Original Article
Risk Factors for Predicting Mortality in a Paediatric Intensive Care Unit
Following the rapid advances in medical therapy and critical care technology over the past 30 years, coupled with the spiralling cost of medical care, outcome analysis including mortality risk prediction has become a challenge for the modern day intensivists. During the early 90s, the focus has shifted from the...
Original Article
Infections in Acute Lymphoblastic Leukaemia
Children undergoing chemotherapy for cancer are especially vulnerable to infection because of immunosuppression related to their underlying illness, the effects of chemotherapy and radiotherapy. Empiric antimicrobial chemotherapy is the mainstay of therapy for febrile neutropenic episodes pending the culture results.
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Original Article
Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore
In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has focused especially on cancer and the possible link between immunology and psychological factors.
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Original Article
Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery
The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have reviewed its use for inguinal and genital surgery in children.
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Original Article
A Retrospective Study of Infants with Severe Persistent Pulmonary Hypertension (PPHN) Managed without Extracorporeal Membrane Oxygenation (ECMO)
Persistent pulmonary hypertension (PPHN) is an important cause of neonatal mortality amongst infants who are of term or post-term gestation. The most severely ill of these infants would meet the criteria for the use of extracorporeal membrane oxygenation (ECMO).
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Original Article
Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia
Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously studied in Singapore children; hence we report our experience with the use of adenosine for the treatment and diagnosis of supraventricular tachycardia in children over...
Original Article
Use of Central Venous Lines in Paediatrics—A Local Experience
Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique for percutaneous insertion of central venous lines. In 1973, Shaw invented a technique of cannulating peripheral veins with silastic catheters, as an alternative approach to...
Original Article
Survey of Aerobic Bacterial Infections in Paediatric Surgical Intensive Care Unit Patients
Data on infections in paediatric surgical patients are few in the literature. Although there are many studies on infection in adult surgical and paediatric medical patients, paediatric surgical patients are a special group in their spectrum of diseases and treatment requirements.
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Original Article
Parainfluenza Type 3 Viral Outbreak in a Neonatal Nursery
Parainfluenza viruses are relatively large RNA paramyxoviruses. Four serologic types cause disease in humans.
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Others
T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report
T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T wave during sinus rhythm without any changes in the QRS complex, is an uncommonly recorded rhythm. We report here an unusual case of T wave...
Others
The Future of Medicine from the Standpoint of the Practising Paediatrician
From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had practised the art and science, on the basis of curing the patient when he has an illness. The doctor is sought out when the patient...
Others
Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children
Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are some such findings in these children1 Mild to moderate hypoxaemia is also well described in children with chronic liver disease.
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Original Article
Bidirectional Cavopulmonary Anastomosis
Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to Fontan’s operation has been undertaken in an effort to reduce the volume load of a single ventricle as early as possible and to minimise the...
Original Article
Retinopathy of Prematurity in Very Low Birth Weight Infants
Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship between the risk of this disease with birth weight and gestational age had been well-documented, in particular, in infants with birth weight ≤1500 g (very...
Others
Echocardiographic Features and Management of Neonatal Ductal Aneurysm
Previously thought to be a rare condition, aneurysms of the ductus arteriosus have been increasingly reported in the medical literature over the past few years. It has been noted as an incidental finding in autopsy, echocardiography and angiography, but can present with symptoms of cough, dyspnoea, hoarseness of voice...
Original Article
Transaminitis in Duchenne’s Muscular Dystrophy
Raised aminotransferase levels, especially that of alanine transaminase (ALT), have been traditionally attributed to liver pathology rather than to muscle disorders. However, raised alanine and aspartate transaminase (AST) levels have been found in patients with muscle diseases such as Duchenne’s and Becker’s muscular dystrophy, myotonic dystrophy and the inflammatory...
Others
Twenty-four hour, Non-invasive, Neonatal Chromosome Analysis—Application in a Case of Mixed Gonadal Dysgenesis
Chromosome analysis in neonates requires venisection and this is sometimes both difficult and distressing. In addition, results can at best take 3 days but longer if the initial 48-h culturing period proves unsuccessful.
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Others
Sandhoff Disease—A Case Report of 3 Siblings and a Review of Potential Therapies
Sandhoff disease is a rare inborn error of metabolism characterised by the absence of both β-hexosaminidase A and B, resulting in an accumulation of G<sub>M2</sub> gangliosides, particularly in the neuronal cells. The infantile form, similar to Tay Sach’s disease, may present in the first year of life with an...
Others
A Case Report on the Perinatal Management of a 30-week Preterm Baby with Congenital Complete Heart Block
The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is the commonest of these disorders, and a leading cause of heart block in newborns.
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Others
Minimal Change Nephrotic Syndrome—A Complex Genetic Disorder
Minimal change nephrotic syndrome (MCNS) is the most common cause of childhood nephrotic syndrome. It is characterised by the presence of gross proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia.
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Others
Candida Arthritis in a Premature Infant Treated Successfully with Oral Fluconazole for Six Months
Candida arthritis in premature infants is regarded as a rare condition. The largest published series of 8 cases from one institution was from Bombay, India.
