Prognostic indicators of survival in infants with congenital diaphragmatic hernia

PURPOSE

This study sought to identify the factors predictive of the short-term outcome in infants with congenital diaphragmatic hernia (CDH).

METHODS

We retrospectively reviewed medical records from September 1985 to December 1998 for all infants born with CDH and managed at National Taiwan University Hospital (NTUH). Coexisting pathology and measures of respiratory function were analyzed to determine the prognostic factors.

RESULTS

A total of 32 infants with CDH were managed at NTUH over the past 13 years. The investigated factors associated with poor prognosis in CDH included congenital heart disease, chromosomal abnormality, pneumothorax, and preoperative parameters including arterial partial carbon dioxide pressure greater than 40 mmHg, arterial partial oxygen pressure less than 100 mmHg, alveolo-arterial partial oxygen pressure greater than 610 mmHg, and oxygen index (OI) greater than 0.4. Multiple logistic regression analyses indicated that only an OI greater than 0.4 and pneumothorax were significant indicators of poor prognosis. When the incidence of pneumothorax was compared between patients who received ventilation using a conventional mechanical ventilator or high-frequency oscillatory ventilator (HFOV), a trend toward a lower incidence of pneumothorax in those using HFOV for initial stabilization was found (p = 0.08).

CONCLUSIONS

An OI greater than 0.4 before surgery and pneumothorax are poor prognostic indicators in infants with CDH. A high OI is reflective of the severity of pulmonary dysfunction in infants. Pneumothorax further compromises the dysfunction of a hypoplastic lung in infants with CDH. The results of this study show the importance of avoiding iatrogenic pneumothorax during management of infants with CDH.

Paraplegia: complication of percutaneous central venous line malposition

Percutaneously inserted central venous lines are usually a safe and effective means of securing prolonged central venous access but can have serious complications. One patient who experienced clinically important morbidity related to inadvertent malpositioning of a central venous catheter is described. It was inserted via the left saphenous vein into the lumbar venous plexus and resulted in milky cerebrospinal fluid, urine retention, and paraplegia. Reviewing the literature, only 11 patients with the same malposition were reported, three of them with percutaneously inserted central venous lines. In these three patients and our patient the left saphenous vein was used. Neurologic sequelae of paraplegia and urine retention were recorded in 25% (3/12) of patients. The mortality rate approached 42% (5/12) but only two patients were related to catheter misplacement. Although the complication rate is extremely low and difficult to recognize, catheter malposition into the ascending lumbar vein can lead to lethal complications.

Urinary uric acid/creatinine ratio as an additional marker of perinatal asphyxia

PURPOSE

To study the validity of urinary uric acid (UA) as a marker of perinatal asphyxia in term and premature infants.

METHODS

The urinary ratio of UA to creatinine (Cr) was obtained within 24 hours after birth in four groups of infants: 17 term infants and 18 premature infants with perinatal asphyxia, and 22 healthy term infants and 20 premature infants without perinatal asphyxia. Perinatal asphyxia was defined as an Apgar score of 3 or less at 1 minute or 5 or less at 5 minutes, and/or a first blood gas pH of less than 7.25 and a base deficit of at least 12 mmol/L.

RESULTS

The urinary ratio of UA to Cr was significantly higher in term infants with perinatal asphyxia than in term infants without asphyxia (1.53 +/- 0.71 vs 0.73 +/- 0.45; p < 0.005). The same result was found between premature infants with and without perinatal asphyxia (3.89 +/- 1.84 vs 2.45 +/- 0.88; p < 0.01). The urinary ratio of UA to Cr in premature infants was significantly higher than in term infants. When the urinary ratio of UA to Cr was greater than 0.95, perinatal asphyxia was identified with a sensitivity of 80% and a specificity of 71% in term infants. In premature infants, a cut-off value of UA/Cr for perinatal asphyxia of 2.9 had a sensitivity of 71% and a specificity of 70%.

CONCLUSIONS

The results of this study indicate that the urinary ratio of UA to Cr may be used as an additional marker of perinatal asphyxia in term and premature infants. In comparison with other markers such as xanthine, hypoxanthine, and ascorbic acid, it is a simple, quick, and inexpensive way to detect hypoxic episodes in a neonatal intensive care unit within 24 hours after birth.

Prognostic factors for walking attainment in very low-birthweight preterm infants

The purpose of this study was to compare the age of walking attainment between very low-birthweight (VLBW) preterm infants and normal term infants, and to determine the variables that affect the walking attainment in VLBW infants. Ninety-six VLBW preterm infants and 82 normal term infants were prospectively followed to determine their age of walking attainment and to monitor gross motor development with sequential clinic visits at 6, 9, 12 and 18 months corrected age. Perinatal and sociodemographic data were collected through review of medical records. The VLBW infants were significantly older at attainment of walking (median 14 months) than the term infants (median 12 months) after correction for prematurity. By the age of 18 months, all term infants had attained walking ability; while 11% of VLBW infants were still unable to walk. Multivariate proportional hazards regression analysis revealed that low gestational age was significantly associated with late attainment of walking in VLBW infants. With the adjustment for gestational age, prolonged ventilation (or oxygen therapy) and severe retinopathy of prematurity were significant predictors of late walking attainment. Our findings indicate that VLBW preterm infants have an increased risk of delayed attainment of walking. Furthermore, the contribution of low gestational age to the delayed walking attainment in VLBW infants may occur via the plausible pathways of neonatal respiratory distress and severe retinopathy of prematurity.

Congenital diaphragmatic hernia misdiagnosed as pneumothorax in a newborn

Congenital diaphragmatic hernia (CDH) is usually left sided and has a large defect allowing abdominal viscera herniated into thoracic cavity. The chest films usually show air-filled stomach and/or loops of bowel in the ipsilateral hemithorax with mediastinal shift. We report a newborn with CDH, presenting as hyperlucent hemithorax, right-shifted mediastinum, apparently normal pattern of abdominal bowel gas, with the tip of nasogastric tube below the left hemidiaphragm on the radiograph. It was initially misdiagnosed as pneumothorax, and the acute respiratory distress was temporarily relieved by needle aspiration. Hyperlucent hemithorax due to intrathoracic gastric dilatation alone is an unusual presentation of CDH in neonatal period. Absence of stomach bubble in the left upper quadrant of the abdomen, in both radiography and abdominal sonography, is an important clue to make diagnosis of CDH in this misleading condition.

