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  • Author: Junya Jirapradittha x
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Open access

Sudarat Sirichaipornsak, Junya Jirapradittha, Pakaphan Kiatchoosakun and Chanyut Suphakunpinyo

Abstract

Background: Gastroschisis is common among congenital abdominal wall defects. The cause is unknown but it was found to be associated with young maternal age. The association between gastroschisis and delayed development is undetermined.

Objective: We described neurodevelopmental outcomes in patients with gastroschisis at 24±6 months corrected age (CA) and identify factors associated with delayed neurodevelopmental outcomes.

Method: This is a cross sectional descriptive study, in patients with gastroschisis born between July 2007 and December 2008, who were admitted to the neonatal unit at Srinagarind hospital, a university hospital in northeast Thailand. The patients underwent developmental assessment at 24±6 months CA by Bayley Scales of Infant Development III (BSID III) which assesses three domains: cognitive, language and motor development.

Result: Fifteen of 21 patients with gastroschisis were included in the study. The mean age at follow up was 21.8±3.9 months. Four patients (26.7%) had delayed development. One was mildly delayed in all aspects including cognitive, language, and motor development. Three patients (20%) had mild delay in language development only. No significant risk factor associated with delayed neurodevelopmental outcomes was identified. Transient hypothyroidism from iodine excess was found in three out of four patients (75%) who had undergone the silooperation (p=0.01).

Conclusion: Developmental evaluation should be performed in patients with gastroschisis because we found that 26.7% of patients with gastroschisis had delayed development. However, significant risk factors could not be identified due to limited number of subjects. If the patient underwent the silo-operation, thyroid function should be tested and closely followed-up.

Open access

Chatchai Suesirisawad, Ouyporn Panamonta, Pakaphan Kiatchoosakun, Junya Jirapradittha, Pranom Buppasiri and Jadsada Thinkhamrop

Abstract

Background: Thailand is an endemic area for iodine deficiency disorders (IDD) in Southeast Asia. More than 50% of pregnant women in northeast Thailand have low urine iodine levels. While rising thyroid- stimulating hormone (TSH) levels in neonates are particularly sensitive to IDD.

Objective: To establish the iodine status of postpartum mothers and neonates and its relationship with TSH in Khon Kaen Province.

Materials and Methods: A prospective study was conducted between June and October 2011. Three hundred postpartum mothers and their neonates were enrolled. Urine iodine was collected and measured using a simple microplate method. TSH assay was performed using an immunoradiometric assay. The optimum level of maternal urine iodine including children <2 years was >100 μg/L and neonatal whole blood TSH <5 mU/L (equivalent to serum TSH <11.2 mU/L).

Results: The median postpartum maternal urine iodine was 208.4 μg/L, 29.3% had values <100 μg/L and 42.3% <150 μg/L. The median neonatal urine iodine was 151.0 μg/L with 26.0% having urine iodine levels <100 μg/L and 49.7 % <150 μg/L. The median neonatal whole blood TSH was 4.3 mU/L, 3.0% had TSH >5 mU/L. There was no significant correlation between postpartum maternal urine iodine and neonatal TSH (p = 0.340, r = 0.055), but there was a significant positive correlation between maternal and neonatal urine iodine levels (p = 0.013, r = 0.143), neonatal urine iodine and TSH levels (p = <0.01, r = 0.203).

Conclusion: After a national campaign of iodized salt coverage and oral iodine supplement for all pregnant women, there was increasing median maternal and neonatal urine iodine and a weakly positive correlation between maternal and neonatal urine iodine levels, neonatal urine iodine and TSH levels, but no correlation between maternal urine iodine and TSH levels. The prevalence of IDD in pregnant women in northeast Thailand seems to have decreased, but intervention programs needs to be extended to reach populations that still have inadequate iodine intake.

Open access

Pongsatorn Paopongsawan, Suwannee Wisanuyotin, Ratana Komwilaisak, Junya Jirapradittha, Apichat Jiravuttipong and Pakaphan Kiatchoosakun

Abstract

Background: Antenatal hydronephrosis (ANH) is a condition characterized by fetal renal pelvic dilatation during pregnancy. It is detected in 1%-5% of all pregnancies. Most cases of ANH are physiological in nature, but some are pathological and can cause morbidity.

Objective: To determine: (a) the causes of ANH; (b) the factors associated with complications; and, (c) the factors associated with surgical intervention.

Methods: We reviewed the medical records of infants diagnosed with ANH; defined by a renal pelvic anteroposterior diameter ≥5 mm (based on antenatal ultrasonography) and being followed-up at Srinagarind Hospital.

