A rare syndrome of hypertension, seizures and intracranial bleed has been reported among patients with congenital hemolytic anemia who underwent multiple blood transfusions. We report this syndrome in a 12-year-old Malay girl with hemoglobin E-beta-thalassemia, who underwent intensive transfusion and subsequently had headache, visual loss, severe hypertension and seizures. A comprehensive literature review revealed 30 patients with this syndrome, of whom 15 had intracranial bleed and 12 among these 15 died. A less-intensive transfusion regimen among patients with chronic hemolytic anemia and prompt detection and management of hypertension may prevent this potentially fatal syndrome.
In a case-control study carried out in the Kuala Lumpur Maternity Hospital between 1st July 1995 and 31st January 1996 the objectives were (1) to determine the rate of breastfeeding in surviving very low birthweight (VLBW, < or = 1500 g) Malaysian infants following the introduction of the Baby Friendly Hospital Concept, and (2) to identify significant predictors associated with successful breastfeeding in these infants. During the study period, 201 (1.24 per cent) of live-born infants were VLBW infants, 192 (95.5 per cent) were Malaysians, and 141 (73.4 per cent) of them survived to go home. The breastfeeding rate among all surviving VLBW Malaysian infants at the time of discharge was 40.2 per cent (57/141). The mothers of 126 (89.4 per cent) VLBW Malaysian infants were interviewed before discharge. Logistic regression analysis showed that, after controlling for various confounders, the significant predictors associated with successful breastfeeding were: (a) Malay mothers (odds ratio: 6.0; 95 per cent CI: 1.9, 19.4), (b) mothers with educational levels of between 7 and 9 years (odds ratio: 3.6; 95 per cent CI: 1.0, 12.2), and (c) earlier age of commencement of enteral feeds in the VLBW infants (for each additional day delay in commencement of feeding, odds ratio of breastfeeding was 0.5; 95 per cent CI: 0.4, 0.8).
A case-control study was carried out on 97 consecutive preterm (< 37 weeks) infants to determine predictors associated with failure of nasal continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS). Logistic regression analysis showed that only three risk factors were significantly associated with failed CPAP. These were: moderate or severe RDS (odds ratio: 5.9; 95 per cent confidence interval (CI): 2.2-16.0); septicemia during CPAP therapy (OR: 8.8; 95 per cent: CI 1.5-50.7); and pneumothorax during CPAP therapy (odds ratio: 6.9; 95 per cent: CI 1.1-41.7).
This study aimed to identify the prevalence of energy misreporting amongst a sample of Malay children aged 9-11 years (n = 14) using a range of commonly used cut points. Participants were interviewed using repeated 24 h dietary recalls over three occasions. The Goldberg equations (1991 and 2000), Torun cut points and the Black and Cole method were applied to the data. Up to 11 of 14 children were classified as misreporters, with more under-reporters (between seven and eight children) than over-reporters (four or less children). There were significant differences in the proportion of children classified as energy misreporters when applying basal metabolic rate calculated using FAO/UNU/WHO (1985) and Malaysian-specific equations (p < 0.05). The results show that energy misreporting is common amongst Malay children, varying according to cut point chosen. Objective evaluation of total energy expenditure would help identify which cut point is appropriate for use in Malay paediatric populations.
Rice-starch based oral rehydration solution (ORS) has been shown to be a suitable alternative to glucose-based ORS in the treatment of both choleragenic and non-choleragenic dehydration in older infants and children. However, in young infants, the wider use of rice-starch ORS has been impeded because of theoretical concern about the poor digestibility of starch. The present study was conducted to evaluate the safety and efficacy of rice-starch ORS in the rehydration of acute diarrhoeal dehydration in infants below 6 months of age. Sixty-three infants with clinical features of acute gastroenteritis were randomly allocated to two groups. Group A, comprising 31 infants, received a rice-starch ORS and group B, comprising 32 infants, received a glucose-based ORS. The response to treatment was monitored by weight gain, stool frequency, and decrease in vomiting. The mean weight gain in moderately dehydrated and mildly dehydrated infants in both groups A and B were closely similar at 12, 24, and 48 h after treatment with the respective ORS solution. The infants without dehydration receiving rice-starch ORS had significantly greater weight gain at 12 h compared to those receiving glucose ORS. However, this difference was not observed at 24 and 48 h. The results of this study show that rice-starch ORS is as safe and efficacious as glucose-based ORS in young infants.
An observational study was carried out in the Kuala Lumpur Maternity Hospital to determine the risk factors associated with feed intolerance in very low birthweight (VLBW, <1501 g) infants given intermittent 3-hourly enteral feeds within 72h after birth. Feed intolerance developed in 85 (64.4 per cent) of 132 infants. Logistic regression analysis showed that the only significant risk factor associated with feed intolerance was the age when the first feed was commenced. For each hour delay in the age of the infants when the first feed was given, the adjusted odds ratios of feed intolerance was 1.03 (95 per cent confidence intervals: 1.01-1.05; p = 0.01). Other factors (modes of delivery, Apgar score at 1 min, sex, ethnicity, history of resuscitation at birth, birthweight, gestation, multiple pregnancy, perinatal asphyxia, types of milk, hypothermia before first feed, hypotension before first feed, respiratory distress syndrome, patent ductus arteriosus, septicaemia, theophylline therapy, indomethacin therapy, ventilatory support, continuous positive airway pressure, umbilical catheterization, and surfactant therapy) were not significantly associated with feed intolerance. Our study suggests that to promote tolerance of enteral feeds in VLBW infants, intermittent orogastric feeds should be commenced as soon as possible during the first 72 h of life.
