Search

Objectives The use of technology has rapidly increased in the past century. Artificial intelligence (AI) and information technology (IT) are now applied in healthcare and medical education. The purpose of this study was to assess the readiness of Indonesian teaching staff and pediatric residents for AI integration into the curriculum. Methods An anonymous online survey was distributed among teaching staff and pediatric residents from 15 national universities. The questionnaire consisted of two sections: demographic information and questions regarding the use of IT and AI in child health education. Responses were collected using a 5-point Likert scale: strongly disagree, disagree, neutral, agree, and highly agree. Results A total of 728 pediatric residents and 196 teaching staff from 15 national universities participated in the survey. Over half of the respondents were familiar with the terms IT and AI. The majority agreed that IT and AI have simplified the process of learning theories and skills. All participants were in favor of sharing data to facilitate the development of AI and expressed readiness to incorporate IT and AI into their teaching tools. Conclusions The findings of our study indicate that pediatric residents and teaching staff are ready to implement AI in medical education.

Abstract Background High-flow nasal cannula (HFNC) is often used in pediatric populations with respiratory distress. In adults, the respiratory-rate oxygenation (ROX) index is used as a predictor of HFNC therapy; however, children have age-associated differences in respiratory rate, thus may not be applicable to children. This study aims to find the reliability of ROX index and modified P-ROX index as predictors of HFNC therapy failure in pediatric patients. Methods Subjects in this analytical cross-sectional study were taken from January 2023 until November 2023 in Cipto Mangunkusumo Hospital. Inclusion criteria are children aged 1 month to 18 years with respiratory distress and got HFNC therapy. Receiver operating characteristics (ROC) analysis was used to find mP-ROX index cutoff value as a predictor of HFNC failure. The area under curve (AUC) score of mP-ROX index was assessed at different time point. Results A total of 102 patients, with 70% of the population with pneumonia, were included in this study. There are significant differences in the ROX index between the successful and failed HFNC group therapy (p

Introduction: Adequate sedation and analgesia are two crucial factors affecting recovery of intensive care patients. Improper use of sedation and analgesia in intensive care patients may adversely lead to brain oxygen desaturation. This study aims to determine cerebral oxygenation as measured by near-infrared spectroscopy (NIRS) and inotropic interventions received among mechanically ventilated children in the pediatric intensive care unit (PICU). Methods: This study is a nested case − control study in the PICU of Indonesian tertiary hospital. Children aged 1 month to 17 years on mechanical ventilation and were given sedation and analgesia were included in the study. Subjects were divided into two groups according to the protocol of the main study (Clinical Trial ID NCT04788589). Cerebral oxygenation was measured by NIRS at five time points (before sedation, 5-min, 1, 6, and 12 h after sedation). Results: Thirty-nine of the 69 subjects were categorized into the protocol group and the rest were in the control group. A decrease of >20% NIRS values was found among subjects in the protocol group at 5-min (6.7%), 1-h (11.1%), 6-h (26.3%), and 12-h (23.8%) time-point. The mean NIRS value was lower and the inotropic intervention was more common in the control group (without protocol), although not statistically significant. Conclusion: This study found that mechanically ventilated children who received sedation and analgesia based on the protocol had a greater decrease of >20% NIRS values compared to the other group. The use of sedation and analgesia protocols must be applied in selected patients after careful consideration.

Background Children are susceptible to SARS-CoV-2 infection and often present mild manifestations. However, severe and critical cases have also been reported. The inflammation and coagulation marker profile pattern in these patients along with the white blood cell differential count in critical PICU cases with non-COVID-19 etiology is not entirely clear. Objective To evaluate the inflammation and coagulation profiles in children presenting with severe/critical SARS-CoV-2 infection. Methods A systematic search and review of scientific literature was conducted following the PRISMA guidelines using ProQuest, SCOPUS, EBSCOHost, ScienceDirect, Cochrane, EMBASE, and Pubmed databases. All relevant original studies until March 11, 2021, were included. The risk of bias was appraised using the Modified Newcastle Ottawa Scale and JBI Critical Appraisal Checklist tools. Results We identified 14 studies across 6 countries, including a total sample of 159 severe and critically ill pediatric COVID-19 patients. Most of the subjects showed normal leukocytes, but increased CRP, procalcitonin, ferritin, and IL-6. Studies on coagulation profiles showed normal thrombocytes, PT, aPTT, and inconsistent D-dimer results. Conclusion Inflammation and coagulation parameters in severe/critically ill children with COVID-19 are atypical. Several inflammatory markers were elevated, including CRP, ferritin, procalcitonin, and IL-6. However, the elevated marker values are still lower compared to non-COVID infection patients. Further investigation of the parameters need to be done in serial examination multicenter studies, which include control subjects.

