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Profil Jantung Pasien Akut Limfoblastik Leukemia Anak yang Mendapatkan Terapi Anthracycline WAÃ¢Â€Â™U, DAVID VICTORY; MULATSIH, SRI; MURNI, INDAH KARTIKA
Indonesian Journal of Cancer Vol 11, No 1 (2017): Jan-Mar
Publisher : Indonesian Journal of Cancer

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ABSTRACTAcute lymphoblastic leukemia (ALL) is the most common malignancy in children under fifteen years of age. Advanced cancer therapy with anthracycline has increased survival rate but also chronic health problem and the most iscardiovascular. This study aims to describe cardiac events of ALL patients who received anthracyline during chemotherapy. We conducted a cross sectional study of childhood ALL who were hospitalized at DR Sardjito hospital between April and June 2016. Electrocardiography (ECG) and echocardiography were performed. Results of this study shows childhood ALL who received anthracycline may suffer from cardiotoxicity. Cardiac events can be found in all stage of chemotherapy.ABSTRAKLeukemia limfoblastik akut (LLA) adalah keganasan yang paling banyak dialami anak di bawah usia 15 tahun. Kemajuan pengobatan kanker dengan anthracycline telah meningkatkan angka kesintasan penderita LLA dan masalah kesehatan kronik, terutama penyakit kardiovaskuler. Penelitian ini bertujuan untuk mengetahui kelainan jantung pada pasien LLA yang mendapatkan kemoterapi anthracyline. Penelitian dilakukan secara potong lintang dengan subjek anak penderita LLA yang dirawat di rumah sakit Dr. Sardjito antara AprilâJuni 2016. Pasien menjalani pemeriksaan elektrokardiografi (EKG) dan echocardiography. Penelitian ini menyimpulkan bahwa anak penderita ALL yang mendapatkan anthracycline dapat mengalami kardiotoksisitas. Kelainan jantung dapat ditemukan pada semua tahap kemoterapi.

Pola Kuman Pasien Pneumonia di Instalasi Rawat Intensif Anak (IRIA) RSUP Dr. Sardjito Amalia Setyati; Indah Kartika Murni
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 3 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

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Bacterial pattern of pneumonia patient admitted in pediatric intensive care unit (PICU) Dr. Sardjito General HospitalBackground: Pneumonia is an inflammation of the lung parenchyma. The causative agent of pneumonia is difficult to determinate. This study was to attemp the pattern of bacteria and antibiotic sensitivity of pneumonia, and to see the risk of pneumonia mortality by age and bacteria obtained from cultures.Methods: Data of tracheal aspirate and blood cultures and its sensitivity to antibiotics of pneumonia patients who admitted to PICU of Sardjito General Hospital Yogyakarta in January-June 2011 were collected retrospectively from medical records. Analyzed by using chi-square test and the relative risk is expressed by odds ratio.Results: Ninety-four isolates of bacteria were obtained. There are 63 of tracheal aspirate and 32 of blood specimens. Gram (+) were 39.36% and gram (-) were 60.64%. The most cultures of tracheal aspirate was Pseudomonas, which the sensitivity of imipenem, amikacin, fosfomisin, netilmisin were 81.25%, 80.95%, 76.19%, 68.42%. The sensitivity of Klebsiella pneumoniae to fosfomisin, imipenem, amikacin were 92.31%, 84.62%, 76.92%. All isolates of coagulase negative Staphylococcus (CONS) were resistant to cephalosporin, likely 100% were sensitive to vancomisin. The sensitivity of Pseudomonas aeruginosa in the blood to ciprofloxacin, chloramphenicol, amikacin, cefepime and ceftazidim, gentamicin netilmisin and imipenem were 93.75%, 87.50%, 81.25%, 75%, 68.75%. The odds ratio (OR) of pneumonia death of age <1 year was 1.6, as well as the OR of pseudomonas was 2.5.Conclusion: The bacteria found were Pseudomonas aeruginosa, Klebsiella pneumoniae and CONS. The sensitivity of imipenem, amikacin, fosfomisin and ciprofloxacin were good to the three kind of bacteria. Patient under 1 year old and Pseudomonas aeruginosa are risk factors for death in pneumonia.Keywords: Pneumonia, culture, antibiotics ABSTRAKLatar belakang: Pneumonia adalah peradangan pada parenkim paru-paru. Penentuan penyebab pneumonia adalah sulit, Tujuan penelitian ini adalah melakukan pemetaan pola kuman dan kepekaan antibiotik pada pneumoni, melihat risiko kematian pneumonia berdasarkan umur dan kuman yang didapatkan dari kultur.Metode: Data kultur aspirat trakeal dan darah beserta kepekaan terhadap antibiotik pasien pneumonia yang dirawat di Instalasi Rawat Intensif Anak (IRIA) RSUP Dr. Sardjito Yogyakarta Januari- Juni 2011 diambil secara retrospektif dari catatan medik. Data dianalisis menggunakan uji x 2, risiko relatif dinyatakan dengan rasio odd.Hasil: Didapatkan 94 isolat kuman. Aspirat trakeal ada 63, isolat spesimen darah 32 isolat. Bakteri gram (+) 39,36% dan gram (-) 60,64%. Dari kultur aspirat trakeal terbanyak Pseudomonas, kepekaan terhadap Imipenem 81,25%, amikasin 80,95%, fosfomisin 76,19%, netilmisin 68,42%. Kepekaan Klebsiella pneumonia terhadap fosfomisin 92,31%, imipenem 84,62%, amikasin 76,92%. Semua isolat Staphylococcus coagulase negative (CONS) resisten terhadap sefalosporin, namun 100% peka dengan vancomisin. Kepekaan Pseudomonas aeruginosa dalam darah: ciprofloxacin 93,75%, kloramfenikol 87,50% amikasin, cefepime, ceftazidim 81,25%, gentamisin dan netilmisin 75%, imipenem 68,75%. Rasio odd (RO) kematian pasien pneumonia umur <1 tahun 1,6, RO kematian karena kultur pseudomonas 2,5.Simpulan: Kuman utama adalah Pseudomonas aeruginosa, Klebsiella pneumonia dan CONS. Kepekaan imipenem, amikasin, ciprofloksasin dan fosfomisin baik terhadap ketiga kuman tersebut. Umur <1 tahun dan pseudomonas merupakan faktor risiko kematian pada pneumoni