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Original Article
DNA Testing for Fragile X Syndrome in 255 Males from Special Schools in Singapore
Fragile X syndrome is the most common inherited cause of mental retardation, affecting approximately 1 in 1250 males and 1 in 2500 females. It is associated with a cytogenetically visible fragile site in Xq27.3, termed FRAXA, which results from the unstable expansion of a trinucleotide (CGG)n repeat sequence in...
Original Article
Initial Experience of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Paediatric Patients
Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations, or some other less specific complaints such as nausea, pallor and sweatiness.
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Original Article
Diagnosing and Prognosticating Acute Meningitis in Young Infants within 24 Hours of Admission
Meningitis is an important cause of fever in young infants (infants 90 days old or younger). Most cases of meningitis are acute meningitis which present with a short history of symptoms and are caused by either bacteria (acute bacterial meningitis, ABM) or viruses (acute aseptic meningitis, AAM).
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Others
Book Review
The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it as there are so few books of medicine written and published in Singapore.
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Review Article
Enteral Nutrition of the Very Low Birth Weight (VLBW) Infant
Optimal nutrition is critical in the management of the preterm infant. The fetus in utero receives continuous intravenous nutrition that is interrupted when prematurely delivered.
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Original Article
A Case Series of Six Children with Primary Pulmonary Hypertension
Pulmonary arterial hypertension (PAH) is an uncommon but serious and debilitating disorder seen in children and adults. By definition, it is an elevation of the pressure in the pulmonary artery to above a mean of 25 mmHg at rest, or 30 mmHg during exercise.
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Others
2nd Chapter of Paediatricians Lecture: The Future of Paediatrics in Singapore
When I was first invited to give this 2nd Chapter of Paediatricians Lecture by the Chapter, my obvious answer was no. I could think of quite a few other paediatricians more qualified and appropriate as speakers and hoped that my emphatic no would work.
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Others
Liver Transplantation in a Child With Severe Hypercholesterolaemia in Alagille Syndrome
Alagille syndrome (AS) or arteriohepatic dysplasia is a genetic disorder transmitted in an autosomal dominant inheritance. The chromosomal abnormality has been identified to the short arm of chromosome 20.
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Original Article
The Use of Vigabatrin in Infantile Spasms in Asian Children
Infantile spasms are a form of age-dependent myoclonic epilepsy that is difficult to control. Agents such as adrenocorticotrophic hormone (ACTH) and prednisolone have been used as first-line therapy, but are associated with major side effects.
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Original Article
Problems Related to Epidural Analgesia for Postoperative Pain Control
Epidural analgesia has been shown to provide excellent pain relief following thoracotomy, abdominal and other surgery. Studies have shown improvement in specific variables with epidural analgesia; and effective postoperative pain relief is a prerequisite to attain improved postoperative outcome.
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Original Article
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous group of tumours.
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Original Article
Two-year Outcome of Normal-birth-weight Infants Admitted to a Singapore Neonatal Intensive Care Unit
With the rapid advances in the field of neonatal intensive care, the focus of interest has been on the very-low-birthweight (VLBW) infant in recent years. The outcome of these infants has been extensively studied and widely reported. On the other hand, data on the incidence, risk prediction and outcome...
Others
Bronchopulmonary Dysplasia and Chronic Lung Disease of Infancy: Strategies for Prevention and Management
Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy (CLD) are two chronic pulmonary conditions which are the result of incomplete resolution or abnormal repair of lung injury in the neonatal period. Although BPD and CLD are closely related, they have differing diagnostic criteria and the spectrum of severity...
Original Article
Intussusception: A Three-Year Review
Intussusception is the most common cause of intestinal obstruction in infants and young children. It occurs when one segment of the intestines telescopes into another.
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Others
Severe Newborn Encephalopathy Unrelated to Intrapartum Hypoxic Events: 3 Case Reports
Since Little’s article of 1862, it was popularly believed that brain damage in the majority of cases of cerebral palsy occurs during labour and delivery. However, the growing evidence in literature has refuted this belief.
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Others
A Case Series of Pre-Viable Severe Twin-Twin Transfusion Syndrome
Monozygotic twinning has an incidence of approximately 3.5 per 1000 pregnancies. Only 25% of monozygotic twins have a dichorionic placenta.
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Others
Idiopathic Chronic Fetomaternal Haemorrhage Resulting in Hydrops – A Case Report
Small amounts (<0.1 mL) of fetal blood are commonly found in maternal circulation. Massive fetomaternal haemorrhage (FMH) involves fetal blood loss into the maternal circulation of greater than 150 mL or more than half the fetal blood volume.
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Others
Imaging of Paediatric Mediastinal Masses
A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for thoracic masses in children.
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Others
The Relationship Between Scoring Systems and Cytokine Levels in Neonatal Sepsis
In newborn infants, the early diagnosis of sepsis is an important problem because the early signs and symptoms of septicaemia in term or preterm infants are usually nonspecific. Many clinical and haematological scoring systems have been developed in the early diagnosis of neonatal sepsis.
