Garuda - Garba Rujukan Digital

Tata Laksana Hiperglikemia dengan Insulin Tight Controlled di Ruang Intensif Anak Desy Rusmawatiningtyas; Nurnaningsih Nurnaningsih
Sari Pediatri Vol 21, No 6 (2020)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp21.6.2020.346-51

Latar belakang. Penelitian tata laksana hiperglikemia dengan insulin dan pengaruhnya terhadap keluaran klinis anak sakit kritis belum banyak dilakukan.Tujuan. Mengetahui keluaran kejadian hipoglikemia, lama rawat inap di ruang intensif, dan angka kematian dalam tata laksana hiperglikemia dengan insulin menggunakan metode tight controlled (gula darah sewaktu/GDS diturunkan sampai kadar 80-120mg/dL) dan metode permissive controlled (GDS diturunkan sampai <150mg/dL).Metode. Menggunakan rancangan uji klinis tak terkontrol dengan randomisasi sederhana. Subyek adalah pasien bukan kasus bedah yang dirawat di Pediatric Intensive Care Unit/PICU RSUP Dr. Sardjito dengan PRISM skor 24 jam pertama â‰¤8 dan kadar GDS >150mg/dL dalam dua kali pengukuran pada 24 jam pertama perawatan. Subyek dibagi menjadi dua kelompok terapi, yaitu kelompok dengan metode tight controlled dan permissive controlled. Keluaran yang dinilai adalah kejadian hipoglikemia, lama rawat di ruang intensif dan kematian.Hasil. Lima belas anak masuk dalam kriteria inklusi. Sembilan pasien masuk dalam tight controlled dan 6 pasien dalam permissive controlled. Tidak terdapat keluaran hipoglikemia pada kedua kelompok. Didapatkan 66,7% subyek meninggal baik pada grup tight dan perminssive controlled (p=1). Rerata lama rawat tight dan permissive controlled adalah 8,89Â±5,69 dan 13Â±9,32 hari (p=0,407).Kesimpulan. Tidak terdapat keluaran hipoglikemia pada kedua kelompok dan tidak ada perbedaan bermakna secara statistik pada mortalitas.Â

Mycophenolate Mofetil for a Flare Child Lupus Nephritis: A Case Reports Gina Puspita; Desy Rusmawatiningtyas; Sumadiono
Archives of The Medicine and Case Reports Vol. 2 No. 2 (2021): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v2i2.18

Renal involvement is the most common complication of systemic lupus erythematosus (SLE) and is also an important predictor of patient mortality. The incidence of flares is estimated at 65% each year in patients with lupus nephritis. Therapy in lupus nephritis with flare also uses high doses of steroid agents and strong immunosuppression agents. Mycophenolate mofetil (MMF) as an immunosuppression agent tends to favor for flare in lupus nephritis. We describe a patient who had a flare in lupus nephritis that resolved with high-dose steroid and MMF. The combination of immunosuppression agents and high-dose corticosteroids is effective for the control of active diseases. Cyclophosphamide as the steroid-sparing agent was discontinued because of adverse effects as well as hematuria. Partial remission was later achieved and maintained with MMF and corticosteroid after five months of protocol treatment. Thus, MMF while maintaining the steroid dose may induce remission for this case.

Early detection of anemia among school children using the World Health Organization Hemoglobin Color Scale 2006 Desy Rusmawatiningtyas; Dwikisworo Setyowireni; Sri Mulatsih; Sutaryo Sutaryo
Paediatrica Indonesiana Vol 49 No 3 (2009): May 2009
Publisher : Indonesian Pediatric Society