Irrational use of antibiotics and clinical outcomes in children with pneumonia Yusuf Yusuf; Indah Kartika Murni; Amalia Setyati
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Pneumonia is a major cause of morbidity and mortality in children under five. Antibiotic treatment must be started immediately in children with pneumonia. The irrational use of antibiotics may increase morbidity and mortality in children with pneumonia.Obejctive To determine the prevalence of the irrational use of antibiotics and clinical outcomes in children with pneumonia.Methods We conducted a cross-sectional study in children with pneumonia who were admitted to the Pediatric Ward or PICU at Dr. Sardjito Hospital, Yogyakarta, from December 2010 to February 2013. Data were obtained from subjectsâ€™ medical records. Children with malnutrition, congenital heart defects, sepsis, shock, central nervous system disorders, syndromes, or other concomitant infections were excluded.Results Of 46 children who fulfilled the inclusion criteria, 13 (28.3%) used antibiotics irrationally and 7 (15.2%) died. Most subjects were aged less than 1 year (25 subjects, 54.3%) and 1 - < 5 years (18 subjects, 39.1%). The female to male ratio was 1:1. Most cases were referred from other hospitals (23 subjects, 50%). Twenty-eight (60.9%) subjects stayed in hospital > 7 days. Ampicillin was the most common first-line, empirical antibiotic used (32 subjects, 69.6%). Blood cultures were obtained in 20 (43.5%) patients, yielding no growth in 16 subjects, coagulase-negative staphylococci (CONS) in 3 subjects, and Pseudomonas aeruginosa in 1 subject. The irrational use of antibiotics was significantly associated with mortality in a univariate analysis [PR 6.35; (95%CI 1.40 to 28.69); P=0.006]. Conclusion The irrational use of antibiotics is common among children with pneumonia and is significantly associated with mortality.

Lung function test in children with left-to-right shunt congenital heart disease Carolina Kurniawan; Indah Kartika Murni; Sasmito Nugroho; Noormanto Noormanto; Roni Naning
Paediatrica Indonesiana Vol 58 No 4 (2018): July 2018
Publisher : Indonesian Pediatric Society

