OBJECTIVES: Early onset fetal growth restriction substantially contributes to neonatal mor-bidities and mortalities. The main dilemma lies on the timing of delivery, especially for pre- and peri-viable fetuses, due to the challenge in creating an ideal balance of minimized in-utero hy- poxia-induced fetal injury or death versus the risks of iatrogenic preterm delivery. We wished to determine the ideal timing of delivery among growth-restricted fetuses <32 weeks gestation us- ing a stage-based doppler protocol. MATERIALS AND METHODS: A retrospective-cohort study of 67 singleton-pregnant wom- en with growth restriction at <32 weeks gestation and hospitalized from January 2010 to Sep- tember 2021 was conducted. Medical records were reviewed, and the outcomes were extracted. The primary outcomes were arterial pH at birth and mortality, while secondary outcomes includ- ed neonatal morbidities. RESULTS: Fetal growth restriction progressed by an average of 3 stages (41.79%) within a 2- to 3.5-week period. More than half had arterial pH <7.20, which was lowest at Stage II FGR (50.00%). The prevalence of neonatal mortality was 16.42% and was lowest at Stage I (8.70%) and Stage II FGR (18.75%). CONCLUSION Doppler studies may be conducted weekly for Stage I, biweekly for Stage II, every 1-2 days for Stage III and every 12 hours for Stage IV. Delivery is ideal at Stage II as this resulted in the least number of acidosis and neonatal mortalities.

OBJECTIVES: The Cancer and Hematology Division of the PCMC receives an average of 24 cases of pediatric intrathoracic masses annually. Comprehensive data on the demographic status, clinical profile, management, and outcome are still not available. This study aims to determine the clinical features, diagnosis, management and outcome of children and adolescents with intrathoracic masses from 2017 to 2019. MATERIALS AND METHODS: Descriptive study design was utilized. Data were collected by doing a chart review. Possible associations between the clinical features and outcome were described. RESULTS: Sixty-eight (68) cases were referred from January 2017 to December 2019. Mean age at diagnosis is 8.8 years with a 2.4:1 male to female ratio. Severe wasting was seen in 21%. All subjects were symptomatic at presentation, 50% with respiratory compromise. Anterior mediastinal lesions are observed at 82% of cases. Elevated LDH was seen in 50% of the patients. Malignant hematologic lesions are the most common etiology. Steroid pretreatment was given in 40% of patients. Only a small percentage (<20%) underwent definitive treatment. Patients were symptomatic for 18 days on average before consult. It took an average of 18 days for a case to be diagnosed definitively, and 10 days from the diagnosis to start of directed treatment. Mortality rate was high at 57.4% CONCLUSION Patients with intrathoracic mass and malnutrition are 1.4x more likely to die. Diagnosis is the most significant factor associated with death. Observed data can be used as basis to formulate protocols which can streamline the diagnostic and therapeutic approach in these patients.
leukemia ; lymphoma

OBJECTIVES: This study evaluated the antibiotic prescribing patterns in pediatric patients in the Out Patient Department (OPD) of the Philippine Children’s Medical Center (PCMC) where it may encourage drug monitoring and improvement in the utilization of antibiotics in the department. MATERIALS AND METHODS: A descriptive, cross-sectional study involving patient encounters selected using convenience sampling was conducted at the outpatient department of PCMC. All previously healthy pediatric patients aged 3 months to 18 years diagnosed with pediatric community- acquired pneumonia (PCAP) with no known acute and chronic comorbidities were included. The observed values of the antibiotic prescribing indicators were compared with the optimal values recommended by the World Health Organization (WHO), and the Index of Rational Drug Prescribing (IRDP) was calculated. RESULTS: A total of 600 patients diagnosed with PCAP were included in the study seen at the PCMC OPD from January 2020 to July 2022. Ninety-six percent of the patient encounters had at least one antibiotic prescribed (SD + 0.20). The average number of medicines prescribed per patient encounter was 2.05 (SD + 0.85). Of these, 100% were prescribed by generic name and were prescribed from the essential drug list. The most commonly prescribed medications were antibiotics (43.17%) with coamoxiclav (42.93%), amoxicillin (37.76%), and cefuroxime (7.59%) being the top three commonly prescribed antibiotics. CONCLUSION With respect to the IRDP, PCMC scores well with 3.16 where the most rational score is 4. However, this study highlights the high occurrence of prescribing antibiotics in the institution.
Outpatients ; Pediatrics

