MyMedR

The overall mortality rate of babies delivered in the University Hospital, Kuala Lumpur has improved significantly from 18.5 in 1969-1971 to 9.9 per thousand live births in 1979-1981. This drop in mortality is also seen in those infants weighing 1001 - 2000 g at birth. Indian babies in the weight group 1001 - 1500 g at birth appear to have a significantly lower mortality than the other races. Babies referred from outside have a much higher mortality rate compared to babies delivered in University Hospital, Kuala Lumpur.

Matched MeSH terms: Infant, Premature, Diseases/mortality*

Fulltext Methicillin resistant Staphylococcus aureus--first case of bacteremia in the University Hospital, Kuala Lumpur

Puthucheary SD, Lim CT, Parasakthi N, Tan A, Lam KL

Singapore Med J, 1987 Oct;28(5):456-8.

PMID: 3433116

Matched MeSH terms: Infant, Premature, Diseases/drug therapy*

Neonatal septicaemia in Kelantan, Malaysia

Choo KE, Wan Ariffin WA, Chua SP

Ann Acad Med Singap, 1988 Jul;17(3):438-42.

PMID: 3218934

A retrospective study of 84 cases of neonatal septicaemia admitted into a neonatal unit in a rural area of Malaysia for 1 year between 1st September 1985 to 31st August 1986 was carried out to determine the spectrum of micro-organisms and predisposing factors in relation to early and late onset septicaemia. The incidence of neonatal septicaemia was 2.13 per 1,000 live-births per year and the case fatality was 41.7% with higher case fatality in those who were premature, those who presented as early onset and those who had gram negative septicaemia. The mean age of onset of septicaemia was 7.8 days (range from 2 hours to 27 days). Forty four (52%) neonates had early onset septicaemia with mean age of onset at 2.7 days; forty (48%) neonates had late onset septicaemia presenting at 13.6 days of life. Gram negative organisms such as Klebsiella, Pseudomonas, sp., E. coli and Streptococcus, especially group B Streptococcus were the major organisms in the early onset septicaemia. Staphylococcus aureus and Staphylococcus epidermidis were the major organisms responsible for the late onset septicaemia. Obstetrical factors played an important role in early onset septicaemia. Prematurity was the most common predisposing factor. Invasive diagnostic and therapeutic procedures including surgery highlighted once again the importance of these procedures in predisposing the newborn to infection.

Matched MeSH terms: Infant, Premature, Diseases/microbiology*; Infant, Premature, Diseases/mortality

Biosocial variances and infant survival: a path analysis approach

Frisch AS, Kallen DJ, Griffore RJ, Dolanski EA

J Biosoc Sci, 1992 Apr;24(2):175-83.

PMID: 1583032

This study used path analysis to assess the chances of survival of babies in a neonatal intensive care unit in Lansing, Michigan, USA. Two paths to neonatal survival were identified and the variables accounted for 20% of the variance in gestational age. The first path showed that prior infant losses were negatively correlated with gestational age while in the second path, gestational age showed negative relationships with pre-pregnancy weight and household job worries.

Matched MeSH terms: Infant, Premature, Diseases/etiology; Infant, Premature, Diseases/mortality*

Fulltext Early onset neonatal septicaemia in a level II nursery

Malik AS, Pennie RA

Med J Malaysia, 1994 Mar;49(1):17-23.

PMID: 8057985

A prospective study of 486 high risk neonates admitted to a level II nursery in a relatively poor and rural area of Malaysia was carried out to determine the incidence, the spectrum of micro-organisms and predisposing factors in relation to early onset septicaemia. The incidence of proven or probable septicaemia was 57.61 per 1000 high risk newborns over 1.5 kg. The case fatality was 10.71 per cent. Coagulase negative staphylococci, Streptococcus Group B and Klebsiella species were the most commonly isolated organisms. Meconium staining of liquor was the most common risk factor for admission to the nursery, and prematurity was the most significant risk factor for early neonatal infection (P < 0.005) followed by small for gestational age (P < 0.04). Although the incidence of septicaemia was quite high in the level II nursery, the mortality rate was comparable to established figures.

Matched MeSH terms: Infant, Premature, Diseases/diagnosis; Infant, Premature, Diseases/etiology; Infant, Premature, Diseases/epidemiology

Measurement of androstenedione levels by an in-house radioimmunoassay

Lo MS, Ng ML, Wu LL, Khalid BA

Malays J Pathol, 1996 Jun;18(1):53-8.

