Diagnosis and Surgical Outcomes of Patients with Anomalous Left Coronary Artery from the Pulmonary Artery: A Single Taiwanese Medical Center Experience.

BACKGROUND: Anomalous left coronary artery from the pulmonary artery (ALCAPA), a very rare congenital cardiac anomaly, is associated with a high mortality rate among infants who are not diagnosed or treated in a timely manner. Surgical intervention with the reconstruction for a two-coronary-system circulation is the main treatment; however, there have been very few reported cases from Taiwan. In this study, we aim to describe the clinical manifestations, diagnostic methods, surgery types, and surgical outcomes in patients with ALCAPA from a single Taiwanese medical center. METHODS: We retrospectively reviewed patients diagnosed with ALCAPA who underwent surgery at our institution between January 2001 and October 2018. Clinical presentations, noninvasive and invasive study results, surgical methods, and postoperative follow-up results were assessed from medical records. Moreover, literature on this particular cardiovascular anomaly was reviewed. RESULTS: The study included 6 patients (5 children and 1 adult). The diagnosis was confirmed using cardiac catheterization and coronary angiography in four patients and only echocardiography in two patients. All patients underwent surgical correction and survived. Four patients showed improvements in left ventricular function and mitral regurgitation (MR). CONCLUSION: Early diagnosis and timely surgical intervention could avoid mortality regardless of the method of operation. ALCAPA can be definitively diagnosed using noninvasive echocardiography. Both left ventricular systolic function and mitral insufficiency could improve after the surgical intervention in pediatric patients. Repair or replacement of the mitral valve could be reserved for persistent MR complicated with congestive heart failure, particularly in patients who received the initial operation beyond infancy.

Initial validation of a healthcare needs scale for young people with congenital heart disease.

AIM: To validate the initial psychometric properties of a Healthcare Needs Scale for Youth with Congenital Heart Disease. BACKGROUND: As the number of patients with congenital heart disease surviving to adulthood increases, the transitional healthcare needs for adolescents and young adults with congenital heart disease require investigation. However, few tools comprehensively identify the healthcare needs of youth with congenital heart disease. DESIGN: A cross-sectional study was employed to examine the psychometric properties of the Healthcare Needs Scale for Youth with Congenital Heart Disease. METHODS: The sample consisted of 500 patients with congenital heart disease, aged 15-24 years, from paediatric cardiology departments and covered the period from March-August 2015. The patients completed the 25-item Healthcare Needs Scale for Youth with Congenital Heart Disease, the questionnaire on health needs for adolescents and the WHO Quality of Life-BREF. Reliability and construct, concurrent, predictive and known-group validity were examined. RESULTS: The Healthcare Needs Scale for Youth with Congenital Heart Disease includes three dimensions, namely health management, health policy and individual and interpersonal relationships, which consist of 25 items. It demonstrated excellent internal consistency and sound construct, concurrent, predictive and known-group validity. CONCLUSION: The Healthcare Needs Scale for Youth with Congenital Heart Disease is a psychometrically robust measure of the healthcare needs of youth with congenital heart disease. It has the potential to provide nurses with a means to assess and identify the concerns of youth with congenital heart disease and to help them achieve a successful transition to adult care.

Congenital heart disease with pulmonary artery hypertension in an Asian cohort-initial report from TACHYON (TAiwan congenital heart disease associated with pulmonarY arterial hypertension) registry.

BACKGROUND: Prospective registry studies of congenital heart disease (CHD)-associated pulmonary artery hypertension (PAH) are rare. We established a multicenter registry of CHD-PAH: the TACHYON (TAiwan Congenital Heart disease associated with pulmonarY arterial hypertension) registry. METHODS: The prospective TACHYON registry was initiated in January 2016. Nine pediatric cardiology centers with 99 patients were included. Using this database, we evaluated clinical characteristics and outcomes. RESULTS: Twelve patients with incomplete data were excluded. For the remaining 87 patients, mean age of enrollment was 37.4(SD 18.2) years, and the male to female ratio was 60:27. PAH after defect closure accounted for 46 (52.9%) and Eisenmenger syndrome for 30 (34.5%) cases. Atrial septal defect was the most common (48.3%) disease, followed by ventricular septal defect. Mean pulmonary artery pressure was 56.7 (SD 19.4) mmHg. PAH-targeted therapy was used in 95.4% of patients. Sildenafil and bosentan were the most common drugs. After mean 23.9 months of follow-up, the 2-year Kaplan-Meier survival rate was 93.2%. According to univariate Cox regression analysis, significant risk factors included right heart failure signs, symptom progression, high-risk baseline N-terminal pro-brain natriuretic peptide (BNP)/BNP, high-risk baseline 6-min walking distance (6MWD), and high baseline hemoglobin/hematocrit level. Using the three noninvasive parameters (functional class, 6MWD, NT-pro BNP/BNP) proposed by the European Society of Cardiology, the total number of high-risk criteria predicted survival rate reliably. CONCLUSIONS: Using the TACHYON registry is feasible, but the physicians' adherences to guidelines are unsatisfactory. Midterm outcomes of PAH-target therapy are favorable and predictable using noninvasive parameters.

