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  • 1
    In: Pediatric Respirology and Critical Care Medicine, 2018, Vol.2(3), p.38-44
    Description: Pediatric interventional flexible bronchoscopy (IFB) procedures are difficult to standardize because of a lack of consensus across different countries. The current literature are scant with retrospective case series or case reports in single center only. The main aim of IFB is to keep an enough and patent central airway lumen. The prerequisites are secure environment, skillful technique, appropriate instruments, clear airway vision, and maintenance of cardiopulmonary status of patients. Noninvasive ventilation (NIV) with pharyngeal oxygen with intermittent nose-closure and abdomen-compression or Soong's ventilation is the preferred method in the author's center as it provides a simple and reliable ventilation support during IFB. Pulmonologists should be trained in basic IFB procedures such as tracheobronchial intubation, bronchoalveolar lavage, balloon dilatation, laser ablation, cryotherapy, or even stent placement and maintenance. Pulmonologists should achieve and maintain high skill levels during their career. There is a rapidly evolving IFB role for in the intensive care units (ICUs) because of critical and cardiopulmonary compromised patients. IFB procedures require intense training and a multidisciplinary approach for patient care. With developing technology, the role of IFB is destined to grow. The IFB modality of using short-length bronchoscopes, supported with a NIV and ICU facilities is a viable, instant, and effective management in pediatric patients. Successful IFB could result in rapid weaning of respiratory supports in ICU without the need for transport to the operation theater and more invasive procedure.
    Keywords: Bronchoalveolar lavage; bronchoscopy; child
    ISSN: 2543-0343
    E-ISSN: 2543-0351
    Source: Medknow Publications
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  • 2
    Language: English
    In: PLoS ONE, 01 January 2014, Vol.10(4), p.e0121906
    Description: Acute airway infections, including bronchiolitis, are common causes of early childhood hospitalization. The development of later asthma may be related to early airway infections in young children. This study is to investigate the relationship between hospitalized airway infections (HAI) in young children (〈 3 years old) and later childhood asthma.Hospitalized children (〈 3 years old) with bronchiolitis or other acute airway infections (other HAI group) from 1997-2000 were retrieved from the National Health Insurance Research Database of Taiwan, and compared to age- and gender-matched subjects with regards to asthma until 10 years of age; and potential comorbidities and medical care conditions.In total, 3,264 children (1,981 with bronchiolitis; 1,283 with other HAIs) were compared to 18,527 controls. The incidence of childhood asthma was higher in the study (16.2%) than the control (11.7%) group, and most cases were diagnosed between 3-5 years old. The hazard ratios were 1.583 (95% CI: 1.414-1.772) and 1.226 (95% CI: 1.053-1.428) for the bronchiolitis and other HAI subgroups, respectively, compared to the control group, and 1.228 (95% CI: 1.075-1.542) in the bronchiolitis subgroup compared to the other HAIs subgroup. A significantly higher odds ratio (1.973, 95% CI: 1.193-3.263) for the children with congenital heart disease (CHD) in the bronchiolitis subgroup was found at an age of 3-5 years compared to the control group.Young children (〈 3 years old) hospitalized due to acute HAIs are at a higher risk of developing childhood asthma at age 3 to 10 years. The parents of children with HAIs at age 0 to 2 years should be informed for the higher risk of developing childhood asthma, especially in children with CHD and bronchiolitis.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 3
    Language: English
    In: PLoS ONE, 01 January 2015, Vol.10(9), p.e0137437
