Letters to the Editor
References
1 Jarrett OM, Gim D, Puusepp-Benazzouz H, Liu A, Bhurawala H. Factors con-
tributing to neonatal readmissions within 28 days after birth to a level 4 hos-
pital. J. Paediatr. Child Health 2022; 58: 1251–5.
2 Gribble J. Factors contributing to neonatal readmissions to a level
4 hospital within 28 days after birth: The effect of neonatal fluid load-
ing. J. Paediatr. Child Health 2022; 58: 1492.
3 Noel-Weiss J, Woodend AK, Peterson WE, Gibb W, Groll DL. An obser-
vational study of associations among maternal fluids during parturi-
tion, neonatal output and breastfed newborn weight loss. Int.
Breastfeed. J. 2011; 6: 9.
4 Lamp JM, Macke JK. Relationships among intrapartum maternal fluid intake,
birth type, neonatal output, and neonatal weight loss during the first
48 hours after birth. J. Obstet. Gynecol. Neonatal. Nurs. 2010; 39: 169–77.
5 Watson J, Hodnett E, Armson BA, Davies B, Watt-Watson J. A random-
ised controlled trial of the effect of intrapartum intravenous fluid man-
agement on breastfed newborn weight loss. J. Obstet. Gynecol.
Neonatal. Nurs. 2012; 41: 24–32.
6 Dahlenburg GW, Burnell RH, Braybrook R. The relation between
cord serum sodium levels in newborn infants and maternal intra-
venous therapy during labour. Br. J. Obstet. Gynaecol. 1980; 87:
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doi:10.1111/jpc.16055
Dear Editor,
CHALLENGES IN PHILIPPINE DEVELOPMENTAL
PAEDIATRIC CARE
A multidisciplinary approach is critical in developmental pae-
diatric care. Unfortunately, economic instability, financial
incapacity and fragmentation of health services hinder achiev-
ing holistic care. In a high-income region like Queensland,
Australia, paediatric cases in rural clinics are dominated by
developmental conditions (59.2%), much higher than the
national average (33.8%). Counterintuitively, these patients
are less likely to be referred to allied health services for co-
management (rural 24.9% vs national 35.9%) due to chal-
lenges accessing these services.1
Thus, in a low-middle income country like the Philippines, where
developmental disabilities are often neglected, incidence and referral
rates are expected to be worse. Data on incidence and referrals are
lacking due to research scarcity and absence of a centralised data
network. Currently, most data are sourced from tertiary hospitals
with subspecialists in developmental and behavioural paediatrics.
Hence the community caseload of developmental disabilities in the
Philippines remains largely undetermined.2 A 5-year review of
referrals in a Philippine major tertiary hospital revealed that 1300
children are seen annually for developmental concerns.2 Addition-
ally, a patient would need to wait at least 6–8 months before being
evaluated by a developmental paediatrician, posing a significant
concern for these conditions where early intervention is vital to
1490
© 2022 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
optimising outcomes.2 Currently, the Philippines only has 99 devel-
opmental paediatricians, with a majority (52%) practising in the
National Capital Region. The scarcity and inequitable distribution of
trained paediatric practitioners nationwide result in underreporting
of cases, poor early detection and missed multidisciplinary referrals.
On top of this, financial and logistical challenges hinder prompt
access to a multidisciplinary team for long-term holistic manage-
ment.3 Even if the Philippines is rich in competent health practi-
tioners, the lack of a centralised system for recruitment, training,
retention and placement of health workers leads to inequitable
deployment, hence poor patient utilisation.4
To ameliorate these, policies and programmes are
institutionalised to support patients with disabilities in the
Philippines. Frameworks for implementing health programmes
for children and laws conferring benefits for persons with disabil-
ities exist. However, challenges in implementation, and skewed
distribution of health resources still hinder equitable access to
these services and benefits.
Therefore, it is clear that gaps exist in case reporting and ser-
vice delivery for Philippine paediatric patients with developmen-
tal conditions. Family and community engagement must be
strengthened by effectively implementing enabling policies that
will improve these patients’ access to competent health profes-
sionals for timely holistic interventions.
Rafael L G Valenzuela
Julian E D Mendoza
Ourlad Alzeus G Tantengco
Eric D B Ornos
College of Medicine, University of the Philippines Manila, Manila,
Philippines
Accepted for publication 31 May 2022.
Conflict of interest: The authors declare no conflicts of interest
with regard to the present work.
References
1 Kardell LD, Lee J, Pinidiyapathirage J, Brumpton K. Managing behav-
ioural and developmental paediatric conditions in rural outpatient
clinics: An insight to the challenge ahead. J. Paediatr. Child Health
2022; 58: 1145–50.
2 Reyes AL, Herrin JA. A five-year review of referrals to the developmen-
tal pediatrics section of a major tertiary hospital. Acta Med. Philipp.
2009 43: 12-7.
3 Reyes CM, Reyes CC, Arboneda AA. Health practices of children and
women with disabilities. PIDS Discussion Paper Series; 2017.
4 World Health Organization. Human resources for health country pro-
files: Philippines. WHO, WHO Regional Office for the Western Pacific;
2013.
Journal of Paediatrics and Child Health 58 (2022) 1489–1495