2021 Journals
Carmina A. delos Reyes, M.D.
It’s been 1 year 4 months and 15 days since the world dealt with this pandemic head on. At the onset, we struggled with COVID-19 diagnosis, treatment and prevention. It was a tough process. We know better now as we continue to discover new things.
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Feature Article
Rational Use of Polymyxins Against Multi-Drug Resistant Gram-Negative Bacteria
Paul Sherwin O. Tarnate, M.D.DPPS , Cecilia C. Maramba-Lazarte, M.D., MScID, MScCT
Abstract
The current strategy in treating multi-drug resistant gram-negative bacterial (MDR-GNB) infections is salvage therapy by using polymyxins. However, the beginning emergence of polymyxin resistance should enforce strict antimicrobial stewardship programs to preserve polymyxin efficacy. Knowledge of structural characteristics, pharmacodynamic, and pharmacokinetic profiles of polymyxins, as well as consideration of efficacy, safety, suitability, and cost, will help in the choice of the appropriate polymyxin for therapy. Polymyxin B is the recommended polymyxin for systemic use, while colistin is recommended for lower urinary tract infections, intraventricular, and intrathecal use. Either polymyxin can be used for hospital-acquired and ventilator-associated pneumonia. Combination therapy over monotherapy remains to be advantageous due to synergism and decreased resistance development. The choice of the second drug to be used should be based on full susceptibility, or if unavailable, a drug with the least minimum inhibitory concentration relative to the breakpoint set by the Clinical and Laboratory Standards Institute. Using the mnemonic ESCAPE can also guide physicians in their polymyxin prescription process: (1) Checking if the pathogen is Extensively resistant or multi-drug resistant; (2) checking the patient’s clinical status if compatible with Significant infection; (3) using Combination therapy; (4) ensuring Adequate dosing; (5) Proper preparation and administration of drug; and (6) keeping an Eye for response and adverse effects.
Keywords: Polymyxin B, Colistin, MDR-GNB, Polymyxins
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Case Reports
Fulminant Hepatic Failure in a SARS-CoV-2 Positive Pediatric Patient: A Case Report
Jerrymae R. Blasurca, M.D.
Abstract
Respiratory symptoms are the most common manifestation of COVID-19 across all age groups and it is most often associated with radiographical findings consistent with pneumonia.2 A recent systematic review estimated that 16% of children with SARS-CoV-2 infection are asymptomatic,3 or others may present with seizures, gastrointestinal bleeding or jaundice. This reports a 2-year old boy with no known co-morbidity who had a 2-week history of abdominal pain and jaundice then had a rapidly progressive course of neurological deterioration and eventual demise. He had markedly elevated liver enzymes and deranged bleeding parameters with elevated ammonia and ferritin levels. Hepatitis B and hepatitis A titers were non-reactive. He was managed as a case of hepatic encephalopathy secondary to cholestatic jaundice. His chest x-ray was normal but his SARS-CoV-2 RT PCR result was positive with a low cycle threshold. Locally, this is the first reported case of SARS-CoV-2 RT-PCR positive pediatric patient presenting as fulminant hepatic failure with no associated respiratory manifestations. Clinicians should be mindful that such presentation, however uncommon, is possible and a high index of suspicion should be maintained.
Keywords: COVID-19, SARS-CoV-2, hepatic failure, fulminant hepatitis, case report
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Multisystem Inflammatory Syndrome In Children (MIS-C): A Case Series in a Tertiary Hospital
Jerrymae R. Blasurca, M.D.
Abstract
The clinical course of COVID-19 in the pediatric population has been reported to be mild in the majority of affected patients. However, a condition referred to as multisystem inflammatory syndrome in children (MIS-C) can occur with SARS-CoV-2 infection where patients can become critically ill. In this series, we describe five pediatric patients with the spectrum of MIS-C associated with SARS-CoV-2 infection.
Keywords: MIS-C, COVID-19, SARS-CoV-2
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A Rapid Review on the sensitivity of SARS-CoV-2 RT-PCR done on different clinical specimens
Denise L. Sembrano, M.D.
Abstract
Background: RT-PCR using respiratory tract specimens, most commonly nasopharyngeal swab (NPS), has been used to confirm the diagnosis of COVID-19. NPS is a relatively invasive procedure that causes patient discomfort and risks viral transmission. Other specimens are therefore being investigated for the detection of SARS-CoV-2 RNA.
Objective: To determine the sensitivity of non-respiratory tract specimens in detecting SARS-CoV-2 RNA in patients with COVID-19.
