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Bai-Horng Su

Publications and source records attributed to Bai-Horng Su.

At least 19 recordsLinked to original sources
PubMed2006

Protective and anti-inflammatory effect of a traditional Chinese medicine, Xia-Bai-San, by modulating lung local cytokine in a murine model of acute lung injury.

We investigated the effects of Xia-Bai-San (XBS) on acute lung inflammation induced by LPS in vivo. Mice were challenged with intratracheal lipopolysaccharide (100 microg) 30 min before administering XBS (1 mg/kg oral administration). Bronchoalveolar lavage fluid (BALF) was obtained after 4 and 24 h to measure proinflammatory cytokine (TNF-alpha, IL-1beta, IL-6), anti-inflammatory cytokines (IL-10), chemokines (KC, MCP-1 and MIP-2), total cell counts, nitric oxide production, and proteins. The results indicated that XBS down-regulated the LPS-induced expression of TNF-alpha, IL-1beta, IL-6, KC, MIP-2, and MCP-1. Furthermore, it also enhanced the production of IL-10, which had increased 24 h after LPS challenge. In addition, total leukocyte counts, nitric oxide production, iNOS expression, and BALF's proteins had significantly decreased 24 h after LPS challenge. XBS was also believes to have reduced the acute inflammation by attenuating the activation of NF-kappaB. In conclusion, XBS seem to suppress lipopolysaccharide-induced lung inflammation by stimulating the production of anti-inflammatory cytokines in lung. These results suggest that XBS could be a useful adjunct in the treatment of acute respiratory distress syndrome.

Animals↗
PubMed2005

Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants.

OBJECTIVE: We evaluated the efficacy of probiotics in reducing the incidence and severity of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. PATIENTS AND METHODS: A prospective, masked, randomized control trial was conducted to evaluate the beneficial effects of probiotics in reducing the incidence and severity of NEC among VLBW (<1500 g) infants. VLBW infants who started to fed enterally and survived beyond the seventh day after birth were eligible for the trial. They were randomized into 2 groups after parental informed consents were obtained. The infants in the study group were fed with Infloran (Lactobacillus acidophilus and Bifidobacterium infantis) with breast milk twice daily until discharged. Infants in the control group were fed with breast milk alone. The clinicians caring for the infants were blinded to the group assignment. The primary outcome was death or NEC (>or= stage 2). RESULTS: Three hundred sixty-seven infants were enrolled: 180 in the study group and 187 in the control group. The demographic and clinical variables were similar in both groups. The incidence of death or NEC (>or= stage 2) was significantly lower in the study group (9 of 180 vs 24 of 187). The incidence of NEC (>or= stage 2) was also significantly lower in the study when compared with the control group (2 of 180 vs 10 of 187). There were 6 cases of severe NEC (Bell stage 3) in the control group and none in the study group. None of the positive blood culture grew Lactobacillus or Bifidobacterium species. CONCLUSION: Infloran as probiotics fed enterally with breast milk reduces the incidence and severity of NEC in VLBW infants.

Bifidobacterium↗
PubMed2005

Interleukin-8 in bronchoalveolar lavage fluid of premature infants at risk of chronic lung disease.

