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Parents' and caregivers' satisfaction with community-based rehabilitation (CBR) services for children with disability in east coast states in Peninsular Malaysia

Hasan H, Abdul Aziz AF, Aljunid SM

Health Soc Care Community, 2021 01;29(1):215-226.
PMID: 33189086 DOI: 10.1111/hsc.13084

The Community-Based Rehabilitation (CBR) services under the Malaysian Ministry of Women, Family and Community Development have provided two types of services for disabled children: centre-based and home-based care since 1984. A cross-sectional study was conducted among parents and caregivers with children receiving treatment at CBRs on the east coast of Peninsular Malaysia, to determine the level of satisfaction with the services provided. Respondents were recruited via multi-staged sampling, and simple randomisation at CBR level. Respondents self-administered the Physical Therapy Satisfaction Questionnaire (PTSQ) and provided sociodemographic data. A total of 297 respondents were recruited and all the questionnaires were returned complete, making the response rate 100%. Total satisfaction scores and factors influencing respondents' satisfaction for both groups were analysed. The mean total satisfaction score for centre-based and home-based were 84.69 (SD = 10.01) and 75.30 (SD = 12.23; t = 7.160, p ≤ .001) respectively. Ninety-eight per cent of centre-based and 89% of home-based respondents were satisfied with the current services. There were significantly mean differences in the satisfaction level of respondents of different states respectively (Kelantan mean 84.92 10.83, Terengganu mean 77.49 11.16 and Pahang mean 77.47 12.93, p ≤ .001). Factors associated with satisfaction were education (p = .002), occupation (p = <0.001), monthly income (p = .001) and source of income (p = .001). In conclusion, majority of parents and caregivers were satisfied with current services provided at CBR and satisfaction with services was dependent on CBR centre location and education and financial earning capacity.

Matched MeSH terms: Disabled Children*
The strain among caregivers of children with disabilities at the community-based rehabilitation centres in Kudat division of Sabah, Malaysia

Khairul AY, Kannan TC, Erna FP

Med J Malaysia, 2024 Mar;79(Suppl 1):59-66.
PMID: 38555887

INTRODUCTION: The prevalence of children with disabilities (CWD) is increasing. CWD requires exceptional long-term attention, which often falls on the caregivers. Caring for a CWD affects caregivers in multiple ways, such as physical, social, personal, and financial aspects. Most of the CWD will be cared in Community-Based Rehabilitation (CBR) centres where the caregivers have to play a crucial role as they become partners in the respective service delivery. However, there is still insufficient information on the impact (strain) of a disabled child on the caregivers in the CBR centre in the Kudat division of Sabah, Malaysia specifically. Hence, this study aims to explore the strains among caregivers of CWD at the CBR centre in the Kudat.
MATERIALS AND METHODS: A cross-sectional study through a purposive sampling method was employed, involving 142 caregivers of CWD at the selected CBR centre. Four CBR centres were selected in this study, which were located in the Kudat division of Sabah. The Malay version of the Modified Caregiver Strain Index Questionnaire (M-CSI-M) was used in this study to obtain information about the caregiver's strain.
RESULTS: Findings from this study revealed that most caregivers experienced moderate strain (72.5%). Some of the leading causes of their strain were upsetting CWD's behaviour (10.6%), financial strain (9.2%), and overwhelmed (9.2%). In addition, there were significant differences between caregiver strain and their level of education, income, and the types of their child's disabilities (p ≤ 0.05).
CONCLUSION: The well-being of the caregivers may significantly impact the effectiveness of rehabilitation for CWD, as caregivers are vital interdisciplinary team members.

