Malaysian Journal of Paediatrics and Child Health <p>The online Malaysian Journal of Paediatrics and Child Health (MJPCH) provides a forum for the dissemination of original research articles as well as review articles in all areas related to Paediatrics and Child Health.</p> <p>This open-access journal focuses on cutting-edge research in the field of Paediatrics and Child Health, including case reports on different clinical findings, hence sharing not only the knowledge but the experience of specialists and consultants in the related fields. Researchers will also have the opportunity to submit their findings in a form of short communications. Different types of submissions will benefit not only the paediatricians but also the general medical profession.</p> <p>&nbsp;</p> en-US (Zilfalil Bin Alwi) (Abdul Halim Fikri Bin Hashim) Mon, 03 Jun 2019 00:00:00 +0000 OJS 60 NEURO-ENTERIC DYSFUNCTION IN CHILDREN WITH SEVERE NEUROLOGICAL IMPAIRMENT <p>Visceral hyperalgesia, intestinal dysfunction and unexplained irritability in neurological impaired children is a medical enigma for many healthcare professionals. The neuro-medical management can be challenging and difficult, due to poor understanding of the underlying aetiology and pathophysiology of the condition. Neuro-enteric axis has been proposed as emerging physiologic mechanism in the pathogenesis of many gastrointestinal diseases. The bidirectional connection between enteric and central nervous system may represent a direct relationship between neurological system and gut physiology. Insult to the brain indirectly contribute to the ongoing gut and brain axis sequalae. Microbiota has been an important modulator in the brain-gut axis. Irritability episodes in severe neurological impairment children has been commonly associated with pain originated from gastrointestinal pathology. Management of such condition requires a holistic approach to tackle multidimensional factors that has contributed to the ‘totality’ of the symptoms.</p> Fahisham Taib, Nik Zainal Abidin Nik Ismail Copyright (c) 2019 Malaysian Journal of Paediatrics and Child Health Sun, 15 Dec 2019 14:45:13 +0000 THE USE OF MODIFIED CHECKLIST FOR AUTISM IN TODDLERS (MALAY VERSION) IN DIFFERENTIATING BETWEEN AUTISM SPECTRUM DISORDERS AND OTHER DEVELOPMENTAL BEHAVIOURAL DISORDERS <p><strong>Objective</strong>: The present study examined the sensitivity and specificity of M-CHAT-Malay version [M-CHAT(MV)] to discriminate ASD from other developmental-behavioural disorders. <strong>Methods</strong>: This study was carried out in the Child Development Centre at a tertiary referral centre. Parents of 130 children aged 18–60 months, referred for developmental-behavioural disorders were asked to complete M-CHAT(MV). A child was considered to have ASD if they failed any 3 of the 23 total items or 2 or more of the 6 critical items. <strong>Results</strong>: Looking at the total items, M-CHAT(MV) has a good sensitivity (88.9%) to differentiate between ASD and other developmental-behavioural disorders, although specificity was only 47.8%. However, the critical items only has sensitivity of 71.4% and specificity of 77.6%. Sensitivity for children aged 49–60 months old was lower (80.0%) compared to those in the younger age group (100.0% and 90.3% for those aged 25-36 months and 37–48 months respectively). Based on the ROC curve, the optimal criteria to detect ASD was failing 1 out of 6 critical items or 3 out of 23 total items. <strong>Conclusion</strong>: M-CHAT(MV) is a good screening tool in differentiating ASD from other developmental-behavioural disorders although the critical items’ criteria may need to be lowered to improve its sensitivity in selected cohorts.</p> Doris Sie Chong Lau , Juriza Ismail, Zarina Latiff, Raja Juanita Raja Lope Copyright (c) Mon, 03 Jun 2019 00:00:00 +0000 RELEVANCE OF SCREENING FOR URINARY TRACT INFECTION IN WELL INFANTS WITH PROLONGED JAUNDICE: A PROSPECTIVE COHORT STUDY <table> <tbody> <tr> <td> <p><strong>Background:</strong>&nbsp; Recent retrospective studies suggest irrelevance of urine screening for neonate with prolonged jaundice. We re-evaluated the incidence of urinary tract infection (UTI) among these infants, their renal outcome and evaluated the cost incurred. <strong>Methods</strong>: This is a prospective cohort study. Asymptomatic, prolonged jaundiced infants with unconjugated hyperbilirubinemia were screened for evidence of UTI as per local guidelines. Infants with pyuria would have urine sent for culture and sensitivity. Unit cost was referenced from hospital purchase. Statistical analysis was performed using SPSS 24.0.