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1. Asian Neonatal Network Collaboration (AsianNeo): a study protocol for international collaborative comparisons of health services and outcomes to improve quality of care for sick newborn infants in Asia – survey, cohort and quality improvement studies

Author

Yumi Kono, Hidehiko Nakanishi, Satoshi Kusuda, Hirokazu Arai, Maki Sato, Hiroaki Imamura, Takahide Yanagi, Moriharu Sugimoto, Hiroshi Matsumoto, Takashi Nakano, Satoshi Watanabe, Tomoaki Ioroi, Shigeharu Hosono, Makoto Nabetani, Osuke Iwata, Naho Morisaki, Bin Huey Quek, Kaoru Okazaki, Hideaki Harada, Masaki Kobayashi, Yuh-Jyh Lin, Yayoi Miyazono, Isamu Hokuto, Hiroshi Komatsu, Hiroshi Suzuki, Chayatat Ruangkit, Yuko Maruyama, Daisuke Nishi, Shanika Kosarat, Kapila Jayaratne, Tetsuya Isayama, Toshinori Nakashima, Tsutomu Ogata, Takashi Yamagami, Zubair Amin, Shinya Hirano, Seiji Yoshimoto, Chih-Cheng Chen, Yuji Ito, Rinawati Rohsiswatmo, Pertin Sianturi, Rocky Wilar, Dwi Hidayah, Risa Etika, Afifa Ramadanti, Pudji Andayani, Ema Alasiry, Ellen Sianipar, Yosuke Shima, Takashi Tachibana, Takahiro Okutani, Soon Min Lee, Hitoshi Yoda, Ichiro Morioka, Woei Bing Poon, Asao Yara, Akira Nishimura, Masato Ito, Tadayuki Kumagai, Hiroshi Yoshida, Takashi Okuno, Mei-Jy Jeng, Ee-Kyung Kim, Buranee Swatesutipun, Kei Inomata, Yuichi Kato, Kiyoaki Sumi, Atsushi Uchiyama, Narongsak Nakwan, Juyoung Lee, Keiji Goishi, Hiroshi Yamamoto, Hsiu-Ling Chen, Masahiro Kobayashi, Kazumasa Takahashi, Masayuki Ochiai, Fumihiko Ishida, Seok Chiong Chee, Siew Hong Neoh, Ee Lee Ang, Ann Cheng Wong, Masaru Shirai, Toru Ishioka, Toshihiko Mori, Toru Huchimukai, Kyone Ko, Akira Shimazaki, Tatsuya Yoda, Azusa Kobayashi, Yasushi Uchida, Mitsuhiro Ito, Kuniko Ieda, Toshiyuki Ono, Masashi Hayashi, Kanemasa Maki, Kozue Shiomi, Koji Nozaki, Taho Kim, Yasuyuki Tokunaga, Akihiro Takatera, Hiroshi Sumida, Yae Michinomae, Yoshio Kusumoto, Takeshi Morisawa, Tamaki Ohashi, Takahiko Saijo, Kosuke Koyano, Mikio Aoki, Koichi Iida, Mitsushi Goshi, Miho Sato, Hung-Yang Chang, Hironobu Tokumasu, Yoichi Kondo, Arif Budiman, Arief Budiman, Ken Nagaya, Fumihiko Namba, Yun Sil Chang, Masaru Yamakawa, Atsushi Nakao, Masaki Shimizu, Ming-Chih Lin, Jui-Hsing Chang, Shu-Chi Mu, Hung-Chih Lin, Fuyu Miyake, Rizalya Dewi, Yuri Ozawa, Seiichi Tomotaki, Ma Lourdes S Imperial, Belen Amparo E Velasco, Su Jin Cho, YoungAh Youn, Saman Kumara, Hsiang Yu Lin, Pracha Nuntnarumit, Sopapan Ngerncham, Chatchay Prempunpong, Pathaporn Prempraphan, Sarayut Supapannachart, Isra Firmansyah, Eny Yantri, Henri Azis, Ied Imelda, Mustarim ­, Benny Sana Putra, Leni Ervina Jumnalis, Andhika Tiurmaida Hutapea, Nadia Dwi Insani, Agnes Yunie Purwita Sari, Naomi Esthernita Dewanto, Thomas Harry Adoe, Tetty Yuniarti, Adhie Nur Radityo S, Tunjung Wibowo, Kartika Darma Handayani, Dina Djojo Husodo, Brigitta Ida Resita Vebrianti Corebima, Retno Wulandari, Made Sukmawati, I Ketut Adi Wirawan, Made Yuliari, James Thimoty, Sandra Bulan, Takashi Nasu, Yukiteru Tachibana, Ayumu Noro, Toshiya Saito, Yosuke Kaneshi, Nobuko Shiono, Nobuhiro Takahashi, Yusuke Ohkado, Tatsuro Satomi, Mika Nakajima, Eiki Nakamura, Tomofumi Ikeda, Genichiro Sotodate, Mari Ishii, Takahide Hosokawa, Rikio Suzuki, Masatoshi Sanjo, Michiya Kudo, Takushi Hanita, Satoshi Niwa, Masanari Kawamura, Yousuke Sudo, Tsutomu Ishii, Takashi Imamura, Yoshiya Yukitake, Goro Asada, Yasuaki Kobayashi, Yasushi Oki, Kenji Ichinomiya, Toru Fujiu, Hideaki Fukushima, Tetsuya Kunikata, Chika Morioka, Motoichiro Sakurai, Naoto Nishizaki, Satoshi Toishi, Harumi Otsuka, Masahiko Sato, Kenichiro