BACKGROUND: The only lung volume that can be measured reliably in infants is the functional residual capacity (FRC). Published reference values vary, thus, there is a need to determine values for healthy infants using the available equipment. OBJECTIVES: To determine the normal values of FRC in healthy infants using the baby body plethysmogram (CareFusion) and to determine the correlation between FRC and weight, length, age, and gender. METHODS: FRC was measured using the CareFusion MasterScreen baby body plethysmogram in 62 healthy infants aged 1-24 months old. FRC was measured after sedation with Chloral hydrate at 50 mg/kg body weight. Three measurements were performed from which the mean (SD) FRC was calculated. To depict the change in FRC with growth, regression analysis between FRC as dependent variable and weight, length, and age as independent variables was done. CONCLUSION The FRC values obtained in this study is 24.56 ml/kg (4.41). There is a direct correlation of FRC with age, weight, and length. The result of this study was comparable to other studies and may be used as a reference value for healthy infants.

BACKGROUND: Hearing impairment has a great impact on the functional, social and emotional aspects of a child. Thus, early detection and management is crucial for optimal development of the child. The Newborn Hearing Screening Act was approved in the Philippines to ―institutionalize measures for prevention and early diagnosis of congenital hearing loss among newborns‖. A simple, accurate and readily available hearing screening tool is necessary in less privileged communities. OBJECTIVES: To determine the accuracy of Pen Click Test as compared to otoacoustic emission test as a hearing screening tool among newborns seen in two tertiary government hospitals. The accuracy of Pen Click Test was measured for its sensitivity, specificity, positive and negative predictive value. METHODS: The study is an experimental design consisting of three phases: Phase I is a randomized complete block design; Phase II involves inter-rater and intra-rater variability randomized block design and Phase III is a cross sectional design. The study was done in two government tertiary hospitals. The subjects are term newborns with both ears analyzed independently from each other. RESULTS: Phase I of the study identified Acroball retractable pen as the study stimulus based on its accessibility and its capability to produce high decibel. In phase II, all health workers produced a sound stimulus of more than 70 decibels. Majority of the health workers had no significant difference among each other which means there is minimal deviation from the mean. Phase III showed that pen click test has a high specificity of 98% and a sensitivity of 43%. Based on disease prevalence, the test showed a positive predictive value of 77% and negative predictive value of 93%. Kappa agreement showed moderate result with a Kappa coefficient of 0.54. CONCLUSION The study showed high specificity in identifying hearing impairment and a positive association of Pen Click test to the standard hearing audiometer. The application of this test in the community may be done as a hearing screening tool. This study provides an accessible, easily reproducible and accurate tool for hearing screening that may be applied in communities without facilities.

BACKGROUND: The dose of Sugammadex for rescue reversal of intense neuromuscular block has not been studied in children. The only recommended dose of Sugammadex in children is 2mg/kg to reverse a shallow block. OBJECTIVES: To assess the efficacy and safety of Sugammadex 2mg/kg and 4mg/kg as immediate rescue reversal of intense rocuronium-induced neuromuscular block in pediatric patients METHODS: 80 children, aged 2 to 11 years old, requiring general anesthesia were enrolled in this randomized prospective study. Group 1 given Sugammadex 2mg/kg (40 subjects) while Group 2 received Sugammadex 4mg/kg (40 subjects), at the end of the procedure if PTC=0. The Recovery Time was recorded (TOF ratio ≥0.9) (Primary Outcome). Discharge readiness in the PACU was assessed using Modified Aldrete Scale (Secondary Outcome). Monitoring of adverse effects in the ward continued until 24 hours postoperatively. RESULTS: There were significantly more patients in the Sugammadex 4mg/kg that had a recovery time of ≤2min as compared to those given Sugammadex 2mg/kg (p=0.012). There was no significant difference in the Aldrete score between the two groups (p=0.2776). All patients achieved a very satisfactory discharge score in the PACU. The adverse effects experienced by the patients in the two doses of Sugammadex in the PACU and up to 24 hours postoperatively were not significantly different. CONCLUSION: Sugammadex 4mg/kg can be considered safe and effective as an immediate reversal agent for rocuronium-induced intense neuromuscular blockade in children. RECOMMENDATIONS Clinicians should identify if Sugammadex 6mg/kg, compared with 4mg/kg, would translate to a shorter Recovery time to a TOF ratio of 0.9. The time from TOF ratio of 0.9 to the time of extubation should be measured to increase the efficacy and safety assessment of Sugammadex in this age group.

