OBJECTIVES: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common of all clinically significant enzyme defects of red blood cells. It has a high rate of prevalence in the Philippines. Concern about hemolytic anemia and jaundice due to unrecognized G6PD deficiency led us to determine the prevalence of G6PD deficiency among jaundiced neonates in the Philippine General Hospital, a tertiary referral hospital in the Philippines. It was hypothesized that G6PD deficiency was more prevalent in neonates with jaundice than in the normal population. We also compared the clinical presentation and course (hospital stay and days of phototherapy requirement) for G6PD deficient and G6PD normal neonates.

MATERIALS AND METHODS: We studied 102 clinically jaundiced neonates admitted to the nursery of the Philippine General Hospital. Blood samples in individual microtainers were quantitatively tested for G6PD activity using a commercial G6PD assay kit. The clinical presentation and hospital courses of patients were statistically compared using the t-test for single proportions.

RESULTS: G6PD deficiency was diagnosed in 17 of 102 cases[16.7% (95% CI: 10.0 to 25.3)], which is significantly higher than the normal population (p<0.001). In all G6PD-deficient neonates, no evidence of other factors known to cause hyperbilirubinemia were detected. There was no significant difference on phototherapy requirement and length of hospitalization in G6PD- deficient and other jaundiced neonates.

CONCLUSION: The prevalence of G6PD deficiency among jaundiced neonates was found to be higher than the normal population thus, early detection of this enzymopathy, regardless of sex, and close surveillance of the affected newborns is important in reducing the risk of severe hyperbilirubinemia.

Human ; Male ; Female ; Infant Newborn ; Glucosephosphate Dehydrogenase Deficiency ; Glucosephosphate Dehydrogenase ; Philippines ; Erythrocyte Count ; Erythrocytes ; Hyperbilirubinemia ; Jaundice ; Phototherapy ; Nurseries

Background: Preterm premature rupture of membranes (PPROM) has been associated with chorioamnionitis but studies are inconsistent on the relationship between PPROM latency and the risk of chorioamnionitis and early onset sepsis. Objective: To define the association of PPROM latency and the risk of histologic chorioamnionitis (HCA) and early onset neonatal sepsis (EONS). Methodology: A prospective cohort study was done at a public tertiary hospital on 569 mothers with spontaneous rupture of membranes and with fetuses EONS was defined using test of association and Receiver Operating Characteristics (ROC) curve analysis. The association of HCA with maternal and neonatal characteristics as well as adverse neonatal outcomes were also determined. Results: A total of 569 mothers with PPROM were included. Incidence of HCA and EONS were 13% and 24% respectively. PPROM latency was significantly associated with HCA and is a fair predictor of HCA (AUC = 0.7013; 76% accuracy at 31.5-hour cut-off) but failed as a predictor of EONS (AUC = 0.4799). PPROM, platelet count, CRP, and neutrophil count were ndependent predictors of HCA. HCA was associated with EONS and mortality. Mortality was higher in the presence of both HCA and EONS. Conclusion Longer PPROM is associated with HCA and is a fair predictor of HCA at a cut-off of 31.5 hours. PPROM fails as a predictor of EONS.
Neonatal Sepsis

Background: Neonates and infants experience gastroesophageal reflux as manifested through vomiting, reflux, and coughing. The complaint from many caregivers begins around the 2nd or 3rd month of life and subside around the 6th month of infancy. The standard of care has not been established and treatment options are limited owing to the pharmacological interventions that are deemed safe and effective. Alginate-based formulations, a widely used product in adults such as Gaviscon™, have been explored as another option to treat gastroesophageal reflux. Objectives: To determine the safety and efficacy of alginate-based formulations in reducing symptoms of gastroesophageal reflux in neonates and infants. Methods: An electronic search was conducted for randomized control trials in MEDLINE via PubMed, Herdin Plus, Cochrane Central Register of Controlled Trials, SCOPUS, and Clinical Trials Registry. The search terms were “gastroesophageal reflux,” “acid reflux,” “neonates,” “newborn,” “infants,” “baby,” “babies,”, and “alginate.” Two review authors independently assessed the available full text articles and a third author intervened to settle the discussion. Results: Two studies were identified and included in this study. Due to the difference in the period of measurement of the trials, a meta-analysis was not pursued. However, a systematic review was still conducted. The two studies suggest a significant improvement of symptoms with alginate-based liquid formulations as intervention. No significant adverse events have been noted making this treatment option generally safe for use in infants. Conclusion There is insufficient evidence to conclude that alginate-based formulations ultimately help decrease gastroesophageal reflux in neonates and infants, but initial trials show promising results. There is also insufficient data to conclude the safety profile of this treatment option given the small sample.
Gastroesophageal Reflux ; Infant, Newborn ; Infant ; Alginates