PMID: 10879225

An in-house radioimmunoassay (RIA) for the measurement of androstenedione levels in serum was established and validated. Levels of androstenedione were measured by RIA using serum samples from various normal population groups and patients with congenital adrenal hyperplasia (CAH). Analytical recovery and linearity results were > 95%, while intra- and inter-assay CVs were < 10% and < 22% respectively. The assay sensitivity was 0.5 nmol/l or 25 fmol/tube. In normal population groups, the highest androstenedione levels were found in preterm neonates (1.6-12.4 nmol/l), followed by adult females (1.5-10.2 nmol/l), adult males (1.6-8.0 nmol/l) and term neonates (0.8-8.8 nmol/l), while the lowest values were observed in prepubertal children (0.5-3.4 nmol/l). There were no significant differences in diurnal variation and between follicular and luteal phases. The range of androstenedione levels in untreated or poorly controlled CAH patients (7.6-355.0 nmol/l, median 42.5 nmol/l, n = 20) were significantly higher (p < 0.001) than the upper normal limit of 3.4 nmol/L for prepubertal children. The normal androstenedione reference ranges for paediatric and adult groups have thus been established.

Matched MeSH terms: Infant, Premature, Diseases/blood; Infant, Premature, Diseases/diagnosis

Usefulness and limitations of an in-house direct radioimmunoassay for 17-hydroxyprogesterone in serum

Lo MS, Ng ML, Wu LL, Azmy BS, Khalid BA

Malays J Pathol, 1996 Jun;18(1):43-52.

PMID: 10879224

Since conventional radioimmunoassays (RIA) for measurement of 17-hydroxyprogesterone (17-OHP) in serum samples require a laborious solvent extraction step, a direct and rapid in-house RIA was developed for early diagnosis and management of congenital adrenal hyperplasia (CAH). In-house rabbit anti-17-OHP antiserum, tritium labelled 17-OHP and dextran-coated charcoal were used in assay buffer with low pH 5.1 and preheated serum samples. Both inter- and intra-assay CVs were < 10% and the sensitivity was 1.2 nmol/l or 12 fmol/tube. Results from the direct assay correlated well with values from an extraction assay, r = 0.88 in samples from CAH patients, r = 0.85 in adults and children, 0.69 and 0.40 in term and preterm neonates respectively, 0.66 and 0.63 in luteal phase and third trimester pregnancy; p < 0.001 in all groups except p < 0.05 in preterm neonates. However, results from the direct assay were two to three times higher in serum samples from CAH patients, normal adults and children, but were five to seven times higher in pregnancy and term neonates and thirty times higher in preterm neonates. The markedly elevated levels measured by the direct assay are probably due to cross-reactivities with water-soluble steroid metabolites such as 17-hydroxypregnenolone sulphate and dehydroepiandrosterone sulphate (DHEAS). Although the direct assay is only useful as a screening test for preterm babies, it can be used for both diagnosis and monitoring of treatment of CAH in all other age groups.

Matched MeSH terms: Infant, Premature, Diseases/blood

Hansenula anomala infection in a neonate

Wong AR, Ibrahim H, Van Rostenberghe H, Ishak Z, Radzi MJ

J Paediatr Child Health, 2000 Dec;36(6):609-10.

PMID: 11115044

We present an unusual neonatal fungal infection, Hansenula anomala in a very low birthweight infant who underwent abdominal surgery for an omphalocele. Despite treatment with adequate doses of amphotericin B, the yeast continued to grow from the blood culture, and was only eradicated with the use of oral ketoconazole.

Matched MeSH terms: Infant, Premature, Diseases/microbiology*

Risk factors for hypoxemia and respiratory failure in respiratory syncytial virus bronchiolitis

Chan PW, Lok FY, Khatijah SB

Southeast Asian J. Trop. Med. Public Health, 2002 Dec;33(4):806-10.