BACKGROUND: Bullying most often occurs in the school environment and can affect the social climate of the school as well as the surrounding community. Bullying interferes with learning and student development, and its long-term social and emotional ramifications are solely underestimated. OBJECTIVES: To identify the prevalence and common risk factors for bullying among grade 5 and 6 students in a public elementary school in Quezon City. METHODS: This is a prospective cross-sectional study where in prevalence rate of bullying and the associated risk factors of bullying were analyzed. The Illinois Bullying Scale (IBS) was used to measure the prevalence of bullying. RESULTS: A total of 166 students between 10-12 years old of age participated in the study. All the respondents were old students. Majority of them were male (53.61%). Nine of ten students were Catholics. Majority of the fathers and half of the mothers were employed. The prevalence of bullying was at 15.66%. There was 18% prevalence of bullying on the victim subscale, 13.86% on the bully subscale, and 15.66% on the fight subscale. CONCLUSION Males have increased bully scores compared to female for both bully and fight subscales. Other factors such as being overweight or underweight, educational levels of parents, socioeconomic status, composition of the families play no significant association with bullying among students in public school. Schools and parents should become familiar with the school‘s definition of bullying, bullying prevention policies and the code of conduct.
Bullying

BACKGROUND: Amphotericin B is used in pediatrics for severe fungal infections despite its known nephrotoxic side effects. Tubular injury and renal vasoconstriction range from 15-58% with exact risk factors that predispose children to developing these complications still undefined. OBJECTIVES: To determine the risk factors for nephrotoxicity with deoxycholate Amphotericin B treatment among children 6 months-18 years old at the Philippine Children‘s Medical Center from 2006-2017 METHODS: This is a retrospective case-control study of 150 patients. Cases had decrease in eGFR by at least 25% and/or developed hypokalemia after at least one dose of Amphotericin. Those who did not develop nephrotoxicity were considered controls. Risk factors evaluated were age, sex, nutritional status, underlying medical condition, cumulative dose, concomitant use of nephrotoxic drugs used, treatment with diuretics and intravenous hydration. Results were analyzed using univariate and multivariate regression models. RESULTS: Using logistic regression, underlying malignancy had the highest odds ratio of 33.1 and nutritional status of z score=0 showed the lowest at 0.158. Duration of treatment >14 days had 1.75 times chance of developing nephrotoxicity while total cumulative dose >7.1 mg/kg had 1.5 times more chance of developing nephrotoxicity. Subjects given diuretics had 5.5 times more odds, while those not given concomitant nephrotoxic medications were 5.33% less likely to develop renal toxicity. CONCLUSION: Risk factors for nephrotoxicity were malignancy as an underlying medical condition, duration of amphotericin treatment of >14 days, cumulative dose >7.1 mg/kg and diuretic use. Normal nutritional status and no other concomitant nephrotoxic medication use had lesser odds of developing nephrotoxicity. RECOMMENDATIONS Clinicians should consider these risk factors, institute measures to monitor occurrence of nephrotoxicity and the need for alternative fungal therapy in these children. With identification of the population at risk, prospective research on determining the specific onset of renal effects and possible intervention is recommended.
Amphotericin B