Methodology: This review summarized the results of eight studies obtained from a literature search done in May 2020 in PubMed MEDLINE, Cochrane Library and MedRxiv. Two independent investigators reviewed and appraised the studies that were included, and pooled estimates of sensitivity for each specimen were determined using Stata’s Metaprop function.
Results: The sensitivity in detecting SARS-CoV-2 RNA in non-respiratory tract specimens of diagnosed COVID-19 patients are as follows: Saliva 77% (95% CI 71-83%), stool/rectal swab/anal swab 22% (95% CI 22-37%), blood/serum/plasma 2% (95% CI 1-3%), and urine 22% (95% CI 18-25%).
Conclusion: SARS-CoV-2 RNA is detected in saliva, stool/rectal swab/anal swab, blood/serum/plasma and urine. Among these, saliva has the highest estimated sensitivity. However, more studies are needed to correct the heterogeneity brought about by factors such as timing of specimen collection, disease severity and treatment.
Keywords: COVID-19, nasopharyngeal, oropharyngeal, swabs and respiratory sample
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Outcomes of Infants Born to Mothers with SARS-CoV-2 Infection in a Tertiary Hospital
Jemilly Margaux L. Po, M.D.
Abstract
Introduction: Pregnant women are a susceptible population to emerging infections. Recent published data have shown evidence of possible transplacental transmission of SARS-CoV-2. However, at present there are not enough data to determine its effect on the fetus. This study aims to determine the outcomes of infants born to mothers with SARS-CoV-2 infection.
Methods: A retrospective descriptive institution-based study using data collected from medical records of infants born to confirmed COVID-19 mothers delivered from April to June 2020.
Results: Of the 47 neonates, none of them were positive for SARS-CoV-2 RT-PCR. Majority were born full-term, mean gestational age of 37 weeks, weight of 2867 grams, appropriate for gestational age, good APGAR score, and delivered through cesarean section. Symptomatic neonates (27.7%) had tachypnea and vomiting as the most common manifestation, 13.3% had lymphopenia while pneumonia was the predominant radiologic finding. There was a significant association between the presence or absence of symptoms among mothers and neonates (p=0.037).
Conclusion: The neonatal outcome in this study was good with 98% survival at 2 weeks of life. There was note of 2.1% morbidity and mortality. Given that the clinical data in newborns are very limited and the possibility of a vertical transmission is still uncertain, it is crucial to closely monitor neonates with increased risk of COVID-19 infection.
Keywords: COVID-19, Neonates, Vertical transmission
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Outcomes of HIV-Exposed Infants enrolled in the Prevention of Mother to Child Transmission of HIV (PMTCT) Program in Philippine General Hospital: An 8-year Retrospective Study
Anna Soleil Cheshia V. Tan, M.D. DPPS
Abstract
Background: Our country has the fastest growing number of HIV cases in the Asia-Pacific region with a 203% increase from 2010 to 2018. MTCT represents 6% of infections in children and interventions such as the PMTCT program are essential to help reduce new infant infections.
Objective: To determine the outcomes of HIV-exposed infants born in PGH from 2010 to 2018 enrolled in the PMTCT program. To analyze the association of maternal and neonatal clinicodemographic factors to MTCT of HIV.
Methods: A retrospective cohort study using data collected from medical records of HIV exposed infants enrolled in the program.
Results: Out of 117 mother-infant pairs, only 70 met the eligibility criteria. Maternal factors showed that majority have: timely antenatal visit (56/70), maternal HIV diagnosis (70/70) and ART initiation (67/70) prior to delivery, triple lifelong maternal ART (69/70), CD4 >200 prior to delivery (52/70) and cesarean delivery (67/70). Amongst the infant factors-early infant prophylaxis (60/62), >4weeks prophylaxis duration (62/70) and replacement feeding (62/70) were noted in the majority. 2/70 infants were HIV positive. Mortality rate was 1.4% and 50% for HIV infected infants. Overall LTFU rate was 33.3%. Logistic regression showed that maternal co-infection with Hepatitis B(p=0.0275) was a possible determinant of MTCT. Infant HIV prophylaxis duration of >4 weeks had higher survival proportion(p=.0001).
Conclusion: The HIV MTCT rate was 2.86% upon implementation of our PMTCT program, meeting the <5% goal of WHO, suggesting that the program was an effective health intervention strategy. The high LTFU rate though should be considered in the evaluation of the program effectiveness.
