Background and Aims Critically ill children with anemia often requires blood transfusion, which can cause several complications. It is important to decide when to start the red blood cell (RBC) transfusion; however, the guidelines is still lacking. The aim of this study was to compare restrictive and liberal transfusion strategy. Methods This is an observational retrospective study of critically‐ill children who receive RBC transfusion. Subjects categorized into two groups by initial hemoglobin (Hb), that is, restrictive (Hb ≤ 7 g/dl) and liberal (Hb ≤ 9.5 g/dl) strategy. In each group, subjects categorized based on: (1) Hb increment: high (increased ≥2.5 g/dl) and low (increase <2.5 g/dl) and (2) final Hb level: low (<7.0 mg/dl), moderate (7.0–10.0 mg/dl), and high (>10.0 mg/dl). Patient with hematologic or congenital disorder, severe malnutrition, chronic infection‐related anemia, and transfusion in Hb level ≥9.5 g/dl were exclude. Each patients were evaluated for the clinical outcome, which is: intensive care length of stay (IC‐LOS), length of mechanical ventilation (LoMV), and mortality rate. Results Clinical outcome and mortality rates of both transfusion strategies are similar. The mortality rates were lower in higher Hb increment and final Hb level ( p = 0.04 and p = 0.01, respectively). Multivariate analysis in all groups revealed mortality rate had moderate correlation with Hb increment (odds ratio [OR] = 0.694, 95% confidence interval [CI] 0.549–0.878; p = 0.002) and moderate correlation (OR = 0.642, 95% CI 0.519–0.795; p = 0.000) with final Hb level. The similar results was found after categorization based on transfusion strategy. Conclusion We conclude the restrictive and liberal transfusion strategy have a similar effect to IC‐LOS, LoMV, and mortality rate. High Hb increment (≥2.5 g/dl) and moderate‐high final Hb (≥7.0 g/dl) after transfusion reduce the mortality rate.

Acute Respiratory Distress Syndrome (ARDS) causes much morbidity and mortality in children. In mild to moderate ARDS, non-invasive ventilation (NIV) is the treatment of choice. Recently, there are 2 kinds of NIV used Continuous Positive Airway Pressure (CPAP) or High Flow Nasal Cannula (HFNC). Both of them can be used in various respiratory distress and have different physiological mechanisms. The effectiveness to improve the clinical parameter, morbidity, and mortality are similar between CPAP and HFNC. However, HFNC application is more tolerated in acute respiratory distress in children, with less nasal injury, lower heart rate inflicted, and better comfort index score.

We describe a child with acute fever and abdominal pain who developed rash and edema of extremities. Blood test revealed thrombocytopenia, lymphopenia, positive dengue-IgM, and hypoalbuminemia with elevated procalcitonin. Right pleural effusion revealed from chest x-ray. Diagnosed as dengue hemorrhagic fever (DHF) grade 1, however, at 7 th day of illness, altered mental status, respiratory and circulatory failure occurred. Laboratory examination showed marked thrombocytopenia, transaminitis, metabolic acidosis, elevated D-dimer, decrease fibrinogen, and elevated cardiac marker (troponin I and CKMB). The patient then developed catecholamine-resistant shock and did not survive after 48 hours. Although rapid test of SARS CoV-2 infection was negative, rapid deterioration with some unusual clinical feature suggest multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection. This case raises an awareness of MIS-C that clinical features resemble dengue infection.

Background: Coronavirus Disease-2019 (COVID-19) in children tend to have milder clinical manifestation. However, some develop critical conditions and require mechanical ventilation in the Pediatric Intensive Care Unit (PICU). Various modalities are recommended for mechanical ventilation, such as High Flow Nasal Cannula (HFNC), Continuous Positive Airway Pressure (CPAP), or invasive ventilation with intubation. This study aims to describe the clinical feature, ventilation modalities usage, and the outcome of children with critical COVID-19. Methods: This is a retrospective study in COVID-19 children with respiratory distress who were treated in the COVID-19 isolation PICU room of Saiful Anwar General Hospital for one year. The data was gained from the medical record and analyzed descriptively. Data were analyzed using Ms. Excel for Windows. Results: A total of 51 children with COVID-19 were admitted to Saiful Anwar general Hospital in one year period, with 12 of them in critical condition and 6 children require mechanical ventilation. The main signs developed were fever and dyspnea. Invasive mechanical ventilation applicated in 5 patients, and only 1 patient received Non-Invasive Ventilation (NIV). The mean of PEEP used in invasive ventilation is 7-9 cmH2O, lower than ESPNIC’s recommendation of 8-10 cmH2O. Length of ventilator usage is 2-21 days, with 2 patients passed away, both with a comorbid and organ system injury. Conclusion: The mechanical ventilation setting must be determined individually based on the patients’ condition, despite several guidelines providing the recommendation.