Matched MeSH terms: Disabled Children*
Fulltext Oral health literacy among carers of special needs children in Kuala Terengganu, Malaysia

Fabillah NSA, Mustapa N, Rohani MM, Esa R

Ann Dent, 2015;22(1):15-20.
MyJurnal

Oral health literacy (OHL) is important in empowering people to improve their general and oral health. Carers’ OHL may be associated with their ability to deliver good oral healthcare to their children. The aim of this pilot study was to assess the OHL among carers of special needs children. This is a descriptive cross-sectional study of carers in four Community-Based Rehabilitation Centre. Data were collected through a structured face-to-face interview of 40 carers. Oral Health Literacy Malay Version (OHLI-M) was measured using text passages and prompts with a total of 57 items. These items were used to assess comprehension and numerical ability of carers based on domains namely, accessing dental care, understand appointment and following medication instructions. The results showed that majority of the participants had ‘marginal’ and ‘adequate’ OHL level of 32.5% and 52.5%, respectively. Only four (10%) participants had ‘inadequate’ OHL level. The ‘reading comprehension’ and ‘numeracy’ sections’ mean scores were 37.54 (95% CI 35.7-39.4) and 38.17 (95% CI 34.8-41.6). The total OHL mean score was 75.7 (95% CI 71.2-80.2). In conclusion, majority of the carers of special needs children in this sample had moderate OHL. Such information is important to develop more appropriate intervention programmes for carers to match their OHL.

Matched MeSH terms: Disabled Children
Global leadership is needed to optimize early childhood development for children with disabilities

Olusanya BO, Gulati S, Berman BD, Hadders-Algra M, Williams AN, Smythe T, et al.

Nat Med, 2023 May;29(5):1056-1060.
PMID: 37055569 DOI: 10.1038/s41591-023-02291-x
Matched MeSH terms: Disabled Children*
A comparison of Malaysian and Australian speech-language pathologists' practices with children with developmental disabilities who are pre-symbolic

Joginder Singh S, Iacono T, Gray KM

Int J Speech Lang Pathol, 2011 Oct;13(5):389-98.
PMID: 21888557 DOI: 10.3109/17549507.2011.603429

The aim of this study was to explore the assessment, intervention, and family-centred practices of Malaysian and Australian speech-language pathologists (SLPs) when working with children with developmental disabilities who are pre-symbolic. A questionnaire was developed for the study, which was completed by 65 SLPs from Malaysia and 157 SLPs from Australia. Data reduction techniques were used prior to comparison of responses across questionnaire items. Results indicated that SLPs relied mostly on informal assessments. Malaysian and Australian SLPs differed significantly in terms of obtaining information from outside the clinic to inform assessment. When providing intervention, SLPs focused mostly on improving children's pre-verbal skills. A third of Australian SLPs listed the introduction of some form of symbolic communication as an early intervention goal, compared to only a small percentage of Malaysian SLPs. Regarding family involvement, SLPs most often involved mothers, with fathers and siblings being involved to a lesser extent. Overall, it appeared that practices of Malaysian SLPs had been influenced by developments in research, although there were some areas of service delivery that continued to rely on traditional models. Factors leading to similarities and differences in practice of SLPs from both countries as well as clinical and research implications of the study are discussed.

Matched MeSH terms: Disabled Children/psychology; Disabled Children/rehabilitation*
Fulltext Barriers to unmet needs among mothers of children with disabilities in Kelantan, Malaysia: A qualitative study

Sukeri S, Bakar RS, Othman A, Ibrahim MI

J Taibah Univ Med Sci, 2017 Oct;12(5):424-429.
PMID: 31435274 DOI: 10.1016/j.jtumed.2017.05.002

Objectives: The present study aimed to determine the barriers that deter mothers of children with disabilities from attaining their unmet needs.

Methods: In-depth interviews of 12 mothers of children with disabilities were conducted from November 2014 to January 2015 in Kelantan, Malaysia. The mothers were recruited by purposive sampling. Thematic analysis was used for identifying, analysing and reporting the data.

Results: Barriers to the unmet needs among mothers of children with disabilities were found to stem from the mothers' expectation and further propagated by lack of support, the role of healthcare professionals in providing care, inappropriate policies and shortage of resources required for survival and maintaining care.

