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Background: Long-term home noninvasive ventilation (NIV) is increasingly employed in children with sleep-disordered breathing and chronic respiratory failure. While studies suggest its successful implementation in tertiary care centers, little is known about the situation in a general care setting. Hence, we aim to evaluate the clinical profiles of these children in a general pediatric unit over the past two decades., Methods: Data collected retrospectively on patients younger than 18 years old receiving long-term home NIV from January 1, 1997 to December 31, 2017 in a Hong Kong regional general pediatric unit were reviewed., Results: The number of children on home NIV increased more than 10-fold over the past two decades. In total, 114 children were commenced on NIV during the 21-year period. Upper airway obstruction was the most common cause (77%), followed by neuromuscular diseases (16%), pulmonary disorders (4%), and abnormal ventilatory control (3%). Continuous positive airway pressure was the most common NIV type (59%). To date, 46% of the children remained in our NIV program, while 18% discontinued NIV support. NIV adherence increased significantly with follow-up (median of 78.6% and 82.5% at baseline and last follow-up, respectively). Sixty-five percent of the children used NIV for at least 4 h on 70% of the days monitored. Higher body mass index was associated with lower adherence., Conclusion: Pediatric home NIV is feasible in the general care setting with good outcomes and adherence. As the demand for NIV service grows, input from local hospitals will be of increasing importance and should be considered upon healthcare planning., (© 2021 Wiley Periodicals LLC.)

Objective: To present the application of the pre-epiglottic baton plate (PEBP) in infants with Pierre Robin sequence (PRS) in the Southern Chinese population (Hong Kong) and to present the diagnosis and management protocol of these infants in our centre., Design: Retrospective case series of three patients with PRS., Setting: Neonatal Intensive Care Unit in Kwong Wah Hospital and Craniofacial Orthodontic Centre in United Christian Hospital, Hong Kong., Participants: Three new-born infants (two girls, one boy) with PRS and upper airway obstruction due to glossoptosis., Methods: A protocol for the diagnosis and management of these infants in the Southern Chinese population (Hong Kong) was presented. The three patients received nasal high-flow oxygen and/or continuous positive airway pressure (CPAP) as first-line respiratory support, followed by PEBP for 3-5 months. A two-stage approach was undertaken to ensure accurate positioning of the PEBP., Results: All three infants had improvement in clinical signs, symptoms and polysomnography upon discharge. PEBP and other respiratory aids were weaned off at 3-6 months., Conclusions: The PEBP, combined with other respiratory support, is a useful modality in the treatment of obstructive sleep apnoea in infants with PRS.

Aim: To evaluate the cost-effectiveness of palivizumab prophylaxis for premature infants born <29 weeks in Hong Kong., Method: We evaluated the hospitalization rate for respiratory syncytial virus (RSV) infection within the first 12 months of discharge of a cohort of preterm infants born between 2010 and 2014 at two local hospitals., Results: In total, 40 of 135 infants were given palivizumab. The hospitalization rate for premature infants <29 weeks was reduced from 15.8 to 5% (p = 0.096) and that for infants <27 weeks was reduced from 33.3 to 8.7% (p = 0.046). In the former group, the incremental cost-effectiveness ratio per hospital admission prevented (ICER/HAP) was US dollar (USD) 24 365. In the latter subgroup, the ICER/HAP was USD 3108., Conclusion: The cost-effectiveness as measured for infants <27 weeks is more favorable than that for infants <29 weeks.

Background: Asthma is a significant chronic health problem worldwide. Management aims at disease control by reducing functional impairment and exacerbations and improving quality of life (QoL). We report a multi-center study to survey asthma control and QoL in four cities in the Pearl River Delta., Methods: The conjoint survey involved ten Hong Kong pediatric hospitals/units, two Shenzhen hospitals, two Macau hospitals, and two Guangzhou hospitals on asthma control (using Asthma Control Test) and QoL (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ). Acceptability of a treatment is graded as very good/good/fair/poor., Results: Good asthma control was only reported in 80% subjects in Hong Kong, but higher in sister cities (85-94%, P < 0.001). Allergic rhinitis, "incense burning", and "smoker in family" were prevalent among the four cities. Logistic regression showed better control of asthma was associated with better PADQLQ (B = - 0.029, P < 0.001), better acceptability of bronchodilator (B = - 1.488, P = 0.025), negatively with "smoker in family" (B = - 0.83, P = 0.015) and various PADQLQ domains. Conversely, worse PADQLQ was associated with allergic rhinitis severity (B = 4.77, P < 0.001), poor control of asthma (B = 7.56, P < 0.001), increased frequency of traditional Chinese medicine use (B = 1.7, P < 0.05), increased frequency of bronchodilator usage (B = 1.05, P < 0.05), "smoker in family" (B = 4.05, P < 0.05), and incense burning at home (B = 3.9, P < 0.05)., Conclusions: There are some clinical and cultural differences among the four southern Chinese cities within the Guangdong province. This study identifies potentially modifiable environmental and treatment factors associated with poor asthma control and QoL for health-care interventions. Having a smoker in the family is independently associated with poor asthma control and QoL.

