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Risk factors associated with neonatal hypothermia during cleaning of newborn infants in labour rooms

Cheah FC, Boo NY

J Trop Pediatr, 2000 Feb;46(1):46-50.
PMID: 10730042

Cleaning newborn infants with coconut oil shortly after birth is a common practice in Malaysian labour rooms. This study aimed: (1) to determine whether this practice was associated with a significant decrease in the core temperature of infants; and (2) to identify significant risk factors associated with neonatal hypothermia. The core temperature of 227 randomly selected normal-term infants immediately before and after cleaning in labour rooms was measured with an infrared tympanic thermometer inserted into their left ears. Their mean post-cleaning body temperature (36.6 degrees C, SD = 1.0) was significantly lower than their mean pre-cleaning temperature (37.1 degrees C, SD = 1.0; p < 0.001). Logistic regression analysis showed that the risk factors significantly associated with pre-cleaning hypothermia (< 36.5 degrees C) were: (1) not being placed under radiant warmer before cleaning p = 0.03); and (2) lower labour room temperature (p < 0.001). Logistic regression analysis also showed that the risk factors significantly associated with post-cleaning hypothermia were: (1) lower labour room temperature (p < 0.001); (2) lower pre-cleaning body temperature (p < 0.001); and (3) longer duration of cleaning (p = 0.002). In conclusion, to prevent neonatal hypothermia, labour room temperature should be set at a higher level and cleaning infants in the labour room should be discouraged.
Microbiology of cerebral abscess: a four-year study in Malaysia

Pit S, Jamal F, Cheah FK

J Trop Med Hyg, 1993 Jun;96(3):191-6.
PMID: 8505776

A prospective study was carried out to determine the aetiology of cerebral abscess in relation to the primary source of infections. Seventy-five patients with cerebral abscess were included in the study in the period January 1985 to December 1988. More than half of the patients studied had single lesions and the overall most common sites were in the frontal and parietal regions. Chronic suppurative otitis media, cyanotic congenital heart diseases and meningitis were among the important predisposing conditions in these patients. Approximately 25% of the patients with cerebral abscesses had no documented antecedent infections. Pure cultures were found to be predominant (66.7%) and sterile cultures were obtained from 10 (13.3%) patients. Streptococci were isolated from 23 (30.7%) patients, the commonest species being Streptococcus milleri. Proteus sp, Pseudomonas aeruginosa, Pseudomonas putrifaciens and Bacteroides sp were almost exclusively found in cerebral abscesses secondary to chronic suppurative otitis media; these organisms were found in mixed cultures. Streptococcus milleri, Bacteroides sp and Eikenella corrodens were found in pure cultures in patients with cyanotic congenital heart disease. In patients with ventriculoperitoneal shunts in-situ, Staphylococcus aureus, Staphylococcus epidermidis and diphtheroids were common. Anaerobes were found in 15 (20.0%) patients, the majority in mixed cultures. Culture, as well as gas-liquid chromatographic analysis of volatile fatty acids of cerebral pus, was carried out to enhance the detection of the anaerobes. Based on these findings, an antibiotic regimen consisting of penicillin, chloramphenicol and metronidazole is recommended as an initial therapy while awaiting culture and sensitivity results.
Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates

Kamala F, Boo NY, Cheah FC, Birinder K

Acta Paediatr, 2002;91(12):1350-6.
PMID: 12578294

AIM: To determine whether the addition of heparin to total parenteral nutrition (TPN) fluid would prevent blockage of peripherally inserted central catheters (PICCs) in neonates.
METHODS: This was a randomized, double-blind, controlled study of 66 eligible neonates with PICCs inserted for the administration of TPN. Infants were randomized to receive TPN containing either 1 IU ml(-1) of heparin (n = 35) or no heparin (n = 31).
RESULTS: There was no significant difference in the incidence of blocked catheters between the two groups of infants (heparin: 14.3%; no-heparin: 22.6%, p = 0.4). Although a higher percentage (62.9%) of infants in the heparin group received a complete course of TPN successfully via PICC than those in the no-heparin group (48.4%), the difference was not statistically significant (p = 0.3). There were no significant differences in the incidence of catheter-related sepsis, hypertriglyceridaemia, hyperbilirubinaemia, coagulopathy or intraventricular haemorrhage between the two groups.
CONCLUSION: Addition of heparin to TPN fluid was not associated with a significant reduction in the incidence of blocked PICCs. However, the sample size of this study was too small to exclude even rather marked differences between the groups.
Fulltext Experience with sublabial transseptal transsphenoidal hypophysectomy at the Universiti Kebangsaan Malaysia