    Description: The mortality risk associated with congenital airway anomalies (CAA) in children with congenital heart disease (CHD) is unclear. This study aimed to investigate the factors associated with CAA, and the associated mortality risk, among children with CHD.This nationwide, population-based study evaluated 39,652 children with CHD aged 0-5 years between 2000 and 2011, using the Taiwan National Health Insurance Research Database (NHIRD). We performed descriptive, logistic regression, Kaplan-Meier, and Cox regression analyses of the data.Among the children with CHD, 1,591 (4.0%) had concomitant CAA. Children with CHD had an increased likelihood of CAA if they were boys (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.33-1.64), infants (OR, 5.42; 95%CI, 4.06-7.24), or had a congenital musculoskeletal anomaly (OR, 3.19; 95%CI, 2.67-3.81), and were typically identified 0-3 years after CHD diagnosis (OR, 1.33; 95%CI 1.17-1.51). The mortality risk was increased in children with CHD and CAA (crude hazard ratio [HR], 2.05; 95%CI, 1.77-2.37), even after adjusting for confounders (adjusted HR, 1.76; 95%CI, 1.51-2.04). Mortality risk also changed by age and sex (adjusted HR and 95%CI are quoted): neonates, infants, and toddlers and preschool children, 1.67 (1.40-2.00), 1.93 (1.47-2.55), and 4.77 (1.39-16.44), respectively; and boys and girls, 1.62 (1.32-1.98) and 2.01 (1.61-2.50), respectively.The mortality risk is significantly increased among children with CHD and comorbid CAA. Clinicians should actively seek CAA during the follow-up of children with CHD.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 4
    Language: English
    In: PLoS ONE, 01 January 2017, Vol.12(8), p.e0183078
    Description: Use of therapeutic flexible airway endoscopy (TFAE) is very limited in pediatrics. We report our clinical experiences and long term outcomes of TFAE in small children from a single tertiary referral center.This is a retrospective cohort study. Small children with their body weight no more than 5.0 kg who had received TFAE between 2005 and 2015 were enrolled. Demographic information and outcomes were reviewed and analyzed from medical charts and TFAE videos.A total of 313 TFAE were performed in 225 children. The mean age was 3.50 ± 0.24 (0.01-19.2) months old; the mean body weight was 3.52 ± 0.65 (0.57-5.0) kg. A noninvasive ventilation technique, without mask or artificial airway, was applied to support all the procedures. TFAE included laser therapy (39.6%), balloon dilatation plasty (25.6%), tracheal intubation (24.3%) and metallic stent placement (6.4%). Short-length endoscopes of 30-35 cm were used in 96%. All TFAE were successfully completed without serious adverse events or mortality. Mean procedural time was 27.6 ± 16.1 minutes. TFAE resulted in successful extubation immediately in 67.2% (45/67) and 62.8% (118/188) were able to wean off their positive pressure ventilation support in 7 days after procedures. By the end of this study, these TFAE averted the originally suggested airway surgeries in 93.8% (61/65), as benefited from laser therapy, stent implantation, and balloon dilatation plasty.The TFAE modality of using short-length endoscopes as supported with this noninvasive ventilation and ICU support is a viable, instant and effective management in small children. It has resulted in rapid weaning of respiratory supports and averted more invasive rigid endoscopy or airway surgeries.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 5
    Language: English
    In: PLoS ONE, 01 January 2018, Vol.13(2), p.e0192557
    Description: To assess the placement, surveillance management and long-term outcomes of the tracheobronchial (TB) balloon expandable metallic stent (BEMS) managed by therapeutic flexible endoscopy (TFE).This is a retrospective review and analysis of all computerized medical records and related flexible endoscopy videos of pediatric patients who received TB BEMS during 20 years period, from January 1997 to December 2016. TFE techniques with forceps debridement, balloon dilatation and laser ablation were used to implant stents, perform regular surveillance, maintain their functions, and expand the diameters of BEMS. Short-length (30cm-36cm) endoscopes of OD 3.2mm to 5.0mm coupled with the noninvasive ventilation, without ventilation bag, mask or airway tube, supported the whole procedures.146 BEMS were implanted in 87 consecutive children, including 84 tracheal, 15 carinal and 47 bronchial stents. At the time of placement, the mean age was 35.6 ± 54.6 month-old (range 0.3-228) and the mean body weight was 13.9 ± 10.6 kg (range 