A systematic review and meta-analysis on effectiveness of rice-based oral rehydrating solution for the treatment of acute watery diarrhea among children

OBJECTIVES@#This study aims to compare the effectiveness of rice-based ORS as compared with glucose-based ORS in the treatment of acute watery diarrhea among children. Specifically, it aims to review and analyze the effectiveness of rice-based ORS as compared to glucose-based ORS as to stool output, duration of diarrhea and effect of osmolarity on treatment of diarrhea and to determine associated adverse events associated with rice-based ORS and glucose-based ORS.@*METHOD@#This study used systemic review and meta-analysis of randomized trials. Primary outcomes were computed with 95% confidence intervals to determine the effectiveness of ricebased ORS. Adverse event was expressed as risk ratios with 95% confidence intervals.@*RESULTS@#Sixteen studies met the criteria for the systematic review and meta-analysis. Duration of acute diarrhea was shorter by 5 hours with rice-based ORS (MD= −5.27 hours, 95% CI= −9.63 to −0.91, p-value= 0.02) compared to glucose-based ORS. The stool output was 62.35 mL/kg lower with rice-based ORS (MD= −62.35 mL/kg, 95%CI= −128.43 to 3.74, p-value= 0.06) compared to glucose-based ORS. Vomiting was the only reported associated event with ORS intake (RR= 1.08, 95%CI= 0.81to 1.43, p-value= 0.60).@*CONCLUSION@# Sixteen studies met the criteria for the systematic review and meta-analysis. Duration of acute diarrhea was shorter by 5 hours with rice-based ORS (MD= −5.27 hours, 95% CI= −9.63 to −0.91, p-value= 0.02) compared to glucose-based ORS. The stool output was 62.35 mL/kg lower with rice-based ORS (MD= −62.35 mL/kg, 95%CI= −128.43 to 3.74, p-value= 0.06) compared to glucose-based ORS. Vomiting was the only reported associated event with ORS intake (RR= 1.08, 95%CI= 0.81to 1.43, p-value= 0.60).

Degree of family disaster preparedness and association of demographic characteristics of active consultants of a tertiary hospital for children in Quezon City

@#<p><strong>BACKGROUND:</strong> Increasing incidence of natural and man-made disasters emphasize the need to assess home disaster preparedness of pediatricians.</p><p><br /><strong>OBJECTIVES:</strong> To determine degree of family disaster preparedness and association of demographic characteristics of active consultants of a tertiary hospital for children in Quezon City.</p><p><br /><strong>METHODS:</strong> Cross-sectional study where participants were selected using purposive type of sampling. Fifty-eight active consultants for children answered a self-administered questionnaire on home disaster preparedness. Data was analyzed using SPSS version 24.0.</p><p><br /><strong>RESULTS:</strong> Total of 36 (62.06%) participants scored 70 and above, indicating family disaster preparedness. A total of 22 (37.94%) participants scored below 70, indicating lack of home disaster preparedness. The age of participants 35 to 40 (OR 108.57), 41 to 45 (OR 36.01), 51 to 55 (OR 11.4) and 56 to 60 (OR 17.93) are more likely to be family disaster ready (p value <0.05). Male participants were 7 times more likely to have higher overall family disaster preparedness.</p><p><br /><strong>CONCLUSIONS:</strong> This study has shown that 36 consultants in a tertiary hospital for children in Quezon City are prepared for home disasters. Males and younger population are the demographic characteristics associated with an increased degree of family disaster preparedness.</p><p><br /><strong>RECOMMENDATIONS:</strong> Basics of home disaster management should be included in continuing medical education of the hospital staff. Health education management system should encourage participation of hospital staff in disaster management programs. Bigger sample size of the pediatric society is recommended. Determine association of other demographic variables on home disaster preparedness. Address issues to overcome response bias.</p>

Parental perception and attitude on childhood immunization and other government healthcare programs after the Dengue vaccine controversy: a hospital-based cross-sectional study

