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Infanticide in Malaysia: two case reports and a review of literature

Ong BB, Green M

Am J Forensic Med Pathol, 2003 Mar;24(1):64-9.
PMID: 12605001

In a strict and conservative society like Malaysia, the number of cases of infanticide has continued to occur. The authors present two typical cases of infanticide in Malaysia. Case 1 concerned a body of a fully mature newborn fetus disposed in a rubbish bin. The head was traumatically amputated by the rubbish truck's compactor. The umbilical cord was still attached to the body, with no reddening around the insertion. The severed neck showed features consistent with post-mortem amputation. The significant finding was expanded crepitant lungs, which floated in water. The histology of the lungs showed expanded alveoli. It was concluded that the baby had been born alive, but no cause of death could be elicited. Case 2 concerned a decomposed mature newborn found in a scrub forest. The internal organs showed advanced putrefaction, the lungs being collapsed, congested, and hemorrhagic, typical of decomposed lungs. No conclusion could be made about the state of birth or the cause of death because of the putrefied state of the body. The two cases illustrate the typical cases and problems faced by pathologists locally and probably elsewhere in the world. Most of the bodies are found in a putrefied state. Pathologists have to ascertain not only maturity and live birth but also the cause of death, which may be very subtle or masked by putrefaction. The problems of diagnosis of live birth are discussed.

Matched MeSH terms: Infant, Newborn
Fulltext Enzyme replacement therapy for Gaucher Disease: the only experience in Malaysia

Chan LL, Lin HP

Med J Malaysia, 2002 Sep;57(3):348-52.
PMID: 12440275 MyJurnal

Gaucher Disease may now be treated with enzyme replacement therapy (ERT) or bone marrow transplantation (BMT). Both have their advantages and disadvantages. Results with BMT are curative when successful but limited by the scarcity of an appropriate donor. ERT offers very good relief of symptoms but treatment is lifelong and cost of treatment exorbitant. Patients in developing countries are particularly disadvantaged and management remains a dilemma for both doctor and patient.

Matched MeSH terms: Infant, Newborn
Fulltext Pattern of congenital heart disease and access to tertiary cardiac care in Malaysia

Hung LC, Mohan AJ, Soo TL, Ng HP

Med J Malaysia, 2000 Dec;55(4):424-32.
PMID: 11221153

This prospective, descriptive study was carried out to determine the pattern and the type of congenital heart disease seen in the Paediatric Departments in 4 government hospitals. The accessibility of surgical or transcatheter interventional treatment was also assessed. Consecutive new patients seen for suspected congenital heart disease from 1/1/95 till 31/12/95 (Group I) were registered. Records of patients seen from 1/1/95 to 31/8/95 (Group Ia) were reviewed 6 months after presentation to determine the nature of treatment received. Group II were cardiac patients who were first seen prior to the year 1995 and had undergone cardiac surgery or transcatheter interventional procedures in 1995. Of the 375 patients registered in the 4 hospitals, 250 were new patients and 125 were patients first seen prior to 1995 and had surgery or transcatheter interventional procedures in 1995. Of the 250 new patients, 83.2% had acyanotic cardiac lesions and 16.8% had cyanotic lesions. Ventricular septal defect was the commonest lesion, constituting 37.2%, followed by patent arterial duct (18.8%) and atrial septal defects (9.6%). At 6 month review, access to close-heart surgery or transcatheter interventional treatment were readily available. However, for patients with ventricular septal defects, 42.1% who required closure were still waiting for surgery 6 months after presentation. Of the 4 patients with Fallot's Tetralogy who required surgery, 2 had modified Blalock-Taussig shunt and 2 were awaiting surgery. In 1995, a total of 204 cardiac procedures were performed, there were 114 (55.9%) open heart procedures, 50 (24.5%) surgical ligation of the arterial duct, 28 (13.7%) modified Blalock-Taussig shunts, 11 (5.4%) transcatheter duct occlusion and 1 (0.5%) balloon valvuloplasty. The mean age of Fallot's Tetralogy repair was 6.4 years. No corrective surgery was performed for patients with complex cardiac lesions from the 4 hospitals in 1995. In conclusion, the pattern of congenital heart disease was similar to that seen world wide. Except for patent arterial duct, access to surgical treatment was inadequate.

