Feng-Shun Chen

Chang Gung University, Hsin-chu-hsien, Taiwan, Taiwan

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Publications (12)16.85 Total impact

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    ABSTRACT: Objective: This study aims to investigate the association between fluid intake in the first 4 days of life and the subsequent severity of bronchopulmonary dysplasia (BPD) in very low-birth-weight infants (VLBWI). Study design: A retrospective chart review of 75 infants with a gestational age of less than 32 weeks and a birth weight of < 1,500 g was performed. Demographic, clinical data, associated maternal risk factors, and amount of fluid received in the first 4 days of life were analyzed. Results: Severe BPD was associated with a lower gestational age (27.04 ± 2.073 wks vs. 28.70 ± 1.706 wks, p=0.001), lower birth weight (981.44 ± 244.54 vs. 1,199.63 ± 165.39 g, p < 0.001), use of surfactant (91.7 vs. 63%, p=0.002), patent ductus arteriousus (PDA) (70.8 vs. 37%, p=0.004), pulmonary hemorrhage (14.6 vs. 0%, p=0.045), and more fluids received from the 2nd to 4th days of life (346.44 ± 42.38 mL/kg vs. 323.91 ± 27.62 mL/kg, p=0.007). A cut off point of 345 mL/kg of fluids from the 2nd to 4th days of life was selected using receiver operating characteristic curve analysis, and remained a significant risk factor even after multiple logistic regression analysis. Conclusion: Our findings demonstrate that VLBWI who received higher fluid intake from the 2nd to 4th days of life are at an increased risk of developing severe BPD.
    No preview · Article · Jun 2014 · American Journal of Perinatology
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    ABSTRACT: Objective: To study the efficacy of the WINROP (https://winrop.com) algorithm in Taiwan, a middle income, moderately developed country in Asia. Study design: We enrolled all preterm infants born with a gestational age less than 32(+0) weeks from September 2008 to August 2010. The results of serial retinopathy of prematurity examinations according to the screening guidelines in our hospital were recorded. Weekly body weight was also recorded for the WINROP algorithm. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results: Overall, 148 infants were included. Seventeen infants (11.5%) received treatment for retinopathy of prematurity. But, six infants (35.3%) were missed when severe retinopathy of prematurity was predicted with WINROP algorithm. The sensitivity is only 64.7%. However, when focusing on the preterm infants with a birth weight < 1,000 g or gestational age < 28 weeks, it could predict the need for treatment up to 13 weeks in advance. Conclusion: The WINROP algorithm is a very effective noninvasive screening tool for retinopathy of prematurity, especially in preterm infants with a birth weight < 1,000 g or a gestational age < 28 weeks. However, the overall sensitivity in this report from Taiwan was not as high as that reported in highly developed countries.
    No preview · Article · Jun 2014 · American Journal of Perinatology
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    ABSTRACT: Perforation of the esophagus associated with placement of nasogastric tubes is not uncommon in preterm infants. Herein we report three cases of iatrogenic esophageal perforation associated with nasogastric tube placement. With nonsurgical management of parenteral nutrition and broad-spectrum antimicrobial therapy, all three neonates survived without sequelae. Effective strategies to prevent such complications are discussed.
    No preview · Article · Jan 2014 · Pediatrics & Neonatology
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    ABSTRACT: Objective: The aim of our study is to clarify the perinatal predictive factors of meconium aspiration syndrome (MAS) with neurodevelopmental delay (ND) in infants. Materials and methods: In this retrospective study, data were collected from the infants born between 1990 and 2008. They all had primary diagnosis of MAS. Multivariable analyzed perinatal predictive factors of MAS with ND. The developmental status of these infants was followed at least 2 years with the Wechsler Intelligence Scale for Children. Results: A total of 114 surviving babies met the criteria of MAS. Six babies were defined as ND group. Lower 5-minute Apgar score and diastolic blood pressure were significantly related to the ND group. Elevated asparatate aminotransferase (AST), nucleated red blood cells, and white blood cells at the time of admission were significantly high in ND group. Furthermore, AST had area under the receiver operating characteristic curve of 0.879, (95% confidence interval: 0.801, 0.934), p < 0.0001. At 96 mg/dL, it had 83.33% sensitivity, 80.81% specificity, and negative predictive value of 98.8. Multivariable logistic regression analysis revealed AST was the only significant predictive factor for MAS with ND. Conclusion: Early intervention should be recommended in infants having MAS with high AST level at birth for improving their neurodevelopmental outcomes.
