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  • 1
  • 2
    In: Journal of Paediatrics and Child Health, August 2013, Vol.49(8), pp.629-634
    Description: Byline: Jethro Wu, Alison Joanne Lee, Anne Eng-Neo Goh, Moira Chia, Christopher Ho, Jackelyn Laycano Bugarin, Lynette Pei-Chi Shek, Yiong-Huak Chan, Bee-Wah Lee Keywords: FDA approved; indication; intravenous immunoglobulin (IVIG); Kawasaki disease; trend Aims There is a paucity of data on the pattern of intravenous immunoglobulin (IVIG) usage in the paediatric population. This study aimed to assess the prevalence, trends, indications and burden of cost of IVIG usage in the Singaporean paediatric population. Methods Pharmacy data of all IVIG prescriptions between 2000 and 2009 in the two major paediatric public hospitals in Singapore were retrospectively reviewed. Each prescription was cross-referenced with the patient's hospital records to confirm the administration of IVIG and indication of use. Results Over the 10-year period, a total 78155g of IVIG valued at an estimated $5.2 million was prescribed. There was an increasing trend of 445.6g/year (P = 0.02) over this period. Analysis of patients showed that the most common indication for IVIG use was Kawasaki disease, both in terms of the proportion of patients (60%) and amount of IVIG used (34%). Kawasaki disease was also the only indication where there were significant increasing trends in both patient numbers (7.4 patients/year) and amount of IVIG used (247.5g/year). The indications with the highest amount of IVIG used per patient were for conditions related to primary immunodeficiency diseases and stem cell transplantation, where repeat transfusions were required. More than 75% of indications were Food and Drug Administration approved. Conclusion Albeit substantial and increasing, the use of IVIG in Singaporean children is mostly evidence based. Author Affiliation: Article Note: Conflict of interest: No conflict of interest to declare.
    Keywords: Approved ; Indication ; Intravenous Immunoglobulin ; Awasaki Disease ; Trend
    ISSN: 1034-4810
    E-ISSN: 1440-1754
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  • 3
    Language: English
    In: PLoS ONE, 2010, Vol.5(4), p.e9964
    Description: Eczema is a chronic form of childhood disorder that is gaining in prevalence in affluent societies. Previous studies hypothesized that the development of eczema is correlated with changes in microbial profile and composition of early life endemic microbiota, but contradictory conclusions were obtained, possibly due to the lack of minimization of apparent non-health related confounders (e.g., age, antibiotic consumption, diet and mode of delivery). In this study, we recruited seven caesarean-delivered and total formula-fed infants, and comparatively examined the early-life endemic microbiota in these infants with and without eczema. Using 16S pyrosequencing, infants' fecal microbiota were observed to comprise Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes as the four main phyla, and the presence and absence of specific populations within these four phyla are primarily mediated by ageing. Quantitative analysis of bacterial targets on a larger sample size (n = 36 at 1, 3, and 12 months of age) revealed that the abundances of Bifidobacterium and Enterobacteriaceae were different among caesarean-delivered infants with and without eczema, and the bacterial targets may be potential biomarkers that can correlate to the health status of these infants. Our overall findings suggest that the minimization of possible confounders is essential prior to comparative evaluation and correlation of fecal microbiota to health status, and that stool samples collected from caesarean-delivered infants at less than 1 year of age may represent a good cohort to study for potential biomarkers that can distinguish infants with eczema from those without. These findings would greatly facilitate future efforts in understanding the possible pathogenesis behind certain bacterial targets, and may lead to a timely intervention that reduces the occurrence of early life eczema and possibly allergic disorders in later life.
    Keywords: Research Article ; Ecology -- Environmental Microbiology ; Microbiology -- Applied Microbiology ; Microbiology -- Environmental Microbiology ; Microbiology -- Medical Microbiology
    E-ISSN: 1932-6203
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  • 4
    Language: English
    In: Nutrition, January 2013, Vol.29(1), pp.184-194
    Description: In early infancy, various gastrointestinal symptoms (e.g., constipation, regurgitation, crying/fussiness, infantile colic, and excessive gas) are common problems and may result in numerous visits to pediatricians. Worldwide, this often results in switching infant formulas because parents (and sometimes doctors) believe these symptoms reflect a formula intolerance. However, in many cases, these infants are growing and developing normally. This study was performed to offer family pediatricians consensus-based algorithms on the management of the most common gastrointestinal symptoms in infants. A group of pediatric gastroenterologists and pediatric allergists from Europe, USA, Latin America, and Asia developed guidelines and practical algorithms to assist general pediatricians in addressing this challenge. Five such practice recommendations were developed after a thorough literature review. These algorithms should not be considered as an “evidence-based guideline”; on the contrary, the authors are convinced that challenging these proposals will result in updated and improved versions. To date, these algorithms, based on the published literature, are the result of a broad consensus of pediatric gastroenterologists from different continents.