PMID: 12757230

Respiratory syncytial virus (RSV) bronchiolitis is a common infection in young children and may result in hospitalization. We examined the incidence of, and risk factors associated with, hypoxemia and respiratory failure in 216 children aged < 24 months admitted consecutively for proven RSV bronchiolitis. Hypoxemia was defined as SpO2 < 90% in room air and severe RSV bronchiolitis requiring intubation and ventilation was categorized as respiratory failure. Corrected age at admission was used for premature children (gestation < 37 weeks). Hypoxemia was suffered by 31 (14.3%) children. It was more likely to occur in children who were Malay (OR 2.56, 95%CI 1.05-6.23, p=0.03) or premature (OR 6.72, 95%CI 2.69-16.78, p<0.01). Hypoxemia was also more likely to develop in children with failure to thrive (OR 2.96, 95%CI 1.28-6.82, p<0.01). The seven (3.2%) children who were both premature (OR 11.94, 95%CI 2.50-56.99, p<0.01) and failure to thrive (OR 6.41, 95%CI 1.37-29.87, p=0.02) were more likely to develop respiratory failure. Prematurity was the only significant risk factor for hypoxemia and respiratory failure by logistic regression analysis (OR 1.17, 95%CI 1.06-1.55, p<0.01 and OR 1.14 95%CI 1.02-2.07, p=0.02 respectively). Prematurity was the single most important risk factor for both hypoxemia and respiratory failure in RSV bronchiolitis.

Matched MeSH terms: Infant, Premature, Diseases*

Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants

Subramaniam P, Henderson-Smart DJ, Davis PG

Cochrane Database Syst Rev, 2005 Jul 20.

PMID: 16034858

BACKGROUND: Cohort studies (Avery 1987; Jonsson 1997) have suggested that early post-natal nasal continuous positive airways pressure (CPAP) may be beneficial in reducing the need for intubation and intermittent positive pressure ventilation, and in preventing chronic lung disease in preterm or low birth weight infants.

OBJECTIVES: To determine if prophylactic nasal CPAP commenced soon after birth regardless of respiratory status in the very preterm or very low birth weight infant reduces the use of IPPV and the incidence of chronic lung disease (CLD) without adverse effects.

SEARCH STRATEGY: The search was updated in April 2005. The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Library Issue 1 2005, MEDLINE 1966-April 2005, previous reviews including cross references, abstracts, conferences, symposia, proceedings, expert informants, journal hand searching mainly in the English language.

SELECTION CRITERIA: All trials using random or quasi-random patient allocation of very preterm infants < 32 weeks gestation and / or < 1500 gms at birth were eligible. Comparison had to be between prophylactic nasal CPAP commencing soon after birth regardless of the respiratory status of the infant compared with "standard" methods of treatment where CPAP or IPPV is used for a defined respiratory condition.

DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration and its Neonatal Review Group, including independent assessment of trial quality and extraction of data by each author, were used. Data were analysed using relative risk (RR). Meta-analysis was performed using a fixed effects model.

MAIN RESULTS: There are no statistically significant differences in any of the outcomes studied in either of the eligible trials (Han 1987; Sandri 2004) reporting on 82 and 230 infants respectively. In Han 1987 there are trends towards increases in the incidence of BPD at 28 days [RR 2.27 (0.77, 6.65)], death [RR 3.63 (0.42, 31.08)] and any IVH [RR 2.18 (0.84, 5.62)] in the CPAP group. In Sandri 2004 there is a trend towards an increase in IVH grade 3 or 4 [RR 3.0 (0.96, 28.42)] in the CPAP group. No outcome was significantly different in any of the meta-analyses.

AUTHORS' CONCLUSIONS: There is currently insufficient information to evaluate the effectiveness of prophylactic nasal CPAP in very preterm infants. Neither of the included studies reviewed showed evidence of benefit in reducing the use of IPPV. The tendency for some adverse outcomes to be increased is of concern and further multicentre randomized controlled trials are needed to clarify this.

Matched MeSH terms: Infant, Premature, Diseases/mortality; Infant, Premature, Diseases/prevention & control*

International comparison of care for very low birth weight infants: parents' perceptions of counseling and decision-making

Partridge JC, Martinez AM, Nishida H, Boo NY, Tan KW, Yeung CY, et al.

Pediatrics, 2005 Aug;116(2):e263-71.

PMID: 16061579

To characterize parent perceptions and satisfaction with physician counseling and delivery-room resuscitation of very low birth weight infants in countries with neonatal intensive care capacity.

Matched MeSH terms: Infant, Premature, Diseases

Fulltext The clinical picture of neonatal infection with Pantoea species

Van Rostenberghe H, Noraida R, Wan Pauzi WI, Habsah H, Zeehaida M, Rosliza AR, et al.

