Correlation Between the Inferior Vena Cava/Aorta (Ivc/Ao) Ratio and Serum Lactate Levels in Children With Renal Disorder

Dzulfikar Djalil Lukmanul Hakim,1 Ahmedz Widiasta,2 Dedi Rachmadi,2 Sri Endah Rahayunigsih,3 Putria Rayani Apandi,3 Riyadi Adrizain,4 Muhamad Rinaldhi Akbar Martiano5 1Division of Emergency and Intensive Care, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin, Bandung, Indonesia; 2Division of Nephrology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin, Bandung, Indonesia; 3Division of Cardiology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin, Bandung, Indonesia; 4Division of Infection, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan, Sadikin, Bandung, Indonesia; 5Department of Pediatric, Faculty of Medicine, Universitas Padjadjaran, Bandung, IndonesiaCorrespondence: Dzulfikar Djalil Lukmanul Hakim, Division of Emergency and Intensive Care, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin, Jl. Pasteur No. 38, Pasteur, Bandung, Sukajadi, 40161, Tel +62 681221594677, Email [email protected]: Acute kidney injury (AKI) is common in critically ill children in the PICU, with incidence rates from 2.5% to 58%, impacting mortality and hospital duration. Early AKI detection is vital, but conventional hemodynamic monitoring often lacks specificity. This study investigates the relationship between the inferior vena cava/aortic (IVC/Ao) ratio and serum lactate levels as non-invasive indicators of renal hemodynamics and tissue perfusion in children. Understanding these parameters could improve early diagnosis, aid clinical decisions, and enhance outcomes for pediatric AKI patients, offering an accessible monitoring method for clinicians.Methods: This cross-sectional study involved 48 pediatric patients aged 5– 18 years showing Pediatric Early Warning Score (PEWS) ≥ 3 and diagnosed with renal disorders. Patients were admitted to the emergency department, high care unit, PICU, and pediatric ward at Dr. Hasan Sadikin Hospital, Bandung, between May and August 2023. AKI was diagnosed using pRIFLE or KDIGO criteria. The IVC/Ao ratio was assessed via transabdominal USG, and serum lactate levels were measured. Spearman correlation analysis was conducted to assess their relationship.Results: The median (IQR) IVC/Ao ratio was 0.91 (0.70– 1.10), and serum lactate levels were 1.5 (1.1– 2.4) mmol/L. Spearman correlation analysis revealed a negative correlation between the IVC/Ao ratio and serum lactate (rho = − 0.65, p < 0.001).Conclusion: A decrease in the IVC/Ao ratio correlates with an increase in serum lactate levels in children with AKI.Keywords: acute kidney injury, children, IVC/Ao, serum lactat

Epidemiology of sepsis in hospitalised neonates in Indonesia: high burden of multidrug-resistant infections reveals poor coverage provided by recommended antibiotic regimens

Background Neonatal sepsis is a leading cause of child mortality, and this burden is rising secondary to increasing antimicrobial resistance worldwide. There are marked global disparities in the burden of antimicrobial resistance, with Southeast Asia identified as a region of particular concern. Indonesia is the world’s fourth most populous country, with 4.2 million babies born each year. Despite this, there remains limited published data on the burden of neonatal sepsis and antimicrobial resistance in the country. Methods We conducted a 2-year analysis of the epidemiology of neonatal sepsis across three high-burden clinical settings in Indonesia, alongside an antibiotic point prevalence prescribing survey. Results Of 5439 blood cultures analysed, gram-negative bacteria predominated as causative pathogens for neonatal sepsis in Indonesia, with Klebsiella spp and Acinetobacter spp most common (prevalence 35% and 19%, respectively). Overall, the pathogens causing neonatal sepsis exhibit very low susceptibility to WHO-recommended antibiotic regimens for the treatment of neonatal sepsis, with only 25% coverage provided by aminopenicillins plus gentamicin (95% credible interval (CI) 22% to 29%) and 20% by third-generation cephalosporins (95% CI 17% to 23%). Almost half of all antibiotics prescribed to treat neonatal sepsis across the clinical settings included in our study were Watch and Reserve antibiotics. Conclusion Our multicentre study across three sites in Indonesia revealed neonatal sepsis is predominantly caused by Gram-negative pathogens, with very poor coverage provided by currently recommended empiric regimens. A high burden of multidrug-resistant pathogens drives empirical use of broad-spectrum antibiotics. There is an urgent need for new antibiotic regimens and infection prevention and control strategies to treat neonatal sepsis in regions with a high prevalence of multidrug-resistant infections

Hubungan Jumlah Trombosit dengan Manifestasi Perdarahan pada Pasien Infeksi Virus Dengue Anak yang Dirawat di Beberapa Rumah Sakit di Bandung Tahun 2015

