Memandikan bayi segera setelah lahir masih umum dikerjakan di daerah tropis, meskipun sudah ada anjuran untuk memandikan bayi saat 2 sampai 6 jam setelah lahir. Sampai saat ini belum pernah diteliti kejadian hipotermia pada bayi yang segera dimandikan setelah lahir di Indonesia. Penelitian ini bertujuan untuk mengetahui pengaruh memandikan bayi segera setelah lahir terhadap perubahan suhu tubuhnya dan kemungkinan terjadinya hipotermia. Subyek penelitian ialah 125 bayi yang lahir pada bulan Maret 1999, terbagi dalam dua kelompok yaitu 59 bayi segera dimandikan dan 66 bayi tidak segera dimandikan setelah lahir. Tidak terdapat diantara kedua kelompok dalam hal rerata berat badan lahir, masa gestasi, suhu ruangan, jenis kelamin, cara persalinan, dan risiko infeksi. Rerata suhu tubuh di antara kedua kelompok pada menit ke-0 dan menit ke-30 tidak menunjukkan perbedaan bermakna, sementara pada menit ke-15 tampak suhu tubuh kelompok yang segera dimandikan lebih rendah secara bermakna daripada kelompok yang tidak segera dimandikan setelah lahir [36,84 (SB 0,25) O C berbanding 37,02 (SB 0,27) O C, p=0,0001]. Pada menit ke-15 setelah lahir ditemukan empat (6,8%) bayi mengalami hipotermia (suhu rektal < 36,5 O C) di antara kelompok yang segera dimandikan dan satu hipotermia (1,5%) di antara kelompok yang tidak segera dimandikan (p=0,134). Kesimpulan, memandikan bayi cukup bulan yang sehat segera setelah lahir akan mengakibatkan penurunan suhu tubuh bayi, tetapi secara statistik belum mengakibatkan hipotermia yang bermakna.

Background Obesity in adolescents is a known risk factor for cardiovascular disease mortality and sudden cardiac death. Obesity is associated with a wide variety of electrocardiogram (ECG) abnormalities. Objective  To assess prevalence and describe the ECG abnormalities in obese adolescents. Methods This cross-sectional study was conducted at Children’s Cardiology Clinic – Integrated Heart Center of Sanglah General Hospital, Denpasar, Bali, by recording ECGs of obese adolescents aged 11-15 years from several junior high schools from December 2016 to April 2017. The inclusion criteria were obese adolescents aged 11 to 15 years, who were willing to participate in the study and provided informed consent. Results A total of 78 ECGs of obese adolescents (60% male) were selected. Subjects’ mean weight and age were 82.6 (SD 15.2) kg and 13.2 (SD 1) years, respectively. Pre-hypertension was found in 25 (32%) subjects, while hypertension was found in 18 (23%) subjects. There were 29 (37%) subjects with abnormal ECGs. Sinus tachycardia was present in 13 (17%) subjects, and sinus arrhythmia was identified in 11 (14%) subjects. Eight (10%) patients experienced prolongation of QTc interval and 5 (6%) patients presented with prolongation of PR interval. There were no shifts of the P wave, QRS wave and T wave axes, changes of P wave morphology, low QRS voltage, T wave flattening, ventricular enlargement, or ST segment changes found in this study. Conclusion The prevalence of cardiac abnormalities based on ECG examination in obese adolescents is 37%, consisting of heart rhythm abnormalities, prolonged PR interval, and prolonged QTc interval.

Background: The most serious manifestation of rheumatic fever is carditis, as it can lead to chronic rheumatic heart disease. Neutrophil-to-lymphocyte ratio, platelet-to lymphocyte ratio and mean platelet volume have been accepted as novel indicators of the continuing inflammation that is correlated with the severity of valvular involvement in patients with rheumatic carditis. Objective: As a diagnostic study to investigate the correlation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume with the severity of carditis in children with rheumatic fever. Methods: This was a cross-sectional study at Sanglah Hospital, Bali. Data were collected retrospectively from medical records. Severity of carditis was characterised by a clinical, audible murmur during physical examination and demonstration of valvular involvement by echocardiography. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume were calculated from complete blood count. The correlation between parameters was assessed using Spearman’s correlation tests. Results: From January 2018 to December 2020, we found 45 cases admitted to Sanglah Hospital. Carditis was present in 40 (88.9%) subjects. Neutrophil-to-lymphocyte ratio had a strong positive correlation with severity of carditis (r = 0.66, p = 0.001), while platelet-to-lymphocyte ratio had a weak positive correlation with the severity of carditis (r = 0.23, p = 0.13) and mean platelet volume had a very weak negative correlation with the severity of carditis (r = −0.01, p = 0.95). Using a cut-off of 3.4, neutrophil-to-lymphocyte ratio predicted severe carditis with a sensitivity of 81.8% and specificity of 91.3%. Conclusion: There was a positive correlation between neutrophil-to-lymphocyte ratio and severity of carditis in children with rheumatic fever. Neutrophil-to-lymphocyte ratio might be used as a diagnostic tool to predict the diagnosis of carditis severity.

