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Introduction: The latest Cochrane review supported high-position umbilical artery catheters (UAC) as it led to fewer complications and reduced the need for replacement or re-insertion of the catheters. However, the studies included were dated more than three decades ago. Objectives: To determine the safety (short-term complications) of UAC in the newborn at two different positions. Methods: A randomized control trial was performed from March 2012 to August 2013, among the newborns requiring UAC insertion in Neonatal Intensive Care, at Hospital Universiti Sains Malaysia. Patients were randomly assigned to either high or low UAC positions using block randomization. Outcomes: The primary outcomes were the incidence of aortic thrombosis, intraventricular haemorrhage (IVH), necrotising enterocolitis, hypertension, haematuria and feeding intolerance. The secondary outcome was to compare the incidence of short-term outcomes of UAC position to gestational age and birth weight. Results: One hundred and seventy-eight patients were included (89 per study arm). The mean gestational age was 34 weeks with a mean birth weight of 2.31 kg. There were no significant differences between the two groups in terms of baseline data. The overall incidence of complications was 20 (23%) in the low position and 18 (20%) in the high position group UAC (p=0.76). The observed complications between the low and high position UAC group: IVH 6.7% vs. 9%, p=0.58; feeding intolerance 6.7% vs. 4%, p=0.51; hypertension 4% vs. 6%, p=0.51; peripheral ischemic 2% vs. 0%, p=0.25. Conclusion: This study showed that the rate of complications in the low UAC position was comparable with the high UAC position.

Introduction: Renal scarring, which can be detected by DMSA renal scan, has been demonstrated to cause hypertension, proteinuria and chronic kidney disease (CKD). We reviewed the proportion of renal scarring, risk factors and outcomes among children who were referred for DMSA scan in a tertiary teaching hospital. Methods: All records of children less than 18 years old who underwent DMSA scan over a ten-year period, were reviewed. Among children whose renal cortical defects were confirmed by DMSA scan, data of their risk factors and its outcome were collected manually. Results: Out of 92 children referred for DMSA scan, half were detected to have renal scarring. Vesico-ureteric reflux (VUR) was significantly associated with the development of renal scarring. CKD (27.1%) and hypertension (12.5%) were the commonest complications. The median duration between diagnosis of the complications and detection of renal scarring was 1 year. Conclusion: A high proportion of children undergoing DMSA scans had renal scarring and early development of serious complications was common.

INTRODUCTION: Analyte stability time is challenging to employ in clinical settings. The diversity of processing time may affect the accuracy of results. This study evaluates the maximum time delay permissible before sample centrifugation and analysis. MATERIALS AND METHODS: We evaluated 15 serum electrolytes in 40 samples centrifuged and analysed using an automated analyser. The time was divided into 1, 2, 6, and 24 hours. RESULTS: Most analytes studied remained stable for up to 24 hours before centrifugation. However, delayed processing affected the value of potassium, magnesium, LDH, and calcium after 2 hours up to a maximum of 6 hours at room temperature for total protein, phosphate, and sodium. CONCLUSIONS: Most analytes were unaffected by a delay in centrifugation at room temperatures, but several critical analytes were severely affected.

The objectives of ATAP-NEPAH are to enhance and nurture healthy habits among adolescents as well as to empower adolescents in inculcating these healthy habits among them. Health education through peer-to-peer approach is used to instill the knowledge on important areas such as sexual and reproductive health, smoking, substance abuse, illegal street racing (rempit) and mental health. Specific modules were developed by experts (lecturers) in multidisciplinary fields in collaboration with Malaysian Association for Adolescent Health (MAAH), National Population and Family Development Board (NPFDB), Reproductive Health Association of Kelantan (REHAK) and Rhaudatus Sakinah Kelantan. The trained Medical Students Facilitator Team (MSFT) of USM became trainers to secondary one school students. The selected school students were trained by the medical students to become peer educators to their juniors and peers. There was improvement in the readiness level of peer educators, knowledge and attitude towards healthy habits and risky behaviors of other school students after the intervention.

Background: The low yield and quality of buccal-derived genomic DNA have reduced its applicability in various genetic research. The aim of this study was to assess the quantity, purity and genotyping efficiency of genomic DNA isolated from neonatal buccal swabs. Methods: Paired buccal swabs and whole blood samples were collected from 60 neonates with the mean age 5 days (SD=1.57). The genomic DNA quantity and purity were measured by using Infinite® 200 PRO NanoQuant reader and agarose gel electrophoresis. High-resolution melting (HRM) analysis was used to analyse the sequence variants present in uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1 c.211G>A) and nuclear receptor subfamily 1, group I, member 3 (NR1I3 IVS8+116T>G) genes. Results: Buccal swabs provided lower mean genomic DNA concentration (18.78 ± 8.39 ng/µl versus 40.02 ± 13.03 ng/µl), yield (2.63 ± 1.17 µg versus 8.00 ± 2.61 µg). The purity of buccal samples however were inconsistent with 16 samples (26.7%) having A260/280 ratios below 1.8 which indicated protein contamination. Genomic DNA purity for all blood samples were within the ideal range with average absorbance ratios of 1.8−2.0. However, all buccal genomic DNA demonstrated 100% genotype call rates for all variants. A complete genotype concordance was also observed between paired genomic DNA samples. Conclusion: Despite related to a reduced quantity and purity, neonatal buccal genomic DNA could generate reliable HRM genotyping results. Therefore, buccal swab collection is a promising alternative to the invasive blood sampling to provide genomic DNA for genetic analysis involving paediatric population.

