Objectives: This study was conducted to determine profile of neonates being treated with meropenem as well as to assess its clinical efficacy in the treatment of neonatal infections. Methods: This is a retrospective review of the records of sick neonates admitted at the Newborn Care Unit of a tertiary hospital and treated with meropenem. Those discharged against advice were excluded. Frequency and percentage were used in comparing the following variables: sex, 5-minute APGAR score, age of gestation, birth weight, type of infection, culture results, treatment outcome, and adverse reactions. Results: There were 34 charts available for review, but two were excluded. There were 62.5 % females and 37.5 % males: 28.1 % of them had a 5-minute APGAR score of 10; 37.5 % had 9; 21.9% had 8; and 12.5 % had 7. Sixty-two percent (62.5%) of the subjects were between 32 to 35 weeks age of gestation: 46.9 % were of low birth weight; 34.4 % were of very low birth weight; and 18.7 % had normal weights. Sepsis was the most common indication in the use of meropenem, followed by sepsis with pneumonia, pneumonia then sepsis with meningitis. Majority (68.75%) of the patients had no growth in their blood while 60% had no growth in the CSF. Enterobacter aerogenes (15.6%) was the most common blood isolate while Enterobacter gergeviae (20%) and Klebsiella pneumoniae (20%) were the isolates in the CSF culture. Treatment outcomes were favorable; 84.4% were improved, while 9.4% were unimproved and shifted to other antibiotics, and 6.2% died. Conclusion: The use of meropenem is effective in the treatment of life-threatening infections among newborns.
Human ; Male ; Female ; Infant Newborn ; MEROPENEM ; SEPSIS ; INFECTIONS

Dengue infection, one of the most devastating mosquito-borne viral diseases in humans, is now a significant problem in many countries. The disease, caused by the four dengue virus serotypes, ranges from asymptomatic infection to undifferentiated fever, dengue fever (DF), and severe dengue hemorrhagic fever (DHF) with or without shock. DHF is characterized by fever, bleeding diathesis and a tendency to develop a potentially fatal shock syndrome. Dengue infection with organ impairment mainly involves central nervous system and liver. Consistent hematological Findings include vasculopathy, coagulopathy, and thrombocytopenia. Laboratory diagnosis includes virus isolation, serology, and detection of dengue ribonucleic acid. Successful treatment, which is mainly supportive, depends on early recognition of the disease and careful monitoring for shock. A severity-based revised dengue classification for medical interventions has been developed and validated in many countries. Prevent depends primarily on control of the mosquito vector. The feasibility of a dengue vaccine is high.
Human ; Male ; Female ; DENGUE ; DENGUE HEMORRHAGIC FEVER

Introduction: Community-acquired pneumonia remains to be an important cause of morbidity and mortality among the pediatric age group with Streptococcus pneumoniae and Haemophilus influenzae typ B being the predominant bacteria identified. Conjugate vaccines against these organisms are available however, the prevalence of pneumonia in our country continues to be high. Objectives: The aim of this research is to determine the HiBCV and PCV 7 immunization status of children 5 years and below who were hospitalized due to pneumonia compared to controls. This study also aims to describe the clinical outcome of pneumonia among children who were vaccinated with HiBCV and/or PCV7 compared to those without vaccination. Methods: This retrospective case-control study was conducted in Makati Medical Center from January 1, 2009 to August 31, 2010. Cases were children five years old and below discharged with the final diagnosis of pneumonia. Controls were patients five years and below discharged without pneumonia during the same study period. Medical records were reviewed for information on age, gender, clinical findings upon admission, laboratory results, vaccination status, interventions and outcomes. Conclusion: The findings indicated that clinical and radiologically-confirmed pneumonia still occurred among children with complete vaccination with HiBCV and PCV7. Although not statistically significant, those without vaccination had higher odds of having pneumonia.
Human ; Male ; Female ; Child Preschool ; Infant ; HAEMOPHILUS INFLUENZAE TYPE B ; VACCINES, CONJUGATE ; HEPTAVALENT PNEUMOCOCCAL CONJUGATE VACCINE ; IMMUNIZATION ; PNEUMONIA

Objectives: This aim of this research is to determine the clinical outcome of neonates with Enterobacter spp. positive blood culture and the antibiotic sensitivity pattern of these isolates at Cebu Doctors' University Hospital Neonatal Intensive Care Unit. Methods: This descriptive, cross-sectional, retrospective study retrieved the list of neonates admitted at Cebu Doctors' Hospital - Neonatal Intensive Care Unit (CDUH-NICU) from January 2005 to December 2008 whose bloods were taken for culture. The antibiotic sensitivity patterns of the Enterobacter positive cases were reviewed, along with broad-spectrum cephalosporin (BSC) resistant and multiresistant Enterobacter spp. (MRE) determination and clinical outcome. The relationship between outcome and MRE was analyzed using the Pearson Chi-square test. Conclusion: Most isolates were BSC-resistant while 24% were MRE. Enterobacter was most sensitive to Imipenem, Meropenem, Cefepime, and Piperacillin-Tazobactam.
Human ; Male ; Female ; Infant Newborn ; ENTEROBACTER ; SEPSIS ; BACTEREMIA