Aim: To determine the natural history of snoring in children when they reached adolescence and the underlying risk factors for persistence of habitual snoring., Methods: A follow-up telephone survey was conducted to determine the natural history of snoring in children who reached adolescence. The targeted interviewees of the follow-up survey were parents of 3047 children. Adolescents who were snoring ≥6 nights a week were defined as habitual snorers. Potential risk factors for persistent and incident habitual snoring were studied, including age, gender, allergic rhinitis, asthma, body mass index (BMI), sleep duration and daytime sleepiness., Results: Of the 3047 subjects, 2005 (65.8%) were successfully interviewed by phone. The prevalence of habitual snorers was 12.7%. Ninety-one adolescents were persistent habitual snorers. Allergic rhinitis, male gender and higher BMI at follow-up were identified as significant risk factors for persistent habitual snoring. A further 163 children were identified as incident habitual snorers. The risk factors for incident habitual snoring included male gender, asthma, higher BMI at follow-up and younger age at the first survey. In the current study, the mean sleep duration was 7.6 ± 1.0 h. Overall, 90% of the current cohort slept less than the lower limit of international recommendations for sleep duration., Conclusions: Around 40.6% of habitually snoring children continued to snore habitually as adolescents in the current study, while 9.2% of the initial non-habitual snorers became habitual snorers. Male gender and higher BMI were significant risk factors for both persistent and incident habitual snoring., (© 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

The modified radiosurgery-based arteriovenous malformation (AVM) score (modified AVM score or Pollock-Flickinger AVM score [PFAS]) is a simplified grading system developed to predict outcome after gamma knife radiosurgery for cerebral AVM. The purpose of this study was to test the PFAS in a cohort of patients managed with linear accelerator (LINAC) radiosurgery. We analyzed 70 consecutive patients with cerebral AVM treated with LINAC radiosurgery in Hong Kong. The scores were determined by the following equation: Modified AVM score=(0.1×volume [cm(3)])+(0.02×age [years])+(0.5×location). The location values are as follows: hemispheric/corpus callosum/cerebellar=0; basal ganglia/thalamus/brainstem=1. A total of 74% of patients presented with ruptured AVM before radiosurgery. The overall obliteration rate was 86%. Five (7%) patients developed new permanent neurological deficits from delayed bleeding or radiation-induced complications. Modified AVM score correlated with the percentage of patients with AVM obliteration without new neurological deficits (≤1, 96%; 1.01-1.50, 78%; 1.51-2.00, 90%; >2, 50%; Spearman's rho 0.354, p=0.003). In conclusion, the modified AVM score is a good predictor of patient outcome after LINAC radiosurgery in our cohort. The modified AVM score can be used to guide treatment selection for cerebral AVM and stratify patients for future comparative analyses., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The purpose of this study is to validate the previously-validated Taiwan Chinese version of Sleep-Related Breathing Disorder scale (SRBD scale) in Hong Kong Chinese snoring children. SRBD scale is an instrument used for prediction of obstructive sleep apnea syndrome. (OSA) The Chinese version of SRBD scale were previously translated and validated in Taiwan. The same questionnaire were administered in a group of 102 snoring children (mean age: 10.7 and 65 boys) from a sleep laboratory in Hong Kong before their sleep studies. The SRBD scores were then validated against the results from sleep studies. By using the definition of apnea-hypopnea index larger than 1.5 as OSA, 28 children (27.5%) had polysomnography-confirmed OSA. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of the previously validated cut-off of SRBD score > 0.33 for OSA were 0.5, 0.55, 1.12, and 0.90, respectively. The area under ROC curve was only 0.58, indicates suboptimal performance of SRBD score in predicting OSA. In summary, our study concluded that the previously reported Chinese SRBD scale is not accurate in identifying presence of OSA in Hong Kong Chinese snoring children., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: To compare the probabilities of death predicted by Pediatric Index of Mortality 2 (PIM2) and Pediatric Index of Mortality 1 (PIM1) models against actual mortalities in 3 pediatric intensive care units in Hong Kong., Methods: All consecutive patients admitted to pediatric intensive care units in 3 regional non-teaching hospitals between Jan 2006 and December 2006 were included. The data required for PIM1 and PIM2 were collected. The probabilities of death predicted by PIM1 and PIM2 were validated against the actual probability of mortality., Results: Of the 540 patients were included in this study, only seven deaths were observed (1.3%). PIM 1 and PIM 2 overestimated the mortality rate by giving a greater mortality rate. (PIM1: 13.4, Standardized mortality ratio = 0.52, 95% CI = 0.14 to 0.91; PIM2: 14.2, Standardized mortality ratio =0.49, 95% CI = 0.13 to 0.86) The discrimination of PIM1 and PIM2 were satisfactory as reflected by area under receiver-operator characteristic curve of 0.889 (95% CI: 0.703 to 1.000) and 0.904 (95% CI: 0.738 to 1.000) respectively. Calibration was not possible due to insufficient death cases., Conclusions: The current study showed that PIM2 and PIM1 had similar accuracy in mortality prediction in Hong Kong. The current study also demonstrated the difficulty to calibrate the mortality model when actual mortality rate is low.

