MyMedR

Should All Children Admitted with Community Acquired Pneumonia have Blood Cultures Taken? Authors' Reply

Nathan AM, de Bruyne JA

Indian J Pediatr, 2015 Jul;82(7):660-1.

PMID: 25514886 DOI: 10.1007/s12098-014-1640-z

Erratum to: Should All Children Admitted with Community Acquired Pneumonia have Blood Cultures Taken?

Lai EM, Nathan AM, de Bruyne JA, Chan LL

Indian J Pediatr, 2015 Jun;82(6):579.

PMID: 25640069 DOI: 10.1007/s12098-015-1698-2

Erratum to: Indian J Pediatr DOI 10.1007/s12098-014-1565-6. In the original article, acknowledgement to a grant was missed. Below is the acknowledgement section. This study was partly funded by the UMR grant (no. UM.TNC2/RC/HTM/RP026-14HTM) awarded to AMN and JAdeB by University Malaya. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Should all children admitted with community acquired pneumonia have blood cultures taken?

Lai EM, Nathan AM, de Bruyne JA, Chan LL

Indian J Pediatr, 2015 May;82(5):439-44.

PMID: 25179241 DOI: 10.1007/s12098-014-1565-6

OBJECTIVE: To evaluate the yield of blood cultures and the impact of blood culture results on the adjustment of empiric antibiotic treatment in children hospitalised with community acquired pneumonia (CAP).

METHODS: This was a prospective study conducted at a tertiary hospital in Malaysia, from 1st August 2010 until 31st July 2011. Children aged between 1 mo and 12 y who were admitted for CAP and had blood cultures performed before starting intravenous antibiotics were recruited. Children with congenital pneumonia, immunodeficiency, chronic cardiac or respiratory disorders, nosocomial pneumonia or those on corticosteroids, were excluded. Decision for admission was made by the attending Accident and Emergency physician.

RESULTS: One hundred and seventy-one children were enrolled. The median age was 13 mo (range: 38 d-10 y 3 mo) and 59 % were males. Blood cultures were positive in 1.2 % (2/171) of patients while the contamination rate was 1.8 % (3/171). Doctors altered antibiotics based on blood culture results in only one patient.

CONCLUSIONS: Both the yield and the impact of blood culture results on the adjustment of empiric antibiotic treatment were very small. There was a high contamination rate. The recommended practice of performing blood cultures in all children admitted with CAP should be reviewed.

Chronic suppurative lung disease in a developing country: impact on child and parent

Nathan AM, Muthusamy A, Thavagnanam S, Hashim A, de Bruyne J

Pediatr Pulmonol, 2014 May;49(5):435-40.

PMID: 24482322 DOI: 10.1002/ppul.23001

To investigate the impact of chronic suppurative lung disease (CSLD) on growth and lung function in the child as well as quality of life of the child and parent.

First study of the F508del mutation in Malaysian children diagnosed with cystic fibrosis

Nathan AM, Thong MK, deBruyne J, Ariffin H

J Paediatr Child Health, 2011 Aug;47(8):573-5.

PMID: 21843195 DOI: 10.1111/j.1440-1754.2011.02149.x

Caesarean section and asthma in Malaysian children: a case-control study

Nathan AM, de Bruyne J, Khalid F, Arumugam K

Asian Pac J Allergy Immunol, 2012 Sep;30(3):204-8.

PMID: 23156850

Birth cohort studies in some countries have shown a link between caesarean section and asthma.

Congenital nasal cavity stenosis in children with craniosyntosis: A report of 4 rare cases

Liew YT, Soo SS, Nathan AM, Manuel AM

Auris Nasus Larynx, 2017 Oct;44(5):635-638.

PMID: 27793496 DOI: 10.1016/j.anl.2016.10.001

Congenital bony nasal stenosis (CBNS) is a very rare but life-threatening cause of airway obstruction in neonates and infants. This review aims to assess the presentation and early airway management of 4 new cases of craniosynostosis with bilateral nasal cavity stenosis. Patients were treated with endoscopic endonasal widening of the nasal cavity and stenting. All patients were extubated well post-operatively with resolution of symptoms. They remained asymptomatic with stents in situ for at least 6 months with no complications reported. Minimally invasive endoscopic endonasal widening of the nasal cavity with stenting is an effective and safe way of addressing nasal cavity stenosis.

Fulltext Review: Quality of Life in Children with Non-cystic Fibrosis Bronchiectasis

Nathan AM, de Bruyne JA, Eg KP, Thavagnanam S

Front Pediatr, 2017;5:84.