    Keywords: Constipation ; Colic ; Crying ; Functional Disorder ; Formula ; Fussiness ; Gastrointestinal Symptoms ; Gassiness ; Infant ; Regurgitation ; Anatomy & Physiology ; Diet & Clinical Nutrition
    ISSN: 0899-9007
    E-ISSN: 1873-1244
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  • 5
    Language: English
    In: PLoS ONE, 01 January 2017, Vol.12(10), p.e0184955
    Description: Gut microbiota play an important role in human immunological processes, potentially affecting allergic diseases such as eczema. The diversity and structure of gut microbiota in infants with eczema have been previously documented. This study aims to evaluate by comparative metagenomics differences in genetic content in gut microbiota of infants with eczema and their matched controls. Stools were collected at the age of one month old from twelve infants from an at risk birth cohort in a case control manner. Clinical follow up for atopic outcomes were carried out at the age of 12 and 24 months. Microbial genomic DNA were extracted from stool samples and used for shotgun sequencing. Comparative metagenomic analysis showed that immune-regulatory TCAAGCTTGA motifs were significantly enriched in the six healthy controls (C) communities compared to the six eczema subjects (E), with many encoded by Bifidobacterium (38% of the total motifs in the C communities). Draft genomes of five Bifidobacterium species populations (B. longum, B. bifidum, B. breve, B. dentium, and B. pseudocatenulatum) were recovered from metagenomic datasets. The B. longum BFN-121-2 genome encoded more TCAAGCTTGA motifs (4.2 copies per one million genome sequence) than other Bifidobacterium genomes. Additionally, the communities in the stool of controls (C) were also significantly enriched in functions associated with tetrapyrrole biosynthesis compared to those of eczema (E). Our results show distinct immune-modulatory genomic properties of gut microbiota in infants associated with eczema and provide new insights into potential role of gut microbiota in affecting human immune homeostasis.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 6
    Language: English
    In: The Journal of Allergy and Clinical Immunology, 2010, Vol.126(2), pp.324-331.e7
    Description: There has been a substantial increase in the prevalence of peanut and tree nut allergy in Western populations in the last 2 decades. However, there is an impression that peanut and tree nut allergy is relatively uncommon in Asia. To evaluate the prevalence of peanut, tree nut, and shellfish allergy in schoolchildren in 2 Asian countries (Singapore and Philippines). A structured written questionnaire was administered to local and expatriate Singapore (4-6 and 14-16 years old) and Philippine (14-16 years old) schoolchildren. A total of 25,692 schoolchildren responded to the survey (response rate, 74.2%). Of these, 23,425 responses fell within the study protocol's 4 to 6 and 14 to 16 year age groups and were included in the analysis. The prevalence of convincing peanut and tree nut allergy were similar in both local Singapore (4-6 years, 0.64%, 0.28%; 14-16 years, 0.47%, 0.3%, respectively) and Philippine (14-16, 0.43%, 0.33%, respectively) schoolchildren, but was higher in the Singapore expatriates (4-6 years, 1.29%, 1.12%; 14-16 years, both 1.21%, respectively; 4-6 years, expatriates vs local Singaporeans: peanut,  = .019; tree nut,  = .0017; 14-16 years,  〉 .05). Conversely, shellfish allergy was more common in the local Singapore (4-6 years, 1.19%; 14-16 years, 5.23%) and Philippine (14-16 years, 5.12%) schoolchildren compared with expatriate children (4-6 years, 0.55%; 14-16 years, 0.96%;  〈 .001). When data were pooled, respondents born in Western countries were at higher risk of peanut (adjusted odds ratios [95% CIs]: 4-6 years, 3.47 [1.35-8.93]; 14-16 years, 5.56 [1.74-17.76]) and tree nut allergy (adjusted odds ratios [95% CIs]: 4-6 years, 10.40 [1.61-67.36]; 14-16 years, 3.53 [1.00-12.43]) compared with those born in Asia. This study substantiates the notion that peanut and tree nut allergy is relatively low in Asian children, and instead shellfish allergy predominates. Environmental factors that are yet to be defined are likely to contribute to these differences.
