INTRODUCTION: The rising rate of adolescent suicide, and the burden of self-harm and mental health disorders, pose significant threats to Singapore's future health outcomes and human potential. This study sought to examine the risk profile and healthcare utilisation patterns of Singaporean adolescents who presented to the emergency department (ED) for suicidal or self-harm behaviour. METHOD: A retrospective review of medical records for patients aged 10 to 19 years who visited Singapore's KK Women's and Children's Hospital ED for suicidal or self-harm attempts from January to December 2021 was conducted. RESULTS: A total of 221 patients were identified, with a predominance of female patients (85.5%) over males (14.5%). The mean age was 14.2 ± 1.4 years. Intentional drug overdose (52.0%) was the most commonly used method. Significantly more females presented for intentional paracetamol overdose (46.6% versus [vs] 28.1%, P=0.049), whereas jumping from a height was more common among males (18.8% vs 5.8%, P=0.022). The most frequently observed mental health challenges were stress-related and emotional coping difficulties (50.7%), followed by mood and anxiety symptoms (53.4%). A history of self-harm and suicidal behaviours were the most common psychosocial risk factors. Within the year prior to their ED presentation, 15.4% had accessed healthcare services for mild medical ailments, 19.5% for medically unexplained symptoms, and 17.2% for previous self-harm or suicide attempts. CONCLUSION Most cases involved psychosocial and emotional regulation difficulties, some of which displayed sex-specific patterns, rather than complex psychiatric disorders. The identified predictive factors can help inform Singapore's National Mental Health and Well-being Strategy, to guide targeted and transdiagnostic interventions in schools and community settings.
Humans ; Adolescent ; Singapore/epidemiology* ; Female ; Male ; Suicide, Attempted/psychology* ; Emergency Service, Hospital/statistics & numerical data* ; Self-Injurious Behavior/psychology* ; Retrospective Studies ; Child ; Young Adult ; Drug Overdose/epidemiology* ; Risk Factors ; Acetaminophen/poisoning* ; Patient Acceptance of Health Care/statistics & numerical data* ; Sex Factors

BACKGROUND AND OBJECTIVES

The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics.

A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG).

There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213).

Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.

BACKGROUND: Hospitalization in neonatal intensive care units (NICU) exposes preterm infants to adverse stimuli, including continuous 24-hour lighting. There is currently no standardized NICU layout advised for the best development of preterm neonates. This meta-analysis aimed to assess the impact of cycled light (CL) exposure on clinical outcomes in premature infants admitted to NICU as synthesized in previous studies. MATERIALS AND METHODS: This meta-analysis protocol was developed following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. A search was performed in PubMed/MEDLINE, EMBASE, Scopus, and Cochrane databases using the MeSH/key words: ―light exposure‖ AND pre-term AND cycled AND (RCT OR trials OR ―randomized controlled trial). The pooled Mean Difference with corresponding 95% CI was computed for weight gain, duration until start of enteral feeding, and duration of ICU stay using the Mantel–Haenszel random-effect model. RESULTS: Nine studies were included. The pooled mean difference showed that among preterm infants who had cycled light exposure, average daily weight gain (MD=6.24 grams, 95%CI=1.36 to 11.13, p=0.01) was significantly higher than those with continuous light exposure. The average time to start enteral feeding (MD=-3.84 days, 95%CI=-7.56 to -0.13, p=0.04) and average ICU stay (MD=-8.43 days, 95%CI=-12.54 to -4.31, p<0.0001) among neonates who had cycled light exposure were significantly shorter. CONCLUSION Benefits were seen in preterm infants when exposed to cycled light as opposed to continuous light. CL exposed infants showed a daily weight gain that was 6.24 grams higher, on average, and began enteral feeding nearly 4 days sooner. It led to a decrease in the duration of ICU stay by around 8 to 9 days on average. Further trials to determine the impact of cycled light exposure on morbidity and mortality among preterm neonates is recommended.
Human ; Male,Female ; Systematic review ; Meta-analysis ; Infant, Premature ; Intensive care units, Neonatal ; Intensive care, Neonatal ; Light ; Lighting ; Critical care

Objective:To determine the effectiveness of a one-stage hearing screening protocol in detecting hearing loss in high risk newborns at the Neonatal Intensive Care Unit of the Jose R. Reyes Memorial Medical Center.

Methods:
Design:Cross-Sectional Study
Setting:Tertiary Government Training Hospital
Population:High-risk newborns admitted at the Neonatal Intensive Care Unit of the Jose R. Reyes Memorial Medical Center from March to December 2023 underwent a one stage universal newborn hearing screening protocol. Excluded from the study were patients who were admitted for less than 48 hours, without consent from their parents or guardians and babies who were not cleared medically to undergo testing, and those who presented with aural atresia and/or any physical anomaly of the head and the external ear.

Results:A total of 169 babies were initially seen with 16 babies lost to follow up resulting in a final total of 153 babies (or 306 ears) tested. The refer and false positive rates were 9.8% and 8.92%, respectively, on average comparable to or even better than the two-step protocol in most studies. Sensitivity was determined to be 100% while specificity was 91.08%. The incidence of hearing loss in the study population was 19.8/1000, consistent with various study outcomes for high risk newborns. There was no reported incidence of auditory neuropathy in this study. The primary risk factors that were present in babies with hearing loss were: low birth weight, prematurity, neonatal intensive care unit admission of more than 5 days and exposure to ototoxic medications.

