1.

Palma, Liara Faith

28 days/ F
Bacolod City
Informant: Mother
Reliability: 90%
Wt: 3.7kg
Ht: 51.2cm

Cc: Cough

3 days PTA, onset non productive cough with no associated fever. No consult done and no meds taken.
ODA, folks noted that after attempting to make the patient burp after breastfeeding, the patient had
recurrence of non productive cough associated with a cyanotic episode that spontaneously resolved
after a few minutes as claimed by mother. Still no meds taken but due to persistence of cough prompted
consult at ER.

ROS
(-) vomiting
(-) change in sensorium
(-) fever
(-) nasal catarrh
(+)good appetite
(+)good UO and BM

Prenatal Hx
Patient was born term to 22 year old to a G2P2 (2002) at 37 weeks by BS, BW 2.9 kg via NSD at
BCLI. Mother began PNCU at 3 months AOG at a LHC and was regularly done thereafter. No history
of maternal illness during pregnancy Good cry at birth and was immediately discharged well after 24
hours. Newborn screening not yet done, parents plan to do it once patient is 1 month old.

Diet:
Patient was exclusively breastfed until 14th DOL and afterwards mixed diet was started and formula
bona feeding

PMH:
No prev admission
No known FDA

FMHx:
(+)HPN - maternal

Immunization:
Complete as claimed, according to age

Pshx:
Patient lives in a cemented house with their mother, father and older sibling along with extended family
for a total of 7 people in a subdivision.
Mother 22 - unemployed
Father 19 - call center agent
Father 56 – manager
Older brother – 15 3rd year high school
Uncle – 19 senior high
Uncle - 28 unsure of employment
Environmental Hx:
(+) Cough - oldest sibling 15 years old x 1 weeks - self medicated with cetirizine, no consult done
garbage: city
Daily use: BACIWA
Drinking: mineral water

VS:
P 136
R 46
T 36.9C
O2 Sat 95% at RA

Awake, with spontaneous eye opening, not in CP distress

AS, Pink palpebral Conj, (-)alar flaring, moist lips and oral mucosa, (-)NVE/CLAD/ANM, SCE, (+)
occ. rales R LF, (-) wheezing, (-) subcostal retractions, AP, NCRR, (-) murmurs, normoactive bowel
sounds, soft, nondistended abdomen, (-) abdominal tenderness, (+) FPP, CRT <2s, (-) edema

2. Varona, Ayesha
9 mos/ F
Bacolod City
Informant: Grandmother
Reliability: 80%
Wt: 8.5kg
Ht: 65cm

Cc: cough, vomiting

2 months PTA, onset of productive cough with no febrile episodes but sought consult to a private
physician and was noted to have Pneumonia. No imaging done. Prescribed with coamoxiclav but folks
claimed to have no relief despite compliance. No follow up consult done.
Interim, patient tolerated condition and no meds taken nor consult done.
2 weeks PTA, folks claimed presence of an intestinal parasite near the pillow of the patient. Sought
consult following day to the LHC but was advised the deworming was not applicable due to patient’s
age and was referred to Bay Center but was advised to come back once coughing was resolved.
6 days PTA. Patient sought consult at LHC but referred again to Bay Center and was prescribed with
Cefalexin 1ml and Ceterizine 1ml with relief of symptoms.
3 days PTA. Patient had around 5 episodes of nonbilous vomiting 1 tbsp in volume per episode
associated with unrecalled episodes of yellowish and mushy stools with low grade fever. Patient self
medicated with Paracetamol 0.5 ml with relief of fever. No Consult done.

ODA. Persistence of symptoms prompted consult at the ER.

ROS
(+) fever
(+) good appetite
(+) good UO
(+) weight loss

Last meal: 1pm formula (nestogen)

Day 6 of Cefalexin

Prenatal
Patient was born term to a 19 years old, G1P0 (1001) filipino mother via SVD at CLMMRH. Mother
had PNCU at 3 months AOG at a LHC and was regularly done thereafter. No history of maternal illness
or co-morbidities as claimed. Patient was noted to have good cry at birth and was immediately
discharged well. Newborn screening was done with unremarkable results

Diet:
Patient was exclusively breastfed since birth and until 4 months of age. Afterwards, patient was started
with formula feeding (Nestogen).

