[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE. To evaluate potential risk factors, presenting symptoms, management, and outcomes of intracranial haemorrhage in Chinese children with immune thrombocytopenia managed in a regional hospital. DESIGN. Retrospective case series. SETTING. A regional hospital in Hong Kong. PATIENTS. All paediatric patients with immune thrombocytopenia complicated by intracranial haemorrhage in the period January 1996 to December 2009. RESULTS. Nine episodes of intracranial haemorrhage were reported in eight patients (aged 0.9 to 19 years) with immune thrombocytopenia; three of the patients had acute immune thrombocytopenia and the other five had chronic immune thrombocytopenia. Intracranial haemorrhage occurred as early as the initial presentation with immune thrombocytopenia (n=2) and as late as up to 5 years after the diagnosis. The median platelet count at the time of intracranial haemorrhage was 12 x 10(9) /L (<10 x 10(9) /L [n=4]; 10-20 x 10(9) /L [n=2]; >20 x 10(9) /L [n=3]). The bleeding was considered spontaneous in six episodes, while head trauma (n=2) and vascular malformation (n=1) were identified in three patients with mild-to-moderate thrombocytopenia (42-82 x 10(9) /L) at the time of the bleed. Headache and mucosal bleeding were the commonest presenting symptoms (n=5). All patients received multimodal treatment after diagnosis of intracranial haemorrhage, and included platelet transfusion (n=8), intravenous immunoglobulin (n=6), methylprednisolone (n=4), and splenectomy (n=4); three individuals underwent neurosurgical interventions. One (11%) patient died of posterior fossa bleeding and one (11%) had neurological sequelae. All survivors achieved remission of their immune thrombocytopenia with a median follow-up of 5.3 years. CONCLUSION. Intracranial haemorrhage can occur anytime during the course of immune thrombocytopenia. A high index of suspicion for intracranial haemorrhage should be maintained during follow-up, as favourable outcomes can be achieved after early and vigorous interventions.
Full-text · Article · Apr 2013 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
[Show abstract][Hide abstract] ABSTRACT: Objectives:
The aims of this study were to evaluate the specificity of a non-draining hepatobiliary scintigraphy (HBS) for biliary atresia (BA) in preterm and full-term babies, to verify the relationship between non-draining scan and higher levels of direct bilirubin and to find an objective criterion to guide the time in performing HBS.
A total of 175 infants (113 males and 62 females, median age of 45 days) with 181 HBS performed in Tuen Mun Hospital between January 1998 and May 2010 were retrospectively analysed. A 'non-draining' scan was defined as one showing no excretion of radiolabelled tracer into the small bowel 24 h after injection. The disease category, epidemiological and laboratory data were compared between infants having non-draining and draining scans. In addition, the predictive value of a negative scan for BA was compared between preterm and full-term infants.
Twenty infants (11.4%) were surgically confirmed to have BA. A non-draining scan was found to be 100% sensitive for BA, and the specificity was 96% and 78% among full-term infants and preterm infants, respectively. The mean direct bilirubin values of infants with BA and intrahepatic cholestasis were 141.9 and 111.3 μmol/L, respectively, which were significantly higher than 67.2 μmol/L seen in infants with draining scans. This analysis shows that using direct bilirubin ≥63 μmol/L as an objective criterion in guiding the time to perform HBS is most cost-effective.
Our data supported that using direct bilirubin ≥63 μmol/L as an objective criterion in guiding the time to perform HBS will avoid unnecessary scans.
No preview · Article · Dec 2012 · Journal of Paediatrics and Child Health
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES. To clarify the use of ultrasonography by determining the frequency of developmental dysplasia of the hip among breech-presented Chinese neonates in Hong Kong. DESIGN. Prospective case series.
SETTING. Regional hospital, Hong Kong.
PATIENTS. All breech-presented Chinese neonates born during January 2008 to June 2009 were included (except premature neonates). They were examined clinically from birth till the age of 1 year. Ultrasound of the hips was performed at the age of 2 weeks, and X-ray of the pelvis at the age of 1 year.
RESULTS. A total of 209 breech-presented neonates were born during the study period; 110 neonates completed all necessary investigations and follow-up. Among the latter, there were three neonates with developmental dysplasia of the hip warranting treatment, which amounted to a frequency of 2.7%.