Objective: Paediatric Allergic Disease Quality of Life Questionnaire is a health-related assessment tool designed for children with allergic diseases. This study aimed to translate the original English version of the Questionnaire to Chinese and to provide psychometric evidence on the validity and reliability of the translated version., Design: Cross-sectional study., Setting: Out-patient clinic of a non-teaching hospital in Hong Kong., Participants: The Paediatric Allergic Disease Quality of Life Questionnaire was translated to Chinese and then completed by a group of 115 Hong Kong Chinese children (66 male and 49 female; mean age, 11 years) with allergic disease(s). All subjects were asked to respond using visual analogue scales dealing with issues related to the perceived morbidity of allergic diseases. To assess test-retest reliability, 2 weeks later a subgroup of 16 individuals was retested with the same Questionnaire., Results: The internal consistency of the Chinese Paediatric Allergic Disease Quality of Life Questionnaire was satisfactory (Cronbach alpha=0.92). The correlation between the total Questionnaire score and the visual analogue scale score was moderately significant (Spearman's rho=0.49; 95% confidence interval, 0.34-0.62). Structural validity as studied by confirmatory factor analysis found that the structure of subscales was remarkably similar to the original English version. The intra-class correlation between the Questionnaire score from the first and the second test in the subgroup of 16 subjects was 0.75, indicating adequate repeatability., Conclusion: The validity and reliability of the Chinese version of the Paediatric Allergic Disease Quality of Life Questionnaire was established for clinical use.

Aim: The study aims to examine recent childhood asthma hospitalisation rates in the Asia Pacific countries of Australia, Hong Kong and Singapore. On the background of reported decline in many countries with high asthma prevalence during late 1990s., Methods: Annual asthma hospitalisation (ICD9-CM: 493 or ICD10-AM: J45-46)* and population data from 1994 to 2008, of children aged 0-14 years old, were obtained from the Australian National Hospital Morbidity Database, from the Hospital Authority in Hong Kong and from the Ministry of Health in Singapore. Data were stratified in two age groups: 0-4 and 5-14 years old, and also in different periods of calendar years. Time-series regression analyses were used to examine temporal trends. Diagnostic transfer was addressed by examining bronchitis hospitalisations., Results: Significant decreases of up to 6.5% per annum in childhood asthma hospitalisation rates were found over the study period. However, the latter half of the study period showed increases in hospitalisation rates in all countries studied. No evidence of diagnostic transfer was found., Conclusion: Although there has been a decrease in childhood asthma hospitalisation rates since the 1990s, a modest increase was observed from 2003 to 2008. Ongoing monitoring is required., (© 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Background: The correlation between obesity and severity of obstructive sleep apnea (OSA) is well established in adults, but data are inconsistent in children. We hypothesized that there is a significant correlation between the degree of obesity and the severity of OSA in children., Methods: We retrospectively reviewed records of weight, height, history, and polysomnography of all 1- to 15- year-old children referred to our sleep laboratory. Children with known anomalies and repeated polysomnography were excluded from this study. Obesity was defined as body mass index z score (BMI Z score) > 1.96. The correlation between BMI Z score and apnea-hypopnea index (AHI) was assessed. Possible confounding factors, ie, age, gender, and tonsil size, were adjusted by multiple linear regression., Results: Four hundred eighty-two children were included in this study. Obese children had a significantly higher AHI (median, 1.5; interquartile range [IQR], 0.2 to 7.0) than the AHI of nonobese children (median, 0.7; IQR, 0.0 to 2.5). BMI Z score was significantly correlated with log-transformed AHI (Ln[AHI]) [r = 0.156, p = 0.003]. BMI Z score and tonsil size were still correlated with Ln(AHI) even after adjusted for other confounding factors (p = 0.001)., Conclusion: Degree of obesity as measured by BMI Z score and tonsil size are significantly related to severity of OSA as reflected by the AHI, although the correlation is mild.

