P C Ng

The Chinese University of Hong Kong, Hong Kong, Hong Kong

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Publications (191)670.08 Total impact

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    ABSTRACT: Neonatal end-of-life decisions could be influenced by cultural and ethnic backgrounds. These practices have been well described in the West but have not been systematically studied in an Asian population. To determine: (1) different modes of neonatal death and changes over the past 12 years and (2) factors influencing end-of-life decision-making in Hong Kong. A retrospective study was conducted to review all death cases from 2002 to 2013 in the busiest neonatal unit in Hong Kong. Modes of death, demographical data, diagnoses, counselling and circumstances around the time of death, were collected and compared between groups. Of the 166 deaths, 46% occurred despite active resuscitation (group 1); 35% resulted from treatment withdrawal (group 2) and 19% occurred from withholding treatment (group 3). A rising trend towards treatment withdrawal was observed, from 20% to 47% over the 12-year period. Similar number of parents chose extubation (n=44, 27%) compared with other modalities of treatment limitation (n=45, 27%). Significantly more parents chose to withdraw rather than to withhold treatment if clinical conditions were 'stable' (p=0.03), whereas more parents chose withholding therapy if treatment was considered futile (p=0.03). In Hong Kong, a larger proportion of neonatal deaths occurred despite active resuscitation compared with Western data. Treatment withdrawal is, however, becoming increasingly more common. Unlike Western practice, similar percentages of parents chose other modalities of treatment limitation compared with direct extubation. Cultural variance could be a reason for the different end-of-life practice adopted in Hong Kong. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 08/2015; DOI:10.1136/archdischild-2015-308659 · 3.12 Impact Factor
  • Yennie L I Pang · Alice K Y Siu · Pak C Ng ·
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    ABSTRACT: A female infant, born at 31-week gestation with birth weight 1.40 kg, required emergency intubation at birth for respiratory distress syndrome. Generalised convulsion was noted 30 min after delivery. Re-intubation on day 6 revealed a mass in the posterior oropharynx (figure 1). Direct laryngoscopy and rhinoscopy found a lesion measuring 15×20 mm between the right medial and inferior nasal turbinate (figure 2) extending to the posterior oropharynx. MRI confirmed … [Full text of this article]
    Archives of Disease in Childhood - Fetal and Neonatal Edition 12/2014; 100(3). DOI:10.1136/archdischild-2014-307689 · 3.12 Impact Factor
  • HS Lam · HM Cheung · CLS Chau · PC Ng ·
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    ABSTRACT: Background and aim Decisions whether or not to perform high-risk surgery in preterm infants depend on prognosis and preferences/values of society as well as parents and healthcare workers. We aimed to assess differences in preferences between these groups to life-saving surgery in critically ill infants. Methods Paediatric doctors and nurses, parents of preterm infants (PPs) and term infants (PTs) were recruited. A scenario with a critically ill preterm infant with necrotising enterocolitis requiring surgery was presented. Surgery would result in gastrointestinal complications and one of five possible disability health-states (HS1 mild cognitive, severe physical; HS2 moderate respiratory; HS3 severe cognitive and mild physical; HS4 otherwise uncomplicated; HS5 moderate cognitive and mild respiratory complications). Without surgery, the infant would die. Subjects (i) ranked death and the health-states according to perceived severity and (ii) decided for each health-state whether or not to proceed with surgery “at all costs”. Results 55 doctors, 102 nurses, 178 PPs and 201 PTs were recruited. (i) Nurses more likely ranked states with predominant cognitive disability (HS3 and HS5) as worse than death compared with other groups. (ii) In less adverse health-states (HS1 and HS4) there were no differences between groups. Again, nurses were least likely to decide to save-at-all-costs in HS3 and HS5 and PPs were more likely to decide to save-at-all-costs than healthcare workers in a poor outcome (HS5). Conclusions Nurses were least tolerant to adverse health-states. We show that health state preferences vary between doctors, nurses and parents. Parental counselling should account for these differences.
    Archives of Disease in Childhood 10/2014; 99(Suppl 2):A460-A461. DOI:10.1136/archdischild-2014-307384.1274 · 2.90 Impact Factor
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    ABSTRACT: Background: Infants receiving prolonged parenteral nutrition (PN) are at risk of PN-associated cholestasis (PNAC). This can progress to hepatic failure and death if PN cannot be discontinued. Fish oil-based parenteral lipid preparation (FOLP) has been shown to be beneficial in case studies. Objectives: (1) To evaluate whether FOLP could halt or reverse the progression of PNAC compared with soy-based parenteral lipid preparation (SLP) and (2) to assess the effects of FOLP on liver function and physical growth. Methods: Design: double-blind randomised controlled trial. Setting: level III neonatal intensive care unit. Participants: infants with PNAC (plasma-conjugated bilirubin concentration ≥34 µmol/l or 2 mg/dl) expected to be PN-dependent for >2 weeks. Intervention: to receive either FOLP or SLP at 1.5 g/kg/day. Primary outcome measure: reversal of PNAC within 4 months after commencement of lipid treatment; secondary outcomes: rate of change of weekly liver function tests, infant growth parameters, blood lipid profile and episodes of late-onset sepsis. Results: A total of 9 infants were randomised to the FOLP group and 7 to the SLP group. There was no significant difference in reversal of PNAC at 4 months between groups. Rates of increase of plasma-conjugated bilirubin and alanine aminotransferase in the SLP group were significantly greater than the FOLP group (13.5 vs. 0.6 µmol/l per week and 9.1 vs. 1.1 IU/l per week, respectively, p = 0.03). Increased enteral nutrition was associated with significant improvement of PNAC in infants receiving FOLP compared with SLP (-8.5 vs. -1.6 µmol/l per 10% increase in enteral nutrition, respectively). The study was terminated prematurely. Conclusions: progression of PNAC in PN-dependent infants can be halted by replacing SLP with FOLP and reversed by increasing the proportion of enteral nutrition in infants receiving FOLP. Replacement of SLP with FOLP in PN-dependent infants who develop PNAC may be considered.
    Neonatology 02/2014; 105(4):290-296. DOI:10.1159/000358267 · 2.65 Impact Factor
  • H. S. Lam · P. C. Ng ·