@#<p><strong>BACKGROUND:</strong> The dengue vaccine controversy in the Philippines caused significant public anxiety affecting childhood vaccines, as well as other healthcare programs. An assessment of parental perception and attitude on childhood immunization and other government healthcare programs after the dengue vaccine controversy is lacking</p><p><strong>OBJECTIVE:</strong> To determine the perception and attitude of parents on childhood immunization and other government health care programs after the dengue vaccine controversy at a tertiary pediatric hospital.</p><p><strong>METHODOLOGY:</strong> A hospital-based cross-sectional survey was done at a tertiary pediatric hospital. A total of 96 subjects participated in the study. Parents with children ages 9 to 18 years old whose child was either vaccinated or non-vaccinated with dengue vaccine seen in the dengue clinic, outpatient department and private clinics were invited to answer the structured questionnaire. Proportional stratified sampling was employed. Mann Whitney U-test compared the perception and attitude scores between parents of children who were recipients and non-recipients of dengue vaccine. A p-value of</p><p><strong>RESULTS:</strong> The overall perception and attitude of parents on childhood immunization, deworming and vitamin A supplementation did not differ significantly between parents of non-dengue vaccinated children and dengue-vaccinated children. Sociodemographic factors such as gender, marital status, educational attainment, employment, and economic status did not differ significantly in their perception and attitude in terms of childhood immunization, deworming and vitamin A supplementation.</p><p><strong>CONCLUSIONS:</strong> The overall perception and attitude of parents in both groups showed no significant difference toward childhood immunization, deworming and vitamin A supplementation. There is no association with the overall perception and attitude of parents on childhood immunization, deworming and vitamin A supplementation and their sociodemographic factors. RECOMMENDATIONS: Future similar studies may be conducted in other regions to determine parental perception and attitude towards the government's immunization program and other health care programs.</p>

Comparison of the anxiety levels in children with acute lymphoblastic leukemia and their well siblings using the child drawing: Hospital manual”

OBJECTIVES@#The study aims to determine and compare the anxiety of children with acute lymphoblastic leukemia (ALL) and their well siblings based on Child drawing: Hospital manual and to identify factors associated with the level of anxiety.@*METHODS@#A prospective cross-sectional study was done in tertiary pediatric hospitals which included children aged five to eleven years old diagnosed with ALL and their well siblings.@*RESULTS@#A total of forty dyads of participants were studied. ALL patients presented higher anxiety scores than their siblings, but this was not statistically significant. There is a weak direct correlation between overall anxiety scores of ALL patients and their siblings (p = 0.017). There is insufficient evidence for an association between select clinical factors with anxiety scores. The linear regression model explained 49.77% in the variation of the anxiety scores but was not statistically significant.@*CONCLUSIONS@#There is a direct correlation between overall anxiety scores of ALL patients and their siblings. There is also a positive association with larger family size and child‘s response to sibling‘s illness. Larger families are likelier to have a healthier environment. The study also showed low to average anxiety levels among participants which may be related to quality of care and support given by the institution and inherent resiliency of the family.@*RECOMMENDATIONS@#Future research should aim to develop programs in partnership with families and other social support groups and explore the effectiveness of these interventions. Further studies should examine other possible cultural and psychodynamic factors prevalent in Filipino Family.

Accuracy of transcutaneous bilirubin determination in neonatal hyperbilirubinemia: A meta-analysis

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.

A study on the accuracy of pen click test as a hearing screening tool among newborns seen in two tertiary government hospitals

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.

A randomized double blind controlled study on the efficacy of spirulina as an adjunct therapy in the management of pediatric community acquired pneumonia-c in patients 6 months to 5 years old admitted in a tertiary government hospital

OBJECTIVE@#To determine the effect of Spirulina among patients with community acquired Pneumonia-C (PCAP-C) based on the resolution of the following symptoms; fever, respiratory rate, chest indrawings, rales, oxygen saturation and compare their length of hospital stay.@*DESIGN@#A randomized-double blind, placebo controlled clinical trial.@*SETTING@#The study was done at a tertiary government hospital@*PATIENTS/PARTICIPANTS@#Children 6 months to 5 years old with PCAP-C were randomized to either treatment group A or B. The two groups received the standard treatment for pneumonia and adjunct treatment of Spirulina for group A and placebo for group B.@*RESULTS@#A total of 14 7 patients participated in the study. Seventy four patients were randomized to group A and 73 patients to group B. Respiratory rate showed greater improvement with Spirulina supplementation starting day 3, 4 and 5. Resolution of chest in-drawing was significant in Spirulina group on day 2 (p- value < 0.05), day 3 (p - value < 0.05) and day 4 (p - value <0.05). There were more patients in Spirulina group with decreased to absent rales on day 2 (p-value 0.02), day 3 (p-value 0.039), day 4 (p-value 0.01) and day 5 (p-value 0.01). Temperature and oxygen saturation on both groups had almost similar trends. The mean hospital stay in Spirulina group (3.09 days) is shorter as compared to the placebo group (p-value 0.02).@*CONCLUSION@#Spirulina supplementation showed positive effects in PCAP-C. Its immunemodulating effect played a positive role in the treatment outcome of pneumonia.

