UERM MEMORIAL HOSPITAL Healing in Action Message from the Hopital Administrator Romeo A. Divinagracia, MD, MHSA 4 a> Adapting To Changing Child Care In Changing Times Continuous and unprecedented developments and transformations in the organization of child health care are driving changes in the practice of pediatrics. Just like in other specialties and disciplines such as cardiology, infectious diseases, developmental aberrations, psychology and others, pediatric care has advanced at 2 remarkably fast pace sometimes out-pacing the ability of health providers and facilities to cope with. The health care needs of children also are evolving, reflecting changing disease patterns, new technologies, and shifting socioeconomic and demographic characteristics of children and families. ‘These changes need to be responded to proactively by the pediatric community and the facility developers such as hospitals. Yet, the anticipated health care needs of children also must be addressed as models for both pediatrictraining and practice in the future. Our hospital, for the first time in its history, has dedicated a whole wing for Pediatric patients which we hope shall be the nucleus for further developments in the practice of Pediatrics. The current issue of our newsletter features the Department of Pediatrics, its faculty and consultant roster and some of the significant developments in its academic and patient care activities. It summarizes briefly these changes in health care services and in child health needs, addresses training implications, and discusses several initiatives the pediatric department is undertaking to develop programs and guidelines for training pediatricians for the 21st century. hope that the dedication of a wing of the hospital to Pediatrics will serve as an incentive to the pediatricians to develop more efficient and effective care for the benefit of our pediatric patients and our training staff, both nurses and doctors. Pediatric Unit Entrance Vota 7 Tesue 2 MarchApa 2077ce a UERM MEMORIAL HOSPITAL Healing in Action The Department of Pediatrics History of Department of Pediatrics In 1958, the Department of Pediatrics became independent from the Department of Internal Medicine, and was headed by Dr. Florencio N. Quintos. In 1960, a 10-bed capacity Pediatric ward was opened along the corridors of the ‘st floor of the hospital building that now leads to the ER. The nursery was situated on the 2nd floor and the OPD in the Neuro- Psychiatry Ward. In 1986, the Neonatal Intensive Care Unit headed by Dr. Josefina Cabigas-Resurreccion, was established in the Nursery Pay atthe 2nd Floor of the hospital. In 1996, the Department of Pediatrics and the Medical Pediatrics Ward which has a 23-bed capacity serving the financially challenged patients was transferred to the 4th floor of the service hospital, where it is presently located. In 1998, the Neonatal Intensive Care Unit Pay was transferred to the 3rd Floor of the hospital Dr. Milagros S. Bautista_| which can accommodate 3 NICU (Neonatal Intensive Care) patients, 8 Head of the Department of | |MCU (Intermediate Care) patients and 1 for isolation. And in January peaistics| 2011, the 21 bed capacity Pediatrics Pay Unit located in the 4 North wing of the pay hospital was inaugurated. This was through the initiative of Milagros S. Bautista, current head of the Department. Pay eee Pediatric Unit Pay Ward Neonatal Intensive Care Unit Charity ‘Neonatal Intensive Care Unit Pay ‘olume? tesue2 WareUERM MEMORIAL HOSPITAL Healing in Action Commitment of the Department of Pediatrics The UERMMMCI Department of Pediatrics is a group of competent general pediatricians with specialized subspecialty training sharing the same life focus vision and mission dedicated to educating future pediatricians of the country. Life Focus: To provide health service and education to all. Vision: The UERMMMCI Department of Pediatrics envisions itself becoming the premier Department of the Center, the country and Asia-Pacific region, providing the highest quality pediatric education and service and responding to advances in medical service and to the changing needs of the community. Mission: The UERiIMMMCI Department of Pediatrics shall be an internationally