CONCLUSION. Developmental dysplasia of the hip among breech-presented Chinese babies is only slightly less common than in corresponding populations in other regions in the world. Since early diagnosis is important, ultrasonography screening in high-risk cases such as those with breech presentation may be useful.
Full-text · Article · Oct 2012 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
[Show abstract][Hide abstract] ABSTRACT: To investigate whether requests for standard paediatric electroencephalograms accord with guideline recommendations, subsequent changes in clinical management according to reported results, and extent to which the service meets waiting time targets.
Regional hospital, Hong Kong.
All patients aged less than 18 years who underwent electroencephalography between December 2009 and February 2010.
Appropriateness of the electroencephalogram request and the impact of its findings on clinical management.
A total of 109 patients were recruited, but requests for standard electroencephalograms were considered 'inappropriate' with respect to guidelines in 44% of the patients, of which 50% were made to diagnose 'funny turns'. The standard electroencephalogram contributed to the diagnosis or management in only 28% of patients. In all of the latter, the request for an electroencephalogram had been appropriate. Nonspecialists made referrals for 86% of the patients. Inadequate information was provided in 66% of the requests. Standard electroencephalograms were performed within guideline targets, the wait being less than 4 weeks in 95% of requests.
An effective electroencephalogram service was being provided, though abuses were common. These were mainly because of misconceptions regarding the role and limitations of standard electroencephalograms. Through an educative, non-confrontational approach, and with time to explain guideline recommendations to clinicians, sustainable change in practice could be achieved so as to benefit patients, clinicians, and service provision.
No preview · Article · Feb 2012 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
[Show abstract][Hide abstract] ABSTRACT: A Chinese adolescent girl presented with secondary amenorrhea. During follow-up, she gradually developed Cushingoid features and virilization. After a series of endocrine investigations, including urinary steroid profiling, a diagnosis of adrenocortical carcinoma was made. The treatment and prognosis of the disease are discussed.
No preview · Article · Apr 2011 · Journal of pediatric endocrinology & metabolism: JPEM
[Show abstract][Hide abstract] ABSTRACT: This is a retrospective review of the clinico-radiological features and neurological outcomes of reversible posterior leukoencephalopathy syndrome episodes in Chinese cancer children receiving chemotherapy in a regional hospital in Hong Kong from 1998 to 2008. Five children (3 males and 2 females) with a mean age of 7 years were identified, four of whom had acute lymphoblastic leukaemia and one had a central nervous system germ cell tumour. Presenting symptoms included seizures (100%), altered mental function (100%), headache (40%), and visual disturbance (60%). The mean systolic blood pressure at presentation was 158 mm Hg. Approximately 80% had typical radiological features of reversible posterior leukoencephalopathy syndrome. All showed complete recovery after the acute stage, but one subsequently developed epilepsy. Two patients ultimately died of refractory malignant disease. Two others were followed up for a mean of 6 years, and remained neurologically normal. This report was the first case review documenting reversible posterior leukoencephalopathy syndrome in Chinese cancer children. The clinico-radiological features and neurological outcomes were similar to those reported in western series. Early recognition of the syndrome is important to facilitate appropriate treatment. The central nervous system damage may not be reversible and thus long-term follow-up is warranted.
No preview · Article · Feb 2011 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
[Show abstract][Hide abstract] ABSTRACT: Cyclopentolate-phenylephrine eye drops are commonly used to achieve mydriasis during routine screening for retinopathy of prematurity (ROP) in preterm infants. Two cases of necrotising enterocolitis (NEC) following ROP screening in two premature Chinese triplets were reported. Literature studying and reporting the side effects of mydriatrics and the ROP examination were reviewed. Also, safety measures concerning ROP screening were discussed. In our institution two more years after adopting these safety measures, no more feeding difficulties or NEC were noted following ROP screening. We concluded that both the mydriatics and ROP examination may lead to systemic and gastrointestinal side effects in preterm babies and may be associated with NEC in high risk patients. This association warrants further study and the safety measures should be observed.
No preview · Article · Jan 2011 · Hong Kong Journal of Paediatrics
[Show abstract][Hide abstract] ABSTRACT: Women having congenital adrenal hyperplasia (CAH) owing to 21-hydroxylase deficiency, especially those with salt-losing type, have decreased fertility rates. With advances in genital reconstruction, reproductive medicine and optimisation of antenatal care for this group of patients, more documented successful pregnancies have been reported. We report a Chinese woman with classical salt-losing type ofCAH who has successfully delivered a normal baby girl.
