BACKGROUND: Recent guidelines for the management of asthma have advocated the use of a pressurized metered-dose inhaler (MDI) and spacer in the delivery of salbutamol. However, there is a dearth of research in children with severe exacerbation. OBJECTIVES: To compare the effectiveness of MDI with spacers versus nebulizers in drug delivery of salbutamol for the management of pediatric severe asthma exacerbations. METHODOLOGY: A systematic search of the Pubmed, Cochrane library, Herdin, WPRIM, ClinicalTrials and reference review databases was conducted for studies containing “severe asthma” using MDI and spacer as an intervention with nebulization as a comparator. RESULTS: Of 220 articles, 4 met the criteria. In the subgroup analysis, children who received salbutamol through MDI showed no significant difference in hospital admission, pulmonary score, heart and respiratory rate, oxygen saturation, and lung function. CONCLUSION: In severe asthma exacerbations, there is evidence to support that MDI compared with nebulizer is statistically equal in terms of hospital admission, pulmonary scores, clinical improvement, and side effects RECOMMENDATIONS Further randomized controlled trials are suggested to explore the intricacies of drug delivery in management of severe asthma. A meta-analysis may be made possible in the future with more evidence.

BACKGROUND: Anti-N-Methyl-D-Aspartate receptor (anti-NMDAR) Encephalitis is the most common type of autoimmune encephalitis that affects children, adolescents and young adults. Since its discovery in 2007, there is still a paucity of data on the disease and factors affecting its outcome. OBJECTIVES: To describe the clinical characteristics of children and adolescents with anti-NMDAR encephalitis and to analyze factors that may affect its outcome. METHODS: Forty-three patient records of diagnosed anti-NMDAR Encephalitis were included. The outcome was evaluated using the modified Rankin Scale (mRS), and Clinical Assessment Scale for autoimmune Encephalitis (CASE). RESULTS: Ages ranged from 2 years to 18 years old, majority in the 12-18 years age range. Sixty percent were female. First line treatment using immunotherapy was given to all patients: 37% as monotherapy and 84% combination therapy (MPT only 23%, IVIg only 4%, MPT + IVIg or TPE 21-26%, and MPT + IVIg + TPE 16%). Clinical outcomes on discharge and on follow-up were assessed using the mRS and CASE. On discharge the proportion of the patients who had mild impairment (mRS<2, CASE<9) was more than 50%. On median duration follow-up of 31 weeks (range 24-40 weeks), 96.8% had significant improvement (mRS<2, CASE<9). Among the possible factors that were assessed to affect outcome, only severity of the illness at the start of the treatment influenced clinical outcome. CONCLUSION Early diagnosis and initiation of treatment before the progression of the disease will promote faster recovery and more optimal clinical outcome. CASE may be used as an additional tool in assessing response to treatment.

OBJECTIVES: COVID-19, SARS-COV-2, Nasopharyngeal RT-PCR, Saliva RT-PCR, Children, 0- 18 years old. METHODOLOGY: A metanalysis was done to synthesize the diagnostic accuracy of saliva RT-PCR compared to the nasopharyngeal RT-PCR in the detection of SARS-COV 2 in pediatric patients ages 0-18 years old. Five studies published from January to September 2021 were analyzed using the "midas" command of STATA14. MIDAS command is a comprehensive program of statistical and graphical routines for undertaking meta-analysis of diagnostic test performance in Stata. The index and reference tests (gold standard) are dichotomous. Primary data synthesis is performed within the bivariate mixed-effects regression framework focused on making inferences about average sensitivity and specificity. RESULTS: The World Health Organization’s acceptable sensitivity and specificity for products used in COVID-19 diagnostics is ≥ 80% and ≥ 97% respectively. The results of this metanalysis showed the pooled sensitivity of Saliva RT-PCR as compared to the Nasopharyngeal RT-PCR is at 87% (81-92% at 95% CI) and the pooled specificity is at 97% (95% CI: 96-98%). CONCLUSION This metanalysis demonstrates that saliva can be used as an alternative specimen for SARS-COV-2 diagnostic testing in children. Aside from the acceptable pooled specificity and sensitivity, the use of saliva offers several advantages. However, the authors recommend to include more studies for future metanalysis research, to further increase sample size, and to include both symptomatic and asymptomatic pediatric age group participants. A future prospective research study comparing the two diagnostic modalities is likewise recommended.