Keywords: PMTCT, HIV-Exposed Infant, ARV prophylaxis, HIV Philippines
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Fever of Unknown Origin Among Children in Two Private, Urban, Tertiary Hospitals: A 27-year Retrospective Study
Robert Dennis J. Garcia, M.D. MHSA
Abstract
Introduction: Fever of unknown origin (FUO) is a problem commonly encountered by infectious disease specialists, and even general pediatricians, in spite of the improvement in diagnostic modalities. There is no local study on childhood FUO from a private hospital. Thus, there is a need to determine the etiology of FUO seen in private practice, which may be different from those encountered in government or teaching hospitals.
Objectives: The purpose of this study is to identify the etiologies of childhood FUO from two private, urban, tertiary hospitals, as evaluated by a single pediatric infectious disease physician; and to discuss epidemiologic, clinical and diagnostic clues for the most common etiologies.
Methods: Childhood FUO cases were compiled from 1993 to 2020. Each consecutive, inpatient, admission or referral
of a patient, 18 years or younger, was logged into a personal computer, and the discharge diagnosis for the FUO was recorded. Clinical, epidemiologic, diagnostic and therapeutic data, relevant to the FUO diagnosis were likewise recorded. FUO was defined as daily fever of 380C for ten consecutive days, or more, with no etiology identified after being admitted for seven days.
Results: Of 171 cases of childhood FUO, the etiology was an infection in 68%, collagen-vascular disease in 13%, miscellaneous cause in 8%, malignancy in 6%, and no diagnosis in 5%. The most common infections were Epstein Barr Virus (EBV) mononucleosis, tuberculosis, enteric fever, sinusitis, pneumonia and incomplete Kawasaki disease. The most common collagen vascular diseases were juvenile idiopathic arthritis and systemic lupus erythematosus. Hemophagocytic lymphohistiocytosis was the most common miscellaneous cause. Lymphoma was the most common malignancy.
Conclusion: This study found EBV mononucleosis, sinusitis, pneumonia, incomplete Kawasaki disease, lymphoma, HLH and Kikuchi-Fujimoto disease to be FUO etiologies not reported previously in other local reports.
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Etiology, Treatment and Outcome of Children Diagnosed with Secondary Hemophagocytic Lymphohistiocytosis in A Tertiary Hospital
Dianne Loraine P. Clemente, M.D.
Abstract
Background: Hemophagocytic lymphohistiocytosis (HLH) is a clinical syndrome that is associated with a variety of underlying conditions leading to the same characteristic hyperinflammatory phenotype.
Objectives: To describe the clinical profile of patients diagnosed with HLH admitted between January 1, 2010 to September 30, 2019 in a tertiary care hospital.
Methods: Retrospective descriptive study of pediatric patients diagnosed with HLH in a tertiary care hospital.
Results: Eleven subjects were included in the study. Age distribution showed a bimodal pattern: < 5 years old (5, 46%) and 10-15 years old (4, 36%). Male to female ratio is 4.5:1. All patients presented with fever (100%) followed by hepatomegaly (5, 45%) and splenomegaly (4, 36%) on physical examination. All eleven subjects fulfilled the following criteria for HLH such as fever, splenomegaly, and hyperferritinemia. Six out of eleven showed hypofibrinogemia (55%) and hypertriglyceridemia (55%). Among the eleven with two cell cytopenia, five presented with anemia (46%), six with neutropenia (55%), while all of them had thrombocytopenia (100%). Other laboratory findings noted were elevated ALT (5, 46%), CRP (4, 36%), AST (3, 27%), alkaline phosphatase (3, 27%), and hyponatremia (3, 27%). EBV and dengue (3, 27%) were the most common etiologies. Pneumonia (3, 27%) was the most common complication, followed by sepsis (2, 18%). All but one patient were responsive to either dexamethasone (7, 64%) and or IVIG (5, 45%) and chemotherapy (1, 9%). The antibiotic most commonly used was piperacillin tazobactam (3, 27%). The median hospital stay was 17 days. There was one mortality (9%).
Conclusion: HLH should be considered in children presenting with prolonged fever, hepatomegaly, and or splenomegaly, with hyperferritinemia, thrombocytopenia, anemia and neutropenia.
Keywords: Hemophagocytic lymphohistiocytosis, retrospective descriptive study
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Clinical Profile of Pediatric Patients with Leptospirosis admitted at a Tertiary Government Hospital
Kay-Ann M. Pabalate-Aquino, M.D.
Abstract
Background: In the Philippines, Leptospirosis is a seasonal but common and prevalent disease with an average of 680 cases and 40 deaths annually. Cases result from exposure to contaminated flood, water, or soil. Several studies showed that males are more commonly affected, who are believed to be more exposed to the outdoor environment. In terms of pediatric population, early diagnosis is based mainly on clinical and epidemiological factors.