&nbsp; <strong>Results:</strong> A total of 291 cases were analyzed. Majority were term infants (93.8%). The commonest cause of prolonged jaundice was breast milk jaundice, hence an incidence rate of 0.34%. Only one infant persistently showed single uropathogen on urinary culture with concurrent pyuria. Urinary structures were normal on ultrasonography and there was no evidence of renal cortical scarring. No recurrence of UTI documented in the first year of life. Each “clean-catch” urinalysis costed RM7. This unit cost escalated to RM37 for catheterized sample.&nbsp; A negative urine culture costed RM28 while a positive culture twice this price. The average cost effectiveness ratio (ACER) in this study was RM5856.56 per detection of case.&nbsp;&nbsp;&nbsp; <strong>Conclusion: </strong>Incidence of UTI is low. In our study, an undesirable outcome is negligible. Unnecessary parental anxiety from the potentially laborious procedure could be avoided. This study refutes previous literature to include such screening in prolonged jaundice as this may well be irrelevant.</p> </td> </tr> </tbody> </table> Caroline Siew Yin Eng, Thalitha Vijayakulansingam, Boon Hong Ng, Maryam Jamilah Surdi Roslan, Muhammad Zamakhshari Zainal Abidin, Ming Lee Lee Copyright (c) 2019 Malaysian Journal of Paediatrics and Child Health Sun, 15 Dec 2019 02:33:00 +0000 MANAGEMENT OF PALATAL FRACTURE AND AIRWAY CHALLENGE IN A CHILD-A RED FLAG <p>Airway managements in maxillofacial fracture patients are complex and crucial. Trauma to the maxillofacial region may cause hemorrhage, swelling which may lead to pulmonary aspiration and airway obstruction. Airway managements in maxillofacial fracture patients are complex and crucial. Besides being uncooperative, presence of fractures and soft tissue injuries posed challenges in managing pediatric patient who already have smaller airway opening. This condition is an important red flag which required extra caution from the treating clinicians. A 6-year-old boy was involved in a road traffic accident and presented with profuse bleeding from the oral cavity and nostrils. Physical examination showed oozing of blood with step deformity of the midpalate. Multiple attempts in intubation resulted inin failure before succeeding with the aid of suction devices. After intubation was done, intraoral bleeding was successfully managed with transpalatal wiring and nasal packing. The patient was ventilated in the intensive care unit and was extubated two days later. He was discharged well from hospital after one week of admission. Airway management is a rush against time, particularly in a pediatric patient suffering from a palatal fracture. The need for helping hands for suction and child control must be emphasized to ensure the patient’s survival.</p> Lim Min Jim, Tengku Aszraf Tengku Shaeran, Soon Eu Chong Copyright (c) 2019 Malaysian Journal of Paediatrics and Child Health Sun, 24 Nov 2019 00:00:00 +0000 UNWITNESSED SNAKE BITE IN CHILDREN-A CHALLENGE IN DIAGNOSIS AND MANAGEMENT: A CASE REPORT <p>The clinical diagnosis of snakebite is critical, particularly in Southeast Asia where venomous snakebites are a public health concern. Additionally, cases involving unwitnessed snakebite with no species identification, especially in non-verbal children posed a challenge in the emergency setting. A 2-year-2-month-old boy presented to our Emergency Department with signs of neurotoxicity. He was restless and mildly bradypnoeic with the respiratory rate of 24 to 28 breaths per minute. He also had bilateral ptosis with absent gag reflex. There were faint fang marks noted over the medial aspect of his left ankle with local swelling and bruises, despite no history of animal bite and no eyewitness. A high index of suspicion of neurotoxic envenomation was prompted and a total of 6 vials of neuro-polyvalent anti-venom were administered in scheduled batches. Progressive clinical recovery was subsequently observed after the first batch of anti-venom administration. The case illustrated the importance of clinical recognition of neurotoxic envenomation in the absence of snake bite history or species identification. Early administration of anti-venom may potentially reverse the neurotoxic effects of systemic envenomation and saves lives.</p> Lui Sze Yee, Noor Zuraini Abu Bakar, Ida Zaliza Zainol Abidin Copyright (c) 2019 Malaysian Journal of Paediatrics and Child Health Tue, 03 Dec 2019 04:02:37 +0000 BILATERAL NEONATAL BREAST ABSCESS IN A WELL-APPEARING NEONATE <p>Neonatal mastitis and abscess are rare and most often unilateral. Neonatal breast massage for physiological breast hypertrophy is suspected to be a predisposing factor in the case reported here: a 14-day-old neonate with bilateral neonatal breast abscess, treated effectively with intravenous cloxacillin and surgical aspiration.</p> Muhammad Yusoff Mohd Ramdzan, Jamil Aiman Mohd Baharuddin, Nordiyana Azmi, Noraida Ramli, Nor Rosidah Ibrahim, Hans Van Rostenberghe Copyright (c) Thu, 05 Dec 2019 00:00:00 +0000