB. The fat content of each specimen of EBM in HC and SB was measured and cultures were performed. The specimens in the second HC and SB containers were kept frozen for 30 d before thawing and then measuring the fat content and performing cultures. RESULTS: The means ± SD of the fat content of fresh and thawed EBM in HC were 2.98 ± 0.97 and 2.66 ± 0.88 g/100 ml, respectively, with a loss of 0.32 g/100 ml (p < 0.001). The means ± SD of the fat content of fresh and thawed EBM in SB were 3.06 ± 1.00 and 2.77 ± 0.91 g/100 ml, respectively, with a mean loss of 0.29 g/100 ml during storage (p < 0.001). The loss of fat content during frozen storage did not differ significantly between the two types of containers (p = 0.53). All bacterial cultures of fresh and thawed EBM in HC and SB showed only nonpathogenic organisms. CONCLUSIONS: SB can replace HC for the long-term storage of frozen EBM of up to 30 d without deleterious effects on fat loss or contamination.
The Indian Journal of Pediatrics 01/2013; · 0.52 Impact Factor
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ABSTRACT: BACKGROUND:: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a serious threat among critically ill neonates. METHODS:: We performed a case-case-control study in a Thai NICU to identify risk factors and outcomes for CRAB bacteremia. Case Group (CG) I was defined as cases with CRAB (n = 14) and CG II was defined as cases with carbapenem-susceptible A. baumannii (CSAB) (n = 38) bacteremia. The control group (n = 44) was selected from all patients admitted before and after 3 days that CG I was identified, but had no infection. RESULTS:: The mean gestational age and birth weight of CG I, II and control were 33.5, 35.2 and 35.2 weeks and 1,856.5, 2,273.9 and 2,309.5 grams, respectively. By multivariate analysis, CG I was more likely to have had an umbilical artery catheter (aOR = 29.30; P = 0.019) whereas CG II was more likely exposed to ceftazidime (aOR = 5.19; P = 0.046) and aminoglycosides (aOR = 35.59; P = 0.002). There was a significant difference in history of cefoperazone/sulbactam (21.4% vs. 0%; P = 0.01) and imipenem use (35.7% vs. 0%; P < 0.001) among CG I compared with control. Crude mortality in CG I was higher than CG II (42.9% vs. 13.2%; OR = 5.0; P = 0.02). CONCLUSION:: Our cohort of neonatal CRAB bacteremia is characterized by a very high mortality. Infection control interventions inclusive of strict adherence to infection-control process for central vascular line placement and maintenance as well as antimicrobial stewardship program are essential to help reduce CRAB bacteremia.
The Pediatric Infectious Disease Journal 08/2012; · 3.58 Impact Factor
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ABSTRACT: We report a case of neonatal meningitis due to Streptococcus gallolyticus subsp. pasteurianus born to a mother with an asymptomatic urinary tract infection due to Streptococcus group D and Escherichia coli. In the past, this organism may have been reported as Streptococcus bovis or S. bovis biotype II/2. Accurate identification of this organism is necessary to determine the etiology of infection and give correct treatment of neonatal meningitis, caused by this organism.
The Southeast Asian journal of tropical medicine and public health 01/2012; 43(1):145-51. · 0.60 Impact Factor
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ABSTRACT: Acute kidney injury (AKI) is a common contributor to morbidity and mortality in newborns, with prevalences varying by population and hospital. A study of AKI in newborns in tertiary care centers in Thailand, a developing country with limited resources, has not been conducted yet.
The aim of this study was to determine the prevalence of AKI in newborns in a tertiary care hospital in southern Thailand and to investigate the etiology, mortality and risk factors of mortality. The records of patients aged <30 days with high serum creatinine, admitted from 1984 to 2007, were retrospectively reviewed.
Eighty-eight boys and 51 girls were enrolled; 61.4% were premature and 56.5% had a birth weight <2500 g. The prevalence of newborn AKI increased from 0.9 to 6.3% during the 24-year study period. Thirty-nine and 65% had renal failure within 2 and 7 days post-birth, respectively. Sepsis was the most common cause of AKI (30.9%) followed by hypovolemia (18.7%), kidney, ureter and bladder (KUB) anomalies (12.2%), congestive heart failure (12.2%) and birth asphyxia (11.5%). Indomethacin caused AKI in 24.4% with gestational age <32 weeks. Sepsis-induced AKI had the highest mortality rate (65.1%) with an overall mortality rate of 38.8% and nearly 14 times the risk of death compared to hypovolemia-induced AKI.
The prevalence of newborn AKI in our Thai tertiary center over 24 years was 6.3% of admitted newborns. Sepsis was the most common cause of AKI and sepsis-induced AKI is the most common cause of death. Disease etiology was the only risk factor for mortality.