Background The high prevalence of anemic children in Indonesiais caused by the high incidence of diseases caused by parasiticinfection such as malaria as well as iron deficiency. Early detectionis needed for early intervention in order to allow optimal growthand development. A simple, economic, and practical tool forearly detection of anaemic children is needed. The WHOrecommended a Hemoglobin Color Scale as a suitable tool forthe detection of anemia.Objective To assess the sensitivity, specificity, and predictivevalues of the WHO Hemoglobin Color Scale for early detectionof anemic children.Methods A cross sectional diagnostic test was conducted inelementary school age children. Samples consisting of two drops ofvenous blood on paper were assessed by two observers (pediatrician& paramedic) using the Hemoglobin Color Scale to visuallydetermine the level of hemoglobin. In addition, the hemoglobinlevel was also measured using a Hematology Analyzer to allow thevisual test results to be compared to the results obtained using thegold standard of analysis. Agreement between these two methodsof analysis was examined using the Cohen's kappa.Results Hemoglobin levels < 11.5 g/dL were detected in 15 of124 (12%) elementary school children. The sensitivity, specificity,positive and negative predictive values when using the HemoglobinColor Scale were 93%, 100%, 100% and 99% respectively for thefirst observer and 100%,99%,93%, and 100% respectively for thesecond observer. The Cohen's Kappa value was 0. 76.Conclusion The WHO Hemoglobin Color Scale 2006 couldbe used as an early detection method for anemia in children.

Mortality rates in pediatric septic shock Desy Rusmawatiningtyas; Nurnaningsih Nurnaningsih
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Septic shock remains a major cause of morbidity and mortality in children admitted to the intensive care unit. Recent investigations from developed countries have reported mortality rates of 20-30%. Few studies have reported mortality rates from pediatric septic shock in intensive care settings in developing countries with limited resources.Â Objective Â To determine the current mortality rates for pediatric patients with septic shock in a developing country.Methods A retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at DR. Sardjito General Hospital. Medical records and charts were reviewed and recorded for diagnoses of septic shock, from November 1st, 2011 to June 30th, 2014. Results Â A database of all PICU admissions was assembled, and cases with diagnoses of septic shock were reviewed. The final data consisted of 136 patients diagnosed with septic shock. Septic shock was defined as a clinical suspicion of sepsis, manifested by hyperthermia or hypothermia, and accompanied by hypoperfusionÂ The overall mortality rate for the study cohort was 88.2%.Â The median age of patients was 16 months, with 52.2% males. Median initial PRISM III and PELOD scores were 10 and 22, respectively. The median length of PICU stay was 4 days. A total of 48.5% of the subjects were in need of crystalloid and colloid fluid at a median amount of 40 mL/kg. The median time required to complete the initial resuscitation was 60 minutes. Mechanical ventilator support in the first 24 hours was required in 79.4% of the cases. Fluid overload of > 10% (FO>10%) was found in 58.8% of the subjects.Conclusion The mortality rate in pediatric septic shock in our hospital is very high. There is a higher incidence of fluid overload in the non-survival group .

Nutritional therapy and caloric achievement within the first week of PICU admission Melia Yunita; Desy Rusmawatiningtyas; Titis Widowati
Paediatrica Indonesiana Vol 58 No 1 (2018): January 2018
Publisher : Indonesian Pediatric Society

Background Nutritional therapy is an important aspect in managing PICU patients. Careful decisions should be made regarding initiation, route of administration, and achievement based on caloric requirements. Many conditions could affect the application of nutritional therapy. Objective To investigate the implementation of nutritional therapy during the 1st week after PICU admission. Methods We conducted a retrospective study involving 156 children aged 1 month-18 years who were hospitalized for at least 4 days in the PICU during the period of January 1st, 2015 toÂ December 31st, 2015. Subjects were divided into three groups according to initiation time of caloric administration, which were: category I (within the first 24 hours of PICU admission), category II (within the first 25-48 hours of PICU admission), and category III: (more than 48 hours after PICU admission). Caloric requirement was calculated using the Caldwell or Schofield formula, whilst caloric achievement was figured up from PICU daily monitoring sheets containing nutritional therapy given to the subjects. Results Of 131 subjects, 72 (55%) had good nutritional status and 59 (45%) children had malnutrition. Caloric administration was initiated within 24 hours of admission in 101 (77.1%) patients, of whom 90 (89.1%) patients received enteral feeding. Nineteen (14.5%) patients received their initial calories within 25-48 hours of admission, with 16 (84.2%) using the enteral route. At the 4th and 7th days of hospitalization, 93 (71%) and 107 (81.7%) patients achieved >70% of their caloric requirements. Delays in feeding initiation were due to shock, gastrointestinal bleeding, inotropic support, and feeding intolerance, which reduced caloric achievement. Conclusion Most patients receive nutritional therapy in the first 48 hours after PICU admission and achieve >70% of their caloric requirements at the 4th day of hospitalization. The enteral route is preferred. Delayed initiation of nutritional therapy reduce caloric achievement.

