Risk Factors and In-Hospital Outcomes following Tracheostomy in Infants

To describe the epidemiology, risk factors, and in-hospital outcomes of tracheostomy in infants in the neonatal intensive care unit (NICU)

Newborn Resuscitation in COVID-19

10.47102/annals-acadmedsg.2020236ANNALS ACADEMY OF MEDICINE SINGAPORE4911909-91

Trainees’ perception of education in communication and professionalism across two programs in two countries

Background: Different health care systems impact on medical education. Objective: We aim to describe the differences and similarities in the perceptions of pediatric residents on education in professionalism and communication skills across two countries. Methods: We conducted a cross-sectional survey of pediatric residents in the United States and Singapore. A 108-item written questionnaire on perceptions regarding education in communication/professionalism was administered. A five-point Likert scale was used for each attribute in the survey. Quantitative analysis was performed using chi-square test. Results: Response rate was 65.9% (89/135). In the domain of professionalism, residents from both countries ranked shared decision making as the most important attribute (Singapore vs. USA: 26/50 (52.0%) vs. 19/39 (48.7%), p = 0.76). In contrast, there was a difference in ranking of the most important attribute in communication between the two countries, with dealing with difficult family and patient being most important for Singapore trainees (30/50(60.0%) vs. 8/39 (20.5%), p < 0.001). Direct observation and feedback and role modeling by seniors were the most common teaching methods in both centers. Main barriers in learning were high workload (55/89 (61.8%)) and time constraints (53/89 (59.6%)) in both countries. Promoters of teaching these competencies were similar, with role modeling by senior staff rated as most important. Conclusions: This investigation demonstrates more differences in the perception of how communication is taught compared to professionalism across two countries. Barriers and promoters to teaching were similar across these two countries, with role modeling being an important approach to teaching communication and professionalism across both countries

Singapore Neonatal Resuscitation Guidelines 2016

10.11622/smedj.2017066SINGAPORE MEDICAL JOURNAL587391-40

Risk Factors and In-Hospital Outcomes following Tracheostomy in Infants

OBJECTIVE: To describe the epidemiology, risk factors, and in-hospital outcomes of tracheostomy in infants in the neonatal intensive care unit (NICU). STUDY DESIGN: We analyzed an electronic medical record from 348 NICUs from 1997–2012, and evaluated the associations between infant demographics, diagnoses, and pre-tracheostomy cardio-pulmonary support with in-hospital mortality. We also determined the trends in use of infant tracheostomy over time. RESULTS: We identified 885/887,910 (0.1%) infants who received a tracheostomy at a median postnatal and postmenstrual age of 72 days (25(th), 75(th) percentile 27, 119) and 42 weeks (39, 46) respectively. The most common diagnoses associated with tracheostomy were bronchopulmonary dysplasia [396/885 (45%)], other upper airway anomalies [202/885 (23%)], and laryngeal anomalies [115/885 (13%)]. In-hospital mortality after tracheostomy was 125/885 (14%). On adjusted analysis, gestational age (GA) near term, small for gestational age (SGA) status, pulmonary diagnoses, number of days of F(i)O(2)>0.4, and inotropic support before tracheostomy were associated with increased in-hospital mortality. The proportion of infants requiring tracheostomy increased from 0.01% in 1997 to 0.1% in 2005 (P<0.001), but has remained stable since. CONCLUSIONS: Tracheostomy is uncommonly performed in hospitalized infants, but the associated mortality is high. Risk factors for increased in-hospital mortality after tracheostomy include GA near term, SGA, and pulmonary diagnoses

Moisturisers from birth in at-risk infants of atopic dermatitis – a pragmatic randomised controlled trial

10.1111/ajd.13703Australasian Journal of Dermatology62

Guidance for the clinical management of infants born to mothers with suspected/confirmed COVID-19 in Singapore.

10.11622/smedj.2021045SINGAPORE MEDICAL JOURNA

Variations in medical practice of retinopathy of prematurity among 8 Asian countries from an international survey

Abstract Advances in perinatal care have led to the increased survival of preterm infants with subsequent neonatal morbidities, such as retinopathy of prematurity (ROP). This study aims to compare the differences of neonatal healthcare systems, resources, and clinical practice concerning ROP in Asia with review of current literature. An on-line survey at the institutional level was sent to the directors of 336 neonatal intensive care units (NICU) in 8 collaborating national neonatal networks through the Asian Neonatal Network Collaboration (AsianNeo). ROP screening was performed in infants born at < 34 weeks in Indonesia and Japan. In South Korea, Malaysia, and Taiwan, most screened for ROP in infants born at < 32 weeks. In all networks, majority of NICUs conducted ROP screening to infants with birth weight < 1500 g. In most NICU’s in-hospital ophthalmologists performed indirect ophthalmoscopy and some were supplemented with digital imaging. Both laser photocoagulation and anti-vascular endothelial growth factor injection are performed for treatment and, vitreous surgeries are conducted less frequently in all countries. Despite limited information collected by the survey, this first study to compare ROP practices implemented in eight Asian countries through AsianNeo will enable an understanding of the differences and facilitate quality improvement by sharing better practices

Contemporary fluid management, humidity, and patent ductus arteriosus management strategy for premature infants among 336 hospitals in Asia

ObjectivesThe management of patent ductus arteriosus (PDA) is a critical concern in premature infants, and different hospitals may have varying treatment policies, fluid management strategies, and incubator humidity. The Asian Neonatal Network Collaboration (AsianNeo) collected data on prematurity care details from hospitals across Asian countries. The aim of this study was to provide a survey of the current practices in the management of PDA in premature infants in Asian countries.MethodsAsianNeo performed a cross-sectional international questionnaire survey in 2022 to assess the human and physical resources of hospitals and clinical management of very preterm infants. The survey covered various aspects of hospitals resources and clinical management, and data were collected from 337 hospitals across Asia. The data collected were used to compare hospitals resources and clinical management of preterm infants between areas and economic status.ResultsThe policy of PDA management for preterm infants varied across Asian countries in AsianNeo. Hospitals in Northeast Asia were more likely to perform PDA ligation (p &lt; 0.001) than hospitals in Southeast Asia. Hospitals in Northeast Asia had stricter fluid restrictions in the first 24 h after birth for infants born at &lt;29 weeks gestation (p &lt; 0.001) and on day 14 after birth for infants born at &lt;29 weeks gestation (p &lt; 0.001) compared to hospitals in Southeast Asia. Hospitals in Northeast Asia also had a more humidified environment for infants born between 24 weeks gestation and 25 weeks gestation in the first 72 h after birth (p &lt; 0.001). A logistic regression model predicted that hospitals were more likely to perform PDA ligation for PDA when the hospitals had a stricter fluid planning on day 14 after birth [Odds ratio (OR) of 1.70, p = 0.048], more incubator humidity settings (&lt;80% vs. 80%–89%, OR of 3.35, p = 0.012 and &lt;80% vs. 90%–100%, OR of 5.31, p &lt; 0.001).ConclusionsIn advanced economies and Northeast Asia, neonatologists tend to adopt a more conservative approach towards fluid management, maintain higher incubator humidity settings and inclined to perform surgical ligation for PDA

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.</jats:p