Postoperative pulmonary complications following adenotonsillectomy in pediatric patients with obstructive sleep apnea in a tertiary government hospital

Objective@#Our study aimed to identify and describe pulmonary complications and its associated risk factors in children with suspected or confirmed obstructive sleep apnea (OSA) who underwent tonsillectomy or adenotonsillectomy in a tertiary government hospital.@*Methods@#We conducted a retrospective cohort study. Medical charts of pediatric patients with suspected or confirmed OSA who were admitted for tonsillectomy or adenotonsillectomy from January 1, 2016 to December 31, 2020 were retrieved and reviewed. Information of the individual patients including the demographic data, clinical profile, polysomnography results, and presence of postoperative pulmonary complications were recorded. Descriptive statistics was utilized to present continuous data while frequency and percentage for categorical data. Fisher exact test was used to compare the demographic profile of patients with postoperative pulmonary complications from those without. @*Results@#A total of 90 patient records were analyzed. The mean age of the patient population was 7.87 years, 55.6% were male, 17.8% of patients were classified as obese. Thirty-four children had preoperative polysomnography and of these, 47.1% were classified as severe. Only two (2.2%) patients had postoperative pulmonary complications, which were bronchospasm and desaturation, respectively. There were no statistically significant differences noted in comparing the clinicodemographic profile of patients with postoperative pulmonary complications from those without complications. @*Conclusion@#Our results showed that most pediatric patients with suspected or confirmed OSA who underwent adenotonsillectomy did not have pulmonary complications.

Chest CT Scan findings in children with COVID-19: A systematic review

Objectives@#To gather, summarize, and appraise the available evidence on: 1) the accuracy of chest CT scan in diagnosing COVID-19 among children, and 2) the characteristic chest CT scan findings associated with COVID-19 pneumonia in children.@*Methods@#We comprehensively searched databases (MEDLINE, COCHRANE), clinical trial registries, bibliographic lists of selected studies, and unpublished data for relevant studies. Guide questions from the Painless Evidence Based Medicine and the National Institutes of Health Quality Assessment Tools were used to assess study quality.@*Results@#A poor quality study showed 86.0% (95% CI 73.8, 93.0) sensitivity and 75.9% (95% CI 67.1, 83.0) specificity of chest CT scan in diagnosing COVID-19 in children. Thirty-nine observational studies describing chest CT scan in children with COVID-19 showed abnormal findings in 717 of 1028 study subjects. Common chest CT scan findings in this population include: 1) ground glass opacities, patchy shadows, and consolidation, 2) lower lobe involvement, and 3) unilateral lung lesions. @*Conclusion@#Studies which investigate the accuracy of chest CT scan in the diagnosis of COVID-19 in children are limited by heterogeneous populations and small sample sizes. While chest CT scan findings such as patchy shadows, ground glass opacities, and consolidation are common in children with COVID-19, these may be similar to the imaging findings of other respiratory viral illnesses.

Pulmonary manifestations and management of COVID-19 pediatric patients admitted in a tertiary government hospital

@#Background. Coronavirus Disease 2019 (COVID-19) presents with respiratory signs and symptoms in children. Presently, there are no local studies on the pulmonary manifestations and management of COVID-19 among children. Objective. Our study aimed to identify and describe the presenting respiratory signs and symptoms, oxygenation status, radiologic findings, blood gas analysis, and pulmonary interventions among children admitted for COVID-19. We also analyzed the clinical and radiologic variables associated with mortality. Methodology. This is a retrospective study using data obtained from a review of medical records from April 1, 2020, to June 30, 2020, at a tertiary government institution in the Philippines. All pediatric patients (0-18 years) hospitalized for probable or confirmed COVID-19 during the said time period were included in this study. Univariate and multivariate logistic regression was applied to determine factors affecting mortality. Results. A total of 25 pediatric patients with a mean age of 7 years old (age range: 11 days to 18 years) were admitted for COVID-19. Cough (44%) and dyspnea (24%) were the most common presenting respiratory symptoms, while tachypnea (68%), crackles (36%), and peripheral oxygen desaturation (36%) were the most common respiratory signs. Indeterminate findings for COVID-19 such as multifocal or diffuse ground-glass opacities and/or consolidations were the most common radiographic abnormalities. Invasive ventilatory support was administered to 6 cases of severe COVID-19 and 4 critical cases. There were no variables that correlated significantly with mortality. Conclusion. Respiratory signs and symptoms were prominent in our cohort of children admitted due to COVID-19. Mechanical ventilation was required in more severe cases. Larger prospective studies may help identify variables that significantly correlate with poor outcomes among children with COVID-19.