Variant angina in an adolescent coexisting with intermittent Wolff-Parkinson-White syndrome.

Chest pain is not an uncommon complaint among adolescents; however, it often leads them to seek emergency medical care. The variant angina (coronary artery spasm) with resulting acute myocardial ischemia is an extremely rare cause of chest pain among the pediatric population, and there are very few cases reported. We describe a 13-year-old boy with underlying intermittent Wolff-Parkinson-White syndrome and who had an acute coronary artery syndrome due to coronary artery vasospasm.

Comparison of clinical features of childhood norovirus and rotavirus gastroenteritis in Taiwan.

BACKGROUND: Viral gastroenteritis is a common acute infectious disease in infants and young children. This study compared the incidence and clinical features of childhood norovirus (NV) and rotavirus (RV) gastroenteritis in Taiwan. METHODS: Stool specimens were collected from children with acute gastroenteritis aged 6 months to 14 years who were treated at the Children's Medical Center of Taipei Veterans General Hospital between January 2004 and March 2005. The incidence, clinical manifestations, and laboratory findings of childhood NV gastroenteritis were analyzed and compared with those of patients with RV gastroenteritis. Patients with underlying diseases associated with diarrhea or those diagnosed with bacterial gastroenteritis were excluded. Stool specimens were tested for NV and RV using enzyme immunoassay (EIA). NV genogroups were determined by reverse-transcriptase polymerase chain reaction. RESULTS: Among the 201 patients included in this study, NV was detected in 44 (21.9%) by 1 or more tests (22 by EIA). Five of these isolates were genogroup I (11.3%), and 39 were genogroup II (88.7%). Fifty-two (25.9%) specimens had a positive EIA result for RV. Compared with NV, patients with RV gastroenteritis had a significantly higher percentage of diarrhea (94 vs. 69%, p < 0.001), fever (82 vs. 26.2%, p < 0.001), and longer hospital stay (3.81 vs. 2.93 days, p = 0.048). Laboratory studies showed significantly higher liver enzymes and C-reactive protein levels in patients with RV infection. In contrast, white blood cell counts were significantly higher in patients with NV infection. CONCLUSION: Norovirus is one of the leading agents of acute gastroenteritis in children in Taiwan, and genogroup II is the predominant type.

The role of eosinophil cationic protein in patients with Mycoplasma pneumoniae infection.

BACKGROUND: To study the role played by eosinophil cationic protein (ECP) in patients with Mycoplasma pneumonia infection. METHODS: Pediatric patients aged 4 to 14 years old were divided into 3 groups, each consisting of 30 patients. Group 1 comprised patients with known M. pneumoniae infection. Group 2 comprised patients with asthma who were in a stable condition with no infection, acute asthma exacerbation or steroid use in the last 2 months. Group 3 consisted of healthy children and was designated the control group. The level of ECP in patients' serum was measured by an ECP radioimmunoassay kit. RESULTS: There were 90 children enrolled in this study; 59 (65.56%) were boys and 31 (34.44%) were girls. Mean serum ECP levels between males and females was not significantly different (p = 0.544). The variance of serum ECP levels decreased as patient age increased, but there was no relationship between serum ECP level and patient age (gamma = 0.118, p = 0.267). Serum ECP levels were similar in both the M. pneumoniae-infected and asthma groups; serum ECP levels in the control group were less than the levels seen in the other 2 groups. The difference in serum ECP levels among the 3 groups was statistically significant (p < 0.001). CONCLUSION: Both the children who had M. pneumoniae infection and the children with asthma had significantly increased serum ECP levels compared to normal healthy children. The elevated ECP levels found in the serum of patients with M. pneumoniae infection may be associated with damage to the respiratory epithelium and accelerated hypersensitivity in the respiratory system. Decreasing the serum level of ECP may potentially be a method of relieving symptoms in patients with M. pneumoniae infection. Additional studies are warranted to further validate this conclusion.

Characteristics of Chlamydia trachomatis infection in hospitalized infants with lower respiratory tract infection.

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.

Characteristics and outcome of septic arthritis in children.

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.

Is Heart Rate Variability Related to Season of Birth?

