BACKGROUND: A definite diagnosis of asthma during infancy is difficult. Asthma Predictive Index (API) is used to predict asthma at school age, but does not determine who among these actually have asthma. OBJECTIVES: This study aims to determine the bronchodilator response of infants with recurrent wheezing compared with normal control. METHODOLOGY: This cross sectional study included asymptomatic subjects aged 6-24 months with history of recurrent wheezing and age/sex matched controls. After sedation with chloral hydrate (Odan) at 50-75 mg/kg, a bronchodilator challenge test was performed with single dose 400 mcg salbutamol (Ventolin) MDI inhalation delivered via a spacer (Philips Respironic OptiChamber Diamond). Baseline and 15 minutes after salbutamol inhalation Maximum Flow at Functional Residual Capacity (V‘maxFRC) were determined using MasterScreen Paed/BabyBody Option Squeeze version 8.0. ANOVA and Pearson chi-square were used for the statistical analysis of data. RESULTS: Sixty-nine infants (23 previous wheezers and positive API, 23 previous wheezers with negative API and 23 controls) were included. There was a significant difference in the post bronchodilator challenge test V‘maxFRC between wheezers with positive API and controls (p= 0.047). There was no significant difference in other parameter among groups. CONCLUSION AND RECOMMENDATION Absolute values of V‘maxFRC post bronchodilator challenge using the Tidal Rapid Thoracoabdominal compression technique may be used to identify current asthma among asymptomatic infants with recurrent wheezing. Further studies with patient follow-up are recommended to assess response to treatment.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is a novel pathogen that has rapidly caused a devastating pandemic of Coronavirus disease 2019 (COVID-19). The real time reverse transcriptase polymerase chain reaction cycle threshold values are inversely related to viral load and believed to have a role in terms of mortality and severity of the disease however, there is limited data in children. OBJECTIVES: This study aims to determine the RT-PCR cycle threshold level in relation to mortality and pediatric acute respiratory distress syndrome (pARDS) among COVID-19 patients admitted at Philippine Children’s Medical Center. METHODS: A cross sectional study was done on patients with RT-PCR confirmed covid-19 admitted at Philippine Children’s Medical Center from September 2020 to June 2021. RESULTS: 50 nasopharyngeal swab specimens from children admitted for COVID-19 were analyzed. 12 (24%) had acute respiratory distress syndrome. Among the 12 children who had pARDS, six (50%) expired; in those without pARDS, two (5.26%) expired. There was no difference in cycle threshold values between patients who died and who survived, as well as those with or without pARDS. CONCLUSIONS AND RECOMMENDATIONS We have no evidence to demonstrate a difference in Ct values alone between children who died or survived, or those who developed pARDS or those who did not. RT-PCR cycle threshold alone cannot predict mortality and development of pARDS, it can only indicate the presence of infection but not its severity. Cycle threshold and its significance may further be explored with a bigger population size in children in future studies.

BACKGROUND: Severe dengue is a leading cause of serious illness and death, and intensive supportive care is the most important aspect of management. Before fluid resuscitation, a baseline hematocrit is obtained, and frequent monitoring of the complete blood count is needed.

OBJECTIVE: To determine the correlation of ultrasound measurement of inferior vena cava (IVC) to aorta (Ao) diameter ratio with hematocrit levels and severity of shock among children with dengue fever.

METHODOLOGY: This is a prospective study design conducted at the Emergency Room of Philippine Children's Medical Center. Clinical data and hematocrit of the children with dengue fever aged 1 month to 17 years and 364 days old were documented. The Inferior vena cava diameter (IVC)and the Aorta (Ao) diameter ratio was determined using bedside ultrasound.

 RESULTS: The IVC/Ao diameter ratio correlates with high hematocrit and dengue shock in children. There is a significantly higher proportion of subjects with a hematocrit of normal range of age among those with a ratio 1.0.  A ratio of severity of Dengue illness. Sensitivity of IVC/Ao diameter ratio of Measurement of IVC/Ao diameter ratio has high interrater and intrarater reliability.

CONCLUSION AND RECOMMENDATION: IVC/Ao diameter ratio was significantly associated with severity of dengue illness. It should be used to aid decision?making and monitor response to treatments in dengue fever.