Objective: This study was conducted to determine the clinical features and outcomes of pediatric leptospirosis, as well as determine the prognostic factors associated with mortality.
Methodology: A descriptive retrospective study was done in a tertiary hospital from January 2007 – December 2019.
Review of all cases that satisfy the diagnosis of Leptospirosis by WHO Criteria (2003) was done. The data extracted from the chart were encoded using Microsoft Excel; processed and analyzed using STATA SE 15 to generate the required output.
Results & Conclusion: In this 12-year study, a total of 85 cases of leptospirosis in children, aged 0-18 years, were reported. Leptospirosis predominates in males in the adolescent age group. It is noted all year round but noted mostly during the rainy months which increases the risk to exposure to contaminated water through wading, especially in the cities of Navotas, Malabon and Tondo. The mean duration of symptoms was 3.6 days. The most common clinical findings noted in this study were fever, gastrointestinal symptoms, conjunctival suffusion, oliguria, calf tenderness and headache. Abnormal laboratory findings were leukocytosis, neutrophilia, thrombocytosis, elevated BUN and creatinine, hypokalemia and hyponatremia. Significant correlation with poor outcome was found in patients who have had pulmonary hemorrhage.
Keywords: Leptospirosis, leptospirosis in children, clinical profile
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Guidelines
Childhood Immunization Schedule 2021
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Interim Guidelines on the Screening, Assessment and Clinical Management of Pediatric Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19)
John Andrew T. Camposano, M.D.
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COVID Bulletin No. 1
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The UN General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature, and protect health.
Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades. ¹ The science is unequivocal; a global increase of 1.5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse. 2,3 Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions.
Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognizing that only fundamental and equitable changes to societies will reverse our current trajectory.
The risks to health of increases above 1.5°C are now well established.² Indeed, no temperature rise is “safe.” In the past 20 years, heat related mortality among people aged over 65 has increased by more than 50%.⁴ Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality. 5,6 Harms disproportionately affect the most vulnerable, including among children, older populations, ethnic minorities, poorer communities, and those with underlying health problems. 2,4
Global heating is also contributing to the decline in global yield potential for major crops, falling by 1.8-5.6% since 1981; this, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition. ⁴ Thriving ecosystems are essential to human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of pandemics. 3,7,8
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Review Article
A Review of Pneumonia in the Philippines
Jaime A. Santos, M.D.
Abstract
This review article gives an overview of pneumonia in the Philippines, with focus on childhood pneumonia. Its primary objective is to provide information on epidemiology, etiology, economic burden, risk factors and prevention of pneumonia. A review of literature was done to gather information about the disease, with emphasis on local data. In the Philippines, pneumonia is the third leading cause of death across all ages and is the most common cause of death among children<5 years of age. A prospective study on Invasive Pneumococcal Disease conducted in the Philippines looked at the incidence of chest x-ray–confirmed pneumonia (N=5,940) in three hospitals over a 2-year period. The highest incidence was seen in those 28 days to <6 months of age at two sites and those 6–12 months of age in another site. Risk factors include not exclusively breastfeeding infants <6 months, undernutrition, zinc deficiency, crowding and exposure to indoor air pollution, low birth weight, poverty and socio-economic factors, presence of underlying comorbidities and immunodeficiency states. CAP ranks number one in processed Philippine Health Insurance (PhilHealth) claims, showing the huge economic burden. Therefore, rationalizing its management with simple standardized guidelines, exclusive breastfeeding for 6 months and continued breastfeeding with appropriate complementary feeding, improving indoor air pollution, and promoting vaccination are effective interventions.
Keywords: Pneumonia, Pneumococcal disease, Pneumococcal Conjugate Vaccine
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Case Report
Purulent Pericarditis Secondary to Methicillin-Resistant Staphylococcus Aureus in a Previously Healthy Infant: A Case Report
Aaron G. Tulay, M.D. and Elizabeth E. Gallardo, M.D.
