Rickets of premature infants induced by calcium deficiency. A case report.

( Update：2007-01-29 )

Tsai JR, Yang PH

Division of Neonatology, Chang Gung Children's Hospital, Taipei, Taiwan, R.O.C.
Rickets of prematurity is not uncommon in neonatal intensive care units. Nutritional rickets in childhood is usually caused by vitamin D deficiency, but the rickets of prematurity is mainly attributable to calcium and phosphorus deficiencies. We present a premature infant with sequelae of necrotizing enterocolitis who needed prolonged administration of total parenteral nutrition (TPN), and who sustained ricketic fracture. After high calcium-fortified TPN supplementation the fracture healed well, and serum alkaline phosphatase dropped. This finding shows (1) serum calcium and phosphorus levels are of predictive value regarding rickets, (2) regular follow-ups of alkaline phosphatase levels combined with radiography in high-risk groups of premature infants are good tools for monitoring rickets, and (3) prolonged TPN administration needs to contain higher calcium and phosphorus concentrations in prematurity than in childhood.
PMID: 9260376 [PubMed - indexed for MEDLINE]

Typhoid fever in children: a fourteen-year experience.

Chiu CH, Tsai JR, Ou JT, Lin TY

Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
From 1982 to 1995, 71 children admitted in our medical center were diagnosed to have typhoid fever by culture or serology. Of the 71 children, most (83%) were aged 5-15 years. These children usually presented with fever and gastrointestinal symptoms, including abdominal pain, diarrhea, nausea or vomiting, and constipation. Hepatosplenomegaly was the most common physical sign observed and abdominal tenderness ranked the second. Thrombocytopenia occurring in 9 patients (13%) was the most common mode of complication. Other complications included intestinal perforation (3%), rectal bleeding (3%), ascites or pleural effusion (4%), and meningitis (1%). The incidence of complications tended to be higher among children 5 years of age or older (p = 0.31).

Most patients responded well to appropriate antimicrobial therapies. There was no mortality. Relapse was observed in two children, although both had received 10 days of chloramphenicol therapy. The clinical isolates of Salmonella typhi were susceptible in vitro to all the antibiotics tested, including chloramphenicol, which, however, showed a higher MIC90 level than other drugs tested. In conclusion, there were age-specific differences of typhoid fever in children in terms of the incidence and morbidity and antibiotic resistance of S. typhi has not been a problem in this area at least up to 1995.

PMID: 10910556 [PubMed - indexed for MEDLINE]