Pertin Sianturi
Department of Child Health, Universitas Sumatera Utara Medical School, Medan, North Sumatra

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Accuracy of NADAS criteria to establish diagnosis in children with suspected congenital heart disease Rahmawati Rahmawati; Rizky Adriansyah; Yunnie Trisnawati; Juliandi Harahap; Pertin Sianturi; Ayodhia Pitaloka Pasaribu
Paediatrica Indonesiana Vol 63 No 4 (2023): July 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.4.2023.267-73

Abstract

Background The majority of congenital heart disease is diagnosed during evaluation of a murmur detected either during a routine follow-up or while assessing an intercurrent illness. NADAS criteria might be useful as a screening test to differentiate pathologic from innocent murmurs. Objective To assess the accuracy of NADAS criteria in diagnosing pathology in children with suspected congenital heart disease. Methods This diagnostic study included children aged 1 month - 12 years who visited the Outpatient Pediatric Cardiology Clinic at Haji Adam Malik General Hospital, Medan, North Sumatera. Inclusion criteria from history and physical examination were recurrent acute respiratory illness (ARI), poor nutritional status, failure to thrive, cardiac murmurs, and/or a history of cyanosis. Results Seventy children underwent NADAS screening, of whom 60 had CHD. In the <5-year age group, 63.3% had heart disease. All patients had poor nutritional status, both CHD and non-CHD patients. All CHD patients had an abnormal electrocardiogram (ECG), while 88.33% had a history of recurrent ARI, 80% had abnormal chest x-ray, and 55% had abnormal S2 heart sound on auscultation. A grade 3 or higher systolic murmur was found in 78.33% of patients who had CHD. There were 55 children who had a NADAS score of 3 or higher, of which 53 children with CHD and 2 children non CHD (1 of the 2 children non CHD showed only 3 minor criteria of the NADAS score and had infantile fibrosarcoma). The other 15 children had a NADAS score of less than 3 with 7 children with CHD and 8 children without CHD. Conclusion The NADAS criteria can be used as a screening test to diagnose disease in children suspected of having CHD for cut-off score at 3 (1 major + 2 minor), with 87.14% accuracy, 88.33% sensitivity, 80% specificity, and 0.883 AUC value.
Prophylactic efficacy of 400 vs. 200 mg/kg /day calcium gluconate to prevent neonatal hypocalcemia Liza Apsera; Pertin Sianturi; Selvi Nafianti
Paediatrica Indonesiana Vol 63 No 5 (2023): September - October 2023
Publisher : Indonesian Pediatric Society

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Abstract

Background Serum calcium is at its lowest level within 24–48 hours after birth, rendering the neonate vulnerable to hypocalcemia. In our center, despite prophylactic administration of 200 mg/kg/day calcium gluconate, the prevalence of neonatal hypocalcemia remains high. Aim To determine the prophylactic efficacy of 400 vs. 200 mg/kg/day calcium gluconate in preventing neonatal hypocalcemia. Methods A randomized clinical trial with a pre- and post-test experimental design was done on neonates who fasted or received only minimal enteral feeding. Subjects were randomized to receive either 400 mg/kg/day (intervention group) or 200 mg/kg/day (control group) of intravenous calcium gluconate. We compared serum ionized calcium levels on the first day of admission before calcium gluconate administration and on the third day of hospitalization between the intervention and control groups. Results The median ionized calcium levels in the intervention vs. control group before calcium gluconate administration was 1.16 (range 0.4-2.4) mmol/L vs. 1.15 (range 0.6-4.5) mmol/L , respectively (P=0.561). After three days of calcium gluconate administration, the median ionized calcium level was 1.19 (range 0.7-1.45) mmol/L vs. 1.19 (range 0.68-4.6) mmol/L in the intervention vs. control group, respectively (P=0.828). The difference in pre- vs. post-administration ionized calcium levels was significant within the intervention group (P=0.032), but not within the control group (P=0.128). Conclusion Prophylactic intravenous calcium gluconate at 400 mg/kg/day was not more effective in preventing neonatal hypocalcemia than 200 mg/kg/day.