Intraventricular hemorrhage (IVH) remains an important cause of morbidity and mortality in Very Low Birth Weight (VLBW) infants. Since 2004, Indomethacin, which is effective in preventing IVH, has been removed from the Philippine market. Ketorolac is a nonselective cyclooxygenase inhibitor which is structurally-related and of equal potency to Indomethacin.
OBJECTIVE: This study aims to determine if prophylactic ketorolac compared to placebo will decrease IVH and its associated morbidities among preterm neonates.
METHODS: We conducted a double-blind, randomized, placebo-controlled trial among neonates born in a tertiary government university hospital. Newborns with gestational age ?32 weeks and birth weight RESULTS: A total of 134 infants were included in this study. There was no difference in the proportion of infants who developed IVH between the ketorolac and placebo groups (46% vs. 45%). The mean serum creatinine levels were significantly higher in the ketorolac group (1.15 ± 0.69 vs 0.79 ±0.38; p=0.002). The rates of death, sepsis, necrotizing enterocolitis, bleeding, platelet counts of <50,000/mm3, mean urine output and the lengths of hospital stay were similar in the two groups.
CONCLUSION: Prophylactic intravenous ketorolac was ineffective in preventing IVH among preterm infants. Ketorolac cannot be recommended for the prevention of IVH.

Human ; Infant Newborn ; Birth Weight ; Cerebral Hemorrhage ; Creatinine ; Cyclooxygenase Inhibitors ; Echoencephalography ; Gestational Age ; Philippines ; Platelet Count ; Sepsis

Background: Zinc supplementation has been shown to lower mortality and morbidity due to diarrhea and pneumonia. Because of the positive effect of zinc in the prevention of pneumonia, several studies have been conducted to investigate its effect as an adjunct therapy for pneumonia. For this reason, a systematic, quantitative review of available studies is needed to determine the overall effect of zinc as an adjunct in the treatment of pneumonia in children less than five years old. Objectives: To assess from literature the effect of zinc, when given with antibiotics, in reducing mortality, treatment failure, length of hospital stay, and duration of symptoms of pneumonia in children less than five years old. Design: Meta-analysis of randomized, placebo-controlled intervention trials. Methods: Studies for inclusion were identified by PubMed search, journal handsearch, and other methods. The authors independently assessed study quality and extracted data. Statistical Analysis: Revman Version 4.2 was used to analyze the data gathered. The summary relative risks (RRs) and 95% CI for each outcome variable were estimated using a fixed-effects model. Chi-square and I2 were computed to assess for heterogeneity of results. Results: A total of three acceptable studies were included in the meta-analysis. The summary RRs showed that zinc had no overall treatment effect on mortality from pneumonia (RR 0.69, CI 0.08, 5.70) and treatment failure (RR 1.05, CI 0.74, 1.49). These results were statistically insignificant with p-values of 0.73 and 0.77, respectively. Chi2 and I2 tests showed significant heterogeneity of results for treatment failure (Chi2 = 5.06, I2 = 60.5%). The same tests did not show significant heterogeneity of results for mortality (Chi2 = 0.43, I2 = 0%). In one study, the use of zinc reduced the duration of severe pneumonia with mean difference of four (4.2-4.9) versus five (4.5-5.5) days leading to shorter hospitalization [5 (4.8-5.5) versus six (5.1-6.1) days]. In another study, the zinc group's recovery rate from very ill status was 2.6 times (p = 0.004) more, and the resolution of fever was 3.1 times (p = 0.003) more than those in the placebo group. However, these results could not be combined due to lack of data on standard deviation. Conclusion: There is not enough evidence to conclude that zinc is effective in reducing mortality, treatment failure and duration of symptoms of pneumonia. A large population, multi-center, randomized, placebo-controlled trial should be conducted to obtain statistically significant evidence.
Human ; ZINC ; PNEUMONIA

Candidemia is a major cause of nosocomial morbidity and mortality in neonates. Prompt diagnosis and treatment is crucial. Risk factor analyses have been conducted worldwide, but limited local data are available. This study was conducted to help pediatricians practicing locally decide when to suspect if a neonate has candidemia; therefore, helping them in the judicious use of empirical antifungal therapy. Objective: To determine if there was a difference in the risk factors among neonates with candidemia and those without it, who were admitted at the Neonatal Intensive Care Unit of the Philippine General Hospital from October 2003 to August 2006. Methods: Neonates admitted within the mentioned period, surviving at least on the third day of life, and had at least one blood culture on or after day 3 of life were included in the study. A retrospective review of records was performed to identify the presence or absence of known risk factors for candidemia. The outcome of interest was the presence of candidemia. Each variable was analyzed initially using the bivariate analysis chi-square. Cut-off value for inclusion into multivariate analysis was p<0.25. Multivariate analysis, through backward elimination, was done to narrow down independent variables (p value for retention <0.25). Results: One hundred thirty-eight neonates (69 cases and 69 controls) were included. Based on bivariate analysis, patients exhibiting the following characteristics showed increased risk for candidemia: birth weights of 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) and 1500 to 2449g (OR: 3.84; 95% CI 1.31-11.27); pediatric aging < 28 weeks (OR: 1.42; 95% CI: 1.07-8.5) and 28 to 32 weeks (OR: 1.89; 95% CI: 0.74-4.84); central vascular access (OR: 0.52; 95% CI: 0.26-1.03); prolonged broad-spectrum antibiotic use (OR: 2.0; 95% CI: 0.95-4.2); and increased hospital stay (OR: 0.5; 95% CI: 0.24-1.05). Intralipid use was also associated with candidemia, but was excluded due to insufficient data available. In the multivariate analysis, only patients with birth weights of 1500 to 2449g (OR: 3.65; 95% CI: 1.24-10.77) and 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) qualified. A clinical predictive model in diagnosing candidemia was not possible due to insufficient variables available. Conclusion: Based on the study, infants with lower birth weights (<2500 g) were at most risk for developing subsequent candida infection.
Human ; CANDIDEMIA ; SEPSIS