2.2-60). Surveillance period was 9.4 ± 6.7 years (range, 0.3-18.0). Satisfactory clinical improvements were noted immediately in all but two patients. Seventy-two (82.8%) patients were still alive with stable respiratory status, except two patients necessitating TFE management every two months. Fifty-one stents, including 35 tracheal and 16 bronchial ones, were successfully retrieved mainly with rigid endoscopy. Implanted stents could be significantly (〈 .001) further expanded for growing TB lumens. The final stent diameters were positively correlated to the implanted duration. Altogether, 33 stents expired (15 patients), 51 were retrieved (40 patients), and 62 remained and functioning well (38 patients), with their mean duration of 7.4 ± 9.5, 34.9 ± 36.3 and 82.3 ± 62.5 months, respectively.In pediatric patients, TFE with short-length scopes coupled with this NIV support has provided a safe, feasible and effective modality in placing and subsequently managing TB BEMS with acceptable long-term outcomes.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 6
    Language: English
    In: International Journal of Pediatric Otorhinolaryngology, 2011, Vol.75(8), pp.1005-1009
    Description: To evaluate the incidence, characteristics, flexible bronchoscopy (FB) findings, interventions and outcome of pediatric obstructive fibrinous tracheal pseudomembrane (OFTP) in our pediatric and neonatal intensive care units (ICUs). This is a retrospective study of medical and FB video records in a single tertiary university-affiliated teaching hospital over a ten-year period. Data was collected from patients who were admitted and extubated of endotracheal tube in the ICUs with a FB diagnosis of an OFTP-like lesion. The associated medical information, FB interventions and video records were reviewed and analyzed. Eight patients with OFTP were enrolled, with an incidence rate of 1.48% in the postextubation respiratory distress patients. Mean age was 32 ± 32 months (range, 2 months to 13 years); mean body weight was 13.7 ± 8.1 kg (range, 4.3–45 kg); mean intubation period was 37.6 ± 12.3 h; mean time for symptoms to develop after extubation was 3.6 ± 1.4 h. Symptoms lasted for 20.8 ± 20.3 h before FB examination. All patients were accurately diagnosed with OFTP at the first postextubation FB examination and revealed various morphologies. The estimated cross-sectional tracheal lumen was reduced by 70–90% and the mean length of lesion was 18.1 ± 5.2 mm (range, 10–30 mm). All OFTP were successfully ablated immediately after the diagnosis in one FB session by using various techniques and without any complication. Total duration for both diagnostic and interventional FB was 19.4 ± 2.5 min. No recurrence was noted thereafter. OFTP should always be considered in the event of postextubation respiratory distress, especially in the pediatric and neonatal ICUs. Early diagnosis and effective ablation can be achieved with aid of FB.
    Keywords: Stridor ; Dyspnea ; Tracheal Pseudomembrane ; Extubation ; Flexible Bronchoscope ; Medicine
    ISSN: 0165-5876
    E-ISSN: 1872-8464
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  • 7
    Language: English
    In: PLoS ONE, 01 January 2015, Vol.10(2), p.e0116844
    Description: The relationship between congenital heart disease (CHD) and malignancies has not been determined. This study aimed to explore the association of CHD with malignancies and examine the risk factors for the development of cancer after a diagnosis of CHD.This nationwide, population-based cohort study on cancer risk evaluated 31,961 patients with newly diagnosed CHD using the Taiwan National Health Insurance Research Database (NHIRD) between 1998 and 2006. The standardized incidence ratios (SIRs) for all and specific cancer types were analyzed, while the Cox proportional hazard model was used to evaluate risk factors of cancer occurrence.Among patients with newly diagnosed CHD regardless of ages, 187 (0.6%) subsequently developed cancers after a diagnosis of CHD. Patients with CHD had increased risk of cancer (SIR, 1.45; 95% CI, 1.25-1.67), as well as significantly elevated risks of hematologic (SIR, 4.04; 95% CI, 2.76-5.70), central nervous system (CNS) (SIR, 3.51; 95% CI, 1.92-5.89), and head and neck (SIR, 1.81; 95% CI, 1.03-2.94) malignancies. Age (HR, 1.06; 95% CI, 1.05-1.06) and co-morbid chronic liver disease (HR, 1.91; 95% CI, 1.27-2.87) were independent risk factors for cancer occurrence among CHD patients.Patients with CHD have significantly increased cancer risk, particularly hematologic, CNS, and head and neck malignancies. Physicians who care for patients with CHD should be aware of their predisposition to malignancy after the diagnosis of CHD. Further studies are warranted to clarify the association between CHD and malignancies.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 8