    No preview · Article · Dec 2013 · American Journal of Perinatology
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    ABSTRACT: To determine whether expressed breast milk (milk) reduces procedural pain associated with heel lancing in preterm neonates. In this placebo-controlled trial, preterm neonates received 5 mL of distilled water as placebo (water, n = 44), 25% glucose water (glucose, n = 39) or milk (n = 40). Heel lancing was performed 2 min later. The primary outcome was the duration of first cry after lancing. Participants had similar baseline demographic and clinical characteristics. There was a significant difference in the median duration of first cry among the groups: water = 70.5 sec [interquartile range (IQR) = 5.5–104.5]; glucose = 2.0 sec (IQR = 0.0–45.0); milk = 29.5 sec (IQR = 0.0–65.0). Specifically, the duration of first cry was significantly shorter in the glucose group compared with the water group (Bonferroni adjustment, p = 0.011). Pain scores were significantly lower in the glucose and milk groups compared with the water group 1, 2 and 3 min after heel lancing (p < 0.05). Although milk did not significantly reduce crying time, our finding that pain scores were significantly lower in the milk group suggests that milk may reduce pain associated with heel lancing in preterm neonates.
    No preview · Article · Oct 2012 · Acta Paediatrica
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    ABSTRACT: Objective: To study the incidence of treated retinopathy of prematurity (ROP) using the revised U.S. screening guidelines, the rate of missed treatment, and unfavorable anatomic outcomes over a period of 2 years. Study design: We reviewed the admission records of premature patients treated at our hospital from September 2008 to August 2010. Any baby born with a gestational age (GA) of less than 30 weeks or a birth body weight (BW) of less than 2000 g was included in this study. The ROP screening followed the revised U.S. screening guidelines as presented in 2006. The indications of treatment for ROP were threshold disease as defined by the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity study and type 1 prethreshold ROP as defined by the Early Treatment for Retinopathy of Prematurity Randomized Trial study. Results: There were 385 infants who were examined for ROP screening during this period. Nineteen babies (35 eyes) fit the treatment criteria and received treatment. The incidence of treatment-demand ROP was 4.9% (19/385). Four babies had a birth BW >1500 g (4/19; 21%). Seventeen babies received treatment during their first admission and two babies received treatment during outpatient follow-up. No baby missed timely treatment. Three eyes progressed to stage 4/5 after receiving intravitreal bevacizumab treatment. The success rate after primary bevacizumab was 91% (30/33 eyes). Conclusion: The incidence of treatment-demanding ROP using revised U.S. screening criteria was 4.9%. Teamwork and cooperation are very important to ensure that the highest-quality care possible is provided to patients in a timely manner.
    No preview · Article · Jul 2012 · American Journal of Perinatology
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    ABSTRACT: Gastroschisis (GS) is defined as a full-thickness paraumbilical abdominal wall defect associated with evisceration of fetal abdominal organ. Although the concomitant nongastrointestinal anomalies and aneuploidy are rarely presented, fetal growth restriction is common. The aim of this study is to compare the primary and secondary outcomes of GS between infants small for gestational age (SGA) and those appropriate for gestational age as well as term and late preterm infants. Chart records of neonates born with gestational age at or more than 34 weeks were reviewed. All babies received repair procedure immediately after birth. SGA was defined as birth weight for gestational age below the 10th percentile. The primary outcomes were the length of hospital stay, duration of total parental nutrition used, and the surgical complications. The secondary outcome was the percentile of body weight at 6 months old. There were 21 babies diagnosed with GS from January 1990 to January 2010 at Kaohsiung Chang Gung Memorial Hospital. Four (19%) babies expired soon after operation. Nine (53%) of the 17 surviving babies had SGA. Length of hospital stay, surgical complications, and the percentile of body weight at 6 months old were significantly poorer for the SGA compared with appropriate for gestational age group (p = 0.005, 0.050, and 0.035). Furthermore, preterm neonates in SGA group had lower Apgar scores at 1 minute and 5 minutes than did term neonates (p = 0.045 and 0.031). SGA commonly occurred in GS cases and it was associated with longer hospital stay, more operative complications, and less body weight gain. Our conclusion may provide informative data to parents of GS fetuses during prenatal consultation, and reminds us that long-term follow-up of these cases could be necessary.
