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Biomedical subjects

N K Ho

Publications and source records attributed to N K Ho.

At least 37 records · Page 2Linked to original sources
PubMed1993

Factors affecting responses of infants with respiratory distress syndrome to exogenous surfactant therapy.

Approximately 20% to 30% of infants with respiratory distress syndrome (RDS) do not respond to surfactant replacement therapy. Unfortunately there is no uniform definition of 'response' or 'non-response' to surfactant therapy. Response was based on improvement in a/A PO2 and/or mean airway pressure (MAP) by some and on improvement in FIO2 and/or MAP by others. Even the point of time at which evaluation of response was done is different in various reports. There is an urgent need to adopt an uniform definition. Most premature babies are surfactant deficient which is the aetiological factor of RDS. Generally good antenatal care and perinatal management are essential in avoidance of premature birth. Babies with lung hypoplasia and who are extremely premature (less than 24 weeks of gestation) do not respond well to exogenous surfactant replacement because of structural immaturity. Prompt management of asphyxiated birth and shock are necessary as there may be negative response to surfactant replacement. Foetal exposure to glucocorticoids improves responsiveness to postnatal administration of surfactant. Antenatal steroid therapy has become an important part of management of RDS with surfactant replacement. The premature lungs with high alveolar permeability tend to develop pulmonary oedema. With the presence of plasma-derived surfactant inhibitors, the response to exogenous surfactant may be affected. These inhibitors may also be released following ventilator barotrauma. The standard of neonatal intensive care such as ventilatory techniques has an important bearing on the outcome of the RDS babies.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1992

Neonatal jaundice in Asia.

Neonatal jaundice is a major clinical problem globally, especially in the Asian and south-east Asian regions. There is no universal definition of hyperbilirubinaemia, and comparisons of management and control of hyperbilirubinaemia in infants at different centres are difficult. G6PD deficiency, ABO incompatibility, low birth weight and sepsis are the common causes of neonatal jaundice, but there is a group of babies whose cause of neonatal jaundice has yet to be found. Genetic factors may be responsible for ethnic differences in the ability to eliminate bilirubin, while unidentified environmental factors may also play a role in the prevalence of neonatal jaundice. As a result of a surveillance programme for neonatal jaundice in Singapore, involving health education of doctors, nurses and the lay public, screening of the newborn and the early treatment of jaundice, we have not seen a single case of kernicterus in Singapore for more than 10 years.

Asia↗
PubMed1992

Spondylothoracic dysplasia (Jarcho-Levin syndrome) in a Chinese baby.

Spondylothoracic dysplasia (STD) syndrome or the Jarcho-Levin syndrome has been seen commonly in Puerto Ricans. A case of STD syndrome in a Chinese baby which we believe is the first reported case in an Asian baby is reported. The skeletal disorder syndrome affecting the spine, ribs and thorax is an autosomal recessive disorder with associated non-skeletal anomalies. It should not be confused with the phenotypically similar skeletal disorder known as spondylocostal dysplasia, which is an autosomal dominant disease.

Abnormalities, Multiple↗
PubMed1992

The Moebius sequence--report of a case and a short annotation.

A Malay baby with multiple cranial nerve involvement consistent with the Moebius sequence (syndrome) is reported. He also had many non-Central Nervous System (CNS) related defects which include limb reduction defects and the Poland sequence. A short annotation and the spectrum of this disorder are presented. In view of many reported related disorders, Moebius sequence may occur as a part of a broader pattern of malformation.

Abnormalities, Multiple↗
PubMed1992

Neonatal outcome of breech babies in Toa Payoh Hospital 1984-1989.

From 1984 to 1989, a total of 575 breech babies were born out of 21,243 livebirths (2.71%) in the Toa Payoh Hospital, Singapore. There were 259 male and 316 female infants, a sex ratio of 1 to 1.22. There were also no marked differences in the frequency of breech birth among the different racial groups. Many breech babies (385 or 67%) were delivered by Caesarean section and the mortality and morbidity were noted to be low in this series. We had 7 deaths, all weighing below 2000gm and only one, a premature infant, was delivered by Caesarean section. The majority of the infants had no evidence of asphyxia at birth (87.7%); and for those who had asphyxia (13.3%), two-thirds were delivered vaginally and one-third, by Caesarean section. The malformation rate in breech babies was twice that of non-breech babies (7.13% vs 3.08%, p = 10(-6)). Most birth defects were minor in nature. Only 10% of birth defects were major malformations. 5.9% (34) of all the breech babies were low birth weight (LBW), 1/3 (11) of them were delivered by Caesarean section with one death. However, there was no increasing trend of Caesarean section for LBW breech infants in the Hospital. Over the past 6 years, out of the 23 LBW breech babies delivered vaginally, 6 deaths were noted. There were 13 breech stillbirths, the majority of which were macerated (7/13 or 53.8%). The stillbirth rate (SBR) for breech was 22 per 1000 breech livebirths and stillbirths. The SBR for babies born normally was 5.15. The corrected breech SBR was 18.7 after exclusion of lethal malformations.(ABSTRACT TRUNCATED AT 250 WORDS)

