Department of Pediatrics MONTHLY TRENDS Department of Pediatrics September 22, 2016

Emergency Room

2016 ER Trends August 2822 698 3520 MONTH INFECTIOUS NON INFECTIOUS TOTAL January 2484 853 3550 February 2060 669 2904 March 1665 599 2264 April 982 488 1470 May 1127 579 1706 JUNE 1073 522 1771 JULY 1702 504 2206 August 2822 698 3520

MONTHLY ER CENSUS FOR 2015 AND 2016

AUGUST ER TRIAGE URGENT 2014 57% 1502 43% EMERGENT 4 0% 3520 100% TRIAGE OF PATIENTS URGENT 2014 57% 1502 43% EMERGENT 4 0% 3520 100%

AUGUST ER DISPOSITION Disposition % Discharged 2917 83% Admitted 558 16% DAMA 30 0% THOC 13 PICU 5 NICU 1 Expired

DAMA/THOC Reasons For DAMA Number of Patients Percent Transfer to another hospital 13 31% Observe at Home with close follow-up Will not wait for Lab results 7 1% Non reason given 6 14% Unsatisfied due to no rooms available 2 4% Financial Difficulties

TOP 10 INFECTIOUS DISEASES NUMBER OF PATIENTS PERCENT 1. Systemic Viral Illness 1017 29% 2. Upper Respiratory Tract Infection 877 25% 3. Acute Gastroenteritis 193 5% 4. Pneumonia 126 4% 5. Non-Specific Viral Exanthem 89 3% 6. Acute Respiratory Tract Infection 88 7. Dengue Fever 77 2% 8. Acute Rhinitis 53 1% 9. Presumptive Urinary Tract Infection/ Acute Otitis Media 35 0% 10. Acute Nasopharyngitis 25

TOP 10 ER INFECTIOUS CASES JULY, 2016 AUGUST, 2016 Upper Respiratory Tract Infection 49% Systemic Viral Illness 29% 14% 25% Acute Gastroenteritis 12% 5% Pneumonia 3% 4% Skin Infections Non-Specific Viral Exanthem Acute Otitis Media Acute Respiratory Tract Infection Nonspecific Viral Exanthem 1% Dengue Fever 2% Urinary tract Infection Acute Rhinitis Conjunctivitis Presumptive Urinary Tract Infection/ Acute Otitis Media 0% Roseola Acute Nasopharyngitis

TOP 10 NONINFECTIOUS DISEASES NUMBER OF PATIENTS PERCENT 1. Acute Urticaria 77 2% 2. Bronchial Asthma 56 1% 3. Food Intolerance 52 4. Animal Bite 35 0% 5. Functional Constipation 26 6. Non-Ulcer Dyspepsia 23 7. Simple Febrile Convulsion 22 8. Well Child 18 9. Costochondritis/ Functional Constipation 9 10. Allergic cough 7

TOP 10 ER NONINFECTIOUS CASES JULY, 2016 AUGUST, 2016 Food Intolerance 13% 1. Acute Urticaria 2% Acute Urticaria 10% 2. Bronchial Asthma 1% Animal Bite 3. Food Intolerance Dyspepsia 7% 4. Animal Bite 0% Foreign Body 4% 5. Functional Constipation Bronchial Asthma 3% 6. Non-Ulcer Dyspepsia Functional Constipation 7. Simple Febrile Convulsion Well Child 8. Well Child Musculoskeletal Strain 9. Costochondritis/ Functional Constipation Impacted Cerumen 10. Allergic cough

NON URGENT CASES DISPOSITION PERCENT DISCHARGED 93% ADMITTED 6.5% DAMA/THOC 0%

TOP 10 NONURGENT INFECTIOUS CASES JULY 2016 AUGUST 2016 Upper Respiratory Tract Infection 54% 48% Systemic Viral Illness 16% 20% Acute Gastroenteritis 12% 10% Acute Otitis Media 3% Acute Tonsillitis Nonspecific Viral Exanthem Dengue Fever Pneumonia 2% Conjunctivitis Roseola 1% Acute rhinitis Infected Wound Non-specific viral Exanthem Impetigo Acute Respiratory tract infection

TOP 10 NONURGENT NON INFECTIOUS CASES JULY, 2016 AUGUST 2016 Animal Bite 15% Bronchial Asthma 12% Acute Urticaria 13% Food Intolerance 11% 9% Dyspepsia 5% Well baby/ Animal Bite 8% Musculoskeletal Strain 3% Functional Constipation/ Non ulcer dyspepsia Well Child Allergic cough Functional Constipation 2% Functional abdominal pain Impacted Cerumen Foreign body, Nose 1% Allergic Conjunctivitis Impacted cerumen/ Anterior epistaxis Anterior Epistaxis Allergic rhinitis/ Atopic dermatitis 0%