Matched MeSH terms: Infant, Newborn
Fulltext Characteristics of Malaysian infants with biliary atresia and neonatal hepatitis

Karnameedi S, Lim CT

Med J Malaysia, 1997 Dec;52(4):342-7.
PMID: 10968111

Cholestatic disorders of infancy (viz neonatal hepatitis and biliary atresia) have not been well studied in Malaysia. In a retrospective study in the Department of Paediatrics, University Hospital, Kuala Lumpur from January 1982 through December 1991, a total of ninety-three infants with such conditions were identified: 35 (38%) had biliary atresia, 58 (62%) neonatal hepatitis. There was a statistically significant male preponderance in the neonatal hepatitis group (P = 0.020). There was no significant difference in the racial distribution and in the proportions of low birthweight infants between the two groups of disorders. When the biliary atresia group was compared with the neonatal hepatitis group, significant differences were observed in the age of presentation (mean +/- SD) 9.8 +/- 6.8 VS 20 +/- 17.3 weeks (P < 0.001), proportion of infants with prolonged jaundice (> seven weeks) 28/35 (80%) VS 20/58 (34.5%) (P < 0.00001), occurrence of alcoholic stools 26/35 (74.3%) VS 27/58 (46.6%) (P = 0.020), liver size (mean +/- SD): 4.3 (1.6 cm VS 3.3 +/- 1.8 cm (P < 0.01) and splenic size: 2.5 (1.8 cm VS 1.4 (1.2 cm (P < 0.001). There was however considerable overlap between the two groups in these features at presentation, making clinical differentiation between the two conditions difficult. Infants with cholestasis tended to present late, compromising the chance of survival. In order to improve the medical care of these patients, these conditions must be emphasised during the training of medical practitioners, and efforts to increase public awareness of these conditions must be created.

Matched MeSH terms: Infant, Newborn
Viral aetiology of lower respiratory tract infection in young Malaysian children

Chan PW, Goh AY, Chua KB, Kharullah NS, Hooi PS

J Paediatr Child Health, 1999 Jun;35(3):287-90.
PMID: 10404452

OBJECTIVE: To study the viral aetiology of lower respiratory tract infection (LRTI) in young Malaysian children.
METHODOLOGY: A retrospective review was performed of LRTI patients aged less than 24 months who were admitted to the University Malaya Medical Centre between 1982 and 1997. Respiratory viruses in their nasopharyngeal secretion were identified by indirect immunofluorescence, viral culture, or both.
RESULTS: A total of 5691 children were included in the study. The mean age was 8.6 +/- 6.6 months and the M:F ratio was 1.6:1. The most common diagnosis was pneumonia (52%) followed by bronchiolitis (45%) and croup (2%). Positive viral isolation rate was 22.0%. Respiratory syncytial virus (RSV) was the commonest virus isolated (84%), followed by parainfluenza virus (8%), influenza virus (6%) and adenovirus (2%). Patients with positive virus isolation were younger (7.8 +/- 6.2 vs 8.7 +/- 6.7 months, P = 0.0001) and were more likely to have bronchiolitis.
CONCLUSION: Young Malaysian children admitted with LRTI had a 22% viral isolation rate and RSV was the commonest virus isolated.

Matched MeSH terms: Infant, Newborn
Chronic diarrhoea in infants and young children: causes, clinical features and outcome

Lee WS, Boey CC

J Paediatr Child Health, 1999 Jun;35(3):260-3.
PMID: 10404446

OBJECTIVES: To review the causes, clinical features and outcomes of Malaysian children who had chronic diarrhoea.
METHODOLOGY: A prospective study was performed on children with diarrhoea of more than 14 days' duration who were managed at the Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur from 1 January 1996 to 31 December 1997.
RESULTS: Twenty-seven patients (14 boys and 13 girls) were studied. The median age of onset of diarrhoea was 6 months and the mean duration of symptoms before referral was 66.5 days. The underlying causes of diarrhoea were found to be: (i) prolonged diarrhoea due to well-defined entities (intestinal lymphangiectasia, two cases; congenital glucose-galactose malabsorption, one case; post-small bowel resection, one case; (ii) postenteritis diarrhoea (cow's milk protein intolerance, eight cases; secondary lactose intolerance, four cases; transient monosaccharide intolerance, one case; (iii) gastrointestinal infections (nontyphoid Salmonella gastroenteritis, three cases; trichuriasis, two cases; amoebiasis, one case; adenovirus, one case; (iv) cases in which a firm diagnosis could not be established (three cases). The mean duration of hospital admission was 63 days. Sixteen cases required a change in diet, while nine cases required total parenteral nutrition. One death occurred.
CONCLUSIONS: Chronic childhood diarrhoea in Malaysia had a variety of aetiologies. A specific diagnosis could be established in 90% of cases. Making a diagnosis was important because this led to appropriate therapy and a good outcome in 96% of cases.