No preview · Article · Jul 2010 · Hong Kong Journal of Paediatrics
[Show abstract][Hide abstract] ABSTRACT: Objective: To evaluate the reliability of Minolta JM-103 Jaundice Meter as a screening tool for neonatal jaundice in preterm Chinese neonates on day 0-14. Methods: This prospective study studied the correlation between the total serum bilirubin (TSB) measurements and the paired transcutaneous bilirubin measurements obtained at the forehead (TcB_F) and sternum (TcB_S) between April and September 2009. Findings: 110 pairs of TcB_F, TcB_S and TSB measurements were evaluated in 30 preterm newborns. Both TcB measurements were significantly correlated with TSB, with a correlation coefficient of 0.81 and 0.83 for TcB measurements obtained at the forehead and sternum, respectively. The mean of the difference of the pairs (TcB_F minus TSB) and (TcB_S minus TSB) were 9.30 and 20.18 μjmol/L. respectively. The corresponding standard deviation measured 27.10 and 27.46 at p<0.01, respectively; the JM-103 tended to overestimate TSB. Conclusion: TcB correlates significantly with TSB in preterm neonates and JM-103 appears to be useful as a screening tool in preterm (<35 weeks) neonates.
No preview · Article · Apr 2010 · Hong Kong Journal of Paediatrics
[Show abstract][Hide abstract] ABSTRACT: To describe the disease burden, clinical pattern and outcome of influenza-related hospitalisations in children.
This is a retrospective study carried out in a regional hospital in Hong Kong. Children hospitalised with established diagnosis of influenza infection from January to June of 2005 were studied. Length of hospitalisation, demographic characteristics, symptoms, clinical diagnosis and complications of influenza infection were analysed.
Influenza A infection accounted for 93.5% of these hospitalisations. Children less than 5 years of age comprised 70% of admission. Highest rate of admission occurred in May and April. One fourth of emergency admission during the study period and over 70% in the peak season was a result of influenza-related illness. Underlying medical disease was observed in 14.6% of children. Mean duration of hospitalisation was 3.0 days. Fever was the commonest presenting symptoms. Fever lasting for 7 days or more was observed in one-fifth of patients. Respiratory tract diseases (upper and lower) were the most frequent non-neurological diagnosis. Febrile convulsion was the complication observed in 27.6% of admission. One patient died as a result of acute necrotising encephalopathy.
Influenza contributed to heavy health-care burden. Mortality was rare but did occur. Hospitalisations occurred in both healthy children and those with underlying chronic illness. Young children played an important role in such hospitalisations. Means to prevent influenza-associated morbidity and mortality especially among young children are needed.
No preview · Article · Nov 2009 · Journal of Paediatrics and Child Health
[Show abstract][Hide abstract] ABSTRACT: Using polymerase chain reactions, this study aimed to evaluate the incidence of neonatal chlamydial conjunctivitis in our region of Hong Kong and explore any association between such conjunctivitis and nasopharyngeal colonisation with Chlamydia trachomatis.
Prospective epidemiological study.
Regional hospital, Hong Kong.
Consecutive patients with neonatal conjunctivitis presenting to our hospital were recruited from May 2004 to April 2005 inclusive. Both eyes were investigated separately for Chlamydia trachomatis by polymerase chain reaction, direct immunofluorescent assay, and cell culture by two assigned ophthalmologists. Neonates diagnosed to have ocular Chlamydia trachomatis infection were subjected to additional nasopharyngeal investigations. Complete sets of ocular and nasopharyngeal investigations were also undertaken 1 week after oral erythromycin treatment to confirm complete eradication of Chlamydia trachomatis.
Of 192 patients with neonatal conjunctivitis, 24 were diagnosed to have chlamydial conjunctivitis. Fifteen of them had nasopharyngeal colonisation with Chlamydia trachomatis. Among the 20 neonatal chlamydial conjunctivitis patients that completed the follow-up study, one suffered treatment failure. None had clinically diagnosed systemic Chlamydia trachomatis infection 3 months after oral erythromycin.