Conclusions: Identification of the barriers to the attainment of unmet needs among mothers of disabled children is crucial for resolving the issue of unmet needs. Deeper understanding of these barriers may facilitate positive actions toward addressing the needs of these mothers and to alleviate the stress on mothers of disabled children. A concerted effort to coordinate services across all disciplines is required to dismantle these barriers by improving the provision of health care delivery and evaluation of welfare policies and services.

Matched MeSH terms: Disabled Children
Health Related Quality of Life in Malaysian children with thalassaemia

Ismail A, Campbell MJ, Ibrahim HM, Jones GL

Health Qual Life Outcomes, 2006;4:39.
PMID: 16813662

Health Related Quality of Life (HRQoL) studies on children with chronic illness such as thalassaemia are limited. We conducted the first study to investigate if children with thalassaemia have a lower quality of life in the four dimensions as measured using the PedsQL 4.0 generic Scale Score: physical, emotional, social and role (school) functioning compared to the healthy controls allowing for age, gender, ethnicity and household income.

Matched MeSH terms: Disabled Children/psychology*
Fulltext An Assessment of the Movement and Function of Children with Specific Learning Disabilities: A Review of Five Standardised Assessment Tools

Baharudin NS, Harun D, Kadar M

Malays J Med Sci, 2020 Mar;27(2):21-36.
PMID: 32788838 MyJurnal DOI: 10.21315/mjms2020.27.2.3

Various standardised assessment tools have been used to evaluate children with disabilities. However, assessment tools that provide information on the movement and function of children with specific learning disabilities (SLD) are still limited. This article provides a narrative review of the characteristics of five movement and/or function assessment tools. The strengths and limitations of the tools will be highlighted. Empirical studies on the assessment tools used are reviewed based on three criteria: (i) standardised tools; (ii) assessment of movement and/or function; (iii) applicability to children with SLD ranging from 4-17 years of age and widely used in practice. The following instruments have been included as they have been found to fulfil the criteria: (i) the Bruininks-Oseretsky test of motor proficiency-2 (BOT-2); (ii) the movement assessment battery for children-2 (MABC-2); (iii) the pediatric balance scale (PBS); (iv) the Vineland adaptive behaviour scale-II (VABS-II) and (v) the pediatric evaluation of disability inventory-computerised adaptive test (PEDI-CAT). The article presents the characteristics, strengths and limitations of five standardised assessment tools that are currently in use, which measure the movement and/or function of children with SLD. This article concludes with a discussion of recommendations for the best approaches to evaluating the movement and functional abilities of children with SLD.

Matched MeSH terms: Disabled Children
An initial look at the quality of life of Malaysian families that include children with disabilities

Clark M, Brown R, Karrapaya R

J Intellect Disabil Res, 2012 Jan;56(1):45-60.
PMID: 21435066 DOI: 10.1111/j.1365-2788.2011.01408.x

While there is a growing body of literature in the quality of life of families that include children with disabilities, the majority of research has been conducted in western countries. The present study provides an initial exploration of the quality of life of Malaysian families that include children with developmental/intellectual disabilities. Dynamics characterising Malaysian society are described as developments in social policy and service delivery that support persons with disabilities and their families.

Matched MeSH terms: Disabled Children/statistics & numerical data*
Correlates of low back pain among Filipino caregivers of children with disability: A preliminary study

Zamora MAL, Labao HC

Enferm Clin, 2020 02;30 Suppl 1:120-123.
PMID: 32115158 DOI: 10.1016/j.enfcli.2019.09.033

