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Latar belakang. Infeksi saluran kemih (ISK) pada anak memiliki manifestasi klinis yang tidak khas sehingga sulit untuk diagnosis dini. Biakan urin memerlukan waktu hingga lima hari sehingga dapat menyebabkan keterlambatan terapi serta tingginya komplikasi ISK. Kelainan urinalisis yang saat ini digunakan masih memiliki spesifisitas yang rendah. Tujuan. Mengetahui nilai diagnostik Neutrophil gelatinase-associated lipocalin (NGAL) urin, kelainan urinalisis, dan kombinasi keduanya untuk mendiagnosis dini ISK pada anak usia 2-5 tahun. Metode. Uji diagnostik menggunakan biakan urin sebagai baku emas dengan desain potong lintang pada anak berusia 2-5 tahun dengan tersangka ISK dan dirawat di Rumah Sakit Dr. Cipto Mangunkusumo. Hasil. Pemeriksaan NGAL urin diketahui memiliki sensitivitas 85,7% (IK95%: 63,6-96,9%), spesifisitas 74,3% (IK95%: 57,8-86,9%), positive predictive value 64,3% (IK95%: 50,6–75,9%), dan negative predictive value 90,6% (IK95%: 76,9-96,5%) pada anak dengan minimal satu kelainan urinalisis. Pemeriksaan NGAL urin hanya meningkatkan spesifisitas kelainan urinalisis berupa leukosituria saja dan tidak meningkatkan spesifisitas pada yang telah memiliki tiga kelainan urinalisis. Kesimpulan. Neutrophil gelatinase-associated lipocalin urin tidak dianjurkan untuk meningkatkan spesifisitas urinalisis dalam diagnosis ISK pada anak usia 2–5 tahun. Gabungan tiga kelainan urinalisis tanpa NGAL urin sudah memiliki spesifisitas yang baik. Perlu dilakukan penelitian biomarker lain untuk mendiagnosis dini ISK dengan lebih baik.

Abstract Background In light of prolonged hypoxia, children with cyanotic heart disase (CHD) are at a high risk of developing iron deficiency iron deficiency (ID) and iron deficiency anemia (IDA). Reticulocyte hemoglobin equivalent (Ret-He) is a novel and dependable indicator for assessing iron status. However, there has been no previous study regarding cut-off value in pediatric CHD group. The purpose of this study is to assess the role of Ret-He and to establish cut-off points in the diagnosis of iron deficiency and IDA in pediatric cyanotic heart disease. Method This study was conducted in two tertiary hospitals in Jakarta, Indonesia. 59 children with CHD, aged 3 months to 18 years, were enrolled consecutively. To determine iron status, hematological parameters (hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin) and biochemical parameters for iron status (serum ferritin, transferrin saturation) were analysed and compared to Ret-He levels. The receiver operating characteristic (ROC) analysis was performed for the Ret-He cut-off points for ID and IDA. Sensitivity, specificity, positive and negative predictive value were calculated for each cut-off point. Result Normal iron status was identified in 27 (45.8%) subjects, ID in 8 (13.5%) subjects, and IDA 24 (40.7%) subjects. The ID cut-off value for Ret-He is 28.8 pg (sensitivity 75%, specificity 85.2%, PPV 60%, NPV 92%, and AUC 0.828) and the Ret-He cut-off point for IDA is 28.15 pg (sensitivity 75%, specificity 88.9%, PPV 85.7%, NPV 80%, and AUC 0.824). Hemoglobin should be used in conjunction with Ret-He. ID might be detected in this cohort with Ret-He 28.8 pg and hemoglobin > 16,5 g/dL. While Ret-He 28.15 pg or Ret-He 28.15–28.8 pg with hemoglobin 16.5 g/dL could be used to diagnose IDA. Conclusion The reticulocyte hemolgobin equivalent could be utilised as an iron status parameter in pediatric CHD, with a cut-off value of 28.8 pg for ID and 28.15 pg for IDA.

