Nem Yun Boo

Risk factors associated with subaponeurotic haemorrhage in full‐term infants exposed to vacuum extraction

Objectives  To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to vacuum extraction.

Comparison of serum cardiac troponin T and creatine kinase MB isoenzyme mass concentrations in asphyxiated term infants during the first 48 h of life

Objective: This prospective study aimed to compare serum creatine kinase MB isoenzyme (CK‐MB) mass concentrations and cardiac troponin T (cTnT) concentrations during the first 48 h of life in asphyxiated term infants.

Prediction of severe hyperbilirubinaemia using the Bilicheck transcutaneous bilirubinometer

Objectives:  To determine the sensitivity and specificity of different levels of bilirubin measured by the transcutaneous bilirubinometer Bilicheck on forehead and sternum for predicting severe hyperbilirubinaemia of total serum bilirubin (TSB) ≥ 300 µmol/L in Malay, Chinese and Indian infants.

Predictors of failure of nasal continuous positive airway pressure in treatment of preterm infants with respiratory distress syndrome

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).

The role of expressed breastmilk and continuous positive airway pressure as predictors of survival in extremely low birthweight infants.

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.

Risk factors associated with neonatal hypothermia during cleaning of newborn infants in labour rooms.

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.

Neonatal seizures due to maternal primary hyperparathyroidism.

I would like to bring notice the significant error concerning digoxin dosage that occurs in the above book on page 205 Table 7-4: ‘Oral Digoxin Dosage for Congestive Heart Failure’. The total daily dose and maintenance dose have been written in milligrams (mg) not micrograms ( μ g). I would urge all those who have access to this handbook to change the table. The publishers of this book have notified those that they can identify through sales records. I would concur with Dr Weintraub’s recent review of the book in this journal 1 that there are some outdated management strategies such as the routine use of digoxin for heart failure and ‘digoxin is no longer preferred therapy for chronic management of supraventricular arrhythmias.’ The history of use of digoxin for management of congenital heart defects in infancy and childhood has been characterized by too many fatal overdoses already.

Risk factors associated with feed intolerance in very low birthweight infants following initiation of enteral feeds during the first 72 hours of life

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.

Using digital photography to facilitate learning for medical students

presentations more interactive. The PowerPoint slides were converted to MPEG-4 movies using Camtasia software (TechSmith Corp., Okemos, MI, USA [http://www.techsmith.com]) and an audio track including a voiceover was added. It is important that the voiceover is recorded using a good microphone in a quiet room without extraneous noise. For viewing, an 800 · 600-pixel matrix was selected. This spatial resolution was sufficient to enable viewing on a notebook computer or possibly a hand-held device such as an iPad or tablet computer. The files were stored on the university’s media server and accessed via a link on the Blackboard website, to which students had 24-hour access. This allowed students to view the movies online or to download them. What lessons were learned? There are obvious advantages to using an e-learning platform to teach medical students, especially in a highly visual discipline such as radiology. These include improved efficiencies in the production of learning resources and transfer of information. Successful e-learning depends on how the content is delivered to the student and how it enhances his or her learning, rather than simply the provision of online resources. If students find the e-learning experience interesting and rewarding, they are more likely to learn effectively. Our students enjoyed the novelty of the chest radiology movies and their interactivity, but they saw the movies as complementing face-to-face radiology tutorials rather than replacing them. To be useful, the movie file sizes must be small enough to be downloaded in a reasonable time period and to be suitable for use on hand-held tablet computers or smartphones. This is a definite drawback of current file design as most tablet devices and smartphones have maximum storage of 64 Gb and 32 Mb, respectively. Students are comfortable with the e-learning format, but further studies are required to determine whether this format actually improves medical students’ learning.