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BACKGROUND: Malposition of an endotracheal tube (ETT) may lead to many serious consequences. Recently, various methods have been proposed to estimate the proper position of orotracheal intubation (Pro-depth) for neonates. OBJECTIVES: To determine and compare the accuracy of various methods for estimating the Pro-depth and to define the most accurate method for the Asian population. METHOD: This cross-sectional study was conducted at the Chiang Mai University Hospital, Thailand in Asian neonates who required orotracheal intubation and their ETT's position were confirmed with anteroposterior chest radiographs. The estimated depths of orotracheal tubes (Est-depth) were calculated by using 4 methods: the rule of 7-8-9, NTL + 1 cm, corrected gestational age (GA)-based table, and body weight (BW)-based table. We defined the Pro-depth as the depth which provided the ETT's tip placed at mid trachea. The Pearson's correlation coefficient, the Bland-Altmann plot and mean differences with standard deviation (SD) between paired Est-depth by each method and Pro-depth were determined. New formulae were generated to estimate the Pro-depth based on a linear regression equation. The accuracy of each method to predict the optimal depth of orotracheal intubation (Opt-depth) was calculated. RESULTS: Fifty-eight Asian neonates were enrolled of which, 82.8% were Thai. The mean ± SD of GA and BW were 33 ± 5 weeks and 1562 ± 842 g, respectively. NTL + 1 cm and the Pro-depth showed the strongest correlation (r = 0.90, p-value < .01) and agreement with mean difference ± SD of 0.28 ± 0.53 cm. The accuracies of the rule of 7-8-9, NTL + 1cm, corrected GA-based and BW-based table to predict the Opt-depth were 56.9%, 63.8%, 62.1%, and 60.3%, respectively. We created two simple formulae for our population to increase the accuracy of NTL parameter: NTL + 1 cm for measured NTL ≤ 6.5 cm and NTL + 0.5 cm for measured NTL > 6.5 cm. This new method provided more accuracy (72.4%) with mean difference ± SD of -0.03 ± 0.53 cm. CONCLUSION: NTL was the most suitable parameter for estimating the Pro-depth. Our new modified NTL method should be used for Thai neonates with high accuracy and non-significantly underestimated trend. However, promptly clinical assessment and final confirmation by a chest radiography should be done in all intubated patients.

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BACKGROUND: Preterm and low birth weight infants are at risk of iron deficiency. Reticulocyte hemoglobin concentration may be useful as a screening test to diagnose iron deficiency in preterm neonates. OBJECTIVE: To evaluate the accuracy and establish the reticulocyte hemoglobin concentration cutoff value for iron deficiency diagnosis in very low birth weight preterm neonates. METHOD: This study was conducted between May 2018 and March 2019 at Chiang Mai University Hospital. Preterm infants born at gestational age ≤34 weeks and birth weight ≤1500 g were enrolled. Blood samplings were obtained within the first 48 h of life. Iron deficiency was defined by using two or more of these following parameters: mean corpuscular volume <100 fL, transferrin saturation <16% and serum ferritin <30 µg/L. Neonatal anemia was defined as hemoglobin <15 g/dL. The optimum reticulocyte hemoglobin concentration cutoff values were performed by using predictive values and receiving operation characteristic analysis. RESULT: Fifty-seven preterm neonates were enrolled. Nine (15.7%) and three (5.3%) neonates had iron deficiency and iron deficiency anemia, respectively. The reticulocyte hemoglobin concentration cutoff value of <29 pg showed the optimum accuracy to diagnose iron deficiency in very low birth weight preterm neonates with sensitivity, specificity, positive and negative predictive values of 89%, 79%, 42% and 97%, respectively. CONCLUSION: Reticulocyte hemoglobin concentration can be used as a screening parameter to diagnose iron deficiency for VLBW preterm neonates. The optimum cutoff value which provided the acceptable accuracy was <29 pg.

