cheo lian Yeo - Academia.edu (original) (raw)
Papers by cheo lian Yeo
Journal of Paediatrics and Child Health
Journal of Paediatrics and Child Health, Aug 31, 2001
To study the efficacy, safety and cost effectiveness of recombinant human erythropoietin (r-HuEPO... more To study the efficacy, safety and cost effectiveness of recombinant human erythropoietin (r-HuEPO) in reducing erythrocyte transfusion needs in very low birthweight (VLBW) infants. Methods: We conducted a non-blind randomized controlled trial and assigned 100 VLBW infants, less than 33 weeks gestation, to receive either r-HuEPO 750 U/kg per week subcutaneously from day 5 to day 40 or no erythropoietin (EPO). Infants received oral iron 3-6 mg/kg per day from day 10. Transfusion needs were analysed for all enrolled infants and in five weight subgroups: birthweight of less than 600 g, 600-799 g, 800-999 g, 1000-1199 g and infants more than 1200 g. Results: VLBW infants on r-HuEPO attained higher reticulocyte counts and haematocrit than control infants but the mean number of transfusions and volume of erythrocyte transfused per infant were not statistically different. Of infants 800-999 g at birth, the mean number of transfusions per infant was 2.1 compared with 3.5 transfusions per control infant (P = 0.04). Volume of erythrocytes transfused was 34.9 ± 32.1 mL/kg in r-HuEPO-treated infants and 56.6 ± 25.8 mL/kg in control infants (P = 0.03). The cost per patient for transfusion and EPO was S$388 for r-HuEPO recipient and S$438 for control infant. Blood pressure, neutrophil count, platelet count and complications of prematurity were not significantly different in both groups of VLBW infants. Conclusion: r-HuEPO at 750 U/kg per week stimulates erythropoiesis in VLBW infants but significantly reduces the need for erythrocyte transfusion only in infants weighing 800-999 g at birth.
Journal of Neonatal-Perinatal Medicine, 2020
Trapped fourth ventricle (TFV) as a complication of post-hemorrhagic hydrocephalus (PHH) is widel... more Trapped fourth ventricle (TFV) as a complication of post-hemorrhagic hydrocephalus (PHH) is widely reported in the pediatric population with a prior history of ventriculo-peritoneal (VP) shunt placement. Characterized by disproportionate dilatation of the fourth ventricle on serial neuro-imaging, it is rarely encountered in the early course of preterm infants and the differentiating clinical features are subtle and non-specific. Clinical alertness and sonographic correlation hold the key to early diagnosis. We report an early emergence of TFV in an extremely low gestational age newborn (ELGAN) following fulminant Pseudomonas aeruginosa meningitis, approach to management, and the neurological outcome. Fourth ventricle entrapment as a complication of perinatally acquired Pseudomonas aeruginosa meningitis in a surviving ELGAN is extremely rare.
Journal of paediatrics and child health, 2016
Thermoregulatory stability and monitoring are crucial in neonatal care. However, the current stan... more Thermoregulatory stability and monitoring are crucial in neonatal care. However, the current standard of temperature measurement using Axillary Thermometry (AT) poses multiple limitations. Temporal Artery Thermometry (TT) is a promising new method, which thus begs the question: Can TT replace AT in neonates? Previous studies reveal conflicting results, with none involving a Southeast-Asian multi-ethnic neonatal population under different environments. A 6-month prospective comparative study involving neonates managed in a tertiary neonatal centre. Subjects were divided into 4 groups based on the required nursing environment: A) Room air B) Phototherapy C) Radiant warmers D) Incubators. Six hundred and sixty-one paired TT and AT temperature readings were obtained, with concurrent FLACC scoring to evaluate the discomfort associated with each thermometry method. TT readings were higher than AT in all groups. The mean temperature difference between both methods (TT-AT) was lowest in Gro...