BACKGROUND AND PURPOSE: Persistence of neutrophils in the tracheal fluid of premature infants is associated with chronic lung disease (CLD). Interleukin-8 (IL-8) is a potent neutrophil chemoattractant. This study investigated whether IL-8 is increased in the bronchoalveolar lavage fluid of premature infants with different types of CLD. METHODS: Forty two very low birth weight infants who required mechanical ventilation were recruited. Twenty eight of these infants developed CLD and 14 infants recovered without developing CLD. Four additional infants receiving mechanical ventilation for non-respiratory reasons were also enrolled as controls. CLD was defined as requirement for supplemental oxygen at 28 days of age and chest radiograph showing characteristic appearance. CLD was further classified into 3 subtypes: bronchopulmonary dysplasia (BPD), Wilson-Mikity syndrome (WMS) and chronic pulmonary insufficiency of prematurity (CPIP). RESULTS: IL-8 in bronchoalveolar lavage fluid was significantly increased in the CLD group by 8 days of age compared to those who did not develop CLD (p < 0.05). For infants without CLD, IL-8 increased from 963 pg/mL on day 1 after delivery to 1463 pg/mL on day 4, and decreased to 1,000 pg/mL on day 8. For infants with BPD, IL-8 increased from 925 pg/mL on day 1 after delivery to 2,650 pg/mL on day 8, and then gradually decreased to 1,500 pg/mL on day 28. Infants with WMS had significantly higher IL-8 from the first day after delivery (4,567 pg/mL) than infants with BPD or CPIP and this difference persisted to age 28 days (2475 pg/mL). CONCLUSIONS: Persistent inflammation could be a major contributory factor in the development of CLD. The different patterns of response to inflammation in different types of CLD may have implications for the design of appropriate strategies to prevent and treat CLD.

Bronchoalveolar Lavage Fluid↗
PubMed2005

Epidemiologic trends in nosocomial bacteremia in a neonatal intensive care unit.

The primary goal of this study was to analyze the epidemiologic features of nosocomial bloodstream infection (NBSI) in a neonatal intensive care unit over a 7-year period. All neonatal patients with NBSI treated from January 1997 to December 2003 were retrospectively analyzed. 232 NBSI episodes were diagnosed in 208 patients. The average NBSI patient-day rates were 4.69 and 2.59 per 1000 patient-days in 1997-1999 and 2000-2003, respectively. The average NBSI rates were 5.00 and 1.50 per 1000 patient days in neonates <1500 g and > or =1500 g, respectively. The proportion of Gram-positive organisms increased from 24% in 1997-2001 to 41% in 2002-2003, whereas the proportion of Gram-negative isolates decreased from 65% in 1997-2001 to 47% in 2002-2003. The implementation of measures for the prevention of nosocomial infection was associated with the reduction of NBSI rates. Low birth weight was demonstrated to be a significant risk factor for NBSI. The fact that Gram-positive organisms were isolated in increasing frequency may impact on the appropriate selection of empiric antimicrobial therapy for NBSI in the neonatal intensive care unit.

Bacteremia↗
PubMed2004

Nonassociation of interleukin 4 intron 3 and 590 promoter polymorphisms with bronchopulmonary dysplasia for ventilated preterm infants.

Interleukin 4 (IL-4) stimulates and amplifies the inflammatory response, stimulates collagen synthesis in fibroblasts, promotes the progression to fibrosis and has been shown to inhibit the production of several inflammatory cytokines in the development of bronchopulmonary dysplasia (BPD) and airway hyperreactivity. We aimed to investigate whether IL-4 polymorphisms in ventilated preterm infants were associated with BPD. BPD was defined as infants who remained dependent on active respiratory support or oxygen supplementation at 36 weeks postconceptional age. A case-control study of 224 preterm infants (<30 weeks) who had respiratory distress syndrome and needed intermittent mandatory ventilation (IMV) were undertaken between January 1999 and December 2003. The typing of each genetic polymorphism was performed by polymerase-chain-reaction-based restriction analysis. Genotype distribution and allelic frequencies were compared between ventilated preterm infants who developed BPD and those who did not and the duration of IMV. The demography of these ventilated BPD and non-BPD preterm infants was not different. We observed no significant differences in genotype distribution or allelic frequency of the IL-4 intron 3 or IL-4 promoter polymorphisms between ventilated preterm infants who developed BPD and who did not. There was no significant association of the genotype or allelic frequency of IL-4 polymorphism with duration of IMV. We conclude that neither IL-4 intron 3 nor the 590 promoter polymorphism is a useful marker for predicting the susceptibility to BPD in ventilated Taiwanese preterm infants.

Bronchopulmonary Dysplasia↗
PubMed2004

Role of antibiotics in management of non-ventilated cases of meconium aspiration syndrome without risk factors for infection.

