Kawasaki disease in Hong Kong, 1994 to 2000.

OBJECTIVE: To describe the epidemiology, clinical characteristics, and management of Kawasaki disease in children in Hong Kong. DESIGN: Retrospective survey of medical records from July 1994 to June 1997, and prospective data collection from July 1997 to June 2000. SETTING: Hospitals with a paediatric unit in Hong Kong. PATIENTS: Patients diagnosed with Kawasaki disease between July 1994 and June 2000 in public hospitals in Hong Kong. MAIN OUTCOME MEASURES: Incidence of Kawasaki disease and coronary artery aneurysm rates. RESULTS: A total of 696 cases of Kawasaki disease were reported. There were 435 (62.5%) boys and 261 (37.5%) girls giving a male to female ratio of 1.7:1. The age ranged from 1 month to 15 years 5 months with a median of 1.7 years. Infants (<1 year) constituted the largest group of patients (223, 32.0%) and overall, 638 (91.7%) were younger than 5 years. Skin rash, conjunctivitis, and oral signs were among the principal clinical features present in over 80% of cases. Prominent cervical lymph nodes larger than 1.5 cm were less commonly found (24%). Coronary artery aneurysms or ectasia were present in 15.7% (109/696), 8.5% (59/696), and 5.0% (35/696) of patients at 2, 4, and 8 weeks, respectively. The incidence of Kawasaki disease per 100,000 children under 5 years was significantly higher in the prospective study period than in the retrospective period (39 vs 26, P<0.001). CONCLUSION: The incidence of Kawasaki disease is high in Hong Kong and is 39 per 100,000 children below 5 years of age. The coronary artery aneurysm prevalence is 5%. Intravenous gamma-globulin and high-dose aspirin is the mainstay of treatment.

Echocardiography as a tool for determining the incidence of congenital heart disease in newborn babies: a pilot study in Hong Kong.

We studied, with echocardiography as the main tool, the incidence of congenital heart disease in newborn babies in Hong Kong. The population examined was the 20,928 babies who were born alive in the Prince of Wales Hospital from January 1987 to December 1989. All had a thorough physical examination by a paediatrician after birth, and an estimated 95% of the babies who were discharged from hospital received another routine physical examination at one of the five local Maternal and Child Health Centres within two months of birth. All babies with either suspected congenital heart disease or multiple congenital abnormalities were referred to the paediatric cardiologists in the Prince of Wales Hospital for further cardiovascular assessment that included echocardiographic examination. In all, 492 babies had Doppler and cross-sectional echocardiographic studies. Various abnormalities of the cardiovascular system were diagnosed in 216 babies. Almost all the babies who died within two months of life underwent autopsy. This proved the presence of congenital cardiac malformations in 15 babies, of whom 10 had correct echocardiographic diagnoses during life. One had a patent arterial duct which was missed by the echocardiography. The other four babies did not have echocardiographic examination while alive, either because of early death or absence of clinical suspicion. In total, congenital cardiac malformations were confirmed in 221 babies by echocardiographic examination and autopsy. Excluding 82 premature babies with patency of the arterial duct, and 6 babies with transient tricuspid regurgitation, there were 133 cases of structural cardiac malformation in the studied population, giving an incidence of 6.35 per thousand live births.(ABSTRACT TRUNCATED AT 250 WORDS)

Patterns of referral to the paediatric specialist clinic of a regional hospital: descriptive study.

OBJECTIVE: To study the patterns of referral to a paediatric specialist out-patient clinic. DESIGN: Descriptive study. SETTING: Regional hospital, Hong Kong. PATIENTS: The 1985 referral letters of patients who were referred to the paediatric specialist clinic during 1998 were studied. MAIN OUTCOME MEASURES: Common referral diagnoses according to sources of referral. RESULTS: The common sources of referral were maternal and child health centres (34.7%), accident and emergency departments (26.9%), the Student Health Service (12.9%), private practitioners (10.5%), and general out-patient clinics (9.8%). The common referral diagnoses from maternal and child health centres (n=689) were growth problems (37. 7%), heart murmurs (16.8%), and neonatal jaundice (10.9%). Asthma or suspected asthma constituted the majority of referrals from accident and emergency departments (227/533; 42.6%). Deviations in growth (41. 4%), problems regarding puberty (13.7%), apparent heart problems (13. 3%), and nocturnal enuresis (11.7%) were the common referral diagnoses from the Student Health Service (n=256). CONCLUSIONS: Studying referral patterns from various sources is helpful in organising medical services and identifying training needs.

Evaluation of the accuracy of leukocyte esterase testing to detect pyuria in young febrile children: prospective study.