    Neonatology 01/2014; 106(3):278-279. · 2.65 Impact Factor

  • Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 12/2013; 19 Suppl 8:10-1. · 0.87 Impact Factor
  • C K Wong · M Hm Chan · J Ss Kwok · C S Ho · P C Ng · S H Suen · K P Fung · C M Lau · T F Fok ·

    Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 12/2013; 19 Suppl 8:12-5. · 0.87 Impact Factor
  • T F Leung · A M Li · G Wk Wong · S Ps Wong · C Wk Lam · P C Ng ·
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    ABSTRACT: 1. Prediction equations and normograms are established using incentive spirometry in a community cohort of 770 Hong Kong Chinese children aged 2 to 6 years. 2. All spirometric parameters depend mainly on standing height. Boys have higher values than girls. 3. Forced expiratory volumes depend on birth weight, place of birth, history of wheezing, and environmental tobacco smoke (ETS) exposure. 4. High urinary cotinine level as a biomarker of ETS exposure is noted in about one tenth of the children. 5. Urinary cotinine level is inversely associated with all spirometric parameters. This supports implementation of the smoking cessation programme.
    Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 12/2013; 19 Suppl 9:21-5. · 0.87 Impact Factor
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  • T F Leung · P K S Chan · G W K Wong · T F Fok · P C Ng ·
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    ABSTRACT: 1. Respiratory viruses and atypical bacteria were detected in 51.0% of Hong Kong children with asthma exacerbations, which was significantly higher than the detection rate of 27.3% in children with chronic stable asthma. 2. Co-infections of two or more respiratory pathogens were more commonly found in children with asthma exacerbations (10.7%) than in patients with stable asthma (2.6%). 3. Human rhinovirus infection was a significant risk factor for asthma exacerbations. 4. There was no significant association between the severity of asthma exacerbations and respiratory viral or atypical bacterial infections. 5. Routine use of macrolide antibiotics in the treatment of childhood asthma exacerbations should be discouraged.
    Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 06/2013; 19 Suppl 4:11-4. · 0.87 Impact Factor