AIM The optimal placement of the endotracheal tube (ETT) in ventilated infants is essential, but birthweight may be not the best parameter to predict it. The aim of this study was a direct comparison of shoulder-umbilical length (experimental group) versus birthweight (control group) as predictor of optimal ETT placement in Malaysian ventilated infants. METHODS All infants requiring ventilation in the neonatal intensive care unit of a tertiary hospital in Malaysia during the 4-month study period were eligible to enter this randomised controlled trial. All participants were randomised into two groups: experimental and control group. The main outcome measure was malposition of the ETT (requiring adjustment), as seen on the chest X-ray performed within 1 h after intubation. Tube placement was assessed by two neonatologists, blinded to the allocation. RESULTS One hundred and ten infants were randomised, 55 in each group. The ETT was malpositioned in 13 of 55 infants (23%) for the experimental group and 22 of 55 infants (40%) in the control group (P = 0.06). CONCLUSION In the experimental group, fewer infants showed a need for tube adjustment than in the control group. While a larger study may be necessary to show statistical significance, the difference shown in this study may be large enough to be of clinical significance.

Background There is presently no certainty about the ideal feeding intervals for preterm infants. Shorter feeding intervals of, for example, two hours, have the theoretical advantage of allowing smaller volumes of milk. This may have the potential to reduce the incidence and severity of gastro-oesophageal reflux. Longer feeding intervals have the theoretical advantage of allowing more gastric emptying between two feeds. This potentially provides periods of rest (and thus less hyperaemia) for an immature digestive tract. Objectives To determine the safety of shorter feeding intervals (two hours or shorter) versus longer feeding intervals (three hours or more) and to compare the effects in terms of days taken to regain birth weight and to achieve full feeding. Search methods We used the standard search strategy of Cochrane Neonatal to run comprehensive searches in CENTRAL (2020, Issue 6) and Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions, and CINAHL on 25 June 2020. We searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs. Selection criteria We included RCTs and quasi-RCTs comparing short (e.g. one or two hours) versus long (e.g. three or four hours) feeding intervals in preterm infants of any birth weight, all or most of whom were less than 32 weeks' gestation. Infants could be of any postnatal age at trial entry, but eligible infants should not have received feeds before study entry, with the exception of minimal enteral feeding. We included studies of nasogastric or orogastric bolus feeding, breast milk or formula, in which the feeding interval is the intervention. Data collection and analysis We used standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Our primary outcomes were days taken to achieve full enteral feeding and days to regain birth weight. Our other outcomes were duration of hospital stay, episodes of necrotising enterocolitis (NEC) and growth during hospital stay (weight, length and head circumference). Main results We included four RCTs, involving 417 infants in the review. One study involving 350 infants is awaiting classification. All studies compared two-hourly versus three-hourly feeding interval. The risk of bias of the included studies was generally low, but all studies had high risk of performance bias due to lack of blinding of the intervention. Three studies were included in meta-analysis for the number of days taken to achieve full enteral feeding (351 participants). The mean days to achieve full feeds was between eight and 11 days. There was little or no difference in days taken to achieve full enteral feeding between two-hourly and three-hourly feeding, but this finding was of low certainty (mean difference (MD) ‒0.62, 95% confidence interval (CI) ‒1.60 to 0.36). There was low-certainty evidence that the days taken to regain birth weight may be slightly longer in infants receiving two-hourly feeding than in those receiving three-hourly feeding (MD 1.15, 95% CI 0.11 to 2.20; 3 studies, 350 participants). We are uncertain whether shorter feeding intervals have any effect on any of our secondary outcomes including the duration of hospital stay (MD ‒3.36, 95% CI ‒9.18 to 2.46; 2 studies, 207 participants; very low-certainty evidence) and the risk of NEC (typical risk ratio 1.07, 95% CI 0.54 to 2.11; 4 studies, 417 participants; low-certainty evidence). No study reported growth during hospital stay. Authors' conclusions The low-certainty evidence we found in this review suggests that there may be no clinically important differences between two- and three-hourly feeding intervals. There is insufficient information about potential feeding complications and in particular NEC. No studies have looked at the effect of other feeding intervals and there is no long-term data on neurodevelopment or growth.

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disorder attributed to an ischaemic stimulus in preterm infants. Haemoglobin, the main component for oxygen transportation, may be implicated in ROP development. This retrospective study compared the mean weekly haemoglobin levels between infants with and without ROP over the first six weeks of life. Premature infants of less than 32 weeks gestational age and less than 1.5 kg birth weight were grouped into age and birth weight-matched ROP cases and controls. Weekly mean haemoglobin levels were documented. An independent t-test was used to analyze the difference in mean haemoglobin levels between infants with ROP and infants without ROP. Adjustment for confounders was performed using one-way analysis of covariance. There was a statistically significant difference in adjusted mean haemoglobin levels between the ROP and non-ROP group during the first week of life (p = 0.038). No significant intergroup differences were observed at the other weeks. Haemoglobin monitoring during the first week of postnatal life may be useful to guide ROP screening in premature infants.

Caffeine is the most commonly used methyl xanthine for the prevention of apnoea in prematurity, but the ideal dose was uncertain, until now. This study compared two doses of caffeine for the prevention of apnoea in prematurity. A clinical trial was conducted on 78 preterm infants ≤32 weeks in Neonatal Intensive Care Unit. They were randomly allocated to receive the intervention (loading 40 mg/kg/day and maintenance of 20 mg/kg/day) or the control (loading 20 mg/kg/day and maintenance of 10 mg/kg/day) dose of caffeine. The primary outcome of the study was the frequency and total days of apnoea per duration of treatment for both groups. The frequency of apnoea ranged from zero to fourteen in the intervention group and zero to twelve in the control group. There was no statistically significant difference between the groups, with a p-value of 0.839. The number of days of apnoea was also similar between both groups, with a p-value of 0.928. There was also no significant difference in adverse events between both regimens. This study did not support the use of higher doses of caffeine as a prevention for apnoea in prematurity.