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Original Article
Clinical Characteristics of an Outbreak of Hand, Foot and Mouth Disease in Singapore
The enterovirus family causes a wide array of illnesses, some easily recognised clinically and others diagnosed as non-specific viral illnesses. This large family of viruses, composed of more than 70 serotypes, accounts for at least 10 to 15 millions of asymptomatic infection per year in the United States.
This article...
Review Article
Perinatal Care at the Threshold of Viability—From Principles to Practice
One of the major challenges in neonatal-perinatal medicine in the new century is the optimal management of the mother and infant when delivery is imminent or at the threshold of viability. Considerable debate has arisen regarding the appropriate approach and strongly polarised viewpoints are held with and without supporting...
Original Article
Eight-year Outcome of Very-low-birth-weight Infants Born in KK Hospital
The outcome of very-low-birth-weight (VLBW) premature babies with birth weights of <1500 g has remained an area of great concern for both parents and medical personnel.
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Review Article
Long-term Follow-up and Outcome of Extremely-low-birth-weight (ELBW) Infants
With the progressive improvement in the survival of premature neonates, including those born at the extreme edge of viability, there has been a great degree of interest focused on the functioning of these high-risk survivors and their outcome into childhood and recently up to adolescence and early adulthood. Prospective...
Review Article
Exogenous Surfactant Therapy in Newborn Infants
Exogenous surfactant therapy is widely used in the management of neonatal respiratory distress syndrome (RDS) and may have a role in the management of other neonatal respiratory disorders as well. Numerous randomised controlled trials have been conducted in neonatology to study different aspects of surfactant therapy.
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Others
The Use and Abuse of Steroids in Perinatal Medicine
Preterm birth, delivery prior to 37 weeks of gestational age, accounts for a major and disproportionate amount of infant and neonatal morbidity and mortality. Despite advances in medical technology, the prevalence of preterm birth in Singapore has increased, secondary to an increase in multiple gestations and obstetric interventions.
This article...
Review Article
Mass Newborn Screening in Singapore—Position and Projections
Mass newborn screening is an essential preventative public health programme which aims to diagnose, in the presymptomatic phase, diseases that have a better outcome with early intervention. The development in 1960 by the late Dr Robert Guthrie of a simple test, the GuthrieTest, that enabled the detection of phenylketonuria...
Others
Neonatology In Singapore: The Way We Were, The Way Forward
Over a span of 35 years of my working life, I have witnessed the growth of, and also grown together with, neonatology in Singapore. As I look at the present-day status of neonatology, it gives me a sense of achievement and accomplishment.
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Original Article
Chorioamnionitis and Outcome in Extremely Preterm Infants
Preterm delivery is associated with considerable morbidity and mortality, especially among the 1% to 2% infants delivered at less than 32 weeks. Chorioamnionitis is a major predisposing factor for preterm delivery.
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Editorial
Challenges in Perinatal Medicine
One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This signaled the beginning of increased collaboration between the obstetricians and neonatologists in the management of high-risk pregnancies through multidisciplinary birth defect clinics and high-risk perinatal...
Others
Predicting Significant Hyperbilirubinaemia and Early Discharge for Glucose-6-Phosphate Dehydrogenase Deficient Newborns
Glucose-6-phosphate dehydrogenase (G6PD) deficiency occurs in 2.5% of Singapore’s population, and affected newborns are at risk for severe neonatal hyperbilirubinaemia and kernicterus. In the past four decades, neonatology units in local restructured hospitals have hospitalised all affected newborns for at least 14 days after birth because of this risk.
This...
Others
Autoimmune Liver Disease in Children
Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1) and serologically by the presence of non-organ and liver-specific autoantibodies and increased levels of immunoglobulin G (IgG), in the absence of a known aetiology. They...
Others
HIV/AIDS in Children
The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major public health threat with wide-ranging medical, social and economic consequences. First gaining foothold among intravenous drug users and commercial sex workers, HIV quickly spreads to...
Original Article
Hepatic Resection for Colorectal Metastases to the Liver: The National Cancer Centre/Singapore General Hospital Experience
Colorectal carcinoma is the fourth most common malignancy and the second leading cause of death worldwide. Although surgical resection in combination with adjuvant chemotherapy in certain cases provide curative treatment, more than 50% will develop metastases in the course of their disease.
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Review Article
Adolescent Health Education Programmes: Theoretical Principles in Design and Delivery
Over the past three decades, the patterns of health need in youth have changed. Psychosocial problems such as depression, substance abuse, eating disorders, sexually transmitted infections and unplanned pregnancy, accidental and intentional injury, including suicide, affect youth disproportionately and appear to be increasing.
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Review Article
Art and “the Language of Well-Being” in Adolescent Health Care
Creative processes involve imagining, making unexpected connections, maintaining discipline while letting go of controlling the outcome, opening oneself to pleasure, and moving beyond frustration. Creative activity parallels important strategies for mental and spiritual health—people who participate in well-designed creative processes report that it is powerfully restorative.