    Language: English
    In: Journal of the Chinese Medical Association, Dec, 2011, Vol.74(12), p.556(5)
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jcma.2011.09.016 Byline: Wen-Jue Soong (a)(b), Yu-Sheng Lee (a)(b), Pei-Chen Tsao (a)(b), Chia-Feng Yang (a)(b), Mei-Jy Jeng (a)(b) Abstract: Supplemental oxygen (O.sub.2) is mandatory during flexible bronchoscopy (FB) in infants, but there are limited studies that deal with the efficacy of different O.sub.2 delivery methods. This study aims to compare the oxyhemoglobin saturation in infants during FB among three different O.sub.2 delivery methods, as measured by pulse oximeter (SpO.sub.2). Author Affiliation: (a) Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC (b) Department of Pediatrics, Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC Article History: Received 31 January 2011; Accepted 13 July 2011
    Keywords: Infants -- Comparative Analysis ; Infants -- Methods ; Bronchoscopy -- Comparative Analysis ; Bronchoscopy -- Methods ; Oxyhemoglobin -- Comparative Analysis ; Oxyhemoglobin -- Methods
    ISSN: 1726-4901
    Source: Cengage Learning, Inc.
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  • 9
    Language: English
    In: Archives of Disease in Childhood, 22 October 2018, Vol.103(10), p.927
    Description: To investigate the burden of clinically significant neonatal jaundice (SNJ) in Taiwan, 20002010.
    Keywords: Neonatal Jaundice ; Incidence ; Mortality
    ISSN: 0003-9888
    ISSN: 00039888
    E-ISSN: 1468-2044
    E-ISSN: 14682044
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  • 10
    Language: English
    In: Journal of the Chinese Medical Association, November 2012, Vol.75(11), pp.551-559
    Description: Air leak syndrome includes pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, subcutaneous emphysema, and systemic air embolism. The most common cause of air leak syndrome in neonates is inadequate mechanical ventilation of the fragile and immature lungs. The incidence of air leaks in newborns is inversely related to the birth weight of the infants, especially in very-low-birth-weight and meconium-aspirated infants. When the air leak is asymptomatic and the infant is not mechanically ventilated, there is usually no specific treatment. Emergent needle aspiration and/or tube drainage are necessary in managing tension pneumothorax or pneumopericardium with cardiac tamponade. To prevent air leak syndrome, gentle ventilation with low pressure, low tidal volume, low inspiratory time, high rate, and judicious use of positive end expiratory pressure are the keys to caring for mechanically ventilated infants. Both high-frequency oscillatory ventilation (HFOV) and high-frequency jet ventilation (HFJV) can provide adequate gas exchange using extremely low tidal volume and supraphysiologic rate in neonates with acute pulmonary dysfunction, and they are considered to have the potential to reduce the risks of air leak syndrome in neonates. However, there is still no conclusive evidence that HFOV or HFJV can help to reduce new air leaks in published neonatal clinical trials. In conclusion, neonatal air leaks may present as a thoracic emergency requiring emergent intervention. To prevent air leak syndrome, gentle ventilations are key to caring for ventilated infants. There is insufficient evidence showing the role of HFOV and HFJV in the prevention or reduction of new air leaks in newborn infants, so further investigation will be necessary for future applications.
    Keywords: Air Leak Syndrome ; High-Frequency Oscillatory Ventilation ; Neonate ; Pneumothorax ; Pulmonary Interstitial Emphysema ; Medicine
    ISSN: 1726-4901
    E-ISSN: 1728-7731
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