Alberta infant motor scale: reliability and validity when used on preterm infants in Taiwan

BACKGROUND AND PURPOSE

The goal of this study was to examine the reliability and validity of measurements obtained with the Alberta Infant Motor Scale (AIMS) for evaluation of preterm infants in Taiwan.

SUBJECTS

Two independent groups of preterm infants were used to investigate the reliability (n=45) and validity (n=41) for the AIMS.

METHODS

In the reliability study, the AIMS was administered to the infants by a physical therapist, and infant performance was videotaped. The performance was then rescored by the same therapist and by 2 other therapists to examine the intrarater and interrater reliability. In the validity study, the AIMS and the Bayley Motor Scale were administered to the infants at 6 and 12 months of age to examine criterion-related validity.

RESULTS

Intraclass correlation coefficients (ICCs) for intrarater and interrater reliability of measurements obtained with the AIMS were high (ICC=.97-.99). The AIMS scores correlated with the Bayley Motor Scale scores at 6 and 12 months (r=.78 and.90), although the AIMS scores at 6 months were only moderately predictive of the motor function at 12 months (r=.56).

CONCLUSION AND DISCUSSION

The results suggest that measurements obtained with the AIMS have acceptable reliability and concurrent validity but limited predictive value for evaluating preterm Taiwanese infants.

Congenital intracranial teratoma

Congenital intracranial teratoma is a rare disease. A fetus with a congenital intracranial teratoma presenting with a disproportionately enlarged head at 27 weeks gestation is presented. Prenatal ultrasonography and fetal magnetic resonance imaging demonstrate a huge, heterogenous intracranial mass in the left supratentorial region, with the left cerebral hemisphere being compressed and flattened. The infant died of respiratory failure within 24 hours of birth at 28 weeks gestation. On postmortem examination the histologic report revealed an immature teratoma. Fetal MRI is helpful in the prenatal diagnosis and evaluation of intracranial tumor.

Cyanotic congenital heart disease and necrotizing enterocolitis: report of three cases

Three infants with cyanotic congenital heart diseases (CCHD) had abdominal distension, poor activity at day 2, day 3, and day 23. The abdominal roentgenograms showed dilated bowel loops, pneumatosis intestinalis, and pneumoperitoneum. Necrotizing enterocolitis (NEC) was diagnosed. After medical and surgical intervention, one infant survived. In this report, we discuss the relationship between CCHD and NEC. The possible risk factors were also discussed, and it is recommended that NEC be a considered significant complication of infants with CCHD.

Power Doppler ultrasound imaging in neonatal cerebral venous sinus thrombosis

Neonatal sinus thrombosis is a rare occurrence in sick neonates. Because of its nonspecific manifestations, the incidence is underestimated. This disease may not be demonstrated by conventional color Doppler and is diagnosed by computed tomography or magnetic resonance imaging. The authors report a neonate with neonatal sinus thrombosis diagnosed by power Doppler and suggest that the technique may be used as a less expensive and more available screening and follow-up method in high-risk neonates.

Effects of prokinetic agents on contractile responses to electrical field stimulation of isolated guinea pig trachea

We investigated the effects of two prokinetic agents, metoclopramide and cisapride, on the contractile response of isolated guinea pig tracheal segments exposed to electrical field stimulation (EFS). Tracheal segments were suspended between two platinum electrodes in organ baths. Frequency-response curves were obtained by increasing the frequency of the stimuli on equilibrated tracheal segments, in a stepwise manner. Metoclopramide potentialed the EFS-induced contraction of the tracheal; the potentiation was more prominent at lower stimulation frequencies (< or = 10 Hz). Cisapride significantly inhibited the electrically stimulated contraction in trachea strips when the frequency of the stimulus was higher than 10 Hz. In the presence of both metoclopramide and cisapride, there was a potentiation of the contractile response at lower frequencies, and this potentiation was reduced when the frequency was higher than 10 Hz. These results demonstrate that metoclopramide enhances and cisapride reduces the airway tonicity elicited by EFS in isolated guinea pig trachea segments. Further studies are needed to verify the effects of these prokinetic agents on EFS-induced contraction of isolated guinea pig trachea and to determine the mechanisms involved.

Neonatal intestinal perforation caused by congenital defect of the small intestinal musculature: report of one case

Congenital defect of the small intestinal musculature is a rare cause of neonatal spontaneous intestinal obstruction or perforation. Its etiology and pathogenesis are still controversial. A male infant presented with intestinal obstruction at two days of age and rapidly progressed to perforation and septic shock. He died at seven days of age. Autopsy finding revealed a perforation hole at twenty-five cm proximal to ileocecal valve. Histology examination demonstrates multifocal deficiency of the inner circular muscle layer three cm around the perforation site. The clinical and histological characteristics are reviewed and discussed. We propose that the muscle defect of small intestine, especially ileum, is secondary to ischemic injury rather than an embryological malformation.

Granulocyte colony-stimulating factor in the cord blood of premature neonates born to mothers with pregnancy-induced hypertension

OBJECTIVES

To estimate the cord blood levels of granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in preterm infants and to study the relationship of these levels to pregnancy-induced hypertension (PIH) and absolute neutrophil counts.

STUDY DESIGN

G-CSF and GM-CSF levels in the cord blood of preterm neonates (n = 74) either with or without maternal PIH were estimated by enzyme-linked immunosorbent assay.

RESULTS

Infants in the PIH group had lower white blood cell, absolute neutrophil, absolute lymphocyte, and monocyte counts. The levels of G-CSF in cord blood were significantly lower in infants whose mothers had PIH (P =.04) and in infants with neutropenia (P =. 01). G-CSF levels were positively correlated with both absolute neutrophil count (P =.02) and total white blood cell count (P =.01). GM-CSF was undetectable in all subjects. According to logistic regression with neutropenia as the dependent variable, only maternal PIH (P <.001), gestational age (P <.001), and G-CSF (P =.01) were independently related.

CONCLUSION

In this study maternal PIH and low gestational age were significantly associated with neutropenia in premature infants. Low G-CSF levels may contribute to the neutropenia that is commonly seen in infants born to mothers with PIH.

