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  1. Kok HC, Muhammad Anuar AS, Choo MY, Gill SS
    MyJurnal
    Objective: To study the demographic, clinical features, management and outcome of neonatal tetanus treated at Tawau Hospital.
    Method: A retrospective study of neonatal tetanus admitted to a district hospital in Sabah was conducted.
    Results: In 2015, the hospital handled 18 cases of babies with neonatal tetanus in the Tawau Hospital. This implies an occurrence of 1.5 cases per month. All the mothers were non-citizens and did not have any proper antenatal follow up. All the tetanus babies required invasive mechanical ventilation with a median of 20 days (range, 5 to 32 days). The survival rate was 94.4%.
    Conclusion: Despite the promotion of maternal and childhood vaccination along with hygienic practices of delivery, neonatal tetanus still remains a threat to babies born in Sabah.
  2. Kok HC, McCallum GB, Yerkovich ST, Grimwood K, Fong SM, Nathan AM, et al.
    Pediatr Infect Dis J, 2024 Sep 01;43(9):872-879.
    PMID: 38830139 DOI: 10.1097/INF.0000000000004407
    BACKGROUND: Pediatric community-acquired pneumonia (CAP) can lead to long-term respiratory sequelae, including bronchiectasis. We determined if an extended (13-14 days) versus standard (5-6 days) antibiotic course improves long-term outcomes in children hospitalized with CAP from populations at high risk of chronic respiratory disease.

    METHODS: We undertook a multicenter, double-blind, superiority, randomized controlled trial involving 7 Australian, New Zealand, and Malaysian hospitals. Children aged 3 months to ≤5 years hospitalized with radiographic-confirmed CAP who received 1-3 days of intravenous antibiotics, then 3 days of oral amoxicillin-clavulanate, were randomized to either extended-course (8-day oral amoxicillin-clavulanate) or standard-course (8-day oral placebo) arms. Children were reviewed at 12 and 24 months. The primary outcome was children with the composite endpoint of chronic respiratory symptoms/signs (chronic cough at 12 and 24 months; ≥1 subsequent hospitalized acute lower respiratory infection by 24 months; or persistent and/or new chest radiographic signs at 12-months) at 24-months postdischarge, analyzed by intention-to-treat, where children with incomplete follow-up were assumed to have chronic respiratory symptoms/signs ("worst-case" scenario).

    RESULTS: A total of 324 children were randomized [extended-course (n = 163), standard-course (n = 161)]. For our primary outcome, chronic respiratory symptoms/signs occurred in 97/163 (60%) and 94/161 (58%) children in the extended-courses and standard-courses, respectively [relative risk (RR) = 1.02, 95% confidence interval (CI): 0.85-1.22]. Among children where all sub-composite outcomes were known, chronic respiratory symptoms/signs between groups, RR = 1.10, 95% CI: 0.69-1.76 [extended-course = 27/93 (29%) and standard-course = 24/91 (26%)]. Additional sensitivity analyses also revealed no between-group differences.

    CONCLUSION: Among children from high-risk populations hospitalized with CAP, 13-14 days of antibiotics (versus 5-6 days), did not improve long-term respiratory outcomes.

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