Matched MeSH terms: Infant, Newborn
Practical aims to maintain neonatal resuscitation skills

Tudehope DI, Osuch M

J Paediatr Child Health, 2001 Apr;37(2):103-4.
PMID: 11328460
Matched MeSH terms: Infant, Newborn
Fulltext Use of Wigglesworth pathophysiological classification for perinatal mortality in Malaysia

Amar HSS, Abdul Hamid M, Wong SL

Arch. Dis. Child. Fetal Neonatal Ed., 1996 Jan;74(1):F56-9.
PMID: 8653438

A one year prospective study of perinatal deaths was conducted to test the feasibility of using the Wigglesworth pathophysiological classification in the Malaysian health service. Four regions with high perinatal mortality rates were selected. Deaths were actively identified. Nursing staff were trained to use the classification and every death was reviewed by a clinician. A total of 26,198 births and 482 perinatal deaths were reported. The perinatal mortality rate was 18.4. Only 14 (2.9%) deaths had their Wigglesworth category reclassified. Most deaths were in the normally formed macerated stillbirths (34.4%), asphyxial conditions (26.8%), and immaturity (20.1%) subgroups. The results were compared with data from other countries that used this classification. This study has shown that the Wigglesworth pathophysiological classification can be applied to perinatal deaths in the existing Malaysian health service.

Matched MeSH terms: Infant, Newborn
Fulltext Alpha-1-antitrypsin deficiency in babies with prolonged jaundice

Zakiah I, Zaini AR, Jamilah B, Zawiah A

Malays J Pathol, 1992 Dec;14(2):91-4.
PMID: 1304630

Over a three-year-period, 310 babies with prolonged jaundice admitted to GHKL were studied, to determine the incidence of alpha-1-antitrypsin deficiency as a cause of the problem. Ninety-two babies (29.7%) were found to be alpha-1-antitrypsin deficient. The percentage incidence was found to be highest in Indians (33.3%), followed by Malays (31.9%) and Chinese (26.7%). There was a male preponderance with a M:F ratio of 1.6:1. Most of these babies presented at the hospital at the age of more than two weeks but less than one month. Apart from the problem of prolonged jaundice and alpha-1-antitrypsin deficiency, 2 had associated bleeding problems, 11 associated infections and 3 respiratory problems. Two babies had clinical features of Down's syndrome, 2 had G6PD deficiency and 1 had congenital hypothyroidism. AST, ALT and ALPO4 were high in 20, 26 and 3 babies respectively.

Matched MeSH terms: Infant, Newborn
Fulltext Infant feeding practices and attitudes of mothers in Kelantan towards breastfeeding

Yusof YA, Mazlan M, Ibrahim N, Jusoh NM

Med J Malaysia, 1995 Jun;50(2):150-5.
PMID: 7565185

The incidence of breastfeeding among 96 mothers (88/96 were Malays) who were attending various clinics at Universiti Sains Malaysia Hospital and Kota Bharu General Hospital was about 95%. The feeding patterns show that about 72% of mothers gave mixed feedings (breastmilk plus infant formula) while only 30% gave exclusive breastmilk to their infants in the first six months. Two main reasons for giving mixed feedings were that mothers had to start working soon after giving birth and reported "insufficient milk". Mixed feedings were seen to be more prevalent in the higher income group mothers (> RM1000 per month). About 64% of them who breastfed their child continued to do so beyond 6 months. Regarding their knowledge on breastfeeding, most mothers (98%) knew that breastmilk is good for baby's health, economical, strengthens bonding between mother and child, and was sufficient for the sustenance of the baby. However, when asked about colostrum, 66% of mothers who breastfed their child threw away the colostrum before feeding; some of the reasons given were that colostrum is dirty, and not suitable for the baby's health and it might cause some diseases.