Objectives: This study was performed to investigate the Serratia marcescens outbreak in the Newborn Care Unit of a tertiary hospital. Methods: This is a retrospective, descriptive study. Charts of all neonates with S. marcescens growth in their blood culture were retrieved from the Records Section of the Baguio General Hospital and Medical Center (BHGMC) from July 2002 to July 2003. During the outbreak period, the following interventions were performed: 1) orientation and re- orientation of the entire health care team, especially, the staff of the unit on infection control and prevention; 2) aerobic culture of possibly contaminated hands of concerned staff and equipment of both the delivery room and the intensive care unit; 3) closing of the pediatric newborn care unit for general cleaning and disinfection. Results: Of the 132 cases reported to have grown S. marcescens in their blood cultures, 63 (48%) charts were available for review: 63% were term; 51% male; 81% were appropriate for gestational age; and 30% had birth weights of 2500 to 2999 grams and delivered via normal spontaneous delivery. The most common reasons for admission were: respiratory distress syndrome (5%), multiple congenital anomalies (5%), congenital heart disease (5%), urinary tract infection (5%), severe asphyxia (3%), and pneumonia (3%). The clinical manifestations seen during the first 4 days of life were respiratory distress (51%), poor suck (25%), bleeding (22%), jaundice (6%), sclerema (5%), and vomiting (5%). Blood transfusion (46%), such as fresh frozen plasma and packed red blood cells, was the prevalent invasive procedure done, followed by endotracheal intubation (41%), and umbilical catheterization (38%). Eighteen out of 63 cases died with a case fatality rate of 29%; 28% died of septic shock. S. marcescens showed 100% sensitivity to Piperacillin-Tazobactam, Cefepime, Imipenem, and Meropenem. Environmental cultures showed isolation of S. marcescens from the suction machines used in the aseptic and septic areas of the neonatal intensive care unit. Furthermore, this study showed that the following factors contributed to the occurrence of an outbreak: paucity of manpower, lack of equipment and area assigned for the pediatric newborn care unit. Conclusion: This investigation showed that the S. marcescens outbreak in the pediatric newborn care unit has been associated with environmental contamination and breakdown in infection control measures such as overcrowding, understaffing, and other major disruptions of routine nursery care, particularly hand hygiene.
Human ; Male ; Female ; Infant Newborn ; SERRATIA MARCESCENS ; DISEASE OUTBREAKS ; SEPSIS ; INFECTION

BACKGROUND: The H1N1/09 virus was reported to be similar to the seasonal flu. However, the World Health Organization (WHO) documented a substantial proportion of patients with H1N1/09 who developed severe illness and death particularly among those with underlying medical conditions. Presently, to our knowledge, there is no data in the Philippines where the demographic and clinical characteristics, risk factors and outcome of children positive for H1N1/09 virus were compared to those with influenza but were negative for H1N1/09.

OBJECTIVE: The objective of this study was to compare the demographic and clinical characteristics, risk factors, treatment and outcome of the two groups.

METHODS: A review was done of the charts of 162 patients who were tested for H1N1/09 virus by RT-PCR assay at the Makati Medical Center from May 5 to July 16, 2009. Demographic characteristics, risk factors, clinical features, treatment and outcomes were compared between the two groups. Categorical variables used between the two groups were compared using Fisher's exact test or Chi square test while quantitative variables were compared using T-test; odds ratio was determined.

RESULTS: A total of 162 patients were included in this study. The largest group of patients positive for H1N1/09 was from the age group of 11-15 years old (35.8%). Risk factors such as travel history and exposure to a confirmed case showed no association to having a positive H1N1/09 test. Clinical features such as fever (100%) and cough (82.1%) were the most common presenting symptoms for both groups. Majority of these patients were given supportive treatment and out of 162 subjects, 91.4 % were treated as outpatient. Clinical outcome showed one mortality from the case group and none from the controls.

CONCLUSION: Thus, the demographic characteristics and clinical findings were similar for both groups. Future studies are recommended to include those with influenza-like illness not tested for H1N1/09 virus.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; INFLUENZA A VIRUS ; Oseltamivir ; DIAGNOSIS ; DEMOGRAPHY ; PREVENTION AND CONTROL

Rabies is a viral disease that produces uniformly fatal encephalitis in humans and most other mammals. It remains one of the most common viral causes of mortality in the developing world.

OBJECTIVE: The aim of this study was to determine the factors that affect compliance of pediatric patients advised to receive rabies Post-exposure Prophylaxis (PEP).