There are limited data on the efficacy of antibiotics in the management for meconium aspiration syndrome (MAS). This purpose of the prospective randomized controlled clinical trial compared the infection-related outcome of non-ventilated cases of MAS without perinatal risk factors for infection, treated with or without antibiotics therapy, as measured by the incidence of pneumonia and sepsis up to the age of 2 months. From January 1997 to July 2003, this study was carried out in our nursery. Infants with MAS without perinatal risk factors for infection and without ventilator use were randomly allocated to study and antibiotics groups after informed parental consent was obtained. The study group did not receive antibiotics, while the antibiotics group received antibiotics including ampicillin and gentamicin for 3 days until the blood cultures were negative, as was standard practice in the nursery. Other management and monitoring of MAS were the same in both groups. Of a total of 425 cases of MAS, 119 cases were excluded because there were at risk for infection or respiratory failure needing ventilator support. The study group comprised 148 cases and the antibiotics group 158 cases. Among these patients, 127 from the study group and 132 from the antibiotics group were followed up until 2 months of age. The profile of patients with respect to the method of delivery, the characteristics of meconium, Apgar score, sex, gestational age and birth body weight was similar in both groups. There were no significant differences in the duration of tachypnea, O2 supplementation and nasal continuous positive airway pressure (CPAP) between the two groups. Pneumothorax occurred in 4 cases in the study and 7 cases in the control group. There was no mortality in either group. Blood cultures at 6 and 72 h of age were all negative in both the study and the antibiotics groups. No infant developed bacterial pneumonia, sepsis or meningitis in the follow-up program at 2 months of age. We conclude that antibiotic treatment did not affect the clinical course and outcome related to infection in MAS without perinatal risk factors for infection and without ventilator use. The role of antibiotics in the management of MAS may need to be reevaluated in a study with a larger sample size.

Anti-Bacterial Agents↗
PubMed2003

Risk factors for retinopathy of prematurity in very low birth-weight infants.

PURPOSE: To calculate incidence and evaluate the risk factors of the threshold retinopathy of prematurity (ROP) in very low birth-weight (VLBW, birth weight less than 1,251 gram) infants. We also compared the incidence of threshold ROP in Taiwan with those of Caucasians and Negros. Additionally, the post-conception age when threshold ROP happened was considered. METHODS: From February 1995 to February 2000, we enrolled 458 VLBW infants at the China Medical College Hospital. Patients with congenital anomalies and those who survived less than 6 months were excluded. The perinatal and neonatal data of enrolled infants were reviewed. Student's t test and chi-square test were used to evaluate the statistical significance of risk factors. We also used logistic regression test and correct classification rate to evaluate different risk factors. RESULTS: The incidence of threshold ROP in our study was 6.8%. The gestational age (GA), birth weight (BW), number of days in using ventilator, continuous positive airway pressure (CPAP) and oxygen supplements, the occurrence of broncopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC) and the length of hospitalization were statistically different between patients groups with and without threshold ROP (p < 0.05). However, small size for gestational age (SGA), sepsis status, intraventricular hemorrhage (IVH) status (Gr.III and Gr.IV) and type of delivery were not significantly different between patients with and without threshold ROP (p > 0.05). Threshold ROP was noted at an average post-conception age of 34.25 weeks. CONCLUSIONS: The incidence of threshold ROP (6.8%) in VLBW Taiwan babies is comparable with the incidence of Caucasian patients in Western countries. Risk factors including PVL, NEC, BPD and RDS should be avoided to prevent the occurrence of threshold ROP. Threshold ROP occurred at an average of 34.3 weeks of post-conception age; the premature baby around this age must be checked carefully.

Bronchopulmonary Dysplasia↗
PubMed2002

Nosocomial bloodstream infection in a neonatal intensive care unit of a medical center: a three-year review.