Predictors of mortality in children with acute kidney injury in intensive care unit Umi Rakhmawati; Indah K. Murni; Desy Rusmawatiningtyas
Paediatrica Indonesiana Vol 59 No 2 (2019): March 2019
Publisher : Indonesian Pediatric Society

Background Acute kidney injury (AKI) can increase the morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Previous published studies have mostly been conducted in high-income countries. Evaluations of possible predictors of mortality in children with AKI in low- and middle-income countries have been limited, particularly in Indonesia. Objective To assess possible predictors of mortality in children with AKI in the PICU. Methods We conducted a retrospective cohort study at Dr. Sardjito Hospital, Yogyakarta, Indonesia. All children with AKI admitted to PICU for more than 24 hours from 2010 to 2016 were eligible and consecutively recruited into the study. Logistic regression analysis was used to identify independent predictors. Results Of the 152 children with AKI recruited, 119 died. In order to get a P value of <0.25, multivariate analysis is run to degree AKI, ventilator utilization, primary infection disease, MOF and age.Multivariate analysis showed that ventilator use, severe AKI, and infection were independently associated with mortality in children with AKI, with odds ratios (OR) of 19.2 (95%CI 6.2 to 59.7; P<0.001), 8.6 (95%CI 2.7 to 27.6; P<0.001), and 0.2 (95%CI 0.1 to 0.8; P=0.02), respectively. Conclusion The use of mechanical ventilation and the presence of severe AKI are associated with mortality in children with AKI admitted to the PICU. Interestingly, the presence of infection might be a protective factor from mortality in such patients.

Fluid overload and length of mechanical ventilation in pediatric sepsis Winda Paramitha; Rina Triasih; Desy Rusmawatiningtyas
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Background Children with sepsis often experience hemodynamic failure and would benefit from fluid resuscitation. On the other hand, critically ill children with sepsis have a higher risk of fluid accumulation due to increased capillary hydrostatic pressure and permeability. Therefore, fluid overload may result in higher morbidity and mortality during pediatric intensive care unit (PICU) hospitalization. Objective To evaluate the correlation between fluid overload and the length of mechanical ventilation in children with sepsis admitted to the PICU. Methods Our retrospective cohort study included children aged 1 month-18 years with sepsis who were admitted to the PICU between January 2013 and June 2018 and mechanically-ventilated. Secondary data was extracted from subjectsâ€™ medical records. Data analyses used were independent T-test and survival analysis. Results Of 444 children admitted to the PICU, 166 initially met the inclusion criteria. Of those, 17 children were excluded due to congenital heart disease. Subjects' median age was 19 months and median PELOD-2 score was 8. Eighteen children (12.1%) had positive fluid balance in the first 48 hours. Median mechanical ventilation duration was 5 days. Fluid overload was significantly correlated with length of mechanical ventilation (P=0.01) and PICU mortality (RR=2.06; 95%CI 2.56 to 166; P=0.001). Neither length of PICU stay nor extubation failure were significantly correlated to fluid overload. Conclusion Fluid overload was significantly correlated with length of mechanical ventilation and may be a predictor of mortality in children with sepsis in the PICU.

Predictors of prolonged stay in the pediatric intensive care unit Yudha Fadhol Arafah; Indah Kartika Murni; Desy Rusmawatiningtyas
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Background Prolonged stay in the pediatric intensive care unit (PICU) reflects not only disease severity and patient health status, but also the performance and quality of patient care. Objective To to determine whether surgical procedure, severe malnourishment, cardiovascular condition, sepsis, and ventilator use were the predictors of prolonged PICU stay. Methods This nested, case-control study was conducted with secondary data from medical records of pediatric inpatients at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. We included pediatric patients aged 1 month-18 years treated in the PICU between 1 January - 31 December 2018. Predictors of prolonged stay were identified including surgical procedures, severe malnourishment, cardiovascular conditions, sepsis, and ventilator use. Logistic regression was used to identify independent predictors. Results Subjects' overall median age was 3.12 (IQR 0.76-18.8) years and the male to female ratio was 1:1. Median duration of ventilator use was 4 (IQR 1-21) days. The most common diagnosis was neurological disease (26.7%). Multivariate analysis showed that surgical procedure (OR 5.75; 95%CI 2.06 to 14.61) was statistically significant as an independent predictor of prolonged PICU stay. Conclusion Surgical procedure is the significant predictor of prolonged stay in PICU.