METHODS: Pediatric patients zero months to 18 years old who were bitten by animals and thereafter sought consult from January to March 2009. Subjects with Category II and III exposure bites and advised PEP, who have telephone contact numbers, and gave verbal consent to participate were included. Excluded subjects were those who cannot be accessed by telephone or mobile, had previous animal bite and had received prior rabies immunization. Data were gathered through chart review and telephone interviews. Total number of patients who complied and did not comply with PEP and the factors related to compliance were determined.

RESULTS: One thousand two hundred forty three pediatric patients sought consult and were advised to receive PEP: 757 (61%) were males and 496 (39%) were females. Most common age group was 2-to-5 yrs (41%), followed by 6-to-10 years (32%). A higher proportion of females were noted under Category II exposure while a higher proportion of males were noted under Category III. Most common biting animal was dog. The highest proportion of subjects with multiple body bites were from the very young age group (0 to 1 year old). Most commonly injured body parts were the upper extremities (32.7%), lower extremities (42.7%) and head (16%). The two-site intradermal (ID) rabies vaccine regimen was prescribed on days 0, 3, 7 and 30; however, there was a declining trend in rabies vaccine and rabies immune globulin (RIG) received. Compliance rate of RIG (55%) and rabies vaccine (31%) were low. Factors affecting compliance to rabies PEP were: 1) fear of acquiring rabies and knowledge of the gravity of the disease; 2) vaccine cost and affordability; and 3) knowledge on status of biting animal.

CONCLUSION: The most salient issue in rabies PEP compliance is the affordability of the vaccine.

Human ; Animal ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; RABIES-PREVENTION AND CONTROL ; VACCINES ; RABIES VACCINES-COSTS AND COST ANALSYSIS,ECONOMICS,IMMUNOGLOBULINS ; Post-Exposure Prophylaxis ; Compliance

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

BACKGROUND: Diarrhea is one of the most common adverse effects of antibiotic treatment. In Saint Louis University-Hospital of the Sacred Heart (SLU-HSH), about three out of ten patients at the outpatient department and one third of admitted pediatric patients are given antibiotics. Although international studies document the efficacy of probiotics in preventing antibiotic associated diarrhea (AAD), there is limited research in our country about this.

OBJECTIVES: The main objective of this study was to evaluate the efficacy of a yeast probiotic, Saccharomyces boulardii, in preventing AAD.

METHODS: This was a randomized clinical trial conducted between June and October 2012 at Saint Louis University-Hospital of the Sacred Heart. A total of 140 patients aged 6months to 18years with PCAP were enrolled. The patients either received the standard antibiotic treatment alone (control group n=71) or the oral antibiotic treatment plus 250mg of Saccharomyces boulardii (treatment group n=69) twice a day for the entire duration of treatment. Analyses were based on treatment and included data from 136 patients.

RESULTS: Patients who received S. boulardii had shorter duration of diarrhea than those who did not receive it [3.06 days (0.68) vs. 2.45 days (0.69), P value of 0.032]. However, the incidence of diarrhea between the two groups was not statistically significant [16 of 68 (23.5%) vs. 11 of 66 (16.7%), P value of 0.391].

CONCLUSION: This is the first randomized-controlled trial in our locality which showed evidence that S. boulardii shortens the duration of antibiotic-associated diarrhea.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Anti-Bacterial Agents-adverse effects ; Diarrhea ; treatment ; Probiotics ; Dietary Supplements ; Treatment Outcome ; Saccharomyces

OBJECTIVE: The aim of this study was to determine the prevalence and pattern of Extra-pulmonary Tuberculosis (EPTB) cases that were admitted and diagnosed in a tertiary government hospital from January 2006 to December 2010.

METHODOLOGY: Records of pediatric patients who were admitted in a tertiary government hospital from January 2006 to December 2010 with a diagnosis of Extra-pulmonary Tuberculosis were reviewed. The following information was gathered: demographic profile, clinical profile, results of PPD, complications and mortality rate, and laboratory results.

RESULTS: The sixty-six cases constituted 7.8% of the total pediatric admissions during the same period. There was no significant difference as to sex distribution (53% males vs. 47% females, with 1:1 ratio). Majority of cases involved the meninges (72.7%) followed by lymph node (6.1%), liver (6.1%), bone (6.1%) and genitourinary (3.0%). The three most common symptoms were nonspecific: fever, anorexia and weight loss. The occurrence of fever was universal among all admitted cases of Extrapulmonary TB. With regards to prognosis, the majority (83%) of cases were discharged in improved condition. The case fatality rate was 16.7%.

CONCLUSION: The incidence of new cases of EPTB has remained constant, despite the decline in new cases of active pulmonary TB.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Tuberculosis-prevalence, epidemiology, incidence, therapy, history, diagnosis ; Tuberculosis, Meningeal ; Tertiary Care Centers ; ;