Hirakawa, Kenichiro Hosoi, Hiromichi Shoji, Atsuo Miyazawa, Yuko Nagaoki, Naoki Ito, Ken Masunaga, Reiko Kushima, Sakae Kumasaka, Manabu Sugie, Daisuke Haruhara, Satsuki Kakiuchi, Riki Nishimura, Daisuke Ogata, Ayako Fukuyama, Kuriko Nakamura, Kanji Ogo, Masahiko Murase, Katsuaki Toyoshima, Maha Suzuki, Yoshio Shima, Atsushi Nemoto, Yukihide Miyosawa, Takehiko Hiroma, Gen Kuratsuji, Yoshihisa Nagayama, Tohei Usuda, Rei Kobayashi, Takeshi Hutani, Taketoshi Yoshida, Kazuhide Ohta, Shuya Nagaoki, Yasuhisa Ueno, Toru Ando, Ritsuyo Taguchi, Takeshi Arakawa, Shinji Usui, Tokuso Murabayashi, Shigeru Oki, Reiji Nakano, Taizo Ueno, Masami Shirai, Akira Oishi, Hikaru Yamamoto, Hiroshi Takeshita, Koji Takemoto, Masashi Miyata, Makoto Ohshiro, Masanori Kowaki, Osamu Shinohara, Yasunori Koyama, Takahiro Muramatsu, Akinobu Taniguchi, Naoki Kamata, Hiroshi Uchizono, Kenji Nakamura, Masahito Yamamoto, Jitsuko Ohira, Machiko Sawada, Ryosuke Araki, Daisuke Kinoshita, Ryuji Hasegawa, Shinsuke Adachi, Toru Yamakawa, Masahiko Kai, Hirotaka Minami, Kenji Mine, Reiko Negi, Satoru Ogawa, Ryoko Yoshinare, Atsushi Ogihara, Satoshi Onishi, Hiroyuki Ichiba, Misao Yoshii, Hitomi Okabe, Hiroshi Mizumoto, Masaaki Ueda, Kazumichi Fujioka, Takeshi Utsunomiya, Toshiya Nishikubo, Ken Kumagaya, Akiko Tamura, Masumi Miura, Yuki Hasegawa, Rie Kanai, Kei Takemoto, Koichi Tsukamoto, Misao Kageyama, Rie Fukuhara, Yutaka Nishimura, Seiichi Hayakawa, Yasuhiko Sera, Masahiro Tahara, Shinosuke Fukunaga, Keiko Hasegawa, Hiroshi Tateishi, Tomomasa Terada, Toru Kuboi, Osamu Matsuda, Shinosuke Akiyoshi, Takahiro Motoki, Yusei Nakata, Toshiharu Hikino, Shutaro Suga, Mitsuaki Unno, Hiroshi Kanda, Yasushi Takahata, Hiroyasu Kawano, Takayuki Kokubo, Toshimitsu Takayanagi, Muneichiro Sumi, Fumiko Kinoshita, Masanori Iwai, Naoki Fukushima, Yuki Kodama, Shuichi Yanagibe, Takuya Tokuhisa, Yoriko Kisato, Tatsuo Oshiro, Kazuhiko Nakasone, ChangWon Choi, Young-Ah Youn, Jae Won Shim, Jang Hoon Lee, Ga Won Jeon, Byong Sop Lee, Jin A Lee, Jae Woo Lim, Zuraidah Abdul Latif, Zainah Shaikh Hedra, Baizura Jamaluddin, Hasri Hafidz, Zainab Ishak, Geok Hoon Ngian, Chiong Hung Kiew, Mehala Devi Baskaran, Maslina Mohamad, Chee Sing Wong, Rozitah Razman, Maneet Kaur, Choo Hau Lim, Maizatul Akmar, Sheila Gopal Krishnan, Chae Hee Chieng, Chong Meng Choo, Eric Boon- Kuang Ang, AngShiau Chuen Diong, Angeline Seng- Lian Wan, Sharifah Huda Engku Alwi, Kwee Ching See, Rohani Abdul Jalil, Agnes Suganthi, Mei Ling Lee, Pauline Poh-Ling Choo, Lee Ser Chia, Azanna Ahmad Kamar, Anand Mohan A/L Mohana Lal, Agnes Huei- Hwen Foo, Abdul Nasir Mohamed Abdul Kadher, Ma. Lourdes Imperial, Belen Velasco, Ma. Esterlita V. Uy, Daisy Evangeline Garcia, Jacinto Blas Mantaring, Nethmini Thenuwara, Ming-Chou Chiang, Lan-Wan Wang, Xiao-Ping Wang, Yi-Li Hung, Yung Chieh Lin, Pen-Hua Su, Yung-Ning Yang, Po-Nein Tsao, Liang-Ti Huang, Yi-Yu Su, Shau-Ru Ho, Yan-Yan Ng, Kai-Ti Tseng, Yi-Yin Chen, Tsung-Yu Wu, Wei-Tse Chiu, Li-Jung Fang, Kao-Hsian Hsieh, Anavat Bupphachareonsuk, Anchalee Limrungsikul, Anita Luvira, Anucha Thatrimontrichai, Buranee Yangthara, Cholticha Laohajeeraphan, Hathitip Chaiprapa, Junya Jirapradittha, Kanmalee Jenjarat, Kannikar Booranavanich, Namtip Intub, Patcharin Thanomsingh, Pirarat Kotcharit, Piyawan Phummaphuti, Pornpimon Janyoungsak, Prapaiporn Chongkongkiat, Rapeephun Hansuebsai, Roongrawee Torbunsupachai, Santi Punnahitanan, Sommon Jindakul, Sopida Tanthawat, Sudarat Sirichaipornsak, Sudatip Kositamongkol, Supamas Supabanpot, Suparat Tipprasert, Tanin Pirunnet, Thanatda Siriporn, Usakorn Taesiri, Vasita Jirasakuldech, and Eleanor DR Cuarte