The caregiver's role in rearing a child with disability requires huge physical demands which may lead to development of musculoskeletal disorders such as low back pain (LBP). This study aims to determine the factors associated with low back pain among caregivers of children with disability. A quantitative, correlational research design was used. Data were gathered among caregivers of children with disabilities enrolled in a specialized educational and pediatric rehabilitation unit in Valenzuela City. A personal information sheet was used to gather relevant demographic data while Oswestry Disability Index (ODI) was used to measure low back pain and disability. Pearson's correlation and Chi-square were used to determine the relationship and association among demographic factors and low back pain and disability. Majority of the respondents are mothers (59.09%) caring for children with autism spectrum disorder (31.82%), married (68.18%), and living in an extended family (36.36%). Chi-squared revealed a statistically significant association between caregivers' gender (p=0.003), relationship to child (p=0.000), and marital status (p=0.000) to low back pain and disability. Results imply that married mothers who are the primary caregivers to children with disability are prone to develop low back pain and disability. Preventive and restorative physical interventions, such as caring rotation, is recommended. Future studies should focus on other factors such as psychosocial, physical, and emotional aspects of low back pain and disability among caregivers of children with disability.

Matched MeSH terms: Disabled Children*
Fulltext Accuracy of different dental age assessment methods to determine chronological age among children with special needs

Ismail AF, Adnan NH, Suhaidi NNS, Mokhtar IW, Yusof MYPM, Mallineni SK

J Indian Soc Pedod Prev Dent, 2024 Jan 01;42(1):64-70.
PMID: 38616429 DOI: 10.4103/jisppd.jisppd_47_24

AIM: This study aimed to validate the accuracy of dental age (DA) based on the dental development of permanent teeth in children with special needs using Demirjian, Willems, and London Atlas methods and to correlate the dental and chronological age (CA) of children with special needs in Malaysia.
MATERIALS AND METHODS: The panoramic radiographic images belonging to children with special needs from the two teaching dental hospitals in Malaysia aged between 5 and 16 years were included in the study. The evaluation was performed by two observers using three methods (London Atlas, Demirjian, and Willems methods) to estimate the accurate DA. The outcome was determined by comparing the mean of the DA and CA.
RESULTS: A total of 52 panoramic radiographs were available for the analysis. The London Atlas and Demirjian methods overestimated the DA with a mean of 0.05 and 0.20 years, respectively, while the Willems method underestimated by 0.19 years. The London Atlas method was highly precise and accurate, while Demirjian and Willems methods were the least precise and accurate.
CONCLUSION: The London Atlas method of DA estimation is highly accurate and valid for children with special needs in the Malaysian population, followed by the Willems and Demirjian methods.

Matched MeSH terms: Disabled Children*
Health and quality of life among the caregivers of children with disabilities: A review of literature

Isa SN, Ishak I, Ab Rahman A, Mohd Saat NZ, Che Din N, Lubis SH, et al.

Asian J Psychiatr, 2016 Oct;23:71-77.
PMID: 27969083 DOI: 10.1016/j.ajp.2016.07.007

Families caring for children with disabilities face particular challenges and demands compared to those caring for children without disabilities. Evidence suggests that there is considerable variation in how caregivers of children with disabilities adapt to their caregiving demands and stressors. The different adaptations to the children with disabilities may cause different impacts on the health and well-being of caregivers. This paper provides a brief overview of the literature on the impact of caring for children with disabilities on the health and quality of life of caregivers and the factors related to the health outcomes and quality of life. A literature search was conducted by using various electronic databases, including PsychINFO, ScienceDirect, ProQuest, and MEDLINE using specific key terms. Thirty-one articles published in peer-review journals from the last six years (2009-2014) were reviewed. Most of the studies were quantitative studies. Factors discussed that impact on caregivers' health and quality of life include the caregivers' sociodemographic background and child's disability-related factors. Several mediators and moderators including coping strategies, social support, parental stress, self-esteem and self-efficacy are described in this paper. This review highlighted the importance of these factors to better understand the complex nature of stress processes and the caregivers' adaptations to their children's disabilities.