Background Increased pulmonary blood flow may lead to abnormal lung function in children with left-to-right (L to R) shunt congenital heart disease. This condition has been linked to considerable mortality and morbidity, including reduced lung function. Objective To assess for lung function abnormality in children with L to R shunt congenital heart disease. Methods We conducted a cross-sectional study involving children aged 5-18 years and diagnosed with L to R shunt congenital heart disease at Dr. Sardjito Hospital from March to May 2017. Subjects underwent spirometry tests to measure forced expiratory volume-1 (FEV-1), forced vital capacity (FVC), and forced expiratory volume-1 (FEV-1)/forced vital capacity (FVC). Results Of 61 eligible subjects, 30 (49.2%) children had atrial septal defect (ASD), 25 (41%) children had ventricular septal defect (VSD), and 6 (9.8%) children had patent ductus arteriosus (PDA). Spirometry revealed lung function abnormalities in 37 (60.7%) children. Restrictive lung function was documented in 21/37 children, obstructive lung function in 11/37 children, and mixed pattern of lung function abnormality in 5/37 children. Pulmonary hypertension was found in 21 children. There was no significant difference in lung function among children with and without pulmonary hypertension (P=0.072). Conclusion Abnormal lung function is prevalent in 60.7% of children with L to R shunt congenital heart disease, of which restrictive lung function is the most common. There was no significant difference in lung function among children with and without pulmonary hypertension.

Low peripheral oxygen saturation as a risk factor for brain abscess in children with cyanotic congenital heart disease Nadia Qoriah Firdausy; Indah Kartika Murni; Agung Triono; Noormanto Noormanto; Sasmito Nugroho
Paediatrica Indonesiana Vol 58 No 5 (2018): September 2018
Publisher : Indonesian Pediatric Society

Background Brain abscess is a severe infection of brain parenchyma, which occurs in 25-46% of cases of uncorrected cyanotic congenital heart disease. Low arterial oxygen saturation is the main risk factor for brain abscess in children with cyanotic congenital heart disease, however, the arterial oxygen saturation test is invasive and not routinely done in our setting. Objective To evaluate low peripheral oxygen saturation as a risk factor for brain abscess in children with cyanotic congenital heart disease. Methods We conducted a matched, case-control study at Sardjito Hospital, Yogyakarta for children aged less than 18 years with cyanotic congenital heart disease, from 2010-2016. Case subjects were children with brain abscess complications. The control group had only cyanotic congenital heart disease, and were matched for age and sex to the case group. During hospitalization due to the brain abscess complication in the case group, data regarding peripheral oxygen saturation, polycythemia, pneumonia, sepsis, dental caries and restricted pulmonary blood flow were collected and compared between both groups. Results During the study period, 18 children with cyanotic congenital heart disease had brain abscesses. This group was compared to the control group of 36 children. Bivariate analysis revealed that the lowest level of peripheral oxygen saturation (OR 0.92; 95%CI 0.85 to 0.98; P=0.02) and dental caries (OR 3.3; 95%CI 1.01 to 11.18; P=0.04) were significant risk factors for brain abscess. However, in the multivariate analysis, the only statistically significant risk factor associated with brain abscess was the lowest level of peripheral oxygen saturation (OR 0.92; 95%CI 0.86 to 0.99; P=0.04). Conclusion Low peripheral oxygen saturation is a significant risk factor for brain abscess development in children with cyanotic congenital heart disease. A decrease of 1% peripheral oxygen saturation may increase the risk of brain abscess by 8%.

Tuberculous pericarditis in adolescents: A case series Winda Paramitha; Indah Kartika Murni; Eggi Arguni; Dwikisworo Setyowireni
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

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Tuberculosis (TB) is one of the major causes of childhood mortality, especially in endemic areas. In 2013, the World Health Organization (WHO) estimated 550,000 new cases and 80,000 deaths due to TB among children. Around 70-80% of the cases were pulmonary TB, while the rest were extra-pulmonary TB.1 Tuberculous pericarditis accounts for only 8% of all TB cases, however, tuberculosis is the main cause of pericarditis in high-TB-burden countries, including Indonesia.2 The mortality rate reached 17-40% and is affected by treatment adequacy.3 Without adequate therapy, the mean life expectancy is 3.7 months, with only 20% surviving to the sixth month.4 A 2004 study reported that successful treatment of TB in children depends on several factors, such as treatment compliance, timing and accuracy of diagnosis, concurrent human immunodeficency virus (HIV) infection and its clinical stage of disease, malnutrition, and drug resistance.5 Adolescents and young adults are at the highest risks of having TB.6 We report here on three cases of tuberculous pericarditis in adolescents and their outcomes following pericardiocentesis and medication.