Chronic kidney dissease and complex urinary tract infection in children with left renal agenesis : A case report Maria Ulfa; Tunjung Wibowo; Desy Rusmawatiningtyas; Kristia Hermawan
JKKI : Jurnal Kedokteran dan Kesehatan Indonesia JKKI, Vol 12, No 2, (2021)
Publisher : Faculty of Medicine, Universitas Islam Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20885/JKKI.Vol12.Iss2.art13

Child with left renal agenesis fulfill the diagnostic criteria for chronic kidney disease due to its structural abnormalities that lasted for more than three months. It is important to monitored the disease progression and also growth, development and quality of life in children with chronic disease. Management of other risk factors that can accelerate disease progression must be carried out comprehensively. The patient's was 9 months old girl with stage I chronic kidney disease and also having recurrent complex urinary tract infections with left renal agenesis. The interventions was to identify other abnormalities of the urinary tract and syndromic disorders, prevention of urinary tract infection (UTI) recurrence, prevention of renal injury, renal scaring and dietary education. After 18 months of observation there was no urinary tract abnormality in imaging results, there was one episode of mild recurrent UTI, no renal injury and there was no sign of renal scaring. The final outcome was no significant decrease in glomerular filtration rate (GFR), growth and development was good and good quality of life. The immunizations was given as scheduled. Monitoring and multidisciplinary intervention of prognostic variables such as urinary tract and syndromic disorders, recurrence UTI, renal injury, renal scaring and diet in children with chronic kidney disease are important for optimal outcome. No decrease of GFR, good growth, development and optimal quality of life and also knowing the progression of chronic kidney disease was the final outcomes of the intervention.

Evaluation of performance of Indonesian Sepsis National Guidelines (PNPK) 2021 in diagnosing pediatric bacterial sepsis asiyani, Lilis siti; Rusmawatiningtyas, Desy; Indrawanti, Ratni Indrawanti; Arguni, Eggi Arguni; Wibowo, Tunjung Wibowo; Nurnaningsih, Nurnaningsih Nurnaningsih
Paediatrica Indonesiana Vol 64 No 3 (2024): May 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.3.2024.258-63

Background Sepsis remains one of the causes of child morbidity and mortality worldwide. The reference standard diagnosis of sepsis is blood culture, but its false negative is relatively high. Therefore, a validated triage tool is needed for rapid diagnosis. In Indonesia, diagnosis and management of pediatric sepsis are based on Indonesian Sepsis National Guidelines 2021. Objective To evaluate the performance of Indonesian Sepsis National Guidelines 2021 in diagnosing pediatric bacterial sepsis in PICU. Methods This cross-sectional study was conducted in the PICU unit of Dr. Sardjito Hospital, Yogyakarta, using subject’s the medical records. All patients with suspected bacterial infection who were admitted to the PICU, had complete evaluation of PELOD-2 score, and the blood culture results were included in this study. Sepsis was assessed with Indonesian Sepsis National Guidelines 2021. Performance analysis of the guidelines was conducted with SPSS version 25, by assessing sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and likelihood ratio. Results Two hundred subjects were enrolled in this study, of whom 52.5% were males. Most subjects aged under one year (40.5%), and the most common infection was respiratory system (49%). A total of 63.5% were referral cases, with the length of stay in the previous hospital more than 48 hours (69.7%). There were 77% of subjects had antibiotics treatment at the previous hospital. As for outcomes, 63.5% survived and 36.5% died. The positivity rate of blood culture in this study was 19%. Performance evaluation of Sepsis Indonesian Sepsis National Guidelines 2021 revealed sensitivity 28.95%, specificity 87.65%, accuracy 76.5%, positive predictive value 35.48%, negative predictive value 84.02%, positive likelihood ratio 2.34 (95%CI 1.28 to 4.32) and negative likelihood ratio 0.81 (95%CI 0.7 to 0.94). Conclusion Indonesian Sepsis National Guidelines 2021 (PNPK Sepsis 2021) has low sensitivity and high specificity in diagnosing bacterial sepsis.

Title

Found 10 Documents
Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title Search

Found 10 Documents Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title

Found 10 Documents
Search