Background Children with Down syndrome (DS) differ from typical children because of many genetic-related aspects that may affect outcomes after congenital heart surgery. To date, there have been no studies on outcomes after congenital heart surgery on pediatric DS patients in Indonesia. Objective To determine outcomes and mortality in DS patients who underwent heart surgery at Dr. Cipto Mangunkusumo Hospital, Jakarta. Methods A prospective and retrospective cohort study was conducted in DS patients aged

Introduction: During the COVID-19 pandemic, social media has become the main platform to find information in every aspect. It is important for professional organizations to develop social media in their field. The Indonesian Pediatric Society (IPS) has distributed information through various social media channels, like Professional Official Website. It is formed to reach various target users, hoping that information will be spread evenly among all Indonesian parents. This study aims to describe how the IPS media ecosystem provides trusted health information, which can help disseminate health information among parents and health practitioners during the pandemic. Methods: The study used a descriptive design using IPS social media platforms such as Professional Official Website (idai.or.id), Instagram, Facebook, Twitter, YouTube, Public Official Website (anakindonesiasehat.com), and Telemedicine Mobile Application (PrimaKu). Results: The IPS's social media accounts have shown significant growth during the pandemic showing that people are more aggressively seeking information from trusted sources. A public education-related Instagram live footage titled “Drugs and Vitamins for children with COVID-19 during quarantine at home” has become the most demanded material for social media users. This shows that social media is an excellent platform for health promotion. Conclusion: IPS, as a professional organization, needs to provide accurate, reliable, and up-to-date information on its social media and should take advantage of this opportunity to disseminate the latest guidelines and educate the public more thoroughly, especially parents, to help them obtain information on children's health.

Latar belakang. Infeksi Streptococcus yang memicu demam rematik dapat mendasari terjadinya penyakit jantung didapat pada anak. Demam rematik dapat dicegah baik dari pencegahan primordial, primer, dan sekunder. Anak dengan penyakit jantung rematik dapat dicegah keparahan penyakitnya dengan mencegah terjadinya infeksi Streptococcus berulang atau pencegahan sekunder. Pencegahan sekunder dianjurkan oleh World Health Organization (WHO) adalah dengan pemberian Benzathine Penicillin G (BPG) setiap 3 – 4 minggu. Tujuan. Mengetahui apakah pemberian BPG setiap 3 minggu dapat mengurangi peristiwa infeksi Streptococcus pada anak dengan penyakit jantung rematik dibanding pemberian setiap 4 minggu. Metode. Penelusuran pustaka database elektronik, yaitu Pubmed, ScienceDirect, Cochrane, dan Google Scholar dengan kata kunci “rheumatic heart disease”, “AND” “benzathine penicillin g”, “AND”, “streptococcal infection”, “AND”, “children”. Hasil. Diperoleh satu studi systematic review dan satu studi kohort yang sesuai. Kedua studi menunjukkan bahwa pemberian BPG setiap 3 minggu mengurangi kejadian infeksi Streptococcus daripada pemberian setiap 4 minggu dengan nilai NNT berturut-turut 6 dan 8. Kesimpulan. Pemberian BPG setiap 3 minggu terbukti dapat menurunkan kejadian infeksi Streptococcus pada pasien dengan penyakit jantung rematik.

BackgroundPost-operative systemic inflammation response syndrome (SIRS) is an event that results from surgical trauma, white blood cells contact activation, and intra-surgical bacterial translocation, which is difficult to distinguish from sepsis. Presepsin is a novel biomarker that is increased since the early stages of bacterial infection and can be used to confirm the diagnosis of post-operative infectious complications. This study aimed to investigate the diagnostic performance of presepsin for post-operative infectious complications compared to other well-known biomarkers.MethodThis cross-sectional study included 100 post-operative patients admitted to Cipto Mangunkusumo National Hospital and Bunda Hospital in Jakarta, Indonesia. The objective was to identify the optimal cutoff and trend of plasma presepsin concentration on the first and third day after surgery and to compare them with other biomarkers.ResultPlasma presepsin level was higher in the infection group compared to the non-infection group (median 806.5 pg/ml vs. 717 pg/ml and 980 pg/ml vs. 516 pg/ml on the first and third day, respectively). Presepsin levels tended to increase on the third post-operative day (median + 252 pg/ml) in children with infection. The opposite trend was observed in the non-infection group from the first to the third day (median -222.5 pg/ml). Presepsin delta, a three-day difference between the first and third post-operative day, had the best diagnostic performance compared to other biomarkers (Area Under the Curve 0.825). The optimal cutoff for presepsin delta to diagnose post-operative infection was +90.5 pg/ml.ConclusionSerial assessments of presepsin levels on the first and third days post-surgery and their trends are helpful diagnostic markers for clinicians to detect post-operative infectious complications in children.