Matched MeSH terms: Disabled Children*
Implementation of video modeling in the occupational therapy intervention process for children and adolescents with special needs: A scoping review

Abd Aziz N, Kadar M, Harun D, Mohd Rasdi HF

Occup Ther Health Care, 2021 Apr;35(2):227-244.
PMID: 33511894 DOI: 10.1080/07380577.2021.1876967

This scoping review explores the implementation of video modeling (VM) by occupational therapists during the intervention process for children and adolescents with special needs. Four primary electronic databases were used to conduct the scoping review: PubMed, Scopus, CINAHL, and Proquest (Nursing and Allied Health). Research methodologies by Arksey and O'Malley were used as a framework to perform the review process. From the review, two themes emerged: (1) implementing VM by occupational therapists during the intervention process can successfully improve a client's desired skills; (2) VM can be applied through several types of technologies. The findings support occupational therapists' use of VM during interventions to positively enhance and promote desired skills among children and adolescents with special needs. Also, it can be incorporated into technological devices to suit a client's specific needs.

Matched MeSH terms: Disabled Children/rehabilitation*
Malaysian teachers' experience using augmentative and alternative communication with students

Joginder Singh S, Diong ZZ, Mustaffa Kamal R

Augment Altern Commun, 2020 06;36(2):107-117.
PMID: 32706287 DOI: 10.1080/07434618.2020.1785547

Teachers play an important role in the successful implementation of augmentative and alternative communication (AAC) for students with complex communication needs. The goal of this two-phase, mixed-methods study was to explore Malaysian teachers' use of, experience with, and perceptions about AAC. Phase 1 involved 252 teachers who completed a questionnaire that was aimed at collecting nationwide data about their use and overall perceptions of AAC. Phase 2 involved semi-structured interviews with 13 teachers who had experience supporting students who used AAC. Approximately half of the participants who completed the questionnaire knew about AAC and had used AAC with their students. Almost all of the participants had positive views of AAC though some misconceptions were reported. Most participants had limited knowledge about AAC that led them to experience difficulties supporting their students. Teachers were motivated to receive AAC-related training to enable them to use AAC more successfully with their students given the small number of SLPs in the country.

Matched MeSH terms: Disabled Children/education*
Fulltext Assessing the unmet needs among caregivers of children with disabilities at the community-based rehabilitation centres in Selangor

Suriati, S., Sharifah Zainiyah, S.Y., Lye, M.S., Norlijah, O.

Malaysian Journal of Public Health Medicine, 2011;11(2):32-40.
MyJurnal

Caregivers may experience the need for information, social support, a range of services and financial support in caring for children with disabilities. However, some of these needs are unmet. This study aims to determine the perceived unmet needs among caregivers of children with disabilities at the Community-based Rehabilitation centre (CBR). A cross-sectional study was carried out among a total of 337 caregivers, who were recruited from 12 CBR centres in Selangor. The unmet needs were assessed using Family Needs Survey (FNS) questionnaire, which included six subscales of needs such as need for information, social support, community services, explaining to others, financial support and family functioning. Caregivers identified the need for information that the child might receive in the future as their greatest need (94.4%) and the least was the need for getting more counseling or help in getting a job (16.3%). The mean score for the overall unmet needs was 18.67 (SD=7.623). Out of six subscales of FNS, the need for information had the highest rating which was 98.3%, followed by need for social support (93.4%), need for community services (84.0%), need for financial support (79.9%), need for family functioning (61.8%) and need for explaining to others (46.2%). The unmet needs varied within the subscales. Therefore, more effective intervention programs are needed in community-based rehabilitation centres to match or reduce those varied unmet needs in order to allow caregivers to provide better care for their children with disabilities.

Matched MeSH terms: Disabled Children
Fulltext Mixture of anxiety and depression among parents of physical disabled children in rural Sabah. [Campuran kebimbangan dan kemurungan dalam kalangan ibu bapa kanak-kanak kurang upaya fizikal di luar bandar Sabah]

Lineker T, Ferlis B, Nurul Hudani Mohd N

Jurnal Psikologi Malaysia, 2016;30:61-73.

