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All Journal Jurnal Kedokteran Brawijaya Paediatrica Indonesiana Pediatric Sciences Journal
Kurniawan Taufiq Kadafi
Division Of Pediatric Emergency And Intensive Care, Department Of Pediatrics, Faculty Of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Indonesia
Health Professions Medicine & Pharmacology Public Health

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Hambatan Implementasi Surviving Sepsis Campaign Guidelines 2012 pada Pasien Anak di Rumah Sakit Rujukan Tersier Yuliarto, Saptadi; Kadafi, Kurniawan Taufiq; Nugrahani, Iin Tri Listiyanti; Aminingrum, Rahmawati; Asariati, Husnul
Jurnal Kedokteran Brawijaya Vol 28, No 1 (2014)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (523.824 KB) | DOI: 10.21776/ub.jkb.2014.028.01.11

Abstract

Tata laksana adekuat sepsis dapat memperbaiki luaran pasien. Surviving sepsis campaign (SSC) guidelines 2012 merupakan panduan internasional tata laksana sepsis berat dan syok septik, namun implementasinya dipengaruhi oleh sumberdaya dan fasilitas kesehatan. Penelitian ini mengevaluasi implementasi SSC di rumah sakit. Studi prospektif dilakukan antara Februari-Juni 2013 pada seluruh pasien usia 1 bulan–18 tahun yang memenuhi kriteria sepsis, dengan menilai penggunaan cairan resusitasi dan obat vasoaktif, waktu pemberian antibiotika, waktu pengambilan kultur, pemberian nutrisi, penggunaan ventilator, dan angka kematian. Di antara 40 pasien, 34 merupakan kasus syok septik. Seluruh pasien syok septik mendapatkan resusitasi cairan dan obat vasoaktif. Obat vasoaktif diberikan kurang dari 6 jam pada 21 pasien. Hanya 14 pasien mendapatkan antibiotika pada jam pertama, dan hanya 6 pasien dilakukan pemeriksaan kultur darah sebelum pemberian antibiotika awal. Sebanyak 28 pasien membutuhkan ventilator, namun 13 pasien tidak bisa mendapatkannya.Hal ini meningkatkan risiko mortalitas 2,1 kali (95% IK 1,2; 3,7). Saat perawatan di unit intensif, 27 pasien mendapatkan nutrisi pada 6-24 jam pertama, namun sebagian besar (32 pasien) mendapatkan kalori kurang dari 80% dalam 48 jam pertama yang meningkatkan risiko mortalitas 3 kali (95% IK 1,1; 8,2). Mortalitas terjadi pada 24 pasien. Hal ini menunjukkan adanya hambatan pelaksanaan SSC guidelines 2012 dalam hal pemberian antibiotika, pemeriksaan kultur darah, penggunaan ventilator, dan pemberian nutrisi adekuat. Ketidaktersediaan ventilator dan terapi nutrisi inadekuat meningkatkan risiko mortalitas.Kata Kunci: Antibiotika, kultur darah, mortalita, nutrisi, sepsis, ventilator
The difficulty of establishing the diagnosis of pediatric COVID-19 in Indonesia Kurniawan Taufiq Kadafi
Pediatric Sciences Journal Vol. 1 No. 1 (2020): (Supplementary)
Publisher : Medical Faculty of Brawijaya University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (222.413 KB) | DOI: 10.51559/pedscij.v1i1.10

Abstract

The Covid-19 pandemic has not shown any signs of ending soon. Until May 1, 2020, the latest data recorded that Covid-19 cases in the world have reached 3,336,680 cases, with 235,245 people died and 1,054,786 people recovered. Of  the number of still-active cases, 98% are mild cases, while the remaining 2% are severe. Since it was first identified (December 2019) until it was announced as a pandemic on March 11, 2020), cases of children have not escaped the effects of infection.
Mechanical ventilation practice of pediatric patients with Covid-19 in Indonesian tertiary hospital Kurniawan Taufiq Kadafi; Erviani Maulidya; William Prayogo Susanto; Saptadi Yuliarto
Pediatric Sciences Journal Vol. 2 No. 1 (2021): (Available online 1 June 2021)
Publisher : Medical Faculty of Brawijaya University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (467.872 KB) | DOI: 10.51559/pedscij.v2i1.22

