SARS-CoV-2 Infection in Filipino Children: An interim report from the SALVACION registry

Background@#The COVID-19 pandemic continues to afflict nations worldwide. The Philippines is no exception which has recorded more than 3 million cases as of December 2021 with children comprising 12% of total cases. Since the start of the pandemic, the Pediatric Infectious Disease Society of the Philippines (PIDSP) has been collecting data nationwide, through an online pediatric COVID-19 registry (SALVACION registry), to provide a better understanding of COVID-19 in children in the local setting. @*Methods@#This was an ambispective cohort study of pediatric COVID-19 cases in the Philippines reported from March 2020 to December 2021. Data on clinical features, laboratory findings, disease severity, and treatment outcomes were voluntarily reported by physicians across the country. This study was approved by the Department of Health Single Joint Research Ethics Board. @*Results@#As of December 30, 2021, there were 2,127 cases reported in the registry, with a median age of 5 years (interquartile range: 1-13 years) and mostly mild (41.9%) or moderate (24.5%) in severity. The top symptoms reported were fever (57.9%), cough (42.7%), coryza/colds (29.4%), anorexia (25.2%), and difficulty of breathing (23.1%). The most common comorbidities were hematologic-oncologic diseases (7.4%), neurologic diseases (7.0%) and surgical conditions (4.4%), while the most common coinfections were sepsis (6.3%), dengue fever (4.8%) and healthcare-associated pneumonia (2.1%). Significantly higher median CRP, procalcitonin, D-dimer, ferritin, transaminases and lactate dehydrogenase were seen among severe/critical cases compared to non-severe cases. There was a high frequency of antibiotic use (58%). Most cases recovered, although 172 deaths were reported with an 8.6% case fatality rate. The most common comorbidities in those who died were neurologic (15.7%), cardiac (12.8%) and hematologic (11.6%) diseases. @*Conclusion@#Children across all age groups are susceptible to COVID-19 and most cases are mild or moderate in severity. Among severe and critical cases, the most common comorbidities were neurologic, hematologic-oncologic and cardiac diseases. Most patients recovered with supportive management.

Intraventricular Antimicrobial Therapy in children with Multi-Drug Resistant Ventriculitis: A tertiary hospital experience and literature review

Background@#Intraventricular antimicrobial therapy (IVT), defined as the direct installation of antimicrobial agents into the lateral ventricles has been utilized as the last therapeutic option for the treatment of multidrug-resistant ventriculitis. The aim of this case series is to report our institution’s experience with IVT in pediatric patients with ventriculitis. @*Material and Methods@#Retrospective chart review was done. The demographic data, cerebrospinal fluid (CSF) culture isolates, treatment regimens, and clinical outcomes of these patients were collected and described. @*Results@#Between 2016 to 2018, seven (7) pediatric patients diagnosed with ventriculitis caused by multidrug-resistant organisms underwent intraventricular antimicrobial therapy in combination with intravenous therapy. The median age was 1 year (range 1 month to 17 years old, mean: 4.4 years). Fifty-seven (57) percent of the patients were females. The isolated pathogens were Acinetobacter baumannii MDRO (n = 3), Klebsiella pneumoniae MDRO (n = 2), Methicillin-resistant Staphylococcus aureus (n = 1), and Methicillin-resistant Staphylococcus epidermidis (n = 2).One patient had mixed isolates on CSF culture (Acinetobacter baumannii and MRSE). The antimicrobial agents for IVT used were colistin (n = 4), vancomycin (n = 2), and gentamicin (n = 1). The mean time to initiation of intraventricular therapy from the diagnosis of ventriculitis was 19 days. The mean duration of IVT therapy was 15 days. The survival rate was 57%. @*Conclusion@#Ventriculitis caused by drug-resistant organisms is an emerging concern. Optimal therapy is not yet established and experience with IVT is limited. This series showed that there were no adverse effects related to IVT thus it may be considered an option for MDRO ventriculitis. Gram negative organisms are more common causes of ventriculitis in our institution.

Comparison of various methods of detection of Hypoxemia and Correlation of Hypoxemia with clinical features among pediatric patients 3 months to 5 years old with community-acquired Pneumonia at a tertiary hospital emergency room

Introduction@#Pulse oximetry is frequently utilized as a rapid, non-invasive, point-of-care alternative to arterial blood gas analysis in measuring oxygen saturation of children with pneumonia.@*Objectives@#To compare portable fingertip pulse oximetry saturation (SpO2PF), handheld pulse oximetry saturation (SpO2H) and arterial oxygen saturation (SaO2) in detection of hypoxemia, and correlate hypoxemia with clinical features in children with pneumonia.@*Methodology@#This was a prospective, observational, cross-sectional study involving patients 3 months to 5 years old with pneumonia. Oxygen saturation was measured using a portable fingertip pulse oximeter, a handheld pulse oximeter, and arterial blood gas analysis. @*Results@#Eighty-six children were included. SpO2 PF underestimated oxygen levels by 0.126% (95% CI -0.240 to 0.491), while SpO2H underestimated it by 0.323% (95% CI -0.075 to 0.721). Between portable and handheld readings, the mean difference was 0.198% (95% CI -0.089 to 0.484). Across the three methods, limits of agreement ranged from -3.388 to +4.035%. There was no statistically significant difference in variance among the three measurements. Children with tachypnea (cOR 2.623, 95% CI 1.06 – 6.48, p = 0.037), difficulty breathing (cOR 6.316, 95% CI 1.96 – 20.34, p = 0.002), and subcostal retractions (cOR 2.842, 95% CI 1.05 to 7.69, p = 0.040) were more likely to have hypoxemia. @*Conclusion@#Pulse oximetry closely correlates with arterial blood gas analysis within acceptable limits of agreement and with no significant differences in variance among measurements. Difficulty breathing, tachypnea and subcostal retractions were significantly more likely to be observed in hypoxemic children.