Previous researchers have shown that parents of children with physical disabilities have a higher risk of mental health problems that may be caused by significant challenges in raising children with disabilities. This challenge is compounded by the difficulty of living in rural areas. This study aimed to identify whether parents of children with physical disabilities experience Mixed Anxiety and Depression (MAD) and build a deep understanding of "why" parents experienced MAD. Material for this case study was obtained using the Kessler psychological stress scale (K-10) and in-depth interviews. Six parents who have MAD has been interviewed. Inductive content analysis with the help of computer program ATLAS.ti 7 has produced six symptoms of MAD among parents (sleep disturbance, irritable, anxious, easy crying, expecting something worse will happen, hopeless about the future) and five sources of MAD (lack of support, acceptance problems, lack of information and experience, the rural factor, child health problem). It can be concluded, this finding relates to the challenges faced by parents in raising children with physical disabilities in rural Sabah.

Matched MeSH terms: Disabled Children
Fulltext Factors associated with fall injury at home among children under 5 years old in Yemen

Al-Abed A. Al-Abed, Rosnah Sutan, Sami A.R. Al - Dubai, Yassin Ibrahim, Syed M. Aljunid

Malaysian Journal of Public Health Medicine, 2014;14(1):101-110.
MyJurnal

Falls are the most common injury causing death or long term disability particularly among children. This study aimed to identify the risk factors of the unintentional injuries due to falls in children aged less than five years in Yemen. This cross sectional study enrolled a total of 439 children under five years old from the emergency department of 6 hospitals in Sana'a city. Multistage sampling was used to select six hospitals from public and private sectors in Sana'a city. Face to face interviews were conducted by using a structured questionnaire. Simple logistic regression and multiple logistic regression were used in the analysis. The prevalence of falls among children under five years old was 21.2%. In the multivariate analysis, factors associated with falls among children were young mother (aOR= 0.9, 95% CI 0.81-0.91), working of mother (aOR= 4.5 95% CI 2.40-7.65), frequent family social gatherings (aOR= 2.7, 95% CI 1.54-4.61), number of children at home (aOR= 2.6, 95% CI 1.43-4.64), chewing khat by father (aOR= 2.4, 95% CI 1.38-4.10), presence of staircase in the house (aOR= 2.1, 95% CI 1.24-3.70), number of rooms at home (aOR= 2.2, 95% CI 1.17-3.99) and disabled children (aOR= 3.3, 95% CI 1.20-9.27). In the study, socio-economic and cultural factors such as family gathering and chewing khat were associated with home fall injury among children under 5 years old in Yemen. Health promotion program should take place to reduce the occurrence of fall injury.

Matched MeSH terms: Disabled Children
Development and psychometric properties of a scale assessing the needs of caregivers of children with disabilities

Tan SH

Disabil Health J, 2015 Jul;8(3):414-23.
PMID: 25595295 DOI: 10.1016/j.dhjo.2014.11.003

BACKGROUND: Planning and evaluation of health care services for children with disabilities requires information on their caregivers' needs.
OBJECTIVE: This paper aims to present the development and psychometric properties of the Caregiver Needs Scale (CNS), a scale assessing the needs of caregivers of children with disabilities aged 0-12 years in Malaysia.
METHODS: Development of the scale went through a multistage process of literature review, modification of an existing instrument, input from experts and feedback from service users. Literature review identified content domains and response options. An exploratory factor analysis (EFA) was undertaken to identify subscales of caregiver needs. The internal consistency reliability, convergent validity and discriminant validity of the new scale were examined.
RESULTS: 273 caregivers of children with disabilities completed the fielded questionnaire. EFA revealed 4 subscales of caregiver needs: need for 'Help getting information and services for the child,' 'Help coping with the child,' 'Help getting child care' and 'Help with finances.' Three items with factor loading <0.4 were dropped. Cronbach's alpha coefficients of the subscales ranged from 0.813 to 0.903. Total CNS score correlated with number of child's needs and unmet needs. The score was also higher in families with financial and employment problems.
CONCLUSION: A new instrument was developed to assess the needs of caregivers of children with disabilities for use in the Malaysian population. The CNS showed satisfactory psychometric properties but further examination is warranted to confirm its validity.
KEYWORDS: Caregivers; Children with disabilities; Instrument development; Needs assessment; Psychometric properties