Background. Liver transplantation is the definitive treatment for pediatric end-stage liver disease. Infections posttransplantation might significantly affect the outcome of the surgery. This study aimed to identify the role of pretransplant infection among children who underwent living donor liver transplantation (LDLT) in Indonesia. Methods. This is an observational, retrospective cohort study. A total of 56 children were recruited between April 2015 and May 2022. Patients were categorized into 2 according to the presence of pretransplantation infections requiring hospitalization before the surgery. Diagnosis of posttransplantation infection was observed for up to 1 y based on the clinical features and laboratory parameters. Results. The most common indication for LDLT was biliary atresia (82.1%). Fifteen of 56 patients (26.7%) had a pretransplant infection, whereas 73.2% of patients were diagnosed with a posttransplant infection. There was no significant association between pretransplant and posttransplant infection in all 3-time points (≤1 mo, 2–6 mo, and 6–12 mo). The most common organ involvement posttransplantation was respiratory infections (50%). The pretransplant infection did not significantly affect posttransplant bacteremia, length of stay, duration of mechanical ventilation, initiation of enteral feeding, hospitalization cost, and graft rejection. Conclusions. Our data showed that pretransplant infections did not significantly affect clinical outcomes in post-LDLT procedures. A prompt and sufficient diagnosis and treatment before and after the LDLT procedure is the best way to obtain an optimal outcome.

RESUMO Objetivo: Analisar a correlação entre a lesão do glicocálix medida pelo nível sérico de sindecano 1 e as disfunções de órgãos avaliadas com o escore PELOD-2, assim como avaliar sua associação com a mortalidade em sepse pediátrica. Métodos: Realizou-se um estudo prospectivo observacional em um hospital terciário público. Sessenta e oito pacientes pediátricos, com diagnóstico de sepse segundo os critérios da International Pediatric Sepsis Consensus Conference, foram consecutivamente recrutados. Nos dias 1 e 5, realizaram-se dosagens dos níveis séricos de sindecano 1 e avaliação dos componentes do escore PELOD-2. Os pacientes foram seguidos por até 28 dias após o diagnóstico de sepse. Resultados: Em geral, o nível de sindecano 1 estava aumentado em todos os participantes, com nível significantemente mais elevado nos pacientes em choque (p = 0,01). O nível de sindecano 1 no dia 1 teve correlação positiva com o escore PELOD-2 no dia 1 e coeficiente de correlação de 0,35 (p = 0,003). Nos primeiros 5 dias após o diagnóstico de sepse, as alterações nos níveis de sindecano 1 tiveram correlação positiva com modificações no escore PELOD-2, com coeficiente de correlação de 0,499 (p < 0,001). Com utilização de um ponto de corte dos níveis de sindecano 1 no dia 1 ≥ 430ng/mL, a disfunção de órgãos (escore PELOD-2 ≥ 8) pôde ser predita com área sob a curva de 74,3%, sensibilidade de 78,6% e especificidade de 68,5% (p = 0,001). Conclusão: O nível de sindecano 1 no dia 1 teve correlação com o escore PELOD-2 no dia 1, porém não se associou com a mortalidade aos 28 dias. A disfunção de órgãos (PELOD-2 ≥ 8) pôde ser predita pelo nível de sindecano 1 nas primeiras 24 horas de sepse, sugerindo seu significante envolvimento na fisiopatologia da disfunção de órgãos associada à sepse.

BACKGROUND: Sepsis is still leading cause of death in critically ill children. Early recognition of sepsis and treatments are needed to reduce its mortality. The use of citrullinated Histone H3 (Cit-H3) as an early sepsis marker and outcome predictor has been validated in previous studies among adults. However, only one study in pediatric meningococcal sepsis was reported with contradictory results. This study aims to determine Cit-H3 levels in pediatric clinical sepsis and analyze its association with sepsis severity and survival rate. METHODS: A prospective observational cohort study involving 67 pediatric subjects clinically diagnosed with sepsis was conducted. Cit-H3 levels, Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score, and Pediatric Sequential Organ Failure Assessment (pSOFA) score were assessed at the time of diagnosis (0-hour) and 48 hours later. Pearson Correlation test was used to determine the correlation between Cit-H3 levels with PELOD-2 and pSOFA scores and receiver operating curve to find the cut-off of Cit-H3 levels on clinical sepsis patients. RESULTS: Among clinically sepsis patients, the median Cit-H3 level was 1,210 (800-32,160) ng/mL, with optimal cut-off point ≥1200 ng/mL (sensitivity 83.3% and specificity 75.7%) to discriminate sepsis. The median Cit-H3 levels at 0-hour were lower in survivor compared to non-survivor group (p=0.016). Cit-H3 level was able to predict mortality with optimal cut-off point ≥1,200 ng/mL, sensitivity 72.2% and specificity 57.1% (AUC of 69.2%; p=0.017). Using survival analysis, Cit-H3 was significantly associated with the mortality rate (p=0.023; hazard ratio of 3.45). CONCLUSION: Cit-H3 level could be potential to predict pediatric sepsis events and its outcome. KEYWORDS: citrullinated histone H3, neutrophil extracellular traps, pediatric sepsis, PELOD-2 score, pSOFA score, survival