Subjects
Medicine
Abstract

Introduction Reducing neonatal deaths in premature infants in low- and middle-income countries is key to reducing global neonatal mortality. International neonatal networks, along with patient registries of premature infants, have contributed to improving the quality of neonatal care; however, the involvement of low-to-middle-income countries was limited. This project aims to form an international collaboration among neonatal networks in Asia (AsianNeo), including low-, middle- and high-income countries (or regions). Specifically, it aims to determine outcomes in sick newborn infants, especially very low birth weight (VLBW) infants or very preterm infants, with a view to improving the quality of care for such infants.Methods and analysis Currently, AsianNeo comprises nine neonatal networks from Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan and Thailand. AsianNeo will undertake the following four studies: (1) institutional questionnaire surveys investigating neonatal intensive care unit resources and the clinical management of sick newborn infants, with a focus on VLBW infants (nine countries/regions); (2) a retrospective cohort study to describe and compare the outcomes of VLBW infants among Asian countries and regions (four countries/regions); (3) a prospective cohort study to develop the AsianNeo registry of VLBW infants (six countries/regions); and (4) implementation and evaluation of educational and quality improvement projects in AsianNeo countries and regions (nine countries/regions).Ethics and dissemination The study protocol was approved by the Research Ethics Board of the National Center for Child Health and Development, Tokyo, Japan (reference number 2020–244, 2022–156). The study findings will be disseminated through educational programmes, quality improvement activities, conference presentations and medical journal publications.

