V Y Yu

Monash University (Australia), Melbourne, Victoria, Australia

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Publications (15)19.41 Total impact

  • Victor YH Yu
    Australian and New Zealand Journal of Obstetrics and Gynaecology 01/2006; 46. · 1.30 Impact Factor
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    ABSTRACT: This study was undertaken to evaluate physician counselling practices and resuscitation decisions for extremely preterm infants in countries of the Pacific Rim. We sought to determine the degree to which physician beliefs, parents' opinion and medical resources influence decision-making for infants at the margin of viability. A survey was administered to neonatologists and paediatricians who attend deliveries of preterm infants in Australia, Hong Kong, Japan, Malaysia, Taiwan and Singapore. Questions were asked regarding physician counselling practices, decision-making for extremely preterm infants and demographic information. Physicians counsel parents antenatally with increasing frequency as gestational age increases. Most physicians discuss infant mortality and morbidity with parents prior to delivery. Physicians less frequently discuss the option of no resuscitation of an extremely preterm infant, withdrawal of support at a later time, or financial costs to parents. Severe congenital malformations, perception of a poor future quality of life, parental wishes and a high probability of death for the infant are influential in limiting resuscitation in very preterm infants for a majority of physicians. Less influential factors are parent socioeconomic status, language barriers, financial costs for the family, allocation of national resources, moral or religious considerations, or fear of litigation. Physician thresholds for resuscitation of infants ranged between 22 and 25 weeks gestation and between 400 and 700 g birthweight. We report physician beliefs and practices regarding resuscitation and the counselling of parents of extremely preterm infants in Pacific Rim countries. While we find variation among countries, physician practices appear to be determined by ethical decision-making and medical factors rather than social or economic factors in each country.
    Journal of Paediatrics and Child Health 05/2005; 41(4):209-14. · 1.25 Impact Factor
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    Victor Yh Yu
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    ABSTRACT: Multiple pregnancies have increased over time, and currently account for 10% of perinatal deaths. Compared to singleton births, the perinatal mortality rate is four times higher and the cerebral palsy rate is five times higher in twins. Monozygotic monochorionic twins are at the highest risk, due firstly to the cell division process leading to chromosomal or other anomalous lethal aberration in one fetus, and secondly to twin twin transfusion syndrome (TTTS) especially from its adverse consequences on the surviving fetus if there is fetal death of its co-twin. The incidence of TTTS is 20% in monozygotic monochorionic twins. Although perinatal mortality in TTTS has reduced from 80% to 40%, neonatal and paediatric morbidity remains high. Ultrasonographic studies showed cardiac dysfunction in 80% and brain lesions in over 50% of cases. Serious ischaemic and embolic complications can also occur in the gut, liver, kidneys and limbs. Cerebral palsy develops in 20% of TTTS survivors, especially if the co-twin dies in utero, with another 20% having minor neurodevelopmental disabilities. Data are emerging on the obstetric risks, survival and neurological outcome associated with interventions for treating TTTS. Randomised controlled trials to examine the benefits and risks of these strategies and a TTTS registry at a national or an international level are recommended to help improve management and audit perinatal and paediatric outcomes. Introduction The increase in the rate of twinning and higher order multiple births from the late 1980s 1-3 has been attributed to increasing maternal age and the increasing use of fertility enhancing therapies. 4,5 In Australia, the multiple pregnancy rate has increased from 9 to 14 per 1,000 confinements over two decades. 6 The true incidence of multiple pregnancies is higher than was reported because of the vanishing twin syndrome: for every twin pair born, at least 10 singletons are conceived as one of a twin pair. 7 The monozygotic twinning rate was steady at 3-5 per 1000 pregnancies, though in Australia, as with other developed countries, this has increased. Consequently, the dizygotic to monozygotic (Dz:Mz) ratio for twins which was over 2.0 is now under 1.0. 8,9 The Dz twinning rate is lowest in the Far East and highest in Africa (Caucasians and Indians in between) and it increases with maternal age and parity.
    J Arab Neonatol Forum. 01/2004; 1:9-14.
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    Victor Y Yu
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    ABSTRACT: Globally, the perinatal mortality rate (PMR) is 53/1000 (7.5 million annual perinatal deaths) and the neonatal mortality rate (NMR) is 36/1000 (5.1 million annual neonatal deaths). Of the 141 million annual livebirths, 127 million (90%) are born in developing countries, which, compared to developed countries, have a higher PMR (57/1000 vs 11/1000, 5.2x) and NMR (39/1000 vs 7/1000, 5.6x). Five million annual neonatal deaths (98% of the world's total) occur in developing countries. Regional annual livebirths figures are: Asia-Oceania 76 million, Africa 31 million, Central and South America 12 million, Europe 8 million, and North America 4 million. Regional annual neonatal death figures are: Asia-Oceania 3.3 million, Africa 1.3 million, Central and South America 0.3 million, Europe 0.07 million, North America 0.03 million. The Asia-Oceania region has a PMR of 53/1000 and a NMR of 41/1000. It has half of the world's livebirths and two-thirds of the world's neonatal deaths. The PMR and NMR have often been used as an indicator of the standard of a country's social, educational and healthcare systems. Strategies, which address inequalities both within a country and between countries, are necessary if there is going to be further improvement in global perinatal health.