Longitudinal study of serum free thyroxine and thyrotropin levels by chemiluminescent immunoassay during infancy

From October 1996 to December 1997, ninety normal infants born at full-term were enrolled in this study. There were 59 female infants and 31 male infants. Both serum free thyroxine and thyrotropin levels were measured by chemiluminescent immunoassay in the first week (n = 75), 3 months (n = 66), 6 months (n = 79), and 12 months (n = 77) of age. Serum free thyroxine levels (ng/dL) (mean +/- standard deviation) were 2.2 +/- 0.5, 1.3 +/- 0.2, 1.2 +/- 0.2, 1.0 +/- 0.2 for each age group, respectively. Serum thyrotropin levels (mIU/L) (mean +/- standard deviation) were 9.7 +/- 6.7, 3.0 +/- 1.6, 2.7 +/- 1.3, 2.5 +/- 1.2 for each age group, respectively. There was no significant difference between the levels of these two parameters between male and female. The present study provides the reference data for the normal range of thyroid function during infancy. Our results also show that the serum free T4 and TSH levels tend to decline during the first year of life.

Factors affecting the mortality of sick newborns admitted to intensive care units

In order to provide better understanding of the factors affecting the mortality of sick newborns in the Taipei metropolitan area, data of newborns admitted to the intensive care units (ICU) were analyzed retrospectively according to the hospital type of care. Fourteen of the 19 hospitals with an ICU admitting sick newborns joined the data collection: 3 were local hospitals, 7 were regional hospitals and 4 were medical centers. Perinatal and neonatal data of 1083 sick newborns were analyzed: 60% were premature newborns and 58% were male newborns. The maternal referral rate was 7.8% and the neonatal transport rate was 36.2%. Fifty-nine percent of very low birth-weight newborns and 66% of extremely low birth-weight (ELBW) newborns were admitted to the medical centers. The two most common illnesses were perinatal asphyxia and respiratory distress syndrome. About 40% needed assisted ventilation. There were higher incidence of maternal referral, fetal distress, resuscitation in the delivery room, perinatal asphyxia, and necrotizing enterocolitis; lower incidence of meconium aspiration syndrome, sepsis and pneumothorax in newborns admitted to the medical center than those newborns admitted to other hospitals. A total of 153 newborns (14%) died. The most common cause of death was sepsis (22.9%). Multivariate logistic regression analysis revealed that factors significantly related to the mortality were gestational age < 28 weeks, congenital anomaly, sepsis, resuscitation in the delivery room, neonatal transport, congenital heart disease, hospital type of care, ELBW, pneumothorax and high-risk pregnancy. The results of the study stress the importance of regionalization of perinatal and neonatal care, organization of neonatal transport system, newborn resuscitation training, infection control, and delicate ventilatory care in the further improvement of the outcome of sick newborns in the Taipei metropolitan area.

Factors predisposing infants to lower respiratory infection with wheezing in the first two years of life

BACKGROUND

Acute lower respiratory illness (LRI) early in life has been implicated as a factor for adverse respiratory outcomes later in life. Factors that predispose infants to LRI with wheezing have not been conclusively defined.

OBJECTIVES

This prospective study assessed factors that might contribute to LRI with wheezing in the first 2 years of life.

METHODS

Seventy-one healthy full-term infants (44 boys, 27 girls) completed the 2-year follow-up. Demographic and environmental factors were evaluated by questionnaire. Respiratory function was assessed by single occlusion technique and rapid thoracic compression technique. Both techniques were performed successfully in 40 infants at 2.6 (+/- 1.4) months old before they developed any episode of LRI.

RESULTS

Eighteen infants (25%) developed LRI with wheezing. The first episode of LRI with wheezing occurred in the first year of life in 8 infants, and in the second year of life in 10 infants. There were no significant differences in the demographic or environmental features between infants with or without wheezing LRI, or between infants who acquired LRI with wheezing in the second year of life and those who did not acquire or acquired in the first year of life. Infants from different groups did not differ in airway resistance or maximal flow at functional residual capacity. Infants who developed LRI with wheezing had higher incidence of low values for total respiratory system compliance corrected for body weight compared with those who did not (5/30 versus 6/10, odds ratio = 7.5, 95% confidence interval: 1.53 to 36.7, P = .013). None of the variables of the pulmonary function test could differentiate infants who subsequently developed LRI with wheezing in the first year of life or did not develop any episode of LRI with wheezing from those who developed LRI with wheezing in the second year of life.

CONCLUSIONS

Differences in lung function in early life may predispose infants to LRI with wheezing in the first 2 years of life.

The use of prophylactic intravenous immunoglobulin therapy in very low birthweight infants

BACKGROUND

Nosocomial infections are a major cause of death in premature infants, especially in very low birthweight (VLBW) infants. The VLBW infants have low serum immunoglobulin G levels, which may have an effect on infections in early infancy. Thus, prophylactic administration of intravenous immunoglobulin (IVIG) is proposed to maintain higher immunoglobulin G and reduce the rate of hospital-acquired infection.

MATERIALS AND METHODS

A study for the effects of prophylactic IVIG therapy in VLBW infants was performed. A total of 61 VLBW infants were enrolled, and divided into the IVIG group (n = 31) and the control group (n = 30). The dose for each infant was 750-1000 mg/kg for those whose birthweight was less than 1000 g, and 500-750 mg/kg for infants whose birthweight was between 1001 and 1500 g. The control group received saline infusion. The infusions were given every 2 weeks until the infant weighed 1800 g, or was discharged.

RESULTS

The results showed: there were no major differences in the perinatal and neonatal characteristics between the two groups, consistently higher IgG levels were found in the IVIG group, and the age of first documented sepsis was earlier in the control group.

CONCLUSION

In this study, the prophylactic IVIG therapy may give substantially higher IgG levels, which may last for 2 months. However, a prophylactic effect for hospital-acquired infections was not observed.

The controversy regarding diagnostic criteria for early myoclonic encephalopathy

To re-evaluate the diagnostic criteria for early myoclonic encephalopathy (EME), the following study was done. During the past 2 years, five patients with erratic, fragmentary myoclonus of neonatal onset, in association with other types of seizures, were analyzed with regard to etiologies, electroclinical features and their evolution, using a series of examinations including electroencephalographies (EEGs) and metabolic investigations. Of these five patients, three were diagnosed to have non-ketotic hyperglycinemia (NKH); one was pyridoxine-dependent; the other was cryptogenic. Only two cases (one NKH and one cryptogenic) had initial typical suppression-burst (S-B) EEG pattern, which subsequently evolved into multiple paroxysmal abnormalities with random asynchronous attenuation (MP-AA) pattern. The other two cases with NKH had MP-AA EEG pattern throughout both awake and sleep recordings in two consecutive EEG studies. All three cases with NKH survived with increasing microcephaly, muscle tonicity; all developed infantile spasm with hypsarrhythmia on EEGs. The patient with pyridoxine-dependency had an initial MP-AA EEG pattern, which converted into S-B pattern after the first use of pyridoxine, eventually becoming normal after a supplement with the second-dose of pyridoxine. In conclusion, either S-B or MP-AA pattern may reflect the severity of the underlying pathologies or the disease stages. These results suggest that, from both etiological and electroclinical viewpoints, EME may represent a broader spectrum than previously recognized. The still ongoing controversy regarding whether the S-B pattern should be recognized as the sole EEG criteria for the diagnosis of EME needs further experience to clarify.