Abstract
Purulent pericarditis with cardiac tamponade caused by community-acquired methicillin-resistant Staphylococcus aureus is rare and fatal. There are limited data in children in the current antibiotic era, and available reports usually involve patients with immune dysfunction and prior thoracic instrumentation or has a thoracic focus of infection. Rapid recognition and treatment are paramount in the survival of patients. We report a case of purulent pericarditis with cardiac tamponade secondary to community-acquired MRSA in a previously healthy 10-month-old male infant who presented with fever, pallor, shock, and cardio-respiratory distress. CBC showed leukocytosis with neutrophilia, markedly elevated inflammatory markers, and cardiomegaly on chest radiography. The ECG showed diffuse concave ST-segment elevation, low QRS voltages on precordial leads, and electrical alternans consistent with pericarditis with probable significant pericardial effusion confirmed by 2D echocardiography with note of cardiac tamponade. He was managed effectively with pericardiostomy in combination with a 4-week course of vancomycin. Blood and pericardial fluid culture grew MRSA. This case underscores the organism’s lethality and its potential to infect immunocompetent children without predisposing factors. The value of early recognition, prompt initiation of treatment and management is of utmost importance.
Keywords: Purulent pericarditis, Pericardiostomy, CA-methicillin resistant Staphylococcus aureus, Case report
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Original Articles
Accuracy of Nasopharyngeal Aspirate GeneXpert Compared to Gastric Aspirate TB Culture and GeneXpert in Diagnosing Pulmonary Tuberculosis in Pediatric Patients
Joy L. Morcilla, M.D., Ma. Liza Antoinette M. Gonzales, M.D. and Anna Lisa T. Ong-Lim, M.D.
Abstract
Background: Pulmonary TB in children remains to be a burden in the Philippines. Diagnosis remains to be a challenge for pediatricians due to its paucibacillary nature, difficulty in obtaining specimens, cost of test as well as the varied sensitivity of the different tests available. Gastric aspirate (GA), commonly used for bacteriological diagnosis of pulmonary tuberculosis (PTB) in children, involves an invasive procedure that may cause discomfort and sometimes require admission. Nasopharyngeal aspirate (NPA), on the other hand, can be easily and non-invasively obtained but is currently not a recommended specimen for testing for PTB.
Objectives: This study aims to determine the accuracy of NPA GeneXpert in diagnosing PTB among pediatric patients 0-18 years old
with presumptive TB using GA GeneXpert as the initial screening test and GA TB culture as gold standard.
Methodology: This prospective, cross-sectional diagnostic study involved collection of single NPA and GA specimens for GeneXpert and TB culture in 100 patients with presumptive PTB seen at a tertiary government hospital in the Philippines.
Results: Of the one hundred pediatric patients (mean age 6 ± 5.63 years) enrolled, 50 were clinically diagnosed PTB, 16 bacteriologically-confirmed and 34 were not PTB disease. Sensitivity, specificity and predictive values with 95% confidence intervals of the NPA GeneXpert were determined compared to GA GeneXpert and GA culture. Sensitivity, specificity, positive and negative predictive values of the NPA GeneXpert compared to GA GeneXpert were 70%, 96.67%, 70% and 96.67%, respectively. While NPA GeneXpert compared to GA TB culture were 40%,91.58%, 20% and 96.67%, respectively.
Conclusion: GeneXpert testing on a single NPA specimen is a highly specific and rapid test that can be used to diagnose PTB in pediatric patients, particularly where gastric aspiration or mycobacterial culture is not feasible.
Keywords: GeneXpert, Gastric Aspirate, Nasopharyngeal Aspirate, TB Culture
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The Effect of Storage Time on the Growth of Microorganisms in Pasteurized and Unpasteurized Donor Human Milk in a Tertiary Hospital in Davao City: A Quasi-Experimental Study
Loradel Marbella S. Calio, M.D.
Abstract
Background: Donor Human Milk (DHM) is the recommended food of infants whenever mom’s own milk (MOM) is not available. However, due to the pathogenic microbiological component of DHM, concerns on the safety of the milk are inevitable.
Objective: To determine the effect of storage time on the microbial growth of pasteurized and unpasteurized Donor Human Milk maintained at a constant temperature of -20°C.
Methodology: This is a Quasi-experimental Research done in the Newborn Care Unit (NCU) and Bacteriology Section of a private tertiary hospital in Davao City. The effect of storage time to the microbial growth of pasteurized and unpasteurized DHM was determined using Friedman Test 2-way Analysis of Variance by Ranks. Pairwise comparison of microbial growth between pasteurized and unpasteurized DHM at different storage times was determined using the Mann-Whitney U test.
Results: Baseline DHM samples had moderately heavy bacterial growth of Staphylococcus epidermidis. There was a decrease from moderately heavy to light growth of the same species in the 24-hour storage time for both pasteurized and unpasteurized DHM. Pasteurized DHM did not have any microbial isolates at 48h, 72h, 4w, 8w and 12w while unpasteurized DHM had Acinetobacter baumanii, Staphylococcus warneri, Kocuria kristinae, and Staphylococcus saprophyticus growths. The analysis revealed that there is a statistically significant difference in the microbial growth in both pasteurized and unpasteurized DHM samples when stored at different times, χ2 (6) = 28.457, p = 0.00.