recognized center of excellence in Pediatrics, It shall commit itself to: 1. Provide total quality service through a holistic approach to patient care. 2. Develop globally competent, compassionate, ethical and socially responsible pediatricians through a dynamic residency training program 3, Pursue relevant medical research in pediatrics of international standards 4, Provide an environment conducive to the intellectual and emotional growth of its faculty, residents, students and support staff. The UERMMMCI Department of Pediatrics commits itself to utilize its resources effectively, efficiently and equitably. PEDIA CARDIOLOGY SECTION Juliet J. Balderas, MD Pediatric Cardiologist The Department of Pediatrics —-Section of Cardiology, ever since, has shared the vision in "Prevention of Heart Disease among Filipino Children", The Department of Health 2010 data shows that Coronary artery disease ranks 2nd among the Top 10 causes of mortality. It is believed that coronary artery disease develops in 20 years or two decades, so prevention in the young should therefore be emphasized As part of increasing awareness, there is strong research support from the College of Medicine among our faculty and students. In 2004, 2nd year students completed a research entitled “A Cross-Sectional Study on Hypertension in Children Ages 6-14 years in Roosevelt Memorial School Quezon City, and its Association with Obesity” (Pias, Pineda, Plasabas, Porquez, Pua, Quilala, and Rabena C. Adviser Juliet J. Balderas, MD | : Balderas JJ, Molina MD). This was followed in 2005 by another study Pediatric Cardiologist _] “The Correlation Between BMI and Lipid Profile Components Among Filipino Children Ages 7-12 years old in Selected Public Elementary Schools District 1V*. (Salin, Salvacion, Salvana, Samonte MV, Santos JP, Sarao KB, Sason GP. Sasondocillo MM, Tanteo MCJ, Tapangco MP. Thiam JR. Adviser Balderas JJ). Both were presented at the Philippine Heart Association Convention in 2007 which initiated several researches in children. The Department now has an ongoing research on the "Clinical Risk Factor assessment in Children ages 6-19 years", estimating their risk for heart disease in adulthood, with correlation to the LV posterior wall thickness on echocardiography. (please tum to page 4) oiume Issue 2 MarchvApil 2071aw =a UERM MEMORIAL HOSPITAL Healing in Action (from page 3)The other directions in the section are strengthening maternal and prenatal care through Fetal echocardiography. This is importantas future directions towards prevention of heart disease starts in childhood, and become the basis for future health recommendations in children. Dra. Balderas while performing a 2-D echo in a neonate (Left photo) and adolescent patient (Right photo) THURSDAY MORNINGS at UERMMMCI OPD Joselyn C. Alonzo Euseblo, MD i lini President, Philippine Society for Pee enter Developmental and Behavioral Pediatrics Developmental-behavioral disorders presently constitute the "new morbidities" in children. The World health Organization estimates that about 15-20% of children worldwide are handicapped. Improvements and advancements in medical technology and care have greatly increased the survival of infants who are at risk for developmental-behavioral disorders. The role of early recognition and intervention cannot be overemphasized. It is for this that a Child Development Unit was envisioned and put up in the early 1990's through the support of former Dean Joven Cuanang and Pediatrics’ Department > Chair, Dr. Felicisima Paz. The aim of the clinic was to provide a 7 multidisciplinary assessment of children with special needs to enable \Joselyn C. Alonzo-Eusebio, MD| them toreach their optimal developmental potentials. President, PSDBP The Child Development Clinic Section of the Department of Pediatrics located at the Out Patient Departmentis held every Thursday morning from 9 to 12am, Patients suspected and/or identified as having a developmental and/or behavioral problem, either seen atthe OPD or referred from schools, and from other professionals undergo developmental assessment. Depending upon the most likely condition of the patient, referral to other disciplines for further evaluation and/or intervention is done. For