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Review Article
From Recreation to Creative Expression: The Essential Features of an Adolescent Inpatient Psychosocial Support Programme
In 1984, the Royal Children’s Hospital (RCH) in Melbourne, Australia opened a new ward specifically for adolescent inpatients. This initiative was the result of many years of observation, patient survey, discussion and debate about the possibility of allowing teenagers to stay in a children’s hospital.
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Review Article
Clinical Assessment, Management and Outcomes of a Group of Adolescents Presenting with Complex Medico-psychosocial Conditions
Increased sensitivity to biological change can make adolescents particularly vulnerable to non-organic symptomatic disorders. A variety of pains, headaches, dizziness and fatigue may remain unexplained after medical assessment.
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Original Article
Adolescent Chronic Illness: A Qualitative Study of Psychosocial Adjustment
Chronic illness during adolescence can have significant psychological and social consequences within many life domains. Growing up with a chronic medical condition presents many challenges including dealing with the symptoms of illness, side effects of medications, altered body image, unpredictable disease progression, depression and anxiety.
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Review Article
Strategies to Promote Better Outcomes in Young People with Chronic Illnesses
The epidemiology of child health in the developed world is changing. Mortality from infectious diseases has fallen sharply over the past century due to public health measures, such as sanitation and immunisation, better housing and sweeping improvements in health care.
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Review Article
Adolescent Alcohol and Other Substance Use: Sharing the Australian Experience
The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent and future adult health and well being. Adolescent substance use and abuse is an example of this.
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Review Article
Sexually Transmitted Infections in Singapore Teenagers
Adolescence can be a difficult period for many individuals who have to navigate their way through complicated emotional, psychological, physical and social demands and changes. The transition from childhood to adulthood includes the formation of successful intimate relationships and avoidance of the pitfalls of sexually transmitted infections (STI), including...
Review Article
Eating Disorders in Singapore: A Review
Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms of shape/weight dissatisfaction and eating abnormalities. Anorexia nervosa is characterised by significant self-induced weight loss secondary to fear of fatness, amenorrhoea (cessation of menstruation for...
Review Article
Youth Suicide and Parasuicide in Singapore
The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or herself in the knowledge, or expectation, of its fatal outcome. Parasuicide or attempted suicide is distinguished from suicide by the non-fatal outcome.
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Original Article
Five-Year Review of Adolescent Mental Health Usage in Singapore
The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in almost every area, including epidemiology, classification and treatment.
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Others
The Perils of Puberty
Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such as cytochrome P450 systems, accretion of peak bone mass, and the development of sexually dimorphic adult patterns in blood lipids, blood pressure, haemoglobin and red...
Editorial
Adolescent Health—A New Perspective in Singapore
In the past five decades, there have been significant advances in the fields of Paediatrics and Adult Medicine in Singapore. However, the bridging field of Adolescent Health has only recently been recognised to be an important specialty which has not received due emphasis in the medical curriculum for undergraduates,...
Others
MELAS: A Case Report
A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to multiple dental caries, phenytoin-induced gingival hyperplasia and severely worn-down and eroded dentition. He is under regular follow-up by the Paediatrics Department of the National University...
Original Article
Oropharyngeal Carriage and Penicillin Resistance of Neisseria meningitidis in Primary School Children in Manisa, Turkey
Infections by Neisseria meningitidis are significant causes of mortality and morbidity in young children and adolescents. The epidemiology of serious meningococcal disease is an area of considerable interest, and many unanswered questions surround this organism and the types of diseases it causes.
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Letter to the Editor
A Fatal Turkish Case of Campomelic Dysplasia
Paediatric Medicine (CD) is a rare form of congenital short-limbed dwarfism, classically characterised by campomelia (bowing of the long bones of the lower extremities) in association with a posterior cleft palate, flattened facies and hypoplastic scapulae. It was first fully and originally described by Spranger et al and Maroteaux...
Original Article
Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore
Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase in prevalence has also been attributed to the changes in lifestyle and urbanisation in developed countries.
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Others
Clinical Report: A Case of Williams Syndrome and Klinefelter Syndrome
Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. The syndrome was first described in 1961 and the phenotype was subsequently expanded in 1972.
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Others
Skin Manifestation of Stenotrophomonas maltophilia Infection – A Case Report and Review Article
Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is found in aquatic environments. It is a frequent coloniser of fluids used in the hospital setting, such as nebulisers, water baths, dialysis machines and intravenous fluids.
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Original Article
Gender Disparity in Paediatric Hospital Admissions
Gender difference in the incidence of childhood diseases has long been recognised. but the magnitude of this effect and consistency across many disease categories appears not to attract much attention or research interest. Gissler and colleagues, in a longitudinal follow-up of all children born in Finland in 1987, reported...
Original Article
Study of Inherited Metabolic Disorders in Singapore – 13 Years Experience
Inborn errors of metabolism (IEMs) described in the early 1900s by Garrod were due to a block in a metabolic pathway, arising from an enzyme deficiency which led directly to the disruption of cellular metabolism. However 40 years later, it was discovered that many inherited diseases were not due...
