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Determination of the ideal timing of delivery among growth- restricted fetuses at less than 32 weeks age of gestation using a stage-based doppler protocol for admitted patients at the Philippine Children’s Medical Center.

Ma. Theresa Acosta Muldong ; Maria Estrella Yu Flores

The Philippine Children’s Medical Center Journal.2023;19(1):1-13.

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.

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Intrathoracic masses in children and adolescents: a single tertiary pediatric institution experience.

May Priscilla Villarin Cero ; Maria Cherry Añ ; ana ; Beatriz P. Gepte

The Philippine Children’s Medical Center Journal.2023;19(1):14-26.

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

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Evaluation of prescribing patterns for pediatric community-acquired pneumonia in the outpatient department of a tertiary-care medical center in the Philippines.

Teresa D. Dacalanio ; Mary Antonette C. Madrid

The Philippine Children’s Medical Center Journal.2023;19(1):27-35.

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

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Resilience among pediatric healthcare workers during the COVID-19 pandemic in a tertiary hospital.

Maria Yasmin Soriano Kalaw ; Soraya A. Alvarado

The Philippine Children’s Medical Center Journal.2023;19(1):36-46.

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

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Modified pediatric nutrition screening tool to identify malnutrition and those at risk for malnutrition among patients aged 6 to 18 years old admitted at Philippine Children’s Medical Center.

Maria Beatrice P. Teves ; Hannah Bettina V. Reyes ; Angelina Grace C. Robles ; Jennifer A. Olay

The Philippine Children’s Medical Center Journal.2023;19(1):62-74.

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

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Efficacy of intravenous lidocaine in controlling emergence agitation in children for surgery under sevoflurane anesthesia: a meta-analysis.

Nina Kashka E. Pamintuan ; Ana Maria de la Cerna

The Philippine Children’s Medical Center Journal.2023;19(1):47-61.

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

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Factors associated with the development of Tumor Lysis Syndrome among pediatric cancer patients at the Philippine Children’s Medical Center.

Maria Carmela Gabrielle L. Tingne ; Anne Lolita B. Tomas &ndash ; Abadilla ; Maria Beatriz P. Gepte

The Philippine Children’s Medical Center Journal.2023;19(1):75-87.

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

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Association between training culture and burnout among residents and fellows during the Covid-19 pandemic in a pediatric tertiary hospital

Alvin C. Agustin ; Soraya A. Alvarado

The Philippine Children’s Medical Center Journal.2024;20(2):1-15.

OBJECTIVE: Medical trainees have increased burnout compared to the general population. This may be attributed to physiological stress, increased workload, work demands, and the training culture. This study evaluated the association between the current training culture of the residents and fellows and prevalence of burnout at the Philippine Children‘s Medical Center. MATERIALS AND METHODS: Two validated survey instruments were utilized in this study: the Organizational Culture Assessment Instrument (OCAI) to assess the current and preferred training culture among the trainees, and the Maslach Burnout Inventory (MBI) to evaluate the prevalence of burnout among participants. RESULTS: Ninety-two (pediatric residents = 50; fellows = 42) trainees were included in the study. Whereas the current identified training culture in the institution was the market or compete culture, respondents preferred the clan or collaborative culture. Majority of trainees scored high among the 3 domains of burnout: 72% for emotional exhaustion, 64% for depersonalization, and 57% in personal accomplishment. Market culture was significantly associated with emotional exhaustion and depersonalization. CONCLUSION The prevalence of burnout among medical trainees is a significant issue that requires attention. It is essential to implement programs to decrease burnout and shift towards a supportive training culture. This study suggests a gradual shift towards a clan culture, which can help promote collaboration, mentorship, and mutual support among trainees. Such changes will not only improve the well-being of trainees, but also enhance the quality of patient care.
Burnout, Psychological

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Short term outcomes of children with acute kidney injury treated with hemodialysis in a tertiary pediatric hospital: A six-year review

Socorro Marie V. Buensalido ; Nathan C. Bumanglag

The Philippine Children’s Medical Center Journal.2024;20(2):16-28.