The human tail

The human tail is a congenital anomaly with a protruding lesion from the lumbosacrococcygeal region. A newborn with a tail-like structure over the coccygeal area observed since birth is presented. Lipoma accompanied by tethered spinal cord were found. In reviewing the literature from 1960 to 1997, 59 cases were described. Higher incidences of spinal dysraphism (49.15%) and tethered spinal cord (20.34%) compared with previous reports were evident. This fact plays an important role in understanding the disturbance of development and regression of human tails. A new classification according to whether the anomaly appears in combination with spinal dysraphism is proposed for clinical usage. Preoperative detailed image studies are needed to clarify the possibility of tethered spinal cord syndrome developing in the future and thus prevent it. Magnetic resonance imaging is the modality of choice if available. Long-term follow-up for possible sequelae after operation, especially in cases with spinal dysraphism, is necessary.

Neurobehavioral development at term in very low-birthweight infants and normal term infants in Taiwan

We compared the neurobehavioral performance at term between very low-birthweight (VLBW) infants and term infants in Taiwan, and investigated the relationships between neonatal factors and neurobehavioral performance in VLBW infants. Sixty VLBW infants and 58 healthy term infants were examined using the Neonatal Neurobehavioral Examination-Chinese version (NNE-C) at 40 weeks postmenstrual age. Medical records of the VLBW infants were reviewed to assess neonatal factors. The mean total score of the preterm infants (67.4+/-5.0) was significantly lower than that of the term infants (73.8+/-3.0) (t = 8.51, P < 0.0001). Furthermore, respiratory illness had a marginal effect on the rate of low neurobehavioral score (defined as 2SD below the mean score of term infants) in the preterm infants after adjustment for gestational age (odds ratio = 7.67, chi2 = 3.36, P = 0.067). Our findings indicate that preterm infants have lower neurobehavioral scores at term than their healthy term counterparts. Furthermore, respiratory illness may be a potential risk factor for low neurobehavioral score at term in preterm infants when gestational age is adjusted for.

Perinatal candidiasis and transient maternal candidemia: report of one case

A premature infant who contracted candida pneumonia and candidemia early in the postnatal period was reported. Fungal hyphae was found in the pus-like gastric aspirate soon after birth, giving the first clue to the diagnosis and prompting an early institution of antifungal therapy. Maternal candidemia was documented in the immediate postpartum period, which resolved spontaneously without specific antifungal treatment.

Early outcome of extremely low birth weight infants in Taiwan

We retrospectively evaluated the outcome and the risk factors for mortality among extremely low birth weight (ELBW) infants born at National Taiwan University Hospital. The records of all live-born infants with body birth weight of less than 1,000 g from January 1, 1993, to December 31, 1996, were evaluated. Infants with major anomalies or whose parents refused resuscitation were excluded from the analysis. There were 81 ELBW infants (0.59%) among a total of 13,835 live births during the study period, and 73 cases were enrolled for study. The mean gestational age (GA) was 27.2 (range, 24-34) weeks. Sixty-six percent of the ELBW infants were born by cesarean delivery. Respiratory distress syndrome occurred in 64% of infants and exogenous surfactant therapy was given to 47%, while intermittent mandatory ventilation was given to 85%. Symptomatic patent ductus arteriosus occurred in 34% of infants, septicemia in 30%, chronic lung disease in 48%, grade III to IV intraventricular hemorrhage in 27%, stage III to V retinopathy of prematurity in 33%, and necrotizing enterocolitis in 8%. Neonatal survival was 74%, survival to discharge was 60%, and intact survival was 50%. The survival rate was 40% for infants with a birth body of weight less than or equal to 750 g, and 68% for those with a birth body weight of greater than 750 g. While survival was 27% for infants with a GA of less than 26 weeks, it was 75% for those with a GA of greater than or equal to 26 weeks. The survival rate improved year by year for those with a GA less than 28 weeks. Cox regression analysis of survival showed that Apgar score at 1 minute (p = 0.0063), pulmonary hypertension (p = 0.012), and severe intraventricular hemorrhage (p = 0.0031) were the most important factors associated with mortality. Though the outcome of ELBW infants in our institute seems poorer than in some more developed countries, it is improving. The prognosis for ELBW infants of 24 to 25 weeks' GA remains guarded under our present care.

Comparison of the outcome of extremely-low-birth-weight infants between two periods

A comparison was made of the outcome of 73 neonates born with their birth weight of 500-999 gm in National Taiwan University Hospital during the period between January 1, 1993 and December 31, 1996 (Period II), with the outcome of 21 such neonates born between April 1, 1988 and October 31, 1992 (Period I). Exclusion criteria included parental refusal for resuscitation, and major anomalies. Data were collected via a predetermined record sheet. The incidences of the extremely-low-birth-weight infants were 23/10,173 (0.23%) and 81/13,835 (0.59%) in Periods I and II, respectively. Early neonatal mortality rate was significant decreased in Period II (43% versus 14%). The limit of viability was improved from gestational age of 26 weeks or 700 gm to gestational age of 24 weeks or 600 gm. The incidence of neonatal morbidity (80% versus 50%) and total survival rate (48% versus 60%) have not changed significantly as seen in this limited number of cases. This study concluded that, with the introduction of exogenous surfactant and modern neonatal care, early neonatal survival rate and the limit of viability were improved.

