Maternal poor glycemic control increases risk of neonatal left ventricular hypertrophy.

BACKGROUND: Left ventricular hypertrophy (LVH) is an important complication of infants of diabetic mothers (IDMs). However, the defined factors, such as the influence of glycemic control, insulin administration of diabetic mothers and large for gestational age (LGA) in infants, are largely unknown on the incidence of LVH. Therefore, this study aimed to evaluate the prevalence of maternal and neonatal risk factors associated with LVH in IDMs. METHODS: This prospective analytic study was conducted at tertiary care hospitals in a 1-year period. Inborn IDMs were enrolled, and ventricular hypertrophy was identified by 2D echocardiography in the first 72 hours after birth. RESULTS: A total of 160 IDMs met the inclusion criteria, 33 (20.6%) of which had LVH. The incidence of infants with LVH born to mothers with poor glycemic control (fasting blood sugar >95 mg/dL) was significantly elevated than those with good glycemic control (45.5% vs. 14.4%, P<0.001). Twelve IDMs (12/33, 36.5%) of LVH and 17 IDMs (17/127, 13.4%) of non-LVH were LGA. IDMs with LVH, compared those with non-LVH, had significantly increased left ventricular (LV) geometry; IVSd (6.5±0.8 vs. 4.0±0, 7 mm), LV IDd (16.8±3.3 mm vs. 18.4±1.1), left ventricular ejection fraction (LVEF) (68.3±8.5% vs. 62.9±17.5%), left ventricular fraction shortening (LVFS) (35.9±6.6% vs. 32.2±5.5%), LV mass (15.3±11.6 vs. 9.3±2.5 g) and LV mass index (66.2±17.5 vs. 46.6±9.7 g/m2), all with P<0.001. There was significant correlation in LV mass with infants' weight, height and body surface area (BSA) (r=0.408, 0.337 and 0.424, respectively; P<0.001). CONCLUSIONS: The prevalence of neonatal ventricular hypertrophy in IDMs was 20.6%. Maternal poor glycemic control and LGA status in IDMs were dominant risk factors of LVH.

Feasibility of mobile phone application "Epilepsy care" for self-management of children and adolescents with epilepsy in Phramongkutklao hospital: A randomized controlled trial.

Epilepsy is a common neurological disorder in children. Mobile applications have shown potential in improving self-management for patients with chronic illnesses. To address language barriers, we developed the first Thai version of the "Epilepsy care" mobile application for children and adolescents with epilepsy in Thailand. A prospective, randomized controlled trial with 220 children and adolescents living with epilepsy who had a smartphone and were treated at the pediatric neurology clinic was conducted, with one group using the mobile application and the other receiving standard epilepsy guidance. The primary outcome assessed epilepsy self-management using the Pediatric Epilepsy Self-Management Questionnaire (PEMSQ) in the Thai version, which comprised 27 questions. These questions aimed to determine knowledge, adherence to medications, beliefs about medication efficacy, and barriers to medication adherence. The secondary outcome evaluated seizure frequency at baseline, 3, and 6 months after initiation of an application. Eighty-five participants who were randomized to a mobile application achieved significantly higher PEMSQ scores in the domain of barriers to medication adherence (p < 0.05) at 6 months follow-up. Other domains of PEMSQ showed no statistically significant difference. Baseline median seizure frequencies per month were 7 in the control group and 5.5 in the intervention group. At 3 and 6 months, these decreased significantly to 1.5 and 1 for the control group and 2.5 and 1 for the intervention group (p < 0.001). In addition, the study revealed that 94.9 % of the participants in a mobile application group were highly satisfied with using application. These findings suggest that the mobile application "Epilepsy care" may serve as an effective adjunctive therapy to enhance self-management and seizure control in children and adolescents with epilepsy.

A Randomized Controlled Trial of Evaluating the Efficacy of Alternative Swaddles for Body Temperature Control of Newborns.