PMID: 28596950 DOI: 10.3389/fped.2017.00084

Non-cystic fibrosis bronchiectasis (NCFB) has gained renewed interest, due to its increasing health-care burden. Annual mortality statistics in England and Wales showed that under 1,000 people die from bronchiectasis each year, and this number is increasing by 3% yearly. Unfortunately, there is a severe lack of well-powered, randomized controlled trials to guide clinicians how to manage NCFB effectively. Quality-of-life (QOL) measures in NCFB are an important aspect of clinical care that has not been studied well. Commonly used disease-specific questionnaires in children with NCFB are the St George's Respiratory Questionnaire, Short Form-36, the Leicester Cough Questionnaire, and the Parent Cough-Specific Quality of Life questionnaire (PC-QOL). Of these, only the PC-QOL can be used in young children, as it is a parent-proxy questionnaire. We reviewed pediatric studies looking at QOL in children with NCFB and cystic fibrosis. All types of airway clearance techniques appear to be safe and have no significant benefit over each other. Number of exacerbations and hospitalizations correlated with QOL scores, while symptom subscales correlated with lung function, worse QOL, frequent antibiotic requirements, and duration of regular follow-up in only one study. There was a correlation between QOL and age of diagnosis in children with primary ciliary dyskinesia. Other studies have shown no relationship between QOL scores and etiology of NCFB as well as CT changes. As for treatments, oral azithromycin and yoga have demonstrated some improvement in QOL scores. In conclusion, more studies are required to accurately determine important factors contributing to QOL.

Does a written asthma action plan reduce unscheduled doctor visits in children?

Wong SS, Nathan AM, de Bruyne J, Zaki R, Mohd Tahir SZ

Indian J Pediatr, 2013 Jul;80(7):590-5.

PMID: 22798280 DOI: 10.1007/s12098-012-0839-0

The aim of this study was to evaluate the impact of a written asthma action plan (WAAP) on reducing unscheduled doctor visits, asthma control and quality of life in children with all severities of asthma. This was a randomised controlled, single-blinded study whereby 80 children with asthma were randomly assigned to be either provided a WAAP or verbally counseled . The number of asthmatic exacerbations requiring unscheduled doctor visits, asthma control and quality of life were monitored over 9 mo. At the end of the study, there was no significant difference in the number of unscheduled doctor visits between the 2 groups (p = 0.352). There was no significant difference in asthma control or quality of life between both groups. Hence, the WAAP did not reduce unscheduled doctor visits, nor improve asthma control or quality of life in children with all severities of asthma.

Combined low-dose oral propranolol and oral prednisolone as first-line treatment in periocular infantile hemangiomas

Koay AC, Choo MM, Nathan AM, Omar A, Lim CT

J Ocul Pharmacol Ther, 2011 Jun;27(3):309-11.

PMID: 21542771 DOI: 10.1089/jop.2011.0013

The purpose of this report was to describe 2 cases of periocular infantile hemangiomas (IHs) that were successfully treated with low-dose oral propranolol alone and in combination with oral prednisolone.

Fulltext Clinical features of Malaysian children hospitalized with community-acquired seasonal influenza

Sam IC, Abdul-Murad A, Karunakaran R, Rampal S, Chan YF, Nathan AM, et al.

Int J Infect Dis, 2010 Sep;14 Suppl 3:e36-40.

PMID: 20153233 DOI: 10.1016/j.ijid.2009.10.005

OBJECTIVES: The clinical impact of seasonal influenza is understudied in tropical countries. The aim of this study was to describe the clinical features and seasonal pattern of influenza in children hospitalized in Malaysia, and to identify predictors of severe disease.
METHODS: Children hospitalized with community-acquired, laboratory-confirmed influenza at a teaching hospital in Kuala Lumpur, Malaysia during 2002-2007 were identified retrospectively. Clinical data were collected, and predictors of severe disease were identified by multivariate logistic regression. All influenza cases from 1982 to 2007 were also analyzed for seasonal patterns.
RESULTS: A total of 132 children were included in the study, 48 (36.4%) of whom had underlying medical conditions. The mean age was 2.5 years and 116 (87.9%) were <5 years old. The most common presenting features were fever or history of fever, cough, rhinitis, vomiting, and pharyngitis. Severe influenza was seen in 16 patients (12.1%; nine previously healthy), including 12 (9.1%; eight previously healthy) requiring intensive care. There were three (2.3%) deaths. Severe disease was associated with age <12 months, female sex, and absence of rhinitis on admission. Influenza was seen year-round, with peaks in November-January and May-July.
CONCLUSIONS: Seasonal influenza has a considerable impact on children hospitalized in Malaysia, in both the healthy and those with underlying medical conditions.

Study site: University Malaya Medical Centre (UMMC)

Noninvasive ventilation in a tertiary pediatric intensive care unit in a middle-income country

Lum LC, Abdel-Latif ME, de Bruyne JA, Nathan AM, Gan CS

Pediatr Crit Care Med, 2011 Jan;12(1):e7-13.