Original Article
Does Visual Turbidity Correlate With Serum Triglyceride Levels in Babies on Total Parenteral Nutrition?
Intravenous lipid infusion is commonly used as part of total parenteral nutrition (TPN) in newborn babies. Upon infusion, it forms an emulsion that resembles endogenously produced chylomicrons.
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Original Article
Corticosteroids are not Present in a Traditional Chinese Medicine Formulation for Atopic Dermatitis in Children
Atopic dermatitis (AD) is a common, chronic inflammatory skin disease. It has been estimated that 15% of schoolchildren aged 13 to 14 years have a history of AD.
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Original Article
Use of Complementary and Alternative Medicine in Paediatric Oncology Patients in Singapore
Complementary and alternative medicine (CAM) has been gaining acceptance throughout the world. The efficacy of CAM is unproven, yet it remains popular with the general public, with many of them utilising it for a whole spectrum of ailments.
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Original Article
The Epidemiology of Paediatric Intussusception in Singapore: 1997 to 2004
Intussusception (IS) is the most common cause of intestinal obstruction in infants and young children. The peak age of presentation is 4 to 8 months.
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Others
A Report of Two Families with Sarcosinaemia in Hong Kong and Revisiting the Pathogenetic Potential of Hypersarcosinaemia
Sarcosinaemia (OMIN 268900) is an autosomal recessive condition due to the deficiency of sarcosine dehydrogenase (E.C. 1.5.99.1). It is a rare condition with an estimated incidence of 1 in 350,000 in a newborn screening programme.
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Others
Neonatal Priapism Associated With Spontaneous Bilateral Pyocavernositis
Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this entity became more frequent after the introduction of vasoactive drugs for intracavernosal injections.
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Editorial
Paediatrics to Geriatrics: The Continuum
In many parts of Asia today, paediatricians are still grappling with the childhood problems of infectious diseases, diarrhoeal diseases and malnutrition. In Singapore, it was no different up to the mid 1980s.
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Original Article
Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore
Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection from close contact.
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Review Article
A Rotavirus Vaccine for Infants: The Asian Experience
Of all the enteric pathogens that infect young children, rotavirus is recognised as the leading cause of severe gastroenteritis worldwide. Rotavirus accounts for 20% of all diarrhoea-related deaths and global mortality among children less than 5 years of age is estimated at nearly half a million.
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Editorial
Therapeutic Hypothermia for Neonatal Hypoxic-Ischaemic Encephalopathy
Hypoxic-ischaemic encephalopathy (HIE) is an important cause of death and later neurological disability in full-term neonates worldwide. Perinatal asphyxia causes about 19% of the over 5 million neonatal deaths worldwide annually.
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Others
Outcome of Organic Acidurias in China
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Others
Organising Services for IMD in Thailand: Twenty Years Experience
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Others
Newborn Screening in Pakistan – Lessons from a Hospital-based Congenital Hypothyroidism Screening Programme
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Others
Newborn Screening in Bangladesh
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Others
Newborn Screening in China: Phenylketonuria, Congenital Hypothyroidism and Expanded Screening
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Others
Minimising Harm from Newborn Screening Programmes
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Others
Developmental Dysplasia of the Hip: Universal or Selective Ultrasound Screening?
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Others
Financing Newborn Screening Systems: US Experience
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Others
Inborn Errors of Metabolism Presenting as Neonatal Encephalopathy: Practical Tips for Clinicians
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Others
Legal Issues in Neonatal Screening
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Others
Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening
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Others
External Quality Assurance Programme for Newborn Screening of Glucose-6-Phosphate Dehydrogenase Deficiency
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Others
Glucose-6-Phosphate Dehydrogenase Deficiency: Correlation between the Genotype, Biochemistry and Phenotype
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Others
Disorders of Vitamin B12 Metabolism Presenting Through Newborn Screening
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Others
Diagnosis of Tetrahydrobiopterin (BH4) Responsive Mild Phenylketonuria in Japan over the Past 10 Years
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Others
Fatty Acid Oxidation Defects
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Others
Disorders of the Carnitine Cycle and Detection by Newborn Screening
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Others
Spectrum of Inherited Metabolic Disorders in Malaysia
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Others
Establishing a Universal Newborn Hearing Screening Programme
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Others
Current Understanding of Auditory Neuropathy
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Others
A Multidisciplinary Approach to Paediatric Hearing Loss: Programme at the Centre for Hearing Intervention and Language Development, National University Hospital, Singapore
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Others
Early Intervention For Hearing Impairment: Appropriate, Accessible and Affordable
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Others
Impact of the National Hearing Screening Programme in China
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Others
Outcome of Early Cochlear Implantation
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Others
Eliminating Iodine Deficiency: Obstacles and Their Removal
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Others
Neuro-developmental Deficits in Early-treated Congenital Hypothyroidism
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Others
Issues on Universal Screening for Galactosemia
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Others
Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: The Negative Case
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Others
Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: Supporting Arguments
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Others
My Early Experiences in Establishing Neonatal Screening and the Reason for Regional Meetings of the International Society for Neonatal Screening
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Others
Diagnosis and Management Support for an Expanded Newborn Screening Programme
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Others
Considerations in Choosing Screening Conditions: One (US) Approach
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Others
Clinical Applications of Molecular Genetics: The Model of Congenital Adrenal Hyperplasia
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Others
Newborn Screening in Japan: Restructuring for the New Era
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Others
Improved Health and Development of Children who are Deaf and Hard of Hearing Following Early Intervention
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Others
Towards Universal Newborn Screening in Developing Countries: Obstacles and the Way Forward
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Others
Improving Child Health – Newborn Screening for All?
