Neonatal mortality in singleton pregnancies: a 20-year retrospective study from a tertiary perinatal unit in Hong Kong.

INTRODUCTION: The global neonatal death (NND) rate has been declining in recent decades, but there are no comprehensive data concerning the characteristics of NNDs in Hong Kong. This study investigated the trends and aetiologies of NNDs among singleton pregnancies in Hong Kong. METHODS: This study included all cases of NND from singleton pregnancies in a tertiary hospital in Hong Kong between 2000 and 2019. The rates, clinical characteristics, and aetiologies of NND were compared between the first (2000-2009) and the second (2010-2019) decades. RESULTS: The NND rate decreased from 1.66/1000 livebirths (97 cases) in the first decade to 1.32/1000 livebirths (87 cases) in the second decade. Congenital or genetic abnormalities (82 cases) caused 44.6% of all NNDs. There was a significant reduction from 0.82/1000 livebirths in the first decade to 0.52/1000 livebirths in the second decade (P=0.037). Other causes of NND were prematurity (69 cases; 37.5%), sepsis (16 cases; 8.7%), hypoxic-ischaemic encephalopathy (15 cases; 8.2%), and sudden infant death syndrome (2 cases; 1.1%). Gestational age-specific neonatal mortality for moderately preterm neonates (31-33 weeks of gestation) significantly decreased from 34.73/1000 in 2000-2009 to 8.63/1000 in 2010-2019 (P=0.001), but there were no significant changes in neonatal mortality for other gestations. CONCLUSION: The NND rate in Hong Kong is among the lowest worldwide. Neonatal deaths in our centre declined over the past two decades, mainly because of improvements in the prenatal diagnosis and treatment of congenital or genetic abnormalities, as well as an improved survival rate among moderately preterm neonates.

Respiratory viruses and atypical bacteria triggering severe asthma exacerbation in children.

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.

Spirometric reference standards for preschool children in Hong Kong.

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.

Practical application of using local anaesthetics: surgical perspectives.

With reduction in surgical training, surgical trainees may find it difficult deal with local anaesthetic agents because of lack of exposure and knowledge. We have summarised the common usage of local anaesthetics in various situation. The trainees need to gain competence by understanding the basics and practising them under supervision.

Human coronavirus NL63 in children: epidemiology, disease spectrum, and genetic diversity.

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.

Breakfast frequency inversely associated with BMI and body fatness in Hong Kong Chinese children aged 9-18 years.

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.

Implications of using World Health Organization growth reference (2007) for identifying growth problems in Hong Kong children aged 6 to 18 years.

OBJECTIVE: 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. DESIGN: Cross-sectional study. SETTING: Thirty-six randomly selected primary and secondary schools in Hong Kong. PARTICIPANTS: A total of 14 842 children and adolescents aged 6 to 18 years in Hong Kong during 2005/06. MAIN OUTCOME MEASURES: Creation of age-specific z-scores for height, weight, and body mass index relative to HK1993 and WHO2007 references. RESULTS: 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. CONCLUSIONS: 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.

Simple technique of selecting the correct feeding gastrostomy button.

Feeding gastrostomy is often performed in children with neurological conditions e.g. cerebral palsy or cystic fibrosis. A feeding button is often used to replace the gastrostomy tube for convenience. The button often leaks and the correct size and length is difficult to choose. The authors describe an easy and perfect way of choosing the correct size and length button by using Foley catheters.

Outcome of laparoscopy-assisted feeding tube insertion in elderly stroke victims.

BACKGROUND: When percutaneous endoscopic gastrostomy (PEG) is not possible, or fails, the patient is referred for laparoscopic gastrostomy or jejunostomy (LAG/J). METHOD: During 2005-2008, we performed laparoscopy-assisted feeding tube insertion on 15 patients. We assessed the outcome in terms of leaks, infection, longevity etc. The patients were followed-up for up to 12 months. RESULTS: The procedure was successful in 14/15 patients. However, thirteen died within little more than a year, of whom seven suffered from pneumonia or aspiration. DISCUSSION: Our study confirms that LAG/J is technically possible, carries a high morbidity, is a last ditch attempt and that it does not change the general prognosis of these debilitated patients.