Journal of Clinical Medicine and Research, 2012
To describe the demographic characteristics, clinical presentations and outcome of neonatal enter... more To describe the demographic characteristics, clinical presentations and outcome of neonatal enterovirus infection and to evaluate infection control measures effective in preventing the spread of infection. Detailed perinatal history, demography, neonatal conditions and laboratory investigations were retrieved retrospectively from 5 Enterovirus positive patients in the level II nursery of the Singapore General Hospital in October 2010. Five premature neonates tested positive for Enterovirus during the outbreak. All infected neonates presented with lethargy, 4 (80%) poor suck, 4 (80%) apnea, 2 (40%) poor perfusion and 1 (20%) had pyrexia. Enterovirus was positive on PCR analysis of the stool specimen in four infected neonates and on spinal fluid in one neonate. All infected neonates required respiratory support; 3 needed continuous positive airway pressure (CPAP), one required SIPPV and another needed HFOV. Inotropes was needed in 1(20%) infant and severe thrombocytopenia was documented in 3 infected neonates. The neonate who required High frequency oscillatory ventilation (HFOV) and inotropic support died on day 5 of illness. Four (80%) neonates recovered 5 days following the onset of illness. Neonatal enterovirus infection can lead to morbidity and even death. Pertinent history of exposure, early recognition, timely intervention and appropriate infection control measures are necessary to prevent dissemination of infection.
Annals of the Academy of Medicine, Singapore, 2005
To determine whether chronic lung disease (CLD) influences specific aspects of motor development ... more To determine whether chronic lung disease (CLD) influences specific aspects of motor development in infancy. Twenty-nine very low birthweight infants with CLD at 36 weeks' post-conceptional age and 31 infants without CLD were evaluated at 8 months' and 24 months' corrected age using the Neurosensory Motor Development Assessment. Perinatal and neonatal characteristics of the infants with CLD and control infants were compared using the chi-square test for categorical variables and Student's t-test for continuous variables. The relationship between CLD and adverse outcome was measured by the odds ratio (OR) and its 95% confidence interval (CI). The overall developmental scores of the CLD infants were significantly different compared with control infants at 8 months. By 2 years of age, both groups of infants showed marked improvement in motor performance. However, differences persisted in the area of postural balance and sensory motor skills. Taking periventricular haemo...
Journal of Paediatrics and Child Health, 1994
This study addresses the dilemma of whether to attempt resuscitation of the previously undiagnose... more This study addresses the dilemma of whether to attempt resuscitation of the previously undiagnosed fresh stillborn infant and evaluates factors predictive of survival and long-term outcome. We reviewed the clinical spectrum, immediate complications and long-term outcome of 45 successfully resuscitated apparently stillborn infants (34 term, 11 preterm) who were admitted to the Intensive Care Nursery. Significant obstetric and intrapartum events were identified in 34 (75%) infants while 11 (25%) had no apparent risk factors. Of the 39 infants with neonatal complications, 37 had hypoxic-ischaemic encephalopathy (HIE; Sarnat stage 1 in 5, stage 2 in 15, stage 3 in 17); 12 (27%) had oliguria. 10 (22%) had hypotension, 7 (16%) experienced hypoglycaemia, 4 (9%) had disseminated intravascular coagulopathy (DIC) and 1 (2%) had persistent pulmonary hypertension of the newborn (PPHN). Fourteen infants (31%) died in the neonatal period and four (9%) died during infancy. Risks of death and adverse neurodevelopment were significantly increased in infants with stage 2 or 3 HIE (P<0.005). Follow-up assessment of 24 of the 27 surviving infants revealed a normal outcome in 15 (63%), severe disability in six (25%), moderate disability in two (8%) and mild disability in one (4%) infant. The positive predictive value of stage 2 or 3 HIE was 70% for mortality and 80% for morbidity. One-third (15/45) of successfully resuscitated apparently stillborn infants were normal at follow-up assessment and the outcome for these infants was predicted with complete accuracy by the stage of HIE present during the neonatal period.
Journal of Paediatrics and Child Health, 1994
The prevalence of inguinal hernia during primary hospitalization was determined in 250 infants wi... more The prevalence of inguinal hernia during primary hospitalization was determined in 250 infants with gestational age 24-29 weeks. Fourteen per cent developed hernia, with prevalence significantly higher in boys than girls. Infants with respiratory distress syndrome and those requiring prolonged mechanical ventilation were significantly predisposed to the development of hernia. Male infants, especially those who required prolonged ventilatory assistance, were at greatest risk. This information may be used when counselling parents regarding complications of very preterm infants.