Said H, Cheah F, Mohamed AS, Hadi AR

Med J Malaysia, 1993 Jun;48(2):222-4.
PMID: 8350800

The transseptal transsphenoidal hypophysectomy has become a relatively frequent procedure in recent years. We performed 20 such procedures between January 1984 and December 1987 for various pituitary disorders. Significant complications such as CSF rhinorrhea, meningitis, diabetes insipidus, haemorrhage and septal perforation are discussed. The mortality rate for the series was 5%. In analysing the data, we feel that this technique of hypophysectomy is a safe procedure.
Fulltext Intraperitoneal extravasation of total parental nutrition infusate from an umbilical venous catheter

Shareena I, Khu YS, Cheah FC

Singapore Med J, 2008 Feb;49(2):e35-6.
PMID: 18301823

A preterm male infant who had an umbilical venous catheter (UVC) in situ for infusion of total parenteral nutrition (TPN) subsequently developed abdominal distension. He was initially diagnosed to have necrotising enterocolitis. However, a diagnostic abdominal paracentesis yielded fluid which biochemical analysis found to be consistent with TPN. TPN is often infused through a UVC, in the first few days of life, for the nutritional support of a premature infant. Various complications have been reported to be associated with this path of delivery, one of which will be illustrated in this case report.
Use of gas liquid chromatography as an adjunct to conventional bacteriological methods in the diagnosis of anaerobic cerebral abscess

Pit S, Jamal F, Cheah FK, Abbas MA

Ann Saudi Med, 1991 Jul;11(4):424-8.
PMID: 17590760

Forty cases of cerebral abscesses were studied prospectively to establish the microbial agents implicated in these cases. Chronic otitis media (14 patients, 35%), congenital heart disease (five patients, 12.5%),a and meningitis (five patients, 12.5%) were among the important predisposing factors. Streptococcus (14 patients, 35%) was the most common causative pre-isolated, the predominant species being Streptococcus milleri (11 patients, 27.5%). Other organisms isolated included Proteus mirabilis in six patients (15%) and Staphylococcus aureus in five patients (12.5%). Anaerobes (12 patients, 30%), predominantly Bacteroides sp. (eight patients, 20%), played an important role in these cases, the majority of which were isolated in mixed cultures. Gas-liquid chromatographic analysis of pus detected the presence of anaerobes in another 11 cases of cerebral abscess, in which cultures of anaerobes were negative. Therefore, gas-liquid chromotography is useful as an adjunct to conventional bacteriological methods in providing a rapid and sensitive means of detecting anaerobes in pus obtained especially from patients who had received antibiotic therapy prior to hospitalization.
ABO incompatibility and glucose-6-phosphate dehydrogenase deficiency presenting as hydrops foetalis

Suria AA, Nurasyikin Y, Adibah AG, Cheah FC, Leong CF

Clin Ter, 2014;165(3):151-4.
PMID: 24999569 DOI: 10.7417/CT.2014.1714

ABO incompatibility and glucose-6-phosphate dehydrogenase deficiency G6PD are common haematological problems affecting the newborn. The resulting haemolytic disease of foetus and newborn (HDFN) caused by either of these pathologies generally follows a benign course. It is typically characterized by mild jaundice without significant anaemia. ABO incompatibility alone as a cause of foetal hydrops is extremely rare. We report a case of a newborn baby girl with an anti-B isoimmunisation and G6PD deficiency manifesting with hydrops foetalis, anaemia and hyperbilirubinaemia, born to a mother with blood group O.
Fulltext Tracheal agenesis: a rare cause of unsuccessful tracheal intubation during resuscitation

Iszuari M, Mazita A, Tan GC, Hayati AR, Shareena I, Cheah FC

Med J Malaysia, 2010 Dec;65(4):317-8.
PMID: 21901957

Tracheal agenesis is a rare congenital airway anomaly that usually results in a fatal outcome. The diagnosis is usually made through post-mortem examination. In the current literature, there has been no reported long-term survival although a few reports claimed prolongation of life of several hours to days. This condition is commonly associated with premature birth, polyhydramnios and a male predominance. In 90% of the cases, it is associated with multiple cardiovascular, gastrointestinal and genitourinary tract anomalies which are incompatible with life. We report a case of a premature newborn with severe respiratory distress, absent cry and cyanosis soon after birth. Attempts at endotracheal intubation failed as it was no possible to negotiate the tube beyond the vocal cords. Needle cricothyrotomy and attempted tracheostomy also failed to secure the airway. The diagnosis was confirmed at post-mortem examination.
Spontaneous knot formation impeding the removal of a silicone urethral catheter

Mustafa NA, Lope RJ, Cheah FC

Arch. Dis. Child. Fetal Neonatal Ed., 2006 Jul;91(4):F287.
PMID: 16790731
Successful clot lysis using low dose of streptokinase in 22 neonates with aortic thromboses