    Keywords: Peanut Allergy ; Tree Nut Allergy ; Shellfish Allergy ; Food Allergy ; Anaphylaxis ; Epinephrine Autoinjectors ; Singapore ; Philippines ; Asia ; Medicine
    ISSN: 0091-6749
    E-ISSN: 1097-6825
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  • 7
    In: The American Journal of Clinical Nutrition, 2017, Vol. 105(3), pp.705-713
    Description: Background: Infant body mass index (BMI) peak characteristics and early childhood BMI are emerging markers of future obesity and cardiometabolic disease risk, but little is known about their maternal nutritional determinants. Objective: We investigated the associations of maternal macronutrient intake with infant BMI peak characteristics and childhood BMI in the Growing Up in Singapore Towards healthy Outcomes study. Design: With the use of infant BMI data from birth to age 18 mo, infant BMI peak characteristics [age (in months) and magnitude (BMI peak ; in kg/m 2 ) at peak and prepeak velocities] were derived from subject-specific BMI curves that were fitted with the use of mixed-effects model with a natural cubic spline function. Associations of maternal macronutrient intake (assessed by using a 24-h recall during late gestation) with infant BMI peak characteristics ( n = 910) and BMI z scores at ages 2, 3, and 4 y were examined with the use of multivariable linear regression. Results: Mean absolute maternal macronutrient intakes (percentages of energy) were 72 g protein (15.6%), 69 g fat (32.6%), and 238 g carbohydrate (51.8%). A 25-g (∼100-kcal) increase in maternal carbohydrate intake was associated with a 0.01/mo (95% CI: 0.0003, 0.01/mo) higher prepeak velocity and a 0.04 (95% CI: 0.01, 0.08) higher BMI peak . These associations were mainly driven by sugar intake, whereby a 25-g increment of maternal sugar intake was associated with a 0.02/mo (95% CI: 0.01, 0.03/mo) higher infant prepeak velocity and a 0.07 (95% CI: 0.01, 0.13) higher BMI peak . Higher maternal carbohydrate and sugar intakes were associated with a higher offspring BMI z score at ages 2–4 y. Maternal protein and fat intakes were not consistently associated with the studied outcomes. Conclusion: Higher maternal carbohydrate and sugar intakes are associated with unfavorable infancy BMI peak characteristics and higher early childhood BMI. This trial was registered at clinicaltrials.gov as NCT01174875.
    Keywords: Adiposity ; Carbohydrate ; Childhood Bmi ; Growth Modeling ; Infancy Bmi Peak ; Macronutrient ; Developmental Origins ; Maternal Diet ; Pregnancy Diet ; Sugar
    ISSN: 0002-9165
    E-ISSN: 1938-3207
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  • 8
    Language: English
    In: American Journal of Clinical Nutrition, May, 2017, Vol.105(5), p.1158(8)
    Description: Background: Studies have demonstrated associations between polyunsaturated fatty acids (PUFAs) and adiposity. It is unclear whether PUFAs in pregnancy have an effect on maternal weight retention after childbirth, which can contribute to long-term obesity. Objective: We examined the association of maternal plasma PUFAs in pregnancy with 18-mo postpartum weight retention (PPWR) in a multiethnic Asian cohort. Design: We studied pregnant women (n = 653) recruited between June 2009 and September 2010 from a prospective cohort. At 26-28 wk of gestation, plasma phosphatidylcholine PUFA concentrations were measured and determined as percentages of total fatty acids (FAs). PPWR was calculated based on the difference between measured weight at the first antenatal clinic visit and at 18 mo postpartum. Results: The median retained weight of women was 0.90 kg (IQR: -1.40, 3.25) at 18 mo postpartum. Of 653 women, 544 women (83.3%) had PPWR of 〈5 kg and 109 (16.7%) had PPWR of [greater than or equal to]5 kg. In adjusted linear regression models, higher plasma eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and total [omega]-3 (n-3) PUFA concentrations were associated with lower PPWR [EPA: [beta] = -0.62 kg/1% increase of total FAs (95% CI: -1.18, -0.05); DHA: [beta] = -0.24 kg/1% increase (95% CI: -0.45, -0.02); total [omega]-3 PUFAs: [beta] = -0.20 kg/1% increase (95% CI: -0.36, -0.03)], whereas a higher ratio of plasma [omega]-6-to-[omega]-3 PUFAs was associated with a higher PPWR [beta] = 0.21 kg/unit increase (95% CI: 0.05, 0.36)]. Conclusions: Higher plasma percentages of [omega]-3 PUFAs and a lower ratio of [omega]-6-to-[omega]-3 PUFAs in the late-second trimester of pregnancy are associated with less weight retention at 18 mo postpartum. This may offer an alternative strategy to assist postpartum weight reduction by increasing EPA and DHA status together with a decreased ratio of [omega]-6-to-[omega]-3 PUFA through diet or fish-oil supplementation during pregnancy. This study was registered at clinicaltrials.gov as NCT01174875. Am J Clin Nutr 2017;105:1158-65. Keywords: adiposity, obesity, polyunsaturated fatty acids, postpartum weight, pregnancy doi: 10.3945/ajcn.116.151258