Jpn J Infect Dis, 2006 Apr;59(2):120-1.

PMID: 16632913

Pantoea infections are uncommon in humans. Most reports have involved adults or children after thorn injuries. There are only a few reports of systemic infections with Pantoea. This is the first report of the clinical picture of systemic Pantoea spp. infection in neonates as observed during an outbreak in a neonatal intensive care unit caused by infected parenteral nutrition solutions. Even though detected early, the infections had a fulminant course, causing septicemic shock and respiratory failure. Pulmonary disease was prominent and presented mainly as pulmonary hemorrhage and adult respiratory distress syndrome. The organism was sensitive to most antibiotics used in neonatal intensive care units, but the clinical response to antibiotic therapy was poor. The fatality rate was very high: 7 out of 8 infected infants succumbed to the infection (87.5%).

Matched MeSH terms: Infant, Premature, Diseases/drug therapy; Infant, Premature, Diseases/microbiology; Infant, Premature, Diseases/epidemiology

Mother with post-partum group B Streptococcus meningitis and cerebellar abscess

Ghani NA, Jaafar R, Ishak S, Zainuddin AA, Mukari SA, Mahdy ZA

J Obstet Gynaecol Res, 2007 Apr;33(2):195-8.

PMID: 17441895

We report the case of a 25-year-old Malay woman, admitted for preterm delivery at 35 weeks' gestation. Vaginal swab did not isolate any organism. She delivered a baby girl who developed respiratory distress syndrome, requiring ventilation. Although chest radiograph showed hyaline membrane disease with pneumonia, septic workout was negative. The mother was discharged on the next day. Seven days postpartum, the mother presented with fever and fits and was diagnosed to have meningo-encephalitis. Lumbar puncture isolated group B Streptococcus (GBS) and MRI revealed a superior cerebellar abscess. She was treated and survived the episode. This case illustrates the uncommon situation where GBS infection was confirmed via maternal septic workout rather than neonatal, although both presented with severe disease.

Matched MeSH terms: Infant, Premature, Diseases/microbiology*

Reducing hypothermia in preterm infants with polyethylene wrap

Rohana J, Khairina W, Boo NY, Shareena I

Pediatr Int, 2011 Aug;53(4):468-74.

PMID: 21105964 DOI: 10.1111/j.1442-200X.2010.03295.x

Occlusive plastic applied immediately after birth to reduce evaporative heat loss has been proven effective in preterm infants <28 weeks' gestation. However its effectiveness on preterm infants >28 weeks' gestation has not been shown. This study aimed to determine the effect of occlusive wrap at birth on the temperature at neonatal intensive care unit (NICU) admission among infants of greater than or equal to 24 weeks' and less than 34 weeks' gestation.

Matched MeSH terms: Infant, Premature, Diseases/prevention & control*

Refractive status of children under the age of three years born premature without retinopathy of prematurity

Sharanjeet-Kaur, Norlaila MD, Chung KM, Azrin EA, Boo NY, Ong LC

Clin Ter, 2011;162(6):517-9.

PMID: 22262320

A cross-sectional study was undertaken to determine and compare the refractive status of premature children without retinopathy of prematurity (ROP) and full term children below the age of three years.

Matched MeSH terms: Infant, Premature, Diseases/epidemiology*

Fulltext Does oral lansoprazole really reduce gastric acidity in VLBW premature neonates?

Tham SY, Rogers IM, Samuel KF, Singh A, Ong KK

Med J Malaysia, 2012 Jun;67(3):284-8.

PMID: 23082418 MyJurnal

Premature neonates of very low birth weight (VLBW) whose treatment required the use of naso-gastric tube feeding were investigated. 10 infants suspected of having GERD (gastroesophageal reflux) received oral lansoprazole therapy by tube administration. 9 other infants formed a control group. In the treated group a fasting pH was determined before treatment and again after 7 days treatment. The control group was similarly assessed at an interval of 7 days. Despite acid reduction, the post-treatment pH mean of 1.31 would continue to pose a threat to the esophageal mucosa. The physiology of neonatal acid secretion is discussed to explain these findings.

Matched MeSH terms: Infant, Premature, Diseases/drug therapy*; Infant, Premature, Diseases/physiopathology

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