Background: The incidence of coronavirus disease 2019 (COVID-19) is still increasing rapidly, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aimed to describe the characteristics of children with COVID-19 with fatal outcomes in a tertiary referral hospital in Indonesia. Methods: This cross-sectional study used data collected from the medical records of patients with COVID-19 admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from March to October 2020. Results: During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, and 20 (40%) had a fatal outcome. The fatality rate was higher in patients aged ≥10 years, categorized with severe disease upon admission, PaO2/FiO2 ratio ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase and presepsin levels were found in all fatal cases. One patient met the criteria of multisystem inflammatory syndrome in children. Conclusion: Our work highlights the high mortality rate in paediatric patients with positive SARS-CoV-2 polymerase chain reaction test. These findings might be related to or co-incided with COVID-19 infection. Further studies are needed to improve understanding of the role of severe acute respiratory syndrome coronavirus-2 in elaborating the mechanisms leading to death in children with comorbidities.

Introduction: The fluid therapy is crucial in the treatment of critically ill children. Inadequate or excessive fluid resuscitation leads to increased mortality and morbidity, thus necessitating an accurate parameter for predicting fluid responsiveness when conducting fluid resuscitation. The inferior vena cava/abdominal aorta (IVC/Ao) ratio is suggested as a good guide for fluid resuscitation. However, the cutoff value for predicting fluid responsiveness in children has not been established. Is IVC/Ao ratio can be used to predict fluid responsiveness? Methods: The objective was to determine the accuracy and a cutoff value of IVC/Ao in predicting fluid responsiveness. A prospective cross-sectional study was conducted in the emergency room and the pediatric intensive care unit of the tertiary hospital from March to August 2017. We consecutively enrolled all critically ill children aged 1 month to 18 years' old who were hemodynamically unstable (shock). Measurements of IVC/Ao with ultrasound and stroke volume with ultrasound cardiac output monitor were obtained before and after fluid challenge. Results: Of 167 subjects enrolled in this study, only 58 subjects were included, most of whom were male (58.6%) and ranging in age from 1 to 11 months (32.8%). The mean IVC/Ao ratio before the fluid challenge in the fluid responsive group was 0.70 ± 0.053. The best cutoff of the IVC/Ao ratio is 0.675 with area under the curve 70.8% (95% confidence interval of 54.6%–87%), 75.7% sensitivity, and 61.9% specificity for predicting significant fluid responsiveness. Conclusion: The measurement of IVC/Ao is an accurate, sensitive, and specific parameter to predict fluid responsiveness. The best cut-off for the IVC/Ao ratio is 0.675.

BackgroundAll sectors are affected due to COVID-19 pandemic occurring worldwide, including the education industry. School closure had been taking place for more than a year in Indonesia. Despite the controversies, Indonesian government had decided to begin school reopening.ObjectivesThis study aims to assess parental readiness for school reopening, and factors affecting parental attitude toward school reopening.MethodsA cross-sectional study using online questionnaire distributed via official Indonesian Pediatric Society (IPS) official social media account collected between March and April 2021. The questionnaire contained the general characteristics of study participants, parents' knowledge, and perspectives on COVID-19, and health protocols for school reopening.ResultsA total of 17,562 responses were collected, of which 55.7% parents were ready to send their children to school should school reopens. Factors significantly contribute to parental decision to keep their child at home were: presence of vulnerable population at home [OR = 1.18 (1.10–1.27), p < 0.001], children with comorbidities [OR = 2.56 (2.29–2.87), p < 0.001], perception of COVID-19 as a dangerous disease [OR = 28.87 (14.29–58.33), p < 0.001], experience with COVID-19 positive cases in the community [OR = 1.75 (1.61–1.90), p < 0.001], COVID-19 related death in the community [OR = 2.05 (1.90–2.21), P < 0.001], approval for adult COVID-19 vaccination [OR = 1.69 (1.53–1.87), p < 0.001], and ownership of private transportation [OR = 1.46 (1.30–1.66), p

Surviving sepsis campaign (SSC) mengeluarkan pedoman tata laksana klinis pasien sepsis. Pedoman tata laksana ini dibuat atas dasar ilmu kedokteran berbasis bukti berdasarkan data pasien sepsis dewasa. Dalam panduannya, terdapat target-target tata laksana yang perlu dicapai dalam batas waktu tertentu, termasuk target hemodinamik sebagai panduan resusitasi, seperti jumlah cairan resusitasi, rerata tekanan arteri, dan tekanan vena sentral. Makalah ini bertujuan untuk mengupas permasalahan dari adaptasi target SSC, khususnya pada pasien anak di Indonesia.