Results: Forty-six infants (32 boys and 14 girls) with ANH were identified. Over half (57%) were born in our hospital (in-hospital) with the condition. The two most common causes of ANH were ureteropelvic junction obstruction (32%) and transient hydronephrosis (22%). Of the 63 abnormal kidneys, 52% needed surgical intervention. Twenty-two patients (48%) had urinary tract infections and most had more than 1 episode. None of the 46 patients had end-stage renal disease, but one died because of lung hypoplasia during the neonatal period. The severity of ANH and time of first postnatal ultrasonography were related to medical complications, while bilateral ANH and more severe ANH were associated with the need for surgical intervention. A milder degree of ANH and postnatal ultrasound findings were significantly associated with transient hydronephrosis.

Conclusion: Most cases of ANH were pathological and half required surgical intervention. Severe ANH and delayed investigation were associated with poor outcomes.

Open access

Kittiphop Somboonnithiphol, Ouyporn Panamonta, Pakaphan Kiatchoosakun, Junya Jirapradittha, Manat Panamonta, Pagakrong Lumbiganon and Pichet Somsapt

Abstract

Background: Salt wasting 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) is the most common cause of adrenal insufficiency during neonatal periods. Newborn screening for CAH will improve case early detection and decrease associated morbidity and mortality. The previous nationwide incidence of CAH in 1999 was 1:19,521. To date, CAH newborn screening has not been included in national newborn screening program.

Objective: We evaluated the incidence of CAH in newborns delivered at Srinagarind Hospital.

Methods: Between September 2005 and June 2008, the filter paper blood spot 17-hydroxyprogesterone (17-OHP) tests were determined in newborns delivered at Srinagarind Hospital. The tests were concurrently performed with TSH and phenylketonuria screening in national newborn screening program of the Ministry of Public Health of Thailand. Re-evaluation with completed physical examinations, repeated blood test for serum 17-OHP and serum electrolytes were performed in newborns who had 17-OHP levels higher than cut-off values. CAH was indicated in patients who had abnormal high serum 17-OHP concentration with or without hyperpigmentation and/or ambiguous genitalia in affected females and/or electrolyte imbalance.

Results: Five thousand seven hundred seventy one of 7,147 (80.74%) live births were screened for CAH. Fourteen infants (0.24%) were recalled for re-evaluation. Eight of fourteen (57.14% response rate) infants had the repeated blood tests. Abnormal elevated serum 17-OHP concentrations were found in two infants. Only one had clinical and laboratory findings indicative of CAH. The incidence of CAH was therefore 1:5,771.

Conclusion: The incidence of CAH from newborn screening in Srinagarind Hospital was obviously higher than national incidence of Thailand. The implement of CAH screening for all neonates should be reconsidered.

Open access

Warawut Siwaprapakorn, Manat Panamonta, Arnkisa Chaikitpinyo, Pagakrong Lumbiganon, Ouyporn Panamonta, Orathai Pachirat, Sompop Prathanee, Yuttapong Wongswadiwat, Junya Jirapradittha and Kaewjai Thepsuthammarat

Abstract

Background: Infective endocarditis (IE) is an important cause of child morbidity and mortality, but the current burden of the disease in Thai children is unknown.

Objectives: To determine the current burden of IE in Thai children.

Patients and Methods: The records of all children aged <15 years admitted to Khon Kaen University Hospital from 1992 to 2011 were reviewed.

Results: Of 69,822 admissions, 56 patients fulfilled the modified Duke criteria for definite IE giving a rate of 0.8 cases per 1,000 admissions. Age at diagnosis was 7.9 ± 3.8 years (range, 8 days to 14.8 years). There was congenital heart disease in 38 (68%) patients, rheumatic heart disease (RHD) in 10 (18%), and no previous heart disease in 8 (14%). RHD was a less frequent underlying disease during the latter half (2002-2011) of the period studied (1/34 vs. 9/22, P < 0.001). Blood cultures were positive for pathogens in 34 (61%) patients with 11 cases of Streptococcus viridians and 8 cases of Staphylococcus aureus infections. Vegetations on echocardiography were present in 46 (82%) patients. For 8 embolic events, patients with large vegetations had a higher rate (4/6) than patients with small and no vegetations (4/50) (P < 0.003). In-hospital mortality was 11%. Eight patients with S. aureus infection had a higher mortality (5/8) than 26 patients (1/26) infected with other pathogens (P < 0.001).

Conclusion: The changing epidemiology of pediatric IE was toward fewer children with RHD. Mortality among children with IE was higher in those with S. aureus infection.