OBJECTIVE: This paper aimed to describe the clinical profile and short-term clinical outcomes of children with Acute Kidney Injury (AKI) requiring hemodialysis in a tertiary pediatric hospital. MATERIALS AND METHODS: A retrospective cohort on in-patients who received hemodialysis treatments at our institution was performed. Medical charts of patients admitted between July 2018 and July 2023 were retrieved. Demographic data, clinical profiles and subsequent outcomes in terms of mortality and recovery or non-recovery from AKI were recorded. RESULTS: After meeting the inclusion and exclusion criteria, 129 patients were included in the study‘s statistical analysis. There was an even distribution between males and females. The average age of treated patients was 10 years old (SD ± 4.3). The average weight of patients was 35kg (SD ± 16.9). The most common diagnosis of patients was severe dengue (21.7%), followed by severe sepsis (14.7%). More than half of patients (51.9%) had an existing co-morbidity, of which Systemic Lupus Erythematosus (22.4%) and solid tumors (22.4%) were most common. The most common indication for hemodialysis was uremia (52.7%). In terms of short-term outcome, majority of patients died during the same admission (56.5%), while 31 patients (24.0%) recovered. CONCLUSION The clinical profile of patients who underwent hemodialysis treatments for AKI were comparable to international data. The study did not differentiate deaths from AKI or underlying illness, but demonstrated a higher mortality rate compared to other existing studies. This study is the first known local paper to describe the profile and outcomes of children who received hemodialysis for AKI.
Hemodialysis ; Renal Dialysis ; Severe Sepsis ; Sepsis ; Severe Dengue

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Utility of the BLUE (Bedside lung ultrasound in emergency) protocol in acute undifferentiated dyspnea among pediatric patients

Christian Anne C. Dauz ; Jenina Liza Danao ; Joie Aseamie Flores ; Cristan Q. Cabanilla ; Michael D. Cabato ; Jacquelyn Olib-Velazquez

The Philippine Children’s Medical Center Journal.2024;20(2):29-43.

OBJECTIVE: This cross-sectional study aimed to evaluate the effectiveness of the BLUE (Bedside lung ultrasound in emergency) protocol compared to clinicoradiologic diagnosis for promptly identifying acute undifferentiated dyspnea in pediatric patients. MATERIALS AND METHODS: Conducted at the emergency room of the Philippine Children's Medical Center from August 2022 to May 2023, the study involved performing the BLUE protocol within 2 hours of patient arrival. Chest radiography was also conducted, with images independently interpreted by a pediatric pulmonologist, emergency medicine specialist, and radiologist. The results were then compared to the clinicoradiologic findings. RESULTS: A total of 111 participants were included, with the majority being male (55.4%) and under 1 year old (48.2%). Pneumonia was the most observed diagnosis (88.2%), followed by asthma (7.2%). Utilizing the BLUE protocol, pneumonia was identified as the most prevalent diagnosis (81%), followed by pleural effusion (12.6%) and asthma (6%). The pulmonologist, emergency medicine specialist, and radiologist exhibited high sensitivity in diagnosing pneumonia (91.01%, 89.89%, 96.77% respectively) but low specificity (26%, 21%, 57.89%). Diagnosing pleural effusion and/or congestion showed high sensitivity (89%) and low specificity (21%) based on the pulmonologist's reading, low sensitivity (37%) and high specificity (99%) based on the emergency medicine specialist's reading, and 100% specificity based on the radiologist's reading. All readers demonstrated high specificity (95%, 93%, 93%) and low sensitivity (50%, 71%, 71%) in diagnosing asthma. The ultrasound readings between the readers exhibited a high concordance rate of 98%. CONCLUSION The study findings show that the BLUE protocol has high sensitivity in diagnosing pneumonia and high specificity in diagnosing asthma. The high concordance rate among readers suggests consistent ultrasound findings. These results support the practical application of the BLUE protocol for promptly diagnosing acute undifferentiated dyspnea in pediatric patients within the emergency department.
Dyspnea

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