BACKGROUND: Timely initiation of therapy for neonatal hyperbilirubinemia is routinely made based on total serum bilirubin levels. However, serial samplings by invasive needle pricks are needed for laboratory analyses. Studies comparing the correlation between serum bilirubin and transcutaneous bilirubin have yielded diverse results. A meta- analysis was done to find out the relationship between transcutaneous bilirubin measurements and serum bilirubin values. OBJECTIVE: This study aims to analyze scientific articles regarding the accuracy of transcutaneous bilirubin measurements among healthy neonates as an alternative screening for hyperbilirubinemia. STUDY DESIGN: Diagnostic Accuracy meta- analysis. METHODS: Studies on the accuracy of transcutaneous bilirubin measurements were identified through intensive literature search. Local studies were confirmed thru personal communication. RESULTS: Three hundred eighteen studies were identified through literature search. Ten studies met the eligibility criteria. Eight of the ten studies reported results as correlation coefficients. The pooled estimates of correlation coefficients is high at r = 0.85 (95% CI = 0.84 to 0.857). Five studies reported results with data for diagnostic accuracy. The pooled analysis for sensitivity and specificity are high at 0.84 (95% CI 0.8-0.88) and 0.79 (95% CI 0.77-0.81) respectively. The pooled likelihood ratio has a significant difference with a pooled positive LR of 4.19 (95% CI 2.98-5.9, P<0.01) while the negative likelihood ratio is 0.23 (95% CI: 0.17 to 0.29). The AUC for transcutaneous bilirubinometry is 0.89. CONCLUSIONS Transcutaneous bilirubin measurement can be an alternative in monitoring the risk of healthy neonates for hyperbilirubinemia based on the pooled analysis of correlation coefficient and diagnostic accuracy.

BACKGROUND: Among critically ill pediatric patients, a common complication experienced is nosocomial pneumonia. One field that garnered special interests as an alternative and promising way of preventing infection is the utilization of Probiotics. But whether it can prevent occurrence of ventilatorassociated pneumonia (VAP) among critically ill pediatric patients remains unclear. OBJECTIVES: To determine whether probiotic supplementation will prevent the incidence of ventilatorassociated pneumonia among critically ill pediatric patients. METHODS: Literature search was conducted in PubMed, MEDLINE, EMBASE, CINAHL, SciHub, Herdin, Google Scholar, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews to identify all relevant randomized controlled trials (RCTs) published between 1980 and 2016. The reviewers extracted data and reviewed the quality of the studies independently. RESULTS: Three randomized controlled studies with a total of 327 pediatric patients admitted at the PICU were analyzed. Pooled analysis showed a statistically significant reduction in nosocomial pneumonia rates (odd ratio [OR] = 0.31, 95% CI 0.18 to 0.55, P< 0.0001, I 2 = 53%) and statistically significant difference was found regarding overall mortality (OR =0.51 , 95% CI 0.30 to 0.88, P = 0.01, I 2 = 0%) due to probiotics. However, no statistically significant difference was found between groups regarding duration of stay in the PICU (Mean Difference [MD] in days = 2.93, 95% CI 1.84 to 4.01, P < 0.00001, I2 = 97% ), and duration of stay in the hospital (MD = 4.33 days, 95% CI 2.85 to 5.81, P < .00001, I 2 = 97%). CONCLUSIONS AND RECOMMENDATIONS The use of probiotics was associated with statistically significant reduction in the incidence of VAP in critically ill children. However, larger and well-designed, multi-center, RCTs are needed to further establish the effects of probiotic in the pediatric population of critically ill children who are at risk of developing nosocomial infection.
Probiotics