Latar belakang. Trombositopenia merupakan salah satu kriteria diagnosis klinis infeksi virus dengue (IVD), perlu yang lengkap sebelum singkatan digunakan Pada kondisi trombositopenia, fungsi trombosit pada hemostasis terganggu dan hal ini dapat menyebabkan integritas vaskular berkurang yang mengarah pada terjadinya perembesan plasma/perdarahan. Perdarahan umum ditemukan pada IVD dan merupakan salah satu tanda bahaya yang harus diwaspadai. Tujuan. Mengetahui hubungan antara jumlah trombosit dan manifestasi perdarahan pada pasien IVD anak.Metode. Penelitian potong-lintang dengan data sekunder rekam medis pasien IVD anak yang dirawat di tujuh rumah sakit di Bandung periode Januari–Desember 2015. Data yang dikumpulkan meliputi jenis kelamin, usia saat terdiagnosis IVD, diagnosis IVD, jumlah trombosit saat dirawat inap, dan manifestasi perdarahan. Analisis data menggunakan Fisher-exact test pada program komputer SPSS 25.0. Penelitian ini telah mengantongi izin etik oleh Komite Etik Penelitian Kesehatan Fakultas Kedokteran Universitas Padjadjaran No. 1383/UN6.KEP/EC/2019.Hasil. Jumlah pasien paling banyak berada pada kelompok usia &gt;5–10 tahun (43,75%) dan didiagnosis DHF (50,83%). Jumlah pasien laki-laki (50%) sama dengan jumlah pasien perempuan (50%). Sebagian besar pasien (75,83%) mengalami trombositopenia (jumlah trombosit terendah ≤ 100.000 sel/mm3). Sebagian besar pasien mengalami perdarahan spontan sedang (93,33%) dengan epistaksis sebagai manifestasi perdarahan terbanyak (87,91%). Nilai signifikansi yang didapatkan dari analisis data adalah p=0,57 (p&gt;0,05).Kesimpulan. Tidak terdapat hubungan antara jumlah trombosit dan manifestasi perdarahan pada pasien IVD anak.</jats:p

Carbapenems for the Treatment of Pneumonia: A literature review regarding resistance, risk factors, and mortality

Carbapenem is one of antibiotic to treat respiratory infections such as pneumonia that frequently used in tertiary care facilities and started to create resistances. This study aims to review the resistance of carbapenems, assess the risk factors for resistance that leads to mortality, and the more effective antibiotic treatment options to overcome the resistance. Assessment of the use of carbapenems in pneumonia through previous studies were carried out by searching the articles in search engine databases in 2011 to 2021. Articles reporting carbapenems resistance, risk factors, and mortality were selected based on inclusion and exclusion criteria. Of 14 articles included in inclusion criteria, 4 studies reported the occurrence of resistance to gram-negative bacteria such as Acinetobacter aumanii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, and 10 articles reported risk factors and mortality. The risk factors for carbapenems resistance are the history of carbapenems use, duration of hospitalization, use of mechanical ventilation, high Simplified Acute Physiology Score (SAPS) scores, and high Acute Physiologic and Chronic Health Evaluation (APACHE). Carbapenems resistance causes mortality such as septic shock, high Sequential Organ Failure Assessment (SOFA) scores, and elevated risk at &gt; 60 years of age, female sex, and inappropriate choice of antibiotics. The results showed that imipenem has higher resistance than other carbapenems members, the risk factors for carbapenems resistance are dominated by a history of carbapenems use, mortality caused by high score SOFA, and colistin can be the current choice to overcome carbapenems resistance.</jats:p

Answers to common questions about COVID-19 vaccines in children with cancer

Background: The SARS-CoV-2 outbreak in 2020 evolved into a global pandemic, and COVID-19 vaccines became rapidly available, including for pediatric patients. However, questions emerged that challenged vaccine acceptance and use. We aimed to answer these questions and give recommendations applicable for use in pediatric patients with cancer by healthcare professionals and the public. Methods: A 12-member global COVID-19 Vaccine in Pediatric Oncology Working Group made up of physicians and nurses from all world regions met weekly from March to July 2021. We used a modified Delphi method to select the top questions. The Working Group, in four-member subgroups, answered assigned questions by providing brief recommendations, followed by a discussion of the rationale for each answer. All Working Group members voted on each recommendation using a scale of 1 to 10, 10 being complete agreement. A “pass” recommendation corresponded to an agreement ≥7.5. Results: We selected 15 questions from 173 suggested questions. Based on existing published information, we generated answers for each question as recommendations. The overall average agreement for the 24 recommendations was 9.5 (95% CI 9.4–9.6). Conclusion: Top COVID-19 vaccine-related questions could be answered using available information. Reports on COVID-19 vaccination and related topics have been published at record speed, aided by available technology and the priority imposed by the pandemic; however, all efforts were made to incorporate emerging information throughout our project. Recommendations will be periodically updated on a dedicated website