example, a patient with motor delay due to cerebral palsy, would be in need of physical therapy, hence, he is referred to the Rehabilitation Department; (please turn to page 5) ‘Warne Besue 2 MSR ADA DDIUERM MEMORIAL HOSPITAL. Healing in Action (from page 4)those with socio-emotional and behavioral disorders are directed to the Psychiatric Department, and/or to Occupational Therapy Centers; those with hearing-related problems , to the ENT Department; those with eye-related concerns, to the Ophthalmology Department; those with speech- related disorders, to Speech Therapy Centers, and those with cognitive impairments, to Special Schools The Child Development Clinic helps in the training of students, interns, residents, and fellows, particularly in applying their core knowledge of growth and development. feel that every minute of my time spent doing these training-related activities for future physicians and pediatricians and serving less-privileged patients with developmental and behavioral problems, is all worth it, as this is one way | get to share my own wealth of experience in this specialty and a way of helping the less-fortunate ones in our society. Dra. Eusebio while interviewing a Neurodev patient ALLERGOLOGY SECTION Ruby N. Foronda, MD President, Philippine Society of Allergy, Asthma & Immunology Allergy is an exaggerated response of an individual to normally harmless substances in the environment, manifesting as disorders such as allergic | asthma, allergic rhinitis, atopic dermatitis, some types of urticaria, food allergy and drug allergy. These diseases usually run in families. Diagnosis requires a good personal, family and environmental history. An allergy skin prick test can give the allergy sufferer an idea of the allergen(s) he or she is possibly sensitive to. This test involves slight uplifting of the uppermost layer of the skin with a lancet through a drop of Ruby N. Foronda, MD—_| allergen then waiting 15-20 minutes for a wheal -and-flare response. President, PSAAI Vouume 2 esue 2 March Api 2077. UERM MEMORIAL HOSPITAL Healing in Action Allergy skin prick test Result of the allergy skin prick test UERMMIMCI PEDIATRIC UI SCOPE OF CARE & PROPOSED ADMITTING POLICY DESCRIPTION: The Pediatric Pay In-patient unit specializes in the care of sick children from birth (neonates) to 18 years and 364 days (adolescence.) The unit delivers comprehensive medical and surgical care. NO ADULT PATIENT WILL BE ADMITTED TO THE UNIT. LOCATION: The pay pediatric unit is located in the north wing of the fourth (4th) floor of the pay hospital building, BED CAPACITY: There are 21 beds with the following distribution; four (4) wards with three (8) beds per ward, four (4) junior single rooms and five (5) junior de luxe rooms. SERVICES: General Pediatrics Subspecialty Services: Allergology/Immunology Intensive Care Cardiology Neonatology Developmental Pediatrics Nephrology Gastroenterology Neurology Hematology Pulmonology Infectious DiseasesUERM MEMORIAL HOSPITAL Healing in Action Pediatric Unit - Pay Hospital Nurse Station Play Room Semi-Private Room V. ADMISSION CRITERIA: All Pediatric Patients with the following diseases but not limited to may be admitted t UERMMMCI PEDIATRIC UNIT: 1. Allergic Disease a. Patients with allergic reactions toa known or unknown allergen, anaphylactic reactions. b. Patients who require maintenance of intravenous steroids orintravenous antihistamines. 2. Cardiovascular Disease a, Patients with known congenital heart disease who have had surgical correction admitted for a non-life-threatening, non-cardiac intervention. b. Patients with acute or known cardiac disease who may progress to moderate to severe cardiovascular compromise will be referred to a facility that provides intermediate and intensive pediatric care. 3. Endocrine a. Patients with known or new-onset diabetes. b, Diabetic patients with ketoacidosis requiring intermittent subcutaneous insulin. However, patients who are not in the state of ketoacidosis but require continuous insulin infusion must be evaluated by the pediatric endocrinologist, before admission to the inpatient pediatric unit. (please turn to page 8) Saune ese 2uachapizanel UERM MEMORIAL HOSPITAL Healing in Action (from page 7) 