OBJECTIVE:To test the efficacy and safety of PhilVent™, a pressure limited, time cycled, Philippine ventilator through animal and clinical studies.
METHODS AND RESULTS:
Animal study: Term, newborn piglets (N=8) were intubated and alternately cycled to the PhilVent™ or to a pressure limited, time cycled, commercial ventilator (Sechrist) at peak inspiratory pressures of 10, 13 and 15 cm H20 and rates of 15, 20, 25 breaths per min and constant FiO2 (0.40) and positive end expiratory pressure (+4). Blood gases and adverse events (pneumothorax, sudden deterioration, death) were monitored. Results show no significant difference in blood gases on either machine at the various ventilator settings. No adverse events occurred.
Clinical study: Prospective, randomized, controlled trial of 90 preterm infants with respiratory distress, randomized either to PhilVent™ (N=45) or Sechrist (N=45). Ventilator settings were adjusted to achieve predetermined range of blood gases. Arterial blood gases and any adverse events e.g., pneumothorax, pulmonary hemorrhage were monitored. There were no clinically significant differences in the ventilator settings or blood gases of the infants on the PhilVent™ or Sechrist. No increase in adverse events were noted with the PhilVent™.
CONCLUSION: In animal and clinical studies, the efficacy and safety of the PhilVent were comparable to the Sechrist. The PhilVent™ is an effective, alternative ventilator for the treatment of respiratory insufficiency in newborn infants.

Animal ; Male ; Female ; Infant Newborn ; Animals ; Blood Gas Analysis ; Gases ; Infant, Newborn ; Infant, Premature ; Philippines ; Pneumothorax ; Positive-pressure Respiration ; Prospective Studies ; Respiratory Insufficiency ; Ventilators, Mechanical ; Respiratory Distress Syndrome, Newborn ; Respiratory Insufficiency ; Equipment And Supplies

OBJECTIVE: To explore the effects of pesticide exposure on the auditory system, specifically on hearing status based on auditory brainstem responses.

METHODS: A cohort of pregnant women was identified in several communities in a rural area from April 2002 to February 2003 and followed up until delivery. Mother-infant dyads were assessed for exposure to pesticides. Maternal and fetal exposures to environmental toxic products were determined by measuring levels in maternal hair and blood, and infant cord blood, hair, and meconium, respectively. Hearing status was measured using otoacoustic emissions (OAE) and confirmed by diagnostic auditory brainstem responses (ABR) measured at 80, 60, and 40 decibels. Waves I, III, V were identified and absolute latencies measured, including inter-peak latencies from waves 11III, I-V, and III-V. Pesticide exposure was then correlated with latencies of Waves I, III, V, and interpeak latencies of waves I-III, IIV, and III-V. Hearing loss and pesticide exposures were correlated with Griffiths Mental Development Scores (GMDS).

RESULTS: Significant delays in the ABR wave latencies were noted in the group with exposure to pesticides. Propoxur was the most common toxic product detected in infants and meconium the best substrate for its detection. There was a 1.4% risk of hearing loss with exposure to propoxur (RR=0.52 (0.12-2.30), p = 0.06), a 6.25% risk with cypermethrin exposure (RR= 4.53 (0.61133.64), P = 0.10) and 6.25% risk with pretilachlor exposure (3.13 (0.44-22.30), p = 0.07). Griffith's Mental Developmental Scale scores (GMDS- hearing and speech subscale and general quotient scores) were not significantly different between exposed and unexposed groups. However, three infants with positive exposures and hearing loss had below average, or low to average scores using this scale.

CONCLUSION: Maternal exposure to environmental toxic products may affect the auditory pathway in infants at birth. Pregnant women should limit their exposure to such toxic products in order to avoid neurodevelopmental effects particularly on hearing because this is very important in the critical stage of language and speech development.

Human ; Male ; Female ; Infant Newborn ; Auditory Pathways ; Maternal Exposure ; Meconium ; Speech ; Otoacoustic Emissions, Spontaneous ; Hearing Loss ; Deafness ; Hearing Tests ; Acetanilides ; Pesticides ; Hair