Cheah FC, Boo NY, Rohana J, Yong SC

J Paediatr Child Health, 2001 Oct;37(5):479-82.
PMID: 11885713

OBJECTIVE: To determine whether intravenous infusion of low dose of streptokinase was effective in lysing umbilical arterial catheter (UAC)-associated aortic thrombi.
METHOD: A prospective cohort study of 31 consecutive newborn infants with UAC-associated aortic thrombi which were detected by abdominal ultrasonography after removal of UAC. Twenty-two infants were treated with intravenous infusion of low dose (1000 U/h) streptokinase, while nine others were not treated due to various contra-indications. Thrombolysis occurred after a mean interval of 2.2 days (standard deviation (SD) = 1.8) in the treated infants. In the untreated infants, spontaneous thrombolysis occurred significantly later, after a mean interval of 16.9 days (SD = 14.7) (95% confidence intervals of difference between mean intervals - 26.0, - 3.4; P = 0.02). Only one treated infant developed mild bleeding directly attributed to streptokinase therapy.
CONCLUSION: Low dose streptokinase infusion was effective and safe in thrombolysing UAC-associated aortic thrombi.
Gardnerella vaginalis in perinatology: An overview of the clinicopathological correlation

Wong YP, Tan GC, Wong KK, Anushia S, Cheah FC

Malays J Pathol, 2018 Dec;40(3):267-286.
PMID: 30580358

Gardnerella vaginalis (GV) is a facultatively anaerobic gram-variable bacillus and is the major organism involved in bacterial vaginosis. GV-associated bacterial vaginosis has been associated with adverse pregnancy outcomes include preterm parturition and subclinical chorioamnionitis. Inflammatory response induced by GV presents paediatric problems as well. Studies had shown that increased levels of proinflammatory cytokines include TNF-α, IL-1β and IL-6 following fetal inflammatory response syndrome secondary to GV-induced intrauterine infection may result in the development of periventricular leukomalacia and bronchopulmonary dysplasia in the infected fetus. There is increasing evidence that GV-associated BV infection serves as a risk factor for long-term neurological complications, such as cerebral palsy and learning disability. GV is fastidious and could elude conventional detection methods such as bacterial cultures. With current more sophisticated molecular biology detection methods, its role and pathogenic effects have been shown to have a greater impact on intrauterine inflammation and fetal/neonatal infection. This review gives an overview on the characteristics of GV and its virulence properties. Its detrimental role in causing unfavourable GV-related perinatal outcomes, with emphasis on the possible mechanistic pathways is discussed. The discovery of disease mechanisms allows the building of a strong platform where further research on innovative therapies can be based on, for instance, an anti-TLR monoclonal antibody as therapeutic agent to halt inflammation-precipitate adverse perinatal outcomes.
Severe acute respiratory syndrome-Coronavirus-2 infection: A review of the clinical-pathological correlations of Coronavirus disease-19 in children

Teo JTR, Abidin NH, Cheah FC

Malays J Pathol, 2020 12;42(3):349-361.
PMID: 33361715

The coronavirus disease-19 (COVID-19) has become a global pandemic of acute respiratory disease in just less than a year by the middle of 2020. This disease caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has resulted in significant mortality especially among the older age population and those with health co-morbidities. In contrast, children are relatively spared of this potentially ravaging disease that culminates in the acute respiratory distress syndrome, multi-organ failure and death. SARS-CoV-2 infection induces exuberant release of pro-inflammatory mediators, causing a "cytokine storm" and hypercoagulable states that underlie these complications. The SARS-CoV-2 infection median incubation is 5.1 days, with most developing symptoms by 11.5 days. It is highly infectious, spreading via the horizontal mode of transmission, but there is yet very limited evidence of vertical transmission to the newborn infant occurring either transplacentally or through breastfeeding. This said, various immune factors during childhood may modulate the expression of COVID-19, with the multisystem inflammatory syndrome in children (MIS-C) at the severe end of the disease spectrum. This article gives an overview of the SARS-CoV-2 infection, clinical presentation and laboratory tests of COVID-19 and correlating with the current understanding of the pathological basis of this disease in the paediatric population.
Fulltext Chylothorax after repair of congenital diaphragmatic hernia--a case report

Cheah FC, Noraida MH, Boo NY, Amin TY

Singapore Med J, 2000 Nov;41(11):548-9.
PMID: 11284614

Chylothorax is a rarely recognised post-operative complication following repair of congenital diaphragmatic hernia. We report here a newborn infant with this condition which resolved with percutaneous chest drainage, total parenteral nutrition and enteral feeding of a formula high in medium-chain triglycerides.
Fulltext A quality assurance study on the administration of medication by nurses in a neonatal intensive care unit

