Parental knowledge, attitudes and perceptions regarding infant basic life support

<p><b>INTRODUCTION</b>Out-of-hospital cardiopulmonary arrest (CPA) in children is rare but significant, with poor survival rates and high morbidity. Asystole is the most common dysrhythmia, and cardiopulmonary resuscitation (CPR) is of great importance in such cases. We aimed to survey the knowledge, attitudes and perceptions of parents in Singapore regarding infant basic life support (IBLS).</p><p><b>METHODS</b>A questionnaire survey was administered to parents of children managed at the Neonatal Department of Singapore General Hospital, Singapore, between 1 September and 31 December 2008. The questionnaire consisted of three sections--section A collected demographic data, section B included questions on knowledge, and section C explored attitudes and perceptions. Knowledge T-scores were analysed for the entire cohort and subanalysed with respect to prior IBLS training.</p><p><b>RESULTS</b>In our study cohort (n = 375), the median Basic Knowledge (BK) T-score was 7 (range 1-9) and the pass rate was 55%. Median BK T-scores were significantly different between untrained (6; range 3-9) and previously trained (8; range 3-9) participants. A majority of the trained participants obtained pass marks. Median Total Knowledge T-score, involving advanced questions, for previously trained participants was 11 (range 3-14), but pass rate was low (35.7%). Higher educational qualification was a significant factor impacting all scores. Untrained participants indicated interest in attending IBLS courses, while trained participants were interested in refresher courses.</p><p><b>CONCLUSION</b>IBLS training, as part of basic cardiac life support training, is important given that CPR can significantly alter the outcome in children with CPA. Our survey revealed knowledge gaps that could be bridged through formal training. Refresher courses to regularly update parents' knowledge are recommended.</p>

A Comparison of the Short-term Morbidity and Mortality Between Late Preterm and Term Newborns

<p><b>INTRODUCTION</b>Late preterm babies are defined as those born between 34 to 36 completed weeks. There has been a recent increased awareness that this group of babies has a higher incidence of morbidity as compared to term babies. The aim of this study was to evaluate the short-term morbidities occurring in this group of babies managed in the neonatal unit at Singapore General Hospital (SGH).</p><p><b>MATERIALS AND METHODS</b>A retrospective study was done of babies managed in the neonatal unit at SGH from January 2005 to December 2008. Maternal, perinatal and neonatal data were obtained from the departmental database. The outcomes of late preterm infants were compared with term infants.</p><p><b>RESULTS</b>A total of 6826 babies were admitted. Ten percent (681 out of 6826) of babies were late preterm babies, making up 63% (681 out of 1081) of all preterm babies. Late preterm babies had significantly greater need for resuscitation at birth. They also had statistically significant increased risks of developing hyaline membrane disease (2.5% vs 0.1%), transient tachypnoea of the newborn (TTN) (8.1% vs 1.7%), pneumonia (7.0% vs 2.8%), patent ductus arteriosus (PDA) (4.3% vs 1.1%), hypotension (0.7% vs 0%), apnoea (3.7% vs 0%), gastrointestinal (GI) bleeding (1.5% vs 0.3%), polycythaemia (2.2% vs 1.0%), anaemia (3.4% vs 1.2%), thrombocytopenia (3.2% vs 0.6%), hypoglycaemia (6.6% vs 1.7%), neonatal jaundice requiring phototherapy (41.1% vs 12.2%) and sepsis (1.7% vs 0.6%).</p><p><b>CONCLUSION</b>Late preterm infants are indeed a vulnerable group of infants with significant morbidities that need to be addressed and treated. Despite their relatively large size and being almost term, the understanding that late preterm infants are not similar to term infants is important to both obstetricians and neonatologists.</p>

Profile of children diagnosed with autistic spectrum disorder managed at a tertiary child development unit

<p><b>INTRODUCTION</b>There has been a rising trend in childhood developmental and behavioural disorders (CDABD). This study reports the profile of children with autistic spectrum disorders (ASD) initially referred for evaluation of CDABD.</p><p><b>METHODS</b>The CDABD database prospectively collected data of all consenting children referred in 2003 to the then Child Development Unit at KK Women's and Children's Hospital. All received medical consultation, followed by further assessments and intervention. Patients were tracked for one year.</p><p><b>RESULTS</b>Among 542 referred children, 32% (n = 170) received a diagnosis of ASD one year after the first consultation. Most were male, with a male to female ratio of 4.5:1. The median age at the first consultation was 41 (19,109) months. The main presenting concern was a delay in the development of speech and language skills in 78% of the children. A significant number had behavioural (63%) and social interaction (34%) issues. Criteria for the diagnosis of ASD according to the Diagnostic Statistical Manual IV-Revised were fulfilled in almost 90%. With the remaining refusing or deferring evaluation, only 74% received a psychological assessment. ASD was assessed to be severe or moderate in 86% of the children. Three-quarters remained on follow-up one year after the first consultation. The majority were referred for either centre- or school-based intervention programmes, with 70% assessed to have improved at the one-year mark.</p><p><b>CONCLUSION</b>This is the first presentation of local data that aids programme planning and resource allocation. Children with ASD have varied outcomes. It is important to identify and intervene early in order to optimise development and functionality.</p>

