AbstrakIkterus pada kolestasis merupakan refleksi dari keadaan patologis yang serius. Kolestasis-
Abstract
Cholestatic jaundice represents serious pathological condition. Septic-cholestasis is a kind of hepato-cellular cholestasis that occured during or after sepsis caused by biliary flow obstruction. This is a cohort study from February to June 2007 on neonatal sepsis patients at Neonatology ward Department of Child Health Faculty of Medicine University of Indonesia-Cipto Mangunkusumo General National Hospital. Aim of this study is to find out the incidence of intrahepatic cholestasis in neonatal sepsis
(AUC 0.903 and 0.903, respectively). Conclusion Axillary temperature measurement is as good as tympanic membrane temperature measurement and can be used in daily clinical practice or at home. By increasing the optimum fever cut-off point for axillary and tympanic membrane temperature to 37.8oC, we find sensitivity 81% and 88%, specificity 86% and 73%, PPV 95% and 91%, and NPV 95% and 91%, respectively.
Background Dengue shock syndrome (DSS) mortality is still high.Monitoring of blood lactate level is important to evaluate shock.Objectives The study were to review the difference between bloodlactate level of DSS and that of dengue hemorrhagic fever (DHF),to correlate blood lactate level with hypoxia state as shock riskfactors (PaO 2 , oxygen saturation, and anion gap) and to determinethe cut-off point of blood lactate level to predict shock.Methods The study was carried out at the Department of ChildHealth, Medical School, University of Indonesia, CiptoMangunkusumo Hospital, Jakarta, from January until July 2006.Three mL venous blood specimen was collected from all subjectsfor peripheral blood, blood gasses, serology, and blood lactateexaminations. This study consisted of a retrospective cohort anda cross sectional method. Data were analyzed with Chi-squaretest. Continous data tested using Mann-Whitney method. Toknow the correlation between blood lactate level and shock riskfactors we use logistic regression test.Results In DSS group, 73% shows hyperlactatemia (lactate =2mmol/L). Conversion of lactate means between two groups issignificantly different from day one to day two and three. Therewas a negative correlation between lactate level and pO 2 andoxygen saturation. Oxygen saturation is the only value that hasclinical correlation. Regressions analysis can be applied using Y= 7.05–0.05 X equation. The cut-off point of lactate level asmarker for shock by using ROC curve is 32.015 mmol/L with 70%sensitivity and 83.3% specificity.Conclusions Hyperlactatemia in DSS can be considered as a signfor unappropriate treatment of shock. Blood lactate level can beused as a biochemical marker for tissue hypoxia, to assess severityof the disease, as monitoring of treatment, and has prognosticvalue of DHF cases.
Latar belakang. Kandidemia menjadi salah satu masalah di PICU, angka kejadiannya meningkat setiap tahun dengan angka kematian yang tinggi, serta memperpanjang masa rawat di rumah sakit. Sampai saat ini, data insidens kandidemia pada anak masih terbatas. Tujuan. Mengetahui Background. Candidemia has become an important problem in PICU because the incidence has dramatically increased every year and with a high mortality rate as well as high health care costs. To date incidence data in children is limited. Objective. To know the incidence of candidemia in PICU RSCM. Methods. A retrospective study was conducted in Cipto Mangunkusuomo general hospital with medical record data recorded diagnosis of septic shock in children period from 1 january 2013 to December 31, 2014. Results. A total of 32 candidemia events in the period of data collection. The median age of patients was 12.8 months, 57.7% male sex. Nutritional status of patients some of which have mild malnutrition.There were 