The incidence of neonatal chlamydial conjunctivitis in our region of Hong Kong was 4 in 1000 live births, of whom 63% had nasopharyngeal presence of Chlamydia trachomatis. Owing to the high rate of nasopharyngeal isolation and possibility of treatment failure, post-treatment ocular and nasopharyngeal polymerase chain reaction testing for Chlamydia trachomatis may be considered to confirm complete eradication.
Preview · Article · Mar 2007 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
[Show abstract][Hide abstract] ABSTRACT: We report two cases of newborn death and two cases of near-miss newborn death. One neonate was strangled to death after delivery in the hospital and one died from lethal congenital malformations. The third was found on the verge of death after being abandoned in a dumpster. The fourth was rescued from the toilet bowl by the mother's boyfriend while the mother was in a state of panic. In the three cases where the infants' maternal identities were known, the women were all primiparous and aged 22, 13, and 17 years. The paternity was extramarital, incestuous, and concealed, respectively. Denial or concealment of pregnancy was present in all cases, but none of the women had any overt psychiatric manifestations at the time of delivery. Neonaticide and newborn abandonment are closely associated with denial of pregnancy, and are serious forms of childhood victimisation. Their occurrence in Hong Kong is poorly understood and no representative figures are available. A concerted effort among the health care, social work, and judicial professionals is needed to define the scope of the problem and devise preventive measures.
Preview · Article · Mar 2006 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
[Show abstract][Hide abstract] ABSTRACT: To review the bacteriological causes and clinical features of acute neonatal conjunctivitis in a local paediatric centre.
Paediatric unit of a regional hospital, Hong Kong.
All neonates who presented to Tuen Mun Hospital from 1 January 1996 to 31 December 2002 with persistent eye discharge and a positive eye swab culture.
Clinical features of neonates with chlamydial and non-chlamydial conjunctivitis.
Of 90 neonates with positive eye swab or conjunctival scraping cultures, Chlamydia trachomatis was the second most common (n=19, 21%) cause of acute neonatal conjunctivitis after Staphylococcus aureus (n=32, 36%). All of the neonates with chlamydial conjunctivitis were delivered vaginally: two of them had concomitant chlamydial pneumonia. Neisseria gonorrhoeae conjunctivitis was rare (n=1, 1%). None of the mothers of neonates with Chlamydia had any history of sexually transmitted disease. The timing of presentation, gestational age, birth weight, and sex of the neonates did not suggest a risk of chlamydial infection. Nonetheless haemorrhagic eye discharge had a specificity of 100% and positive predictive value of 100% for chlamydial infection. There were no adverse ophthalmological consequences or complications of pyloric stenosis in any neonate following treatment with oral erythromycin.
Haemorrhagic eye discharge is a highly specific sign of neonatal chlamydial conjunctivitis. Early and prompt treatment with oral erythromycin is safe and effective.
Preview · Article · Mar 2006 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
[Show abstract][Hide abstract] ABSTRACT: We evaluated early diffusion-weighted imaging findings, the quantitative apparent diffusion coefficient, and magnetic resonance spectroscopy (the presence of lactate and ratios of N-acetylaspartate to total creatine and choline to total creatine) in the prediction of the 18-month neuromotor outcome of term newborns with hypoxic-ischemic encephalopathy. Conventional T1- and T2-weighted and diffusion-weighted imaging was performed in 20 asphyxiated term newborns, with additional basal ganglia magnetic resonance spectroscopy in 15 newborns between 2 and 18 days of life (mean 7.3 days). Neuromotor outcome was dichotomized into normal and abnormal for statistical analysis. Statistically significant differences in the ratios of N-acetylaspartate to total creatine, but not apparent diffusion coefficient values and ratios of choline to total creatine, were found between infants with a normal and an abnormal outcome (Mann-Whitney U-test, P = .010). There was a significant association between the presence of a lactate peak and an abnormal outcome (chi-square test, P = .017). The presence of a lactate peak for predicting an abnormal outcome had a sensitivity of 100% and a specificity of 80%, and the odds ratio was 37.4. Ischemic lesions were more conspicuous and/or extensive on diffusion-weighted imaging in all except one neonate. The presence of normal findings on both diffusion-weighted imaging and conventional magnetic resonance imaging is predictive of a normal neuromotor outcome, whereas lactate and a reduced ratio of N-acetylaspartate to total creatine in the basal ganglia, but not an apparent diffusion coefficient, are associated with an abnormal outcome at 18 months of age.
No preview · Article · Dec 2004 · Journal of Child Neurology