Background. Mild elevation of serum amino-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is associated with myocardial dysfunction. A significantly lower Smith–Madigan inotropic index (SMII) has been shown to accurately represent cardiac contractility among heart failure subjects. We aim to monitor the effect of fluid resuscitation on cardiac function among paediatric patients by measuring serum NT-pro-BNP and SMII. Methods. This is an observational study on 70 paediatric shock patients. NT-pro-BNP and noninvasive bedside haemodynamic monitoring were done by using an ultrasonic cardiac output monitor (USCOM, USCOM, Sydney, Australia). The presence of cardiac diseases was excluded. SMII was obtained from the USCOM. An increase in the stroke volume index (SVI) of ≥15% indicates fluid responders. Measurements were taken before and after fluid loading. Results. Preloading NT-pro-BNP and SMII category were significantly different between the fluid responsiveness group, p=0.001 and p=0.004, respectively. Higher median NT-pro-BNP (preloading NT-pro-BNP of 1175.00 (254.50–9965.00) ng/mL vs. 196.00 (65.00–509.00) ng/mL, p=0.002) was associated with fluid nonresponders (subjects >12 months old). Preloading NT-pro-BNP 12 years old. Delta NT-pro-BNP in fluid responders (15.00 (−16.00–950.00) ng/mL) did not differ from fluid nonresponders (505.00 (−797.00–1600.00) ng/mL), p=0.456. Postloading SMII >1.25 W·m−2 was associated with fluid responders (AUC: 0.683 (0.553–0.813), p = 0.011), 61.9% sensitivity, and 66.7% specificity, but not preloading SMII. Fluid responders had a higher mean postloading SMII compared to nonresponders (1.36 ± 0.38 vs. 1.10 ± 0.34, p=0.006). Conclusion. Higher NT-pro-BNP and lower SMII in the absence of cardiac diseases were associated with poor response to fluid loading. The SMII is affected by low preload conditions.

Purpose: Outcome of pediatric liver transplant patients is affected by various factors, including critical care management in the early phase following surgery. This article focuses on early recognition of complications in pediatric liver transplant patients in Pediatric Intensive Care Unit (PICU). In particular, this article highlights the common problem in post-liver transplant pediatric patients in Indonesia, and the strategies to optimize recovery and minimize complications. Summary: Almost every system organ is affected by the surgery and medications given intra- and post-operatively. Careful monitoring and appropriate management are needed to ensure long-term success of surgery and prevent both early and late complications. Early extubation is recommended, however some may need PEEP titration to obtain optimal oxygenation. Advanced hemodynamic monitoring paired with clinical signs is recommended for optimal perfusion and ventriculo-arterial coupling. Routine electrolytes examination and neurological assessment are needed. Infection control and immunosuppression have to be optimized. Early enteral nutrition, nutritional support for recovery is needed, however should be gradually administered in malnourished patients. Conclusion: Early detection of post-transplant complications must be identified to ensure appropriate management is given as soon as possible. The ultimate goal is to retain graft acceptance as long as possible and the reduction of morbidity and mortality post-transplantation.

Background The primary goal of intensive care is to prevent mortality in patients with reversible critical illness, while preserving or improving functional outcome. It follows that the capability to estimate patient's risk of death is extremely important. Objective To identify the prognostic factors of death, evaluate the probability of death by using Pediatric Index of Mortality (PIM) model, and develop the new model for predicting probability of death in children admitted to PICU in accordance with characteristic of patients in the study unit. Methods Design Retrospective study. Setting Pediatric intensive care unit of Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Patient Two hundreds and sixty five consecutive admissions,

An 18-year-old woman with annular pancreas and duodenal duplication presented with recurrent acute pancreatitis and underwent a resection of duodenal duplication. However, the patient experienced recurrent abdominal pain after resection. Abdominal computed tomography and magnetic resonance imaging showed a dilatation of the peripheral pancreatic duct and stenosis and malformation of both the Wirsung's and Santorini's duct due to multiple stones. The modified puestow procedure was performed. The main pancreatic ducts in the body and tail were opened, and the intrapancreatic common bile duct was preserved. A Roux-en-Y pancreatico-jejunostomy was performed for reconstructing the pancreaticobiliary system after removing the ductal protein plug. The patient experienced no abdominal pain, no significant elevation of the serum amylase and lipase levels, and no stone formation during the 2 years of follow-up. This procedure is considered to be beneficial for pediatric patients with chronic pancreatitis due to annular pancreas and duodenal duplication. [ABSTRACT FROM AUTHOR]