Early Human Development, 2012
Background: Using pure oxygen (PO) in neonatal resuscitation increases oxidative stress and morta... more Background: Using pure oxygen (PO) in neonatal resuscitation increases oxidative stress and mortality in full-term hypoxic infants. International neonatal resuscitation guidelines recommend air or blended oxygen for resuscitation regardless of gestational age but this requires education and equipment that may not be globally available. Objective: To determine current neonatal resuscitation practices and availability of oxygen blending equipment in non-Western hospitals. Design: 196 email addresses were obtained through perinatal societies representing 45 hospitals in 14 countries in Asia, Africa and the Middle East. Results: 68 (34.6%) responses were received from all 14 countries. The majority (90%, n = 61) of respondents were aware of recent guideline changes but continued to resuscitate with PO because of the lack of equipment and uncertainty about international guidelines (61%, n = 41 for term, 44%, n = 30 for preterm). Most (81%, n = 55) believed that PO caused adverse effects in term neonates. The availability of oxygen blending equipment correlated significantly with the country's gross domestic product. Conclusion: The majority of the practitioners we surveyed in non-Western countries are aware of the most recent recommendations regarding oxygen use in neonatal resuscitation. However, lack of oxygen blending equipment remains a hindrance to the use of blended gas at resuscitation in low resource, non-western countries. Global guidelines from developed countries must take into account the resource limitations and implementation difficulties faced by countries with restricted resources, where the majority of the high-risk infants are born.
Purpose: Combination antibiotics consisting beta-lactam and aminoglycoside are commonly utilized ... more Purpose: Combination antibiotics consisting beta-lactam and aminoglycoside are commonly utilized in the treatment of neonatal septicaemia. The aims of this study were (1) to determine safety and efficacy of the revised gentamicin dosage regimen and (2) to compare intravascular (IV) versus intramuscular (IM) route of gentamicin administration, in term of attaining peak and trough serum concentration targets. Methods: This was a retrospective study from 2012 to 2017. All neonates who received gentamicin with therapeutic drug monitoring performed were included in this study. Data for all eligible neonates were collected from electronic medical records and included demographics, serum creatinine levels, the complete gentamicin dosing and concentration history. Results: A total of 737 neonates who received the correct institutional gentamicin dosage regimen (± 5% of the intended dose) were included in this study. There were 635 trough concentrations (within 30 minutes prior to subsequent...
Additional file 1: Appendix I. Details of Web-based Game Product. Appendix II a. Skills Assessmen... more Additional file 1: Appendix I. Details of Web-based Game Product. Appendix II a. Skills Assessment Checklist (Baseline Assessment). b. Skills Assessment Checklist (Final Assessment).
Abnormalities of the external ear are described in many syndromes and genetic conditions.1-3 Meln... more Abnormalities of the external ear are described in many syndromes and genetic conditions.1-3 Melnick et al4 reported an incidence of 1 in 90 births for external ear malformations and branchial sinuses and tags, with about 1 in 670 births
Journal of Neonatal-Perinatal Medicine, 2021
BACKGROUND: Parent-completed tools like the Ages and Stages Questionnaire Third Edition (ASQ-3) a... more BACKGROUND: Parent-completed tools like the Ages and Stages Questionnaire Third Edition (ASQ-3) are important in developmental screening. As a screening tool, a high negative predictive value (NPV) is critical to avoid missing the diagnosis of developmental delay. This study evaluated the NPV and accuracy of the ASQ-3 in assessing the development of preterm infants. METHODS: Infants born at <32 weeks and/or <1250 grams, presenting to the Neonatal Neurodevelopmental Clinic at the Singapore General Hospital for follow-up from January 2014 to June 2017, at 6, 12, and 18 months corrected age, were included. The ASQ-3 and standardized tests – Peabody Developmental Motor Scale-Second Edition (PDMS-2) and Preschool Language Scale, Fourth Edition UK (PLS-4 UK) – were administered. ASQ-3 gross motor and fine motor scores were compared to PDMS-2 at 6 and 12 months, and ASQ-3 communication scores to PLS-4 UK at 18 months. RESULTS: At 6 months (n = 145), NPV for gross motor and fine motor...
Singapore Medical Journal, 2021
In this paper, we provide guidance to clinicians who care for infants born to mothers with suspec... more In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.
The Permanente Journal, 2011
Introduction: Globally about 8% to 10% of newborns require neonatal intensive care (NICU) care. F... more Introduction: Globally about 8% to 10% of newborns require neonatal intensive care (NICU) care. Families face emotional and financial difficulties when their sick newborns are hospitalized for prolonged periods in a NICU. Methods: We conducted a study to assess the feasibility and acceptance of an Internet-based telemedicine program in an intensive care setting and to evaluate its impact on newborns' length of stay (LOS) in hospitals. We identified eligible newborns and obtained their parents' written consent before installing a Web camera by the babies' beds. Using child-specific, confidential passwords, families viewed real-time video images of their newborns through a secure portal via an Internet browser or 3G (thirdgeneration) cell phone. Parents of study subjects completed a survey that detailed the performance of the system. Frequency of parental visits and LOS of babies were tracked and compared with the same data for similar high-risk newborns matched for gestation and birth weight. Results: Parents responded favorably to the stability of the system and clarity of the image. Eighty percent requested a larger image frame. Frequencies of hospital visits made by parents of newborns in the study group and of those made by parents in the control group were not statistically different. LOS and postmenstrual age on discharge of study infants were not statistically different compared with infants in the control group. Conclusion: Virtual visitation is well accepted by families with sick newborns requiring prolonged hospitalization. Inclusion of information technology to optimize NICU visitation resulted in no significant decrease in duration of hospitalization; however, its role in improving post-discharge transition care must be evaluated further.