Respiratory manifestations, radiologic findings and respiratory management of hospitalized children with COVID-19 among different age groups: A systematic review

@#<p style="text-align: justify;"><strong>Objective:</strong> This paper aims to determine the respiratory manifestations, radiologic findings, and management of coronavirus-19 (COVID-19) among the hospitalized children of different age groups based on a systematic review of literature.</p><p style="text-align: justify;"><strong>Methodology:</strong> We searched the MEDLINE, Google Scholar, Cochrane, and MedRvrix databases for relevant studies on pediatric COVID-19 done between January 1 to May 25, 2020. Data on demographic features, pulmonary symptoms, chest imaging findings, and oxygen support were extracted in a data abstraction form and analyzed among the different pediatric age groups.</p><p style="text-align: justify;"><strong>Results:</strong>?Sixteen studies were included in this systematic review, with a total of 61 patients. Thirty-nine patients (64%) belong to the 2 to 12 year age group. Cough was the most commonly reported respiratory symptoms among children older than one month. Most of the patients, particularly adolescents, had asymptomatic or mild infection. On chest imaging, infiltrates and ground-glass opacities were the most common abnormalities. Oxygen supplementation via nasal cannula, non-invasive ventilation, and mechanical ventilation was noted in three cases.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Our systematic review shows that COVID-19 can present with a spectrum of respiratory manifestations and disease severity as well as a variety of radiologic abnormalities across different pediatric age groups. Whilemost children do not develop hypoxemia warranting oxygen supplementation, a severe respiratory infection can still manifest in children. Asymptomatic and milder infections are common and highlight the need for appropriate respiratory precautions. More pediatric studies on the pulmonary manifestations and management of children with COVID-19 can aid in a better understanding of this novel disease.</p>

The yield of Acid-Fast Bacilli (AFB) and tuberculosis (TB) culture in the microbiologic diagnosis of childhood tuberculosis using sputum induction: A randomized controlled trial with interrupted time series

@#<p style="text-align: justify;"><strong>Objectives:</strong> This study aims to determine the diagnostic yield and safety of sputum induction with hypertonic saline in the microbiologic confirmation of childhood tuberculosis (TB) in a tertiary hospital in the Philippines.</p><p style="text-align: justify;"><strong>Methods:</strong> This is a randomized controlled trial with an interrupted time series in the control group. One hundred twelve (112) pediatric patients (4-18 years old) with clinical findings suggestive of TB were enrolled in the study. Patients were randomized into two groups composed of 56 patients each. Group A patients underwent sputum induction. Group B patients underwent spontaneous expectoration followed by sputum induction. The microbiologic yield for acid-fast bacilli and TB culture were determined and analyzed.</p><p style="text-align: justify;"><strong>Results:</strong> Among the patients randomized to Group A, microbiologic confirmation for TB was 8/56 patients (14.3%) after sputum induction. For patients randomized to Group B, microbiologic yield was 4/56 patients (7.1%) from spontaneous expectoration; after sputum induction, the microbiologic yield increased to 5/56 patients (8.9%). There is insufficient evidence of statistical significance in microbiologic yield on parallel analysis of the two separate groups (p=0.22). Furthermore, for patients randomized to Group B, the increase in microbiologic yield after sputum induction compared to spontaneous expectoration did not reach statistical significance (p=1.000). The procedure was well-tolerated among children; no serious adverse events were observed.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Sputum induction is a feasible and safe method of specimen collection for microbiologic diagnosis of TB among children. While the microbiologic yield increased after sputum induction compared to spontaneous expectoration, the additional yield does not seem to be significant.</p>

Effectiveness of non-invasive ventilation in treating infants aged 1 to 12 months with severe bronchiolitis: A systematic review and meta-analysis

@#<p style="text-align: justify;"><strong>Objective.</strong> This study was done to determine the effectiveness of non-invasive ventilation (NIV) in treating infants aged 1 to 12 months with severe bronchiolitis based on a systematic review of literature and meta-analysis of quantitative results.</p><p style="text-align: justify;"><strong>Methods.</strong> We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for identification, screening, and identification of eligible studies. Five databases (PubMed, Herdin, Cochrane Library, Google Scholar, and Science Direct) were searched for relevant studies involving the use of NIV among children with severe bronchiolitis. Included studies were assessed for quality and risk of bias.</p><p style="text-align: justify;"><strong>Results.</strong> There were 9 included eligible studies. The length of hospital stay and duration of respiratory support were significantly lower with the use of NIV compared with IMV (invasive mechanical ventilation) based on pooled standard mean difference (SMD) estimates; however, there was high statistical heterogeneity in the included studies. This can be attributed to differences in the mode of intervention used among studies, patient-specific factors, and viral virulence. Significant improvements in heart rate, oxygen saturation, and tCO2 were seen in the included studies. One study showed statistically significant differences in changes in respiratory rate and improvement in respiratory status based on two bronchiolitis severity scores among infants placed on NIV.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Fair to good-quality evidence from included studies reveals that there is a significant reduction in length of hospital stay, duration of respiratory support, and improvements in respiratory parameters among infants who received NIV for severe bronchiolitis. Larger, well-designed clinical trials on the use of NIV among resource-limited settings wherein it may offer valuable clinical utility, are recommended for future study</p>