Matched MeSH terms: Infant, Newborn
Fulltext Severe and fatal postoperative bronchospasm in a child with a pulmonary artery sling

Norzila MZ, Azizi BH, Mazeni A, Ahmad S, Devadass P, Lokman S

Med J Malaysia, 1994 Jun;49(2):182-4.
PMID: 8090102

We report a case of left pulmonary artery sling in a child who also had duodenal atresia. He was admitted for respiratory failure requiring prolonged respiratory support due to a bronchiolitis-like illness at two months of age. Diagnostic procedures confirmed the presence of left pulmonary artery sling. He had a corrective procedure which relieved the compression. However postoperatively he had intermittent episodes of severe bronchospasm in addition to a persistent airway obstruction. Finally one such episode of severe bronchospasm did not respond to medical and resuscitative therapy and the baby succumbed. To our knowledge no case of left pulmonary artery sling has been described previously in a Malaysian child. This case also highlights the postoperative airway problems that may be encountered.

Matched MeSH terms: Infant, Newborn
Fulltext Low birth weight incidence in Lundu, Sarawak

Yadav H

Med J Malaysia, 1994 Jun;49(2):164-8.
PMID: 8090096

The overall mean birth weight of the total deliveries (1986-1988) in Lundu Hospital was 2.96 kg. The mean birth weight for the male babies was 2.94 kg. The Chinese babies had a significantly higher mean birth weight (3.12 kg) than the other ethnic groups (p < 0.05). The overall incidence of low birth weight (LBW) in this study was 11.84 per cent. The Chinese again had a lower incidence of LBW of 6.73 per cent compared to Ibans who had the highest incidence of LBW, 13.59 per cent, with the Bidayuhs 12.97 per cent and Malays, 12.45 per cent. It was also noticed that of the 14.9 per cent preterm deliveries, 37.5 per cent were LBW. The very young mothers (15-19 years) and older mothers (> 40 years) seem to have a higher incidence of LBW. Mothers who had medical conditions like anaemia, hypertension, pre-eclampsia also had a higher incidence of LBW when compared to mothers who did not have a medical condition. Special emphasis should be given to mothers who have medical conditions, and to very young and very old mothers during antenatal care, to prevent incidence of LBW.
Comment in: Chia CP. Low birth weight babies. Med J Malaysia. 1995 Mar;50(1):120

Matched MeSH terms: Infant, Newborn
Fulltext Paediatric day care anaesthesia--our first two years experience at the Paediatric Institute, Hospital Kuala Lumpur

Lim SK, Lew YS

Med J Malaysia, 1997 Jun;52(2):151-4.
PMID: 10968073

The first two years anaesthetic experience of paediatric day care surgery is reviewed. Four hundred and three patients underwent 447 general surgical procedures. The mean age of the patients was 5.4 years with the youngest being 5 months old. The commonest procedures performed were herniotomy, circumcision, correction of hydrocoele and orchidopexy. The overall postoperative admission rare was 2.5%. No major complications were seen. Anaesthesia for paediatric day care surgery is safe provided patients are carefully selected and evaluated, appropriate anaesthetic management instituted and proper discharge criteria adhered to.

Matched MeSH terms: Infant, Newborn
Fulltext Teronac and teratogenecity

Rachagan SP

Med J Malaysia, 1993 Jun;48(2):250.
PMID: 8350808
Matched MeSH terms: Infant, Newborn
Bilateral ovarian cysts in a newborn: a case report

Lim CT, Wong KK, Yap YF, Sivanesaratnam V

Asia Oceania J Obstet Gynaecol, 1992 Mar;18(1):19-22.
PMID: 1627057

Large ovarian cysts in the fetus are uncommon. Ultrasonography has helped in the detection of these cysts antenatally and in the newborn female infant. A case of bilateral ovarian cysts in a newborn is presented. The choice of management between conservative measures and surgical approaches remains controversial.

Matched MeSH terms: Infant, Newborn
Neonatal meningitis and septicaemia caused by Burkholderia pseudomallei

Halder D, Zainal N, Wah CM, Haq JA

Ann Trop Paediatr, 1998 Jun;18(2):161-4.
PMID: 9924578

We report a case of meningitis and one of fatal septicaemia in neonates due to Burkholderia pseudomallei and review the literature on neonatal melioidosis. Pneumonia was the primary presentation and was complicated by shock in the latter case. The epidemiological findings suggest that the cases reported from Malaysia were community-acquired in contrast with those from the USA and Thailand.