Annals of the Academy of Medicine, Singapore, 2013
Neurodevelopmental outcome of borderline viability neonates have lagged behind improvement in sur... more Neurodevelopmental outcome of borderline viability neonates have lagged behind improvement in survival figures. Accurate figures based on local outcome allow us to better counsel parents and to prognosticate with greater accuracy on both short- and longterm outcomes. A retrospective cohort study of 101 consecutively born neonates, born from 21 to 26 weeks gestation over an 11-year period from 1 January 1994 to 31 December 2005 was conducted. Long-term outcomes were assessed at 2, 5 and 8 years of age in terms of mental developmental index (MDI) or intelligence quotient (IQ) scores, hearing and visual impairments, handicaps and impairments, school placement and interventions required. Survival rates were 20.0%, 60.9%, 70.4% and 73.2% for neonates born at 21 to 23, 24, 25 and 26 weeks gestation respectively. Factors that predicted increased mortality included higher alveolar-arterial oxygen difference (AaDO2) with odds ratio (OR) 1.005 and lower birth weight OR 0.993. Rates of severe ...
Annals of the Academy of Medicine, Singapore, 2012
Singapore medical journal, 2009
Current medical advances have increased the survival rate of the premature infant with its compli... more Current medical advances have increased the survival rate of the premature infant with its complications. Risk factors for prematurity include maternal diabetes mellitus, hypertension, smoking and alcohol intake. A true/false questionnaire survey focusing on risk factors, outcomes/follow-up and costs was administered to adults attending a parenting-related public forum. One point was awarded per correct answer. Entire prematurity knowledge and section T-scores were calculated, (a pass mark was defined as at least 50 percent for each T-score). Missing answers and affected T-scores were considered invalid. There were 81 respondents: predominantly within 21-40 years of age, Chinese, female, public-housing dwellers, first-time parents-to-be and with graduate or higher-level qualifications. A pass in entire and prematurity knowledge T-scores was achieved in 69 percent (median 13 [range 3-21]) and 62 percent (median 12 [range 0-19]) respectively. A pass in section T-scores on risk factors...
Annals of the Academy of Medicine, Singapore, 2008
External ear abnormalities accompany many syndromes and genetic conditions. Yet, there are curren... more External ear abnormalities accompany many syndromes and genetic conditions. Yet, there are currently limited Asian references and no local norms for ear measurements and definitions for "low-set ears". The authors therefore describe ear measurements in a Singapore newborn population and seek to establish the applicability of the general accepted definition of "low-set ears" being that of "less than a third of the entire ear height being above the inter-medial canthal line". Babies managed by the Department of Neonatal and Developmental Medicine during a 3-week period were measured by 2 investigators using the Feingold and Bossert technique. Intra- and inter-rater reliabilities were calculated. The influence of various anthropometric factors on and their relationships with ear length (EL) and width (EW) was analysed. A total of 104 neonates (20% preterm at birth) were included in this study. Median gestation was 38 weeks (range, 32 to 42). Mean birth wei...
Singapore medical journal, 2007
Cultural, religious and personal factors impact greatly on parenting. This survey aims to identif... more Cultural, religious and personal factors impact greatly on parenting. This survey aims to identify gaps in knowledge and perception about common parenting issues, with respect to mandarin-speaking Chinese in Singapore. There is an emphasis on first-time parents, who the authors feel may be the group which will require additional education and support on these issues. A 37-item written survey was conducted before a public mandarin-language forum. Our response rate was 67 percent. Only 44 percent felt that paediatricians allocated sufficient time to discuss parenting issues. 99 percent of parents believed that breast milk was better than formula milk and that 93 percent intended to breastfeed. However, the vast majority of respondents thought that breastfeeding should be stopped if jaundice developed, and that sunning was effective in preventing jaundice. Moreover, the majority did not recognise the seriousness of jaundice, prolonged or otherwise. Widespread misconceptions existed abo...
