Predictor of mitral valve regurgitation severity and left ventricular dilatation using amino-terminal pro-brain natriuretic peptide marker in pediatric rheumatic heart disease.

Background: Early rheumatic heart disease (RHD) is characterized by valve regurgitation, leading to ventricular distention and possible elaboration of amino-terminal pro-brain natriuretic peptide (NT-proBNP). Methods: Thirty-one children with RHD were entered in the study. Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and cardiac function, thus will be classified into three groups: mild, moderate, and severe mitral valve regurgitation (MR), with and without left ventricular (LV) dilatation. At the time of echo, venous blood samples were drawn; thus, NT-proBNP levels were measured using sandwich immunoassay. Results: The median NT-proBNP levels in mild, moderate, and severe MR were 32.34, 120.75, and 7094 pg/ml, respectively. The median NT-proBNP levels in patients with and without LV dilatation were 3045 and 30.82 pg/ml. There was a significant correlation between the severity of MR and NT-proBNP levels (P < 0.001), thus a significant correlation between LV dilatation and NT-proBNP levels (P = 0.013). A cutoff value of 2598.50 pg/ml was obtained with a sensitivity value of 90% and a specificity of 90.5% for NT-proBNP levels against severe MR. A cutoff value of 199.35 pg/ml was obtained with a sensitivity value of 73.3% and a specificity of 75% for NT-proBNP levels on LV dilatation. A cutoff value of 2598.50 pg/ml was obtained with a sensitivity value of 85.7% and a specificity of 79.2% for NT-proBNP levels against severe MR with LV dilatation. Conclusion: There was a significant relationship between NT-proBNP levels and the severity of MR and LV dilatation in children with RHD.

Predictors of neurocognitive and psychological disorders in children after intensive care admission: A prospective cohort study.

Background and Aims: Children admitted in the pediatric intensive care unit (PICU) often deal with long-term morbidities affecting physical, cognitive, emotional, social, and psychiatric symptoms. We aimed to identify the internal and external factors which predict the occurrence of neurocognitive and psychological disorders in survivors at 3 months after PICU discharge. Methods: We identified 53 critically ill children, ages 4-18 years old, admitted in PICU for more than 24 h, and survived. We evaluated neurocognitive disorder with Pediatric Cerebral Perfomance Category (PCPC) and psychological disorders with Strengths and Difficulties Questionnaire (SDQ) at the time of PICU discharge and repeated in 3 months afterward. We evaluated the internal and external risk factors related to neurocognitive and psychological disorders in PICU survivors. The internal risk factors were age, gender, family composition, and socioeconomic status. The external risk factors were: surgical intervention, neurological disease, predicted death rate by pediatric index mortality (PIM)-2 score, PICU length of stay (LOS), days of mechanical ventilation, and the number of therapeutic interventions. Results: There were significant improvement in neurocognitive disorders (p < 0.001), peer problems, (p = 0.01), and prosocial behaviors (p = 0.00) in children at 3 months after the PICU discharge. Age of 4-5 years has a significant effect on neurocognitive disorders (p = 0.04), while male gender (p = 0.02), low-social economy, non-intact family composition (p = 0.01), neurological disease (p = 0.04), surgical intervention (p = 0.01), and TISS score (p = 0.00) have a significant effect on psychological disorders in children at 3 months after the PICU discharge. Conclusion: Neurocognitive disorders, peer problems, and prosocial behaviors improved in a few patients 3 months after PICU discharge. Age of 4-5 years was a risk factor of the persisted neurocognitive disorder, whereas male gender, low-social economy, non-intact family composition, neurological disease, surgical intervention, and TISS score were risk factors of persisted psychological disorder at 3 months after PICU.

Corrigendum on: Pediatric COVID-19: Report from Indonesian pediatric society data registry.

[This corrects the article DOI: 10.3389/fped.2021.716898.].

Impact of restrictive versus liberal transfusion and clinical outcomes in critically ill children: A retrospective observational study.

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.

Parents' Perspectives Toward School Reopening During COVID-19 Pandemic in Indonesia-A National Survey.

Background: All sectors are affected due to COVID-19 pandemic occurring worldwide, including the education industry. School closure had been taking place for more than a year in Indonesia. Despite the controversies, Indonesian government had decided to begin school reopening. Objectives: This study aims to assess parental readiness for school reopening, and factors affecting parental attitude toward school reopening. Methods: A cross-sectional study using online questionnaire distributed via official Indonesian Pediatric Society (IPS) official social media account collected between March and April 2021. The questionnaire contained the general characteristics of study participants, parents' knowledge, and perspectives on COVID-19, and health protocols for school reopening. Results: A total of 17,562 responses were collected, of which 55.7% parents were ready to send their children to school should school reopens. Factors significantly contribute to parental decision to keep their child at home were: presence of vulnerable population at home [OR = 1.18 (1.10-1.27), p < 0.001], children with comorbidities [OR = 2.56 (2.29-2.87), p < 0.001], perception of COVID-19 as a dangerous disease [OR = 28.87 (14.29-58.33), p < 0.001], experience with COVID-19 positive cases in the community [OR = 1.75 (1.61-1.90), p < 0.001], COVID-19 related death in the community [OR = 2.05 (1.90-2.21), P < 0.001], approval for adult COVID-19 vaccination [OR = 1.69 (1.53-1.87), p < 0.001], and ownership of private transportation [OR = 1.46 (1.30-1.66), p <0.001]. Conclusion: We identified several factors affecting parental perception on school reopening during COVID-19 pandemic that should be addressed. This study can be used for policy-maker to make further recommendations and health educations prior to school reopening in Indonesia.