  • Archives of Disease in Childhood - Fetal and Neonatal Edition 03/2013; 99(1). DOI:10.1136/archdischild-2013-303717 · 3.12 Impact Factor
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    ABSTRACT: OBJECTIVES:: To evaluate the use of gut barrier proteins, liver-fatty acid binding protein (L-FABP), intestinal-fatty acid binding protein (I-FABP), and trefoil factor 3 (TFF3), as biomarkers for differentiating necrotizing enterocolitis (NEC) from septicemic/control infants and to identify the most severely affected surgical NEC from nonsurgical NEC infants. BACKGROUND:: Clinical features and routine radiologic investigations have low diagnostic utilities in identifying surgical NEC patients. METHODS: : The diagnostic utilities of individual biomarkers and the combination of biomarkers, the LIT score, were assessed among the NEC (n = 20), septicemia (n = 40), and control groups (n = 40) in a case-control study for the identification of proven NEC and surgical NEC infants. RESULTS: : Plasma concentrations of all gut barrier biomarkers and the LIT score were significantly higher in the NEC than in the septicemia or control group (P < 0.01). Using median values of biomarkers and the LIT score in the NEC group as cutoff values for identifying NEC from septicemic/control cases, all had specificities of 95% or more and sensitivities of 50%. Significantly higher levels of biomarkers and the LIT score were found in infants with surgical NEC than in nonsurgical NEC cases (P ≤ 0.02). The median LIT score of 4.5 identified surgical NEC cases with sensitivity and specificity of 83% and 100%%, respectively. A high LIT score of 6 identified nonsurvivors of NEC with sensitivity and specificity of 78% and 91%, respectively. CONCLUSIONS: : The LIT score can effectively differentiate surgical NEC from nonsurgical NEC infants and nonsurvivors of NEC from survivors at the onset of clinical presentation. Frontline neonatologists and surgeons may, therefore, target NEC infants who are most in need of close monitoring and those who may benefit from early surgical intervention.
    Annals of surgery 03/2013; 258(6). DOI:10.1097/SLA.0b013e318288ea96 · 8.33 Impact Factor
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    ABSTRACT: This article summarizes the commonly used biomarkers currently available for diagnosis of necrotizing enterocolitis. The most exciting advances in diagnostic tests were the use of new nucleic acid sequencing techniques (eg, next-generation sequencing) and molecular screening methods (eg, proteomics and microarray analysis) for the discovery of novel biomarkers. The new technology platform coupled with stringent protocols of biomarker discovery and validation would enable neonatologists to study biologic systems at a level never before possible and discover unique biomarkers for specific organ injury and/or disease entity.
    Clinics in perinatology 03/2013; 40(1):149-59. DOI:10.1016/j.clp.2012.12.005 · 2.44 Impact Factor
  • H S H S Lam · T F Fok · P C Ng ·

    Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 12/2012; 18 Suppl 6:23-4. · 0.87 Impact Factor
  • Pak C Ng · Hugh S Lam ·
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    ABSTRACT: Over the past two decades, neonatal clinicians have commonly used host response biomarkers to diagnose and assess the severity of systemic infection. Most of these biomarkers, such as acute-phase proteins or cytokines, are non-specific immunomodulating mediators of the inflammatory cascade. With advances in biochemical/genetic research, it is anticipated that future biomarkers will be 'organ and/or disease specific'. There is also the quest for discovery of 'novel' biomarkers to assist diagnosis and prognosis of neonatal diseases using powerful mass-screening techniques, e.g. the next-generation sequencing, proteomics and arrays. This article aims to introduce the concept of the next generation of biomarkers to practising neonatal clinicians, and, hopefully, to integrate basic science research into day-to-day clinical practice in the future.
    Neonatology 06/2012; 102(2):145-51. DOI:10.1159/000338587 · 2.65 Impact Factor
  • T F Leung · P K S Chan · W K G Wong · M Ip · W T F Cheng · P C Ng ·
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    ABSTRACT: 1. Human coronaviruses (HCoVs)were detected in 2.5% of 2982 local children hospitalised for acute respiratory infections in 2005 to 2007. 2. Using the 'pancoronavirus' reverse transcription-polymerase chain reaction assay, detection rates were 0.6% for HCoVNL63,1.2% for HCoV-OC43,0.5% for HCoV-HKU1, and 0.2% for HCoV-229E. Notably, HCoV-NL63 infections were significantly more common among children hospitalised in 2006/2007 (1.2%) than in 2005/2006 (0.3%).3. The peak season for HCoVNL63 infection was autumn(September to October). 4. HCoV-NL63 infection was associated with younger age,croup, febrile convulsion, and acute gastroenteritis. Such disease associations were not found with the other three HCoVs. 5. Most local HCoV-NL63 isolates were closely related to the prototype strain in Netherlands(NL496), but a few were phylogenetically distinct from the major cluster.
    Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 02/2012; 18 Suppl 2:27-30. · 0.87 Impact Factor
  • Pak C Ng ·
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    ABSTRACT: No abstract available.
    Neonatology 06/2011; 100(3):297-8. DOI:10.1159/000327846 · 2.65 Impact Factor
  • H K So · E A S Nelson · R Y T Sung · P C Ng ·
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    ABSTRACT: To evaluate the implications of replacing Hong Kong's 1993 growth references (HK1993) with the World Health Organization's 2007 references (WHO2007) for children aged 6 to 18 years. Cross-sectional study. Thirty-six randomly selected primary and secondary schools in Hong Kong. A total of 14 842 children and adolescents aged 6 to 18 years in Hong Kong during 2005/06. Creation of age-specific z-scores for height, weight, and body mass index relative to HK1993 and WHO2007 references. Use of WHO2007 instead of HK1993 could classify an additional 1.4% children aged 6 to 10 years and 2.8% children aged 11 to 18 years as having a short stature. Using WHO2007, respective proportions that could be classified as underweight and obese increased by 3.5% and 2.1% among children aged 6 to 10 years, and 5.5% and 1.6% among children aged 11 to 18 years. Use of WHO2007 could increase clinical workload and patient and parent anxiety by 'over-diagnosing' short stature and underweight. Although WHO2007 may have a role in international comparative research, retention of HK1993 would seem appropriate from a clinical perspective.
    Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 06/2011; 17(3):174-9. · 0.87 Impact Factor
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    ABSTRACT: The present study assessed the relationship between breakfast frequency and measures of obesity in Hong Kong Chinese children aged 9-18 years. A total of 11,570 children (50 % boys) underwent anthropometric measurements and completed a simple self-administered dietary behaviour questionnaire. Their parents completed a questionnaire providing demographic information. Breakfast frequency was assessed by a single question, 'How many days over the past week did you have breakfast?' Children were categorised into three groups: skippers (ate breakfast 0-2 times/week); semi-skippers (ate breakfast 3-4 times/week); non-skippers (ate breakfast 5-7 times/week), to assess all associated characteristics. Of the 3644 primary and 7926 secondary school students, 8 % (8·7 % of boys and 6·9 % of girls) and 14 % (14 % of boys and 15 % of girls), respectively, were breakfast skippers. The prevalence of obesity among breakfast skippers, semi-skippers and non-skippers was, respectively, 9·8, 10·6 and 3·8 % (P < 0·001) for primary school students and 3·9, 3·1 and 2·4 % (P < 0·001) for secondary school students. The 12 % of Hong Kong children aged 9-18 years who skipped breakfast had higher BMI, BMI z-scores and percentage of body fat (PBF) than their counterparts. The dose effects of breakfast frequency (unstandardised regression coefficient, P < 0·001) on BMI and PBF were, respectively, -0·125 kg/m2 and -0·219 % for boys and -0·165 kg/m2 and -0·353 % for girls, adjusting for physical activity per additional breakfast meal per week. Further study is recommended to elucidate whether regular breakfast consumption may have a role in the prevention of childhood obesity.
    The British journal of nutrition 05/2011; 106(5):742-51. DOI:10.1017/S0007114511000754 · 3.45 Impact Factor

Publication Stats

4k Citations
670.08 Total Impact Points


  • 1994-2014
    • The Chinese University of Hong Kong
      • • Department of Paediatrics
      • • Prince of Wales Hospital
      Hong Kong, Hong Kong
  • 1994-2013
    • Prince of Wales Hospital, Hong Kong
      Chiu-lung, Kowloon City, Hong Kong
  • 2004
    • Christian Hospital
      Сент-Луис, Michigan, United States