Factors associated with high-frequency oscillatory ventilation response in infants with respiratory failure

A prospective, clinical study was conducted to investigate the factors associated with the effectiveness and outcome of high-frequency oscillatory ventilation (HFOV) in infants with respiratory failure unresponsive to optimal conventional respiratory and pharmacological therapy. A high-lung volume strategy was used in cases with diffuse lung disease. A total of 30 treatments in 24 patients (including 14 premature infants), aged 1 to 127 days, was included for analysis. By 6 to 8 hours, > 20% improvement in oxygenation (good response) was noted in 57% of treatments. < 20% improvement (poor response) in 20%, 23% showed delayed response 10 to 24 hours after initiation of HFOV. Thirty-five percent of treatments with initial good response deteriorated later because of severe underlying problems or occurrence of ventilatory complications. Seventeen treatments (57%) were weaned successfully to conventional mechanical ventilation (CMV). Poor response was associated with a higher oxygenation index prior to HFOV and a severe underlying problem. Failure to be successfully weaned to CMV was associated with a higher mean airway pressure and a severe underlying condition. Premature infants and infants with the persistent pulmonary hypertension of newborn usually had a good response to HFOV. From results of this study, it is concluded that patients with severe lung disease and a severe underlying problem responded poorly to HFOV. An initial good response did not predict successful weaning.

Clinical experience in airway endoscopy in children: an emphasis on the comparison between flexible and rigid endoscopy

Congenital and acquired lesions of the pediatric airway frequently pose perplexing problems in children, infants and newborns. Prompt investigation into the etiology and early intervention are essential to decrease the morbidity and to prevent some tragic events. Endoscopy grants access to the lesion sites for either diagnostic or therapeutic purposes. From April 1994 to May 1997, totally 509 endoscopic procedures, including 292 flexible and 217 rigid endoscopic procedures were performed in 296 pediatric patients at National Taiwan University Hospital. For routine diagnostic procedures, the flexible fiberscope is the instrument of choice which should include a detailed examination of entire upper airway, as farther to tracheobronchi as possible. When flexible endoscopy fails to demonstrate the exact airway lesion or certain surgical manipulation is demanded, rigid endoscopy is favored. The indications for endoscopy were: stridor, respiratory distress, follow-up endoscopy or tracheostoma evaluation, feeding difficulty, hoarseness or weak voice, and suspicious airway foreign body. Common airway problems in serial orders were: laryngomalacia, subglottic stenosis, tracheo/bronchomalacia and airway foreign body. Nearly 20% of patients in this series had multiple synchronous airway lesions. There was no major complication in our 292 flexible endoscopic procedures. Two major complications attributed to endoscopic manipulations occurred in 217 rigid endoscopic procedures.

Etiology and outcome of hydrops fetalis

Hydrops fetalis is a morbid condition caused by a wide variety of diseases. Although treatment for some underlying pathologies is becoming available, the prognosis remains poor. To analyze the etiology and outcome of hydrops fetalis, we reviewed the records of 79 fetuses encountered at the National Taiwan University Hospital between January 1993 and October 1996. The mean +/- standard deviation gestational age at presentation was 24.9 +/- 6.3 weeks. One case was due to RhE incompatibility. Seventy-eight fetuses were diagnosed as having nonimmune hydrops fetalis; this was idiopathic in 20 fetuses. In the other 58, the causes and associated conditions were classified into eight groups: hematologic (25), cardiovascular (15), chromosomal (5), gastrointestinal (4), cystic hygroma (3), pulmonary (2), infection (2), and miscellaneous (3). One fetus with cystic hygroma also had a chromosomal abnormality (Turner's syndrome). The most common cause of nonimmune hydrops fetalis was homozygous alpha-thalassemia (31%). Twenty-nine fetuses were lost to follow-up after initial evaluation and 50 fetuses were delivered at our hospital. Of these, there were eight cases of antepartum death, 24 cases of intrapartum death, and 18 live births. Seventeen of the live-born infants were treated at our neonatal intensive care unit, of whom only seven survived.

Mature teratoma arising from an intra-abdominal undescended testis presenting as a fetal abdominal mass

Teratoma of the intra-abdominal testis is a rare finding in infants. We describe the case of a full-term newborn treated for a calcified abdominal mass which was observed unexpectedly on prenatal sonography. An undescended right testis was also noted. During laparotomy, a twisted retroperitoneal tumor was found just above the right deep inguinal ring. Histological analysis revealed a mature teratoma of the intra-abdominal right testis. The tumor was removed and there was no recurrence at follow-up 1 year later. A teratoma should be considered in cases of fetal abdominal mass, especially when the testes cannot be detected in the scrotum by the 8th month. Prenatal sonographic diagnosis might be possible.

Congenital short bowel syndrome with left acheiria: report of one case

A case of congenital short bowel syndrome with left acheiria, hemivertebra and dextrocardia is described. Dilatation of the fetal bowel was observed at the 24th week of gestation during a routine ultrasonic scan of a healthy 23-year-old primigravida from a non-consanguineous marriage. Amniocentesis and chorionic villus sampling were denied. The baby was delivered at 38 weeks of gestational age. After delivery, multiple anomalies were noted: left acheiria, congenital short bowel syndrome (15 cm in length of the ileum), pseudo-obstruction of intestine, dextrocardia, and hemivertebrae. We suspected these abnormalities might be due to a vascular accident or failure of lateralization during the early gestational period. To our knowledge, these combinations have not been reported previously in English literature.

Retinopathy of prematurity in very-low-birthweight neonates: epidemiology and risk factors

A retrospective study of 143 very-low-birthweight infants cared in a level III neonatal intensive care unit who had survived for at least 28 days. Initial eye ground evaluation was done at the postnatal age between 4 and 6 weeks. Follow-up evaluation was done every one to two weeks at the discretion of the ophthalmologists. Thirty-four variables were reviewed for each case. Statistical analysis was done for each variable, with the development of retinopathy of prematurity (ROP), severity of ROP and development of threshold ROP as the dependent variables, by Mann-Whitney U test or X2 test when adequate. Variables with P-valu < 0.05 were included in multiple regression. One hundred and thirty-eight cases were survived for more than 28 days with their eyes been checked. Twenty-six (18.8%) of them developed ROP. The prevalence of stage I was 2.2% (3/138), stage II was 3.6% (5/138), stage III was 12.3% (17/138), and stage V was 0.7% (1/138). Threshold disease, stage 3 (+) and above, was found in 5 cases (3.6%). Seventeen variables were found to be correlated with the development of ROP. Only the duration of continuous positive airway pressure (CPAP) was significantly correlated to the development of ROP in multivariate logistic regression. Fifteen variables were correlated with the severity of ROP, but only peak direct bilirublin level, peak total bilirubin level and duration of CPAP could entered multiple stepwise linear regression. Thirteen variables were correlated with the development of threshold ROP, but only episodes of septicemia enter the multivariate logistic regression. We postulate that the longer duration of CPAP in ROP cases may reflect the severity of apnea and episodes of hypoxic attacks. Reducing episodes of apnea may prevent the development of ROP. The number of episodes of septicemia was the only significant variable for threshold ROP so that infection control is important for the prevention of threshold disease.