    No preview · Article · Aug 2011 · Pediatrics & Neonatology
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    ABSTRACT: Intracranial hemorrhage (ICH) is an uncommon but important cause of morbidity and mortality in term neonates. We conducted a retrospective analysis of the clinical characteristics and developmental outcomes of symptomatic ICH in term neonates. A retrospective chart review was conducted of all term neonates (less than 1 month old) diagnosed with ICH and admitted to the neonatal intensive care unit of Kaohsiung Chang Gung Hospital from December 1991 to December 2008. Demographic characteristics, mode of delivery, laboratory data, clinical presentation, and developmental status were recorded. Data for 24 term neonates (17 boys and 7 girls) with a diagnosis of ICH were collected for analysis. The clinical manifestations of ICH included anemia (13/24, 54%), seizure (11/24, 46%), cyanosis (7/24, 29%), tachypnea (5/24, 21%), fever (1/24, 4%), hypothermia (1/24, 4%), and poor feeding (1/24, 4%). Age at symptom onset ranged from 2 hours to 11 days following birth. The most common type of ICH was subdural hemorrhage. All ICHs resolved, except in one infant, who died from hypoxicischemic encephalopathy at 25 days. Ten children with symptomatic ICH were reported to have normal development, while the remainder (13/23, 57%) showed developmental delays or disabilities. Unexplained anemia, seizure, and cyanosis were the major presenting signs in infants with symptomatic ICH. A diagnosis of ICH should be considered in term neonates who present with one or more of these signs. Although the mortality in term infants with symptomatic ICH was low, more than half.
    No preview · Article · Aug 2010 · Pediatrics & Neonatology
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    ABSTRACT: Despite advances in therapeutic modalities, congenital diaphragmatic hernia (CDH) still accounts for significant neonatal mortality. This study aimed to describe the demographic features, clinical experiences of postnatal care, and differences between non-survivors and survivors with CDH. We retrospectively reviewed medical records of neonates with CDH admitted to Kaohsiung Chang Gung Memorial Hospital over a 21-year period. Neonates with diaphragmatic eventration and those transferred after surgery were excluded. A total of 24 live-born neonates fulfilled the study criteria; 13 (54%) were boys and 11 (46%) were girls. Eight (33%) patients were prenatally diagnosed. The mean gestational age was 38.8 +/- 1.8 weeks (range, 35-41 weeks). Twenty-three (96%) had Bochdalek hernia [19 (83%) left-sided, 4 (17%) right-sided], and one (4%) had right-sided Morgagni hernia. Additional major congenital anomalies were identified in five patients (21%). The overall mortality was 21% (5/24); all deaths occurred before surgery. Statistically significant differences between survivors and non-survivors were found for right-sided CDH, low 1-minute and 5-minute Apgar scores, and low pH of the first arterial blood gas. Deaths were attributed to severe persistent pulmonary hypertension, unresponsiveness to aggressive resuscitation at birth, and major associated malformations. Seventy-nine percent of our CDH patients survived to hospital discharge. Resuscitation by a skilled neonatology team to prevent low Apgar scores and low pH, careful evaluation of other anomalies, and overcoming pulmonary hypertension might improve the survival rate. Recognizing unfavorable factors in CDH may help clinicians manage the critical care of these babies.
    No preview · Article · Apr 2010 · Pediatrics & Neonatology
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    ABSTRACT: The aim of the present study was to compare the neonatal outcome of very low-birthweight (VLBW) preterm infants with regard to inborn and outborn status in a medical center of Southern Taiwan, where short-distance neonatal transport is the rule and maternal transport was not well established. This retrospective study included outborn VLBW preterm infants admitted to the neonatal intensive care unit of Chang Gung Memorial Hospital at Kaohsiung after neonatal transport during the period from 1999 through 2003. An equal number of inborn preterm infants matched for gender and birthweight were included as controls. Infants with lethal congenital anomalies or who died in the delivery room were excluded. Data were collected from reviewing medical charts. A total of 34 inborn VLBW infants and 34 outborn VLBW infants with neonatal transport were included. Chronic lung disease (CLD) was significantly more frequent in the outborn group according to McNemar test (P = 0.0124) and logistic regression. Logistic regression also showed that outborn status (P = 0.0173) and birthweight (P = 0.0024) were the two most important risk factors for development of CLD. Well-trained short distance neonatal transport is useful and valuable for VLBW infants with gestation age of 27-34 weeks in Southern Taiwan. The respiratory outcome, however, was poor in the outborn group in terms of incidence of CLD. To improve the respiratory outcome, further modification of respiratory care during transportation or antenatal maternal transport is crucial.