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BACKGROUND: The outcome of perinatal hypoxic-ischaemic encephalopathy (HIE) in middle-to-low-income countries varies between regions. OBJECTIVES: To determine the mortality and morbidity, and factors influencing the deaths of infants with perinatal HIE. METHODS: A retrospective study was conducted at Chiang Mai University Hospital, Thailand. Perinatal HIE infants of >35 weeks gestation, birthweight ≥2000 g and admitted during 2005-2019 were reviewed. Baseline Characteristics, clinical course and outcome at discharge were compared between the period before and after initiation of therapeutic hypothermia (TH). Risk of death in HIE infants who underwent TH was identified. RESULTS: A total of 162 HIE infants were included. Compared to the period before TH initiation, the mortality rate was significantly decreased in the TH period. (27% vs. 12.8%, p=0.04) Among 100 HIE infants who underwent TH, the mortality rates was 14%(14/100), of whom 2.5% (2/76) and 50% (12/24) were in the moderate and severe HIE groups. Apgar score at 5 mins ≤1, severe HIE, seizures, hypoglycaemia, organ involvement ≥ five sites, ammonia ≥100 umol/L, lactate ≥14 mmol/L, and requirement for two or more inotropic drugs were risks of death. Multivariate analysis demonstrated that severe HIE (aOR 732.8, 95% CI 4.7-114643, p=0.01) and a need for two or more inotropic drugs (aOR 45.7, 95% CI 1.5-1040, p=0.029) were significant factors for mortality. CONCLUSION: In the period of TH, perinatal HIE infants had decreased mortality. Severe HIE and a need for two or more inotropic drugs were associated with death in the infant with HIE who underwent TH.Abbreviations: AED: anti-epileptic drug; BW, birthweight; CI: confidence interval; CMU: Chiang Mai University; EEG: electro-encephalogram; GA: gestational age; HIE: hypoxic-ischaemic encephalopathy; IQR: interquartile range; NICU: neonatal intensive care unit; SD: standard deviation; TH: therapeutic hypothermia.

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Background: Poor postnatal weight gain has been associated with low serum IGF-1, a key factor in the pathogenesis of retinopathy of prematurity (ROP).Aim: To investigate an association between relative weight gain (RWG) and severe ROP in very low-birthweight (VLBW) Thai infants.Methods: The medical records of VLBW infants who were admitted to the neonatal intensive care unit in Chiang Mai University Hospital from June 2014 to December 2016 and screened for ROP were reviewed. RWG and total calorie intake (TCI) in the 2nd, 4rth and 6th week of age were calculated and those with no ROP/mild ROP and severe ROP requiring laser treatment were compared.Results: The study included 139 VLBW infants, 24 (17.3%) of whom had ROP requiring laser treatment. Infants with severe ROP requiring laser treatment had a lower median birthweight (840 vs 1,195 g, p < 0.001) and median gestational age (GA) (27 vs 30 wk, p < 0.001) than those with no ROP/mild ROP. When RWG and TCI were compared, the infants with severe ROP requiring laser treatment had a lower RWG at the 2nd (p < 0.01) and 4th weeks of age (p < 0.05) and had a lower TCI at the 2nd week of age (p < 0.001) than those with no ROP/mild ROP. Multivariate logistic analysis demonstrated that GA <29.5 w (p < 0.01), hypotension (p < 0.05), RWG <2.9 g/kg/d (p < 0.05) and TCI <98.5 kcal/kg/day (p < 0.001) at the 2nd week of age were independent risk factors for severe ROP requiring laser treatment.Conclusions: Poor weight gain and low calorie intake at the 2nd week of age were associated with severe ROP requiring laser treatment in VLBW infants. Monitoring weight gain and calorie intake during this period are essential and may improve the outcome of ROP.Abbreviations: BPD, bronchopulmonary dysplasia; IVH, intraventricular haemorrhage; NEC, necrotising enterocolitis; PDA, patent ductus arteriosus; PRC, packed red cells; PVL, periventricular leucomalacia; RDS, respiratory distress syndrome; ROP, retinopathy of prematurity; RWG, relative weight gain; SGA, small for gestational age; TCI, total calorie intake; VLBW, very low birthweight.