Published
2024
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2. Clinical and economic impact of medication administration errors among neonates in neonatal intensive care units.

Author

Josephine Henry Basil, Nurul Ain Mohd Tahir, Chandini Menon Premakumar, Adliah Mhd Ali, Zamtira Seman, Shareena Ishak, Kwee Ching See, Maslina Mohamed, Khai Yin Lee, Nazedah Ain Ibrahim, Kokila Vani Jegatheesan, and Noraida Mohamed Shah

Subjects
Medicine, Science
Abstract

Despite efforts in improving medication safety, medication administration errors are still common, resulting in significant clinical and economic impact. Studies conducted using a valid and reliable tool to assess clinical impact are lacking, and to the best of our knowledge, studies evaluating the economic impact of medication administration errors among neonates are not yet available. Therefore, this study aimed to determine the potential clinical and economic impact of medication administration errors in neonatal intensive care units and identify the factors associated with these errors. A national level, multi centre, prospective direct observational study was conducted in the neonatal intensive care units of five Malaysian public hospitals. The nurses preparing and administering the medications were directly observed. After the data were collected, two clinical pharmacists conducted independent assessments to identify errors. An expert panel of healthcare professionals assessed each medication administration error for its potential clinical and economic outcome. A validated visual analogue scale was used to ascertain the potential clinical outcome. The mean severity index for each error was subsequently calculated. The potential economic impact of each error was determined by averaging each expert's input. Multinomial logistic regression and multiple linear regression were used to identify factors associated with the severity and cost of the errors, respectively. A total of 1,018 out of 1,288 (79.0%) errors were found to be potentially moderate in severity, while only 30 (2.3%) were found to be potentially severe. The potential economic impact was estimated at USD 27,452.10. Factors significantly associated with severe medication administration errors were the medications administered intravenously, the presence of high-alert medications, unavailability of a protocol, and younger neonates. Moreover, factors significantly associated with moderately severe errors were intravenous medication administration, younger neonates, and an increased number of medications administered. In the multiple linear regression analysis, the independent variables found to be significantly associated with cost were the intravenous route of administration and the use of high-alert medications. In conclusion, medication administration errors were judged to be mainly moderate in severity costing USD 14.04 (2.22-22.53) per error. This study revealed important insights and highlights the need to implement effective error reducing strategies to improve patient safety among neonates in the neonatal intensive care unit.

Published
2024
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3. Characteristics and outcomes of SARS-CoV-2 positivity in neonates born to mothers with COVID-19 in Klang Valley, Malaysia: a retrospective observational study

Author

Sok Bee Lim, Kwee Ching See, Kian Boon Law, and Nor Izwah Mohamed Kamarudin

Abstract

The aim of this study was to analyze the clinical characteristics of neonates born to mothers with coronavirus disease 2019 (COVID-19), along with the incidence and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) positivity in Klang Valley, Malaysia.The clinical records of all neonates born to mothers with COVID-19 who were admitted to Sungai Buloh Hospital, Selangor, Malaysia from October 1, 2020 to September 30, 2021 were reviewed retrospectively. Data collected included demographic details and the incidence, risk factors, and clinical outcomes of neonates with SARS-CoV-2 positivity.A total of 766 neonates from 753 mothers with COVID-19 were included. Overall, 23 (3%) neonates tested positive by nasopharyngeal swab SARS-CoV-2 PCR taken within the first 8 days of life. There were three (0.4%) confirmed and four (0.5%) probable neonatal infections acquired intrapartum, seven (0.9%) confirmed neonatal infections acquired postpartum, and nine (1.2%) cases that did not fit within the classification. The rate of preterm delivery was 25% among all neonates born to mothers with COVID-19 and 39.1% among SARS-CoV-2-positive neonates. Of the SARS-CoV-2-positive neonates, 43.5% required ventilatory support. Factors identified to have a significant association with neonate SARS-CoV-2 positivity included maternal antepartum hemorrhage (odds ratio (OR) 7.33,This study identified a risk of SARS-CoV-2 transmission from mothers with COVID-19 to their offspring, with infection acquired predominantly postpartum. A higher incidence of preterm delivery and ventilatory support were observed among SARS-CoV-2-positive neonates.