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Editorial
Neonatal Screening – A Global Perspective
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Original Article
Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia
Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected vision equal to or worse than 20/40, and it varies from as low as 2.72% in South Africa to as high as 15.8% in Chile.
This...
Letter to the Editor
Assessment of Medical Graduates Competencies
Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate medical education in the region is to produce doctors who are competent and able to meet the health needs of the community while also being...
Commentary
When Words Really Matter
I think a lot these days about doctors giving advice. Nobody taught me, back in medical school, how to give advice.
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Review Article
Behavioural Sleep Disorders in Children and Adolescents
Overall, children spend one-third to one-half of their life sleeping. Although sleep comprises such a significant portion of a child’s day, sleep disturbances are often overlooked by healthcare practitioners.
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Review Article
Cardiovascular Changes in Children with Snoring and Obstructive Sleep Apnoea
Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the prevalence of childhood OSA diagnosed by varying criteria was 1% to 4%.
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Review Article
Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children
Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a problem affecting about 10% to 15% of our school-going population in Singapore, affecting disease burden in virtually every medical subspecialty.
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Review Article
Sleep Disorders in Children: The Singapore Perspective
Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in 1% to 3% of children.
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Review Article
Diagnosis and Evaluation of Obstructive Sleep Apnoea in Children
Children with obstructive sleep apnoea (OSA) may present with nocturnal and/or diurnal symptoms. The history is best obtained from parents, or siblings who share a bedroom, since the child is often unaware of what happens when he or she is asleep.
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Review Article
The Scope of Paediatric Sleep Medicine
Despite apparent similarities to adult sleep medicine, the disorders of paediatric sleep medicine have a distinct epidemiology and pathophysiology. During childhood, the physiology of sleep develops and matures, resulting in changing patterns of normal behaviours and of sleep disorders.
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Original Article
Sleep Disturbances in Singaporean Children with Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder with various studies reporting prevalence rates of between 1.7% and 16%. The most current version of the Diagnostic and Statistical Manual of Diseases (DSM), fourth edition, has 2 lists of behavioural symptoms grouped under “inattentive” and “hyperactive-impulsive” symptoms,...
Original Article
Inflammatory Cytokines and Childhood Obstructive Sleep Apnoea
Obstructive sleep apnoea (OSA) is characterised by repeated episodes of upper airway occlusion during sleep that are associated with daytime behavioural changes and abnormalities in cardiovascular function. In adults, it has been shown that OSA is an independent risk factor for cardiovascular diseases.
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Original Article
Nasal Obstruction in Children with Sleep-disordered Breathing
Nasal breathing is critical in infants and children; for example, neonatal choanal atresia often leads to respiratory distress and may require urgent intervention in the newborn nursery. Later, during development in the first years of life, abnormal nasal breathing has important consequences for facial growth.
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Original Article
Immunogenicity, Reactogenicity and Safety of a Diphtheria-Tetanus-Acellular Pertussis-Inactivated Polio and Haemophilus Influenzae Type b Combination Vaccine in a Placebo-controlled Rotavirus Vaccine Study
Singapore’s national immunisation programme for the 6 traditional Expanded Programme on Immunisation (EPI) vaccines (i.e. BCG, diphtheria, tetanus, pertussis, polio and measles) and hepatitis B has been in place for many years and its success has been dramatic. Despite being previously endemic to Singapore in the 1950s, diphtheria has...
Images in Medicine
Transfusion-dependent Microcytic Anaemia in a 10-year-old Girl
A 10-year-girl from Bangladesh presented with a moderately severe anaemia (lowest recorded haemoglobin level of 5.6 g/dL) and a mild jaundice (latest serum bilirubin, 31 μmol/L) 3 years ago (Figs. 1 and 2). Test for haemoglobin electrophoresis on agarose gel did not reveal any abnormal bands.
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Images in Medicine
Caudal Regression Syndrome
A white female with an uncomplicated history of birth delivery and a familial history of diabetes mellitus presented to the orthopaedic clinic at the age of 16 months old with bowel dysfunction, inability to walk, one kidney, and a gibbus noted at T12. A “frog-like” appearance was noted of...
Others
3rd College of Paediatrics and Child Health Lecture – The Past, the Present and the Shape of Things to Come…
In the post-war days of the 1950s, Singapore children were faced with problems of malnutrition and infectious diseases. There was poverty, overcrowded housing and lack of hygiene, and the social conditions were apparently appalling.