Abstract

Background: Coronavirus Disease-2019 (COVID-19) in children tend to have milder clinical manifestation. However, some develop critical conditions and require mechanical ventilation in the Pediatric Intensive Care Unit (PICU). Various modalities are recommended for mechanical ventilation, such as High Flow Nasal Cannula (HFNC), Continuous Positive Airway Pressure (CPAP), or invasive ventilation with intubation. This study aims to describe the clinical feature, ventilation modalities usage, and the outcome of children with critical COVID-19. Methods: This is a retrospective study in COVID-19 children with respiratory distress who were treated in the COVID-19 isolation PICU room of Saiful Anwar General Hospital for one year. The data was gained from the medical record and analyzed descriptively. Data were analyzed using Ms. Excel for Windows. Results: A total of 51 children with COVID-19 were admitted to Saiful Anwar general Hospital in one year period, with 12 of them in critical condition and 6 children require mechanical ventilation. The main signs developed were fever and dyspnea. Invasive mechanical ventilation applicated in 5 patients, and only 1 patient received Non-Invasive Ventilation (NIV). The mean of PEEP used in invasive ventilation is 7-9 cmH2O, lower than ESPNIC’s recommendation of 8-10 cmH2O. Length of ventilator usage is 2-21 days, with 2 patients passed away, both with a comorbid and organ system injury. Conclusion: The mechanical ventilation setting must be determined individually based on the patients’ condition, despite several guidelines providing the recommendation.
Global climate change issues, natural disasters and their impact on Indonesian children Kurniawan Taufiq Kadafi; Dimas Dwi Saputro; Martinus M. Leman; Aslinar; Badai Buana Nasution; Dimas Tri Anantyo; Niken Wahyu Puspaningtyas; Fathy Zuandy Pohan; I Nyoman Arie Purwana; Muhammad Reza; Jaya Ariheryanto Effendy; Yogi Prawira; Piprim Basarah Yanuarso,
Pediatric Sciences Journal Vol. 3 No. 1 (2022): (Available online 1 June 2022)
Publisher : Medical Faculty of Brawijaya University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/pedscij.v3i1.35

Abstract

Climate change that contributes to the destruction of the earth is one of the impacts of human behavior. One example of damage to the earth due to human behavior is global warming. One of the effects of global warming is the melting of permafrost. Melting of glaciers due to global warming will result in an isostatic rebound phenomenon, where melting glaciers will cause the weight of the earth's crust to decrease and it is easy to move and bounce, resulting in the movement of earth faults and increased activity in the magma chamber (increased seismic activity). The big impact is the occurrence of natural disasters that not only occur in parts of the world where glaciers melt but in other parts of the world far from where glaciers melt. Natural disasters that can occur are earthquakes, volcanic eruptions, tsunamis, and landslides. Global warming will also have an impact on the emergence of disease outbreaks. Indonesia is the meeting place of three major tectonic plates in the world, namely the Eurasian plate, the Indo-Australian plate and the Pacific plate. In addition, Indonesia is also located in the Pacific ring of fire, making Indonesia an area with high volcanic activity and seismic activity. Climate change will increase the risk of disasters in Indonesia. The long experience of the Indonesian people in dealing with natural disasters that often occur should be used as a strategy to prevent and reduce the impact of disasters in the future.
Comorbidities as risk factors for clinical outcomes in pediatric patients with COVID-19: a comprehensive literature review Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Rakhman Tyas Perdana; Takhta Khalasha
Pediatric Sciences Journal Vol. 3 No. 2 (2022): Available online : 1 December 2022
Publisher : Medical Faculty of Brawijaya University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/pedscij.v3i2.40

Abstract

Background: The population that in a high risk to have a svere COVID-19 infection is children. The difficulties can influence the risk of controlling their hygiene and be worsened by the immaturity immune system, especially in children with comorbidities. Moreover, this problem needs to be prioritized in children. Despite in worldwide spread of severe COVID-19 infection, there are limited data regarding severe COVID-19 disease in children. Thus, we investigated the effects of comorbidities as risk factors for clinical outcomes in paediatric patients with COVID-19. Methods: This comprehensive literature review was from the PubMed, Google Scholar, and Science Direct databases through January 2021. The keywords used to obtain the literature include “COVID-19”, “coronavirus”, ” pediatric”, ”children”, ”severity”, ”comorbidity”, ”mortality”, ”death,” and “intensive”. The article with the inclusion criteria was involved. The information about the COVID-19 severity and underlying comorbidities in children were the main criteria that were enrolled. Results: The severe clinical risk factors in paediatric patients with COVID-19 that are reported most often are chronic lung disease (including asthma) (4312 critical patients), obesity (1007 critical patients), diabetes mellitus (815 patients), cardiovascular disorders (677 patients) and neurological disorders (542), prematurity (183 patients) and immunosuppression conditions including malignancy (143 patients). Other conditions in the form of hematological disorders, airway abnormalities, malnutrition and gastrointestinal disorders can also contribute to the clinical severity of paediatric COVID-19 patients. Conclusion: Children with underlying diseases such as obesity, chronic lung disease, cardiovascular disease, and neurologic disease had a higher risk of severe COVID-19 than children without comorbidities.
Difference in outcomes of pediatric septic shock after fluid resuscitation according to the Ultrasound-guided Fluid Resuscitation (USFR) and American College of Critical Care Medicine (ACCM) protocols: A randomized clinical trial Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Nelly Pramita Septiani; Irene Ratridewi; Savitri Laksmi Winaputri
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.49-56