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

Background: Indonesia has a high number of COVID-19 cases and mortalities relative to not only among the Asia Pacific region but the world. Children were thought to be less affected by the virus compared to adults. Most of the public data reported combined data between adults and children. The Indonesian Pediatric Society (IPS) was involved in the COVID-19 response, especially in the area of child health. One of IPS's activities is collecting data registries from each of their chapters to provide a better understanding of COVID-19 in children.Objective: The objective of this study was to share the data of suspected and confirmed COVID-19 cases in children from IPS's COVID-19 data registry.Method: This is a retrospective study from the IPS's COVID-19 registry data. We collected the data of COVID-19 in children during March to December 2020 from each of the IPS chapters. We analyzed the prevalence, case fatality rate (CFR), age groups, diagnosis, and comorbidities of the children diagnosed with COVID-19.Result: As of December 21, 2020, there were 35,506 suspected cases of children with COVID-19. In total, there were 522 deaths, with a case fatality ratio (CFR) of 1.4. There were 37,706 confirmed cases with 175 fatalities (CFR 0.46). The highest mortality in confirmed COVID-19 cases was from children ages 10–18 years (42 out of 159 cases: 26%). The most common comorbidity and diagnosis found were malignancy (17.3%) and respiratory failure (54.5%).Conclusion: The CFR of confirmed COVID-19 cases in children in Indonesia is high and should be a major public concern.

Background Patent ductus arteriosus (PDA) is a congenital heart disease most commonly occurring in premature infants. Spontaneous ductus arteriosus (DA) closure in premature infants has been suggested to be associated with duct lumen maturity and the DA sensitivity to prostaglandin E2 (PGE2). Objective To assess for a possible correlation between serum PGE2 levels and PDA size in premature infants. Methods This observational study using repeated measurements on premature infants with PDA detected at days 2-3 of life was undertaken in Cipto Mangunkusumo Hospital and Fatmawati Hospital, Jakarta, from April to May 2014. The PDA was diagnosed using 2-D echocardiography and PGE2 levels were measured by immunoassay. Pearson’s correlation test was used to evaluate a possible correlation between PGE2 level and DA diameter. Results Thirty-three premature infants of median gestational age 31 (range 28-32) weeks and median birth weight 1,360 (range 1,000-1,500) grams were enrolled. Almost two-thirds of the subjects were male. Almost all (30/33) subjects had spontaneous DA closure before the age of 10 days. Subjects’ mean DA diameter was 2.9 (SD 0.5) mm with maximum flow velocity of 0.2 (SD 0.06) cm/sec, and left atrial-to-aortic root ratio (LA/Ao) of 1.5 (SD 0.2). Their mean PGE2 levels at the ages of 2-3, 5-7, and after 10 days were 5,238.6 (SD 1,225.2), 4,178.2 (SD 1,534.5), and 915.2 (SD 151.6) pg/mL, respectively. The PGE2 level at days 2-3 was significantly correlated with DA diameter (r = 0.667; P < 0.001), but not at days 5-7 (r = 0.292; P = 0.105) or at day 10 (r = 0.041; P = 0.941). Conclusion There is a strong, positive correlation between the PGE2 level and DA diameter in preterm infants at 2-3 days of age. However, there is no significant correlation between PGE2 level and persistence of PDA.

Background Pulmonary arterial hypertension (PAH) is a common complication seen in those with a left-to-right shunt congenital heart defect (CHD). Corrective procedures by surgery or catheterization are the therapies of choice for reversible PAH. Since morbidity and mortality due to PAH after correction is high, sildenafil has been used as a selective vasodilator of the pulmonary artery, in order to decrease pulmonary arterial pressure. Objectives To evaluate the effect of sildenafil on pulmonary arterial pressure and clinical outcomes after left-to-right shunt CHD corrective procedures. Methods Left-to-right shunt patients aged < 18 years scheduled for corrective treatment were randomized in a double-blind fashion, to receive either oral sildenafil or placebo, given on days 3 to 30 after the corrective procedure. Clinical and pulmonary arterial pressures were evaluated by echocardiography before, 3 days after, and 30 days after the corrective procedure. Results From July 2013 to June 2014, 36 patients were included in the study: 17 in the placebo and 19 in the sildenafil groups. There were no differences in pulmonary arterial pressure or in clinical outcomes after corrective procedure between the two groups. There were no adverse events during the treatment. Conclusion Sildenafil has little effect on decreasing pulmonary arterial pressure, as most of our subjects seem to have hyperkinetic PAH. As such, pulmonary arterial pressure returns to normal soon after corrective procedures.