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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 3 | Issue 2
Page Nos. 21-39

Online since Thursday, August 8, 2019

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EDITORIAL  

Diagnosis and outcomes p. 21
Chih-Yung Chiu
DOI:10.4103/2543-0343.264104  
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REVIEW ARTICLE Top

What does it mean when a child is diagnosed with pneumonia? p. 22
Miles Weinberger
DOI:10.4103/prcm.prcm_17_18  
Pneumonia is a frequent diagnosis without adequate consideration of the etiology. Pneumonia implies the presence of inflammation of the lung parenchyma with consolidation. That inflammation may be from infectious or noninfectious causes. Radiologic diagnosis of pneumonia is subject to interobserver interpretation and may misdiagnose noninflammatory radiological opacifications as pneumonia. The common diagnosis of community-acquired pneumonia in children most commonly has a viral rather than bacterial etiology. Antibiotics should be reserved for those where the clinical course, laboratory measure of biomarkers, and radiology are consistent with the diagnosis of pyogenic bacterial pneumonia.
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ORIGINAL ARTICLES Top

Clinical outcomes of critically ill infants requiring interhospital transport to a paediatric tertiary centre in Hong Kong p. 28
Karen Ka Yan Leung, So Lun Lee, Ming-Sum Rosanna Wong, Wilfred Hing-Sang Wong, Tak Cheung Yung
DOI:10.4103/prcm.prcm_6_19  
Background: Specialised transport teams are associated with fewer complications during interhospital transport. Such teams are currently unavailable in Hong Kong. The aim of this study was to review the clinical outcomes of critically ill infants requiring interhospital transport in Hong Kong. Methods: We retrospectively reviewed the characteristics and clinical outcomes of all infants transported from the neonatal units of regional or private hospitals into the neonatal or cardiac intensive care unit (ICU) of Queen Mary Hospital, a tertiary-wide academic centre in Hong Kong from 1st August 2013 to 31st July 2016. Results: A total of 256 infants with a mean gestational age of 31.7 ± 5.5 weeks and birth weight of 1732 ± 1007 g were included in the study. While 143 (55.9%) patients were intubated during transport, there was no documentation of close monitoring of physiological parameters for 91.4% of the patients. Close to half of the patients (44.1%) had complications on admission and 23.4% required significant interventions immediately after the transfer. The median length of stay in the ICU was 3.3 (range: 0.5–342.6) days. Five patients died of non-transport-related causes within 7 days of admission. Multiple logistic regression analysis showed that intubated patient (P = 0.001) or patient requiring inotropic support during transport (P = 0.027) were more likely to develop complications. Higher birth weight (P = 0.022) and younger chronological age at transfer (P = 0.030) were also significant risk factors for complications. Conclusions: Complications and interventions are considerable during interhospital neonatal transport in Hong Kong. The complication rate was higher than medical infrastructures that provided a specialised team for this process. Documentation during transport was inadequate.
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McGill oximetry score to predict risk of obstructive sleep apnea in pediatric patients p. 36
Wing-Shan Chan, Eric Yat-Tung Chan, Daniel Kwok-Keung Ng, Ka-Li Kwok, Ada Yuen-Fong Yip, Shuk-Yu Leung
DOI:10.4103/prcm.prcm_7_19  
Objective: The aim of this study is to investigate the use of overnight oximetry to predict high Apnea–Hypopnea Index (AHI) in Hong Kong children with habitual snoring. Methodology: We have retrospectively analyzed the polysomnography (PSG) of 573 patients with habitual snoring with age ranged from 6 months to 18 years old. Patients with syndromal diagnosis or neuromuscular disorders were excluded from the study. The sensitivity, specificity, positive predictive value , and negative predictive value (NPV) of oximetry to predict AHI were calculated. Results: McGill score >1 had high specificity 99.07% and low sensitivity 16.81% to detect AHI >1. SpO2 nadir <95% has high sensitivity 98.56% and NPV 97.56% to predict AHI >5. Conclusion: The use of the McGill score together with nadir SpO2 in overnight oximetry can help in stratifying the severity of obstructive sleep Apnea and thus prioritizing PSG testing.
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