Background and Objective: Pediatric COVID-19 epidemiology and factors associated with adverse outcomes-mortality, need for invasive mechanical ventilation, and ICU admission, are largely unstudied. We described the clinicodemographic characteristics of Filipino pediatric COVID-19 patients and determined the factors associated with adverse outcomes. Methods: This is a retrospective cohort study of 180 hospitalized SARS-CoV-2-confirmed cases 0-18 years old from April 2020 to August 2021 in a tertiary COVID-19 referral hospital in Manila, National Capital Region. Crude associations were determined using chi-squared or Fisher’s exact tests; and medians were compared using the Mann-Whitney test. Factors predictive of mortality were determined using Cox proportional hazards regression analysis. The survivor functions were depicted in graphs. Results: About 41.67% had mild disease, 58.33% were males, 39.4% aged 0-4 years, and 69.44% had at least one comorbidity. About 9.44% died (adjusted 9.2 persons per 1000 patient-days, 95% CI 5.5%-15.2%), 17.78% needed invasive mechanical ventilation, and 20% needed ICU admission. Independently, severe-critical COVID-19 (HRc 11.51, 95% CI 3.23, 41.06), retractions (HRc 10.30, 95% CI 3.27, 32.47), alar flaring (HRc 4.39, 95% CI 1.53, 12.58), cyanosis (HRc 4.39, 95% CI 1.72, 14.11), difficulty of breathing (HRc 7.99, 95% CI 2.25, 28.71), poor suck/appetite (HRc 4.46, 95% CI 1.59, 12.40), ferritin (HRc 1.01, 95% CI 1.00, 1.01), IL-6 (HRc 1.01, 95% CI 1.00, 1.01), aPTT (HRc 1.05, 95% CI 1.01, 1.10), IVIg (HRc 4.00, 95% CI 1.07, 14.92) and corticosteroid (HRc 6.01, 95% CI 2.04, 17.67) were significant hazards for mortality. In adjusted Cox analysis, only retractions (HRa 34.96, 95% CI 3.36, 363.79), seizure (HRa 9.98, 95% CI 1.76, 56.55), and corticosteroids (HRa 8.21, 95% CI 1.12, 60.38) were significantly associated with mortality while alar flaring appeared to be protective (HRa 0.10, 95% CI 0.01, 0.95). Several clinical characteristics were consistently associated with adverse outcomes. Conclusions Majority of hospitalized pediatric COVID-19 patients were very young, males, had mild disease, and had at least one comorbidity. Mortality, invasive mechanical ventilation, and ICU admission were relatively low. Except for alar flaring which appeared to be protective, retractions, seizure, and use of corticosteroids were associated with adverse outcomes.
COVID-19 ; Epidemiology ; Philippines ; Child ; Pediatrics

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 and Objective: Endocrine Disrupting Chemicals (EDCs) are ubiquitously found as low-level contaminants and pose serious threat to women’s health. EDCs may result in various reproductive disorders, fetal birth and developmental abnormalities, and endocrine and metabolic disorders. EDCs can be detected in body fluids of exposed individuals including blood and urine. This study aimed to detect four EDCs — Methyl Paraben (MP), 2,4-Dichlorophenoxyacetic acid (2,4-D), Monobutyl Phthalate (MBP), and Bisphenol A (BPA) in urine samples of women using Ultra-Performance Liquid Chromatography – Quadrupole Time-of-Flight (UPLC-QTOF) mass spectrometry. Methods: Sequential steps of enzymatic deconjugation, liquid-liquid extraction, solid phase extraction, and liquid chromatography separation and mass spectrometry detection were optimized in urine samples. The method was used to analyze 70 urine samples from women of reproductive age. Results: The sample preparation method showed a recovery ranging from 86.6% (MBP) to 100 % (2,4-D). The method demonstrated limits of quantitation ranging from 1.52 ng/m(MP) to 6.46 ng/mL(2,4D). Intra-day precisions expressed as relative standard deviation were all below 15% while accuracy was shown to range from 67.10% (2,4-D) to 102.39% (MBP). MP was detected in nine samples (12.86%) with a geometric mean value of 10.15 ng/ml (range: 3.62-52.39 ng/ml). MBP was detected in 68 samples (97.14%) with a geometric mean value of 97.62 ng/ml (range: 15.32-698.18 ng/ml). BPA was detected only once (9.58 ng/ml) while 2, 4-D was not detected in all samples. Conclusion A UPLC-QTOF mass spectrometry method to detect four EDCs at parts per billion level (ng/ml) was adapted and applied for analysis of urine samples. This method can find applicability in routine testing of clinical specimens as well as surveillance and other epidemiological studies.
Endocrine Disruptors

Context: Exposure to environmental pollutants (EP) and Endocrine-disrupting chemicals (EDCs) is associated with several general negative health effects which compromise women's reproductive health, maternal, and neonatal outcomes. Unfortunately, many nonpregnant and pregnant women are unaware of their active exposure to these potentially slow-acting toxic substances, EPs, and EDCs. At any stage of life, and in the long-term minute exposures, there is no established safe level of exposure to these substances. Due to the potentially harmful effects on women in general, and to the pregnant and her unborn child in particular, it is important to establish the prevalence of their exposure. Aims: The aim of this study was to determine the magnitude (prevalence) of exposure among nonpregnant and pregnant women aged 18–49 years to common EPs/EDCs such as bisphenol A, pesticides, phthalates, and perfluorinated compounds among others. Settings and Design : This study was conducted at the Philippine General Hospital, University of the Philippines Manila. Subjects and Methods : The study participants were nonpregnant and pregnant women, with low-risk singleton pregnancy, and had a prenatal checkup and eventual delivery at the Philippine General Hospital. After consent, women were asked to answer a survey focused on their sociodemographics and frequency of exposure to EP- and EDC-containing items. Satatistical Analysis Used: Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Null hypotheses were rejected at 0.05 α-level of significance. The computer software STATA 13.1 was used for data analysis. Results: One hundred and fifty-nine survey responses by women were analyzed. Possible EDC-containing household items (carpets, linoleum, upholstered, and stain-resistant furniture) are more prevalent in the homes of pregnant women compared to nonpregnant women. Pregnant women are also exposed to wallpapers compared to nonpregnant individuals. Nonpregnant women were 1.5 times more exposed to lotions. Unexposure to hand sanitizers is 1.3 times higher among pregnant individuals. Conclusions There are differences in the prevalence of exposure to household EDC-containing items between pregnant and nonpregnant women, with pregnant women having a higher prevalence of exposure.
Endocrine-disrupting chemicals ; environmental pollutants ; pregnancy