Conclusion:The one-staged Automated Auditory Brainstem Response (AABR) is an effective and efficient newborn hearing screening protocol for high-risk newborns in the Neonatal Intensive Care Unit (NICU) setting and eventually, may be considered as an alternative hearing screening technique whenever available in this cohort. More studies about improving newborn hearing screening, cost-analysis, diagnostics and interventions of hearing loss should be pursued in implementation of the Universal Hearing Screening Law in the Philippines.

INTRODUCTION: Paediatric patients admitted to the inpatient units from the emergency department (ED) are increasing, but the mean length of stay has fallen significantly. We aimed to determine the reasons behind paediatric one-day admissions in Singapore and to assess their necessity. METHODS: A retrospective study involving paediatric patients who were admitted from a general ED of an adult tertiary hospital to a paediatric tertiary hospital between 1 August 2018 and 30 April 2020. One-day admission was defined as an inpatient stay of less than 24 h from the time of admission to discharge. An unnecessary admission was defined as one with no diagnostic test ordered, intravenous medication administered, therapeutic procedure performed or specialty review made in the inpatient unit. Data were captured in a standardised form and analysed. RESULTS: There were 13,944 paediatric attendances - 1,160 (8.3%) paediatric patients were admitted. Among these, 481 (41.4%) were one-day admissions. Upper respiratory tract infection (62, 12.9%), gastroenteritis (60, 12.5%) and head injury (52, 10.8%) were the three most common conditions. The three most common reasons for ED admissions were inpatient treatment (203, 42.2%), inpatient monitoring (185, 38.5%) and inpatient diagnostic investigations (32, 12.3%). Ninety-six (20.0%) one-day admissions were unnecessary. CONCLUSION Paediatric one-day admissions present an opportunity to develop and implement interventions targeted at the healthcare system, the ED, the paediatric patient and their caregiver, in order to safely slow down and perhaps reverse the trend of increased hospital admissions.
Humans ; Retrospective Studies ; Singapore ; Child ; Emergency Service, Hospital/statistics & numerical data* ; Patient Admission/statistics & numerical data* ; Female ; Male ; Child, Preschool ; Length of Stay/statistics & numerical data* ; Infant ; Adolescent ; Tertiary Care Centers ; Hospitalization/statistics & numerical data* ; Infant, Newborn ; Gastroenteritis/therapy* ; Respiratory Tract Infections

INTRODUCTION: Foreign body (FB) ingestion is a common paediatric emergency. While guidelines exist for urgent intervention, less is known of the natural progress of FBs passing through the gastrointestinal tract (GIT). We reviewed these FB transit times in an outpatient cohort. METHODS: A retrospective review was performed on all children (≤18 years) treated for radiopaque FB ingestion at two major tertiary paediatric centres from 2015 to 2016. Demographic data, FB types, outcomes and hospital visits (emergency department [ED] and outpatient) were recorded. All cases discharged from the ED with outpatient follow-up were included. We excluded those who were not given follow-up appointments and those admitted to inpatient wards. We categorised the outcomes into confirmed passage (ascertained via abdominal X-ray or reported direct stool visualisation by patients/caregivers) and assumed passage (if patients did not attend follow-up appointments). RESULTS: Of the 2,122 ED visits for FB ingestion, 350 patients who were given outpatient follow-up appointments were reviewed (median age 4.35 years [range: 0.5-14.7], 196 [56%] male). The largest proportion (16%) was aged 1-2 years. Coins were the most common ingested FB, followed by toys. High-risk FB (magnets or batteries) formed 9% of cases ( n =33). The 50 th centile for FB retention was 8, 4 and 7 days for coins, batteries and other radiopaque FBs, respectively; all confirmed passages occurred at 37, 7 and 23 days, respectively. Overall, 197 (68%) patients defaulted on their last given follow-up. CONCLUSION This study provides insight into the transit times of FB ingested by children, which helps medical professionals to decide on the optimal time for follow-up visits and provide appropriate counsel to caregivers.
Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Eating ; Emergency Service, Hospital ; Foreign Bodies/diagnostic imaging* ; Gastrointestinal Tract/diagnostic imaging* ; Gastrointestinal Transit ; Retrospective Studies ; Singapore ; Tertiary Care Centers

Humans ; Nebulizers and Vaporizers ; Child ; Administration, Inhalation ; Respiratory Tract Diseases/therapy* ; Asthma/therapy* ; Home Care Services ; Practice Guidelines as Topic ; Respiratory Therapy/methods*

Humans ; Milk, Human ; Milk Banks/standards* ; Intensive Care Units, Neonatal ; Infant, Newborn ; China ; Consensus

Humans ; Pediatric Obesity/epidemiology* ; Child ; Consensus ; China/epidemiology* ; Ambulatory Care Facilities/organization & administration*

Humans ; Pulmonary Valve Stenosis/therapy* ; Infant, Newborn ; Perioperative Care/standards* ; Consensus ; Balloon Valvuloplasty/methods* ; Pulmonary Valve/surgery*