BACKGROUND: COVID-19 resulted in a public health emergency and quarantine measures which may negatively impact vulnerable populations. OBJECTIVES: This study intends to determine the quality of life, situations and emerging concerns of parents of children with neurodevelopmental disorders during the ongoing pandemic. METHODOLOGY: A cross-sectional survey using a socio-demographic questionnaire, situations and emerging concerns during the coronavirus pandemic and WHOQOL-BREF (Filipino version) for parental quality of life was documented via Google Forms. Parents of patients aged 2-18 years seen at the PCMC Neurodevelopmental Pediatrics OPD during July to December 2019 were recruited. RESULTS: Data from 115 respondents showed a lower score in the environmental domain. Child characteristics comparable with QoL scores include sex, severity of ID and ADHD while parent characteristics comparable with the QoL scores include educational attainment, monthly family income, father’s employment status and family structure (P-value <0.05). Most respondents reported situations of physical distancing (82.61%) and curfew (80.87%). Inability to access essential services (43.48-74.48%) were further compounded by limited financial resources (51.30%) and public transport (60%). Government policy received included quarantine pass (90.43%), food allowance or relief package (86.09%), disinfection (60.87%), DSWD-SAP (42.61%) and cash distribution (41.74%). RECOMMENDATIONS Programs and policies should be planned accordingly to provide improvement of quality of life to parents and their child with neurodevelopmental disorder.
Neurodevelopmental Disorders

BACKGROUND: Out of pocket expenses still comprises a major share in health financing. A reactive approach in COVID-19 treatment may be problematic for the patient’s finances. National health insurance systems like PHIC have COVID-related care benefits, but whether these offer sufficient coverage is unknown. OBJECTIVES: This study aims to describe the hospitalization costs incurred by pediatric COVID-19 patients admitted at a Filipino tertiary pediatric hospital, to determine the major cost drivers of hospitalization, and to determine how various payment methods provide coverage in paying for hospitalizations costs. METHODS: Financial statements of pediatric COVID-19 patients were reviewed, from which costs were categorized. Deductions were also compared with total hospitalization to determine adequacy of various financial assistance programs. RESULTS: Fifty-six charts and financial statements were reviewed for a 9-month period. Majority of the patients are of the 1-month to 6-year-old group (39.3%), of critical severity (66.1%), and with comorbidities (76.8%). Aggregated hospitalization costs of all COVID-19 patients amounted to PHP 9.5 million; medical costs accounted for the majority of the hospital costs at 35.40%. Mean total hospitalization cost per patient was determined to be PHP 170,170 and mean daily cost was PHP 16,870. PHIC COVID-19 packages may provide deducted as much as 90.56% of the overall costs, but only 28.6% of patients were able to avail of this privilege. Out-of-pocket expenditure remains at 33% of the total hospitalization cost. CONCLUSION: COVID-19 hospitalization in this institution mainly consists of the 1-month to 6 years old, and the costs in the average can reach up approximately PHP 170,000, as basic medical fees drive the majority of the costs. Patients with no known comorbids tend to have higher costs of care but more data is needed to elaborate on the trend. Availing PHIC packages can greatly ameliorate the financial burden of hospitalization. However, checks in timely and accurate filing of claims should be in place to assure those that can avail this assistance are rightfully supported. RECOMMENDATIONS A larger patient base with equal representation of patient categories is recommended in order to determine more comprehensive cost patterns and make significant associations.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is a novel pathogen that has rapidly caused a devastating pandemic of Coronavirus disease 2019 (COVID-19). The real time reverse transcriptase polymerase chain reaction cycle threshold values are inversely related to viral load and believed to have a role in terms of mortality and severity of the disease however, there is limited data in children. OBJECTIVES: This study aims to determine the RT-PCR cycle threshold level in relation to mortality and pediatric acute respiratory distress syndrome (pARDS) among COVID-19 patients admitted at Philippine Children’s Medical Center. METHODS: A cross sectional study was done on patients with RT-PCR confirmed covid-19 admitted at Philippine Children’s Medical Center from September 2020 to June 2021. RESULTS: 50 nasopharyngeal swab specimens from children admitted for COVID-19 were analyzed. 12 (24%) had acute respiratory distress syndrome. Among the 12 children who had pARDS, six (50%) expired; in those without pARDS, two (5.26%) expired. There was no difference in cycle threshold values between patients who died and who survived, as well as those with or without pARDS. CONCLUSIONS AND RECOMMENDATIONS We have no evidence to demonstrate a difference in Ct values alone between children who died or survived, or those who developed pARDS or those who did not. RT-PCR cycle threshold alone cannot predict mortality and development of pARDS, it can only indicate the presence of infection but not its severity. Cycle threshold and its significance may further be explored with a bigger population size in children in future studies.