Platelets are a primary source of pro- and anti-angiogenic cytokines. However, the evidence of their role in retinopathy of prematurity (ROP) is controversial. This retrospective study aimed to compare mean weekly platelet counts between infants with and without ROP over the first 6 weeks of life. A total of 93 infants matched by gestational age and birth weight were recruited (31 with ROP, 62 without ROP). Weekly mean platelet counts and other related risk factors were documented. The repeated measure analysis of variance (ANOVA) and the repeated measure analysis of covariance (ANCOVA) were used to compare mean platelet counts over time between the two groups, with and without adjusting for confounders. We found significant differences in the weekly mean platelet counts of infants with and without ROP over the first 6 weeks of life (p = 0.002). These differences disappeared after adjusting for covariates (p = 0.489). Lower mean platelet counts in ROP infants are not directly related to ROP, but rather to the presence of other risk factors for ROP, such as culture-proven sepsis, blood transfusion and bronchopulmonary dysplasia.

25 March 2021 We withdrew the published protocol ibecause it is out of date and does not meet the current methodological standards of Cochrane.

Heme oxygenase (HO) is the rate-limiting enzyme in the heme catabolic pathway, which degrades heme into equimolar amounts of carbon monoxide, free iron, and biliverdin. Its inducible isoform, HO-1, has multiple protective functions, including immune modulation and pregnancy maintenance, showing dynamic alteration during perinatal periods. As its contribution to the development of perinatal complications is speculated, two functional polymorphisms of the HMOX1 gene, (GT)n repeat polymorphism (rs3074372) and A(-413)T single nucleotide polymorphism (SNP) (rs2071746), were studied for their association with perinatal diseases. We systematically reviewed published evidence on HMOX1 polymorphisms in perinatal diseases and clarified their possible significant contribution to neonatal jaundice development, presumably due to their direct effect of inducing HO enzymatic activity in the bilirubin-producing pathway. However, the role of these polymorphisms seems limited for other perinatal complications such as bronchopulmonary dysplasia. We speculate that this is because the antioxidant or anti-inflammatory effect is not directly mediated by HO but by its byproducts, resulting in a milder effect. For better understanding, subtyping each morbidity by the level of exposure to causative environmental factors, simultaneous analysis of both polymorphisms, and the unified definition of short and long alleles in (GT)n repeats based on transcriptional capacity should be further investigated.

Caregiving for children with cerebral palsy (CP) has proved to negatively impact on the physical and psychological well-being of their primary caregivers. The aim of the current study was to examine the overall impact of caregiving for children with CP on the primary caregivers’ health-related quality of life (HRQOL) and family functioning, and to identify potential factors associated with primary caregivers’ HRQOL and family functioning. The cross-sectional study involved a total of 159 primary caregivers of children with CP with a mean age of 42.8 ± 8.4 years. Demographic data and information on the physical and leisure activities of the primary caregivers were collected, and their quality of life (QOL) was measured based on the self-reported Pediatric Quality of Life Inventory Family Impact Module (PedsQL FIM). Primary caregivers in the current study have shown good HRQOL and family functioning, with scores of 82.4 and 85.3 out of 100, respectively. Through multiple linear regression analyses, the mother’s level of education, family monthly income, sleeping problems in children with CP, and the existence of children with other types of disability have been identified as factors contributing to HRQOL and family functioning. The findings help set out the course for stakeholders to establish action to enhance the QOL of primary caregivers.

The coronavirus disease 2019 (COVID-19) pandemic is severe and has not shown any signs of warning up to today. Biotech companies around the world have raced to come up with an acceptable vaccine and recently two mRNA vaccines have received emergency usage authorisation from regulatory bodies in several countries. mRNA vaccines, which consist of a new and revolutionary technology have not been previously tested widely on humans. Medium-and long-term safety data are not available. While many experts seem to support the start of a mass vaccination campaign, others feel there are too many unknowns to embark on a mass vaccination campaign. Concerns include uncertainties about the long-term effects of foreign mRNA on human cellular physiology and the possibility of vaccine-enhanced disease severity, which may not be unlikely with the current disease presentation of COVID-19. © Penerbit Universiti Sains Malaysia, 2021.

Neonatal mastitis and abscess are rare and most often unilateral. Neonatal breast massage for physiological breast hypertrophy is suspected to be a predisposing factor in the case reported here: a 14-day-old neonate with bilateral neonatal breast abscess, treated effectively with intravenous cloxacillin and surgical aspiration.

Background Oedema is a common clinical symptom in people with nephrotic syndrome and human albumin has been widely used in the treatment of oedema by increasing vascular volume and this inducing diuresis. It may be used with or without diuretics such as furosemide. However, the quantitative contribution of human albumin in treating oedema is not fully understood. If human albumin were found to be effective and safe in the treatment of oedema, it could help clinicians to develop therapeutic strategies to improve the management of diuretic resistance associated with nephrotic syndrome. Objectives This review aimed to examine the benefits and harms of human albumin infusion for treating oedema associated with nephrotic syndrome. Search methods We searched the Cochrane Kidney and Transplant Register of Studies up to 23 June 2019 through contact with the Information Specialists using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. Selection criteria We included randomised controlled trials (RCTs) and quasi-RCTs evaluating the effect of human albumin infusion compared with placebo or no intervention, human albumin with diuretics compared with diuretic alone, human albumin compared with diuretics and other treatments, clinical outcomes, death, quality of life, kidney function and adverse effects in people with nephrotic syndrome. We excluded cross-over studies but data for the first period was to be included if available. Data collection and analysis Standard methods of the Cochrane Collaboration were used. Two authors independently assessed eligibility, risk of bias, study quality and extracted data. We calculated mean difference (MD) for continuous data with 95% confidence intervals (CI). We assessed the certainty of the evidence using GRADE. Main results One study met our inclusion criteria (26 children with minimal change nephrotic syndrome) and 11 were excluded (nine cross-over studies, one where albumin was not used for nephrotic syndrome and one where authors did not state whether the children had oedema). Risk of bias for the included study was unclear for selection bias, high for performance and detection bias, low for attrition bias, and high for selective reporting. The included study compared albumin plus furosemide with an equal volume of dextrose. Of our prespecified outcomes, the authors reported clinical improvement as weight change, serum sodium and adverse outcomes (blood pressure). The authors reported a greater weight loss in the albumin treated group initially but no difference overall at 10 days. However, the data in the text and the figures were inconsistent so we could not confirm the authors statements (very low certainty evidence). It is uncertain whether albumin infusion improves serum sodium when compared with an equal volume of dextrose (MD 2.00 mEq/L, 95% CI -0.09 to 4.09), systolic blood pressure (MD 2.00 mmHg, 95% CI -3.52 to 7.52) or diastolic blood pressure (MD 2.00 mmHg, 95%CI -4.29 to 8.29). Death, quality of life, and kidney function were not reported. Authors' conclusions We identified only one small study that was relevant to our review, therefore we are unable to draw any conclusions regarding the use of human albumin with or without diuretics in nephrotic syndrome. More RCTs are needed.