Predictive pulmonary function of school children in an area of low air pollution in Taiwan

The objective of this study was to determine the effect of different parameters on a predictive model of pulmonary function for elementary school children in an area of low air pollution in Taiwan. Healthy children aged 7 to 12 years from three elementary schools in low-air-pollution areas (Da-Chen, Mai-Liau and Tai-Si) participated in the study. A total of 836 children (423 boys and 413 girls) were included in the study. During summer vacation, each child underwent a physical examination including a screening spirometry. A questionnaire regarding respiratory symptoms and indoor air pollutants was also completed by the children's parents. Air monitoring showed that the levels of outdoor pollutants were relatively low. Multiple linear regression analysis was performed with FVC (forced vital capacity) and FEV1 (forced expiratory volume in 1 sec) as dependent variables. Gender, age, height, weight, technician and indoor air pollution parameters were the independent variables. The results showed that gender,height, weight and technician were the most significant variables for predicting FVC and FEV1. The various indoor air pollution parameters seemed to have no influence on the pulmonary function of children, except that mildew in bedrooms mildly decreased FEV1. Regression analysis showed that all the pulmonary function parameters measured had a positive correlation with height, whereas weight correlated only with certain parameters. Because both indoor and outdoor air pollution was relatively low, we suggest that this model could be used as a basic predictive model of pulmonary function for elementary school children in Taiwan.

High-frequency oscillatory ventilation for infants and children with adult respiratory distress syndrome

Two infants and two children suffered from severe hypoxemia, presenting as a ratio of arterial to alveolar PaO2 < 0.1, persisting for more than 3 hours in spite of high settings on conventional mechanical ventilator. Adult respiratory distress syndrome was diagnosed with the support of bilateral diffuse haziness on chest radiographs. High-frequency oscillatory ventilation with high-lung-volume strategy resulted in prompt decrease in oxygenation index and increase in ratio of arterial to alveolar P O2 in three (75%) of the 4 patients within 6 hours. After a mean duration of 96 hours, high-frequency oscillatory ventilation could be weaned off and conventional ventilation could be resumed at lower mean airway pressure in 3 patients. They continued to improve and finally recovered. The other one showed initially steady improvement on high-frequency oscillatory ventilation for 20 hours, but ultimately died of unresolved cytomegalovirus pneumonitis and intractable pulmonary hemorrhage. There were 2 episodes of pneumothorax developing during high-frequency oscillatory ventilation. After decreasing mean airway pressure and amplitude, the airleak resolved with chest tube insertion. We conclude that high-frequency oscillatory ventilation with high-lung-volume strategy may be an effective rescue therapy to relieve profound hypoxemia in infants and children with adult respiratory distress syndrome.

Tricho-rhino-phalangeal syndrome type II associated with epiglottic aplasia and congenital nephrotic syndrome

A male neonate with tricho-rhino-phalangeal syndrome type II (Langer-Giedion syndrome) and interstitial deletion of chromosome 8 with karyotype 46, XY, del (8) (q24.11-->q24.13) is reported. In addition to hypotrichosis of the scalp hair, abnormally bulbous nose and redundant skin, which are usually found in this syndrome, aplasia of the epiglottis and non-Finnish type congenital nephrotic syndrome were also present. He died of renal failure and respiratory failure at 11 days of age. Electron microscopy of renal necropsy showed foot process loss, focal thickening and splitting of the glomerular basement membrane and mesangial expansion. These have never been reported and could be new associations in this disease that may serve to support the concept of contiguous gene syndrome in patients with tricho-rhino-phalangeal syndrome.

Hydrops fetalis due to placental chorioangioma: report of one case

Chorioangioma is the most common tumor of the placenta. However, a large one complicated with hydrops fetalis is rare. We report a patient who had hydrops fetalis associated with placental chorioangioma. The clinical manifestations included generalized edema, coagulopathy, thrombocytopenia, anemia, hypoproteinemia and hepatosplenomegaly. The hospital course was complicated with acute renal failure and repeated pneumonia. The patient died on the 54th day of life due to persistent lung atelectasis and hypovolemic shock. The pathophysiology and management of the complications of hydrops fetalis with chorioangioma are discussed.

An unusual presentation of multiple congenital melanocytic nevi with a limb distribution

We report a newborn in whom multiple small congenital melanocytic nevi (MN) were noted on the right side involving the scapular area, shoulder, upper arm and forearm. Such a limb distribution of small congenital MN has never been reported in the literature.

Reliability of the Neonatal Neurobehavioral Examination--Chinese version

A Chinese version of the Neonatal Neurobehavioral Examination (NNE-C) was applied to 15 high-risk infants and five normal term infants for investigation of reliability. The infants were assessed by three physical therapists to examine inter-rater reliability and reassessed by one of the therapists within 2 days to examine test-retest reproducibility. The internal consistency of the NNE-C scale was high, with an alpha coefficient of 0.84. The inter-rater reliability was high for item scores (kappa coefficients > 0.75 for 81% of the items) and for section and total scores (all intraclass correlation coefficients > 0.80). The test-retest reproducibility was moderate for item scores (kappa coefficients > 0.40 for 85% of the items) and was high for section and total scores (all intraclass correlation coefficients > 0.80). We conclude that the NNE-C scale is clinically feasible and reliable for the evaluation of neurobehavioral functions of high-risk and normal term infants in Chinese-speaking societies.

Risk factors of cholestasis in very low-birth-weight infants

To evaluate the incidence, clinical course, and possible risk factors of cholestasis in very low-birth-weight infants. A retrospective study of 143 very low-birth-weight infants was performed. Cholestasis was defined as direct-reacting bilirubin > 2 mg/dL for more than 14 days. The clinical course of cholestasis was described, and perinatal risk factors were evaluated for associations with the development and severity of cholestasis. Cholestasis was present in 31 infants (21.7%). The mean (SD) age of onset was 30.3(15.3) days after birth or 26.0 (15.6) days after receiving parenteral nutrition, and the mean (SD) duration was 77.1 (33.8) days. In half of the cholestatic infants, bilirubin continued to rise after discontinuing parenteral nutrition. One infant developed signs of liver cirrhosis and died, two infants died with progressive cholestasis, while the other 28 patients recovered. Analysis of risk factors revealed that birthweight and duration of fasting significantly correlated with the development of cholestasis, and that sepsis significantly influenced the severity of cholestasis. Cholestasis is a common complication of extreme prematurity. The clinical course seems benign but long-term sequelae are unknown. Immature liver function and absence of stimuli for intestinal motility and hormonal secretion predispose to decreased bile flow, while sepsis further impairs hepatic ductular secretion and aggravates cholestasis.

