Publications by authors named "Noraida Ramli"

10 Publications

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Randomised controlled trial: Shoulder-umbilicus length versus body weight measurement for optimal endotracheal tube depth estimation in ventilated infants.

J Paediatr Child Health 2020 05 10;56(5):704-709. Epub 2019 Dec 10.

Paediatric Department, Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Malaysia.

Aim: The optimal placement of the endotracheal tube (ETT) in ventilated infants is essential, but birthweight may be not the best parameter to predict it. The aim of this study was a direct comparison of shoulder-umbilical length (experimental group) versus birthweight (control group) as predictor of optimal ETT placement in Malaysian ventilated infants.

Methods: All infants requiring ventilation in the neonatal intensive care unit of a tertiary hospital in Malaysia during the 4-month study period were eligible to enter this randomised controlled trial. All participants were randomised into two groups: experimental and control group. The main outcome measure was malposition of the ETT (requiring adjustment), as seen on the chest X-ray performed within 1 h after intubation. Tube placement was assessed by two neonatologists, blinded to the allocation.

Results: One hundred and ten infants were randomised, 55 in each group. The ETT was malpositioned in 13 of 55 infants (23%) for the experimental group and 22 of 55 infants (40%) in the control group (P = 0.06).

Conclusion: In the experimental group, fewer infants showed a need for tube adjustment than in the control group. While a larger study may be necessary to show statistical significance, the difference shown in this study may be large enough to be of clinical significance.
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http://dx.doi.org/10.1111/jpc.14705DOI Listing
May 2020

Two-hourly versus 3-hourly feeding for very low birthweight infants: a randomised controlled trial.

Arch Dis Child Fetal Neonatal Ed 2017 May 26;102(3):F225-F229. Epub 2016 Sep 26.

Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Objective: To determine whether feeding with 2-hourly or 3-hourly feeding interval reduces the time to achieve full enteral feeding and to compare their outcome in very low birthweight preterm infants.

Design: Parallel-group randomised controlled trial with a 1:1 allocation ratio.

Setting: Two regional tertiary neonatal intensive care units.

Patients: 150 preterm infants less than 35 weeks gestation with birth weight between 1.0 and 1.5 kg were recruited.

Interventions: Infants were enrolled to either 2-hourly or 3-hourly interval feeding after randomisation. Blinding was not possible due to the nature of the intervention.

Main Outcome Measures: The primary outcome was time to achieve full enteral feeding (≥100 mL/kg/day). Secondary outcomes include time to regain birth weight, episode of feeding intolerance, peak serum bilirubin levels, duration of phototherapy, episode of necrotising enterocolitis, nosocomial sepsis and gastro-oesophageal reflux.

Results: 72 infants were available for primary outcome analysis in each group as three were excluded due to death-three deaths in each group. The mean time to full enteral feeding was 11.3 days in the 3-hourly group and 10.2 days in the 2-hourly group (mean difference 1.1 days; 95% CI -0.4 to 2.5; p=0.14). The mean time to regain birth weight was shorter in 3-hourly group (12.9 vs 14.8 days, p=0.04). Other subgroup analyses did not reveal additional significant results. No difference in adverse events was found between the groups.

Conclusion: 3-hourly feeding was comparable with 2-hourly feeding to achieve full enteral feeding without any evidence of increased adverse events.

Trial Registration Number: ACTRN12611000676910, pre-result.
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http://dx.doi.org/10.1136/archdischild-2015-310246DOI Listing
May 2017

High resolution melting analysis of the NR1I3 genetic variants: Is there an association with neonatal hyperbilirubinemia?

Gene 2015 Dec 16;573(2):198-204. Epub 2015 Jul 16.

Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan 16150, Malaysia; Human Genome Center, School of Medical Sciences, Universiti Sains Malaysia, Kelantan 16150, Malaysia. Electronic address:

Constitutive androstane receptor (CAR) encoded by the nuclear receptor subfamily 1, group I, member 3 (NR1I3) gene regulates the elimination of bilirubin through activating the components of the bilirubin clearance pathway. Hence, NR1I3 genetic variants may affect bilirubin metabolism and result in neonatal hyperbilirubinemia. Thus far, research which investigates the association between NR1I3 variants and neonatal hyperbilirubinemia has not been undertaken in any population. The present study aimed to evaluate the influence of MPJ6_1I3008 (rs10157822), IVS8+116T>G (rs4073054) and 540A>G (rs2307424) on neonatal hyperbilirubinemia development in the Malay population. Buccal swabs were collected from 232 hyperbilirubinemia and 277 control term newborns with gestational age ≥37weeks and birth weight ≥2500g. The NR1I3 variants were genotyped by using high resolution melting (HRM) assays and verified by DNA sequencing. Gender, mode of delivery and birth weight did not differ between hyperbilirubinemia and control groups. The genotypic and allelic frequencies of MPJ6_1I3008, IVS8+116T>G and 540A>G were not significantly different between the groups. However, stratification by gender revealed a significant inverse association between homozygous variant genotype of MPJ6_1I3008 and risk of neonatal hyperbilirubinemia in the females (OR, 0.44; 95% CI, 0.20-0.95; p=0.034). This study demonstrates that the homozygous variant genotype of MPJ6_1I3008 was associated with a significant reduced risk of neonatal hyperbilirubinemia in the females.
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http://dx.doi.org/10.1016/j.gene.2015.07.045DOI Listing
December 2015

A psychologist-led educational intervention results in a sustained reduction in neonatal intensive care unit infections.

Front Pediatr 2014 19;2:115. Epub 2014 Nov 19.

Department of Medical Microbiology and Parasitology, Universiti Sains Malaysia , Kubang Kerian , Malaysia.

Unlabelled: Even though in the corporate world psychological science has been widely used, the formal use of evidence-based psychology in important areas of clinical medicine has been scanty at best. It was the aim of this study to determine the efficacy of a psychologist-led 2-week nurse educator training on the infection rate in the neonatal intensive care unit (NICU).

Materials And Methods: In 2007, six senior neonatal nurses underwent a training course focusing on the retrieval of evidence and knowledge of psychological principles that would allow them to share the evidence in such a way that evidence is effectively brought into practice. The course was led by a psychologist. The nurses created and delivered their own teaching modules, all focused on infection control. The rates of bacteremia, 2 years prior to intervention were analyzed and compared with the rate following the intervention for 3 years.

Results: The immediate output of the course included three teaching modules: hand washing, sterile procedures, and general measures to control infection. These modules were subsequently administered to the NICU nurses in regular structured continuous nursing education sessions. The psychological techniques taught in the course were applied. Bacteremia in the NICU significantly decreased in the year of the course and the subsequent years when compared to previous years (from more than 17 in 2005 and 2006 to less than 10 per 100 admissions to the NICU in 2008 and 2009).

Conclusion: This study suggests that a psychologist-led course, followed by a structured CNE can lead to a sustainable reduction in infection rates in a NICU.
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http://dx.doi.org/10.3389/fped.2014.00115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237142PMC
December 2014

Randomised controlled trial of single phototherapy with reflecting curtains versus double phototherapy in term newborns with hyperbilirubinaemia.

J Paediatr Child Health 2013 May 11;49(5):375-9. Epub 2013 Apr 11.

Advanced Medical and Dentistry Institute, Universiti Sains Malaysia, Penang.

Aim: The use of reflecting curtains with single phototherapy has not yet been directly compared with double phototherapy (DP). The objective of this study is to compare the efficacy of single phototherapy with reflecting curtains (SPRC) and DP in treating neonatal jaundice.