Effect of aspiration and non-aspiration of syringe prior to intramuscular administration of influenza vaccine in pain perception of children 9 to 15 years of age consulting at the out-patient department of a tertiary government hospital

OBJECTIVE@#To determine the effect of aspiration and non-aspiration of syringe prior to intramuscular administration of influenza vaccine in pain perception of children 9 to 15 years of age consulting at the Out Patient Department of a Tertiary Government Hospital.@*DESIGN@#Randomized controlled clinical Trial@*SETTING@#Out Patient Department of a Tertiary Government Hospital@*PARTICIPANTS@#One-hundred twenty children 9 to 15 years old consulting at the Out Patient Department.@*METHODOLOGY@#Subjects were randomized into two groups and were given influenza vaccine with and without aspiration prior to intramuscular injection.@*OUTCOME MEASURES@#Primary outcome measure is the degree of pain experienced by the subject using the Numeric Rating Scale.@*RESULTS@#A total of one hundred twenty children were randomized to either Group A or Group B. IBMSPSS version 21 was used as statistical software. Differences in mean heart rate at baseline and after the intervention within group is significantly different (p value < 0.01). Mean heart rate in between group at baseline and after administration of influenza vaccine is not significantly different ( p value >0.05). The difference in mean oxygen saturation at baseline and after immunization within group is significantly different. Mean oxygen saturation between group pre and post immunization is not statistically different (p value 0.309). Analysis showed there is a significant difference in mean pain scores between Group A and Group B ( p value 0.046)@*CONCLUSION@#This study showed a statistically significant lower pain score for Group A (without aspiration) than Group B (with aspiration). The physiological pain responses, used as outcome measures in this study did not have significant differences between two groups. The result of this study will unleash in health care professionals the burden on whether or not to aspirate before intramuscular administration of vaccine.

Dengue vaccine acceptance and associated factors among parents and caregivers at the Philippine Children’s Medical Center outpatient department: A hospital-based cross-sectional survey

BACKGROUND@#The DOH has recently launched the first ever dengue vaccine that has successfully completed phase III clinical trials but an assessment of the general acceptance of the vaccine is widely lacking. @*OBJECTIVES@# This study determined the dengue vaccine acceptance and the factors associated with acceptance as well as the knowledge, attitudes and practices on dengue fever among parents and caregivers at the PCMC-OPD.@*METHODS@#A hospital-based cross-sectional survey was done at the PCMC-OPD using selfadministered questionnaires regarding the KAP on dengue fever and vaccine acceptance. Multivariate analysis and Spearman’s rank correlation were used to determine predictors of DV acceptance.@*RESULTS@#We found that DV acceptance among the participants was 81.3% (113 out of 139). Educational attainment, employment status, and monthly income are significantly associated with acceptance of dengue vaccine, and being female contributed to high acceptance. DV acceptance was strongly correlated with a lower income class. Educational attainment and employment status seem to affect DV acceptance but are not strong predictors.@*CONCLUSIONS@#The DV acceptance rate of the parents and caregivers of patients consulting at PCMC-OPD was high. The most important factors associated with acceptance are educational attainment, employment status and income class.@*RECOMMENDATIONS@#A similar study may be conducted with a larger population to study target populations in the Philippines. This kind of study can be utilized to formulate new strategies addressing the awareness and acceptance of the community for the new dengue vaccine.