The use of placebo-controlled trials in situations where established therapies are available is considered ethically problematic since the patients randomised to the placebo group are deprived of the beneficial treatment. The pharmaceutical industry and drug regulators seem to argue that placebo-controlled trials with extensive precautions and control measures in place should still be allowed since they provide necessary scientific evidence for the efficacy and safety of new drugs. On the other hand, the scientific value and usefulness for clinical decision-making may be much higher if the new drug is compared directly to existing therapies. As such, it may still be unethical to impose the burden and risk of placebo-controlled trials on patients even if extensive precautions are taken. A few exceptions do exist. The use of placebo-controlled trials in situations where an established, effective and safe therapy exists remains largely controversial.

Objective To determine whether feeding with 2-hourly or 3-hourly feeding interval reduces the time to achieve full enteral feeding and to compare their outcome in very low birthweight preterm infants. Design Parallel-group randomised controlled trial with a 1:1 allocation ratio. Setting Two regional tertiary neonatal intensive care units. Patients 150 preterm infants less than 35 weeks gestation with birth weight between 1.0 and 1.5 kg were recruited. Interventions Infants were enrolled to either 2-hourly or 3-hourly interval feeding after randomisation. Blinding was not possible due to the nature of the intervention. Main outcome measures The primary outcome was time to achieve full enteral feeding (≥100 mL/kg/day). Secondary outcomes include time to regain birth weight, episode of feeding intolerance, peak serum bilirubin levels, duration of phototherapy, episode of necrotising enterocolitis, nosocomial sepsis and gastro-oesophageal reflux. Results 72 infants were available for primary outcome analysis in each group as three were excluded due to death—three deaths in each group. The mean time to full enteral feeding was 11.3 days in the 3-hourly group and 10.2 days in the 2-hourly group (mean difference 1.1 days; 95% CI −0.4 to 2.5; p=0.14). The mean time to regain birth weight was shorter in 3-hourly group (12.9 vs 14.8 days, p=0.04). Other subgroup analyses did not reveal additional significant results. No difference in adverse events was found between the groups. Conclusion 3-hourly feeding was comparable with 2-hourly feeding to achieve full enteral feeding without any evidence of increased adverse events. Trial registration number ACTRN12611000676910, pre-result.

Holistic package of palliative care service for children is not available in most places in the South East Asia. This has resulted in unwanted suffering and loss of hope in the unfortunate families. Pediatric palliative care (PPC) is a new subspecialty in Malaysia. In our region, it was started in 2012 as a University’s ‘community engagement project’ following completion of self-initiated palliative care distance learning in Australia by a pediatrician. The grant was labeled as a flagship project and secured under the Division of Community & Industry Network of USM (BJIM) to provide service in the hospital and outreach home based PPC services, which include nursing care, needs assessment and psychosocial support for the patients and caregivers. ‘Knowledge transfer program’ was initiated, in collaboration with Yayasan Orang Kurang Upaya (YOKUK) or Kelantan Foundation for the Disabled, to equip the outreach team with skills dealing with children with life limiting illnesses (LLI) in Kelantan. The move has propagated regular training setup with transformational program from hospital to community settings. This setup has led to mutual cooperation across the disciplines and provided linkages for stronger networking and training either locally or internationally. Better understanding on the importance of palliative care in the community can be achieved by having active community participation and volunteerism.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.51-56

Respiratory syncytial virus (RSV) is a common pathogen affecting the respiratory tract in infants. To date, there is limited data on RSV occurrence in Malaysia especially in the northeast of Peninsular Malaysia which is significantly affected by the rainy (monsoon) season. This study aimed to determine the prevalence, risk factors (the presence of a male sibling and older school-age siblings, parental education level, monthly income, chronic lung disease, immunocompromised, being a passive smoker, multipara, breastfeeding, prematurity, congenital heart disease, nursery attendance, and rainy season) as well as clinical manifestations of RSV in hospitalized infants and children with lower respiratory tract infection (LRTI). Patients' nasopharyngeal aspirates were tested for RSV antigen, questionnaires, and seasonal variations were used to assess RSV infection. Approximately 22.6% of children were infected with RSV; mean age 7.68 ± 5.45 months. The peak incidence of RSV as a causative agent for LRTI in infants was less than or equal to 1-year old (83%) with approximately 50.5% of the affected children in the younger age group (6 months amd below). RSV infection was significantly but independently associated with the rainy season (odds ratio, 3.307; 95% confidence interval, 1.443-3.688; P < 0.001). The infection was also associated ( P < 0.05) with a higher number of severe clinical courses, poor feeding, vomiting, increased need for medical care and a shorter mean duration of symptoms before hospital admission. Our study suggested administration of the passive prophylaxis for RSV to high-risk infants during the rainy season in the months of October to January.