Methylprednisolone as an alternative therapy for Kawasaki disease: case series Yudha Fadhol Arafah; Sasmito Nugroho; Noormanto Noormanto; Nadya Arafuri; Indah Kartika Murni
Paediatrica Indonesiana Vol 60 No 5 (2020): September 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.5.2020.283-6

Kawasaki disease (KD), or mucocutaneous syndrome, is an acute, systemic vasculitis of small- and medium-sized arteries that predominantly affects patients younger than five years.1 KD is the leading cause of childhood acquired heart disease in the developed world.2 The incidence in those aged under 5 years varies widely throughout the world, accounting for 8.4 per 100,000 in the UK, 17.5 to 20.8 per 100,000 in the USA, and 239.6 per 100,000 in Japan.2 The diagnosis of classic KD is based on the simultaneous presence of high fever for 5 or more days with at least four of five other symptoms (bilateral conjunctival hyperemia, ulcerations of the lips and inflammation of the oral cavity, polymorphous rash, edema and desquamation of the extremities, and cervical lymphadenopathy), or fever associated with less than 4 of the diagnostic criteria and echocardiographic abnormalities of the coronary arteries.3

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.

Predictor factors of pulmonary hypertension in children with left-to-right shunting in acyanotic congenital heart disease Weny Inrianto; Indah Kartika Murni; Ida Safitri
Paediatrica Indonesiana Vol 61 No 3 (2021): May 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.3.2021.119-24

Background Left-to-right shunting in acyanotic congenital heart disease (CHD) is the most common type of defect in childhood heart disease. Limited access to specialist health services causes delays in CHD management. In limited resource settings, identification of factors that influence the occurrence of pulmonary hypertension is important in order to decide which patients should be prioritized for defect closure to prevent further complications. Objective To determine predictive factors of pulmonary hypertension after a left-to-right shunt CHD diagnosis. Methods This retrospective cohort study included children aged 1 month to 17 years with isolated atrial septal defect, or ventricular septal defect, or patent ductus arteriosus. Potential predictors studied were iron deficiency anemia, mitral regurgitation, pneumonia, and heart failure. Bivariate analysis was done with Chi-square test and multivariate analysis was done with Cox regression to determine the hazard ratio. Results Pulmonary hypertension occurred in 68 of 176 subjects. Iron deficiency anemia, mitral regurgitation, and pneumonia were not predictives of pulmonary hypertension. However, heart failure was a significant predictive factor for pulmonary hypertension, with a hazard ratio of 4.1 (95%CI 2.2 to 7.5; P=0.001). Conclusions Heart failure is a predictive factor of pulmonary hypertension in children with left-to-right shunting in acyanotic CHD.

Predictors of transcatheter closure cancellation in children with ventricular septal defect Artha Christin Yulianti; Indah Kartika Murni; Noormanto Noormanto; Sasmito Nugroho
Paediatrica Indonesiana Vol 61 No 6 (2021): November 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.6.2021.311-6

Background Ventricle septal defect (VSD) is the most common type of congenital heart disease in children. If definitive therapy delayed, failure to thrive and developmental delays can lead to decreased quality of life. The options for VSD closure include surgical and minimally invasive procedures with transcatheterization. Although transcatheterization is considered to be the safest therapy, the risk of complications can lead to cancellation of procedure. Objective To determine whether nutritional status, body height, VSD type and size, and type of device used were predictors of cancellation of transcatheter closure of VSD. Methods A retrospective cohort study using medical records was performed for all children who underwent transcatheter closure of VSD at Dr. Sardjito Hospital, Yogyakarta, Central Java, between January 2017 to March 2020. Cancellation of closure was defined as complications occurring during the procedure, such as cardiac conduction problems, valve regurgitation, and device embolization. Multivariate logistic regression analysis was done to determine independent predictors of closure cancellation. Results One hundred thirty-four children were enrolled. Independent variables that were significant predictors were doubly committed subarterial (DCSA) VSD type (OR 5.98; 95%CI 1.52 to 23.61; P=0.045), moderate VSD size (OR 15.59; 95%CI 4.67 to 52.06; P=0.001), and types of devices used: symmetric (OR 27.06; 95%CI 2.75 to 266.17; P=0.001), asymmetric (OR 16.46; 95%CI 2.15 to 210.0; P=0.001), and coil (OR 21.26; 95%CI 2.15 to 210.0; P=0.001). Taller body height was a protective factor against cancellation of the procedure (OR 0.98; 95%CI 0.96 to 1.00; P=0.008). Conclusion Significant predictors of cancellation of transcatheter VSD closure are DCSA VSD, moderate VSD size, as well as coil, symmetric, and asymmetric devices, and increased body height.

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