4. Gastrointestinal Disease a. Patients with stable gastrointestinal disease that requires intravenous rehydration. b. Patients with a gastrointestinal problem requiring urgent endoscopy or surgery, but who do not have cardio-respiratory compromise or acute Gl bleeding . Patients with a stable, chronic gastrointestinal diagnosis who require inpatient care for another non-life-threatening condition 5. Hematologic/Oncologic, Renal, and Metabolic Disease a. Patients with known, chronic disease admitted for intermittent therapeutic intervention b. Patients with known, chronic disease who are potentially unstable or have severe hematologic or metabolic derangements will be referred to a facility that provides intermediate and intensive pediatric care. 6. Neurologic Disease a. Postoperative neurosurgical patients who have had nonlife-threatening neurosurgical procedures and do not require cardio-respiratory monitoring. b. Patients with non-life-threatening neurologic disease who require admission for non-life- threatening interventions. c. Patients with acute inflammation of the central nervous system with low risk for neurologic deficiency or other complications. d. Patients with acute or known neurologic disease who may progress to moderate to severe neurological compromise will be referred to a facility that provides intermediate and intensive pediatric care 7. Respiratory Disease a. Patients with mild or moderate pulmonary (lower or upper airway) disease with stable oxygen requirements and minimal risk of progression to respiratory failure or airway obstruction. b. Patients who require intermittent (every one or more hours) nebulized medications while onthe pediatric ward. Children will be evaluated for transfer to a facility that provides intensive pediatric care if their condition does notimprove after receiving two initial hourly nebs, orif they require increased frequency of nebulized therapy or continuous nebulized therapy during their hospitalization. c. Patients with chronic respiratory disease and/orwhohave artificial airways and may require respiratory support will be referred to a facility that provides intermediate and intensive pediatric care. Pediatric Unit - Charity Hospital ro * eaceingg Medical Pedia Ward Entrance edia ICU and High Risk Neonate — ae Inside the Pedia Ward a 08 ER pSUERM MEMORIAL HOSPITAL Healing in Action Inauguration of the Pediatric Unit at 4-North of the Pay Hospital January 10, 2011 a L to R: Pres. Romeo Divinagracia, Board of “L to R: Officiating Chaplain Fr John Jacob, Trustees Member Corazon de la Paz and Dr. Pres. Romeo Divinagracia, Trustee Corazon Milagros Bautista, Head of Pediatrics Dept. de la Paz and Dr. Milagros Bautista fi L to R: Dr. Maribel Co-Hidalgo, Trustee ntrance to the Pediatric Unit at 4-North with Corazon de la Paz, Dr. Milagros Bautista. In the flower arrangement for the inauguration the background: Chief Nurse Aida Agbayani Pa] =e and Medical Director Andres Borromeo PO PEDIATRICS UNIT -~ Let J Pres. Romeo Divinagracia and Dr. Milagros Pres. Romeo Divinagracia and Dr. Milagros Bautista, Head of Pediatrics Department Bautista with the Hospital Nurses and guests ‘oie TTes0e 2 March pO0 UERM MEMORIAL HOSPITAL Healing in Action Consultant staff of the Department of Pediatrics: General Pediatrics: Neonatology: Pediatric Neurology : Pediatric Cardiology: Pediatric Pulmonary Medicine: Pediatric Critical Care Medicine Pediatric Allergology & Immunology: Pediatric Gastroenterology: Pediatric Nephrology: Pediatric Infectious Disease: Pediatric Hematology and Oncology: Pediatric Developmental Medicine: Edward M. Santos, MD Josefina Cabigas-Resurreccion, MD Jose B. Salazar, MD Josefa Rustia-Paniilio, MD Ignacio V. Rivera, MD Juliet J. Balderas, MD Milagros Salvani-Bautista, MD Gladys Llarena-Gillera, MD Alvin C. Florentino, MD Ruby Nagtalon-Foronda, MD Grace R. Battad, MD Myrna B. Rosel, MD Victor S. Doctor, MD Josefina Cadorna- Carlos, MD Gyneth Lourdes Guevara-Bibera, MD Rosalina Patricio-Anastacio, MD Cynthia Cantos-Castro, MD Joselyn Alonzo-Eusebio, MD ‘Department of Pediatrics Staff with Guests during the 21st Dr. Florencio N. Quintos Memorial Lecture (January 26, 2011 at Nursing Amphitheater B) ‘Votume Desue 2 MarchApl 201 10