Constitutive androstane receptor (CAR) encoded by the nuclear receptor subfamily 1, group I, member 3 (NR1I3) gene regulates the elimination of bilirubin through activating the components of the bilirubin clearance pathway. Hence, NR1I3 genetic variants may affect bilirubin metabolism and result in neonatal hyperbilirubinemia. Thus far, research which investigates the association between NR1I3 variants and neonatal hyperbilirubinemia has not been undertaken in any population. The present study aimed to evaluate the influence of MPJ6_1I3008 (rs10157822), IVS8+116T>G (rs4073054) and 540A>G (rs2307424) on neonatal hyperbilirubinemia development in the Malay population. Buccal swabs were collected from 232 hyperbilirubinemia and 277 control term newborns with gestational age ≥ 37 weeks and birth weight ≥ 2500 g. The NR1I3 variants were genotyped by using high resolution melting (HRM) assays and verified by DNA sequencing. Gender, mode of delivery and birth weight did not differ between hyperbilirubinemia and control groups. The genotypic and allelic frequencies of MPJ6_1I3008, IVS8+116T>G and 540A>G were not significantly different between the groups. However, stratification by gender revealed a significant inverse association between homozygous variant genotype of MPJ6_1I3008 and risk of neonatal hyperbilirubinemia in the females (OR, 0.44; 95% CI, 0.20–0.95; p = 0.034). This study demonstrates that the homozygous variant genotype of MPJ6_1I3008 was associated with a significant reduced risk of neonatal hyperbilirubinemia in the females.

In the nursing profession, EBP makes a positive contribution to healthcare outcomes, care delivery, clinical teaching and research. The research objective was to determine the nurses' knowledge, attitude, practice towards EBP and barriers to use EBP in four (4) Government Hospitals in Malaysia, Hospital Universiti Sains Malaysia (HUSM), Hospital Pulau Pinang (HPP), Hospital Sultan Abdul Halim (HSAH) and Hospital Seberang Jaya (HSJ). A cross-sectional study was conducted from January until December 2012 among (n=600) nurses working in all disciplines, on shift or day time duties in four selected hospitals. The questionnaire was adapted from a Singapore study (Majid, 2011). Results showed that among the nurses working in 4 different Malaysian hospitals, close to fifty percent (53 %) knew what the evidence based practice meant. The items assessing the attitude showed a large number nurses responding that they did neither agree nor disagree with statements provided. The majority of the remaining nurses tended to show a rather positive attitude except when asked about how the workload interfered with their EBP practice. The practice level of EBP scored a mean of more than 3 out of maximal five for most items. Most nurses recognized there were many barriers to EBP in their working place. In conclusion, this study may have helped to increase our understanding of knowledge, attitudes, practice and barriers towards to use of EBP to the utilization of research by nurses through an exploration of perceived barriers and facilitators on the part of nurses.

Introduction: Other than parents, primary care providers such as community workers and rehabilitation service personnel are also important nutritional gatekeepers for persons with disabilities (PWD). Good nutrition management for PWD by joint efforts is most desirable to prevent further disablement in later years. This study aimed to evaluate the effectiveness of a nutrition module intervention on improving trainers' knowledge, attitude and practice in nutrition management for PWD in rehabilitation centres. Methods: This quasi-experimental study which employed mixed methods design recruited 45 trainers as intervention group and another 42 trainers as comparison group. Intervention group participated in a three-consecutive-day nutrition inter- vention while comparison group was trained on general health care services for PWD. Nutrition knowledge, attitude and practice scores for both groups were assessed using a validated questionnaire at baseline (T0), 1-month (T1) and 6-month (T2) intervals after intervention. Intervention trainer's on-the-job nutrition practice was further assessed by qualitative interviews. Results: Repeated measures ANCOVA demonstrated that intervention group attained significantly higher nutrition knowl - edge (p

Malnutrition and growth failure are prevalent among Persons with Disabilities (PWD) and most trainers or care givers in the Community-based Rehabilitation (CBR) centres had limited knowledge in nutrition management for this vulnerable population. The purpose of this study was to develop and examine the validity and reliability of an evaluation instrument, Nutrition Knowledge, Attitude and Practice Questionnaire in Persons with Disabilities (KAP-nOKU) among trainers in CBR centres, Malaysia. KAP-nOKU was a guided self-administered questionnaire and consisted of 30 knowledge, 15 attitude and 15 practice items. After items generation, it was assessed the content validity by an expert panel; and face validity by nine care givers for spastic children. The revised questionnaire was further pre-tested. This pilot study was a cross-sectional survey and recruited 165 trainers from CBR centres in Perlis, Pulau Pinang and Perak, Malaysia. Item analysis or construct validity, internal consistency and test-retest reliability of KAP-nOKU were examined. Five sub-domains were constructed for knowledge domain and three factor-solutions emerged for attitude and practice domains, respectively. Items with low factor loading and correlation were removed. Internal consistency was good-to-excellent for knowledge (KR20 = 0.63), attitude (CA = 0.67) and practice (CA = 0.82) domains. Test-retest reliability- the intraclass correlation coefficients for knowledge, attitude and practice domains were 0.59, 0.73 and 0.91 (p

Aim The use of reflecting curtains with single phototherapy has not yet been directly compared with double phototherapy (DP). The objective of this study is to compare the efficacy of single phototherapy with reflecting curtains (SPRC) and DP in treating neonatal jaundice. Methods This randomised controlled trial involved 160 term newborns with severe neonatal jaundice in the first 2 weeks of life. The subjects were randomised in two groups: the intervention group receiving SPRC (n = 80) and a control group receiving DP (n = 80). Because of post-hoc exclusions, 78 subjects resulted in each group, respectively. The primary outcome was mean decrease in total serum bilirubin (TSB) levels after 4 h of phototherapy. The secondary outcomes were mean decrease in TSB levels after 10 h of phototherapy and duration of phototherapy. Results The mean decrease in TSB after 4 h of phototherapy in the intervention group was similar for the intervention and the control groups (23.46 ± 27.03 vs. 22.43 ± 27.38 μmol/L; P = 0.81). Also, after 10 h, it was similar in both groups (56.06 ± 31.36 vs. 58.17 ± 31.71 μmol/L, respectively; P = 0.67). Cox proportional hazards regression analysis indicated that there was no statistically significant difference in duration of phototherapy in both intervention (SPRC) and control (DP) (x2 change 0.393, P = 0.531; hazard ratio 1.060; 95% confidence interval 0.883–1.273). There were no significant adverse events noted. Conclusions This study suggested that single phototherapy with reflecting curtain is as effective as DP in the treatment of neonatal hyperbilirubinaemia requiring intensive phototherapy.