PMH:
(+) mass, parietal area with CT scan done at 2 months of age as OPD at CLMRRH, unremarkable
results
No prev admission
No known FDA

FMHx:
(+)HPN - maternal

Immunization:
No immunization done due to mass on parietal area. Patient not cleared at LHC

Developmental
Patient was noted to lift head and chest and able to roll over, crawl at around 7 months. First word was
papa as the mother would claim at 9 months. No dental eruptions.

Pshx:
Patient lives in a non concrete bungalow house with 6 adults in a squatter settlements.
Mother 20 – unemployed
Father 17 - unemployed
Grandmother 70 - unemployed
Uncle 40 – carwash worker
Uncle 50 unemployed -stroke productive cough unrecalled onset (cough)
Uncle 31 – carwash worker

Environmental Hx:
(+) Vape exposure: Uncle
(+) exposure to smoke - firewood for cooking
Daily use: deep well water
Drinking: distilled mineral water (refilling station)
Garbage: city collector

VS:
P 175
R 37
T 38.9
O2 Sat 95% at RA

Awake,irritable with spontaneous eye opening, not in CP distress

AS, Pink palpebral Conj, (-)alar flaring, moist lips and oral mucosa, (-)NVE/CLAD/ANM, SCE,
(-)rales (+) occ. wheezing, (-) subcostal retractions, AP, NCRR, (-) murmurs, normoactive bowel
sounds, soft, nondistended abdomen, (-) abdominal tenderness, (+) FPP, CRT <2s, (-) edema

3. Llenos, Pearl Jamar

1 years old/F
Bacolod City
Informant: Grandmother
Reliability: 90%
Wt: 9kg
Ht: 62 cm

Cc: loose stools and vomiting

5 days PTA, folks had patient drank unrecalled herbal medicine due to claimed deworming benefits but
patient had no hx of previous diarrhea or parasite infection.
1 day PTA, post prandial nonbillous vomiing x 3 episodes half a cup in volume per episode with
associated low grade fever. Patient self medicated with pedialyte without relief of symptoms. No
consult done.
ODA. Recurrence of 4 episodes of non bilous vomiting, 1/2 cup/episode and unrecalled no episodes of
greenish, mucoid stools approx 1 tbsp per defecation thus sought consult at the ER.

ROS
(-) abdominal pain
(-)fever
(+)good UO

Prenatal Hx
Mother was 26 years old, G1P0, began PNCU at 4 months AOG at a LHC and was regularly done
thereafter. With history of flu during pregnancy unrecalled AOG. No maternal comorbidities.

Natal Hx
Patient is born full term to 27 year old G1P1 (1001) via NSD with unrecalled BW at BCLI. Good cry at
birth and was immediately discharged well after 24 hours. Newborn screening was done with normal
results
Diet:
Exclusive breastfeeding until 3 months of age and start with mixed feeding afterwards. Nestogen
formula milk. Patient has also tried eating sold foods.

PMH:
No prev surgeries
No prev admissions
No known FDA

FMHx:
(+)asthma - paternal side

Immunization:
Complete immunization as claimed

Pshx:
Patient lives in a house made of mixed cemented and light materials with her mother, father and aunt

Environmental Hx:
Daily use: deep well
Drinking: mineral water

VS
BP 100/60
P 160
R 20
T 36.4 C
O2 Sat 99 % at RA

GCS 15
Asleep, comfortable, not in CP distress
AS, Pink palpebral Conj, (+)sunken eyeballs (-)alar flaring, moist lips and oral mucosa,
(-)NVE/CLAD/ANM, SCE, (+)finevlrales RLF (-) wheezing, AP, NCRR, (-) murmurs, normoactive
bowel sounds, soft, nondistended abdomen, (-) abdominal tenderness, (+) FPP, CRT <2s, (-) edema