Natural history and predictors for progression of mild childhood obstructive sleep apnoea.

AIMS: The natural history of mild childhood obstructive sleep apnoea (OSA) was examined and factors associated with disease progression were identified. METHODS: Subjects were recruited from an epidemiological study which examined the prevalence of OSA in Chinese children aged 6-13 years. The first 56 consecutive children identified with mild OSA (apnoea-hypopnoea index 1-5) were invited for a repeat assessment 2 years after the diagnosis. RESULTS: 45 children participated in the follow-up study, in 13 of whom (29%) the OSA was found to have worsened. Compared with those in whom OSA had not worsened, the worsened OSA group had a greater increase in waist circumference, a higher prevalence of large tonsils (occupying > or =50% of the airway) at both baseline and follow-up, and a higher prevalence of habitual snoring at both baseline and follow-up. The presence of large tonsils had a positive predictive value of 53% and a negative predictive value of 83% for worsening OSA over a 2-year period. Multivariate linear regression analysis showed that the change in obstructive apnoea-hypopnoea index was associated with age at baseline (beta (SE) = -0.92 (0.34), p = 0.009), gender (male = 1; female = 0) (beta (SE) = 4.69 (1.29), p<0.001), presence of large tonsils at baseline (beta (SE) = 4.36 (1.24), p = 0.001), change in waist circumference (beta (SE) = 0.30 (0.09), p = 0.002) and persistently large tonsils (beta (SE) = 5.69 (1.36), p<0.001) over the 2-year period. CONCLUSIONS: Mild OSA in the majority of children does not resolve spontaneously. Subjects with tonsillar hypertrophy, especially boys, should be closely monitored to allow early detection of worsening OSA. Weight control should be stressed in the management of childhood OSA.

Estimating emollient usage in patients with eczema.

BACKGROUND: Atopic eczema (AE) is characterized by reduced skin hydration (SH) and impaired integrity of the skin. Proper emollient usage is an important facet of AE management and patients are encouraged to use emollients liberally. AIM: To evaluate whether the amount of emollient and skin cleanser used correlates with eczema severity, SH or transepidermal water loss (TEWL), and whether liberal usage alters disease severity, SH and TEWL. METHODS: We studied SH and TEWL at three common measurement sites on the forearm (antecubital flexure, 20 mm below the antecubital flexure, mid-forearm) and determined the SCORing Atopic Dermatitis (SCORAD) score, Nottingham Eczema Severity Score (NESS), Children's Dermatology Life Quality Index (CDLQI) and the amount of emollient and cleanser usage over a 2-week period in consecutive new patients seen at the paediatric skin clinic of a teaching hospital. RESULTS: In total, 48 subjects and 19 controls were recruited. Patients with AE had significantly higher TEWL and lower SH in the studied sites. Emollient and cleanser usage was significantly higher (P = 0.001 and P = 0.041, respectively) in patients with AE than in controls. The amount of emollient usage was correlated with NESS, SCORAD, CDLQI, TEWL and mid-forearm SH. No such correlation was found with cleanser usage. Regardless of SCORAD, prescribing 130 g/m(2)/week of emollient met the requirement of 95.8% of patients, and 73 g/m(2)/week met that of 85.4%; for the cleanser, prescribing 136 g/m(2)/week met the requirement of 91.7% of patients. Although skin dryness and SH were improved, there was no significant improvement in SCORAD or TEWL after 2 weeks. In terms of global acceptability of treatment, three-quarters of patients with AE and controls rated the combination of cream and cleanser as 'good' or 'very good'. CONCLUSIONS: Adequate amounts of emollient and bathing cleanser should be prescribed to patients with AE. These amounts can be conveniently estimated based on body surface area instead of the less readily available tools for disease severity, degree of SH or skin integrity. However, liberal usage of emollients and bathing cleanser alone does not seem to alter disease severity or TEWL within 2 weeks, implying that additional treatments are necessary to manage AE.