    No preview · Article · May 2009 · Pediatrics International
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    ABSTRACT: This retrospective study was designed to determine the trend of neonatal group B streptococcal (GBS) infection during the past 7 years at the Chang Gung Memorial Hospital of Kaohsiung, as well as to assess the risk factors, clinical features and patient outcomes. Medical records of infants with neonatal GBS infection identified by positive results of cultures of sterile body fluid in our hospital from January 1996 through December 2002 were reviewed for demographic and clinical data. There were 33 infants with neonatal GBS infections during the past 7 years in our hospital. The number of patients increased from 1996 to 2001. Sixteen infants had early onset infections and 17 infants had late onset infections. Of the nine patients with maternal risk factors in the early onset group, prolonged rupture of membranes (7, 44%) was most frequently encountered. Distressed respiratory sign (8, 50%) was the most common clinical presentation in early onset group, while fever >38 degrees C (17, 100%) was the most common presentation in late-onset group. The mortality rates were 13% and 6% in early and late onset groups, respectively. Gestational age (p = 0.05) and pneumonia (p = 0.015) were two most important factors influencing the mortality rate. The number of GBS-infected infants seemed to have increased during the past 7 years in our hospital. Because the incidence of neonatal GBS infection and maternal colonization in Taiwan has not been collected, we could not determine the necessity of intrapartum chemoprophylaxis. Setting a comprehensive surveillance in Taiwan should be considered.
    Preview · Article · Aug 2004 · Chang Gung medical journal
  • Chung-Bin Huang · Feng-Shun Chen · Mei-Yung Chung
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    ABSTRACT: Transient hypothyroxinemia without elevated thyroid-stimulating hormone (TSH) levels is common in prematurity, especially in very-low-birth-weight (VLBW) infants. The transient hypothyroxinemia of prematurity (THOP) has been seen as a "benign" condition not requiring medical treatment. However, some recent large observational studies have revealed a relationship between THOP and abnormal neurodevelopment. Furthermore, one study showed THOP had twice the risk of brain echolucency, which was the best predictable neurodevelopmental dysfunction, than the premature infants with normal or higher thyroxine levels. The relationships among THOP, illness severity, and neurodevelopmental dysfunction remain unclear. We propose a hypothesis that THOP is associated with abnormal ultrasound and illness severity. We studied 54 infants who were admitted more than 14 days at our neonatal intensive care unit (NICU) with a birth weight <2000 g from March 1999 to March 2000. The infants received serum thyroxine (T4), free-T4, and TSH measurement during the first weeks of life. Most of them had serum thyroxine levels measured at approximately 2 weeks of age. The infants enrolled in the study were examined by at least 1 of 3 cranial ultrasounds during the first weeks of life, illness severity evaluation according to the neonatal therapeutic intervention scoring system (NTISS) score, as well as NICU hospital stay period. Infant were classified as THOP by T4 value <5.3 microg/dL (68 nmol/L), which is 2.6 SD below the mean for term infants in Massachusetts, without elevated TSH value (<20 microIU/mL). After adjusting for some confounding factors, such as gestational age, birth weight, duration of mechanical ventilation, infants with THOP were associated with abnormal cranial ultrasound, illness severity, and lower 1-minute Apgar score. In our studies, THOP was related with brain ultrasound anomaly, neonatal illness, and lower Apgar score at 1 minute. Does early thyroxine intervention improve the prognosis and neurodevelopmental dysfunction? This question requires further investigation.
    No preview · Article · Apr 2002 · American Journal of Perinatology

Publication Stats

73 Citations
16.85 Total Impact Points


  • 2009-2014
    • Chang Gung University
      • Department of Pediatrics
      Hsin-chu-hsien, Taiwan, Taiwan
  • 2002-2014
    • Chang Gung Memorial Hospital
      • Division of Neonatology
      T’ai-pei, Taipei, Taiwan
  • 2004
    • Xiamen Chang Gung Hospital
      Amoy, Fujian, China