Children with developmental and behavioural concerns in Singapore

<p><b>INTRODUCTION</b>Childhood developmental and behavioural disorders (CDABD) have been increasingly recognised in recent years. This study evaluated the profiles and outcomes of children referred for developmental and behavioural concerns to a tertiary child developmental centre in Singapore. This is the first such regional database.</p><p><b>METHODS</b>Baseline information, obtained through a questionnaire, together with history at first consultation, provided information for referral, demographic and presentation profiles. Clinical formulations were then made. Definitive developmental and medical diagnoses, as well as outcomes based on clinical assessment and standardised testing, were recorded at one year post first consultation.</p><p><b>RESULTS</b>Out of 1,304 referrals between January 1, 2003 and December 1, 2004, 45% were 2-4 years old and 74% were boys. The waiting time from referral to first consultation exceeded four months in 52% of children. Following clinical evaluation, 7% were found to be developmentally appropriate. The single most common presenting concern was speech and language (S&L) delay (29%). The most common clinical developmental diagnosis was autism spectrum disorder (ASD) (30%), followed by isolated S&L disorder, global developmental delay (GDD) and cognitive impairment (CI). Recommendations included S&L therapy (57%), occupational therapy (50%) and psychological/behavioural services (40%). At one year, ASD remained the most common definitive developmental diagnosis (31%), followed by S&L disorder, CI and GDD. Most were children with high-prevalence, low-moderate severity disorders who could potentially achieve fair-good prognosis with early intervention.</p><p><b>CONCLUSION</b>Better appreciation of the profile and outcome of children with CDABD in Singapore could enable better resource planning for diagnosis and intervention.</p>

Auricular anthropometry of newborns at the Singapore General Hospital

<p><b>INTRODUCTION</b>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".</p><p><b>MATERIALS AND METHODS</b>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.</p><p><b>RESULTS</b>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 weight was 2910 +/- 657 g. Mean EW and EL for term infants were 2.1 +/- 0.1 cm and 3.6 +/- 0.3 cm respectively, without significant differences for different-sided ears, investigators, race or gender. Mean percentage of right and left ear above the denoted line was 52 +/- 9% and 47 +/- 10% respectively (P = 0.000), with 3rd percentile being 33%.</p><p><b>CONCLUSIONS</b>Singaporean neonatal ears are comparable with other Asian neonates - larger than Hong Kong Chinese babies, though similar to Japanese newborns - but smaller than Caucasian neonates. The definition of "low-set ears" is consistent with the general accepted definition.</p>

Does visual turbidity correlate with serum triglyceride levels in babies on total parenteral nutrition?

<p><b>INTRODUCTION</b>Intravenous lipid is commonly used as part of total parenteral nutrition (TPN) in premature babies. The gold standard of measuring lipid tolerance involves measuring serum triglyceride levels. Many hospitals in Asia do not have this facility and rely on visual turbidity to titrate the rate of lipid infusion. The aim of this study was to determine if visual turbidity correlates with serum triglyceride levels.</p><p><b>MATERIALS AND METHODS</b>Twenty-seven samples were taken from 8 babies on intravenous (IV) lipid infusion for the analysis of serum triglyceride levels and visual turbidity (assessed by 2 senior neonatologists independently). Serum turbidity was classified either as clear or turbid. Lipid intolerance was defined as triglyceride levels greater than 200 mg/dL (2.25 mmol/L).</p><p><b>RESULTS</b>Both neonatologists similarly classified 20 out of 27 specimens. Serum triglyceride levels for clear samples (n = 10) were significantly lower than those for turbid samples (n = 10) (P <0.01). The clear specimens all had normal serum triglyceride levels (mean, 1.16 mmol/L; range, 0.43 to 1.96). Not all turbid specimens had unacceptable serum triglyceride levels (mean, 2.37 mmol/L; range, 1.37 to 5.75). In the remaining 7 specimens, there was a difference in opinion regarding serum turbidity. The triglyceride levels for these 7 samples were all normal (mean, 1.17 mmol/L; range, 0.66 to 1.72).</p><p><b>CONCLUSION</b>Serum turbidity may be used as a screening tool in assessing lipid tolerance in babies on TPN as all clear samples had acceptable serum triglyceride level if we set the maximum cutoff at 2.25 mmol/L. Patients with turbid samples should ideally have their serum triglyceride taken to confirm lipid intolerance before altering their lipid infusion rate as they may have acceptable triglyceride levels.</p>