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ObjectiveWe analyse birth anthropometry of Asian babies and its socioeconomic exposures, develop gestational age and gender-specific birth anthropometry charts and compare to the widely used Fenton chart.DesignRetrospective observational study.SettingDepartment of Neonatology at the National University Hospital in Singapore.Population or sampleWe report data from 52 220 Chinese, Indian and Malay infants, born from 1991-1997 and from 2010-2017 in Singapore.MethodsThe BW, length and head circumference are each modelled with maternal exposures using general additive model. Anthropometry charts are built using smoothed centile curve and compared with Fenton charts using binomial test.Main outcome measuresBW, head circumference, crown-heel length.ResultsIn contrast to the marked differences in birth anthropometry among these ethnic populations, when exposed to a uniform socioeconomic environment, their intrauterine growth and birth anthropometry were almost identical. From the gestational age specific anthropometric charts, until about late prematurity, Asian growth curves, as derived from our cohort, mirrored that of Fenton’s; thereafter, Asian babies showed a marked reduction in growth velocity.ConclusionsThese findings suggest comparative slowing of intrauterine growth among Asian babies towards term gestation. This phenomenon may be explained by two possible postulations, firstly, restrictive effects of a smaller uterus of shorter Asian women towards term and secondly, early maturation and senescence of fetoplacental unit among Asians. In clinical practice the new birth anthropometry charts will more accurately identify true fetal growth restriction as well as true postnatal growth failure in preterm infants when applied to the appropriate population.FundingSingapore Population Health Improvement Centre (NMRC/CG/C026/2017_NUHS).

This study aims to explore coping strategies of fathers of very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU). A qualitative descriptive study among fathers of VLBW babies. Semi-structured interviews were conducted with 15 fathers until data saturation was achieved. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist was used for reporting. The overarching theme was an active pursuit of reassurance. Coping strategies revolved around identifying specific stressors and then making deliberate efforts to address them. Based on the main stressors identified, three subthemes were derived: pursuing information amidst uncertainty, bonding with the infant for normalcy and seeking emotional support in the midst of anxiety. Fathers took on a predominantly problem-focused approach. Empowering fathers with knowledge and emotional support, facilitating bonding with the infant and addressing their concerns are important in supporting them while having an infant in the NICU.

Introduction We evaluated the risk factors associated with Type 1 retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants and compared ophthalmologic outcomes between cases with Type 1 ROP who received treatment and gestational age-matched controls with mild or no ROP not requiring treatment. Methods This was a retrospective case-control study of VLBW infants born in National University Hospital, Singapore, from January 2001 to December 2013. 17 cases with Type 1 ROP were each matched for gestational age with controls who had either mild (below Stage 2) or no ROP. Antenatal, perinatal and postnatal variables, as well as childhood ophthalmologic outcomes, were collected from their clinical records and analysed. Results The number of packed cell transfusions and highest fraction of inspired oxygen given at weeks 7-10 were found to be statistically significant on multivariate analysis (p = 0.045 and p = 0.049, respectively). None of the infants had blindness or retinal detachment, and there were no significant differences in refractive errors between the groups at 1-4 years of age. Strabismus at four years of age was more common in the group with Type 1 ROP (p = 0.023). Conclusion Increased episodes of blood transfusions and chronic lung disease requiring high oxygen supplementation at 7-10 weeks of life are significant risk factors associated with Type 1 ROP in VLBW infants in our study. Strabismus at four years is more common in this group of patients. This study highlights the importance of long-term ophthalmologic surveillance for these high-risk children.

This study aims to explore coping strategies of fathers of very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU).A qualitative descriptive study among fathers of VLBW babies. Semi-structured interviews were conducted with 15 fathers until data saturation was achieved. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist was used for reporting.The overarching theme was an active pursuit of reassurance. Coping strategies revolved around identifying specific stressors and then making deliberate efforts to address them. Based on the main stressors identified, three subthemes were derived: pursuing information amidst uncertainty, bonding with the infant for normalcy and seeking emotional support in the midst of anxiety. Fathers took on a predominantly problem-focused approach.Empowering fathers with knowledge and emotional support, facilitating bonding with the infant and addressing their concerns are important in supporting them while having an infant in the NICU.

Purpose To investigate the association of sleep duration and quality at 12 months and myopia at 3 years. Design Cohort study. Methods The Growing Up in Singapore Towards Healthy Outcomes (GUSTO) birth cohort recruited pregnant women at 2 major public maternity hospitals (n = 1236). We included 376 children of Chinese, Malay, and Indian ethnicity who had completed caregiver questionnaires on the child's sleep at 12 months of age [Brief Infant Sleep Questionnaire (BISQ)] and also completed cycloplegic autorefraction and eye axial length (AL) measurement at 3 years of age. Data on total sleep duration and number of night wakings were collected by BISQ. Univariable and multivariable regression models adjusting for potential confounders (age, sex, ethnicity, parental myopia, maternal education level, outdoor time, near work, and height) were used. Results Thirteen (3.5%) participants were myopic and mean spherical equivalent (SE) was 0.89 diopters (D) (SD 0.88) at 3 years. Total sleep duration and number of night wakings at 12 months were not associated with SE at 3 years (P > 0.05). The total sleep duration (P = 0.07) and number of night wakings (P = 0.49) were not associated with AL in the multivariate model. Total sleep duration in tertile 2 was not associated with AL (P = 0.11) compared with tertile 1. Only total sleep duration in tertile 3 was associated with longer AL (P = 0.006), but there was no association with SE. Conclusions Sleep duration and quality at 12 months of age were not associated with refractive error at 3 years.