4. Dela Cruz, Ydrianna

2/F
Address: Talisay City
Informant: Mother

Wt: 16.5 kg
Ht: 93 cm

CC: Cough

HPI:
45 days PTC, mother noted onset of nonproductive cough. Sought consult with private physician who
prescribed Co-amoxiclav 4ml BID x 7 days, which mother gave to patient with good compliance,
however noted that patient would often spit out the medication.
Interim, noted persistence of cough, usally with onset late at night or early in the morning, and no
cough noted in the middle of the day. Patient tolerated symptoms thus no further management done.

1 week PTC, due to persistence of symptoms, again sought consult and was prescribed Montelukast
chewable tablets x 3 months, Seretide (salmeterol + fluticasone) puff as needed, and Duavent
(ipratropium + salbutamol) x 5 days. Mother noted expectoration of whitish sputum after each use of
Duavent.

Interim, still with persistence of cough. No other noted pertinent symptoms.

5 days PTC, due to persistence of productive cough, sought consult with PP and CXR was requested
revealing Pneumonia in both lower lungs.

1 day PTC, noted onset of fever (Tmax 38.2), relieved by Paracetamol.

ODC, with vomiting of whitish to yellowish phlegm, thus prompting consult at this institution for
private admission. Patient is currently on Clarithromycin 125mg 5ml BID day 2.

(+) nausea
(+) vomiting of phlegm

(-) dyspepsia
(-) orthopnea

PMHx:
Patient was born to a G1P1 (1001) mother via NSVD. Complete prenatal checkups, no birth
complications, no maternal illnesses. Normal newborn screening and complete vaccinations.

No known comorbids
No previous admissions/surgeries
No known food and drug allergies

FMHx:
Maternal - DM
Paternal - BA

PSHx:
Lives in cement home with both parents and maternal grandparents. Currently no family members with
similar symptoms.

(+) exposure to cigarrete smoke outside the household

(-) family members with fever, cough, or colds
(-) family members with TB

PE:
Patient received awake, ambulatory, not in apparent CPD

T: 36.9
HR: 131
RR: 28
O2: 97% at RA

Skin: Warm to touch, good skin turgor

HEENT: AS, PC, nonsunken eyeballs, (-) alar flaring, moist lips and oral mucosa, NCLADs, NNVE
C/L: SCE, (+) fine crackles left lung base, (-) wheezing, (-) retractions
CVS: AP, NCRRR, (-) murmurs
Abd: Soft, nontender
Ext: Full pulses, CRT <2

5. Agaton, Christian Lance

Agaton, Christian Lance
12/M
Address: Sum-ag
Informant: Mother

CC: Seizure

HPI:
17 hours PTC (8am), patient was apparently well until he suddenly fell to the ground and his mother
noted stiffening of extremities lasting around 30 seconds with confusion immediately after the episode.
Patient was able to recover and ambulate afterwards.

At 10am, 12pm, and 2pm, patient had recurrence of stiffening of extremities, each episode lasting less
than 1 minute, with confusion immediately after each episode, but with patient able to return to
baseline level of functioning afterwards, thus no immediate consult sought.

At 5pm, mother noted 2 hours stiffening of extremities and upward rolling of eyeballs. Folks called an
ambulance and patient was brought to LHC, where they were advised admission.

(-) vomiting
(-) fever
(-) cough
(-) history of recent illness
(-) history of fall or trauma to the head

PMHx:
No known comorbids
No previous surgeries
No known food and drug allergies

FMHx:
PTB maternal
Maternal - HPN

PSHx:
Lives in a wooden house with both parents and 8 siblings. Currently no family members with similar
symptoms.
Father - farmer, construction work
Mother - farmer
3rd child-worker (only one employed among siblings)

(+) exposure to cigarrete smoke from father

(-) family members with fever, cough, or colds
(-) family members with TB

H: good relationship with other siblings and parents

E: No history of education but has made friends near their area, however parents claimed that the
patient has the tendency to be violent towards peers.
A: Enjoys any type of physical activity, mostly games that require his body to move. No gadget
exposure.
D: No history of alcohol or illicit drug use
S: No dating history or crushes.
S: No history of self harm
S: No previous experience of abuse.