Human ; Male ; Female ; Dengue ; Hematocrit ; Diagnostic Imaging ; Vena Cava, Inferior

BACKGROUND: The World Health Organization declared on June 11, 2009 the first pandemic of the 21st Century caused by the novel Influenza A (H1N1) virus. The virus was observed to be clinically similar to the seasonal influenza, in which case, patients recover even without medical treatment.The virus affected the younger age group even those who are healthy, which make it different from seasonal flu.

OBJECTIVE: The study aimed to describe the clinical profile and outcome of pediatric patients with Reverse Transcription-Polymerase Chain Reaction (RT-PCR)-confirmed Influenza A (H1N1).

METHODOLOGY: Pediatric patients of the Lung Center of the Philippines seen from May 1 to July 31, 2009 for Influenza-like illness upon presentation and confirmed to have Influenza A (H1N1) virus through Reverse Transcription-Polymerase Chain Reaction (RT-PCR) assay were included in the study. Charts of patients were reviewed. Information from patients was obtained using the WHO Case Summary Form and the National Epidemiology Center Initial Screening of Influenza A (H1N1) form. The patient's demographic data, clinical characteristics, co-morbid conditions, vaccination, clinical course, complications, anti-viral medications received and adverse reactions, and over-all outcome were noted, as well as, exposure to confirmed cases and history of travel.

RESULTS: Out of the 243 RT-PCR-confirmed patients, 71.6% (n=174) came from the adolescent age group, with a median age of 13 years old. A predominance of male patients (57.2%) was noted. Fever (92%), cough (83.1%), nasal congestion (52.7%) and sore throat (35%) were the most common presenting signs and symptoms. Bronchial asthma (14.4%) was the leading co-morbidity present and pneumonia was the most common complication. Eight patients (3.3%) were hospitalized during the course of the disease. All RT-PCR-confirmed Influenza A (H1N1) patients recovered and no mortality was noted.

CONCLUSIONS: In this study, majority of the RT-PCR-confirmed Influenza A (H1N1) patients were characterized by self-limited, uncomplicated, and febrile respiratory illness, who all recovered with minimal complications.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Influenza A virus ; Influenza A Virus, H1N1 Subtype ; virus diseases ; Reverse Transcription ; polymerase chain reaction

OBJECTIVE: This cross-sectional study aimed to evaluate the effectiveness of the BLUE (Bedside lung ultrasound in emergency) protocol compared to clinicoradiologic diagnosis for promptly identifying acute undifferentiated dyspnea in pediatric patients. MATERIALS AND METHODS: Conducted at the emergency room of the Philippine Children's Medical Center from August 2022 to May 2023, the study involved performing the BLUE protocol within 2 hours of patient arrival. Chest radiography was also conducted, with images independently interpreted by a pediatric pulmonologist, emergency medicine specialist, and radiologist. The results were then compared to the clinicoradiologic findings. RESULTS: A total of 111 participants were included, with the majority being male (55.4%) and under 1 year old (48.2%). Pneumonia was the most observed diagnosis (88.2%), followed by asthma (7.2%). Utilizing the BLUE protocol, pneumonia was identified as the most prevalent diagnosis (81%), followed by pleural effusion (12.6%) and asthma (6%). The pulmonologist, emergency medicine specialist, and radiologist exhibited high sensitivity in diagnosing pneumonia (91.01%, 89.89%, 96.77% respectively) but low specificity (26%, 21%, 57.89%). Diagnosing pleural effusion and/or congestion showed high sensitivity (89%) and low specificity (21%) based on the pulmonologist's reading, low sensitivity (37%) and high specificity (99%) based on the emergency medicine specialist's reading, and 100% specificity based on the radiologist's reading. All readers demonstrated high specificity (95%, 93%, 93%) and low sensitivity (50%, 71%, 71%) in diagnosing asthma. The ultrasound readings between the readers exhibited a high concordance rate of 98%. CONCLUSION The study findings show that the BLUE protocol has high sensitivity in diagnosing pneumonia and high specificity in diagnosing asthma. The high concordance rate among readers suggests consistent ultrasound findings. These results support the practical application of the BLUE protocol for promptly diagnosing acute undifferentiated dyspnea in pediatric patients within the emergency department.
Dyspnea