Nonprogressive congenital unilateral ventriculomegaly

Congenital unilateral ventriculomegaly is a rare condition, usually caused by obstruction of the foramen of Monro. In the past, this condition required surgical intervention. We present a female newborn with nonprogressive unilateral ventriculomegaly which was initially detected by prenatal sonography. No surgical intervention was performed, and during the 9 months of follow-up, she had normal head growth and reached appropriate developmental milestones.

Lung mechanics in infants with left-to-right shunt congenital heart disease

To clarify which hemodynamic measurement correlates best with lung mechanics in infants with congenital heart disease and left-to-right shunts, dynamic pulmonary function tests and echocardiography were performed in 26 infants with such disease (study infants) and in 37 normal, healthy infants (control infants). The tidal volume and pulmonary compliance (CL) were lower and airway resistance higher in infants with congenital heart disease than in control infants. A significant correlation was demonstrated between CL, expiratory resistance (Re), and the right pulmonary artery-to-aortic size ratio (RPA/DAO). CL and Re also correlated well with the corrected acceleration time square root of RR ratio (ACT/square root of RR: ACT, acceleration time and RR: length of the cardiac cycle) of pulmonary flow velocity. Stepwise multiple regression analysis revealed that RPA/DAO correlated best with both CL and Re. It is concluded that infants with congenital heart disease and left-to-right shunts have lower lung compliance and higher expiratory airway resistance than normal children, and that RPA/DAO is the echocardiographic parameter that correlates best with the changes in lung mechanics.

Mesenteric arterial thrombosis complicating congenital nephrotic syndrome of Finnish type: report of one case

A female, term neonate presented with generalized edema, heavy proteinuria, hypoalbuminemia and hyperlipidemia in the second week of life. The clinical and laboratory features were compatible with the diagnosis of congenital nephrotic syndrome. Treatment included albumin infusion, empirical penicillin, steroid and continuous arterio-venous hemofiltration. Intestinal perforation developed at the 19th day of age and led to a fatal outcome. At autopsy, thrombosis of the superior mesenteric artery and its branches was noted, and histology of the kidney was compatible with congenital nephrotic syndrome of the Finnish type. The risk of thromboembolism, arterial or venous, should be considered in patients with nephrotic syndrome, even in the neonatal period. Preventive measures, including avoiding volume depletion and femoral arterial/venous puncture, are essential in managing these patients. Prophylactic anticoagulation and infusion of fresh frozen plasma may be warranted to avoid such potentially lethal complications of thromboembolism.

Stable microbubble test for predicting the occurrence of respiratory distress syndrome

To predict the development of respiratory distress syndrome (RDS) in premature neonates who might benefit from early administration of surfactant, the clinical applicability of stable microbubble (SM) test was prospectively evaluated. Fifty-nine preterm neonates with the gestational ages of less than 37 weeks were studied. SM test was performed on gastric aspirates obtained within 30 minutes after birth. The number of microbubbles was correlated with later development of RDS. With a cut-off value of less than 10 microbubbles/mm2, the SM test showed a positive predictive value of 76.0% (19/25) and a negative predictive value of 97.1% (33/34), while sensitivity and specificity were 95.0% (19/20) and 84.6% (33/39), respectively. The overall accuracy was 88.1% (52/59). It was concluded that use of the SM test on gastric aspirates immediately after birth is a rapid, simple and reliable procedure for identifying those neonates with surfactant deficiency who may benefit from prophylactic surfactant therapy.

Trisomy 18 in a patient with CHARGE association

CHARGE association is the non-random association of congenital anomalies, including colobomata of the eyes, heart defects, choanal atresia, retardation of growth and development, genital hypoplasia and ear abnormalities. It is usually a sporadic event of unknown cause. We report a neonate with trisomy 18 and apparent CHARGE association. The associated abnormalities made the diagnosis difficult until the chromosomal results became available. Abnormalities such as clenched hands and short palpebral fissures pointed to the possibility of a chromosomal anomaly. The chromosome study revealed trisomy 18. It is important to perform chromosomal studies quickly when diagnosing a patient with apparent CHARGE association who also has other minor anomalies atypical of CHARGE.

Intrauterine intervention in a case of recurrent meconium peritonitis

We present a case of recurrent meconium peritonitis detected in the second trimester and treated by intrauterine intervention. Antenatal ultrasound findings included fetal ascites and intra-abdominal calcification. Aspiration of fetal ascites under ultrasound guidance and determination of the bilirubin concentration established the diagnosis of meconium peritonitis. Paracentesis was repeated to remove irritating intestinal contents and to decrease pressure on the fetal thorax. Although the exact cause of the meconium peritonitis remains unknown, the recurrence of the condition suggests a genetic basis. A possibility of cystic fibrosis was not considered because the clinical picture did not suggest it. Intrauterine intervention helped to establish the diagnosis of meconium peritonitis and may have contributed to the good outcome.

Thyroid function in normal neonates and infants

This study was undertaken to determine the thyroid function of normal healthy Chinese neonates and infants from birth to 2 years of age. Our results showed that mean serum thyrotropin (TSH) levels decreased steeply in the first 3 days of life. Mean serum thyroxine (T4) concentration was high in the first 7 days of life and it decreased to the level of normal preschool children at 6-9 months of age. On the other hand, there was a tendency for mean serum triiodothyronine (T3) level to increase with age. It is hoped that the establishment of the ranges of the thyroid function study in normal Chinese neonates and infants can help to avoid misdiagnosis and inappropriate therapy of thyroid disorders during this period of life.

Persistent hyperinsulinemic hypoglycemia due to nesidiodysplasia in a neonate

A large, one-hour-old female baby was noted to have hypoglycemia immediately after birth. Although early feeding and then intravenous glucose infusion with a dose gradually increased to 30 mg/kg/min were given, the baby still had recurrent hypoglycemia 14 days after birth. High serum insulin/glucose ratios (> 2.5) were noted twice during hypoglycemic episodes. At the same time, the baby's serum growth hormone, thyroid hormone and cortisol levels were within normal ranges. Hyperinsulinism due to nesidiodysplasia was diagnosed and a near-total pancreatectomy was performed at the age of 14 days. After the operation, euglycemia was achieved and there was no episode of hypoglycemia even after fasting for eight hours. Our experience confirms that surgery is the treatment of choice for patients, including neonates, with hyperinsulinemic hypoglycemia.