Conclusions: Storage time significantly interacts with the microbial growth on both pasteurized and unpasteurized DHM samples. Therefore, microbial growth in DHM samples may be affected by the length of time stored at a constant temperature of -20°C. Pasteurized DHM samples when stored at -20°C for more than 48 hours resulted to a statistically reduced microbial growth.
Keywords: Human milk, Pasteurization, Storage time
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Maternal and Neonatal Clinico-Demographic Profile and Outcomes During the COVID-19 Pandemic at the Chinese General Hospital and Medical Center
Maria Ronallaine d.L. Bello, M.D. and Shirley Kwong-Buizon, M.D.
Abstract
Background: COVID-19 is an ongoing health concern that hospitals have struggled to keep up with, given its increasing burden with the passage of time. Considerations for the management of COVID-19 should be made especially for pregnant patients and their neonates.
Objectives: To determine COVID-19 prevalence and the clinical profile of mothers admitted for childbirth at Chinese General Hospital and Medical Center from May 2020 to July 2020. The profile and outcomes of neonates born to these mothers were likewise studied.
Materials and Method: A descriptive cross-sectional study was done that included mothers admitted for childbirth who had SARS-CoV-2 RT PCR swab test and their neonates. A total of 408 medical records of mother and neonate dyads were reviewed. Relevant variables such as the patients’ demographic profile, clinical characteristics, co-morbidities and the maternal and neonatal outcomes were obtained. Frequency distributions were made to assess the prevalence of COVID-19 among the patients, as well as maternal and neonatal outcomes.
Results: Twenty-two (5.39%) mothers tested positive for COVID-19, while all neonates (n = 22) that underwent RT-PCR swab at the 24th hour of life had negative results. Of the 22 COVID-19 positive mothers, 2 (9.09%) were symptomatic upon admission while 20 (90.09%) were asymptomatic. The following were the key trends among those mothers who tested positive for COVID-19: (1) 81.82% were from ages 20-39 years old, (2) 72.73% were multigravida mothers, (3) 54.55% had normal spontaneous delivery, (4) diabetes mellitus was the only noted comorbidity. Key findings on the neonatal outcomes observed in the study population of both COVID-19 positive and negative cases, include: (1) majority of neonates had an APGAR score of greater than 7 at 1st and 5th minute of life; (2) higher frequency of neonates with Ballard’s score of more than 37 weeks AOG; (3) more male neonates as compared to female neonates; (4) a normal birth weight for majority of cases; (5) 45.45% of neonates born to COVID positive mothers had a length of stay of <48 hours as compared to 72.8% of neonates born to COVID negative mothers; and (6) neonatal pneumonia as the most common comorbid condition in both cases.
Conclusion: This study noted a prevalence of 5.39% COVID-19 positive mothers. SARS-CoV-2 virus was not detected in all of the neonates born to COVID-19 affected mothers. Neonates delivered to COVID-19 positive mothers had similar trends in the neonatal outcomes when compared to neonates delivered to mother who were COVID-19 negative.
Keywords: COVID-19, Neonatal Outcomes, Maternal Outcomes, COVID-19 Pregnant Women
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Rapid Detection of Respiratory Pathogens Using a Multiplex PCR Assay Among Hospitalized Children with Acute Respiratory Infection
Katherine B. Javier, M.D., Josephine Anne Navoa-Ng, M.D. and Nikki Cotoco-Chu, M.D.
Abstract
Background: Acute respiratory infection (ARI) is a major cause of morbidity and mortality among children worldwide however, local data on the etiologic diagnosis of ARI are limited.
Objectives: To determine the prevalence and the most commonly detected respiratory pathogens using a multiplex PCR assay, known as the Respiratory Panel, among hospitalized children with ARI and compare their clinical and laboratory differences.
Methods: This is a cross sectional study of children with ARI who were tested with a multiplex PCR assay. Retrospective chart review was done on these patients admitted from January 2018 to February 2020.
Results: There were 47 charts reviewed, mean age was 4.2 years old. Out of 47 patients, 36 (76.6%) tested positive for a pathogen. Respiratory syncytial virus (RSV) being the most common followed by Influenza A/H1-2009 and Human metapneumovirus (hMPV). Two patients had viral co-infections and no bacteria were detected on all subjects. 61.7% patients were started on antibiotics on admission. Fever and cough were the most common sign and symptom, respectively. Normal WBC (68% with neutrophilic predominance) and platelet were detected in 72.3% and 70.2% of patients, respectively; 50% of patients had normal CRP and 60.5% had abnormal findings on chest x-ray. Only the presence of chest x-ray findings was found to have a higher probability of yielding a positive Respiratory Panel p=0.27.