Matched MeSH terms: Disabled Children*
Assessing the needs of caregivers of children with disabilities in Penang, Malaysia

Tan SH

Health Soc Care Community, 2017 03;25(2):447-457.
PMID: 26833929 DOI: 10.1111/hsc.12325

Disability in a child not only affects the child but also presents socioeconomic and psychological impacts to the child's family. This study aims to describe the service needs of caregivers of children with disabilities in the state of Penang, Malaysia, and to determine the child and family characteristics predisposing to having more caregiver needs. A cross-sectional survey was conducted between February and June 2013 among caregivers of children aged 0-12 years with disabilities registered with the Penang Department of Social Welfare. Caregivers completed a self-administered mailed questionnaire containing a 20-item Caregiver Needs Scale (CNS). Each item in the CNS was rated on a 5-point Likert scale ranging from 'help not at all needed' to 'help extremely needed'. A total of 273 surveys were available for analysis (response rate 34.0%). The CNS contained four domains. The 'Help getting Information and Services for child' domain had the highest mean score (3.61, 95% CI: 3.46, 3.77) followed by 'Help with Finances' (3.29, 95% CI: 3.13, 3.45) and 'Help Coping with child' (3.11, 95% CI: 2.97, 3.25), while the 'Help getting Childcare' domain had the lowest mean score (2.30, 95% CI: 2.13, 2.47). Multivariate regression analysis identified caregivers of younger children and with more severe disability as having more caregiver needs in all domains. Besides that, caregivers of children with learning disability needed more help getting information and help with coping. Caregivers of children with learning and multiple disabilities needed more help getting childcare compared to children with other disability. Caregivers of Indian ethnicity, who had less than a tertiary education and who themselves had medical problems needed more help with finances. The findings on caregiver needs in this study can help inform planning of family support services for children with disabilities in Penang, Malaysia.

Matched MeSH terms: Disabled Children/statistics & numerical data*
Fulltext Targeted Oxygen in the Resuscitation of Preterm Infants, a Randomized Clinical Trial

Oei JL, Saugstad OD, Lui K, Wright IM, Smyth JP, Craven P, et al.

Pediatrics, 2017 01;139(1).
PMID: 28034908 DOI: 10.1542/peds.2016-1452

BACKGROUND AND OBJECTIVES: Lower concentrations of oxygen (O2) (≤30%) are recommended for preterm resuscitation to avoid oxidative injury and cerebral ischemia. Effects on long-term outcomes are uncertain. We aimed to determine the effects of using room air (RA) or 100% O2 on the combined risk of death and disability at 2 years in infants <32 weeks' gestation.
METHODS: A randomized, unmasked study designed to determine major disability and death at 2 years in infants <32 weeks' gestation after delivery room resuscitation was initiated with either RA or 100% O2 and which were adjusted to target pulse oximetry of 65% to 95% at 5 minutes and 85% to 95% until NICU admission.
RESULTS: Of 6291 eligible patients, 292 were recruited and 287 (mean gestation: 28.9 weeks) were included in the analysis (RA: n = 144; 100% O2: n = 143). Recruitment ceased in June 2014, per the recommendations of the Data and Safety Monitoring Committee owing to loss of equipoise for the use of 100% O2. In non-prespecified analyses, infants <28 weeks who received RA resuscitation had higher hospital mortality (RA: 10 of 46 [22%]; than those given 100% O2: 3 of 54 [6%]; risk ratio: 3.9 [95% confidence interval: 1.1-13.4]; P = .01). Respiratory failure was the most common cause of death (n = 13).
CONCLUSIONS: Using RA to initiate resuscitation was associated with an increased risk of death in infants <28 weeks' gestation. This study was not a prespecified analysis, and it was underpowered to address this post hoc hypothesis reliably. Additional data are needed.

Matched MeSH terms: Disabled Children

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