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: 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 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 Congenital heart disease (CHD) is the most common of all congenital lesions and is the most common type of heart diseases among children. Children with congenital heart disease are at increased risk of underweight, stunted and wasted. Wasted is a reflection of acute malnutrition, stunted is a reflection of chronic malnutrition while underweight is a reflection of both. OBJECTIVE To describe the prevalence of underweight, stunted and wasted among children with acyanotic and cyanotic CHD, in tertiary center in Bali, Indonesia. METHODS An observational study with cross sectional approach was conducted in children under 5 years old with newly diagnosed CHD in Sanglah Hospital, Bali. Data were collected from medical records.  Anthropometric z-scores based on WHO 2006 reference ranges were generated for each child including weight-for-age, height-for-age and weight-for-height z-scores. Diagnosis of CHD was retrieved based on echocardiography examination. The significance of the anthropometric status differences between acyanotic and cyanotic group were assessed using Pearson’s Chi Square. RESULTS From January 2017-December 2020, we found total 200 cases of CHD which 160 (80%) cases were acyanotic CHD with predominantly ventricle septal defect (38%) and 40 (20%) cases were cyanotic CHD with predominantly Tetralogy of Fallot with all variant (40%). The prevalence of underweight, stunted and wasted in acyanotic vs cyanotic CHD were: underweight (57.5% vs 40.0%, p=0.047), stunted (47.5% vs 65%, p=0.048) and wasted (67.5% vs 50%, p=0.039). CONCLUSION The prevalence of underweight, stunted and wasted among children with acyanotic and cyanotic CHD were high. Proportion of underweight and wasted were significantly higher in acyanotic CHD, while stunted was significantly higher in cyanotic CHD.

Background The prognosis of neonatal sepsis can be influenced by various risk factors, one of which is a deficiency of zinc micronutrient substances. Objective To assess for a potential association between serum zinc level and prognosis of infants with early-onset neonatal sepsis (EONS). Methods This prospective cohort study was done in neonates with clinical EONS from September 2017 until December 2018. Serum zinc level was measured on the first day of diagnosis and prognosis was assessed on the fourth day. The association between serum zinc levels and prognosis of EONS was analyzed by Chi-square test and logistic regression with adjustment for confounding variables. Results A total of 70 subjects were divided into two groups based on their serum zinc levels. A cut-off point of 75 ug/dL was used based on area under the curve (sensitivity 91.2% and specificity 93.7%), with accuracy 97.8% (95%CI 0.943 to 1.000; P=0.0001). Subjects with lowzinc level had a 16.8 times greater risk compared to subjects with high serum zinc (RR=16.81; 95% CI 4.35 to 65.02; P <0.0001). Multivariate analysis revealed that subjects with low serum zinc levels had 203.7 times greater risk of worsening than subjects who had a higher serum zinc level (RR 203.72; 95% CI 26.79 to 1549.17; P <0.0001). Covariates such as male sex, low gestational age (<37 weeks), low birth weight (<2,500 grams), asphyxia, Caesarean section delivery, and the presence of comorbidities did not have significant associations with outcomes of EONS (P >0.05). Conclusion Serum zinc level is associated with prognosis of early onset neonatal sepsis, with a cut-off of 75 μg/dL. The high level of serum zinc associates with a better prognosis.