BACKGROUND/AIM: The critical drop of body temperature in neonatal termed "hypothermia" increases risk of morbidity and mortality. In order to minimize hypothermia during delivery room to nursery transportation, we trialed for appropriate alternative means of aluminum coated fabric (ACF), cotton swaddle, and their combination. The aim of the present study was to compare the efficacy of aluminum coated fabric, cotton swaddle, and combined method to prevent neonatal hypothermia. PATIENTS AND METHODS: One hundred and seventy-four of eligible infants (birth weight more than 2,500 g) were randomized into three groups (55 infants in aluminum coated fabric, 60 in combined aluminum coated fabric with cotton swaddle, and 59 in cotton swaddle as a control). Rectal temperature was determined before swaddling and arriving at nursery. RESULTS: There was no significant difference in antenatal and perinatal factors. Normothermia was detected in 50, 52, and 55 infants and decrease body temperature from its baseline were evidenced in 25, 24, and 14 infants swaddling with aluminum coated fabric, combined aluminum coated fabric with cotton swaddle and cotton swaddle, respectively (p=0.425 and p=0.210). Interestingly, results indicated that the use of cotton swaddle, ACF, and their combination could reduce the number of hypothermic infants from 4, 3, and 6 to 0, 5, and 1, respectively, pointing that the use of cotton swaddle exhibited the maximum hypothermia recovery potential. CONCLUSION: The cotton swaddle showed the dominant hypothermal control over ACF and combination of cotton swaddle and ACF. These findings may benefit the development of new strategies for hypothermia prevention in newborns.

Genotype-Phenotype Correlation of G6PD Mutations among Central Thai Children with G6PD Deficiency.

BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common X-linked inherited erythroenzymopathy in Thailand. The clinical and hematological manifestations of G6PD deficiency are variable. OBJECTIVE: This study aimed to characterize the genotype-phenotype correlation of G6PD mutations in Thai pediatric patients who were followed-up in Phramongkutklao Hospital, a tertiary center in central Thailand. Material and Method. A total of 102 children including 73 males (71.6%) and 29 females (28.4%) were included in our study. Mutation analysis was performed by direct DNA sequencing of all coding exons of the G6PD gene. Ninety-one patients (89.2%) were presented with neonatal hyperbilirubinemia and 11 patients (10.8%) were presented with acute hemolytic anemia beyond the neonatal period. RESULTS: Molecular analysis of the G6PD gene in 102 G6PD-deficient Thai children identified 12 different mutations. G6PD Viangchan (871G > A) and G6PD Canton (1376G > T) were the first (46.2%) and the second (15.4%) most common identified mutations among both male and female G6PD-deficient individuals, respectively. All affected males were hemizygous for G6PD mutations and had an average G6PD level of 16.7 ± 11.5 (3-76) IU/ml.RBC. Majority of female patients (27 in 29, 93.1%) were heterozygous for G6PD mutations and had an average G6PD level of 133.6 ± 43.4 (9-195) IU/ml.RBC. Two female patients (6.9%) were either homozygous or compound heterozygous for the mutations and had G6PD level in the affected male range (35 and 10 IU/ml.RBC). Only 1 in 27 heterozygous females (3.7%) had G6PD level in the affected male range (9 IU/ml.RBC) which is possibly explained by nonrandom X-chromosome inactivation. The correlation of genotypes, G6PD levels, and clinical phenotypes was not demonstrated in our study in which all of the included G6PD-deficient patients were presented with neonatal hyperbilirubinemia and acute hemolytic anemia, since the genotype-phenotype correlation is normally demonstrated in chronic nonspherocytic hemolytic anemia (CNSHA) G6PD-deficient individuals. CONCLUSION: This study characterizes the molecular heterogeneity of G6PD variants causing G6PD deficiency in Thai children. Our study demonstrated the efficiency of direct DNA sequencing which can identify 12 missense mutations in Thai children.