Nephrology Dialysis Transplantation 09/2011; 27(3):973-7. · 3.40 Impact Factor
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ABSTRACT: Congenital hepatic arteriovenous malformation is a rarely seen vascular malformation with persistent pulmonary hypertension in neonates. The authors report a full-term female newborn presenting with intractable heart failure and respiratory distress soon after birth. Investigation by echocardiography showed severe persistent pulmonary hypertension of the newborn and patent ductus arteriosus. The hepatic angiogram revealed congenital hepatic arteriovenous malformation; therefore, secondary pulmonary artery hypertension complicated with 'steal' phenomenon was conclusively diagnosed.
The Indian Journal of Pediatrics 07/2011; 79(5):673-5. · 0.52 Impact Factor
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ABSTRACT: Background: The standard preparation of fortified preterm human milk (FHM), 1 to 2 packs of human milk fortifier (HMF) in 50 milliliters of expressed breast milk (EBM), may fail to meet the theoretical requirements of ill preterm infants. The superfortified preparation of preterm human milk (SHM), 3 packs in HMF in 50 milliliters of EBM, however, leads to concerns about the osmolality of the preparation, as the higher the osmolality, the greater the risk of necrotizing enterocolitis.
Objective: We evaluated the effect of the superfortification of HMF on the osmolality of EBM
Material and method: Twelve samples of EBM were collected from mothers of a gestational age of less than 37 weeks. We measured the osmolality of the preterm human milk (PHM), FHM, and SHM. The SHM was kept at room temperature to measure the osmolality at 10 minutes after fortification.
Results: The means (SD) osmolality of the PHM and FHM were 293.9 (12.7), 335.2 (18.7) mOsm/kg H2O, respectively. The means (SD) osmolality of SHM immediately after fortification and 10 minutes after fortification at room temperature are 370.6 (17.4) and 369.8 (17.2) mOsm/kg H2O respectively.
Conclusions: The measured osmolality of SHM was less than 450 mOsm/kg H2O. This is still within the international reference range for the composition of PHM, except Ca, P, Zn, Cu, vitamin A, B1, B2, niacin, and folic acid. Therefore, SHM should be considered for feeding in only high-risk preterm neonates for short-term periods. Adverse effects need to be observed.
Asian Biomedicine. 01/2011; 5:825-830.
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ABSTRACT: To determine the mortality and morbidity rates of very low birth weight (VLBW) infants in Songklanagarind Hospital.
A retrospective study of all infants with birth weight < 1,500 g admitted to the neonatal intensive care unit between January 2003 and December 2006.
A total of 178 VLBW infants, met the enrollment criteria, with mean (+/- standard deviation-SD) birth weight and gestational age of 1,123 +/- 273 g and 29 +/- 3 weeks, respectively. Forty-two (23.6%) were referred from other hospitals. The overall mortality rate was 27.0%. Perinatal risk factors of mortality were birth weight < 1,000 g (p < 0.01), congenital anomalies (p < 0.01), and Apgar score at 1 minute < or = 5 (p < 0.01). Among the 130 (73.0%) survivors to discharge, 92 (70.8%) survived without major morbidity. The major morbidities were moderate/severe bronchopulmonary dysplasia, retinopathy of prematurity stage 3, necrotizing enterocolitis stage > or = 2 and intraventricular hemorrhage grade > or = III in 31 (23.8%), 12 (9.2%), 4 (3.1%) and 2 (1.5%) infants, respectively.
The mortality rate of VLBW infants in Songklanagarind Hospital was similar to other developing countries, although greater than in developed countries. Among survivors, the major morbidity rates were acceptable.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2010; 93(2):191-8.
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ABSTRACT: Advances in neonatal care have led to significant
improvements in the survival of preterm
infants. However, bronchopulmonary dysplasia
(BPD) continues to be a major problem in these
infants. BPD is in part thought to be the result of
ventilator-induced lung injury. A number of
modifications to pressure-limited ventilation have
been developed to combine the advantages of
pressure-limited ventilation with the benefits of
controlling delivered tidal volume. These modalities
are designed to deliver a targeted tidal volume by
microprocessor-directed adjustments of inspiratory
pressure or time. These new choices in ventilator
technology can make it difficult to select the most
appropriate mode for each infant. Each mode has
advantages and disadvantages, with limited data
available to judge their effectiveness.
Songkla Med J. 01/2010; 28:155-167.
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ABSTRACT: The pathogenesis of bronchopulmonary dysplasia (BPD) is multifactorial. One cause is ventilator induced lung injury (VILI). Experimental studies show that the magnitude of volutrauma is more closely associated with ventilator-induced lung injury rather than end-inspiratory pressure. The volume guarantee (VG) mode, studied most thoroughly, provides automatic weaning of peakpressure in response to improving lung compliance and respiratory effort. A more consistent tidal volume,
fewer excessively large breaths, lower peak pressure, less hypocarbia and lower levels of inflammatory cytokines have been documented. These short-term benefits translate into a shorter duration of ventilation.