Methods: This randomised controlled trial involved 160 term newborns with severe neonatal jaundice in the first 2 weeks of life. The subjects were randomised in two groups: the intervention group receiving SPRC (n = 80) and a control group receiving DP (n = 80). Because of post-hoc exclusions, 78 subjects resulted in each group, respectively. The primary outcome was mean decrease in total serum bilirubin (TSB) levels after 4 h of phototherapy. The secondary outcomes were mean decrease in TSB levels after 10 h of phototherapy and duration of phototherapy.

Results: The mean decrease in TSB after 4 h of phototherapy in the intervention group was similar for the intervention and the control groups (23.46 ± 27.03 vs. 22.43 ± 27.38 μmol/L; P = 0.81). Also, after 10 h, it was similar in both groups (56.06 ± 31.36 vs. 58.17 ± 31.71 μmol/L, respectively; P = 0.67). Cox proportional hazards regression analysis indicated that there was no statistically significant difference in duration of phototherapy in both intervention (SPRC) and control (DP) (x2 change 0.393, P = 0.531; hazard ratio 1.060; 95% confidence interval 0.883-1.273). There were no significant adverse events noted.

Conclusions: This study suggested that single phototherapy with reflecting curtain is as effective as DP in the treatment of neonatal hyperbilirubinaemia requiring intensive phototherapy.
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http://dx.doi.org/10.1111/jpc.12192DOI Listing
May 2013

Hemolytic disease of the fetus and newborn caused by anti-E.

Asian J Transfus Sci 2013 Jan;7(1):84-5

Department of Hematology and Transfusion Medicine Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus 16150 Kubang Kerian, Kelantan, Malaysia.

Objective: Maternal allo-antibody production is stimulated when fetal red blood cells are positive for an antigen absent on the mother's red cells. The maternal IgG antibodies produced will pass through the placenta and attack fetal red cells carrying the corresponding antigen. Allo-immune hemolytic disease of the fetus and newborn caused by anti-E rarely occurs.

Case Summary: We report two cases of anti-E hemolytic diseases in neonates. One of the neonates had severe hemolysis presenting with severe anemia, thrombocytopenia, and conjugated hyperbilirubinemia, while the other had moderate anemia and unconjugated hyperbilrubinemia. Although both the neonates were treated by phototherapy and intravenous immunoglobulin, one of them received double volume exchange transfusion.

Conclusion: There appeared to be an increase in the occurrence of hemolytic disease of the fetus and newborn caused by Rh antibodies other than anti-D. In this case report, both patients presented with anemia and hyperbilirubinemia but were successfully treated, with a favorable outcome.
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http://dx.doi.org/10.4103/0973-6247.106750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613674PMC
January 2013

Comparison of antimicrobial resistance in neonatal and adult intensive care units in a tertiary teaching hospital.

Am J Infect Control 2012 Aug;40(6):572-5

Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Intrahospital variations in antimicrobial profiles may be related to many factors. This study compared causative agents of nosocomial bloodstream infections between a neonatal intensive care unit (NICU) that adopted a ward-tailored antibiotic policy and adult intensive care units (ICUs). Data on organisms from blood cultures obtained from the respective wards between 2005 and 2009 were analyzed. Compared with the adult ICUs, the NICU had a higher frequency of Enterobacteriacae and lower frequencies of typical hospital-acquired pathogens (eg, Klebsiella pneumoniae, 17.4% vs 10.0% [P < .001]; Acinetobacter baumannii, 3.9% vs 11.6% [P < .001]). Antibiotic resistance of gram-negative organisms was also significantly lower in the NICU, including resistance to imipenem (5.7% vs 32.1%; P < .001), amikacin (8.8% vs 30.3%), and ceftriaxone (36.1% vs 74.6%; P < .001). This could possibly be due to the ward-tailored antibiotic policy adopted by the NICU but not by the other ICUs.
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http://dx.doi.org/10.1016/j.ajic.2012.02.032DOI Listing
August 2012

The effect of delayed transportation of blood samples on serum bilirubin values in neonates.