Background: The aim of this study was to compare the effectiveness of an intensive asthma education program (group B) with that of a standard asthma education program (group A)., Methods: A prospective randomized single blinded study was conducted in the pediatric department of a public hospital in Hong Kong. Children aged 2-15 years admitted to the pediatric department with an acute attack of asthma were recruited. A standard asthma education program (group A) or an intensive asthma education program (group B) for children were offered. The main outcome measures include the number of visits to the emergency department and the number of hospitalization for asthma during the 3 month follow-up period., Results: A total of 45 children were in group A and 55 in group B. Group B had statistically significant reductions in the number of visits to the emergency department and the number of hospitalizations. Drug compliance was also significantly improved in group B. Parents' satisfaction rate was also higher in group B., Conclusion: The intensive asthma education program might be more cost effective than the standard asthma education program in the management of asthmatic children admitted to hospital in Hong Kong.

Background: The Chinese term "Hot Qi" is often used by parents to describe symptoms in their children. The current study was carried out to estimate the prevalence of using the Chinese term "Hot Qi" to describe symptoms in children by their parents and the symptomatology of "Hot Qi"., Method: A cross sectional survey by face-to-face interview with a semi-structured questionnaire was carried out in a public hospital and a private clinic in Hong Kong. The parental use of the term "Hot Qi", the symptoms of "Hot Qi" and the remedies used for "Hot Qi" were asked., Results: 1060 pairs of children and parents were interviewed. 903 (85.1%) of parents claimed that they had employed the term "Hot Qi" to describe their children's symptoms. Age of children and place of birth of parents were the predictors of parents using the term "Hot Qi". Eye discharge (37.2%), sore throat (33.9%), halitosis (32.8%), constipation (31.0%), and irritable (21.2%) were the top five symptoms of "Hot Qi" in children. The top five remedies for "Hot Qi" were the increased consumption of water (86.8%), fruit (72.5%), soup (70.5%), and the use of herbal beverages "five-flower-tea" (a combination of several flowers such as Chrysanthemum morifolii, Lonicera japonica, Bombax malabaricum, Sophora japonica, and Plumeria rubra) (57.6%) or selfheal fruit spike (Prunella vulgaris) (42.4%)., Conclusion: "Hot Qi" is often used by Chinese parents to describe symptoms in their children in Hong Kong. Place of birth of parents and age of the children are main factors for parents to apply the term "Hot Qi" to describe symptoms of their children. The common symptoms of "Hot Qi" suggest infections or allergy.

Study Objectives: To estimate the prevalence of snoring, witnessed sleep apnea, teeth grinding, primary and secondary nocturnal enuresis, and sleep duration in Hong Kong primary school children., Design: Cross-sectional telephone questionnaire survey in a community., Participants: A total of 3,047 6- to 12-year-old apparently healthy children., Intervention: Those who agreed to the study were contacted by telephone. Survey questions were asked about the symptoms of the different sleep disorders, and the frequency of each positive symptom was noted for the preceding 1 week., Outcome Measures: Prevalence and risk factors of sleep disorders in Hong Kong primary school children., Results: The prevalence of the following sleep symptoms was listed as follows: habitual snoring (10.9%), witnessed sleep apnea (1.5%), nocturnal enuresis (5.1%), and sleep teeth grinding (20.5%). Significant risk factors for habitual snoring included witnessed sleep apnea, mouth breathing during sleep, snoring in first-degree relatives, headache on rising, male gender, allergic rhinitis, and sleep teeth grinding. Significant risk factors for witnessed sleep apnea included habitual snoring, allergic rhinitis, tiredness on rising, and excessive daytime sleepiness. Poor academic results were associated with present of witnessed sleep apnea and absence of sleep teeth grinding. None of the sleep problem was associated with poor conduct results. The mean sleep duration was 8.79 h (SD 0.96)., Conclusions: This study provides epidemiologic data of sleep-disordered breathing, enuresis, sleep teeth grinding, and duration of sleep in Chinese primary school children in Hong Kong.