OBJECTIVES: Healthcare workers are at the center of the pandemic, dealing with cases while being at risk of acquiring the infection themselves, causing work-related stress. Despite this, they continue reporting for duty. This paper aims to determine the factors that affect resilience of pediatric healthcare-workers in close contact with patients suspected with COVID infection and its association to sleeping disturbance during the first two years of COVID – 19 pandemic in a tertiary hospital in the Philippines. METHODOLOGY: This is a cross-sectional study. Healthcare-workers who render bedside patient care for those suspected or with COVID-19 infection, not diagnosed with any mental health illness, and fit the inclusion criteria were chosen through purposive sampling and asked to answer questionnaires with demographic survey, BRS and PSQI tool. RESULTS: Among 89 participants, females were predominant (60.67% ). Majority were in the 30- 39 age group (44.94%) and are nurses (40.45%) or doctors (39.33%) who were single (76.40%). Many have normal resilience as measured from their BRS scores with an average PSQI per category equal to or exceeded 5.00. The correlation coefficient was at -0.338 (p-value 0.001) between the BRS and PSQI scores, indicating that a significant negative correlation exists between the two scores. CONCLUSION Normal resilience was reported in the majority of the healthcare workers. All study participants had poor sleep quality as determined in the overall average PSQI score. A negative correlation between resilience and sleep quality was observed, denoting that poor sleep quality can be associated with lower resilience, and vice versa. However, temporality cannot be assumed with this study.
COVID-19

OBJECTIVE: To determine the reliability and validity of the modified pediatric nutrition screening tool in identifying malnutrition and risk of malnutrition among admitted pediatric patients aged 6 to 18 years old. METHOD: The Modified Pediatric Nutritional Screening Tool (PNST) was used to assess 130 admitted patients aged 6 to 18 years old. Evaluation of anthropometric measurements, body weight changes, clinical conditions and dietary intake were done within 48 hours of admission. Intraclass correlation coefficient was used to determine reliability of the tool among different raters while chi square test was used to determine correlation of the tool with the Screening Tool for the Assessment for Malnutrition in Pediatrics (STAMP). RESULT: The comparison of the modified PNST measurements by two observers showed no significant difference with p value of 0.078. All PNST criteria except clinical condition were associated with risk of malnutrition based on STAMP. The overall modified PNST criteria is significantly associated with risk of malnutrition based on STAMP. CONCLUSION The modified PNST accurately identifies malnutrition and risk of malnutrition among admitted patients aged 6-18 years old. The criteria used in the modified PNST were strongly associated with risk for malnutrition measured using previously validated tools and demonstrates a good interobserver reliability. It is recommended to be used as routine screening in the hospital set- ting for early identification of malnutrition and risk for malnutrition.
Malnutrition ; Pediatrics

BACKGROUND: Emergence delirium is a state of mental confusion and agitation after wakening from anesthesia that may result in traumatic injuries to the child. Limited drugs have been studied or used to prevent this occurrence. OBJECTIVE: To determine the efficacy and safety of intravenous lidocaine in controlling emergence agitation (EA) in children undergoing surgeries done under general anesthesia compared to placebo or other intravenous anesthetics. METHODOLOGY: This study is a meta-analysis, where published articles were obtained using PubMed, Cochrane Library, Clinical Trials, and Google Scholar up to August 2022. The primary outcome measure includes incidence of emergence delirium while secondary outcomes are postoperative pain and adverse effects comparing lidocaine and other intravenous drugs. The latter includes nausea and vomiting, untoward airway events and local anesthetic toxicity (LAST). Review Manager 5.4 was used for statistical analysis. RESULTS: There were a total of 6 articles included for quantitative and qualitative analysis. The overall incidence of emergence agitation (RR=1.03, 95% CI [0.50, 2.13], P=0.94) and adverse events were higher in the Lidocaine group, although the differences were not significant. Subgroup analysis by comparator showed significant increased risk of developing EA with Lidocaine compared to other intravenous drugs (RR=2.06, 95% CI [1.32, 2.32], P=0.002). The risk for developing postoperative pain is decreased with Lidocaine compared to placebo and other drugs. CONCLUSION Intravenous lidocaine given to children undergoing general anesthesia with sevoflurane increased their risk for emergence delirium, compared to both placebo and other intravenous anesthetics.
lidocaine ; emergence agitation/delirium ; children ; pediatrics ; anesthesia ; general anesthesia