Clinical review of High Flow Nasal Cannula and Continuous Positive Airway Pressure in pediatric acute respiratory distress.

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.

Pediatric COVID-19: Report From Indonesian Pediatric Society Data Registry.

Background: Indonesia has a high number of COVID-19 cases and mortalities relative to not only among the Asia Pacific region but the world. Children were thought to be less affected by the virus compared to adults. Most of the public data reported combined data between adults and children. The Indonesian Pediatric Society (IPS) was involved in the COVID-19 response, especially in the area of child health. One of IPS's activities is collecting data registries from each of their chapters to provide a better understanding of COVID-19 in children. Objective: The objective of this study was to share the data of suspected and confirmed COVID-19 cases in children from IPS's COVID-19 data registry. Method: This is a retrospective study from the IPS's COVID-19 registry data. We collected the data of COVID-19 in children during March to December 2020 from each of the IPS chapters. We analyzed the prevalence, case fatality rate (CFR), age groups, diagnosis, and comorbidities of the children diagnosed with COVID-19. Result: As of December 21, 2020, there were 35,506 suspected cases of children with COVID-19. In total, there were 522 deaths, with a case fatality ratio (CFR) of 1.4. There were 37,706 confirmed cases with 175 fatalities (CFR 0.46). The highest mortality in confirmed COVID-19 cases was from children ages 10-18 years (42 out of 159 cases: 26%). The most common comorbidity and diagnosis found were malignancy (17.3%) and respiratory failure (54.5%). Conclusion: The CFR of confirmed COVID-19 cases in children in Indonesia is high and should be a major public concern.

Determining pediatric fluid responsiveness by stroke volume variation analysis using ICON® electrical cardiometry and ultrasonic cardiac output monitor: A cross-sectional study.

PURPOSE: The purpose is to determine the adequacy fluid responsiveness by the validity and cut off point of stroke volume variation (SVV) usingelectrical cardiometry, ICON® (Osypka Medical, Berlin, Germany) and ultrasonic cardiac output monitor (USCOM) and to recognize cut off point of tidal volume in shock children with mechanical ventilation. MATERIALS AND METHODS: A cross-sectional study was conducted from March 2017 to September 2017 in a single center. The selection of subject through consecutive sampling. Measurements of SVV and stroke volume (SV) using USCOM and ICON were performed before and after fluid challenge. The tidal volume of individuals was measured and recorded. RESULTS: Analysis was performed in 45 patients with median age of 14 months and 62.2% of male population. It showed that the sensitivity and specificity of ICON were 58% and 74%, respectively. The optimal cut off point of SVV using ICON was 16.5% and the area under the curve (AUC) value was 53% (95% confidence interval [CI] 35.9%-70%), P > 0.05 and cut off point of SVV using USCOM was 33.5% with the AUC value was 70% (95% CI 52.9%-87.7%), P < 0.05. The optimal cut off point of tidal volume to fluid responsivenes was 6.8 ml/kg BW and the AUC value was 44.6% (95% CI 27.4%-61.9%), P > 0.05. CONCLUSION: This study showed that electrical cardiometry (ICON) is unable to assess preload and the response of fluid resuscitation in children.

Differences in systemic humoral immune response among Balb/c mice administered with probiotic, LPS Escherichia coli, and probiotic-LPS E. coli.

BACKGROUND AND OBJECTIVES: The aim of this study was to compare the systemic humoral immune responses, including IgE, IgA, IgG and IgM levels in Balb/c mice administered a probiotic, LPS derived from Escherichia coli (E.coli), and probiotic-LPS derived from E. coli. MATERIALS AND METHODS: Thirty-two male Balb/c mice, 10-12 weeks of age with body weight ranging from 30-40 g were randomly divided into four experimental groups (n=8). The treatment regimens were as follows: Group 1, mice did not receive LPS or probiotic (control group); Group 2, mice received only LPS on the first day; Group 3, mice received probiotic for 7 days; Group 4, mice received LPS on the first day, and then continued, with probiotic for 7 days. The mice were observed for 8 days, and then, euthanized the next day (day 9). The serum was collected, and the levels of IgE, IgA, IgG and IgM were measured using ELISA. RESULTS: The humoral immune response was higher in the presence of a probiotic compared to that in the control; IgE (9.02 ± 0.58 units/ml, p=0.000), IgA (3.26 ± 0.99 units/ml, p=0.316), IgG (7.29 ± 0.24 units/ml, p=0.000), and IgM (4.01 ± 2.98 units/ml, p=0.505). When administered with LPS E. coli along with probiotic, the humoral immune response was the highest; IgE (10.68 ± 1.63 units/ml, p=0.000), IgA (8.34 ± 1.47 units/ml, p=0.000), IgG (9.96 ± 0.98 units/ml, p=0.000), and IgM (4.31 ± 1.05 units/ml, p=0.319) compared to the control group. CONCLUSION: Probiotic-LPS derived from E. coli treatment induced a higher humoral immune response (highest IgE, IgA, IgG and IgM levels) compared to treatment with probiotic only.