BACKGROUND: Season of birth (SOB) has been found to be related to cardiovascular mortality, but the mechanisms are unclear. It is suggested that birth in winter is a protective factor for the circulatory system, and this should be able to be observed using heart rate variability (HRV) measurements. The phenomenon may have a sex difference and is likely to be modulated by climatic factors. This study focused on this problem and investigates healthy school-age children to minimize confounding factors. HYPOTHESIS: Birth in winter is protective to cardiovascular system via autonomic modulation. There is a gender difference in the relationship between SOB and autonomic activity. Climatic factors are the cause of SOB effects on autonomic system. METHODS: A total of 381 healthy school-age children were recruited for this study. Their HRV profiles were measured once and climatic information related to their month of birth was gathered. The HRV profiles of the 2 sexes and 4 seasons of birth were compared. Correlation and regression analysis were performed to clarify the relationship between climatic factors and the HRV results. RESULTS: Boys born in winter have higher high-frequency power (HF) but a lower ratio of low-frequency power to high-frequency power (LF/HF) than do males born in other seasons. This result is not found for girls. Age and the temperature of the SOB are predictive factors for HF among boys. The humidity of SOB is a predictive factor for normalized low-frequency power (LF%) and LF/HF among girls. CONCLUSIONS: Season of birth is related to both parasympathetic and sympathetic activity among school-age children, especially boys. Temperature and humidity are potential causes of this SOB phenomenon.

Comparison of clinical characteristics of adenovirus and non-adenovirus pneumonia in children.

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.

Neonatal bacteremia in a neonatal intensive care unit: analysis of causative organisms and antimicrobial susceptibility.

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.

Significance of pulmonary venous obstruction in total anomalous pulmonary venous return.

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.

Hepatopulmonary syndrome in a child.

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.

Hyperkalemia during the early postnatal days in premature infants.

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: report of one case.

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.

Reaction at the bacillus Calmette--Guérin inoculation site in patients with Kawasaki disease.

BACKGROUND: The bacillus Calmette-Guérin (BCG) reaction is not included in the classical clinical criteria for Kawasaki disease (KD). However, a reaction at the BCG inoculation site has been mentioned among the "other clinical findings" that are present in about 30-50% of KD patients. The objective of this study was to investigate the clinical characteristics of KD patients with reactions at the BCG inoculation site. METHODS: A retrospective study of all patients diagnosed with KD between September 2000 and August 2010 was performed. The clinical presentations, laboratory results, treatment outcomes, and coronary artery abnormalities in the BCG-reactive [BCG(+)] and BCG-nonreactive [BCG(-)] groups were analyzed and compared. RESULTS: In total, 145 patients with KD diagnosed at our institution were included; 46 (31.7%) had a reaction at the BCG inoculation site. The BCG(+) group was younger than the BCG(-) group. Laboratory results showed higher white blood cell counts, platelet counts, and serum potassium levels, and lower low-density lipoprotein levels in the BCG(+) group. The BCG(+) group had a shorter fever duration before intravenous immunoglobulin treatment and a shorter total fever duration than the BCG(-) group. Multivariable logistic regression analysis showed that the age at diagnosis was the only factor significantly associated with a reaction at the BCG inoculation site in KD patients. CONCLUSIONS: In countries with a national BCG vaccination program, a reaction at the BCG inoculation site could be a useful and early diagnostic sign of KD among younger patients, especially those younger than 6 months.

Peritoneal dialysis in infants and children after open heart surgery.

BACKGROUND: Infants and children who undergo surgical repair of complex congenital heart diseases are prone to developing renal dysfunction. The purpose of this study was to investigate the risk factors associated with prolonged peritoneal dialysis (PD) and the mortality of pediatric patients with acute renal failure (ARF) after open heart surgery. METHODS: From June 1999 to May 2007, a total of 542 children underwent open heart surgery for congenital heart disease. Fifteen (2.8%) experienced ARF and seven (1.3%) required PD. The clinical and laboratory variables were compared between the survivor and non-survivor groups of ARF patients that needed PD. RESULTS: The non-survivors (n=3, 43%) had a Longer cardiopulmonary bypass time (154+/-21 vs. 111+/-8 minutes, p=0.012) and longer aorta clamping time (92+/-40 vs. 66+/-15 minutes, p=0.010) than the survivors (n=4, 57%). Before the PD, the pH and base excess of the arterial blood gas analysis in the survivors was much higher than that non-survivors (7.30+/-0.04 vs. 7.16+/-0.10, p=0.039; -5.15+/-3.13 vs. -12.07+/-2.9mmol/L, p=0.031). Furthermore, the survivors had a shorter interval between the onset of ARF and the day the PD was begun (1.2+/-0.4 vs. 4.3+/-1.2 days, p=0.001), and shorter duration of PD (6.6+/-2.7 vs. 13.0+/-3.5 days, p=0.036) than non-survivors. CONCLUSION: Early intervention with PD is a safe and effective method for managing patients with ARF after open heart surgery. The cardiopulmonary bypass and aortic clamping duration, time of initiating PD, duration of the PD, sepsis, and relative complications may predict the prognosis of these patients.

Cardiopulmonary response in obese children using treadmill exercise testing.

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.