Journal of Paediatrics and Child Health
Journal of Paediatrics and Child Health, Aug 31, 2001
To study the efficacy, safety and cost effectiveness of recombinant human erythropoietin (r-HuEPO... more To study the efficacy, safety and cost effectiveness of recombinant human erythropoietin (r-HuEPO) in reducing erythrocyte transfusion needs in very low birthweight (VLBW) infants. Methods: We conducted a non-blind randomized controlled trial and assigned 100 VLBW infants, less than 33 weeks gestation, to receive either r-HuEPO 750 U/kg per week subcutaneously from day 5 to day 40 or no erythropoietin (EPO). Infants received oral iron 3-6 mg/kg per day from day 10. Transfusion needs were analysed for all enrolled infants and in five weight subgroups: birthweight of less than 600 g, 600-799 g, 800-999 g, 1000-1199 g and infants more than 1200 g. Results: VLBW infants on r-HuEPO attained higher reticulocyte counts and haematocrit than control infants but the mean number of transfusions and volume of erythrocyte transfused per infant were not statistically different. Of infants 800-999 g at birth, the mean number of transfusions per infant was 2.1 compared with 3.5 transfusions per control infant (P = 0.04). Volume of erythrocytes transfused was 34.9 ± 32.1 mL/kg in r-HuEPO-treated infants and 56.6 ± 25.8 mL/kg in control infants (P = 0.03). The cost per patient for transfusion and EPO was S$388 for r-HuEPO recipient and S$438 for control infant. Blood pressure, neutrophil count, platelet count and complications of prematurity were not significantly different in both groups of VLBW infants. Conclusion: r-HuEPO at 750 U/kg per week stimulates erythropoiesis in VLBW infants but significantly reduces the need for erythrocyte transfusion only in infants weighing 800-999 g at birth.
Journal of Neonatal-Perinatal Medicine, 2020
Trapped fourth ventricle (TFV) as a complication of post-hemorrhagic hydrocephalus (PHH) is widel... more Trapped fourth ventricle (TFV) as a complication of post-hemorrhagic hydrocephalus (PHH) is widely reported in the pediatric population with a prior history of ventriculo-peritoneal (VP) shunt placement. Characterized by disproportionate dilatation of the fourth ventricle on serial neuro-imaging, it is rarely encountered in the early course of preterm infants and the differentiating clinical features are subtle and non-specific. Clinical alertness and sonographic correlation hold the key to early diagnosis. We report an early emergence of TFV in an extremely low gestational age newborn (ELGAN) following fulminant Pseudomonas aeruginosa meningitis, approach to management, and the neurological outcome. Fourth ventricle entrapment as a complication of perinatally acquired Pseudomonas aeruginosa meningitis in a surviving ELGAN is extremely rare.
Journal of paediatrics and child health, 2016
Thermoregulatory stability and monitoring are crucial in neonatal care. However, the current stan... more Thermoregulatory stability and monitoring are crucial in neonatal care. However, the current standard of temperature measurement using Axillary Thermometry (AT) poses multiple limitations. Temporal Artery Thermometry (TT) is a promising new method, which thus begs the question: Can TT replace AT in neonates? Previous studies reveal conflicting results, with none involving a Southeast-Asian multi-ethnic neonatal population under different environments. A 6-month prospective comparative study involving neonates managed in a tertiary neonatal centre. Subjects were divided into 4 groups based on the required nursing environment: A) Room air B) Phototherapy C) Radiant warmers D) Incubators. Six hundred and sixty-one paired TT and AT temperature readings were obtained, with concurrent FLACC scoring to evaluate the discomfort associated with each thermometry method. TT readings were higher than AT in all groups. The mean temperature difference between both methods (TT-AT) was lowest in Gro...
Journal of Clinical Medicine and Research, 2012
To describe the demographic characteristics, clinical presentations and outcome of neonatal enter... more To describe the demographic characteristics, clinical presentations and outcome of neonatal enterovirus infection and to evaluate infection control measures effective in preventing the spread of infection. Detailed perinatal history, demography, neonatal conditions and laboratory investigations were retrieved retrospectively from 5 Enterovirus positive patients in the level II nursery of the Singapore General Hospital in October 2010. Five premature neonates tested positive for Enterovirus during the outbreak. All infected neonates presented with lethargy, 4 (80%) poor suck, 4 (80%) apnea, 2 (40%) poor perfusion and 1 (20%) had pyrexia. Enterovirus was positive on PCR analysis of the stool specimen in four infected neonates and on spinal fluid in one neonate. All infected neonates required respiratory support; 3 needed continuous positive airway pressure (CPAP), one required SIPPV and another needed HFOV. Inotropes was needed in 1(20%) infant and severe thrombocytopenia was documented in 3 infected neonates. The neonate who required High frequency oscillatory ventilation (HFOV) and inotropic support died on day 5 of illness. Four (80%) neonates recovered 5 days following the onset of illness. Neonatal enterovirus infection can lead to morbidity and even death. Pertinent history of exposure, early recognition, timely intervention and appropriate infection control measures are necessary to prevent dissemination of infection.