Abstract

Background Sepsis is a major cause of morbidity and mortality in children. The American College of Critical Care Medicine (ACCM) protocol currently in use in the management of septic shock carries a risk of fluid overload. With the use of ultrasonographic monitoring, the Ultrasound-guided Fluid Resuscitation (USFR) protocol may reduce the incidence of fluid overload and mortality. Objective To assess the difference in outcomes of fluid resuscitation in pediatric septic shock using the USFR vs. ACCM protocols. Methods This randomized clinical trial involved 36 subjects randomized equally into the USFR and ACCM groups. After randomization, each subject was given fluid resuscitation starting at 20 mL/kg and repeated every 5-10 minutes as needed, according to the ACCM protocol. After fluid resuscitation was given, patients in the ACCM group were evaluated for clinical signs, liver span, and rhonchi, whereas those in the USFR group underwent USCOM examination for cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI). After 60 minutes, subjects in both groups were re-assessed for clinical signs, USCOM, pulmonary edema using lung ultrasound score (LUS), and liver span. Subjects were blinded as to the protocol they received. We compared 24-hour and 72-hour mortality rates, clinical improvement of shock at 60 minutes, cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI), as well as pulmonary edema and hepatomegaly, between the two groups. Results At 60 minutes after resuscitation, there were significant differences between the ACCM and USFR groups in the proportion of clinical improvement (0/18 vs. 5/18, P=0.016), pulmonary edema (15/18 vs. 4/18, P<0.001), and hepatomegaly (16/18 vs. 5/18, P<0.001). Mortality rates at 24 hours and 72 hours in the ACCM vs. USFR groups were 17% vs. 12% (P=0.199) and 78% vs. 39% (P=0.009), respectively. Conclusion The USFR protocol reduces the occurrence of fluid overload and leads to a lower mortality rate at 72 hours compared to the ACCM fluid resuscitation protocol.
Use of hemodynamic and laboratory monitoring tools to reduce the risk of mortality from pediatric septic shock Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Ika Maya Suryaningtias; Irene Ratridewi; Savitri Laksmi Winaputri
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.35-48

Abstract

Background Early recognition of septic shock in terms of clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters is a fundamental challenge in the emergency room and intensive care unit for early identification, adequate management, prevention of disease progression, and reduction of mortality risk. Objective To evaluate for possible correlations between survival outcomes of post-resuscitation pediatric septic shock patients and parameters of clinical signs, macrocirculatory hemodynamics, as well as microcirculatory laboratory findings. Methods This prospective, study was conducted in the PICU at Saiful Anwar Hospital, Malang, East Java. Inclusion criteria were children diagnosed with septic shock according to the 2005 Surviving Sepsis Campaign (SSC) criteria, aged >30 days-18 years, who were followed up for 72h after resuscitation. The measured variables such as cardiac index (CI), systemic vascular resistance index (SVRI), stroke volume index (SVI) were obtained from ultrasonic cardiac output monitor (USCOM). Blood gas and lactate were obtained from laboratory findings. Heart rate, pulse strength, extremity temperature, mean arterial pressure (MAP), systolic blood pressure (SBP), capillary refill time (CRT), Glasgow coma scale (GCS), and diuretic used were obtained from hemodynamic monitoring tools. Survival outcomes of post-resuscitation pediatric septic shock patients were noted. Results There was a significant correlation between the outcomes of the pediatric septic shock patients 72h after fluid resuscitation and clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters. After the 6th hour of observation, strong pulse was predictive of survival, with 88.2% area under the curve (AUC). At the 12th hour of observation, MAP >50th percentile for age was predictive of survival, with 94% AUC. Conclusion For pediatric patients with septic shock, the treatment target in the first 6 hours is to improve strength of pulse, and that in the first 12 hours is to improve MAP >50th percentile for age to limit mortality.
Procalcitonin level, neutrophil to lymphocyte count ratio, and mean platelet volume as predictors of organ dysfunction and mortality in children with sepsis Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Dian Maharani; Irene Ratridewi; Savitri Laksmi Winaputri
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.14-20

