In a case-control study carried out in the Kuala Lumpur Maternity Hospital between 1st July 1995 and 31st January 1996 the objectives were (1) to determine the rate of breastfeeding in surviving very low birthweight (VLBW, < or = 1500 g) Malaysian infants following the introduction of the Baby Friendly Hospital Concept, and (2) to identify significant predictors associated with successful breastfeeding in these infants. During the study period, 201 (1.24 per cent) of live-born infants were VLBW infants, 192 (95.5 per cent) were Malaysians, and 141 (73.4 per cent) of them survived to go home. The breastfeeding rate among all surviving VLBW Malaysian infants at the time of discharge was 40.2 per cent (57/141). The mothers of 126 (89.4 per cent) VLBW Malaysian infants were interviewed before discharge. Logistic regression analysis showed that, after controlling for various confounders, the significant predictors associated with successful breastfeeding were: (a) Malay mothers (odds ratio: 6.0; 95 per cent CI: 1.9, 19.4), (b) mothers with educational levels of between 7 and 9 years (odds ratio: 3.6; 95 per cent CI: 1.0, 12.2), and (c) earlier age of commencement of enteral feeds in the VLBW infants (for each additional day delay in commencement of feeding, odds ratio of breastfeeding was 0.5; 95 per cent CI: 0.4, 0.8).

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Introduction: This study aims to study how the effect of the location of patient collapses from cardiac arrest, in the residential and non-residential areas within Singapore, relates to certain survival outcomes. Materials and Methods: A retrospective cohort study of data were done from the Cardiac Arrest and Resuscitation Epidemiology (CARE) project. Out-of-hospital cardiac arrest (OHCA) data from October 2001 to October 2004 (CARE) were used. All patients with OHCA as confirmed by the absence of a pulse, unresponsiveness and apnoea were included. All events had occurred in Singapore. Analysis was performed and expressed in terms of the odds ratio (OR) and the corresponding 95% confidence interval (CI). Results: A total of 2375 cases were used for this analysis. Outcomes for OHCA in residential areas were poorer than in non-residential areas—1638 (68.9%) patients collapsed in residential areas, and 14 (0.9%) survived to discharge. This was significantly less than the 2.7% of patients who survived after collapsing in a non-residential area (OR 0.31 [0.16 – 0.62]). Multivariate logistic regression analysis showed that location alone had no independent effect on survival (adjusted OR 1.13 [0.32 – 4.05]); instead, underlying factors such as bystander CPR (OR 3.67 [1.13 – 11.97]) and initial shockable rhythms (OR 6.78 [1.95 – 23.53]) gave rise to better outcomes. Conclusion: Efforts to improve survival from OHCA in residential areas should include increasing CPR by family members, and reducing ambulance response times. Key words: Emergency Medical Services, Non-residential, Prehospital, Residential

Introduction: Prompt recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) and defibrillation is necessary for good outcomes from out-of-hospital cardiac arrest (OHCA). This study aims to describe the recognition and treatment of OHCA in patients conveyed by non-emergency ambulance services (EAS) in Singapore. Materials and Methods: This is a multi-centre, retrospective chart review, of cases presenting to public emergency departments (EDs), conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. The study was from October 2002 to August 2009. The following variables were examined: ability to recognise cardiac arrest, whether CPR was carried out by the ambulance crew and whether an automated external defibrillator (AED) was applied. Results: Eighty-six patients were conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. Mean age was 63 years (SD 21.8), 70.9% were males. A total of 53.5% of arrests occurred in the ambulance while 70.9% were found to be asystolic upon ED arrival. Seven patients had a known terminal illness. Survival to discharge was 3.5%. Cardiac arrest went unrecognised by the ambulance crew in 38 patients (44.2%). CPR was performed in 35 patients (40.7%) of the 86 patients and AED was applied in only 10 patients (11.6%). Conclusion: We found inadequate recognition and delayed initiation of treatment for OHCA. Possible reasons include a lack of training in patient monitoring and detection of cardiac arrest, lack of CPR training, lack of confidence in performing CPR, lack of AEDs on ambulances and lack of training in their use. Key words: Automated external defibrillator (AED), Cardiopulmonary resuscitation (CPR), Emergency medical services, Prehospital