Malaysia is advancing and nearly on pace with the international scientific community in human genetics and human genomics research. However, this research poses unique challenges. Although Malaysia already regulates medical genetic services, these regulations are insufficient for coping with the ethical issues emerging from recent genomic technologies. The Universiti Sains Malaysia recently created in-house guidelines and an informed consent template for genetic and genomic research. This article presents these guidelines and the informed consent template and discusses the justification and the background of the initiative. We also propose recommendations pertaining to local social studies and regulatory arrangements.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the most effective and safest feeding interval for bolus feeding for very preterm infants (less than 32 weeks' gestation at birth). To assess whether short feeding intervals (such as one or two hours) compared with long feeding intervals (such as three or four hours) improve the time to full feeding and growth in very preterm infants. Subgroup analysis will address birthweight, gestational age, type of feeding, different short and long feeding intervals and other differences in the feeding protocol such as volume of daily increment and prior use of MEF. Subgroup analysis will address birthweight, gestational age, type of feeding, different short and long feeding intervals and other differences in the feeding protocol such as volume of daily increment and prior use of MEF.

Rationale, aims and objectives The South-East Asia Optimising Reproductive and Child Health in Developing Countries (SEA-ORCHID) project aimed to improve health outcomes for mothers and babies in nine hospitals in South-East Asia by supporting evidence-based perinatal health care. In this research, we aimed to identify and explore the factors that may have acted as barriers to or enablers of evidence-based practice change at each of the hospitals. Methods During the final 6 months of the intervention phase of the project, semi-structured, face-to-face interviews were undertaken with 179 nurses, midwives and doctors from the maternal and neonatal departments at each of the nine participating South-East Asian hospitals. Results The interviews identified several factors that participants believed had a substantial impact on the effectiveness of the SEA-ORCHID intervention. These included knowledge, skills, hierarchy, multidisciplinarity and leadership, beliefs about consequences, resources, and the nature of the behaviours. The success of the SEA-ORCHID intervention in improving practice may reflect the extent to which tailored strategies were effective in overcoming these barriers. Conclusion Effective interventions to align practice with evidence rely on identifying and addressing barriers to practice change. The barriers identified in this study may be useful for those designing similar clinical practice improvement projects, as well as for continued efforts to improve practice in the SEA-ORCHID hospitals.

Aim: To determine the rate, causes and risk factors of non-attendance to the paediatric clinic in a tertiary hospital in Malaysia and to determine the efficacy of one telephone call to confirm a new appointment. Methods: For all non-attending patients, during a 2-month period, a pro forma was filled up based on patients' records. During a phone call, additional questions were asked, and a new appointment was offered. Results: Of 1563 patients who had an appointment, 497 (31.8%) were non-attendees. Weather conditions, the sub-specialty and timing (morning or afternoon) had a significant effect on non-attendance. Forgetfulness was the main cause. Only 160 patients could be successfully contacted. Among the contactable patients, 55 already had an appointment, and 10 had reasons not to get a new appointment. Of the 95 remaining patients, 73 (76.8%) attended the new appointment. Conclusion: The non-attendance rate was high. One telephone call had a reasonable efficacy for the contactable patients, but because a high number of patients were not contactable, overall effectiveness was poor.

The uridine diphosphoglucuronate-glucuronosyltransferase 1A1 (UGT1A1) gene encodes the enzyme responsible for bilirubin glucuronidation. To evaluate the contribution of UGT1A1 promoter mutations to neonatal jaundice, we determined the genotypes of c.-3279T>G, c.-3156G>A, and A(TA)7TAA in Malay infants with neonatal jaundice (patients) and in infants without neonatal jaundice (controls). In our population study, only c.-3279T>G was associated with neonatal jaundice. The genotype distributions between both groups were significantly different (p = 0.003): the frequency of homozygosity for c.-3279G was much higher in patients than those in controls. Allele frequency of c.-3279G was significantly higher in patients than those in controls (p = 0.006). We then investigated changes in transcriptional activity because of c.-3279T>G. Luciferase reporter assay in HepG2 cells demonstrated that transcriptional activity of the c.-3279G allele was significantly lower than that of the c.-3279T allele in both the absence and presence of bilirubin. Luciferase reporter assay in COS-7 cells elucidated that c.-3279T>G modified the synergistic effects of the nuclear factors associated with transcriptional machinery. In conclusion, the c.-3279T>G mutation in the UGT1A1 promoter is a genetic risk factor for neonatal jaundice.