Published
2022
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4. Clinical and epidemiological characteristics of children with COVID-19 in Selangor, Malaysia

Author

Kwee Ching See, Li Peng Tan, Li Teng Ong, and Pei Yin Lee

Subjects
Article
Abstract

Objectives To describe the clinical and epidemiological characteristics of children diagnosed with coronavirus disease 2019 (COVID-19) at Hospital Sungai Buloh (HSgB), Selangor. Methods A retrospective, observational study was performed on children aged below 12 years diagnosed with COVID-19 infection between 25 January to 31 December 2020. Comparative analysis was undertaken between asymptomatic and symptomatic children, and a subanalysis on their caretakers’ COVID-19 status. Results A total of 1498 children were included – 48.7% Female, 51.3% male; mean age 5.6 years (Standard deviation (SD): 3.5 years). 82.3% were detected through contact tracing of positive family members or from the same household. 56.9% were asymptomatic. The most common symptoms reported were fever, nasal congestion/rhinorrhoea and cough. Symptomatic compared to asymptomatic children had higher reported comorbidities; low total white cell, absolute lymphocyte and absolute neutrophil counts; raised C-reactive protein and aspartate transaminase (p

Published
2021

5. Preterm Infant Outcomes after Randomization to Initial Resuscitation with FiO

Author

Valerie, Thamrin, Ola D, Saugstad, William, Tarnow-Mordi, Yueping Alex, Wang, Kei, Lui, Ian M, Wright, Koert, De Waal, Javeed, Travadi, John P, Smyth, Paul, Craven, Rowena, McMullan, Elisabeth, Coates, Meredith, Ward, Parag, Mishra, Kwee Ching, See, Irene G S, Cheah, Chin Theam, Lim, Yao Mun, Choo, Azanna Ahmad, Kamar, Fook Choe, Cheah, Ahmed, Masoud, and Ju Lee, Oei

Subjects
Male, Oxygen, Aptitude Tests, Neurodevelopmental Disorders, Child, Preschool, Resuscitation, Infant, Newborn, Oxygen Inhalation Therapy, Humans, Female, Gestational Age, Infant, Premature, Follow-Up Studies
Abstract

To determine rates of death or neurodevelopmental impairment (NDI) at 2 years corrected age (primary outcome) in children32 weeks' gestation randomized to initial resuscitation with a fraction of inspired oxygen (FiOBlinded assessments were conducted at 2-3 years corrected age with the Bayley Scales of Infant and Toddler Development, Third Edition or the Ages and Stages Questionnaire by intention to treat.Of the 290 children enrolled, 40 could not be contacted and 10 failed to attend appointments. Among the 240 children for whom outcomes at age 2 years were available, 1 child had a lethal congenital anomaly, 1 child had consent for follow-up withdrawn, and 23 children died. The primary outcome, which was available in 238 (82%) of those randomized, occurred in 47 of the 117 (40%) children assigned to initial FiOInitial resuscitation of infants32 weeks' gestation with initial FiOAustralian and New Zealand Clinical Trials Network Registry ACTRN 12610001059055 and the National Malaysian Research Registry NMRR-07-685-957.