Raja Lope RJ, Boo NY, Rohana J, Cheah FC

Singapore Med J, 2009 Jan;50(1):68-72.
PMID: 19224087

This study aimed to determine the rates of non-adherence to standard steps of medication administration and medication administration errors committed by registered nurses in a neonatal intensive care unit before and after intervention.
Fulltext The role of serum insulin-like growth factor I (IGF-I) in neonatal outcome

Hayati AR, Cheah FC, Yong JF, Tan AE, Norizah WM

J Clin Pathol, 2004 Dec;57(12):1299-301.
PMID: 15563671

AIMS: To determine the role of serum insulin-like growth factor I (IGF-I) in predicting the occurrence of septal hypertrophic cardiomyopathy in infants of mothers with diabetes.
METHODS/MATERIALS: In this prospective study, 100 pregnant women (50 with diabetes and 50 controls), matched for age and race, were studied. One intrapartum blood sample was taken at 28 weeks of gestation from both groups of mothers and another sample at delivery. All samples were analysed for maternal IGF-I by an enzyme linked immunosorbent assay method. A chest radiograph and an electrocardiogram were performed on the babies of the mothers with diabetes within the first 24 hours of life. An echocardiogram was performed in the first 3 days of life to look for septal hypertrophy and to measure the myocardial thickness.
RESULTS: In the six cases of neonatal septal hypertrophic cardiomyopathy, all the mothers had greatly raised IGF-I concentrations of more than 400 ng/ml at the time of delivery compared with a mean (SD) of 302 (25) ng/ml in control mothers.
CONCLUSIONS: In the present study a crude analysis revealed that increased IGF-I concentrations correlate with neonatal septal hypertrophic cardiomyopathy.
Study site: Obstetric and gynaecology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Obtaining assent for research involving children in Malaysia: a position statement from the Academy of Medicine of Malaysia College of Paediatrics

Khoo EJ, Zilfalil BA, Thong MK, Yong SC, Chee SC, Lee JK, et al.

Med J Malaysia, 2024 Jul;79(4):494-497.
PMID: 39086351

The Academy of Medicine of Malaysia College of Paediatrics acknowledges the role of children in research and this position statement explores the ethical considerations in obtaining assent from minors in the Malaysian context. It highlights the importance in respecting children's agency and navigating cultural complexities. The College proposes flexibility in the minimum age for assent of at least nine years old, while emphasising the need for a tailored assent procedure. Addressing language and cultural diversities and expanding local empirical research on a formal assent process are some building blocks in developing a standardised nationwide process in obtaining assent from children.
Genotyping of Malaysian G6PD-deficient neonates by reverse dot blot flow-through hybridisation

Alina MF, Azma RZ, Norunaluwar J, Azlin I, Darnina AJ, Cheah FC, et al.

J Hum Genet, 2020 Mar;65(3):263-270.
PMID: 31863082 DOI: 10.1038/s10038-019-0700-7

G6PD deficiency is the commonest enzyme deficiency found in humans. Current diagnostic methods lack sensitivity to detect all cases of G6PD deficiency. We evaluated the reverse dot blot flow-through hybridisation assay designed to detect simultaneously multiple known G6PD mutations in a group of Malaysian neonates. Archival DNA samples from 141 G6PD-deficient neonates were subjected to reverse dot blot flow-through hybridisation assay using the GenoArray Diagnostic Kit (Hybribio Limited, Hong Kong) and DNA sequencing. The method involved PCR amplification of 5 G6PD exons using biotinylated primers, hybridisation of amplicons to a membrane containing oligoprobes designed for G6PD mutations known to occur in the Malaysian population and colour detection by enzyme immunoassay. The assay detected 13 of the 14 G6PD mutations and genotyped 133 (94.3%) out of 141 (102 males, 39 females) cases. Among the 39 female G6PD-deficient neonates, there were 7 homozygous and 6 compound heterozygous cases. The commonest alleles were G6PD Viangchan 871G > A (21%) and G6PD Mahidol 487G > A(20%) followed by G6PD Mediterranean 563C > T, (14%), G6PD Vanua Lava 383T > C (12%), G6PD Canton 1376G > T (10%), G6PD Orissa 131C > G (6.3%) G6PD Coimbra 592C > T (5.6%) plus 6 other mutations. DNA sequencing of remaining cases revealed 6 cases of intron 11 nt 93C > T not previously reported in Malaysia and two novel mutations, one case each of nt 1361G > T and nt 1030G > A. We found the reverse dot blot assay easy to perform, rapid, accurate and reproducible, potentially becoming an improved diagnostic test for G6PD deficiency.
Correction to 'Genotyping of Malaysian G6PD-deficient neonates by reverse dot blot flow-through hybridisation'

Alina MF, Azma RZ, Norunaluwar J, Azlin I, Darnina AJ, Cheah FC, et al.

J Hum Genet, 2020 07;65(7):635.
PMID: 32385338 DOI: 10.1038/s10038-020-0766-2

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

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