Efficacy of Virgin Coconut Oil supplemented-milk feeding in augmenting weight gain among very low birth weight preterm infants: A meta-analysis

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Nutritional status is crucial in neonatal survival, especially among the Very Low Birthweight (VLBW) preterm infants. They have low nutrient reserves with increased metabolic needs and immature gut system. Several studies have proven the efficacy of medium-chain triglycerides (MCT) as a good source of calories among pre-term infants. However, such is not commercially available. Virgin coconut oil (VCO) has the most concentrated content of MCT's, hence a possible source of MCT.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> This review aims to determine the efficacy of VCO-supplementation to milk feeding in augmenting weight gain among very low birth weight preterm infants.</p><p style="text-align: justify;"><strong>METHODS:</strong> Pubmed (1975-September 2016), Cochrane Central Register of Controlled Trials (The Cochrane Library, September 2016), HERDIN (1966 -September 2016), Google Scholar (September 2016), and https://clinicaltrials.gov (last searched September 2016) were thoroughly searched. Manual search in reference and citation lists of the eligible studies and list of abstracts from the Philippine Pediatric Society was also reviewed. Only randomized controlled trials comparing VCO-supplemented milk versus standard care in weight gain among very low birth weight preterm infants were included. The author reviewed each study's quality and extracted data on weight gain. Weighted mean differences with 95% confidence intervals were reported. Risk of biases among studies were also evaluated.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Three randomized controlled trials involving 290 infants were included. All trials were of good quality with relatively low heterogeneity (39%), and low risk of biases. Overall, infants receiving VCO-supplemented milk feeding had statistically significant weight gain compared to those given non-fortified milk (mean difference 5.31, 95% CI: 3.83 to 11.93).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Virgin coconut oil is effective in augmenting weight gain among very low birth weight preterm infants.</p><p style="text-align: justify;"><strong>RECOMMENDATIONS:</strong> Small trials were used in this review, and a single multicenter randomized controlled trial would be ideal to further establish these findings.</p>

Comparison of the anxiety levels in children with Acute Lymphoblastic Leukemia and their well siblings using the child drawing: Hospital manual

OBJECTIVES@#The study aims to determine and compare the anxiety of children with acute lymphoblastic leukemia and their well siblings based on Child drawing: Hospital manual and to identify factors associated with the level of anxiety.@*METHODS@#A prospective cross-sectional study was done in the hematology-oncology outpatient clinic and private clinics of hema-oncology specialist in tertiary pediatric hospitals. The study included children five to eleven years old diagnosed with Acute Lymphoblastic Leukemia (ALL) and their well siblings.@*RESULTS@#A total of forty dyads of participants were included in the study. ALL patients presented higher anxiety scores than their siblings. However, this was not statistically significant. There is a weak direct correlation between overall anxiety scores of ALL patients and their siblings (p = 0.017). There is insufficient evidence to demonstrate an association between select clinical factors with anxiety scores. The linear regression model showed 49.77% in the variation of the anxiety scores.@*CONCLUSIONS@#There is a direct correlation between overall anxiety scores of ALL patients and their siblings. There is a positive association with larger family size and child’s response to sibling’s illness. A larger families are likely to have a healthier environment. The study showed low to average anxiety levels among participants which may be related to quality of care and support given by the institution and inherent resiliency of the family. @*RECOMMENDATIONS@#Future research should aim to develop psychological, emotional and behavioral programs in partnerships with families and other social support groups. Future studies should examine other possible cultural and psychodynamic factors prevalent in Filipino Family.

Comparison of total aerobic count before and after application of different antiseptic solutions prior to venipuncture and its correlation to developing phlebitis, in children admitted at a tertiary hospital in Quezon City

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the effect on Total Aerobic Count (TAC) of application of Isopropyl alcohol, Chlorhexidine, and povidone iodine plus alcohol prior to venipuncture and development of phlebitis in children admitted at a tertiary hospital.</p><p style="text-align: justify;"><strong>METHODS</strong>: A prospective randomized clinical trial in a tertiary hospital in Quezon City. A total of 129 patients one-year old and above with physician orders for IV insertion and extractions. Pre and post swabbing of the venipuncture site was done and placed on a blood agar plate. The three antiseptic solutions were applied over the venipuncture site and swabbed and placed on the agar plate. The primary outcome measure was the TAC in each blood agar of the tested antiseptic solution and correlation to developing phlebitis.</p><p style="text-align: justify;"><strong>RESULTS</strong>: The CFU/mL after disinfection was significantly different between groups, with the lowest CFU/mL observed among patients disinfected with Chlorohexidine. Phlebitis was only noted in the alcohol group. No reactions were observed from patients who were disinfected with povidone iodine and chlorohexidine.</p><p style="text-align: justify;"><strong>CONCLUSIONS</strong>: Single application of Chlorhexidine is the optimal method to be used as antisepsis prior to procedures like venipuncture. However, the use of povidone iodine plus 70% isopropyl alcohol also has comparable effect to Chlorhexidine.</p>