Annals of the Academy of Medicine, Singapore, 2005
To determine whether chronic lung disease (CLD) influences specific aspects of motor development ... more To determine whether chronic lung disease (CLD) influences specific aspects of motor development in infancy. Twenty-nine very low birthweight infants with CLD at 36 weeks' post-conceptional age and 31 infants without CLD were evaluated at 8 months' and 24 months' corrected age using the Neurosensory Motor Development Assessment. Perinatal and neonatal characteristics of the infants with CLD and control infants were compared using the chi-square test for categorical variables and Student's t-test for continuous variables. The relationship between CLD and adverse outcome was measured by the odds ratio (OR) and its 95% confidence interval (CI). The overall developmental scores of the CLD infants were significantly different compared with control infants at 8 months. By 2 years of age, both groups of infants showed marked improvement in motor performance. However, differences persisted in the area of postural balance and sensory motor skills. Taking periventricular haemo...
Journal of Paediatrics and Child Health, 1994
This study addresses the dilemma of whether to attempt resuscitation of the previously undiagnose... more This study addresses the dilemma of whether to attempt resuscitation of the previously undiagnosed fresh stillborn infant and evaluates factors predictive of survival and long-term outcome. We reviewed the clinical spectrum, immediate complications and long-term outcome of 45 successfully resuscitated apparently stillborn infants (34 term, 11 preterm) who were admitted to the Intensive Care Nursery. Significant obstetric and intrapartum events were identified in 34 (75%) infants while 11 (25%) had no apparent risk factors. Of the 39 infants with neonatal complications, 37 had hypoxic-ischaemic encephalopathy (HIE; Sarnat stage 1 in 5, stage 2 in 15, stage 3 in 17); 12 (27%) had oliguria. 10 (22%) had hypotension, 7 (16%) experienced hypoglycaemia, 4 (9%) had disseminated intravascular coagulopathy (DIC) and 1 (2%) had persistent pulmonary hypertension of the newborn (PPHN). Fourteen infants (31%) died in the neonatal period and four (9%) died during infancy. Risks of death and adverse neurodevelopment were significantly increased in infants with stage 2 or 3 HIE (P<0.005). Follow-up assessment of 24 of the 27 surviving infants revealed a normal outcome in 15 (63%), severe disability in six (25%), moderate disability in two (8%) and mild disability in one (4%) infant. The positive predictive value of stage 2 or 3 HIE was 70% for mortality and 80% for morbidity. One-third (15/45) of successfully resuscitated apparently stillborn infants were normal at follow-up assessment and the outcome for these infants was predicted with complete accuracy by the stage of HIE present during the neonatal period.
Journal of Paediatrics and Child Health, 1994
The prevalence of inguinal hernia during primary hospitalization was determined in 250 infants wi... more The prevalence of inguinal hernia during primary hospitalization was determined in 250 infants with gestational age 24-29 weeks. Fourteen per cent developed hernia, with prevalence significantly higher in boys than girls. Infants with respiratory distress syndrome and those requiring prolonged mechanical ventilation were significantly predisposed to the development of hernia. Male infants, especially those who required prolonged ventilatory assistance, were at greatest risk. This information may be used when counselling parents regarding complications of very preterm infants.