Matched MeSH terms: Infant, Newborn
Vertical transmission of dengue

Chye JK, Lim CT, Ng KB, Lim JM, George R, Lam SK

Clin Infect Dis, 1997 Dec;25(6):1374-7.
PMID: 9431381

Dengue, an important mosquito-borne flavivirus infection, is endemic in Southeast Asia. We describe two mothers who had acute dengue 4 and 8 days before the births of their infants. One mother had worsening of her proteinuric pregnancy-induced hypertension, liver dysfunction, and coagulopathy and required multiple transfusions of whole blood, platelets, and fresh frozen plasma. Her male infant was ill at birth, developed respiratory distress and a large uncontrollable left intracerebral hemorrhage, and died of multiorgan failure on day 6 of life. Dengue virus type 2 was isolated from the infant's blood, and IgM antibody specific to dengue virus was detected in the mother's blood. The second mother had a milder clinical course; she gave birth to a female infant who was thrombocytopenic at birth and had an uneventful hospitalization. Dengue virus type 2 was recovered from the mother's blood, and IgM antibody specific to dengue virus was detected in the infant's blood. This report highlights not only the apparently rare occurrence of vertical transmission of dengue virus in humans but also the potential risk of death for infected neonates.

Matched MeSH terms: Infant, Newborn
Undescended testes: incidence in 1,002 consecutive male infants and outcome at 1 year of age

Thong M, Lim C, Fatimah H

Pediatr Surg Int, 1998 Jan;13(1):37-41.
PMID: 9391202 DOI: 10.1007/s003830050239

In a study of 1,002 consecutive Malaysian male newborns, 48 (4.8%) were found to have undescended testes (UDT). The rate and laterality of the UDT were associated with lower birth weight (P < 0.001) and prematurity (P < 0.001). Boys with UDT were also more likely to have other congenital abnormalities of the external genitalia, the commonest being hydrocele. No correlation between UDT and maternal age, birth order, social class, or mode of delivery was demonstrated in this study. Although 26/34 (76.5%) of UDT achieved full spontaneous descent by 1 year of age, 1.1% of all infants whose testes remained undescended required regular long-term follow-up with surgical referral and correction at an appropriate time. A premature infant with UDT is more likely to achieve full testicular descent at 1 year of age than a term infant.
Study site: University Hospital, Kuala Lumpur, Malaysia (University Malaya Medical Centre)

Matched MeSH terms: Infant, Newborn
Child mortality in Malaysia: explaining ethnic differences and the recent decline

Panis CW, Lillard LA

Popul Stud (Camb), 1995 Nov;49(3):463-79.
PMID: 11608959

Infant and child mortality rates have dropped sharply for all ethnic groups in Malaysia between 1950 and 1988, but persistent ethnic differences remain. In this article we assess the contribution of several potential reasons both for the decline and the remaining differences between the Malay and Chinese sub-populations. Increased use of health inputs is found to explain a substantial part of the decline, but increased education of mothers, and income growth are also important. Longer spacing between births, and, higher average age at birth as a result of lower fertility and higher age at marriage provide only a marginal direct contribution to the fall in mortality. We find that lower mortality among the Chinese is accounted for by their higher incomes and greater propensty to purchase medical care. We also control for self-selection among users of medical care, and find that those who use health care in Malaysia tend to be subject to higher-than-average risks.

Matched MeSH terms: Infant, Newborn
Congenital lobar emphysema: a case with bronchial septum

Saim L, Mohamad AS, Ambu VK

Int J Pediatr Otorhinolaryngol, 1994 Jan;28(2-3):241-6.
PMID: 8157425

Congenital lobar emphysema has been described under various designations. Although the etiology is not clear, some form of bronchial obstruction has been documented in about 50% of the patients. A rare case of congenital lobar emphysema with a membranous septum in the left main bronchus is described. Although prompt lobectomy has been the treatment of choice in most cases, this case demonstrates the importance of early bronchoscopy to exclude treatable intra luminal abnormalities.

Matched MeSH terms: Infant, Newborn

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