Bloodstream infections are the most frequent nosocomial infections in neonatal intensive care units. This retrospective study surveyed the epidemiologic characteristics of nosocomial bloodstream infections which occurred in the neonatal intensive care unit from January 1, 1997 to December 31, 1999. The overall infection patient rate was 5.5% in the 3-year period, and the overall infection patient-day rate was 4.4 per 1000 patient-days. Low birth weight was a risk factor for bloodstream infections. The rate of infection for neonates with birth weight below 1000 g ranged from 36.6% to 45.8% (1997: 36.6%; 1998: 45.8% and 1999: 38.9%). The most common pathogens causing nosocomial bloodstream infection were: Staphylococcus aureus (18.5%) (with 92% oxacillin-resistant), Acinectobacter baumannii (16.3%), Klebsiella pneumoniae (11.9%), Escherichia coli (9.6%), and Pseudomonas aeruginosa (8.1%). The mortality due to nosocomial bloodstream infection was highest among gram-negative bacteria, especially with P. aeruginosa (45.5%). Therefore, surveillance of nosocomial bloodstream infection and successful strategies to decrease nosocomial bloodstream infection, such as infection control and optimal antibiotic use, are warranted.

Bacteremia↗
PubMedDate not supplied

Endoscopic survey of post-extubation stridor in children.

Endotracheal intubation is an important airway procedure in the management of neonates and infants. Prolonged intubation may result in severe laryngeal injury which may lead to chronic laryngeal disability. The nature and causes of post-extubation airway obstruction were evaluated with videoendoscopy. From June 1998 to September 2000, detailed videoendoscopic examination of pediatric airway was performed in 30 children who had persistent stridor after endotracheal extubation or failure of elective extubation. Common locations of post-extubation lesion are the posterior glottis and subglottis. Retrospective analysis of the causes of stridor included: (1) isolated intubation laryngotracheitis (n = 19); (2) intubation laryngotracheitis with neuromuscular dysfunction which resulted in tongue drop, laryngotracheal incoordination, saliva pooling over the larynx or poor cough reflex(n = 5); and (3) specific airway problems such as laryngomalacia, subglottic stenosis or vocal paralysis(n = 6). We favored the term of "intubation laryngotracheitis" instead of "intubation injury" or 'intubation trauma". Although most cases of intubation laryngotracheitis heal, leaving a normal or near-normal larynx, some of them still suffer from airway obstruction after endotracheal extubation. Specific airway problems such as severe laryngomalacia or vocal cords paralysis and neurogenic defects should also be taken into consideration.

Adolescent↗
PubMedDate not supplied

The comparison between capillary blood sampling and arterial blood sampling in an NICU.

To study the correlation between the results of blood examination from arterial blood sampling via arterial puncture and capillary blood sampling via heel-stick, 33 premature infants with birthweights ranging from 635 grams to 2500 grams were enrolled in this study. The 33 paired samples of capillary blood sampling via heel-stick and simultaneous arterial blood sampling via arterial puncture were analysed within 3 minutes after collection for hemoglobin, hematocrit, sodium, potassium, chloride, calcium, glucose, lactate, osmolality, and blood gas. The average correlations between capillary and arterial samples were 0.92 for pH, 0.93 for PCO2, 0.87 for hematocrit, 0.88 for hemoglobin, 0.86 for sodium, 1.16 for calcium, 1.14 for glucose, 1.01 for lactate, 1.03 for base excess (BE), 1.05 for HCO3-, 0.91 for osmolality, 1.35 for PO2, 0.28 for O2 saturation, 0.67 for potassium, and 0.78 for chloride. We concluded that capillary blood sampling via heel-stick is a rapid, simple, less invasive, and reliable alternative to arterial blood sampling for the evaluation of hemoglobin, hematocrit, sodium, calcium, glucose, lactate, osmolality, and blood gas (pH, pCO2, HCO3-, BE) in premature infants.

Blood Specimen Collection↗
PubMedDate not supplied

A comparison of survival in extremely low birth weight infants between periods 1997-1998 and 1998-2000.