OBJECTIVE: To study the accuracy and clinical application of the dipstick leukocyte esterase test in the detection of pyuria in young febrile children suspected to have urinary tract infection. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Urine samples were taken from 215 children younger than 2 years who were suspected to have urinary tract infection (fever without an obvious focus of infection). MAIN OUTCOME MEASURES: The accuracy of the dipstick leukocyte esterase test in detecting significant pyuria defined as a leukocyte count >or=10 mm(3) (>or=0.01 x 10(9) /L). RESULTS: Two hundred and fifty-four urine samples collected by bag, midstream clean-catch, suprapubic bladder aspiration, or urethral catheterization were examined. Using urine microscopy results as a reference, the sensitivity and specificity of the leukocyte esterase test in detecting significant pyuria were found to be 72.0% and 85.8%, respectively; the positive and negative predictive values were 55.4% and 92.6%, respectively; and the positive and negative likelihood ratios were 5.1 and 0.3, respectively. CONCLUSIONS: The dipstick leukocyte esterase test cannot accurately detect pyuria in young febrile children. It is also not appropriate as a screening test to exclude pyuria, reduce the need for the microscopic examination of urine, or indicate when a hospital admission for probable urinary tract infection is needed.

Syncope in children and adolescents of Hong Kong.

OBJECTIVES: Syncope occurs commonly in children and adolescents. The objectives of the present study were to quantify this occurrence locally and to examine the profiles of subjects experiencing syncope. METHODOLOGY: A self-administered questionnaire was filled out by students between 6 and 17 years of age from a selected school in January 1999. RESULTS: Out of 2574 completed questionnaires, a total of 121 subjects reported having had at least one previous episode of syncope, including 9.0% of the 15-17 years age group. The overall incidence of a first syncope in the preceding 12 months was 1.7% and was highest (3.3%) in the 15-17 years age group. No significant difference in incidence was noted between sexes. Among those who experienced syncope, 32.2% had sought medical advice and 9.1% had been admitted to hospital; 57.9% became worried, while 37.2% reported restriction of daily activities because of syncope. CONCLUSION: Syncope is a common event in children and adolescents in Hong Kong. It can cause a considerable degree of anxiety and activity restriction. The impact on medical services due to syncope in Hong Kong has been substantial.

Preterm infants with patent ductus arteriosus: treatment with an enteral preparation of indomethacin.

Forty-one preterm infants with a mean gestational age and birthweight of 29.7 weeks and 1322 g, respectively, were treated with an enteral preparation of indomethacin for the closure of haemodynamically significant patent ductus arteriosus. The indomethacin was prepared by diluting the content of the commercially available 25-mg indomethacin capsule with lactose by the method of trituration. The mixture was suspended in solution form just prior to administration to the infants. The ductus arteriosus was successfully closed in 29 infants, giving an overall success rate of 71%. The response to treatment was considered satisfactory, except for infants whose birthweights were less than 750 g. Only two infants (5%) developed major complications, both in the form of ileal perforation. As the outcome of treatment with this enteral preparation of indomethacin was comparable with that of the intravenous preparation reported in previous studies, it would be an acceptable alternative to the intravenous preparation in areas where the latter is not available or considered expensive.

Use of peripheral vessels for exchange transfusion.

During a five and a half year period, exchange transfusions were performed through the peripheral vessels in 201 of the 214 infants (94%) who required either double volume or partial plasma exchange transfusions. Peripheral vessel exchange transfusion is simple, practicable, and safe with few complications. Technical difficulties in catheterizing the peripheral artery and vein may be overcome by using a 24 gauge catheter, which causes no more catheter induced haemolysis than standard umbilical catheters.

Management of a hydropic infant with congenital heart block.

A baby with congenital heart block and hydrops fetalis diagnosed prenatally was delivered at 36 weeks of gestation. Heart failure was controlled with temporary cardiac pacing which was complicated by perforation of the myocardium. She made an uneventful recovery after implantation of a permanent pacemaker. Sjögren's syndrome A antibodies were detected in her serum. Coincidentally, she also had pulmonary valvular stenosis as a structural abnormality.

Late metabolic acidosis and poor weight gain in moderately pre-term babies fed with a casein-predominant formula: a continuing need for caution.

When our neonatal unit opened in 1984 our formula feeding policy for moderately preterm babies was for casein-predominant rather than "humanized" whey-predominant milk formulae to be given. However, an early cluster of cases of late persistent metabolic acidosis prompted an investigation into the acid-base status and weight gain in preterm infants. This study of 70 healthy, moderately preterm (32-35 weeks) Chinese babies has convincingly shown that a casein-predominant low protein formula is associated with significant metabolic acidosis, persisting sometimes for as long as 8 weeks, and poor weight gain when compared with infants fed on either a humanized or a special low-birthweight formula. This is an important message for the many neonatal units in developing countries where the cost of humanized formulae might initially seem prohibitive, encouraging instead casein-predominant formulae when breast milk is not available. Any additional expense incurred in using humanized formulae will be compensated for by the shortened time spent in hospital.