Published
2017

6. Targeted Oxygen in the Resuscitation of Preterm Infants, a Randomized Clinical Trial

Author

Paul Craven, William Tarnow-Mordi, Meredith Ward, Kwee Ching See, Fook-Choe Cheah, Ju Lee Oei, Koert de Waal, Parag Mishra, Ian M. R Wright, Ola Didrik Saugstad, Javeed Travadi, Ahmed Masoud, Azanna Ahmad Kamar, Elisabeth Coates, Yao Mun Choo, Irene G.S. Cheah, Rowena L McMullan, Chin Theam Lim, Kei Lui, Yueping Alex Wang, and John Smyth

Subjects
Risk, Male, Resuscitation, Pediatrics, medicine.medical_specialty, Ischemia, Gestational Age, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, 030225 pediatrics, Intensive Care Units, Neonatal, medicine, Humans, Oxidative injury, 030212 general & internal medicine, Oximetry, Hospital Mortality, business.industry, Air, Oxygen Inhalation Therapy, Infant, Newborn, Gestational age, Infant, medicine.disease, Disabled Children, Increased risk, Child, Preschool, Pediatrics, Perinatology and Child Health, Gestation, Female, Risk of death, business, Infant, Premature, Follow-Up Studies
Abstract

BACKGROUND AND OBJECTIVES: Lower concentrations of oxygen (O2) (≤30%) are recommended for preterm resuscitation to avoid oxidative injury and cerebral ischemia. Effects on long-term outcomes are uncertain. We aimed to determine the effects of using room air (RA) or 100% O2 on the combined risk of death and disability at 2 years in infants METHODS: A randomized, unmasked study designed to determine major disability and death at 2 years in infants RESULTS: Of 6291 eligible patients, 292 were recruited and 287 (mean gestation: 28.9 weeks) were included in the analysis (RA: n = 144; 100% O2: n = 143). Recruitment ceased in June 2014, per the recommendations of the Data and Safety Monitoring Committee owing to loss of equipoise for the use of 100% O2. In non-prespecified analyses, infants CONCLUSIONS: Using RA to initiate resuscitation was associated with an increased risk of death in infants

Published
2016

7. Preterm Infant Outcomes after Randomization to Initial Resuscitation with FiO2 0.21 or 1.0

Author

Chin Theam Lim, Ola Didrik Saugstad, Parag Mishra, Rowena L McMullan, Ju Lee Oei, John Smyth, Javeed Travadi, Ahmed Masoud, Elisabeth Coates, Paul Craven, Yueping Alex Wang, Azanna Ahmad Kamar, Irene G.S. Cheah, William Tarnow-Mordi, Kwee Ching See, Kei Lui, Meredith Ward, Fook-Choe Cheah, Ian M. R Wright, Yao Mun Choo, Valerie Thamrin, and Koert de Waal

Subjects
Resuscitation, Pediatrics, medicine.medical_specialty, Intention-to-treat analysis, Randomization, business.industry, Bayley Scales of Infant Development, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Pediatrics, Perinatology and Child Health, Cohort, medicine, 030212 general & internal medicine, Toddler, business, Oxygen saturation (medicine)
Abstract

Objective To determine rates of death or neurodevelopmental impairment (NDI) at 2 years corrected age (primary outcome) in children Study design Blinded assessments were conducted at 2-3 years corrected age with the Bayley Scales of Infant and Toddler Development, Third Edition or the Ages and Stages Questionnaire by intention to treat. Results Of the 290 children enrolled, 40 could not be contacted and 10 failed to attend appointments. Among the 240 children for whom outcomes at age 2 years were available, 1 child had a lethal congenital anomaly, 1 child had consent for follow-up withdrawn, and 23 children died. The primary outcome, which was available in 238 (82%) of those randomized, occurred in 47 of the 117 (40%) children assigned to initial FiO2 0.21 and in 38 of the 121 (31%) assigned to initial FiO2 1.0 (OR, 1.47; 95% CI, 0.86-2.5; P = .16). No difference in NDI was found in 215 survivors randomized to FiO2 0.21 vs 1.0 (OR, 1.26; 95% CI, 0.70-2.28; P = .11). In post hoc exploratory analyses in the whole cohort, children with a 5-minute blood oxygen saturation (SpO2) Conclusions Initial resuscitation of infants Trial registration Australian and New Zealand Clinical Trials Network Registry ACTRN 12610001059055 and the National Malaysian Research Registry NMRR-07-685-957.

Published
2018
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