Presepsin as a promising biomarker for early detection of post-operative infection in children.

Background: Post-operative systemic inflammation response syndrome (SIRS) is an event that results from surgical trauma, white blood cells contact activation, and intra-surgical bacterial translocation, which is difficult to distinguish from sepsis. Presepsin is a novel biomarker that is increased since the early stages of bacterial infection and can be used to confirm the diagnosis of post-operative infectious complications. This study aimed to investigate the diagnostic performance of presepsin for post-operative infectious complications compared to other well-known biomarkers. Method: This cross-sectional study included 100 post-operative patients admitted to Cipto Mangunkusumo National Hospital and Bunda Hospital in Jakarta, Indonesia. The objective was to identify the optimal cutoff and trend of plasma presepsin concentration on the first and third day after surgery and to compare them with other biomarkers. Result: Plasma presepsin level was higher in the infection group compared to the non-infection group (median 806.5 pg/ml vs. 717 pg/ml and 980 pg/ml vs. 516 pg/ml on the first and third day, respectively). Presepsin levels tended to increase on the third post-operative day (median + 252 pg/ml) in children with infection. The opposite trend was observed in the non-infection group from the first to the third day (median -222.5 pg/ml). Presepsin delta, a three-day difference between the first and third post-operative day, had the best diagnostic performance compared to other biomarkers (Area Under the Curve 0.825). The optimal cutoff for presepsin delta to diagnose post-operative infection was +90.5 pg/ml. Conclusion: Serial assessments of presepsin levels on the first and third days post-surgery and their trends are helpful diagnostic markers for clinicians to detect post-operative infectious complications in children.

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

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

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.

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.

Mortality in children with positive SARS-CoV-2 polymerase chain reaction test: Lessons learned from a tertiary referral hospital in Indonesia.

BACKGROUND: The incidence of coronavirus disease 2019 (COVID-19) is still increasing rapidly, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aimed to describe the characteristics of children with COVID-19 with fatal outcomes in a tertiary referral hospital in Indonesia. METHODS: This cross-sectional study used data collected from the medical records of patients with COVID-19 admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from March to October 2020. RESULTS: During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, and 20 (40%) had a fatal outcome. The fatality rate was higher in patients aged ≥10 years, categorized with severe disease upon admission, PaO2/FiO2 ratio ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase and presepsin levels were found in all fatal cases. One patient met the criteria of multisystem inflammatory syndrome in children. CONCLUSION: Our work highlights the high mortality rate in paediatric patients with positive SARS-CoV-2 polymerase chain reaction test. These findings might be related to or co-incided with COVID-19 infection. Further studies are needed to improve understanding of the role of severe acute respiratory syndrome coronavirus-2 in elaborating the mechanisms leading to death in children with comorbidities.

Agreement test of transcutaneous bilirubin and bilistick with serum bilirubin in preterm infants receiving phototherapy.

BACKGROUND: This study compares the minimally invasive Bilistick and a noninvasive method with standard Total Serum Bilirubin (TSB) measurement in preterm newborns receiving phototherapy. We assess the agreement of Transcutaneous Bilirubinometer (TcB) and Bilistick bilirubin measurements with standard TSB measurement in preterm infants receiving phototherapy. METHODS: Bilirubin was measured by using TcB and Bilistick in 94 preterm infants in RSCM Jakarta Neonatal Ward from October 2016 to March 2017, with gestational ages of < 35 weeks, before phototherapy and after 24 and 48 h of phototherapy. RESULTS: There was significant correlation before, at 24 and 48 h of phototherapy between TSB and either TcB (r = 0.874; r = 0.889; r = 0.878 respectively; p < 0.0001), or Bilistick (r = 0.868; r = 0.877; r = 0.918 respectively; p < 0.0001). The mean difference and limits of agreement before, at 24 and 48 h of phototherapy between TcB and TSB were 0.81 ± 1.51 mg/dL (- 2.14 to 3.77 mg/dL); 0.43 ± 1.57 mg/dL (- 2.66 to 3.51 mg/dL); 0.41 ± 1.58 mg/dL (- 2.69 to 3.50 mg/dL), respectively. For Bilistick they were - 1.50 ± 1.47 mg/dL (- 4.38 to 1.38 mg/dL); - 1.43 ± 1.47 mg/dL (- 4.32 to 1.46 mg/dL); - 1,15 ± 1.31 mg/dL (- 3,72 to 1,42 mg/dL), respectively. CONCLUSIONS: Both methods are reliable for measuring TSB before, during, and after phototherapy in preterm infants. TcB tends to overestimate while Bilistick underestimates TSB.