Timing of Endotracheal Intubation in Patients with Fulminant Enterovirus 71 Infection.

Background and objective: Enterovirus 71 (EV 71) infections may result in the rapid progression of cardiopulmonary failure. Early endotracheal intubation is considered to be of primary importance. However, the appropriate timing for this is still not known. The aim of this study is to investigate the timing of intubation of children with fulminant EV71 infection. Material and Methods: From March 1998 to May 2012, patients with severe EV71 infection who were admitted to the pediatric intensive care unit of the National Cheng Kung University Hospital were enrolled in this study. Medical records were retrospectively reviewed. The patients were classified into three groups in accordance with the outcome of intubation. We used rhombencephalitis grading to describe the neurological presentation of these patients. The study was approved by the institutional review board. Results: There were a total of 105 patients enrolled. Of these, 77 patients were in Grade I, and only three of them needed intubation, who were, however, soon extubated within 24 h. There were 10 patients in Grade II; nine of them needed intubation. In total, 18 patients belonged to Grade III, and all of them need to be intubated. We then compared the outcome of intubation of grades II and III. There was only one patient out of the nine patients in grade II who experienced failed extubation due to the progression of the disease. Among grade III patients, only four patients were successfully extubated. We also listed clinical parameters to determine which one could be a sign that indicated intubation. Comparing the favorable outcomes, cranial nerve involvement was a good indicator for the timing of intubation. Conclusions: This study showed that early intubation in Grade II provides favorable outcomes and improves morbidity and mortality. We also found that if cranial nerve involvement was present, then early intubation is indicated.

Changes in outcome and complication rates of very-low-birth-weight infants in one tertiary center in southern Taiwan between 2003 and 2010.

BACKGROUND: Neonatal intensive care has changed dramatically over the past few decades and the survival of infants has generally improved in many countries. The purpose of this study was to explore the recent evolution of mortality and morbidities among very-low-birth-weight (VLBW) infants in southern Taiwan. METHODS: We retrospectively reviewed the medical records of VLBW (birth weight <1500 g) infants who were admitted to a neonatal intensive care unit at a tertiary medical center in southern Taiwan from 2003 to 2010. The study period was divided into two cohorts: the first cohort of 2003-2006 and the second cohort of 2007-2010. Demographic profiles and complications were recorded, including the following information: sex, birth body weight (BBW), gestational age (GA), Apgar score, patent ductus arteriosus (PDA), necrotizing enterocolitis, retinopathy, chronic lung disease (CLD), inguinal hernia, and sepsis. The length of stay (LOS) in hospital was compared between the two cohorts. RESULTS: A total of 420 (212 male) VLBW infants were enrolled with 52 (12.4%) deaths. Compared to surviving infants, deceased infants had significantly lower GA, Apgar scores, and BBW. The mortality of VLBW infants remained static between the two birth cohorts, but the incidence of major morbidities generally decreased. The LOS for overall surviving infants and the proportion of LOS > 60 days were both reduced in the period of 2007-2010. With further stratification by BBW, the major reduction of long LOS was only found in the group of BBW ≥ 1000 g. The multivariate logistic regression model found PDA, CLD, and BBW < 1000 g were major complications to be associated with long LOS among surviving infants. CONCLUSION: Periodic evaluation of the mortality and morbidity of preterm infants can help to understand the changes and trends of our neonatal care. Further study using the national dataset to provide more representative information is warranted.

Two different tests for total bilirubin in neonates and infants.

BACKGROUND: The most readily available methods for testing serum total bilirubin in neonates are the capillary tube-directed optics color method and serum biochemistry. Because inconsistency between these two methods may cause confusion in clinical practice, this study was designed to quantify their differences. METHODS: In 46 neonates with clinical jaundice, total bilirubin was measured by two different methods, using a nonchemical photometric device and a laboratory analyzer. RESULTS: Differences in results between these two methods were statistically significant, especially when total bilirubin level exceeded 15 mg/dL. CONCLUSION: Clinicians should be aware of the differences between the two methods when making decisions in patient care.