WARDS

TOTAL ADMISSIONS MONTH TOTAL JANUARY 700 FEBRUARY 487 MARCH 373 APRIL 319 MAY 344 JUNE 320 JULY 455 AUGUST 615 From the ER Direct Admissions 558 52

Top 10 Ward Infectious Cases August 2016 No. Percentage Upper Respiratory Tract Infection 147 24% Pneumonia 119 19% Dengue Fever without warning signs 62 10% Acute Viral Illness 53 9% Acute Gastroenteritis 51 8% Bronchiolitis 11 2% Urinary Tract Infection 10 Dengue Fever with warning signs 8 1% Acute Bronchitis 4 Facial Cellulitis 3 0.5%

Top 10 Ward Non-Infectious Cases August 2016 Number Percentage Bronchial Asthma 17 3% Benign Febrile Convulsion 14 2% Food Intolerance 8 1% Congenital Heart Disease 5 Acute Lymphocytic Leukemia Functional Constipation 4 Acute Appendicitis Complex Febrile Seizure Acute Urticaria Seizure Disorder 3 0.5%

PICU

PICU ADMISSIONS FOR 2016 55% increase

66% of last year ----- Meeting Notes (9/19/16 18:00) ----- CAN WE COMPARE IT TO THE NUMBER OF ADMISSIONS?

Cases by Admitting Unit Total PICU Admissions 14 Admitting Unit # of Patients Percentage Emergency Room 6 43% Floors (Post-OR) 2 14% Floors 5 36% Direct Admission 1 7%

Distribution by Subspecialty Infectious 1 Hepatobiliary- GI 3 Cardiology 2 Pulmonology Neurology 4 Others (ENT) Total 14 Majority of the admissions were postoperative referrals from other subspecialties, followed by pulmonology and GI-hepatobiliary cases

Distribution by Age Age N=14 6 1 4 2 0-1 infant 2-3 toddler 3-6 pre-school 6-12 school-age 4 12-18 adolescent 2 ----- Meeting Notes (9/19/16 18:00) ----- BASE AGE ON NELSON's GROWTH and DEVELOPMENT 0-1 infant 2-3 toddler 3-6 pre-school 6-12 school-age 12-18 adolescent p52 NELSONS

Cases from the Wards Length of stay prior to PICU admission Range: 1-5 days

Length of Stay at PICU Range: 1 day to 13 days Mode: 1-2 days

Bed Occupancy Rate (or rate of vacancy) The number of hospital beds occupied by patients expressed as a percentage of the total beds available in the ward, specialty, hospital, area, or region. It is used to assess the demands for hospital beds and hence to gauge an appropriate balance between demands for health care and number of beds. Total number of inpatient days for a given period x 100 Available beds x Number of days in the period 62 x 100 4 x 31 50% BED OCCUPANCY RATE ----- Meeting Notes (9/19/16 18:00) ----- ASK HOW THE HOSPITAL COMPUTES

Outcomes Outcome Number TROC and Eventually Discharged 10 TROC and Still Admitted 1 THOC Discharged from PICU Expired Still admitted 2 ----- Meeting Notes (9/19/16 18:00) ----- Remove when expired *TROC – transferred to room of choice *THOC – transferred to hospital of choice

NICU

Figure 1. TMC LIVEBIRTHS: COMPARISON OF YEARS 2015 VS. 2016 Monthly% 17% 14% 6% 16% 8% ↓17% 3% Yearly % 5% ↓6% ↓25% ↓5% 7% ↓21% ↓11%

Distribution of Total Births According to Manner of Delivery NSD 56/139 CS 83/139

Deliveries by Levels Level I Level II Level III AUG 2016 53 73 10

Level I Admissions

Level II Admissions

Top Reasons for Level II

Level III Admissions

Top Diagnosis for Level III 1 1 6

Admissions at Referral Hyperbilirubinemia is the main reason for admission at referral

Top Diagnosis for Referral 1 1 7

Isolation Admissions

ISOLATION ADMISSION 1 Multi-Organ dysfunction; Complex cyanotic heart disease CAVSD with DORV moderate pulmonary stenosis s/p Modified Right Blalock Tausig shunt 8/1/16; Heterotaxy Syndrome 2 Complete Gut Obstruction secondary to internal herniation and perforation of Illeum; Meckel's Diverticulum t/c G6PD s/p Lysis of adhesions, Segmental ileal resection, Double Barrel Ileostomy (8/15/16) 3 Double Outlet Right Ventricle with Tetralogy of Fallot, with Severe Pulmonic Stenosis; S/P Tetralogy of Fallot Repair (8/16/16)

Breastfeeding Rates: 2016 Month BFHI JCIA AUG 87.50% 87.16%

Figure 2. Large for Gestational Age babies Infant of Type II DM mothers n = 0 Symptomatic n=0 Asymptomatic n = 0 Gestational diabetes n = 4 Symptomatic n =0 Asymptomatic n = 4 No maternal risk factors n = 10 Symptomatic n = 0 Asymptomatic n = 10

