Tjipta Bahtera
Department of Child Health, Universitas Diponegoro Medical School/Dr. Kariadi Hospital, Semarang, Central Java

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Early Ditection of Central Nervous System Infection by C-reactive Protein Examination of Cerebrospinal Fluid Tjipta Bahtera; Bagus Putu Ngurah Arsana; Maria Lidwina
Paediatrica Indonesiana Vol 32 No 5-6 (1992): May - June 1992
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (692.157 KB) | DOI: 10.14238/pi32.5-6.1992.144-52

Abstract

There are still many cases of bacterial meningitis in Indonesia. The highest morbidity rate are between 2 months until 2 years of age. The important factors that influence the success of treatment are early diagnosis and detection of the cause. C-reactive protein (=CRP) could be found in the spinal fluid of meningitis patients. The aim of this study is to judge the ability of CRP as a tool in making diagnosis as soon as possible whether there is a bacterial infection of the central nervous system and to compare it with the result of the spinal fluid culture. Also to compare the ability of it a conventional or routine examination of the spinal fluid was done. This was a prospective study on 30 children that were admitted in the child ward of Kariadi Hospital, Semarang during the first of April until the and of july 1990. The ages of the children were between one month until 14 years, with clinical symptoms such as fever, seizure and neurological disorders. CRP examination was done with Latex Agglutination method. The result of CRP examination on spinal fluid showed that the sensitivity was 91.6% , the specificity 94.4% , the positive prediction value 91.6% and the negative prediction value 94.4%. As a conclusion, CRP examination of spinal fluid gives better results than the conventional or routine examination in distinguishing bacterial meningitis from non bacterial meningitis.
Neurological Sequalae in Survivors of Perinatal Asphyxia Tjipta Bahtera; Santoso Suroso; Bambang Darmanto
Paediatrica Indonesiana Vol 32 No 7-8 (1992): July - August 1992
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (658.108 KB) | DOI: 10.14238/pi32.7-8.1992.169-77

Abstract

Perinatal asphyxia is the most common cause of either death or severely handicapped survivors. Perinatal asphyxia can be identified by one, five, ten minutes APGAR scores less than 7. Prolonged asphyxia produce hypoxemia, acidosis, hypercapnia, thus diminishing cerebral blood flow, which in turn results in clinical patterns of Hypoxic - Ischemic Encephalopathy (HIE). The atm of this study was to evaluate the accuracy of clinical observation on newborn asphyxia to predict the presence of neurological deficits connected with blood gas analysts investigation. Thirty eight newborn babies who bad APGAR scores of less than 7 as an asphyctic newborn baby group compared with an equal number of normal babies as control group. Physical and neurological examinations were performed immediately after birth and at six months of age. Two of the 38 infants who bad perinatal asphyxia died several hours after birth. Two of the 31 of the surviving infants with a historical of perinatal asphyxia bad cerebral palsy. One of the two babies with cerebral palsy bad epilepsy. Twenty nine of the 31 of the surviving infants with a history of perinatal asphyxia with or without mild HIE showed normal neurological outcomes. All of the normal newborn babies as control showed normal neurological outcome. One infant with cerebral palsy and one infant who bad cerebral palsy with epilepsy bad a history of a severe degree of HIE and moderate degree of Hm with neonatal convulsion respectively. One of the 2 infants with cerebral palsy bad severe hypoxia and none on the infants with normal neurological outcome exhibited Pa02 less than 50 mmHg. There were no significant differences ( p > 0.05) of the Pa02 PH and base deficit between the infants with a history of asphyxia and with a history of a vigorous baby, who bad a normal outcome. We concluded that postasphyxia encephalopathy was more accurate than a low APGAR score in predicting an adverse outcome, and the value of the Pa02 very important in predicting an encephalopathy.