The survival rates and the influential perinatal factors of extremely low birth weight (ELBW) infants were compared between two periods, including January 1997 through May 1998 (Period 1, n = 84) and June 1998 through December 2000 (Period 2, n = 145). The survival rate was 48.8% (41/84) during Period 1 and 55.2% (80/145) during Period 2. Gestational age (GA) and birth weight (BW) were the most important factors that influenced the survival rate. The cut off levels, below which mortality rates increased significantly, were GA < 24 weeks and BW < 700 gm during Period 1 and GA < 24 weeks and BW < 500 gm during Period 2. During Period 1, the smallest survival was a female infant with GA of 23 weeks and BW of 530 gm who had no complication and lived well. During Period 2, the smallest survival was a female infant with GA of 21 weeks and BW of 460 gm who was discharged with home oxygen therapy. She was admitted again via emergency due to sudden onset of apnea and cardiac arrest 4 days after discharge, and she died 4 days after the 2nd admission. Our results did not show any advantages to maternal transfer or delivery by Cesarean section. The early neonatal mortality rate was still high during Period 2 and accounted for 50% of the overall neonatal mortality rate. This implies that further training to improve the neonatal care, especially during the early stage of the first week should be reinforced to reduce neonatal deaths. Prevention of the births of extremely premature infants should be more emphasized to decrease neonatal mortality and morbidity rates. When the delivery of an ELBW infant is impending, an active plan of treatment for all infants of GA > or = 24 weeks or BW > or = 500 gm seems appropriate.

Female↗
PubMedDate not supplied

Clinical analysis of necrotizing enterocolitis with intestinal perforation in premature infants.

To identify the prognostic factors correlating with the outcome of the perforated necrotizing enterocolitis (NEC), the charts of 20 premature infants with perforated NEC were reviewed. Eight patients had long-term survival and 12 died. Infants in the survival group had significantly lower incidence of starting to feed before perforation, patent ductus arteriosus, indomethacin use, acidosis, and shock. Sepsis was only found in the group of infants that died The survival group were diagnosed with NEC and intestinal perforation at an earlier age than the infants that died. The time from diagnosis of NEC to intestinal perforation was longer in the infants that died. The localization of necrosis from operativefindings were all confined to the ileum-cecum area in survival group. The infants in the survival group were likely to have a single perforation. In addition, according to the operative management, they were divided into three groups: Group I consisted of six patients who received peritoneal drainage only, group II consisted of three patients who received peritoneal drainage followed by laparotomy, and group In consisted of 11 patients who received primary laparotomy. Infants in groups I and II had significantly lower gestational ages and birth weights than group III. There were no significant differences in mortality rates among infants in groups I, II and III. We concluded that the factors including prior enteral feeding, patent ductus arteriosus, indomethacin use, acidosis, sepsis, shock, delayed onset of NEC and perforation, multiple perforation, and diffuse necrotic changes were significant prognostic factors of poor outcome. Peritoneal drainage was a resuscitative procedure in critical condition and laparotomy should mostly be considered as the final treatment in the infants with perforated NEC.

Enterocolitis, Necrotizing↗
PubMedDate not supplied

Inhaled nitric oxide in persistent pulmonary hypertension of the newborn: four-year experience in a single medical center.