Pulmonary mechanics and the energetics of breathing in healthy infants

In order to understand the change in the pulmonary mechanics and energetics of breathing in infants, dynamic pulmonary function tests were studied on 84 occasions in 70 normal healthy infants between birth and seven months of age. All of the study infants were born at full-term and had no lower respiratory infections after birth. Airflow and transpulmonary pressure were measured simultaneously and utilized to calculate values of pulmonary mechanics and energetics of breathing. Variables of ventilation (respiratory frequency, tidal volume, minute ventilation, and inspiratory time) had good correlation with age. Lung compliance increased with age. However, when it was expressed in body weight the lung compliance was independent of age (1.34 +/- 0.37 mL/cmH2O/kg for infants studied). Pulmonary resistance did not differ statistically between different age-groups and it correlated with the level of lung compliance (r = 0.3411, p < 0.01). Older infants had a higher flow rate and esophageal pressure change. This might imply that the older the infant is, the more forceful the breath becomes. The work of breathing was higher in infants of older age and in infants with higher inspiratory pulmonary resistance or lower lung compliance (r = 0.6257, 0.3825 and 0.4579, respectively; p < 0.05). This study establishes reference values for the pulmonary mechanics and energetics of breathing in infancy which may be of assistance in the objective evaluation of respiratory status in infants.

Total parenteral nutrition-associated cholestasis in infants: clinical and liver histologic studies

To evaluate total parenteral nutrition-associated cholestasis (TPN-C) in infants, a retrospective clinicopathologic study was conducted of 15 infants who had received TPN. The mean gestational age and birth weight were 32.1 weeks (26-40 weeks) and 1807 g (840-5840 g) respectively. Two-thirds of the patients were kept on TPN for more than 60 days. The onset of rising direct bilirubin ranged 2-9 weeks (mean 4.5 +/- 2.4) after TPN therapy. Preterm babies less than 32 weeks of age had an earlier rise of direct bilirubin and AST. Bile sludge of the gallbladder was observed in only one case, and none had gallstone. The main histologic findings of liver biopsy or autopsy were cholestasis (intracellular and canalicular), periportal inflammation, fibrosis and bile ductular proliferation. Sixty percent of these survived, the remaining 40% died of complications unrelated to TPN-C. The liver function profile became normalized within a mean of 14.0 +/- 9.4 (8-34) weeks after discontinuation of TPN in the survival cases. It was concluded that infant TPN-associated cholestasis was mostly reversible, but that the younger preterm babies were susceptible to a prolonged TPN course with more marked clinical and pathological changes.

Delayed-onset intraventricular hemorrhage in a full-term neonate: report of one case

Intraventricular hemorrhage (IVH) in the full-term neonates is not as common as in the premature neonates. We describes a full-term neonate who presented with delayed onset of intraventricular hemorrhage and fever. Her perinatal and delivery course were uncomplicated. Clinically, omphalitis was found on admission. However, no definite etiology of IVH was discovered. Follow-up brain sonography at the age of seven months revealed complete resolution of IVH. The prognosis of the patient was good on follow-up, which was comparable with other reports.

Growth and body composition of preterm, small-for-gestational-age infants at a postmenstrual age of 37-40 weeks

In order to understand the nutritional status of preterm, small-for-gestational-age (SGA) infants in the early postnatal period, the growth and body composition of preterm, SGA infants was followed prospectively from birth to the postmenstrual age of 37-40 weeks. The infants were stratified into different groups by gestational age, clinical condition and body proportionality. In each subgroup, the growth and changes in body composition of SGA infants were compared with appropriate-for-gestational-age (AGA) infants of a comparable postmenstrual age. At birth, the SGA infants of both the 31-33 and 34-36 week gestational-age groups were smaller than AGA infants in all body measurements, including arm area (AA), arm muscle area (AMA) and arm fat area (AFA). When the preterm SGA infants had grown to the postmenstrual age of 37-40 weeks, the amount of fat they had accumulated was as much as, or more than that in term AGA infants. Yet, they had less muscle mass and their body weight, body length and head circumference were less than those in term AGA infants. This pattern of growth and the changes in body composition had been persistently observed in SGA infants of different gestational-age groups, different clinical status and different body proportionality. Differences between postnatal enteral nutrition and placental nutrition, or different energy utilization, in preterm SGA infants are hypothesized to account for these observations. The growth of less mature (31-33 weeks gestation) SGA infants and those preterm SGA infants with an eventful clinical course was suboptimal as compared with other SGA infants in the same subgroup. In this study, the weight to length ratio (WLR) was used to define the status of nutrition in preterm SGA infants: WLR < or = 2 S.D. or > 2 S.D. off the reference mean. Infants in both groups showed some catch-up growth in body weight. Yet, at near-term their body weight were still more than 2 S.D. below the mean of term AGA. In each gestational-age group, the growth of these two body-proportionality groups did not differ from each other except for the low WLR group of 34-36 weeks gestation which had a significantly lower body weight and skinfold thickness than the group with a normal WLR. Multiple regression analysis revealed that skinfold measurements of preterm SGA infants at birth is the best factor for determining the body weight gain at near-term. After use of the skinfold thickness was set aside, WLR became the most important factor.(ABSTRACT TRUNCATED AT 400 WORDS)

Weight to length ratio--a good parameter for determining nutritional status in preterm and full-term newborns

To identify which parameter showed the strongest correlation with neonatal body fat store, when the ratios for assessing both weight-for-length and the mid-arm circumference to head circumference (MAC/HC) were included in the analysis, body anthropometrics and skinfold thickness were measured in 250 full-term and 125 preterm infants. Among the study cases, 66.7% were appropriate for gestational age, 26.7% were small for gestational age and 6.7% were large for gestational age. Sum of the skinfold thickness measured at the midtricepital and subscapular areas correlated well with body anthropometrics, weight/length ratio, body mass index, ponderal index and mid-arm circumference to head circumference ratio. Multiple stepwise regression analysis revealed that the weight/length ratio correlated best with skinfold thickness in both full-term and preterm newborn infants. Therefore, the simple weight/length ratio might be useful for evaluation of the nutritional status of intrauterine growth, and in the prediction of metabolic complications in both full-term and preterm newborns with abnormal intrauterine growth.