Songkla Med J. 01/2010; 28:213-223.
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ABSTRACT: The objective of the study was to evaluate the effect of each additive [FeSO4, multivitamin (MTV), and vitamin E] on the postprandial osmolality of expressed breast milk (EBM) at 0, 30, 45 and 60 minutes. Babies born at Songklanagarind Hospital from 1 August, 2005 to 31 December, 2006 were studied; EBM was collected from mothers with a child born at an estimated gestational age less than 32 weeks or whose babies had a birth weight less than 1,500 grams. The volume of EBM depended on daily needs. The osmolality was determined by the additives in the EBM both before and after administration of each additive and in the gastric contents after gavage feeding at 0, 30, 45 and 60 minutes. Twenty-six infants were enrolled in the study. The median postprandial osmolality of EBM with MTV at 0, 30, 45 and 60 minutes were 413, 386.5, 388 and 383 mOsm/kg, respectively. At no time was the osmolality of FeSO4 or vitamin E-mixed EBM above 400 mOsm/kg.
The Southeast Asian journal of tropical medicine and public health 09/2009; 40(5):1080-6. · 0.60 Impact Factor
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ABSTRACT: MAIN PURPOSES: The study aimed to (1) examine the incidence of infectious complications (ICs) in our referral hospital in southern Thailand in infants with gastroschisis, with analysis of the impact of these complications on outcomes, and (2) identify associated factors to improve the practice at our institution for dealing with this condition.
A retrospective review of consecutive gastroschisis cases at the major teaching and referral hospital in southern Thailand was conducted for an 11-year period (1996-2006). Cases referred after a primary operation at other hospitals were excluded. The study focused on postoperative nosocomial infections as identified by Centers for Disease Control and Prevention criteria.
Sixty-eight patients with gastroschisis were operated on. Twenty-seven patients (39.71%) underwent primary closure. Mortality was 4 of 68 patients (5.9%). Infectious complication occurred in 43 patients (63.2%). The complications significantly increased mechanical ventilation days (10.8 vs 3.8 days in noncomplicated cases), need for parenteral nutrition (25.3 vs 14.5 days), and postoperative stay (33.7 vs 21.1 days). Common ICs were wound infection (32.35%), isolated septicemia (19.1%), and pneumonia (13.24%). Univariate analysis identified an association between the occurrence of IC and birth order (multigravida), time from birth until arrival at our center (5 hours or more), hypoalbuminemia, hypoglycemia, type of operation (staged closure), use of central venous line, and prolonged use of ventilator. On multiple logistic regression, prolonged referral time, use of a central venous line, multigravida, and staged closure independently predicted the risk of IC.
Infectious complication was significantly related to outcome in gastroschisis cases and should not be overlooked. Our data suggest that prompt referral, limiting central line practice on a selective basis, and an attempt to reduce wound infection in cases that require a temporary silo may improve the overall outcomes.
Journal of Pediatric Surgery 04/2008; 43(3):473-8. · 1.45 Impact Factor
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ABSTRACT: Human milk is nutritionally better than formula milk for preterm infants. However, unfortified human milk may fail to meet the theoretical requirements of very low birth weight (VLBW). Human milk fortifier (HMF) increases the nutritional content of human milk. However, the important factor of concern in feeding VLBW is the osmolality, the higher the osmolality, the greater the risk of necrotizing entero colitis (NEC). Therefore, high osmolality in fortified human milk should be considered for this condition.
To evaluate the effect of fortification on the osmolality of human milk.
Twenty samples of human milk were collected from mothers of gestational age less than 32 weeks, at about 1 week postpartum in Songklanagarind Hospital. The osmolality of each sample was determined at baseline and after supplementation with HMF at 10 minutes, 1, 2, 4, and 6 hours at room temperature and 24 hours at 4 degrees C in a refrigerator.
The mean osmolalities (SD) of human milk and HMF dissolved in sterile water were 285.3 (3.3) mOsm/kg H2O and 64.6 (0.7) mOsm/kg H2O, respectively. Thus, the expected osmolality of human milk after supplementation with HMF was 349 mOsm/kg H2O. Mean measured osmolalities (SD) of human milk after supplementation with HMF at 10 minutes, and 1, 2, 4, 6 and 24 hours was 394.7 (2.9), 399.5 (2.8), 402.1 (2.2), 401.0 (2.7), 401.3 (2.3) and 401.2 (3.1) mOsm/kg H2O, respectively. The mean osmolality at 10 minutes, 1, 2, 4, 6 and 24 hours were significantly higher than human milk (p < 0.001) and the mean osmolality at 10_minutes was significantly higher than expected osmolality (p < 0.001). There were no significant differences among groups of osmolality after supplementation with HMF at 10 minutes, 1, 2, 4, 6, and 24 hours (p > 0.05).