Birth and maternal HX

Patient was born to a then G9P9 (9108) mother via NSVD. Patient was born preterm, 2.1 kg, patient
was intubated and stayed at NICU at our institution for 2 months at CLMMRH. Complete prenatal
checkups starting 3 months AOG at their LHC, no maternal illnesses. Normal newborn screening and
complete vaccinations.

G1 1998 M Term NSVD non institutional

G2 2000 F Term NSVD non institutional
G3 2003 F Term NSVD non institutional
G4 2004 F Term nsvd non institutional
G5 2007 F Term nsvd non institutional
G6 2008 7 months breech-CPD
G6 2009 M Term Non institutional
G7 2010 L Term Non institutional
G8 2012 Preterm fraternal twins F/M CLMMRH
-2013 female fraternal twin died, folks claimed that patient had fluid in lungs, edematous extremites.

Developmental Hx
Patient’s mother noted to have learned to walk, spoke mama/papa, and had first dental eruption more
than 1 year of age. Patient learned to speak in sentences at 6 years old but with incomprehensible
phrases. Follows simple house chores but can never complete a task. Patient noted to be easily
distracted. Toilet training started at 4 years old but was able to have control at 6 years of age.

Nutritional Hx:
Patient was exclusively breastfed until 3 years of age. And Started to have eaten solid foods afterwards.
PE:
Patient received awake, conversant, not in apparent CPD

BP: 100/60
T: 36.9
HR: 118
RR: 26
O2: 97% at RA

Skin: Warm to touch, good skin turgor

HEENT: AS, PC, nonsunken eyeballs, (-) alar flaring, moist lips and oral mucosa, NCLADs, NNVE
C/L: SCE, CBS, (-) wheezing, (-) retractions
CVS: AP, NCRRR, (-) murmurs
Abd: Soft, nontender
Ext: Full pulses, CRT <2

NEURO PE:
GCS14 (E4V4M6)

Cranial Nerves:
CN I - not tested
CN II - 3-2 mm PERRLA
CN III, IV, VI - full EOMs, (-) preferential gaze
CN V - (+) corneal reflex
CN VII - (-) facial asymmetry
CN VIII - able to hear from both ears
CN IX , X- (+) gag reflex
CN XI - shoulder shrug and head turn against resistance
CN XII - no tongue deviation

Sensation:
100% all extremities

Motor:
5/5 all extremities

DTR:
2+ all extremities

(+) Horizontal nystagmus

(+) dysmetria

(-) Babinski reflex

(-) Nuchal Rigidity
6. INVENTOR
Pediatric community-acquired pneumonia (PCAP) is considered in a patient who presents with cough
or fever, PLUS any of the following positive predictors of radiographically-confirmed pneumonia1:
(Conditional recommendation, very low-grade evidence) 1. Tachypnea2 1.1 3 months to 12 months old:
≥50 breaths per minute 1.2 >1 year old to 5 years old: ≥40 breaths per minute 1.3 >5 years to 12 years
old: ≥30 breaths per minute 1.4 >12 years old: ≥20 breaths per minute 2. Retractions or chest
indrawing3 3. Nasal flaring 4. O2 saturation <95% at room air4 5. Grunting
CXR – recommended initially
sputum GSCS not routinely done for sever PCAP
Empiric antibiotic therapy – started with clinical signs and symptoms of PCAP with any of the ff ANY
of the ff:
elavated WBC, CRP, PCT, Imaging findings of Alveolar infiltrates in CXR; Unilateral, solitary lung
consolidation or pleural effusion in lung utz
Respiratory Syncytial Virus (RSV), are the most common cause of pneumonia in children younger than
5 years.
Streptococcus pneumoniae is the most common bacteria across all age groups.
Other important bacterial causes in children younger than 5 years include Hemophilus influenzae,
Streptococcus pyogenes and Moraxella catarrhalis. In children 5 years and older, other important
causes include Mycoplasma and Chlamydophila.