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The draining of the right superior vena cava (SVC) into the left atrium is a very rare anomaly of systemic vein drainage. This case report describes a term male infant presenting with central cyanosis diagnosed with right SVC drainage into the left atrium. The diagnosis was performed using conventional echocardiography and computed tomography angiography. Surgical correction with translocation of the right SVC to the right atrium was necessary to treat the symptom of cyanosis and prevent further complications, including brain abscesses and paradoxical embolization.

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BACKGROUND: In low- and middle-income countries (LMIC), haemodynamically significant patent ductus arteriosus (hsPDA) is treated with oral indomethacin (IDC) and ibuprofen (IB) instead of intravenous formulations. No significant differences in efficacy have been reported. However, previous studies had small numbers of VLBW infants (<1500 g). OBJECTIVE: To evaluate the efficacy of oral IDC and IB for closing PDA in VLBW infants with a gestational age of 24-32 weeks. METHODS: This randomised controlled study enrolled 32 infants with hsPDA for treatment with either three doses of oral IDC or oral IB. Echocardiography was performed before and after treatment. RESULTS: Oral IDC was more effective than oral IB (65% vs. 27%, p = 0.03). This difference was attributable to the subset of extremely low-birthweight infants (<1000 g) in whom an hsPDA closed 78% of the time after oral IDC compared with 13% of those treated with oral IB (p = 0.01). In contrast, there was no difference in hsPDA closure rates between the study groups of infants with birthweights of 1000-1499 g. There was no significant difference between the drugs in clinical and laboratory measures of adverse effects, nor of other clinical outcomes Conclusion: Oral IDC was more effective than oral IB for closing PDA in VLBW infants, without significant differences in side-effects or short-term outcomes.

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Those born with sirenomelia, a rare congenital anomaly, have features resembling a mermaid. Characteristics of sirenomelia are a single lower limb, sacral and pelvic bone defects, and anorectal and urogenital malformations. There is an increased incidence of sirenomelia in males and twins. This case was a preterm male, dizygotic twin and product of in vitro fertilisation. The baby was born by caesarean section due to breech presentation. He was found to have a fused lower extremity and absent external genitalia and anus. The baby passed away shortly after birth due to severe respiratory failure. Radiographic findings showed small lung volume and pneumothoraces. There were multiple segmental fusions of the vertebrae. Single femur and single tibia were presented in a fused lower limb. Autopsy demonstrated large intestinal atresia, intra-abdominal testes, absence of kidney, ureter and bladder, single umbilical artery, agenesis of blood vessels at lower extremity and agenesis of sacrum and coccyx.

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OBJECTIVE: 1) To evaluate the accuracy of transcutaneous bilirubin (TcB) compared with serum bilirubin (TsB) in full-term infants, 2) To compare the accuracy of TcB reading from two, three, and four measurements and, 3) To compare the accuracy of TcB measured at the forehead and sternum. MATERIAL AND METHOD: Full-term infants who were diagnosed neonatal jaundice and underwent blood tests for TsB were eligible for enrollment. Infants who were born at gestational age less than 37 weeks, unstable, previously received phototherapy, or exchange transfusion were excluded. TcB was measured at forehead and sternum two, three, and four times at each site. TcB measurements were done within 30 minutes before or after blood sampling for TsB. RESULTS: The authors obtained 294 paired TcB-TsB from 257 full-term infants. TsB ranged from 1.60 to 21.18 mg/dL (mean 11.03, SD 2.73). The correlation coefficients between TcB at forehead and TsB were significant for two, three, and four measurements (r = 0.812, 0.800, and 0.800 respectively). TcB measured at sternum also had significant correlation with TsB (r = 0.829, 0.844, and 0.823 for two, three, and four measurements). TcB tended to underestimate TsB. Measurements at the sternum seemed to have better correlation with TsB than at the forehead. CONCLUSION: TcB has good correlation coefficient to TsB. Two measurements have enough accuracy to estimate TsB level and measurement at the sternum gives better correlation with TsB than at forehead.

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