Early Human Development, 2012
Background: Using pure oxygen (PO) in neonatal resuscitation increases oxidative stress and morta... more Background: Using pure oxygen (PO) in neonatal resuscitation increases oxidative stress and mortality in full-term hypoxic infants. International neonatal resuscitation guidelines recommend air or blended oxygen for resuscitation regardless of gestational age but this requires education and equipment that may not be globally available. Objective: To determine current neonatal resuscitation practices and availability of oxygen blending equipment in non-Western hospitals. Design: 196 email addresses were obtained through perinatal societies representing 45 hospitals in 14 countries in Asia, Africa and the Middle East. Results: 68 (34.6%) responses were received from all 14 countries. The majority (90%, n = 61) of respondents were aware of recent guideline changes but continued to resuscitate with PO because of the lack of equipment and uncertainty about international guidelines (61%, n = 41 for term, 44%, n = 30 for preterm). Most (81%, n = 55) believed that PO caused adverse effects in term neonates. The availability of oxygen blending equipment correlated significantly with the country's gross domestic product. Conclusion: The majority of the practitioners we surveyed in non-Western countries are aware of the most recent recommendations regarding oxygen use in neonatal resuscitation. However, lack of oxygen blending equipment remains a hindrance to the use of blended gas at resuscitation in low resource, non-western countries. Global guidelines from developed countries must take into account the resource limitations and implementation difficulties faced by countries with restricted resources, where the majority of the high-risk infants are born.
Purpose: Combination antibiotics consisting beta-lactam and aminoglycoside are commonly utilized ... more Purpose: Combination antibiotics consisting beta-lactam and aminoglycoside are commonly utilized in the treatment of neonatal septicaemia. The aims of this study were (1) to determine safety and efficacy of the revised gentamicin dosage regimen and (2) to compare intravascular (IV) versus intramuscular (IM) route of gentamicin administration, in term of attaining peak and trough serum concentration targets. Methods: This was a retrospective study from 2012 to 2017. All neonates who received gentamicin with therapeutic drug monitoring performed were included in this study. Data for all eligible neonates were collected from electronic medical records and included demographics, serum creatinine levels, the complete gentamicin dosing and concentration history. Results: A total of 737 neonates who received the correct institutional gentamicin dosage regimen (± 5% of the intended dose) were included in this study. There were 635 trough concentrations (within 30 minutes prior to subsequent...
Additional file 1: Appendix I. Details of Web-based Game Product. Appendix II a. Skills Assessmen... more Additional file 1: Appendix I. Details of Web-based Game Product. Appendix II a. Skills Assessment Checklist (Baseline Assessment). b. Skills Assessment Checklist (Final Assessment).
Abnormalities of the external ear are described in many syndromes and genetic conditions.1-3 Meln... more Abnormalities of the external ear are described in many syndromes and genetic conditions.1-3 Melnick et al4 reported an incidence of 1 in 90 births for external ear malformations and branchial sinuses and tags, with about 1 in 670 births
Journal of Neonatal-Perinatal Medicine, 2021
BACKGROUND: Parent-completed tools like the Ages and Stages Questionnaire Third Edition (ASQ-3) a... more BACKGROUND: Parent-completed tools like the Ages and Stages Questionnaire Third Edition (ASQ-3) are important in developmental screening. As a screening tool, a high negative predictive value (NPV) is critical to avoid missing the diagnosis of developmental delay. This study evaluated the NPV and accuracy of the ASQ-3 in assessing the development of preterm infants. METHODS: Infants born at <32 weeks and/or <1250 grams, presenting to the Neonatal Neurodevelopmental Clinic at the Singapore General Hospital for follow-up from January 2014 to June 2017, at 6, 12, and 18 months corrected age, were included. The ASQ-3 and standardized tests – Peabody Developmental Motor Scale-Second Edition (PDMS-2) and Preschool Language Scale, Fourth Edition UK (PLS-4 UK) – were administered. ASQ-3 gross motor and fine motor scores were compared to PDMS-2 at 6 and 12 months, and ASQ-3 communication scores to PLS-4 UK at 18 months. RESULTS: At 6 months (n = 145), NPV for gross motor and fine motor...
Singapore Medical Journal, 2021
In this paper, we provide guidance to clinicians who care for infants born to mothers with suspec... more In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.
The Permanente Journal, 2011
Introduction: Globally about 8% to 10% of newborns require neonatal intensive care (NICU) care. F... more Introduction: Globally about 8% to 10% of newborns require neonatal intensive care (NICU) care. Families face emotional and financial difficulties when their sick newborns are hospitalized for prolonged periods in a NICU. Methods: We conducted a study to assess the feasibility and acceptance of an Internet-based telemedicine program in an intensive care setting and to evaluate its impact on newborns' length of stay (LOS) in hospitals. We identified eligible newborns and obtained their parents' written consent before installing a Web camera by the babies' beds. Using child-specific, confidential passwords, families viewed real-time video images of their newborns through a secure portal via an Internet browser or 3G (thirdgeneration) cell phone. Parents of study subjects completed a survey that detailed the performance of the system. Frequency of parental visits and LOS of babies were tracked and compared with the same data for similar high-risk newborns matched for gestation and birth weight. Results: Parents responded favorably to the stability of the system and clarity of the image. Eighty percent requested a larger image frame. Frequencies of hospital visits made by parents of newborns in the study group and of those made by parents in the control group were not statistically different. LOS and postmenstrual age on discharge of study infants were not statistically different compared with infants in the control group. Conclusion: Virtual visitation is well accepted by families with sick newborns requiring prolonged hospitalization. Inclusion of information technology to optimize NICU visitation resulted in no significant decrease in duration of hospitalization; however, its role in improving post-discharge transition care must be evaluated further.