Forty-eight infants with persistent pulmonary hypertension of the newborn (PPHN) from July, 1997 to June, 2001 were enrolled for a prospectively study to determine the role of inhaled nitric oxide (NO) treatment and to determine an appropriate weaning strategy of NO. The initial dose of NO was started at 10 ppm for 10 minutes. If the infant's symptoms did not improve, we used a rapid dose ladder schedule for increasing the dose of NO to 20, 40 and 80 ppm every 10 minutes until we achieved the desired response. When oxygenation improved for 30 minutes, NO was decreased by 5 ppm every 10 minutes until reaching 5 ppm which was maintained for 2-3 hours. During the NO weaning period, if the SpO2 decreased by 10% or fell below 85%, the NO was increased to the previous higher dose and maintained this lowest effective dose for 2-3 hours. During this period, FiO2 was decreased by 10% every 10 minutes and peak inspiratory pressure was decreased gradually as the infant tolerable to avoid a decrease in saturation; we then tried to repeat the weaning procedure of NO. Inhaled NO was discontinued at 5 ppm if the infants were stable for 2-3 hours, and at the same time FiO2 was permitted to raise 10-20%. If SpO2 decreased by 10% or fell below 85% within 5 minutes, NO was reinstated at 5 ppm. A second attempt at weaning NO was made 2-3 hours later when the infants were stable. Thirty-four infants (70.8%) survived. Forty infants (83.3%), including 34 who survived and 6 who died, had good responses to inhaled NO. The mean effective NO concentration was 37 (5-80) ppm. The mean duration of inhaled NO treatment was 43 (6-153) hours. This study has demonstrated that inhaled NO is an effective rescue treatment for infants with severe PPHN, but the final outcome of infants depends not only on the response to inhaled NO but also on the associated complications. Using our weaning strategy, we shortened the duration of inhaled NO treatment as compared with a previous study (43 vs. 87 hours). Beginning inhaled NO therapy early in severe PPHN may be an important factor in shortening the duration of NO therapy. Further controlled trials of this weaning strategy are warranted.

Administration, Inhalation↗
PubMedDate not supplied

Risk factors of extubation failure in extremely low birth weight infants: a five year retrospective analysis.

Extubation failure is one of the most serious complications in extremely low birth weight infants (ELBWI) on mechanical ventilation therapy. We performed a 5-year retrospective analysis to realize the status of extubation failure in ELBWI. Extubation failure was defined as requirements of re-intubation within 72 hours after extubation. The extubation failure rate was 21% (29/138). The mean birth body weight was 808.3 +/- 140.4 gm. The mean gestational age was 25.8 +/- 1.2 wks. The incidence of chronic lung disease (CLD) in infants with extubation failure was 100% (29/29). Apnea of prematurity 49% (14/29) and post-extubation atelectasis 39% (11/29) were the most common reasons for reintubation. The major microbiology findings which correlated with nosocomial pneumonia in infants with extubation failure were Acinetobacter baumanni (21%), Klebsiella pneumonia (21%), Pseudomonas aeroginosa (14%), and Methicillin resistant staphylococcus aureus (14%). In conclusion, post-extubation atelectasis and apnea were the most common reasons for reintubation. ELBWI with extubation failure had higher incidences of post-extubation atelectasis, CLD, and nosocomial pneumonia. Further prospective studies are needed in order to clarify the appropriate extubation program for ELBWI and to prevent post-extubation atelectasis and nosocomial pneumonia.

Female↗
PubMedDate not supplied

Risk factors of mortality in meconium aspiration syndrome: review of 314 cases.

Meconium aspiration syndrome (MAS) is a common severe respiratory disease in full-term infants. To investigate the risk factors for mortality of MAS, a retrospective chart-review study of MAS was conducted from 1995 to 2001. All cases of MAS were included except cases of cyanotic congenital heart disease or congenital fetal anomaly. Prenatal, perinatal and postnatal risk factors of mortality were recorded. The risk factors were compared between surviving and deceased cases. There were 314 cases of MAS during the seven years. Total mortality rate was 4.8% (15/314); this did not change significantly during these years. Risk factors of mortality by univariate analysis were: outborn babies, resuscitation before admission, first born baby, low pH, high oxygen index (OI), high alveolar-arterial oxygen tension gradient (AaDO2) at admission, high OI and AaDO2 at 2 hours after admission, shock, pneumothorax, asphyxia, pulmonary hemorrhage, persistent pulmonary hypertension of newborn (PPHN), and renal failure. Logistic regression analysis showed asphyxia, pneumothorax and PPHN are the most important risk factors of mortality in MAS. How to diminish these events is the key point for reducing the mortality rate of MAS.

Apgar Score↗