Amoxicillin is still the treatment of choice because it is effective against the majority of pathogens
causing CAP in this age group. High-dose amoxicillin is recommended for treatment of suspected or
confirmed penicillin-resistant S. pneumoniae; the resistance of which can be overcome at higher drug
concentrations. Practitioners commonly presume that oral cephalosporins are superior to amoxicillin
for S. pneumoniae; this likely stems from the knowledge that some penicillin-resistant pneumococci
isolates are susceptible to ceftriaxone hence, oral cephalosporins are assumed superior to amoxicillin.

However, oral cephalosporins have short half-lives, highly protein bound and often have long dosing
intervals. This results in serum concentrations that do not provide enough bactericidal time. Because
the pharmacokinetics of the oral cephalosporins are far inferior to amoxicillin, their use in CAP should
be reserved for patients who are allergic to penicillin or patients with isolates known to be resistant to
amoxicillin but susceptible to cephalosporins such as M. catarrhalis or beta lactamase–positive H.
influenzae. When atypical pathogens are highly suspected especially in a child who is not ill-looking
despite having clinical pneumonia (“walking pneumonia”), although clinical presentation may be
indistinguishable with viral pneumonia, starting a macrolide may be considered.

Cephalexin is a beta-lactam antibiotic that belongs to the first-generation cephalosporin class and is
characterized by a beta-lactam ring in its structure. Within a bacterial cell, peptidoglycan provides
mechanical stability to the cell wall. Cephalexin, along with other beta-lactam antibiotics, utilizes its
beta-lactam ring to inhibit the synthesis of peptidoglycan, a crucial process in forming the bacterial cell
wall.
More specifically, the beta-lactam ring of cephalexin binds to penicillin-binding proteins (PBPs), which
effectively hinders the final stage of peptidoglycan synthesis, known as the transpeptidation reaction.
This reaction is crucial for the cross-linking of bacterial peptidoglycan. By inhibiting this process,
cephalexin disrupts cell viability, ultimately resulting in bacterial cell autolysis.days PTC, patient
experienced productive cough. Patient was given Cetirizine 5mL OD and was brought for "hilot". No
relief was noted. 1 days PTC, patient had persistence of symptoms associated with fever and vomiting
with whitish phlegm amounting of 1 cup. Sought consult from a private physician and was given ff
medications: Salbutamol neb, 1 neb q6, Budesonide 250mcg, 1neb BID ,Azithromycin susp
200mg/5ml, 3.2ml OD, Phenylpropanolamine drops, 1ml TID, Acetylcisteine 100mg/sachet, 1sachet
mix w/ 1/2 glass water ODAlready started with the nebulization meds with temporary relief and
antibiotic started yesterday but eventually vomit. ODC, persistence of symptoms with episode of 8x
vomiting prompted consult in our institution
1 day PTA, mother claimed that her aunt noted that the patient was becoming yellowish and suddent
onset of non productive cough with no other signs and symptoms. Patient was brought to LHC and was
managed as a case of sepsis and given ampicillin, gentamicin and paracetamol with unrecalled dosage.
Patient was then referred to our institution for further evaluation.
Patient was born male term 37 weeks to a G1P1 (1001) filipino mother via SVD Bw 2.0 kg at LHC.
Patient as claimed by mother that at birth had good cry and good suck. Noted to have cleft lip and
palate and mother was advised to have breastfeeding precaution. Mother started PNCU at 6 weeks
AOG but lost to follow up during 3rd trimester. Mother noted to have productive cough for 7 days but
no meds taken and resolved spontaneously as claimed. Additionally, mother had UTI during 2nd
trimester but no consultation or meds taken. Only during 26 weeks AOG sought consult and was
prescribed with Cefuroxime BID x 7 days. Mother also noted exposure to cigarette exposure from
cousins starting at 6 months of gestation