Neonates in Hong Kong Have Come A Long Way
Special care for sick neonates in Hong Kong is a relatively new venture. Exchange transfusion was only introduced to Hong Kong in 1961 for neonates with hyperbilirubinaemia.1 The first successful attempt to manage a case of severe RDS in 1969 was tried on the Bennett Respirator, an equipment which was not even made for child-patients.1 The subsequent development of specialized care for our sick neonates has taken a very rugged path. In a lecture1 commemorating the inauguration of the Academy of Medicine in 1993, C.Y Yeung described that for some years neonates requiring ventilator care were receiving their life support from HIV (Human Infant Ventilator) utilizing inexperienced nurses to bubble cylinder-oxygen through a manually operated T-adaptor fitted onto a pressure regulating water manometer. Although neonatal jaundice was a major problem, hospital paediatric units were still struggling to purchase phototherapy units in 1982, because the resource distribution to paediatric service was not a focused priority.
It is gratifying to note in the current issue a major emphasis on neonatal medicine by the journal. The increasing sophistication of neonatal practice in Hong Kong is well highlighted by the demand for a number of feature articles ranging from basic molecular genetics2 to understand the scientific basis of neonatal practice, through the natural history of PDA3 and new investigatory approach with near infra-red spectroscopy,4 to a popular mode of ventilatory support for respiratory failure like high frequency ventilation.5 It is also heartening to see increasing interest to publish high quality original work and important commentary from local workers in neonatal medicine. Equally exciting is to find in the recent scientific meeting organized by the Department of Paediatrics of the University of Hong Kong on a theme of "Chinese Paediatric Forum", a large number of presentations was on neonatology and their abstracts reprinted in this issue of the journal.
Of special interest to note are the comments from Dr. Barbara Lam6 warning against a trendy policy of early discharges of newborns from hospitals. While Hong Kong has witnessed a dramatic decline of both the incidence and the severity of neonatal jaundice,7 with kernicterus occurring in term infants reduced from 8.5% among the severely jaundiced baby population in years past (1968-71)8 to only very occasional occurrences in recent times,7 the Americans have suddenly encountered kernicterus in their otherwise healthy term infants whom they have observed in total disbelief.9 Increasing evidence has been gathered on the importance of traditional and home practices, such as herbal consumption10-12 and covering the umbilicus inviting infection,8,13 as contributing factors to the incidence and severity of neonatal jaundice. Discharging babies home early without a good health supervision support system may be asking for deep trouble. Such practice may even invite the resurgence of severe jaundice and kernicterus in Hong Kong again.
With the recent proliferation of new hospitals and new paediatric units, there is also a tendency to develop increasing number of "neonatal intensive care" units. One cannot help asking whether public money should be spent introducing "equality of care" to "spread-out" districts in the small territory of Hong Kong at the expense of "quality care". At Queen Mary Hospital, a specially designed combined intensive care programme has been established since 1984 combining the efforts of a group of intensivists including neonatologist, cardiologist, general intensivist and nephrologist to provide an expertise-concentrated and cost-effective operation. The programme14 has been assessed by most visitors to be highly feasible, practical and cost saving, especially suitable for a place like Hong Kong where funding resources have been relatively restricted for paediatric service and staff turnover rate much higher than other places. The programme has recently been recommended even for UK hospitals to adopt.15
It is important to point out that the "moon in overseas places is not always brighter and fuller". Policies on neonatal practices such as early discharges and mushrooming of neonatal ICUs should not be transplanted to Hong Kong unchanged. Chinese neonates are different.16 When challenged as to his reason for discontinuing the supply to two major Government hospitals of a modified cow milk formula which the company claimed "even the Royal families' babies are taking", the new returnee-professor remarked in 1980: "save it for your Royal families as Hong Kong babies deserve something better". Indeed neonates in Hong Kong deserve the kind of care specially tailored to meet their needs which are not necessarily the same as infants of other ethnic origins.16
1. Yeung CY. Development of neonatal intensive care in Hong Kong. HK J Paediatr 1996;1:55-9.
2. Hall J, Solehdin F. Uniparental dismoy. HK J Paediatr 1997;2:3-8.
3. Yeh TE. Patent ductus arteriosus in preterm infants. HK J Paediatr 1997;2:9-17.
4. Wu PYK. Near-infrared spectroscopy: A window on cerebral microcirculation and metabolism. HK J Paediatr 1997;2:18-22.
5. Stoddard RA, Minton SD, Gerstmann DR. High frequency ventilation. HK J Paediatr 1997;2:23-8.
6. Lam BCC. Early discharge policy of newborn infants. HK J Paediatr 1997;2:58-59.
7. Yeung CY. The changing pattern of neonatal jaundice in Chinese - A Hong Kong experience. J Paediatr Obst Gynae 1996;4:5-12.
8. Yeung CY. Neonatal hyperbilirubinemia in Chinese. Trop Geog Med 1973;22:151-7.
9. Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breast-fed term infants. Pediatrics 1995;96:730-3.
10. Yeung CY, Lee FT, Wong HN. Effect of a popular Chinese herb on bilirubin protein binding. Biol Neonate 1990;58:98-103.
11. Yeung CY, Leung CS, Chen YZ. An old traditional remedy for neonatal jaundice with a newly identified risk. J Paediatr Child Health 1993;29:292-4.
12. Yeung CY. The role of native herbs in neonatal jaundice. J Sing Paediatr Soc 1994;36:7-12.
13. Ngai KC, Yeung CY. Effect of endotoxin and TNFα on bilirubin cytotoxicity. (Abs) Proc International Perinatology Collegium 1996;p12.
14. Wong SN, Tsoi NS, Yeung CY. An experience of renal replacement therapy in a combined neonatal and paediatric intensive care unit in Hong Kong. Pediatr Nephrol 1994;8:122-5.
15. Matthew D. Intensive care facilities for children. (Editorial comment) Pediatr Nephrol 1994;8:126.
16. Yeung CY. Chinese neonates are different. Chap 89 in Yu V, Tsang R, Feng ZK, Yeung CY (Eds) in Textbook of neonatal medicine: a Chinese perspective. 1996, Hong Kong University Press.
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