Abstract

Background Procalcitonin (PCT) level is one of known biomarker in septic diagnosis, but limited studies report its benefit in predicting the outcomes of children with sepsis. Neutrophil to lymphocyte (NLR) and mean platelet volume (MPV) are simple biomarkers of inflammation that can be measured in routine hematological examination which role in predicting organ dysfunction remain unclear. Objective To understand the correlations between PCT level, NLR, and MPV, tested in the first day of admission with outcomes of septic children in intensive care unit. Methods This retrospective cohort study obtained the data from medical record of pediatric patients admitted in PICU and HCU since January 2019. The inclusion criteria were children aged 1 months to 18 years with sepsis; whie exclusion criteria were patients with congenital heart disease, hematologic disease, malignancy, and length of care in intensive care unit less than 3 days or more than 28 days. The PCT, NLR, and MPV levels were assessed in the first day of admission. Organ dysfunction was identified using qSOFA score more than 2 points. Results Sixty-nine septic children were reviewed. Procalcitonin level in the first day of admission correlated significantly with qSOFA score in the third day of admission (R= 0.639; P=0.000); as well as with mortality (R=0.747; P=0.000). Receiver operating characteristic (ROC) curve of PCT level in the first day of admission had area under curve (AUC) of 0.922 to predict organ dysfunction (cut off 3.425; sensitivity 95.8%; specificity 52.4%) and AUC of 0.952 to predict mortality (cut off 21.165; sensitivity 96.4%; specificity 78%). Moreover, NLR in the first day of admission correlated significantly with qSOFA in the third day of admission (R=0.407; P=0.001), but did not correlate with mortality. The ROC of NLR to predict organ dysfunction was 0.829 (cut off 3.52; sensitivity 87.5%; specificity 66.7%). There was no correlation between MPV in the first day of admission with qSOFA score in the third day of admission neither with mortality. Linear regression test showed that PCT level and NLR in the first day of admission simultaneously had correlated with qSOFA score in the third day of admission (R=0.696; P= 0.000) and mortality (R=0.748; P=0.000). Meanwhile, PCT and MPV simultaneously had correlation with qSOFA score in the third day of admission (R=0.688; P=0.000) and mortality (R=0.733; P=0.000). Moreover, NLR and MPV simultaneously had correlation with qSOFA score in the third day of admission (R=0.453; P=0.002). All three independent variables (PCT level, NLR, and MPV) simultaneously correlated with qSOFA score in the third day of admission (R= 0.744; P=0.000) and mortality (R=0.739; P=0.000). Conclusion There are significant correlations between each, PCT level and NLR in the first day of admission with qSOFA score in the third day of admission as well as with mortality. There is no correlation between MPV in the first day of admission with qSOFA score in the third day of admission, neither with mortality. There are significant correlations between PCV level and NLR with or without MPV with qSOFA score in the third day of admission as well as with mortality.
Global impact of climate change on children's health in the world Kurniawan Taufiq Kadafi; Dimas Dwi Saputro; Martinus Martin Leman; Aslinar; Badai Buana Nasution; Dimas Tri Anantyo; Niken Wahyu Puspaningtyas; Fathy Zuandy Pohan; I Nyoman Arie Purwana; Muhammad Reza; Jaya Ariheryanto Effendy; Yogi Prawira; Piprim Basarah Yanuarso
Pediatric Sciences Journal Vol. 4 No. 1 (2023): (Available online: 1 June 2023)
Publisher : Medical Faculty of Brawijaya University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/pedscij.v4i1.57

Abstract

Climate change has a close relationship with the greenhouse effect. The greenhouse effect is needed by the earth, but if there are too many greenhouse gases in the atmosphere this will increase the earth's temperature. Children are a group of people who have a high vulnerability to climate change. Climate change will affect children's health through 4 impacts, namely direct impacts on children's health, impacts on children's health through ecosystems, impacts on children's health through human behavior, and health impacts on children due to natural disasters. To anticipate the impact of climate change on children's health, parents and the government must take anticipatory steps so that children can be saved from the extreme dangers of climate change.
Co-Authors Aslinar Dian Maharani Dimas Dwi Saputro Dimas Tri Anantyo Erviani Maulidya Fathy Zuandy Pohan Husnul Asariati I Nyoman Arie Purwana Iin Tri Listiyanti Nugrahani Ika Maya Suryaningtias Irene Ratridewi Jaya Ariheryanto Effendy Martinus M. Leman Martinus Martin Leman Muhammad Reza Nasution, Badai Buana Nelly Pramita Septiani Niken Wahyu Puspaningtyas Piprim Basarah Yanuarso Piprim Basarah Yanuarso, Rahmawati Aminingrum Rakhman Tyas Perdana Saptadi Yuliarto Saptadi Yuliarto Saptadi Yuliarto Savitri Laksmi Winaputri Takhta Khalasha William Prayogo Susanto Yogi Prawira