Background Short stature/stunting is common in developing

Background:The alternative device to close perimembranous ventricular septal defect (pmVSD) has been searched for better result, less complications and applicable for infants. However, the ideal device is still unavailable. We aimed to evaluate the effectiveness and outcome of transcatheter pmVSD closure using the KONAR-multi functional occluder (MFO).Methods: Clinical, procedural, follow-up data of pmVSD patients with symptom of heart failure or evidence of significant left to right shunt, growth failure, recurrent respiratory tract infection, and history of endocarditis who underwent transcatheter closure using the MFO were prospectively evaluated. Results:Between January 2016 and December 2017, there were complete records of 132 pmVSD children closed using MFO from eleven centers in Indonesia. The median of age was 4.5 (0.3-17.4) years; weight 14.8 (3.5-57) kg, defect size at the smallest part 3.4 (1.0-8.1) mm, flow ratio 1.6 (1.3-4.9), mean pulmonary artery pressure 18 (7-79) mmHg, fluoroscopy time 18 (3.8-91) and procedural time 75 (26-290) minutes. A retrograde approach was done in 41 (31%) patients. Procedures succeeded in first 2 Kuswiyanto et al.

BACKGROUND: Despite the advances in medical and surgical care have improved the survival rates of children with congenital heart disease (CHD), they still remain risky for nutritional, cognitive problems, and quality of life. Those impacts vary according to the severity of heart lesions and still manifested years after surgery. AIM: The objective of this study was to compare growth, development, and quality of life between cyanotic and acyanotic CHD in 52 patients aged 24–69 months old from June to January 2018 in Sanglah Pediatric Cardiology clinic used WHO Anthro software, The Mullen Scales of Early Learning and PedsQL Cardiac module. RESULTS: We found significant different proportion of underweight 11.5% in acyanotic children, 42.3% in cyanotic by weight/age z-score <−2SD (p = 0.033). Height/ age z-score <−3SD 38.5% in cyanotic versus 11.5% in acyanotic (p = 0.025). The cyanotic showed a significant difference in cognitive function, presented by early learning composite score (p = 0.044) particularly in gross motor (p = 0.034) and receptive language (0.047). Quality of life differs significantly between both groups in heart problem and therapy (p = 0.042), treatment anxiety (p = 0.016), cognitive problems (p = 0.038), and communication (p = 0.022). CONCLUSION: Development, growth problems, and lower quality of life are common in cyanotic children, thus highlight the need for longitudinal surveillance.

Background: Pneumonia is a respiratory disease that can cause a lot of morbidity and mortality. Factors that associated with severe pneumonia in children include toddler age, malnutrition, male sex, exclusive breastfeeding, incomplete immunization. This study aims to evaluate the probiotic effectiveness as adjuvant therapy in childhood pneumonia compared to placebo.Methods: This is a randomized, double-blind controlled trial among 54 children with severe pneumonia aged 2 months-5 years who received standard therapy and probiotics compared to standard therapy and placebo from August 2017 to July 2019. Both groups were evaluated for treatment outcomes after receiving 5 days of adjuvant therapy at Sanglah General Hospital, Bali, Indonesia which divided into Group I (n=27) (standard therapy and probiotics) and Group II (n=27) (standard therapy and placebo). Variables assessed in this study include the characteristic of subjects, length of stay, duration of fever, shortness of breath, retractions, rales, C-reactive protein (CRP), probiotics, and history of breastfeeding. Data were analyzed by SPSS version 20 for Windows. Results: Both groups were shown predominantly in male gender (66.67% and 59.26%), exclusive breastfeeding (88.89% and 77.78%), no malnutrition status (81.48% and 77.78%), and having complete immunization history (81.48% and 88.89%) in Group I and II, respectively. There was no statistically significant difference on the length of stay, length of fever, duration of the breath, length of subcostal retraction and decrease in CRP levels on both groups (p>0.05). Meanwhile, there was a statistical difference in rales duration (p=0.037). Multivariate analysis using Ancova found probiotics were able to reduce the duration of rales significantly by 5.87 hours (p=0.022; 95% CI: -10.89 – (-0.86)).Conclusion: This study concluded that adjuvant therapy with probiotics significantly reduced rales duration in children with severe pneumonia.

Background Global morbidities due to dengue viral infection increase yearly. The pediatric mortality rate from dengue shock syndrome (DSS) remains high. Early identification of the risk of recurrent shock may serve to increase awareness and reduce mortality. The Dengue Recurrent Shock Prediction Score (DRSPS) is a tool to predict recurrent shock in children with DSS, but the optimal cut-off point in our population is still unknown. Objective To assess the validity of the DRSPS by determining the optimal cut-off point that can be used in Indonesia Methods This cross-sectional prospective study was done at Sanglah Hospital, Denpasar, Bali, from January 2019. Risk of reccurent shock were classify based on DRSPS in all DSS patient, and they were observed whether they will experienced recurrent shock or not. Results Of 56 children with DSS, 27 subjects had recurrent shock and 29 subjects did not. The optimal DRSPS cut-off point was -189.9 for predicting recurrent shock, with 87.4% area under the curve (AUC), 81.5% sensitivity and 82.8% specificity. Conclusion The optimal cut-off point of DRSPS was -189.9 and it has good validity. The results of this study are expected not only to be used as the basis for further study, but to increase physician awareness in treating DSS patients.