Conclusion: Among admitted patients with ARI, 76.6% tested positive for a respiratory pathogen. All were caused by viruses presenting as nonspecific manifestations – fever and cough. Clinical manifestations, CBC and CRP showed no association with the Respiratory Panel result while abnormal chest x-ray had a higher probability of yielding a positive Respiratory Panel result.
Keywords: Acute respiratory infection, Respiratory Panel, Multiplex PCR assay
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Clinical Characteristics and Patient Symptoms Associated with Poor Outcomes among Children with COVID-19: A Rapid Review
Krista Maye D. Catibog, M.D., Ian Theodore G. Cabaluna, M.D., Anna Lisa T. Ong-Lim, M.D., Chrizarah A. San Juan, M.D., Maria Angela M. Villa, M.D. and Leonila F. Dans, M.D.
Abstract
Objective: To identify specific clinical characteristics and patient signs and symptoms that increase the risk of developing severe/critical COVID-19 disease or death in the pediatric population, and identify strength of these associations
Methodology: A systematic search was done in PubMed, Science Direct, Cochrane Library and grey literature databases focusing on severe and critical COVID-19 disease in the zero to eighteen year old age group until August 26, 2020. Data regarding patient characteristics, signs and symptoms on admission and disease severity were extracted. Outcomes measured were severe or critical COVID-19, Multisystem Inflammatory Syndrome in Children (MIS-C) or death. Results were pooled and meta-analyzed.
Results: Four eligible studies with a total of 292 pediatric patients with COVID-19 were examined. Older children (MD=6.62, 95%CI=4.23 to 9.00, p-value<0.00001, I2=33%) significantly present with a higher percentage of severe disease. Shortness of breath (OR=8.14, 95%CI=2.33 to 28.47, p-value=0.001, I2=42%) was also found to be associated with severe COVID-19 disease. The presence of a pre-existing medical condition (OR=4.02, 95%CI=1.55 to 10.43, p-value=0.004, I2=0%), especially cardiac disease (OR=6.40, 95%CI=1.45 to 28.38, p-value=0.01, I 2=13%) and diabetes (OR=7.01, 95%CI=1.54 to 31.95, p-value=0.01, I2=0%) was noted to be a risk factor for severe disease.
Conclusion: Based on poor quality observational studies, older age group, shortness of breath, and a pre-existing medical condition, especially cardiac disease or diabetes were found to be associated with poor outcomes in children with COVID-19.
Keywords: COVID-19, Pediatrics, Disease severity
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Effects of Rapid Influenza Antigen Test on Antimicrobial Management of Pediatric Patients with Influenza-Like Illness in the Emergency Room
Dianne Alexis C. Millado-Riambon, M.D., Elizabeth E. Gallardo, M.D., FPPS, FPIDSP and Aaron G. Tulay, M.D.
Abstract
Background: Influenza is a commonly encountered respiratory tract infection and diagnosis remains to be a challenge. Use of a rapid antigen test may influence decisions on treatment in the emergency room (ER).
Objectives: This research aims to determine the effects of rapid influenza antigen test (RIAT) on antimicrobial management of influenza-like illness (ILI) in the ER, determine the clinical profile of pediatric patients with ILI and look into the relationship between RIAT result, symptomatology, and immunization status.
Methods: This is a cross-sectional study which involved review of charts of 195 pediatric patients with ILI who underwent RIAT (KlintecTM) through a nasopharyngeal swab in the ER of a tertiary hospital from September 2019 to February 2020. Chi-square, Fischer exact test and likelihood ratio were used for data analysis.
Results: Most pediatric patients were 7–12 years old males. Majority presented with fever, cough, and colds and underwent RIAT at 2–4 days from onset of illness. About 73.33% of study participants did not receive their yearly influenza vaccine and 70.7% of patients with positive RIAT had no influenza vaccine. There is a lower percentage of vaccinated children who developed cough (86.5% vs. 89.5%) and colds (80.8% vs. 83.2%) when compared with unvaccinated children. RIAT result significantly affected management in terms of antimicrobial prescribing to patients with ILI.
Conclusion: Influenza presents with non-specific symptoms and vaccination remains a major preventive measure against the disease. The result of RIAT facilitates targeted treatment for influenza and decreases unnecessary antibacterial use, but this should be done with careful thought and interpretation.