PurposeTo evaluate posterior eye shape variations across a wide refractive error range using brain MRI in a multiethnic cohort.MethodsAdult subjects in the multiethnic Singapore Epidemiology of Eye Disease study were included. Spherical equivalent (SE) was measured using subjective refraction, and axial length (AL) was measured using optical biometry. MRI was performed using a 3-Tesla whole body scanner with a 32-channel head coil. The radii and asphericity based on fitting of the posterior two-thirds of the eye (240°) were calculated. The refractive error status was categorised as myopic (SEResultsA total of 450 adult participants (mean age 64.2±6.5 years old) were included. Less oblate asphericity was associated with more myopic SE, longer AL and with a refractive error categorisation of myopia (pConclusionsA less oblate posterior eye shape was associated with myopic eyes. Chinese eyes have less oblate shapes than Malay and Indian eyes, especially in non-myopic eyes.

Purpose: To evaluate the roles of known myopia-associated genetic variants for development of myopic macular degeneration (MMD) in individuals with high myopia (HM), using case-control studies from the Consortium of Refractive Error and Myopia (CREAM). Methods: A candidate gene approach tested 50 myopia-associated loci for association with HM and MMD, using meta-analyses of case-control studies comprising subjects of European and Asian ancestry aged 30 to 80 years from 10 studies. Fifty loci with the strongest associations with myopia were chosen from a previous published GWAS study. Highly myopic (spherical equivalent [SE] ≤ -5.0 diopters [D]) cases with MMD (N = 348), and two sets of controls were enrolled: (1) the first set included 16, 275 emmetropes (SE ≤ -0.5 D); and (2) second set included 898 highly myopic subjects (SE ≤ -5.0 D) without MMD. MMD was classified based on the International photographic classification for pathologic myopia (META-PM). Results: In the first analysis, comprising highly myopic cases with MMD (N = 348) versus emmetropic controls without MMD (N = 16, 275), two SNPs were significantly associated with high myopia in adults with HM and MMD: (1) rs10824518 (P = 6.20E-07) in KCNMA1, which is highly expressed in human retinal and scleral tissues; and (2) rs524952 (P = 2.32E-16) near GJD2. In the second analysis, comprising highly myopic cases with MMD (N = 348) versus highly myopic controls without MMD (N = 898), none of the SNPs studied reached Bonferroni-corrected significance. Conclusions: Of the 50 myopia-associated loci, we did not find any variant specifically associated with MMD, but the KCNMA1 and GJD2 loci were significantly associated with HM in highly myopic subjects with MMD, compared to emmetropes., Correction--10 Oct 2019: Wong YL, Hysi P, Cheung G, Tedja M, Hoang QV, et al. (2019) Correction: Genetic variants linked to myopic macular degeneration in persons with high myopia: CREAM Consortium. PLOS ONE 14(10): e0223942. https://doi.org/10.1371/journal.pone.0223942

Background:The home literacy environment (HLE) and joint parent–child book reading are key factors in children’s language and literacy acquisition. Child-centered literacy orientation (CCLO) refers to the child’s level of engagement in literacy events.Aim:To describe the HLE and identify demographic and HLE variables associated with a poor CCLO at 12 months of age.Methods:Parents of Singaporean children enrolled in the Growing Up in Singapore Towards healthy Outcomes (GUSTO; n = 1152, birth cohort 2009–2010) completed a childhood literacy questionnaire at 12 months to obtain scores on HLE (0–17) and CCLO (0–6). Logistic regression analyses were employed to identify predictors of low CCLO.Results:Parents of 525 children completed the questionnaire. Mothers were the main caregivers in half the households. Mandarin was the main language (34%). Majority of the respondents had a library card that was used less than weekly, and had fewer than 10 children’s books. 18% of parents read to the child daily, of whom one-quarter read at bedtime. Amongst half of the families who had a CCLO score of 0, two-thirds had the lowest HLE scores (0–2). Correlational analyses indicated significant association between HLE with CCLO at 12 months ( p < 0.001). Non-English speaking caregivers and mothers who had only completed primary education were at high risk of a poor 12-month CCLO.Conclusion:A literacy-rich home environment is associated with 12-month child-centered literacy orientation. Pediatricians and early years’ professionals may be able to promote benefits of literacy related activities to families at risk of poor child-centered literacy orientation.

To investigate the clinical and epidemiologic characteristics of thromboembolism in Japanese children. Clinical data of 77 patients with thromboembolism from a national tertiary pediatric care center were reviewed. Incidence of thromboembolism was calculated to be 15 per 10,000 hospital admissions. Infants younger than one year of age made up the largest age group (25 patients, including nine neonates younger than 30 d). The occurrence of thromboembolism increased over the years in the index population. Thromboembolism was diagnosed as follows: portal vein thrombosis (n = 15), obstruction of central venous catheter (n = 13) and cerebral infarction (n = 9). Among the 77 patients, there were eight mortalities and six significant sequelae. In pediatric care, especially in intensive care, we should pay more attention to thromboembolism in order to detect it promptly.