Breech Presentation↗
PubMed1992

Resuscitation of the small baby--is there a limit?

Innovations in perinatal care in the last decade, in particular delivery room resuscitations and advanced technologies have probably contributed greatly to improved survival of the small newborns. As a result, progressively smaller and less mature infants are being resuscitated; but some survive with severe neurodevelopmental handicap. There should be guidelines about the lower limits of viability below which no resuscitation should be done. It is the view of many that resuscitation of critically ill small babies should be initiated at birth. Further management will be decided depending on the baby's progress and response. Clinicians have to look into the question of withdrawal of life support in small babies who survive with impairment and chronic illnesses.

Decision Making↗
PubMed1991

Neonatal jaundice. A second 4-year experience in Toa Payoh Hospital (1986-1989).

A 4-year experience of neonatal jaundice, from 1982-1985, in Toa Payoh Hospital, Singapore was reported previously. The second 4-year experience (1986-1989) of neonatal jaundice is reported. The Department had a more liberal policy in the management of milder cases of neonatal jaundice since 1986, after acquisition of more phototherapy units. It is the purpose of this paper to examine the change in pattern of neonatal jaundice in the same department over these 2 study periods and a comparison is made. The reported frequency of neonatal jaundice in these 2 study periods rose from 7.9% to 10% of all babies in this hospital. Babies who have some form of treatment such as phototherapy are considered as cases of neonatal jaundice. However, the incidence of hyperbilirubinaemia (defined as serum bilirubin level of 255 umol/L or 15 mg/dl or greater) fell from 3.23% to 2.11% of all livebirths in these 2 study periods. ABO Incompatibility, glucose-6-phosphate dehydrogenase (G6PD) deficiency and low birth weights (LBW) remain as the common aetiological factors of neonatal jaundice. The indications of exchange blood transfusions have changed considerably. There were less exchange blood transfusions for severe neonatal jaundice due to G6PD deficiency. However, more LBW babies underwent exchange blood transfusion. No case of kernicterus was reported for more than 10 years.

ABO Blood-Group System↗
PubMed1991

Congenital malformations in Toa Payoh hospital--a 18 year experience (1972-1989).

A ten year experience (1972-1981) of congenital malformations in Toa Payoh Hospital was presented previously. The experience of birth defects of the second decade (1982-1989) is reviewed and compared. The mortality rates of babies with malformations ranged from 1.52 to 3.55 per 1000 livebirths. There was no significant increase in congenital malformation death rates over the past eight years. There was an increasing trend of malformation deaths among the total neonatal deaths from 1972-1981 (p less than 0.05), but this was not so for the period 1982-1989. The incidence of minor congenital malformations has not changed except that more cases of undescended testes were recorded (p less than 0.05). Central Nervous System (CNS) malformations, congenital heart defects and chromosomal abnormalities still remain the leading cause of malformation deaths. Neural Tube Defects (NTD) were the commonest type of CNS defect and the death rates of NTD for these two periods remain the same (about 0.65 per 1000 births). The prevalence of anencephaly at birth in Chinese and Malay from 1982-1989 is 0.45 and 0.84 per 1000 livebirths respectively. Down syndrome was the commonest type of chromosomal abnormality (63%) and coarctation of aorta (40%) was the commonest type of congenital heart disease causing death. Many congenital malformations are genetically determined. More knowledge of the aetiological factors, antenatal diagnosis of birth defects, preventive measures and genetic counselling are, therefore, important in lowering birth defect rates.

Cause of Death↗
PubMed1991

A study of 8 year neonatal deaths (1982-1989) of Toa Payoh Hospital.