69.2 % was the case surgery and 30.8 % of patients non surgery.Using of steroid was 11.5%.At the treatment in PICU, 96.2 % of patients used ett, 100 % of patients used catheter vein central and catheter urin. Patients that received antibiotics > 15 days was 80.8%. The median initial PELOD day care in the PICU was 12.Patients received antifungal when 15.8 days care in the PICU.The outer covering of life is 65.4 % and die 34.6 %. Lenght of PICU stays was25,8 days.The underlying diseases that required PICU were 7.7% respiratory infection, 3.8%, neurology infection, 19.2% septic shock, 3.8% post head and neck surgery, 11.5% post thorac surgery, and 53.8 post abdomen surgery. Rate length of using ETT was 10.04 days, CVC 15.65 days, urine catheter 11.15 days. The most isolated candida from blood culture was candida parapsilosis. There was 76.8% received >2 antibiotics before antifungal injection. Conclusion. The incidens of candidemia was similar with other developing countries and found increased in patients with characteristic mild malnutrition, post surgical,using invasive medic al devices, and using antibiotics >15 days. Sari Pediatri 2016;18(3):182-6
Latar belakang. Berdasarkan berbagai penelitian, diperlukan skala nyeri yang divalidasi untuk menilai nyeri di ruang perawatan intensif anak dari aspek respon otonom dan evaluasi bentuk intervensi tata laksana nyeri yang diberikan.Tujuan. Mengetahui validitas alat pengukur skala nyeri non verbal pain scale (NVPS) yang dapat dipakai di ruang perawatan intensif anak.Metode. Subyek penelitian yang diberikan intervensi nyeri melalui berbagai prosedur pemeriksaan atau terapi, dinilai respon nyeri melalui perekaman video. Respon dinilai selama 2-10 menit sebelum, selama, dan setelah intervensi nyeri diberikan. Sebagai baku emas digunakan skala nyeri Wong Baker pain scale(WBPS)Hasil. Dari 38 sampel yang dinilai didapatkan sensitifitas NVPSR 85%, spesifisitas 66%, nilai prediksi positif 96%%, negatif prediksi negatif 50%. Nilai korelasi antara skala NVPSR dan WBPS adalah 0,95 (p<0,05).Kesimpulan. Non verbal pain scale revised(NVPSR) memiliki korelasi yang kuat dengan WBPS dalam menilai nyeri pada anak. Sensitifitas yang cukup tinggi sebagai alat skrening nyeri namun memiliki spesifitas yang sedang sebagai alat diagnostik nyeri pada anak.
Latar belakang. Anak yang dirawat di PICU (pediatric intensive care unit) Anak cenderung untuk mengalamimalnutrisi sejak masuk atau selama perawatan. Hal ini akan memperberat penyakit dasar dan komplikasinya,memperpanjang lama rawat, serta meningkatkan mortalitas. Perhitungan kebutuhan kalori yang tepat sertapemberian nutrisi yang adekuat dan sesuai merupakan target perawatan anak di PICU. Baik underfeedingataupun overfeeding dapat terjadi di PICU Anak selama perawatan.Tujuan. Mengetahui status gizi awal pasien masuk PICU Anak, pola pemberian nutrisi, serta faktor yangmemengaruhi pemberian nutrisi pada anak yang di PICU.Metode. Penelitian potong lintang dengan menggunakan data rekam medis pasien yang dirawat di PICUAnak dalam kurun waktu 3 bulan. Didapatkan 45 subjek ikut serta. Dari 45 data pasien didapatkan 127peresepan untuk menilai keseuaian peresepan dengan pemberian nutrisi pada pasien.Hasil. Penelitian ini mendapatkan 47,8% pasien malnutrisi saat awal masuk PICU Anak, 8,7% mengalamiobesitas. Pada hari kedua perawatan, 41,3% pasien mulai mendapat nutrisi. Underfeeding terjadi padapemberian kalori, protein, dan lemak. Selain itu, 44,9% underfeeding terjadi karena perdarahan salurancerna.Kesimpulan. Pemberian nutrisi pada pasien yang dirawat di PICU Anak merupakan hal yang sangat penting.Perlu perhitungan kebutuhan nutrisi yang cermat, pemberian nutrisi tepat yang sesuai kebutuhan pasienagar tidak terjadi malnutrisi yang lebih berat lagi.
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