A Randomized Control Trial of Oral Sucrose Solution for Prevention of Hypoglycemia in High Risk Infants.

BACKGROUND: Neonatal hypoglycemia is found in up to 15% of neonates and 50% of those with risk factors. Hypoglycemia can cause brain damage and increase risk of developmental delay. Nevertheless, the data regarding hypoglycemia prevention by oral sucrose are still limited. The present study aimed to investigate whether oral sucrose solution can prevent hypoglycemia in high-risk infants. PATIENTS AND METHODS: Four hundred and twenty-five infants with high hypoglycemic risk were randomized into two groups (214 infants in the intervention and 211 infants in the control groups). The intervention group received one dose of 0.8 ml/kg of 24% oral sucrose solution followed by enteral feed and was compared to the control group receiving enteral feed alone. Glucose levels were evaluated by Dextrostrix. RESULTS: There was no significant difference in antenatal and perinatal risk factors of neonatal hypoglycemia between groups. Glucose level on admission was 72.1±20.3 and 72.1±24.1 mg/dl in the intervention and control groups, respectively. Although no significant difference was recognized in terms of capillary blood glucose levels between groups, data analysis revealed that the glucose increase over time was significantly higher in the intervention group at 1 h (mean±SE=3.61±1.27 mg/dl; p<0.005), 3 h (mean±SE=7.95±1.57 mg/dl, p<0.001), and 6 h (mean±SE=6.31±1.62 mg/dl, p<0.001) in comparison to those of the control. No serious adverse event was observed in either group. CONCLUSION: A single dose of 24% sucrose solution enhanced the increase of glucose level at 1, 3 and 6 h. However, routine early feeding alone is not inferior to the addition of an oral sucrose solution.

Intraventricular hemorrhage and multiple intracranial cysts associated with congenital cytomegalovirus infection.

Intraventricular hemorrhage with congenital cytomegalovirus (CMV) infection is rare and has been reported only in extremely premature infants or in association with thrombocytopenia. We report the first case of a full-term male infant with congenital CMV infection and intraventricular hemorrhage with a normal platelet count and coagulation profile. The infant also had a left subependymal cyst and bilateral occipital cysts without any other manifestations of CMV infection.

Prevalence of significant weight loss and hypernatremia in breast feeding jaundice infants readmitted to Phramongkutklao Hospital within 1 month of age.

BACKGROUND: Neonatal jaundice, especially breast feeding jaundice is the most common cause of neonatal re-admission within the first month of life. Good maternal support and closed follow-up of newborn infants can promote successful breast feeding without causing any complications. OBJECTIVE: To determine the rate of significant weight loss and hypernatremia in infants with breast feeding jaundice readmitted to Phramongkutklao Hospital within 1 month of age. MATERIAL AND METHOD: Cross-sectional descriptive study was conducted in infants of gestational age > or = 35 weeks and birth weight > or = 2,000 grams who had breast feeding jaundice readmitted between January, 1st and December 31st, 2008. Maternal and neonatal history, laboratory result, complications and treatment were reviewed. STATISTICAL ANALYSIS: Rates of significant weight loss and hypernatremia were calculated. The associations between weight loss and factors, serum sodium, serum bilirubin and weight loss were analyzed using Chi-square and Mann-Whitney U test. RESULTS: There were 30 infants in the study. 12 (40%) were male. The median gestational age and birth weight were 37 (35-40) weeks and 2,945 (2,100-3,810) grams, respectively. Three infants had significant weight loss more than 10% of birth weights. No infant had hyperbilirubinemia. Severity of weight loss was associated with weight loss at the time before discharge from hospital. Weight loss was not associated with gestational age, sex, parity, cesarean section, exclusive breast feeding, serum sodium level, and serum bilirubin level. CONCLUSION: Complications of dehydration such as hypernatremia was not observed in infants with breast feeding jaundice in this study. Maternal education, serial weight measurements and awareness of breast-feeding jaundice problems are helpful strategies to promote successful breast feeding.