A study of 128 jaundiced term neonates showed that 28 (22 per cent) had hearing loss based on brain stem-evoked response. There was no significant difference in the percentage of neonates with hearing loss between those with peak serum bilirubin levels of less than 340 mumol/l (16 per cent) and those with hyperbilirubinaemia > 339 mumol/l (33 per cent) (P = 0.11). Logistic regression analysis showed that severe jaundice which required exchange transfusion and earlier age of onset of hyperbilirubinaemia were statistically significant risk factors associated with hearing loss (P = 0.038 and P = 0.012, respectively).
Cleaning newborn infants with coconut oil shortly after birth is a common practice in Malaysian labour rooms. This study aimed: (1) to determine whether this practice was associated with a significant decrease in the core temperature of infants; and (2) to identify significant risk factors associated with neonatal hypothermia. The core temperature of 227 randomly selected normal-term infants immediately before and after cleaning in labour rooms was measured with an infrared tympanic thermometer inserted into their left ears. Their mean post-cleaning body temperature (36.6 degrees C, SD = 1.0) was significantly lower than their mean pre-cleaning temperature (37.1 degrees C, SD = 1.0; p < 0.001). Logistic regression analysis showed that the risk factors significantly associated with pre-cleaning hypothermia (< 36.5 degrees C) were: (1) not being placed under radiant warmer before cleaning p = 0.03); and (2) lower labour room temperature (p < 0.001). Logistic regression analysis also showed that the risk factors significantly associated with post-cleaning hypothermia were: (1) lower labour room temperature (p < 0.001); (2) lower pre-cleaning body temperature (p < 0.001); and (3) longer duration of cleaning (p = 0.002). In conclusion, to prevent neonatal hypothermia, labour room temperature should be set at a higher level and cleaning infants in the labour room should be discouraged.
A case-control study of antecedents of neonatal septicaemia was performed using 50 cases of neonatal septicaemia and 73 comparison infants from a Malaysian hospital nursery. Multivariate analysis indicated the following independent risk factors: maternal primiparity, pre-eclampsia, prolonged rupture of membranes, twin pregnancy, prematurity, assisted ventilation, umbilical catheterization, and formula feeding. Although the spectrum of causative organisms varied between our study and past studies from Western countries, the risk factors for developing neonatal septicaemia were strikingly similar. Therefore, preventative guidelines based on risk factors described in Western countries, should help reduce the incidence of neonatal septicaemia at this Malaysian hospital.
Infectious complications are the major cause of morbidity and mortality in children with malignancy. Empirical antimicrobial therapy in the management of fever of unknown origin should be tailored to local bacteriological data and antibiotic sensitivity patterns. Five-hundred-and-fifty-nine cases of culture-proven septicaemia occurring in pediatric cancer patients between 1990 and 1994 were retrospectively analysed and compared with a similar study done in our centre between 1976 and 1979. A wide spectrum of organisms was isolated. Staphylococcus epidermidis, Staphylococcus aureus, and Klebsiella pneumoniae were the most common and consistent bacteria isolated during the 5 year period. More than 70 per cent of the staphylococci were sensitive to methicillin and universally sensitive to vancomycin. However, a worrying trend of ceftazidime-resistance amongst gram-negative organisms was found. In these situations, the use of imipenem is recommended as resistance to this antimicrobial agent was exceedingly rare.
To investigate the role of serum C-reactive protein (CRP) in the diagnosis of typhoid fever, we studied 227 febrile Malaysian children hospitalized during a 12-month period. The children were: culture-positive for Salmonella typhi (Group 1; n = 108); culture-negative but with typical clinical features of typhoid fever (Group 2; n = 60); or had non-typhoidal illness (Group 3; n = 59). Group 1 children had the highest serum CRP concentrations (geometric mean [SD range]; 43 [12-150] mg/l vs. 26 [8-85] mg/l in Group 2 and 21 [4-110] mg/l in Group 3; p < 0.001). In regression analysis, age, patient group and fever duration were independently associated with serum CRP (p < 0.05) but gender was not. In Group 1 patients, there was a significant positive association between serum CRP and Widal O and H agglutinin titres. In receiver-operator characteristic (ROC) analysis of serum CRP for Groups 1 and 2 combined, compared with Group 3, the area under the curve (AUC) was 0.65. These data show that the serum CRP is highest in culture-positive children with enteric fever and reflects the immune response to the infection in this group. Nevertheless, serum CRP had relatively low sensitivity and specificity for confirmed or clinically diagnosed typhoid fever (68 and 58 per cent, respectively at 'cut-off' concentration 30.0 mg/l), and an AUC value only moderately above that associated with no predictive power (0.5). Although of limited use as a primary diagnostic test, a raised serum CRP may still have a place as one of a range of features that facilitate assessment of a febrile child in a typhoid-endemic area.