OBJECTIVE: The study aimed to identify risk factors associated with mortality among patients admitted for PCAP C and D. METHODOLOGY: The study was a cross-sectional study involving children admitted for PCAP C and D at PCMC from January 2017 to December 2019. Univariate and multivariate analyses through binomial logistic regression were used to determine significant predictors of mortality. RESULTS: A total of 472 patients were included in the study, of whom 77% had PCAP C and 23% had PCAP D. More than half in each patient group were infants; male; and of normal nutritional status. Most common comorbidities in both groups were neurologic and cardiovascular in nature. Leukocytosis, thrombocytosis, and anemia were the most common hematologic findings. Overall mortality rate among patients was 5.08%. On univariate analysis, being severely underweight (cOR 8.28 [95% CI 2.52–27.23]), with history of antibiotic use (cOR 3.01 [95% CI 1.18–7.62], neurologic comorbidities (cOR 4.04 [95% CI 1.42–11.43]), cardiac comorbidities (cOR 5.33 [95% CI 1.31–21.75]), Down syndrome (cOR 22.11 [95% CI 2.44- 200.30]), and thrombocytopenia (cOR 22.11 [95% CI 2.44-200.30]) were associated with greater odds of mortality among PCAP-D patients. On multivariate analysis, the odds of mortality were 5.02 (95% CI 1.05-23.96) for severely underweight patients, 4.51 (95% CI 1.13-17.95) in patients with neurologic disease, and 73.62 (95% CI 3.63–1491.10) in patients with Down syndrome. CONCLUSION Patients with PCAP D who have severe malnutrition, Down syndrome, cardiac and neurologic abnormalities, and thrombocytopenia should be managed more aggressively to decrease mortality in these patients.

OBJECTIVES: To determine efficacy of continuous heparin infusion vs placebo on maintenance of peripherally inserted central catheter line among neonates admitted at the NICU. METHODS: This is a meta-analysis of randomized controlled trials reported in accordance with PRISMA checklist. Cochrane Risk-of-bias tool was used in assessment of reporting biases. Pooled risk ratios were estimated using random- or fixed-effects model. RESULTS: Of 4519 studies identified, 4 studies were included, and all have low risk of bias. Meta-analysis showed that continuous heparin infusion on PICCs had significantly higher duration of catheter patency compared to the placebo group (MD=2.22, 95%CI=1.03-3.14, pvalue<0.00001). Heparin group also had decreased risk of occlusion (RR=0.47, 95%CI=0.94, pvalues=0.03) compared to control. The risk for other adverse events such as thrombosis, infection, IVH progression, and mortality was comparable between the two groups. CONCLUSION: Continuous heparin infusion in PICC fluids can prolong duration of catheter patency by 2.2 days and reduce risk of catheter-related occlusion by 50%, without having significant effect on incidence of other adverse events. RECOMMENDATIONS Continuous heparin infusion on PICC fluids should be part of maintenance and care policy at the NICU, but precautions should be followed to prevent adverse outcomes. Systematic review of intermittent heparin flushing can be a window of opportunity.

OBJECTIVES: This study aims to compare the effectiveness of rice-based ORS as compared with glucose-based ORS in the treatment of acute watery diarrhea among children. Specifically, it aims to review and analyze the effectiveness of rice-based ORS as compared to glucose-based ORS as to stool output, duration of diarrhea and effect of osmolarity on treatment of diarrhea and to determine associated adverse events associated with rice-based ORS and glucose-based ORS. METHOD: This study used systemic review and meta-analysis of randomized trials. Primary outcomes were computed with 95% confidence intervals to determine the effectiveness of ricebased ORS. Adverse event was expressed as risk ratios with 95% confidence intervals. RESULTS: Sixteen studies met the criteria for the systematic review and meta-analysis. Duration of acute diarrhea was shorter by 5 hours with rice-based ORS (MD= −5.27 hours, 95% CI= −9.63 to −0.91, p-value= 0.02) compared to glucose-based ORS. The stool output was 62.35 mL/kg lower with rice-based ORS (MD= −62.35 mL/kg, 95%CI= −128.43 to 3.74, p-value= 0.06) compared to glucose-based ORS. Vomiting was the only reported associated event with ORS intake (RR= 1.08, 95%CI= 0.81to 1.43, p-value= 0.60). CONCLUSION Sixteen studies met the criteria for the systematic review and meta-analysis. Duration of acute diarrhea was shorter by 5 hours with rice-based ORS (MD= −5.27 hours, 95% CI= −9.63 to −0.91, p-value= 0.02) compared to glucose-based ORS. The stool output was 62.35 mL/kg lower with rice-based ORS (MD= −62.35 mL/kg, 95%CI= −128.43 to 3.74, p-value= 0.06) compared to glucose-based ORS. Vomiting was the only reported associated event with ORS intake (RR= 1.08, 95%CI= 0.81to 1.43, p-value= 0.60).

INTRODUCTION: To determine the factors affecting prolonged hospitalization in children 6 months to 5 years diagnosed with severe pneumonia. METHODOLOGY: The study was a retrospective chart review of patients aged 6 months to 5 years diagnosed with Severe Community Acquired Pneumonia and admitted at the Philippine Children’s Medical Center over a 24-month period from January 2018 to December 2019. Variables such as the age and gender of the child, immunization and socio-economic status as well as presence of hypoxemia, respiratory rate on admission, nutritional status and number of antibiotics were correlated with the duration of stay. RESULTS: Younger age, low socioeconomic status and greater number of antibiotics used were found to be significantly associated with prolonged duration of hospital stay after controlling for other variables. CONCLUSION Findings in this study can help pediatricians to identify children with severe pneumonia who will likely need to be admitted for a prolonged period of time.