The supplementation of human milk with HMF induced an increase in osmolality after mixing. The osmolality, after mixing with HMF which was about 400 mOsm/kg H2O, creates a greater risk of NEC. Therefore, HMF milk should be considered for feeding in only high risk preterm neonates.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2006; 89(9):1400-3.
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ABSTRACT: The purpose of this study was to evaluate the minimum incubation time required to detect positive blood cultures from newborn infants with sepsis. Data were collected retrospectively on seventy-five positive blood cultures from newborn infants in the neonatal intensive care unit of Songklanagarind Hospital. The BacT/Alert Microbial Detection System had been used to culture the samples. Data were obtained retrospectively from the patients' medical records for positive blood cultures. A computer algorithm in the automated blood culture system determined the time to positivity, which was then evaluated for clinically important definite bacterial pathogens, possible bacterial pathogens, fungi and contaminants. Definite bacterial pathogens accounted for 46% (34/74) of the positive blood culture results, possible bacterial pathogens accounted for 39% (29/74), fungi for 7% (5/74) and contaminants for 8% (6/74). The cultures were positive at 24, 36 and 48 hours of incubation in 70.2%, 91.8% and 95.9% respectively. At 36 hours of incubation, the sensitivity, specificity and negative predictive value were 70.3%, 100% and 93.3%, respectively. All cultures growing clinically significant definite bacterial pathogens were positive by 36 hours of incubations, 88% by 24 hours. The cultures had 100% sensitivity, specificity and negative predictive value at 36 hours of incubation. If definite and possible bacterial pathogens were considered, the time to positivity was 71% at 24 hours, 95% at 36 hours and 97% at 48 hours, respectively. The sensitivity, specificity and negative predictive values were 70.3%, 100%, and 93.3%, respectively. Of cultures growing fungi, 80% were positive by 36 hours and all by 48 hours.
The Southeast Asian journal of tropical medicine and public health 02/2006; 37(1):171-6. · 0.60 Impact Factor
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ABSTRACT: Neonatal jaundice is the most frequently encountered diagnostic and therapeutic problem in the newborn. In the jaundiced infant, it is thought that the binding capacity of plasma albumin is exceeded, which allows free bilirubin to diffuse into and accumulate within extravascular tissues, such as the central nervous system. Affected newborns may develop kernicterus. The standard method of serum bilirubin measurement requires blood specimen taken by heel prick or venepunetue which involves pain of the newborn and is time consuming. A non invasive, transcutaneous measurement of bilirubin concentration is developed to be an alternative method as a reliable for the screening method to detect hyperbilirubinemia
To compare the estimates of serum bilirubin using a recently introduced device called a BiliCheck and its transcutaneous bilirubinometer index with the standard direct spectrophotometric measurement of serum bilirubin.
Prospective descriptive study.
Estimates of serum bilirubin, as measured using the BiliCheck, were compared with serum bilirubin concentration measured by direct spectrophotometry in neonates at Songklanagarind Hospital. Transcutaneous bilirubinometer readings were taken on the forehead.
Eighty-two newborns were enrolled in the present study. The means and standard deviations of serum bilirubin concentration and transcutaneous bilirubinometer index were 11.96 +/- 2.98 and 11.61 +/- 2.93 mg/dl, respectively. There was no statistically significant difference (p = 0.44, paired t-test). The correlation coefficient between total serum bilirubin and BiliCheck index was 0.95 with the linear regression equation of Y= 0.99x + 0.4.
Serum bilirubin can be accurately measured by the transcutaneous bilirubinometer index in full term newborn infants prior to any intervention modalities.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 03/2005; 88(2):187-90.
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ABSTRACT: A case of vertical transmission of dengue infection in the perinatal period is reported. The mother, a term pregnancy, had acute dengue the day before admission. The infant was born at term and developed fever on the fifth day of life which lasted for 5 days. No bleeding or plasma leakage was detected during the course of fever in infant or mother. A liver function test showed elevated SGOT and SGPT in the infant. The infant developed a convalescent rash on day 5 of the fever. The diagnosis of secondary dengue hemorrhagic fever in the mother was confirmed by serology and primary dengue infection in the infant was confirmed by serology and serotyped as dengue type 2 by PCR. The clinical course and management of mothers and infants with perinatal dengue infection are reviewed.
The Southeast Asian journal of tropical medicine and public health 01/2004; 34(4):793-6. · 0.60 Impact Factor