Background Phototherapy is a well-established effective therapy for treating babies with significant neonatal jaundice. Studies have shown that increasing light intensity will increase its efficiency. A potentially inexpensive and easy way of increasing the intensity of light on the body of the infant may be to hang reflective materials from the sides of phototherapy units. Objectives To assess the effects of reflective materials in combination with phototherapy compared with phototherapy alone for unconjugated hyperbilirubinaemia in neonates. Search methods We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 11), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R); and the Cumulative Index of Nursing and Allied Health Literature (CINAHL), on 1 November 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Selection criteria We included randomised and quasi-randomised controlled trials if the participants, who were term or preterm infants, received phototherapy with curtains made of reflective materials of any type in the treatment arm, and if those in the comparison arm received similar phototherapy without curtains or other intensified phototherapy, such as a double bank of lights. Data collection and analysis We used standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Main results Of 15 studies identified, we included 12 (1288 babies) in the review - 11 comparing phototherapy with reflective materials and phototherapy alone, and one comparing a single phototherapy light bank with reflective materials with double phototherapy. All reflective materials consisted of curtains on three or four sides of the cot and were made of white plastic (five studies), white linen (two studies), or aluminium (three studies); materials were not specified in two studies. Only 11 studies (10 comparing reflective materials versus none and one comparing reflective curtains and a single bank of lights with a double (above and below) phototherapy unit) provided sufficient data to be included in the meta-analysis. Two excluded studies used the reflective materials in a way that did not meet our inclusion criteria, and we excluded one study because it compared four different phototherapy interventions not including reflective materials. The risk of bias of included studies was generally low, but all studies had high risk of performance bias due to lack of blinding of the intervention. Three studies (281 participants) reported a decline in serum bilirubin (SB) (μmol/L) at four to eight hours (mean difference (MD) -14.61, 95% confidence interval (CI) -19.80 to -9.42; I² = 57%; moderate-certainty evidence). Nine studies (893 participants) reported a decline in SB over 24 hours and showed a faster decline in SB in the intervention group, but heterogeneity (I² = 97%) was too substantial to permit a meaningful estimate of the actual effect size (very low-certainty evidence). Subgroup analysis by type of reflective material used did not explain the heterogeneity. Exchange transfusion was reported by two studies; both reported none in either group. Four studies (466 participants) reported the mean duration of phototherapy, and in each of these studies, it was reduced in the intervention group but there was substantial heterogeneity (I² = 88%), precluding meaningful meta-analysis of data. The only two studies that reported the mean duration of hospital stay in hours showed a meaningful reduction (MD -41.08, 95% CI -45.92 to -36.25; I² = 0; moderate-certainty evidence). No studies reported costs of the intervention, parental or medical staff satisfaction, breastfeeding outcomes, or neurodevelopmental follow-up. The only study that compared use of curtains with double phototherapy reported similar results for both groups. Studies that monitored adverse events did not report increased adverse events related to the use of curtains, including acute life-threatening events, but other rarer side effects could not be excluded. Authors' conclusions Moderate-certainty evidence shows that the use of reflective curtains during phototherapy may result in greater decline in SB. Very low-certainty evidence suggests that the duration of phototherapy is reduced, and moderate-certainty evidence shows that the duration of hospital stay is also reduced. Available evidence does not show any increase in adverse events, but further studies are needed.

Objective: The objectives of this study were to determine the effect of a one and a half year educational intervention on the job dissatisfaction of teachers in 30 Community Based Rehabilitation (CBR) centres in Kelantan, Malaysia, and to identify the factors influencing changes in job dissatisfaction following the intervention. Method: Ten educational modules were administered to the teachers. A validated Malay version of Job Content Questionnaire (JCQ) was used pre intervention, mid intervention and post intervention. Result: Repeated Measure ANOVA revealed there was a statistically significant reduction in the mean of job dissatisfaction (p = 0.048). Multiple Linear Regression revealed that coworker support (β= 0.034 (95% CI = 0.009, 0.059)), having less decision authority (β: -0.023; 95% CI: -0.036, -0.01) and being single (β: -0.107; 95% CI: -0.176,-0.038) were significantly associated with decreases in job dissatisfaction. Conclusion: The intervention program elicited improvement in job satisfaction. Efforts should be made to sustain the effect of the intervention in reducing job dissatisfaction by continuous support visits to CBR centres.

Mutations in the gene encoding UDP-glucuronosyltransferase 1A1 (UGT1A1) may reduce the glucuronidation of estradiol, bilirubin, etc. In the present study, we used a liquid chromatography-tandem mass spectrometry (LC/MS/MS) method to assay the activities of recombinant mutated UGT1A1 toward 17beta-estradiol (E2), by determining its glucuronide (E2G) content. Direct evidence for glucuronide formation was provided by E2G-specific ion peaks. The UGT1A1 activities of G71R (exon 1), F83L (exon 1), I322V (exon 2) and G493R (exon 5) mutants were 24, 30, 18 and 0.6% of the normal UGT1A1 activity, respectively. In conclusion, our study showed that LC/MS/MS enabled accurate evaluation of the effects of mutations on recombinant UGT1A1 activity towards E2.

Background: Gilbert syndrome is caused by defects in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene. These mutations differ among different populations and many of them have been found to be genetic risk factors for the development of neonatal jaundice. Objectives: The objective was to determine the frequencies of the following mutations in the UGT1A1 gene: A(TA)7TAA (the most common cause of Gilbert syndrome in Caucasians), G71R (more common in the Japanese and Taiwanese population), and G493R (described in a homozygous Malay woman with Crigler-Najjar syndrome type 2) in a group of Malaysian babies with hyperbilirubinemia and a group of normal controls. Methods: The GeneScan fragment analysis was used to detect the A(TA)7TAA variant. Mutation screening of both G71R and G493R was performed using denaturing high performance liquid chromatography. Results: Fourteen out of fifty-five neonates with hyperbilirubinemia (25%) carried the A(TA)7TAA mutation (10 heterozygous, 4 homozygous). Seven out of fifty controls (14%) carried this mutation (6 heterozygous, 1 homozygous). The allelic frequencies for hyperbilirubinemia and control patients were 16 and 8%, respectively (p = 0.20). Heterozygosity for the G71R mutation was almost equal among both groups (5.5% for hyperbilirubinemia patients and 6.0% for controls; p = 0.61). One subject (1.8%) in the hyperbilirubinemia group and none of the controls were heterozygous for the G493R mutation (p = 0.476). Conclusions: The A(TA)7TAA seems more common than the G71R and G493R mutations in the Malaysian population.