BACKGROUND: Tumor lysis syndrome (TLS) is an oncologic emergency resulting from cancer chemotherapy; delays in its recognition could be life-threatening. Early recognition of associated risk factors and its management may help prevent its occurrence. OBJECTIVE: To identify the risk factors for TLS among cancer patients at the Philippine Children’s Medical Center. METHODS: This was a retrospective case-control study. Categorical variables were compared using chi-square test and continuous variables were compared using independent t-test. The association between TLS and patients’ characteristics was determined through logistic regression analysis. RESULTS: Medical records of 712 patients with cancer seen between 2016-2020 were reviewed. Children with (n=35) and without (n=137) TLS were selected as cases and controls and matched for age and cancer type. Factors associated with TLS are underweight patients with BMI < 18.5 (cOR 0.33, 95% CI 0.11-0.98); patients with both hepatomegaly and splenomegaly were four times more likely to develop TLS (cOR 3.946, 95% CI 1.2-12.94) while patients with lymphadenopathy were twice more likely to develop TLS (cOR 2.309, 95% CI 1.02-5.21). Patients with elevated WBC, low phosphorus and high uric acid at baseline have increased odds of developing TLS. CONCLUSIONS After group matching for age and cancer type, factors associated with increased odds of TLS among pediatric cancer patients in PCMC are hepatosplenomegaly, lymphadenopathy, elevated WBC, low potassium level, low phosphorus and high uric acid at baseline with higher fluid balance.
tumor lysis syndrome

BACKGROUND: Vitamin D deficiency has been documented as a frequent problem in almost every region of the world even in the tropical countries and its health consequences are enormous. Infancy and adolescence are age groups particularly at risk of developing vitamin D deficiency. However, there are no data on the Vitamin D status of Filipino adolescents.

OBJECTIVES: To determine the serum 25-hydroxyvitamin D levels in Filipino high school students in selected schools in Quezon City

METHODS: A cross-sectional study of Filipino high school students was undertaken. A total of 97 boys and girls aged 11- 18 years old, attending selected private and public secondary schools in Quezon City participated in the study after parents' consent and students' assent were taken. Serum 25(OH)D levels were determined by electrochemiluminescence immunoassay (ECLIA) using Roche HITACHI Cobas e immunoassay analyzer.

RESULTS: The total serum 25-hydroxyvitamin D levels of the students ranged from 19.92 nmol/L to 88.63 nmol/L with a mean of 52.43 nmol/L. Among the 97 high school students, there was a prevalence of hypovitaminosis D (serum 25 (OH)D <50nmol/L) of 41.2% with 20.6% having deficient (

CONCLUSION: Hypovitaminosis D is highly prevalent among Filipino adolescents in secondary school despite abundance of sunlight. Appropriate interventions are needed to address the problem of poor vitamin D status in schoolchildren.

BACKGROUND: One out of 10 Filipino children suffer from bronchial asthma. Its increasing prevalence over the past decades causes significant morbidity to the patients and their families, especially when it is uncontrolled. In developing countries, the form of medicine, cost and access to medications are significant factors in achieving good control of symptoms. No study has been done to determine if the use of low dose oral corticosteroid is a safe and effective alternative treatment for children with asthma.

OBJECTIVE: To compare the safety and efficacy of oral versus inhaled corticosteroid in moderate persistent asthma.

METHODS: An open label randomized controlled trial was carried out in 40 patients 6 to 15 years old with newly diagnosed moderate persistent asthma. They were assigned to either inhaled or oral corticosteroid group. Efficacy of treatment based on daytime and nighttime coughing, limitation of activity, use of bronchodilators, FEV1, PEFR and level of asthma control were assessed. Safety of both treatment options were evaluated by the occurrence of corticosteroid induced hypertension, adrenal insufficiency and diabetes.

RESULTS: The use of inhaled and oral corticosteroid showed improvement in daytime and nighttime cough, need for bronchodilators, limitation of activity, FEV1, PEFR and level of control. Furthermore, both treatment options had comparable safety profile.

CONCLUSION: There was no significant difference on the safety and efficacy of oral versus inhaled corticosteroid in the longterm treatment of moderate persistent bronchial asthma.

BACKGROUND: Human milk is considered the optimal nutritional source for infants. Due to the possibility of microbial contamination during collection and handling, milk is pasteurized to prevent transmission of pathogens. In low-income areas where pasteurization is inaccessible, the pursuit for the best alternative in rendering donor milk safe remains.

OBJECTIVE: We aimed to determine and compare the efficacy of flash heat treatment and holder pasteurization in preserving human milk IgA while reducing bacterial contamination of donor breast milk.

METHODOLOGY: This is an experimental study which utilized pooled donor breastmilk from healthy mothers later subjected to bacterial analysis and immunoglobulin A level determination prior to and post flash heat treatment and pasteurization. Standardized scores were used to normalize population with unknown parameters. T-test comparison of means and Levene's test for equality of variances were used.

RESULTS: Twenty samples of aliquoted breastmilk were subjected to pasteurization and flash heat treatment, both yielding a statistically significant reduction in colony-forming units using Blood agar and MacConkey plates. These sample groups also underwent IgA level determination using Bindarid Kit IgATM and there was no significant decline in IgA levels.

CONCLUSIONS: Flash heat treatment may be an alternative for holder pasteurization in providing safe and effective breastmilk.