BACKGROUND: Conventional epidural anesthesia technique is a blind procedure, which relies solely on the palpation of the landmarks. Pregnancy makes epidural insertion more difficult because of the exaggeration of the lumbar iordosis, increase in subcutaneous fat, and difficulty in positioning due to the gravid uterus. These changes may make the conventional palpation technique less reliable in placing the epidural catheter during labor. Preprocedure ultrasound may be used as an adjunct in facilitating lumbar epidural insertion. OBJECTIVES: The objective of the study was to determine the efficacy of preprocedure ultrasound in facilitating lumbar epidural insertion. This was achieved by determining the number of attempts, number of needle redirections, and incidence of adverse events with and without the use of ultrasound. METHODS: The study was a randomized controlled trial. Forty two (42) subjects were enrolled in the study and were randomized into either the preprocedure ultrasound gorup or the conventional palpation technique group. Efficacy of the technique was measured according to the following variables: number of attempts, number of redirections, incidence of traumatic insertion and incidence of accidental dural puncture. RESULTS: There was a significant difference in the number of attempts (p value of 0.03) and needle redirections (p value of 0.04) between the two (2) groups. There was no significant difference noted in the proportion of subjects with accidental dural puncture and traumatic insertion between the two (2) groups (p=1.00). CONCLUSION: The number of attempts and needle redirections were significantly lower in those with ultrasound use compared to those without. No adverse events were noted on both groups. RECOMMENDATIONS Future studies may focus on the obese population utilizing larger samples wherein the landmarks needed for epidural placement are extremely difficult to identify. The lenght of time required to successfully insert the epidural with and without the use of preprocedure ultrasound can also be considered.

BACKGROUND: Acute lymphoblastic leukemia (ALL) represents the largest group of pediatric malignancies. The high cure rate of childhood ALL represents one of the most remarkable success stories in the war against cancer. In a lower middle income country (LMIC) like the Philippines, we reviewed the 5-year survival in a tertiary referral center. OBJECTIVES: This study aims to determine the 5-year survival of childhood ALL at a tertiary referral center for childhood cancer. METHODOLOGY: Medical charts of newly diagnosed ALL ages 1 to 18 years old from January 2012 to December 2016 were reviewed. OUTCOME: A total of 435 subjects were included in the study. The 5-year overall survival (OS) and event free survival (EFS) were 65.3% and 62.8%, respectively. The 5-year OS for standard risk ALL was 68.8% and for high risk ALL was 50%. The 5-year OS for the remission group was 83.7% and for the relapse was 21.1%. Univariate and multivariate analysis showed that WBC count at diagnosis, risk classification, immunophenotyping, and relapse showed significant prognostic impact for mortality. CONCLUSION The 5-year OS and EFS were lower compared to developed countries but are comparable with other LMICs. The prognostic factors for relapse and mortality were compatible with the literature. Overall, the adopted treatment protocols for childhood ALL in this institution showed acceptable results.

BACKGROUND: A definite diagnosis of asthma during infancy is difficult. Asthma Predictive Index (API) is used to predict asthma at school age, but does not determine who among these actually have asthma. OBJECTIVES: This study aims to determine the bronchodilator response of infants with recurrent wheezing compared with normal control. METHODOLOGY: This cross sectional study included asymptomatic subjects aged 6-24 months with history of recurrent wheezing and age/sex matched controls. After sedation with chloral hydrate (Odan) at 50-75 mg/kg, a bronchodilator challenge test was performed with single dose 400 mcg salbutamol (Ventolin) MDI inhalation delivered via a spacer (Philips Respironic OptiChamber Diamond). Baseline and 15 minutes after salbutamol inhalation Maximum Flow at Functional Residual Capacity (V‘maxFRC) were determined using MasterScreen Paed/BabyBody Option Squeeze version 8.0. ANOVA and Pearson chi-square were used for the statistical analysis of data. RESULTS: Sixty-nine infants (23 previous wheezers and positive API, 23 previous wheezers with negative API and 23 controls) were included. There was a significant difference in the post bronchodilator challenge test V‘maxFRC between wheezers with positive API and controls (p= 0.047). There was no significant difference in other parameter among groups. CONCLUSION AND RECOMMENDATION Absolute values of V‘maxFRC post bronchodilator challenge using the Tidal Rapid Thoracoabdominal compression technique may be used to identify current asthma among asymptomatic infants with recurrent wheezing. Further studies with patient follow-up are recommended to assess response to treatment.