    Journal of Perinatal Medicine 02/2003; 31(5):376-9. · 1.95 Impact Factor
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    ABSTRACT: The attitudes of Australian obstetricians to the resuscitation of extremely premature infants are reported. A structured questionnaire including questions regarding antenatal parent counselling, resuscitation practices, survival rates and personal attitudes about life support was distributed to obstetricians working in Australian hospitals with a Level 3 nursery Eighty-nine (48% response rate) replies were received from 12 units located in seven major cities. Obstetricians are more likely to discuss resuscitation with prospective parents with increasing gestation with a major shift occurring at 23-24 weeks' gestation. They strive for consensus with parents regarding resuscitation options and they act upon the opinion of both the prospective parents and their paediatric colleagues. Threat of litigation rarely influences the decision to limit resuscitation of an extremely preterm infant. Obstetricians may underestimate the prognosis for extremely preterm infants. The data presented offer useful insights into current attitudes and practice of tertiary hospital obstetricians.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 09/2001; 41(3):269-73. · 1.30 Impact Factor
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    ABSTRACT: A questionnaire survey of Australian neonatologists was conducted to ascertain their antenatal counselling and resuscitation practices, and attitudes towards life support in the extremely preterm infant. This study showed that in antenatal parental counselling, whether a paediatrician was given the opportunity to participate depends on the gestation at the time of the threatened preterm delivery The counselling employed almost invariably covered mortality and morbidity. The obstetrician's opinion was considered to be of utmost importance. Both financial and moral obligations were found to be of little importance in counselling and resuscitation. Only one-third of institutions had guidelines for limiting resuscitation. The onus remained on the neonatologists concerning which infant to resuscitate, and the level of the resuscitation to be conducted. In Australia, resuscitation at birth was restricted to infants of 23 weeks' gestation or above, and neonatologists did not believe the legal system has a role to play in limiting or mandating resuscitation of extremely preterm infants. Neither were they concerned with the threat of litigation when they decide to limit resuscitation. The majority of neonatologists agreed with their institution's approach to life support in extremely preterm infants. One grey area was the question of withholding assisted feeding in an infant for which the decision to withdraw life support has been made. Australia lacked a current consensus policy on selective non-treatment. The establishment of national guidelines would be helpful to aid Australian obstetricians and neonatologists in their clinical practice.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 09/2001; 41(3):275-80. · 1.30 Impact Factor
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    ABSTRACT: The attitudes of Australian obstetricians to the resuscitation of extremely premature infants are reported. A structured questionnaire including questions regarding antenatal parent counselling, resuscitation practices, survival rates and personal attitudes about life support was distributed to obstetricians working in Australian hospitals with a Level 3 nursery. Eighty-nine (48 % response rate) replies were received from 12 units located in seven major cities.Obstetricians are more likely to discuss resuscitation with prospective parents with increasing gestation with a major shift occurring at 23–24 weeks' gestation. They strive for consensus with parents regarding resuscitation options and they act upon the opinion of both the prospective parents and their paediatric colleagues. Threat of litigation rarely influences the decision to limit resuscitation of an extremely preterm infant. Obstetricians may underestimate the prognosis for extremely preterm infants. The data presented offer useful insights into current attitudes and practice of tertiary hospital obstetricians.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 07/2001; 41(3):269 - 273. · 1.30 Impact Factor
  • V Y Yu
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    ABSTRACT: In planning enteral feeding in the preterm infant, decisions need to be made regarding the feeding schedule, choice of milk, and the route of administration. Feeds should be commenced within a week after birth beginning with subnutritional quantities. Preterm human milk from the infant's own mother is the milk of choice. When full enteral feeding is established, supplementation with human milk fortifier is recommended. Donor human milk and preterm formula are alternatives. Early establishment of enteral nutrition and maintenance of optimal nutrition during infancy are important as dietary manipulations in preterm infants have potential long-term influences on their health, growth and neurodevelopment.