Twenty-two (42 per cent) out of 52 patients admitted with severe bronchiolitis to our Paediatric Intensive Care Unit required ventilation. Risk factors associated with ventilation included a younger mean age, female sex, low birthweight, failure to thrive and the presence of an underlying illness. Ventilated patients were also more likely to have a higher respiratory distress assessment index (RDAI) score, pneumonic infiltration on chest X-ray, lower serum sodium and a positive respiratory syncytial virus isolation in the tracheal secretion.
We report a case of an 8-year-old aborigine boy referred to our hospital for respiratory insufficiency with skin eruptions over the trunk and limbs. The skin condition was diagnosed as acquired ichthyosis. He also had a non-bleeding form of disseminated intravascular coagulopathy. Radiograph of the lungs showed bilateral perihilar opacities with bilateral pleural effusion. The diagnosis of leptospirosis was confirmed by a 4-fold rise in microagglutinating titre and polymerase chain reaction assay.
Streptococcus pneumoniae (S. pneumoniae) is the most common bacterial cause of pneumonia, meningitis, and otitis media, with the highest incidence among young children and the elderly. S. pneumoniae was once routinely susceptible to penicillin, but since the mid-1980s the incidence of resistance to penicillin and other antimicrobial agents has been increasing all over the world. To optimize empirical regimens and initial therapy for S. pneumoniae infections, clinical healthcare providers must be informed about the prevalence and pattern of drug resistance among the isolates in their communities. No such data are available for the Malaysian population. Therefore, this study was designed to determine the antibiotic susceptibility pattern of S. pneumoniae among colonized pre-school children in Kota Bharu, Malaysia. Pharyngeal swabs were collected from children 1 month to 6 years of age. S. pneumoniae isolates were identified according to the standard and tested for penicillin resistance with a 1-microgram oxacillin disk by the Kirby-Bauer disk diffusion methods. Of 355 nasopharyngeal specimens obtained from kindergarten students, in-patients and pediatric clinics over a period of 1 year, S. pneumoniae was isolated from 36 (10 per cent). All isolates, except one, were susceptible to penicillin. The resistant isolates was susceptible to erythromycin, chloramphenicol and cephalosporins.
Study site: kindergarten, schools, pediatric outpatients clinics, and in-patient wards of Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia.
Universally, mothers often use touching to detect fever in their children. We perform a systematic review of published diagnostic studies evaluating the ability of mothers to detect fever in their children by touching. We found 10 studies satisfying our inclusion criteria. The meta-analysis revealed a summary sensitivity of 89.2% and summary specificity of 50%-maternal touch is perhaps more useful to exclude fever rather than to 'rule in' fever. However, due to significant heterogeneity in the included studies, interpretation of the summary data is difficult.
A case-control study was carried out on 152 extremely low birthweight (ELBW, < 1000 g) infants born consecutively in a large Malaysian maternity hospital during a 21-month period to determine the significant predictors associated with survival at discharge. Forty-nine (32.2 per cent) of these infants survived and 103 (67.8 per cent) died. The survivors weighed significantly heavier (mean = 888 g, SD = 99) than infants who died (mean = 763 g, SD = 131; p < 0.0001). They were also of higher gestational age (mean = 28.7 weeks, SD = 2.2) than those who died (mean = 26.7 weeks, SD = 2.5; p < 0.0001). Logistic regression analysis showed that, after controlling for various confounders, only three factors were significantly associated with the survival of these infants. These were: (1) increasing birthweight of the infants (with every gram increase in birthweight, adjusted odds ratio of survival was: 1.009; 95 per cent CI 1.004, 1.015; p = 0.0006); (2) given nasal continuous positive airway pressure for treatment of respiratory distress syndrome (adjusted odds ratio of survival: 4.2; 95 per cent CI 1.2, 14.0; p = 0.02); and (3) given expressed breastmilk (adjusted odds ratio of survival: 57.5; 95 per cent CI: 7, 474; p = 0.0002). Maternal illness, intrapartum problems, ethnicity, gestational age, use of antenatal steroid, modes of delivery, Apgar scores, congenital anomalies, respiratory distress syndrome, persistent ductus arteriosus, septicemia, necrotising enterocolitis, chronic lung disease, oxygen therapy, intermittent positive pressure ventilation, surfactant therapy, and blood transfusion were not significant factors associated with increased survival.
The susceptibility of children to coronavirus disease-19 (COVID-19) and transmission of COVID-19 from children to others is a relatively unexplored area. The aim of this study was to understand the transmission dynamics of Severe Acute Respiratory Syndrome Coronavirus 2 in children. This was a retrospective observational study where a total of 19 paediatric index cases (including a set of twins) with COVID-19 and 42 primary contacts (adults-36, paediatric-6) from the immediate family members were included. All the index cases and four of the five positive contacts were asymptomatic. Despite adults staying with positive children in the same vehicle, same room in the quarantine centre and the same ward, only four of the parents became positive.