Southeast Asian ovalocytosis (SAO) is a red blood cell abnormality common in malaria-endemic regions and caused by a 27 nt deletion of the band 3 protein gene. Since band 3 protein, also known as anion exchanger 1, is expressed in renal distal tubules, the incidence of SAO was examined in distal renal tubular acidosis (dRTA) in Malays in Kelantan, Malaysia. Twenty-two patients with dRTA and 50 healthy volunteers were examined for complication of SAO by both morphological and genetic analyses. SAO was identified in 18 of the 22 dRTA patients (81.8%), but only two of the 50 controls (4%). The incidence of SAO was significantly high in those with dRTA (p

If a person who died in the early years of the twentieth century would come back today, he would not believe what he saw, heard, felt, tasted, and smelled. The twentieth century has been a century of so many discoveries and advances, unprecedented in any previous era. Also, the understanding, the prevention, the diagnosis and treatment of infectious diseases in pediatrics have made major leaps forward in the previous century (1). Eradication of diseases through vaccines has become possible; proper hygienic measures have reduced spread of infections within hospitals tremendously, antibiotics have allowed us to cure diseases that before carried a grave prognosis (1). Evidence based medicine has allowed us to bust some myths of widely practiced treatments and conclusively proven the efficacy of others. Knowledge and technology have grown exponentially and are continuing to do so in the twenty-first century (1). While the exciting discoveries keep going on, a major challenge ahead of us lies in the effective processing, application, and implementation of all new discoveries of the past and current century. The grand challenge of this new field of Frontiers in Pediatrics will focus on two main areas: getting research evidence in practice and new exciting evidence that could impact clinical practice.

Autonomy is widely accepted to be the third pillar of medical ethics. However, if it comes to refusal of life saving treatments, some extra considerations are necessary, especially if decisions are made by surrogate decision makers. Four cases of problematic decision making are presented here, followed by a discussion about the cultural and religious misconceptions about the rights of surrogate decision makers.

Neonatal sepsis is still a major problem worldwide. Classical neonatal infection has been divided into late or early onset infection, depending on the time of onset of infection: early, before 48 hours and late, after 48 hours. The cut-off point has been varied among authors from 24 hours to 7 days but 48 hours is a widely accepted choice [1]. This classification of neonatal sepsis has important implications for the origin of the causative organisms, the type of causative organisms and the antibiotic choice [2]. Early onset infections are generally accepted to be congenital. The most important organism causing early onset infection is in many places worldwide Streptococcus agalactiae (Group B Streptococcus). Escherichia coli is deemed to be the second most common cause of early onset sepsis, but a variety of other organisms have been implicated [2,3]. A recent survey of neonatal infections in Asia confirmed that the above-mentioned bacteria are still the leading cause of early onset neonatal infections in many Asian countries [4]. In many units, early onset infection in a neonate is empirically treated with penicillin or ampicillin and an aminoglycoside to cover for the most likely causative organisms [2, 3].

Even though in the corporate world psychological science has been widely used, the formal use of evidence-based psychology in important areas of clinical medicine has been scanty at best. It was the aim of this study to determine the efficacy of a psychologist-led 2-week nurse educator training on the infection rate in the neonatal intensive care unit (NICU). Materials and methods: In 2007, six senior neonatal nurses underwent a training course focusing on the retrieval of evidence and knowledge of psychological principles that would allow them to share the evidence in such a way that evidence is effectively brought into practice. The course was led by a psychologist. The nurses created and delivered their own teaching modules, all focused on infection control. The rates of bacteremia, 2 years prior to intervention were analyzed and compared with the rate following the intervention for 3 years. Results: The immediate output of the course included three teaching modules: hand washing, sterile procedures, and general measures to control infection. These modules were subsequently administered to the NICU nurses in regular structured continuous nursing education sessions. The psychological techniques taught in the course were applied. Bacteremia in the NICU significantly decreased in the year of the course and the subsequent years when compared to previous years (from more than 17 in 2005 and 2006 to less than 10 per 100 admissions to the NICU in 2008 and 2009). Conclusion: This study suggests that a psychologist-led course, followed by a structured CNE can lead to a sustainable reduction in infection rates in a NICU.

Abstract. The benefits of human milk for both infants and mothers have been well established. Especially preterm infants benefit from breast milk. However barriers to breast milk expression in mothers with preterm babies result in a relatively low availability of human milk for these particularly vulnerable infants. To overcome this problem, human milk banks have been established in many parts of the world. The Muslim countries have been not participating in these milk sharing activities for preterm babies because of inherent religious cultural issues. This article addresses these issues and discusses potential ways to overcome these issues. Key words: Human milk bank, human milk sharing, breastfeeding, preterm

The use of reflecting curtains with single phototherapy has not yet been directly compared with double phototherapy (DP). The objective of this study is to compare the efficacy of single phototherapy with reflecting curtains (SPRC) and DP in treating neonatal jaundice.This randomised controlled trial involved 160 term newborns with severe neonatal jaundice in the first 2 weeks of life. The subjects were randomised in two groups: the intervention group receiving SPRC (n = 80) and a control group receiving DP (n = 80). Because of post-hoc exclusions, 78 subjects resulted in each group, respectively. The primary outcome was mean decrease in total serum bilirubin (TSB) levels after 4 h of phototherapy. The secondary outcomes were mean decrease in TSB levels after 10 h of phototherapy and duration of phototherapy.The mean decrease in TSB after 4 h of phototherapy in the intervention group was similar for the intervention and the control groups (23.46 ± 27.03 vs. 22.43 ± 27.38 μmol/L; P = 0.81). Also, after 10 h, it was similar in both groups (56.06 ± 31.36 vs. 58.17 ± 31.71 μmol/L, respectively; P = 0.67). Cox proportional hazards regression analysis indicated that there was no statistically significant difference in duration of phototherapy in both intervention (SPRC) and control (DP) (x2 change 0.393, P = 0.531; hazard ratio 1.060; 95% confidence interval 0.883-1.273). There were no significant adverse events noted.This study suggested that single phototherapy with reflecting curtain is as effective as DP in the treatment of neonatal hyperbilirubinaemia requiring intensive phototherapy.