Bridge vacuum-assisted closure: a novel technique of using a single vacuum machine for multiple adjacent wounds.

AIMS: To describe a simple method of applying the VAC dressing to multiple wounds. METHODS: Applying a VAC dressing using a sponge bridge to allow the simultaneous treatment of multiple wounds. RESULTS: Successful healing was achieved using this simple method. CONCLUSION: The use of a simple sponge bridge allowed the simultaneous treatment of two adjacent wounds.

Two port laparoscopic-assisted removal of a migrating rectal foreign body.

A variety of rectal foreign bodies have been documented in the English literature. They are inserted for various reasons including social pleasure. Most of them can be removed manually per ano. Here, we report a case of a big soft foreign body in the recto-sigmoid, which required the assistance of laparoscopy to enable retrieval.

Novel combination combining J-Vac and VAC sponge for draining a rectal wound.

Active drains, which work by negative pressure, require a closed space for retaining the vacuum. Here the authors describe their novel technique of combining a J-Vac drain and the sponge of a vacuum assisted closure dressing pack to drain a rectal wound. This modification may be useful for rectal wounds and anastomotic leaks.

Role of angio-embolisation in trauma--review.

BACKGROUND: Exsanguination from solid organs and from the venous system is one of the commonest causes of mortality in trauma. This review focuses on the role of angioembolisation in trauma. METHOD: A review of the literature was undertaken in PubMed and Embase databases using the key words 'angioembolisation', 'splenic injuries', liver injuries 'pelvic injuries' and 'trauma'. RESULTS: When angioembolisation (AE) is successful, patients with liver and splenic injuries can be managed nonoperatively. AE can also be used as an adjunct to damage control surgery in polytrauma patients with pelvic fractures. Patients with vertebral artery injuries in the neck leading to hypotension are also good candidates for AE. CONCLUSION: AE is very useful in managing patients with isolated spleen and liver injuries non-operatively. It can be used alone or as an adjunct to damage-control surgery in complex polytraumas and may decrease the blood loss in pelvic injuries. Whenever a trauma patient with splenic injury is treated non-operatively, subsequent splenic artery pseudoaneurysm should not be forgotten and the patient should be followed up with caution.

Catheter administered deep intestinal enema--case series.

Enemas are often used in a variety of surgical conditions. We describe the outcome of deep intestinal enema administered either through a flatus tube or a Foley catheter. Deep enemas are useful in constipation, pseudo intestinal obstruction, ileus and colonic volvulus either as an adjunct or an alternative to other procedures such as endoscopic decompression.

Filaggrin null mutations in childhood atopic dermatitis among the Chinese.

Atopic dermatitis (AD) is associated with loss or reduced expression of filaggrin (FLG). We evaluated five FLG null mutations, namely R501X, 2282del4, R2447X, S2554X, and S2889X, in 174 Chinese children with AD and 191 matched controls. 2282del4, R2447X, S2554X and S2889X mutations were not found in these patients. Heterozygous carriage of R501X was only found in four male patients, and associated with long-term disease severity. FLG mutations prevalent in Caucasian and other Asian populations are rarely found in our series.

Perirectal abscess following procedure for prolapsed haemorrhoids successfully managed with a combination of VAC sponge and Redivac systems.

Active drains, which work from negative pressure effect, are commonly used to drain closed airtight wounds. Higher negative pressure is used in vacuum assisted wound closure (VAC) (usually -125 mmHg) dressings and in Redivac system (usually -300 mmHg). As far as we know, combinations of Redivac and VAC have not been used. The authors describe a novel combination using the sponge of the VAC dressing and sealed Redivac system to drain an open rectal wound, consequence of a perforation after stapled haemorrhoidopexy.