Objective: To determine the adverse effect of pre- and postnatal exposure to carbamate (propoxur) and pyrethroid pesticides on children's cognitive functions at 4 and 6 years of age. Method: As part of a prospective cohort study among children with known pre- and postnatal exposure to propoxur and pyrethroids, children were examined at time points, 4 and 6 years, to determine the adverse effect of pesticide exposure on neurocognitive function, i.e., intelligence (IQ) using the WPPSI-III test. Pre- and postnatal pesticide exposures were measured by meconium and hair analysis, respectively, using gas chromatography-mass spectrometry (GCMS). Results: Seven hundred twenty-four (724) maternal/children dyads were seen at four years and 717 at six years of age. Their mean (SD) full-scale IQ was low on average: 83.9 (10.2) at four years and 83.6 (8.6) at six years. Prenatal but not postnatal exposure to propoxur (-0.139, p=0.01) and pyrethroids (-0.097, p=0.05) were significantly correlated (negative) with full-scale IQ at four years but not at six years. The confounders that were significantly correlated to full-scale IQ at four and/or six years of age were maternal IQ, child’s weight, height, head circumference, socio-economic status, child environment, and stimulation at home (HOME) violence or abuse at home. Regression analysis of pesticides and confounders showed similar results, except for weight and head circumference. Conclusion We conclude that prenatal exposure to propoxur and pyrethroids had a negative effect on the children’s IQ at four years but no longer at six years. Thus, the ability of the child’s IQ to recover from the adverse effect of intrauterine pesticide insult may be attributable to the neuronal plasticity of its brain. Similarly, confounders to these outcome measures are multiple and are essential to address when evaluating the effect of pesticides on neuro-cognitive development in children.
carbamate

BACKGROUND: To determine prevalence of delay in 5 developmental domains among Filipino children at 6, 12 and 24 months and investigate influence of socioeconomic status, maternal intelligence, gender and home stimulation. Variations and developmental domains as reliable indicators of potential delay were determined.

METHODS: 754 maternal/ infant dyads were followed up until 2 years old. The Griffiths Mental Development Scales determined sub-quotient scores in locomotor, personal/social, hearing/language, eye-hand coordination and performance subscales before averaging for General Quotient(GQ) score. Score < 85 was considered delayed.

RESULTS: Low GQ scores were noted in 5.4% at 6 months, 19.1% at 12 months and 11.0% at 24 months old. GQ scores were lowered by performance subscale at 6 months, hearing/language and performance at 12 months and hearing/language at 24 months. No single subscale consistently lowered GQ across time. Only 4.2% maintained low GQ scores in all three ages.

CONCLUSION: Prevalence of developmental delay varied across 24 months with highest rates noted at 12 months of age. No developmental domain consistently lowered test scores and no test age was predictive of future outcome but focused early intervention according to age is suggested. Home environment, higher socioeconomic status, maternal IQ and supervision were associated with improved potential.

Human ; Infant ; Child ; Prevalence

Background: With the surge of COVID-19 infections, there were concerns about shortage of mechanical ventilator in several countries including the Philippines. Objective: To transform a locally made, low-cost, neonatal ventilator into a volume- and pressure-controlled, adult ventilator and to determine its safe use among ventilated, adult patients at the Philippine General Hospital. Methods: The modification of the neonatal ventilator (OstreaVent1) to the adult OstreaVent2 was based on the critical need for adult ventilators, in volume or pressure mode, in the Philippines due to the COVID-19 pandemic. The adult ventilator settings were calibrated and tested for two days to check for consistency and tolerance and then submitted to a third party for certification. Once certified, a safety trial of 10 stable adult patients on mechanical ventilator was conducted. The patients were placed on the OstreaVent2 for four hours while ventilator parameters, patient’s vital signs, and arterial blood gases were monitored at baseline, during, and after placement on the OstreaVent2. A poststudy chest radiograph was also done to rule out pulmonary complications, particularly atelectasis and pneumothorax. Results: The prototype OstreaVent2 received an FDA Certification for Medical Listing after passing its thirdparty certification. Ten patients (60% male) recruited in the study had a mean age of 39.1 ± 11.6 years. Half of the patients had a diagnosis of non-COVID-19 pneumonia. During the 4-hour study period, the patients while on the OstreaVent2, had stable ventilator settings and most of the variabilities were within the acceptable tolerances. Vital signs were stable and arterial blood gases were within normal limits. One patient developed alar flaring which was relieved by endotracheal tube suctioning. No patient was withdrawn from the study. One patient who was already transferred out of the ICU subsequently deteriorated and died three days after transfer to the stepdown unit from a non-ventilator related cause. Conclusion The new OstreaVent2 is safe to use among adults who need ventilator support. Variabilities in the ventilator’s performance were within acceptable tolerances. Clinical and blood gas measurements of the patients were stable while on the ventilator.
Respiration, Artificial