Keywords: Influenza, Influenza-like illness, Rapid influenza antigen test
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Clinico-demographic Profile and Outcome of Pediatric HIV/AIDS Patients in Western Visayas Medical Center
Mae Anne Rizalyn J. Allam, M.D., DPPS and Mary Jane Dolores E. Ayson, M.D., DPPS, DPIDSP
Abstract
Objective: Pediatric HIV is a national health concern that has grown exponentially in the past 5 years. This study aimed to determine the clinico-demographic profile and outcome of pediatric HIV/AIDS patients 0-18 years old seen at the Western Visayas Medical Center (WVMC) HIV/AIDS Treatment Hub from March 2006 to September 2018.
Methods: Medical chart records of all pediatric HIV/AIDS patients seen at the treatment hub during the study period were reviewed. Data on clinical and demographic profile and outcomes were gathered and descriptive statistics was used to analyze data.
Results: A total of 30 children 0-18 years old were registered consisting of 29 (97%) males and 1 (3%) female. A sudden increase in pediatric HIV patients was noted in the past 3 years, mostly among male adolescents engaged in male-to-male sexual contact (MSM). Majority (73%) were symptomatic at diagnosis with flu-like symptoms, fever and vomiting. Common physical exam findings were lymphadenopathy and rashes. HIV-related infections were tuberculosis and pneumonia. About 60% of study participants had severe immunodeficiency. Two-year mortality rate was 38%. Correlation of age and baseline CD4 count with outcome did not show any significant results.
Conclusion: Pediatric HIV/AIDS patients were symptomatic, male adolescents who engaged in male to male sexual contact. Co-infections with pneumonia and tuberculosis were common and severe immunodeficiency was present at diagnosis. Thirty-eight percent of patients had poor outcomes 2 years after diagnosis
Keywords: Pediatric HIV/AIDS, Clinico-demographic Profile
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Acetic Acid Versus Chlorine Tablet Solution as Disinfectant of Non-Critical Environmental Surfaces
Abegail Sales Basco, RN, M.D.
Abstract
Objectives: This study aims to determine the bactericidal activity of 4% acetic acid versus chlorine tablets against gram negative and gram-positive microorganisms based on percentage reduction of microorganisms in hospital surfaces and suggest that it may be an effective alternative disinfectant.
Methodology: This was an experimental study where microbiological sampling of hospital surfaces was used to determine bacterial growth. The study was conducted from November to December 2020 at National Children’s Hospital, a 200 bed capacity tertiary government hospital catering to children 0 to less than 19 years old. Non-critical hospital surfaces such as beds, bed rails and bedside tables were swabbed before and after intervention cleaning with chlorine tablets or 4% acetic acid solution.
Result: Pre-swabbing, hospital surfaces showed the presence of Bacillus sp., Klebsiella pneumoniae and Coagulase Negative Staphylococcus (CONS). Post-application of 4% acetic acid solution resulted to 100% reduction of Bacillus sp., 70.8% reduction of CONS, and 19.5% reduction of Klebsiella pneumoniae while post-application of chlorine tablet solution showed 100% reduction of Klebsiella pneumoniae and CONS and 95.2% reduction of Bacillus species.
Conclusion: The use of 4% acetic acid solution significantly reduced more gram-positive than gram-negative organisms and is a highly effective disinfectant against Bacillus sp. but is not effective against gram-negative organisms as it does not fulfil the criteria of at least 90 percent reduction in bacterial growth. Chlorine tablet solution is a more effective disinfectant against gram-negative organisms than gram-positive organisms. Acetic acid 4% solution is not an effective alternative disinfectant to chlorine tablet solution, the currently used hospital disinfectant, but maybe used as an adjunct for better reduction of hospital environmental pathogens.
Keywords: Acetic Acid, Chlorine Tablet, Disinfectant, Healthcare Associated Infection, Bacteria
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Carmina delos Reyes, M.D.
Arlene Dy-Co, M.D.
EDITORIAL BOARD:
Mary Ann Bunyi, M.D.
John Andrew Camposano, M.D.
Mary Antoinette Cuady-Madrid, M.D.
Xenia Catherine Fabay, M.D.
Elizabeth Gallardo, M.D.
Fatima Gimenez, M.D.
Jonathan Lim, M.D.
Sarah Makalinaw, M.D.
Francesca Mae Pantig, M.D.
Paul Sherwin Tarnate, M.D.
ADVISERS:
Cecilia Maramba-Lazarte, M.D., MScID, MScCT
JOURNAL MANAGER:
Patricia Navarro-Parlade, M.D.