A study of 233 neonatal deaths out of 30910 livebirths over an 8 year period in the Toa Payoh Hospital is done. The Hospital has since ceased providing obstetric and neonatal intensive services from April 1990 due to restructuring of hospital care. The Neonatal Mortality Rates (NNMR) from 1982-1989 ranged from 6.52 to 9.55 and there was no significant fall in trend (p = 0.13). One hundred and thirteen (48.5%) neonates who died were below 1500gm (VLBW). Various causes of neonatal deaths were examined and there was a decline in respiratory distress syndrome (RDS) death rates (p less than 0.0002). Deaths due to asphyxia (p greater than 0.05) and infections (p greater than 0.05) have not declined significantly over the same period. It is also observed that less VLBW babies died over this 8 year period and the VLBW mortality rates (p less than 0.02) have declined. However, the congenital malformation mortality has also not declined significantly (p = 0.92) though early study (1972-1981) showed an increasing trend of malformation deaths among total neonatal deaths (p less than 0.02). Improvement in VLBW and RDS management has not contributed to a significant decline in NNMR. It is observed that more VLBW babies were born during this 8 year period (p = 0.01) especially so in the less than 1000 gm group (p = 0.0005) and the survival of VLBW babies has improved (45.5% to 75.8% alive) as a result of advances in neonatal intensive care. The reasons for increase in incidence of VLBW births in the past few years are not known.(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of Death↗
PubMed1990

Giant epignathus with intracranial teratoma in a newborn infant.

A male newborn infant with a giant epignathus associated with intracranial teratoma and obstructive hydrocephalus detected antenatally is reported. Only 4 similar cases have been reported in the literature. This disorder is uniformly lethal. We believe this is the first reported case of epignathus with congenital intracranial teratoma diagnosed antenatally by ultrasonography.

Adult↗
PubMed1990

The usefulness of CRP and I/T ratio in early diagnosis of infections in Asian newborns.

The greatest challenge in neonatal infection is to correctly identify an infected neonate and not to overtreat those who are not. We studied 80 Asian neonates suspected of sepsis. C-Reactive Protein (CRP), Total White Cell Count (TW) and Immature to Total Neutrophil Ratio (I/T ratio) were evaluated in terms of their specificity, sensitivity, positive and negative predictive values. CRP was measured quantitatively by Fluorescence Polarisation Immunoassay Technology (FPIT). There were 36 positive cases (positive blood culture or Chest Radiography [CXR] showed pulmonary infiltrates). Using the FPIT, CRP in 98% of clinically healthy individuals is (less than or equal to) 1.0mg%. When CRP is less than or equal to 1.0mg% is taken as norm, its specificity range from 0.84-0.91 and its sensitivity from 0.22-0.50. However, CRP may be marginally raised in conditions of stress like birth asphyxia and fetal distress. Thus when CRP less than or equal to 1.5mg% is considered as norm, its specificity range from 0.93-1.00 and its sensitivity from 0.14-0.33. The positive predictive value range from 71%-100% and the negative predictive value from 57%-63%. The normal I/T ratio is less than 0.2. The specificity of I/T range from 0.75-0.91 and the sensitivity range from 0.22-0.47. The positive and negative predictive values range from 60%-76% and 58%-66% respectively. Hence CRP is very specific especially when it is less than 1.5mg% but not as sensitive. I/T although less specific is also more specific than sensitive. Combining CRP and I/T as a marker of sepsis only increases its specificity (range 93%-100%) but not its sensitivity (range 16%-45%).(ABSTRACT TRUNCATED AT 250 WORDS)

Asia↗
PubMed1990

Aplasia cutis congenita. A case report and annotation.

Aplasia cutis congenita (ACC) including epidermolysis bullosa (EB) are rare congenital conditions. In ACC there is a localised absence of skin while in EB blistering occurs with a split at the epidermal or dermal level. In the past these 2 conditions have been reported to occur in the same patient. A case of a Gurkha baby girl illustrating just such an entity with severe erosive defects over the head, face, trunk and acral parts of the limbs presenting at birth is reported. There was also widespread blistering over the chest, abdomen and back. The baby died after 3 days from serious complications.

Epidermolysis Bullosa, Junctional↗
PubMed1989

Noonan syndrome with spontaneous chylothorax at birth.

A female Chinese infant having the features of Noonan syndrome presented with acute respiratory distress at birth, secondary to a large spontaneous left-sided chylothorax. This condition must be recognized early in such infants, as prompt thoracentesis is life-saving.

Chromosome Aberrations↗