    Keywords: Unsaturated Fatty Acids -- Health Aspects ; Puerperium -- Health Aspects ; Weight Loss -- Physiological Aspects
    ISSN: 0002-9165
    E-ISSN: 19383207
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  • 9
    In: The American Journal of Clinical Nutrition, 2017, Vol. 105(5), pp.1158-1165
    Description: Background: Studies have demonstrated associations between polyunsaturated fatty acids (PUFAs) and adiposity. It is unclear whether PUFAs in pregnancy have an effect on maternal weight retention after childbirth, which can contribute to long-term obesity. Objective: We examined the association of maternal plasma PUFAs in pregnancy with 18-mo postpartum weight retention (PPWR) in a multiethnic Asian cohort. Design: We studied pregnant women ( n = 653) recruited between June 2009 and September 2010 from a prospective cohort. At 26–28 wk of gestation, plasma phosphatidylcholine PUFA concentrations were measured and determined as percentages of total fatty acids (FAs). PPWR was calculated based on the difference between measured weight at the first antenatal clinic visit and at 18 mo postpartum. Results: The median retained weight of women was 0.90 kg (IQR: −1.40, 3.25) at 18 mo postpartum. Of 653 women, 544 women (83.3%) had PPWR of 〈5 kg and 109 (16.7%) had PPWR of ≥5 kg. In adjusted linear regression models, higher plasma eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and total ω-3 (n–3) PUFA concentrations were associated with lower PPWR [EPA: β = −0.62 kg/1% increase of total FAs (95% CI: −1.18, −0.05); DHA: β = −0.24 kg/1% increase (95% CI: −0.45, −0.02); total ω-3 PUFAs: β = −0.20 kg/1% increase (95% CI: −0.36, −0.03)], whereas a higher ratio of plasma ω-6-to-ω-3 PUFAs was associated with a higher PPWR [β = 0.21 kg/unit increase (95% CI: 0.05, 0.36)]. Conclusions: Higher plasma percentages of ω-3 PUFAs and a lower ratio of ω-6-to-ω-3 PUFAs in the late-second trimester of pregnancy are associated with less weight retention at 18 mo postpartum. This may offer an alternative strategy to assist postpartum weight reduction by increasing EPA and DHA status together with a decreased ratio of ω-6-to-ω-3 PUFA through diet or fish-oil supplementation during pregnancy. This study was registered at clinicaltrials.gov as NCT01174875.
    Keywords: Adiposity ; Obesity ; Polyunsaturated Fatty Acids ; Postpartum Weight ; Pregnancy
    ISSN: 0002-9165
    E-ISSN: 1938-3207
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  • 10
    In: The American Journal of Clinical Nutrition, 2018, Vol. 107(1), pp.71-79
    Description: Background: Evidence linking maternal diet quality during pregnancy with infant birth outcomes is limited in Asia. Objective: We investigated the association of maternal diet quality with the risk of preterm birth, offspring birth size, and adiposity in a multiethnic Asian birth cohort. Design: Dietary intakes of 1051 pregnant women were ascertained at 26-28 wk of gestation with the use of 24-h recalls and 3-d food diaries, from which diet quality (score range: 0-100) was measured by the Healthy Eating Index for pregnant women in Singapore (HEI-SGP). Gestational age was established by first-trimester ultrasound dating scan. Neonatal weight and length were measured at birth. Body composition was assessed by air displacement plethysmography in a subset of infants (n = 313) within 72 h after birth, and abdominal adiposity was assessed by MRI (n = 316) within the first 2 wk of life. Associations were assessed by multivariable linear regression for continuous outcomes and logistic regression for preterm birth. Results: The mean [+ or -] SD maternal HEI-SGP score was 52.1 [+ or -] 13.6. Maternal diet quality during pregnancy was not associated with preterm birth or birth weight. Greater adherence to the HEI-SGP (per 10-point increment in HEI-SGP score) was associated with longer birth length [[beta] (95% CI): 0.14 (0.03, 0.24 cm)], lower body mass index (in kg/[m.sup.2]) at birth [-0.07 (-0.13, -0.01)], lower sum of triceps and subscapular skinfold thickness [-0.15 (-0.26, -0.05 mm)], lower percentage body fat [-0.52% (-0.84%, -0.20%)], lower fat mass [-17.23 (-29.52, -4.94 g)], lower percentage abdominal superficial subcutaneous adipose tissue [-0.16% (-0.30%, -0.01%)], and lower percentage deep subcutaneous adipose tissue [-0.06% (-0.10%, -0.01%)]. Conclusions: Higher maternal diet quality during pregnancy was associated with longer birth length and lower neonatal adiposity but not with birth weight and preterm birth. These findings warrant further investigation in independent studies. This trial was registered at clinicaltrials.gov as NCT01174875. Keywords: maternal diet, diet quality, preterm birth, birth weight, adiposity doi: https://doi.org/10.1093/ajcn/nqx003
    Keywords: Maternal Diet ; Diet Quality ; Preterm Birth ; Birth Weight ; Adiposity
    ISSN: 0002-9165
    E-ISSN: 1938-3207
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