Breastmilk/Breastfeeding Jaundice HYPERBILIRUBINEMIA Hyperbilirubinemia n=9 ABO Incompatibility N= 7 AO: n=1 BO: n = 6 Unspecified N=1 Breastmilk/Breastfeeding Jaundice Breastmilk n = 1 Breastfeeding n = 0

OPD

General Census Number of Cases Well baby/child 24 Infectious Cases 42 Non-Infectious Cases 31 Total Patients seen 97 Total Cases Total number of patients seen at the OPD for the month of July was 97 while the total number of cases was 97. Infectious and non infectious cases are 42 and 31% respectively. 24% of the general census were well baby or child consults.

OPD Census 2016 Month Infectious Well Child Total January 65 36 16 117 Non Infectious Well Child Total January 65 36 16 117 February 47 38 18 103 March 66 32 6 104 April 28 98 May 29 43 9 81 June 50 52 13 115 July 15 August 42 31 24 97

Monthly Census (2014-2016) In comparison to previous month, there was a decreased number of total cases seen

Top 3 Infectious Cases Upper Respiratory Tract Infection 34 33% Rank Diagnosis Number of Cases Percentage 1 Upper Respiratory Tract Infection 34 33% 2 Acute Gastroenteritis 4 4% 3 Viral Infection, unspecified 2% The most common cause for consult is for Upper Respiratory Tract Infection, comprising 33% of cases seen, majority of which is from the 2-5 years age group. There were 4 cases of acute gastroenteritis and 2 cases of unspecified viral infection.

Top 4 Non-Infectious Cases Rank Diagnosis Number of Cases Percentage 1 Infected Wound 7 7% 2 Allergic Rhinitis 5 5% 3 Developmental Assessment 4 4% Bronchial Asthma not in Excaterbation 2% Top on the list of Non infectious cases are infected wound, allergic rhinitis, consults from Developmental Pediatrics, coming in for developmental screening and assessment prior to enrollment to special education center, as well as follow ups of patients with bronchial asthma not in exacerbation

Subspecialty Referrals Neurology 29% (2); Pulmonology 14% (1); Developmental Pediatrics 57% (4) Majority of subspecialty referral are with Developmental Pediatrics – Known cases of Autism, ADHD for developmental assessment prior to enrolment to SPED; Majority are suspect for delay hence for Dev Peds Assessment Neuro referrals comprise of patients who were noted to have previously diagnosed cerebral palsy and seizure disorder. Pulmonology referral composed of …

Department of Pediatrics MONTHLY TRENDS Department of Pediatrics September 22, 2016

MORBIDITY and MORTALITY Department of Pediatrics September 22, 2016

NICU Mortality Pre term baby girl delivered via Stat CS for nonreassuring fetal status (decelerations) To a 43 yo G2P2 (0202) at 28 2/7 weeks AOG BW 830 AS 9,9 MT 29 AGA Probable sepsis Pulmonary hemorrhage Respiratory distress syndrome Pneumoperitoneum probably secondary to gastrointestinal perforation Resident in charge: Dr. Laddale Sy*, Dr. Iris Tagaro Attending Physicians: Dr. Carina Quimbo Multi-Organ dysfunction; Complex cyanotic heart disease CAVSD with DORV moderate pulmonary stenosis s/p Modified Right Blalock Tausig shunt 8/1/16; Heterotaxy Syndrome Dr Laddale Sy*, Dr. Iris Tagaro Dr. Dexter Cheng, Dr. Catherine Chua ER Mortality Cardiopulmonary Arrest secondary to Severe Pneumonia Large ASD in Failure Dr. Hannah Arce* Dr. Cecil Acosta PICU Mortality Brain herniation syndrome; (Clinically brain dead) Hydrocephalus secondary to Subdural Hematoma s/p External Ventriculostomy Drain (8/2/16) Multiple fractures secondary to Non-Accidental Trauma Pneumonia, Bilateral r/o Lung Contussion Hemolytic Anema (Microangiopathic) Developmentally High Risk Infant t/c Diabetes Insipidus, r/o Osteogenesis Imperfecta, Vitamin Deficiency and hypophosphatemia (genetics) Right Popliteal Deep Vein Thrombosis, Resolved Oral Thrush, Resolved s/p Subduroperitoneal Shunt Insertion, Left (8/18/16) Dr. Pristine Bernardo* Dr. Neva Batayola, Dr. Dexter Cheng, Dr. Jabson, Dr. Ace Prodgalidad, Dr. Vincent Alba, Dr. Therese Pernia, Dr. Teresita Rabanal, Dr. Marco Abad, Dr. Sumpaico, Dr. Jacqueline Navarro, Dr. Cynthia Aguirre, Dr. Eva Cutiongco-dela Paz