Annals of the Academy of Medicine, Singapore, 2013
Neurodevelopmental outcome of borderline viability neonates have lagged behind improvement in sur... more Neurodevelopmental outcome of borderline viability neonates have lagged behind improvement in survival figures. Accurate figures based on local outcome allow us to better counsel parents and to prognosticate with greater accuracy on both short- and longterm outcomes. A retrospective cohort study of 101 consecutively born neonates, born from 21 to 26 weeks gestation over an 11-year period from 1 January 1994 to 31 December 2005 was conducted. Long-term outcomes were assessed at 2, 5 and 8 years of age in terms of mental developmental index (MDI) or intelligence quotient (IQ) scores, hearing and visual impairments, handicaps and impairments, school placement and interventions required. Survival rates were 20.0%, 60.9%, 70.4% and 73.2% for neonates born at 21 to 23, 24, 25 and 26 weeks gestation respectively. Factors that predicted increased mortality included higher alveolar-arterial oxygen difference (AaDO2) with odds ratio (OR) 1.005 and lower birth weight OR 0.993. Rates of severe ...
Annals of the Academy of Medicine, Singapore, 2012
Singapore medical journal, 2009
Current medical advances have increased the survival rate of the premature infant with its compli... more Current medical advances have increased the survival rate of the premature infant with its complications. Risk factors for prematurity include maternal diabetes mellitus, hypertension, smoking and alcohol intake. A true/false questionnaire survey focusing on risk factors, outcomes/follow-up and costs was administered to adults attending a parenting-related public forum. One point was awarded per correct answer. Entire prematurity knowledge and section T-scores were calculated, (a pass mark was defined as at least 50 percent for each T-score). Missing answers and affected T-scores were considered invalid. There were 81 respondents: predominantly within 21-40 years of age, Chinese, female, public-housing dwellers, first-time parents-to-be and with graduate or higher-level qualifications. A pass in entire and prematurity knowledge T-scores was achieved in 69 percent (median 13 [range 3-21]) and 62 percent (median 12 [range 0-19]) respectively. A pass in section T-scores on risk factors...
Annals of the Academy of Medicine, Singapore, 2008
External ear abnormalities accompany many syndromes and genetic conditions. Yet, there are curren... more External ear abnormalities accompany many syndromes and genetic conditions. Yet, there are currently limited Asian references and no local norms for ear measurements and definitions for "low-set ears". The authors therefore describe ear measurements in a Singapore newborn population and seek to establish the applicability of the general accepted definition of "low-set ears" being that of "less than a third of the entire ear height being above the inter-medial canthal line". Babies managed by the Department of Neonatal and Developmental Medicine during a 3-week period were measured by 2 investigators using the Feingold and Bossert technique. Intra- and inter-rater reliabilities were calculated. The influence of various anthropometric factors on and their relationships with ear length (EL) and width (EW) was analysed. A total of 104 neonates (20% preterm at birth) were included in this study. Median gestation was 38 weeks (range, 32 to 42). Mean birth wei...
Singapore medical journal, 2007
Cultural, religious and personal factors impact greatly on parenting. This survey aims to identif... more Cultural, religious and personal factors impact greatly on parenting. This survey aims to identify gaps in knowledge and perception about common parenting issues, with respect to mandarin-speaking Chinese in Singapore. There is an emphasis on first-time parents, who the authors feel may be the group which will require additional education and support on these issues. A 37-item written survey was conducted before a public mandarin-language forum. Our response rate was 67 percent. Only 44 percent felt that paediatricians allocated sufficient time to discuss parenting issues. 99 percent of parents believed that breast milk was better than formula milk and that 93 percent intended to breastfeed. However, the vast majority of respondents thought that breastfeeding should be stopped if jaundice developed, and that sunning was effective in preventing jaundice. Moreover, the majority did not recognise the seriousness of jaundice, prolonged or otherwise. Widespread misconceptions existed abo...