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Original Article
Auricular Anthropometry of Newborns at the Singapore General Hospital
Abnormalities of the external ear are described in many syndromes and genetic conditions. Melnick et al reported an incidence of 1 in 90 births for external ear malformations and branchial sinuses and tags, with about 1 in 670 births having malformations of the pinna.
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Others
Treatment of Cardiogenic Pulmonary Oedema by Helmet-delivered Non-invasive Pressure Support Ventilation in Children With Scorpion Sting Envenomation
Scorpion stings represent an important and serious public health problem worldwide due to their high incidence and potentially severe and often fatal clinical manifestations, especially among children. The severity of the envenomation is related to haemodynamic and cardiorespiratory alterations, with cardiac failure and cardiogenic pulmonary oedema being the major...
Original Article
Screening Tools for Bacteraemia in a Selected Population of Febrile Children
Bacteraemia refers to the presence of bacteria in the bloodstream. The presence or absence of toxicity differentiates occult bacteraemia, which is relatively asymptomatic, from bacteraemia and sepsis, which is accompanied by findings of serious systemic illness.
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Original Article
Review of the Management Outcome of Slipped Capital Femoral Epiphysis and the Role of Prophylactic Contra-lateral Pinning Re-examined
Slipped capital femoral epiphysis is the commonest hip problem in the adolescent age group. The goals of treatment are aimed at avoiding the complications of osteonecrosis and chondrolysis, preventing further slips, and promoting physeal closure.
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Images in Medicine
Paediatric perineal skin pit: More than skin deep?
A 2.5-year-old boy was referred to our clinic for abnormal genitalia and a febrile urinary tract infection (Escherichia coli >105 colony-forming units/mL). At birth, his parents were informed that he had a “bilobed scrotum and a deep perineal skin pit” that may pose hygiene and cosmetic issues. They had...
Letter to the Editor
Recurrent Group B Streptococcal Septicemia in a Very Low Birth Weight Infant with Infective Endocarditis and Submandibular Cellulitis
Maternal Group B streptococcal colonisation can lead to neonatal pneumonia, meningitis or sepsis. Neonatal Group B Streptococcal (GBS) sepsis is common, but infective endocarditis is rare.
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Original Article
Morbidity of Parainfluenza 3 Outbreak in Preterm Infants in a Neonatal Unit
Parainfluenza type 3 virus (PIV-3) is an important nosocomial pathogen. It closely mimics respiratory syncytial virus (RSV) in its clinical presentations, and in infants. It is the second commonest cause of pneumonia and bronchiolitis after RSV.
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Letter to the Editor
An Unexpected Outcome following Radial Head Excision for Jeffrey Type II Fracture-Dislocation of the Proximal Radius in a Child
We present a case of a 10-year-old child who sustained a traumatic fracture-dislocation of his proximal radius and subsequently underwent surgical removal of the radial head. At 3 years of follow-up, he had regained full painless flexion and extension with loss of pronosupination.
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Letter to the Editor
Temporary Tattoo Associated Type IV Delayed Hypersensitivity Dermatitis in a Child – A Case Report and Call for Parental Caution in Singapore
A 5-year-old, previously healthy French Caucasian boy was seen at a Paediatric Emergency Department for a skin rash over his left forearm.
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Images in Medicine
A Case of Congenital Haemolytic Anaemia and Thrombocytopenia
A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to thrive since birth.
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Images in Medicine
An Exanthem with An Annular Pattern in a 2-year-old Girl
A 2-year-old Chinese girl was seen in clinic with an erythematous annular itchy rash which began on the thighs and had spread to the trunk and hands. The parent’s concern was the rash’s duration and association with 2 episodes of fever.
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Original Article
Clinical Features Differentiating Biliary Atresia from Other Causes of Neonatal Cholestasis
Causes of neonatal cholestasis (NC) are long and diverse but the responses of newborn liver, either physiological or anatomical, are limited. This is because the ability of a developing liver of responding in the face of a variety of insults are limited.
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Original Article
Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children
Congenital heart defects (CHD), with an incidence of approximately 1 in 100 live births, are the most important and frequent congenital malformations. It can cause significant morbidity and mortality in children as well as adults.
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Letter to the Editor
Bannayan Riley Ruvalcaba Syndrome
Bannayan-Riley-Ruvalcaba syndrome (BRRS) classically presents with macrocephaly, subcutaneous and visceral lipomata, haemangiomata, hamartomatous intestinal polyps and pigmented macules involving the genitalia. This autosomal dominant disorder is linked to germline mutations of the phosphatase and tensine homologue gene (PTEN), a tumour suppressor gene which has a significant role in the...
Images in Medicine
Dyke-Davidoff-Masson Syndrome
An 8-year-old boy presented with uncontrolled seizures. He was born as the second child to non-consanguineous parents. He had significant perinatal asphyxia in the newborn period. He had developmental delay since infancy and was noticed to have right-sided tonic clonic seizures since the age of 3 years, which was...