PMID: 20190672 DOI: 10.1097/PCC.0b013e3181d505f4

To determine the factors that predict outcome of noninvasive ventilation (NIV) in critically ill children.

Fulltext Parents are poor at labelling wheeze in children: a cross-sectional study

Shanmugam S, Nathan AM, Zaki R, Tan KE, Eg KP, Thavagnanam S, et al.

BMC Pediatr, 2016 06 23;16:80.

PMID: 27339265 DOI: 10.1186/s12887-016-0616-8

BACKGROUND: Noisy breathing is a common presenting symptom in children. The purpose of this study is to (a) assess parental ability to label wheeze, (b) compare the ability of parents of children with and without asthma to label wheeze and (c) determine factors affecting parental ability to label wheeze correctly.

METHODS: This cross-sectional study in a tertiary hospital in Kuala Lumpur, Malaysia involved parents of children with asthma. Parents of children without asthma were the control group. Eleven validated video clips showing wheeze, stridor, transmitted noises, snoring or normal breathing were shown to the parents. Parents were asked, in English or Malay, "What do you call the sound this child is making?" and "Where do you think the sound is coming from?"

RESULTS: Two hundred parents participated in this study: 100 had children with asthma while 100 did not. Most (71.5 %) answered in Malay. Only 38.5 % of parents correctly labelled wheeze. Parents were significantly better at locating than labelling wheeze (OR 2.4, 95 % CI 1.64-3.73). Parents with asthmatic children were not better at labelling wheeze than those without asthma (OR1.04, 95 % CI 0.59-1.84). Answering in English (OR 3.4, 95 % CI 1.69-7.14) and having older children with asthma (OR 9.09, 95 % CI 3.13-26.32) were associated with correct labelling of wheeze. Other sounds were mislabelled as wheeze by 16.5 % of respondents.

CONCLUSION: Parental labelling of wheeze was inaccurate especially in the Malay language. Parents were better at identifying the origin of wheeze rather than labelling it. Physicians should be wary about parental reporting of wheeze as it may be inaccurate.

Socioeconomic costs of children <5 years hospitalised with acute respiratory infections in Kuala Lumpur, Malaysia

Sam IC, Ahmad Jaafar N, Wong LP, Nathan AM, de Bruyne JA, Chan YF

Vaccine, 2021 05 21;39(22):2983-2988.

PMID: 33931252 DOI: 10.1016/j.vaccine.2021.04.010

BACKGROUND: Acute respiratory infections (ARI) are a major cause of morbidity and mortality in Malaysian children

Fulltext Antibiotics in childhood pneumonia: how long is long enough?

Grimwood K, Fong SM, Ooi MH, Nathan AM, Chang AB

Pneumonia (Nathan), 2016;8:6.

PMID: 28702286 DOI: 10.1186/s41479-016-0006-x

Improved access to healthcare, vaccines and treatment with antibiotics has reduced global mortality from childhood community-acquired pneumonia. However, as respiratory viruses are responsible for most episodes of pneumonia, important questions remain over who should receive these agents and the length of each treatment course. Worldwide concerns with increasing antibiotic resistance in respiratory pathogens and appeals for more prudent antibiotic prescribing provide further urgency to these clinical questions. Unfortunately, guidelines for treatment duration in particular are based upon limited (and often weak) evidence, resulting in national and international guidelines recommending treatment courses for uncomplicated pneumonia ranging from 3 to 10 days. The advantages of short-course therapy include a lower risk of developing antibiotic resistance, improved adherence, fewer adverse drug effects, and reduced costs. The risks include treatment failure, leading to increased short- or long-term morbidity, or even death. The initial challenge is how to distinguish between bacterial and non-bacterial causes of pneumonia and then to undertake adequately powered randomised-controlled trials of varying antibiotic treatment durations in children who are most likely to have bacterial pneumonia. Meanwhile, healthcare workers should recognise the limitations of current pneumonia treatment guidelines and remember that antibiotic course duration is also determined by the child's response to therapy.

Predictive risk factors for complicated pneumonia in Malaysian children

Ooi JM, Eg KP, Chinna K, Nathan AM, de Bruyne JA, Thavagnanam S

J Paediatr Child Health, 2019 Apr;55(4):406-410.

PMID: 30198175 DOI: 10.1111/jpc.14213

AIM: To investigate baseline characteristics associated with complicated community-acquired pneumonia (CAPc) in Malaysian children. CAPc, such as pleural effusion and/or empyema, is on the rise, especially in Southeast Asian children, and the reasons for this are unknown.

METHODS: A retrospective study was conducted on all children aged 2-16 years who were admitted to the University Malaya Medical Centre with community-acquired pneumonia between 2012 and 2014.