    Early Human Development 01/2000; 56(2-3):89-115. · 2.02 Impact Factor
  • V Yu
    Indian pediatrics 12/1998; 35(11):1081-96. · 1.04 Impact Factor
  • V Y Yu
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    ABSTRACT: The increase in the rate of multiple pregnancies in Australia in recent years is primarily due to the use of assisted reproduction technology. Compared to singleton births, fetal, neonatal, and perinatal mortality rates are 3-6 times higher in twins and 5-15 times higher in multiple births of a higher order. Cerebral palsy rates among survivors are six times higher in twins and twenty times higher in triplets. The increased risks in multiple pregnancies are not entirely explained by their higher prematurity and low birthweight rates. In Australia, the practice of transferring more than three embryos in any one assisted reproduction technology cycle has declined in recent years and, as a result, the number of multiple pregnancies from assisted reproduction technology has also declined. Nevertheless, assisted reproduction technology pregnancies remain to have poorer than normal outcome with regards to spontaneous abortion, ectopic pregnancy, preterm birth, low birthweight, and perinatal mortality. Infants born after assisted reproduction technology have a higher neonatal morbidity rate, including a greater requirement for assisted ventilation, and a higher long-term neurodevelopmental disability rate. These adverse outcomes following assisted reproduction technology are partly due to the increased risk of multiple pregnancy and partly due to preterm and low birthweight. This fact and the lack of evidence that the transfer of more than two embryos improves pregnancy rates, make it advisable to limit the number of embryos transferred to no more than one or two per cycle.
    Croatian Medical Journal 06/1998; 39(2):208-11. · 1.25 Impact Factor
  • Pediatric Research 01/1998; 43. · 2.67 Impact Factor
  • V Y Yu
    Early Human Development 12/1993; 35(1):1-14. · 2.02 Impact Factor
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    Victor Yu, Jeanie-Beth Tan
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    ABSTRACT: Background: With advances in neonatal intensive care, increasing numbers of preterm neonates are now surviving. In the past they would have died before there was time to develop chronic lung disease (CLD). Based on the definition of a neonate requiring any form of respiratory therapy (oxygen or assisted ventilation) at 36 weeks' post-menstrual age, the CLD rate in Australia is 52% in those
  • V Y Yu
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    ABSTRACT: A neonatologist must acquire the basic knowledge of a perinatologist through training in a perinatal centre with close obstetric collaboration. As a clinician, he/she must acquire competence in the medical care of critically-ill neonates through 3 years of neonatal experience following general paediatric training. As an administrator, skills are required in nursery management, regional planning, audit and follow-up of high-risk survivors. Skills are required as an educator for medical/nursing staff and the community. Training as a researcher enables appreciation of perinatal research and appropriate application of scientific advances to clinical practice. He/she must become a person who cares, able to understand psychosocial and ethical issues in neonatology.
    Early Human Development 29(1-3):121-3. · 2.02 Impact Factor
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    Victor Yh Yu
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    ABSTRACT: Most studies of assisted reproduction technologies reported that c ongenital malformations and a berrations, childhood cancers, acquired medical conditions, c hronic illness, physical growth, and cognitive and socioemotional development were within the expected range for naturally conceived pregnancies. However, few studies had included children beyond adolescence, and many unanswered questions remain about their long-term outcomes. To optimise outcome, the endpoint one aims to achieve should be B ESST outcome (Birth Emphasising a Successful Singleton at Term). A multiple preterm birth is the main factor that adversely affects the outcome of children conceived by assisted reproduction technologies. Introduction Edwards and Steptoe in England and Trounson and Woods in Australia first published their pioneering work on in vitro fertilisation (IVF) in 1980 and 1981, respectively. The first outcome study of nine babies from eight IVF pregnancies was published by our Monash University group in 1982. 1 Many follow-up studies have since been performed, examining the health outcomes, cognitive and socio-emotional development, and parental-child relationships for a variety of assisted reproduction technologies (ART) involving o varian stimulation, frozen sperm, cryopreserved embryos, i ntracytoplasmic sperm injection (ICSI), and non-traditional families, including gamete donation families (sperm or egg) and surrogacy families. Established ART risks include that from a higher maternal age (leading to increased obstetric and neonatal problems), from multiple births (lower gestation and birthweight and a higher long-term neurodevelopmental disability rate), and a l ower gestation and birthweight even f or singletons. Theoretical ART risks include biochemical damage from the culture medium, physical damage during embryo manipulation, ice crystal formation within the frozen embryo, damage during the thawing process, and DNA damage during embryo storage. The problem with knowing whether there is an increased risk is that if the condition has a prevalence rate of 2%, to detect a doubling of the risk using a 5% one-tailed test of significance with 80% chance of detection, one is required to study 1,000 ART babies and 1,000 controls. For a condition that affects 1 in 1,000 births, one needs 20,000 babies in each group.