Review Article
Childhood Food Allergy: A Singaporean Perspective
Food allergy is defined as reaction to a food which has an immunologic mechanism. If immunoglobulin E (IgE) is involved in the reaction, the term IgE-mediated food allergy is appropriate.
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Original Article
Transcatheter Closure of Atrial Septal Defects – Is Balloon Sizing Still Necessary?
Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of devices has been developed for use over the years, with significant advances achieved in terms of profile and safety.
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Original Article
Survey of Healthcare Workers’ Attitudes, Beliefs and Willingness to Receive the 2009 Pandemic Influenza A (H1N1) Vaccine and the Impact of Educational Campaigns
Since the first positive 2009 pandemic influenza A (H1N1) case was reported in Singapore on 26 May 2009, the country saw an exponential rise in numbers of infected cases despite initial containment followed by mitigation efforts. Local incidence for acute upper respiratory infections (which was a reasonable surrogate for...
Letter to the Editor
Reply from Author: Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?
We would like to thank the author for suggesting that the definition of ADHD should be revised. This is an important consideration in the light of some of the points raised such as frequent comorbidities that occur with ADHD as is the case of Autistic disorder and other conditions...
Letter to the Editor
Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?
I read with interest the article published in the Annals entitled “Attention Deficit Hyperactivity Disorder: Coping or Curing?”, which concluded that coping rather than curing for attention deficit hyperactivity disorder (ADHD) is taking place. There are some evidence-based points that should be noted.
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Original Article
Dedicated Cytogenetics Factor is Critical for Improving Karyotyping Results for Childhood Leukaemias – Experience in the National University Hospital, Singapore 1989-2006
Acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) make up the bulk of childhood leukaemia cases. With risk stratified therapy being one of the cornerstones of the treatment of childhood leukaemia, it is important to determine the prognostic factors on which risk stratified therapy depends.
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Original Article
Epidemiological Surveillance and Control of Rubella in Singapore, 1991-2007
Rubella is a mild febrile viral exanthematous disease transmitted through droplets or direct contact with the nasopharyngeal secretion of an infected person. It is of public health importance because of the teratogenic effects of the virus on the developing fetus.
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Original Article
Emerging Trends in Breastfeeding Practices in Singaporean Chinese Women: Findings from a Population-based Study
The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breastfeeding for 6 months and partial breastfeeding thereafter for at least 12 or 24 months....
Images in Medicine
A Missed Bilateral Choanal Atresia
What do you see in the image?
a) Deviated posterior nasal septum
b) Nasopharyngeal tumour
c) Rhinolith with mucous plug
d) Bilateral choanal atresia
e) Nasal pyriform aperture stenosis
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Original Article
Health-related Quality of Life in Children with Cancer Undergoing Treatment: A First Look at the Singapore Experience
Health-related quality of life (HRQOL) has been progressively acknowledged as an essential health outcome measure in clinical trials and health services research and evaluation. HRQOL, compared to QOL, is a more defined conceptual term which encompasses only health-related aspects of life directly amenable to healthcare services and medical products.
This...
Original Article
Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore
The increasing prevalence of childhood overweight and obesity and its associated adverse health outcomes have become an important health issue. Childhood obesity can persist into adulthood and increases the risk of cardiovascular metabolic diseases, giving rise to an increased healthcare burden. In Singapore, the prevalence of obesity for adults...
Original Article
Short- and Long-Term Outcomes at 2, 5 and 8 Years Old for Neonates at Borderline Viability—An 11-Year Experience
Singapore was listed consistently among the top 3 countries in the world with the lowest infant mortality rate. In particular, Asia had seen its infant mortality rate improve dramatically with time. Advances in perinatal care had however, failed to improve the survival of extremely low birth weight infants of...
Letter to the Editor
Prevalence of vitamin D deficiency and insufficiency in Malaysian infants
Vitamin D deficiency, a worldwide health problem, is also prevalent in tropical countries. It is estimated that 15% of the world’s population are either vitamin D deficient or insufficient. In a study on the state of Kelantan in Malaysia (2010–2012), 60% of pregnant women were vitamin D deficient. Maternal...
Letter to the Editor
Impact of true fetal mosaicism on prenatal screening and diagnosis
Over the past decade, the non-invasive prenatal test (NIPT) has increasingly been used as a method for prenatal screening for trisomy 21 (T21) and other aneuploidies, complementing the traditional approach of first trimester screening (FTS). FTS comprises ultrasound of the nuchal thickness and blood test to measure the levels...
Original Article
Paediatric emergency department attendances during COVID-19 and SARS in Singapore
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...
Original Article
Epidemiology and risk stratification of minor head injuries in school-going children
Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports and road traffic injuries are common causes in school-going children. Majority of paediatric head injury cases are mild traumatic brain injuries, defined as a Glasgow...
Original Article
Perinatal Drug Abuse in KK Women’s and Children’s Hospital
In recent years, perinatal drug abuse has been emerging as an area of major concern for the perinatologists. Chasnoff found the prevalence of substance abuse in a pregnant population to be approximately 11% (range 0.4% to 27%) in a survey of 35 perinatal centres in the United States.
This article...