RESULTS: In this study, of the 343 children, 58 (17%) developed CAPc. Chinese ethnicity (P < 0.001), reduced breastfeeding duration (P = 0.003), not receiving outpatient antibiotic (P < 0.001) and exposure to parental smoking (P < 0.001) were identified as risk factors for CAPc. Markedly increased respiratory rate (P = 0.021) and thrombocytosis (P < 0.001) were noted as the clinical parameters for CAPc.

CONCLUSION: This study identifies some modifiable risk to reduce the burden of pneumonia complications.

Fulltext Obstructive sleep apnoea syndrome (OSAS) as a risk factor for secondary osteoporosis in children

Sies NS, Zaini AA, de Bruyne JA, Jalaludin MY, Nathan AM, Han NY, et al.

Sci Rep, 2021 02 04;11(1):3193.

PMID: 33542317 DOI: 10.1038/s41598-021-82605-6

Repetitive hypoxia seen in obstructive sleep apnoea syndrome (OSAS) may affect bone metabolism increasing the risk for secondary osteoporosis. This study investigates the association between OSAS in children and secondary osteoporosis. This cross-sectional study included 150 children aged 10-17 years: 86 with OSAS and 64 with no OSAS. OSAS was confirmed by polysomnography. Quantitative ultrasound (QUS) of calcaneum measuring speed of sound (SoS) and broadband ultrasound attenuation (BUA) were collected. Other parameters collected including bone profile, vitamin D levels, physical activity scoring and dietary calcium intake. Majority were male and Malay ethnicity. OSAS children were mostly obese (84%) and 57% had moderate to severe OSAS. Most had lower physical activities scores. Mean (SD) phosphate and Alkaline phosphatase were lower in OSA children compared to controls: PO4, p = 0.039 and ALP, p

Pre-operative parameters do not reliably identify post-operative respiratory risk in children undergoing adenotonsillectomy

Thavagnanam S, Cheong SY, Chinna K, Nathan AM, de Bruyne JA

J Paediatr Child Health, 2018 May;54(5):530-534.

PMID: 29168911 DOI: 10.1111/jpc.13789

AIM: Adenotonsillectomy is performed in children with recurrent tonsillitis or obstructive sleep apnoea. Children at risk of post-operative respiratory complications are recommended to be monitored in paediatric intensive care unit (PICU). The aim of the study is to review the risk factors for post-operative complications and admissions to PICU.

METHODS: A review of medical records of children who underwent adenotonsillectomy between January 2011 and December 2014 was performed. Association between demographic variables and post-operative complications were examined using chi-square and Mann-Whitney tests.

RESULTS: A total of 214 children were identified, and of these, 19 (8.8%) experienced post-operative complications. Six children (2.8%) had respiratory complications: hypoxaemia in four and laryngospasm requiring reintubation in a further two. Both of the latter patients were extubated upon arrival to PICU and required no escalation of therapy. A total of 13 (6.1%) children had non-respiratory complications: 8 (3.7%) had infection and 5 (2.3%) had haemorrhage. A total of 26 (12.1%) children were electively admitted to PICU and mean stay was 19.5 (SD ± 13) h. No association between demographic characteristics, comorbid conditions or polysomnographic parameters and post-operative complications were noted. A total of 194 (90.7%) children stayed only one night in hospital (median 1 day, range 1-5 days).

CONCLUSION: The previously identified risk factors and criteria for PICU admission need revision, and new recommendations are necessary.

Fulltext Fatal influenza A (H3N2) and Campylobacter jejuni coinfection

Kahar-Bador M, Nathan AM, Soo MH, Mohd Noor S, AbuBakar S, Lum LC, et al.

Singapore Med J, 2009 Mar;50(3):e112-3.

PMID: 19352555

The rapid diagnosis and subtyping of influenza is particularly important in areas where avian influenza (H5N1) is present. The ability to recognise both typical and atypical presentations of influenza is also critical in such settings. A six-month-old male child who visited a H5N1-affected area subsequently died from a severe febrile diarrhoeal illness with minimal respiratory symptoms, and was initially diagnosed with influenza A of an unknown subtype. The final microbiological results showed a highly unusual combination of influenza A (H3N2) and Campylobacter jejuni infection.

Fulltext Clinical risk factors for life-threatening lower respiratory tract infections in children: a retrospective study in an urban city in Malaysia

Nathan AM, Rani F, Lee RJ, Zaki R, Westerhout C, Sam IC, et al.

PLoS One, 2014;9(10):e111162.

PMID: 25360811 DOI: 10.1371/journal.pone.0111162

Lower respiratory tract infections (LRTIs) are an important cause of morbidity and mortality, especially in low income countries. The aim of this study was to determine risk factors of life-threatening LRTIs in hospitalised children in Malaysia.

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