Malays J Med Sci 2010 Jul;17(3):27-31

Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

Background: Delays in transporting blood samples may cause inaccurate results. Samples may be exposed to light or heat during delays, resulting in the degradation of analytes, for example, bilirubin. This study was done to determine the effect of delays in the transportation of blood samples on serum bilirubin test results.

Methods: Samples taken from neonates admitted to a tertiary hospital with jaundice were included in the study. The samples were collected through venipuncture in 3 labelled containers. The first container was sent immediately to the laboratory, while the second and third containers were sent after being kept in the ward for 1 and 3 hours, respectively. Bilirubin values were measured colourimetrically at a wavelength of 578 nm using a Roche Hitachi 912 Chemistry Analyser upon arrival in the laboratory.

Results: A total of 36 serum samples were studied. The mean of the indirect bilirubin measurements for 0-, 1-, and 3-hour samples were 174 (SD 68.65), 186.97 (SD 60.47), and 184.56 (SD 66.93), respectively. There was a significant difference in the mean indirect bilirubin measurement of 1-hour samples (P = 0.047, 95% CI -24.66 to -1.18) and 3-hour samples (P = 0.045, 95% CI -19.77 to -0.23) compared with 0-hour samples. There were no significant differences observed in either the mean total bilirubin or the mean direct bilirubin measurements of different time intervals.

Conclusion: This study confirms that delays in the transportation of blood samples influence the bilirubin test results.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216170PMC
July 2010

First isolation of Burkholderia tropica from a neonatal patient successfully treated with imipenem.

Int J Infect Dis 2010 Jan 23;14(1):e73-4. Epub 2009 May 23.

Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.

We report the first case of a human Burkholderia tropica infection. The patient was a premature neonate who had necrotizing enterocolitis with bowel perforation requiring surgical intervention. The stoma care and difficulties in feeding were a chronic problem. At the age of almost 4 months he developed septicemia due to B. tropica. Three consecutive blood cultures grew this organism. The organism was cleared from the blood after a course of imipenem and resolution of post-operative ileus. Our case suggests that environmental and plant pathogens can cause human infection especially in those in an immunocompromised condition.
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http://dx.doi.org/10.1016/j.ijid.2009.03.005DOI Listing
January 2010

Frequencies of A(TA)7TAA, G71R, and G493R mutations of the UGT1A1 gene in the Malaysian population.

Biol Neonate 2006 6;89(3):171-6. Epub 2005 Oct 6.

Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia.

Background: Gilbert syndrome is caused by defects in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene. These mutations differ among different populations and many of them have been found to be genetic risk factors for the development of neonatal jaundice.

Objectives: The objective was to determine the frequencies of the following mutations in the UGT1A1 gene: A(TA)7TAA (the most common cause of Gilbert syndrome in Caucasians), G71R (more common in the Japanese and Taiwanese population), and G493R (described in a homozygous Malay woman with Crigler-Najjar syndrome type 2) in a group of Malaysian babies with hyperbilirubinemia and a group of normal controls.

Methods: The GeneScan fragment analysis was used to detect the A(TA)7TAA variant. Mutation screening of both G71R and G493R was performed using denaturing high performance liquid chromatography.

Results: Fourteen out of fifty-five neonates with hyperbilirubinemia (25%) carried the A(TA)7TAA mutation (10 heterozygous, 4 homozygous). Seven out of fifty controls (14%) carried this mutation (6 heterozygous, 1 homozygous). The allelic frequencies for hyperbilirubinemia and control patients were 16 and 8%, respectively (p=0.20). Heterozygosity for the G71R mutation was almost equal among both groups (5.5% for hyperbilirubinemia patients and 6.0% for controls; p=0.61). One subject (1.8%) in the hyperbilirubinemia group and none of the controls were heterozygous for the G493R mutation (p=0.476).

Conclusions: The A(TA)7TAA seems more common than the G71R and G493R mutations in the Malaysian population.
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http://dx.doi.org/10.1159/000088844DOI Listing
May 2006