The Roles of Renal Oxygen Saturation in Septic Shock Children.

Introduction: Septic shock, the most severe form of sepsis, has high morbidity and mortality rates among children. In patients with septic shock, impaired microcirculatory perfusion is associated with the severity of organ failure and the likelihood of death. Because near-infrared spectroscopy (NIRS) can assess microcirculation status and peripheral tissue oxygenation directly and noninvasively, provides real-time results, and can be performed at the patient's bedside. This study aimed to determine the prognostic value of renal oxygen saturation (rRSO2) measured by NIRS in septic shock among children. Methods: This prospective observational study enrolled children aged 1 month to 18 years with septic shock who were treated in a pediatric intensive care unit from August 2020 to January 2021. NIRS was used to measure rRSO2 in patients diagnosed with septic shock according to the Third International Consensus Definition of Sepsis and Septic Shock. The baseline rRSO2 value (%) formed a receiver operating characteristic curve and was used to calculate the optimal cutoff value, sensitivity, specificity, and odds ratio (OR). Results: We enrolled 24 patients, 13 nonsurvivors and 11 survivors, whose mean baseline rRSO2 values were 67.27 ± 12.95 versus 48.69 ± 16.17, respectively (P = 0.006). The optimal cutoff value for baseline rRSO2 was <60.5%, with a sensitivity of 76.9%, a specificity of 81.8%, and an area under curve 0.804 (95% confidence interval [CI]: 59.2%-98.1%, P = 0.012; OR = 15; 95 CI: 2.04-111.74). Conclusion: Measured by NIRS, rRSO2 values are a good predictor of mortality among children with septic shock.

Renal Oxygen Saturation as an Early Indicator of Shock in Children.

Background: Shock is a life-threatening syndrome in which tissue perfusion and oxygen delivery are inadequate. Near-infrared spectroscopy (NIRS) has been suggested as a noninvasive tool for monitoring and detecting the state of inadequate tissue perfusion. Renal and mesenteric oximetry show decreased cardiac output earlier than systemic or global parameters of tissue oxygenation or cerebral oximetry. However, until now there has been no study on the validity of regional renal oxygen saturation (rRSO2) by NIRS for diagnosing shock in children. Purpose: To analyze the validity of rRSO2 by NIRS to diagnose shock in children. Patients and Methods: This cross-sectional study was conducted in critically ill children (aged 1 month-18 years) who were admitted to the pediatric intensive care unit (PICU), from September to November 2020, consecutively. Patients were classified into two groups: shock and non-shock. The diagnosis of shock is based on clinical criteria (tachycardia, sign of hypoperfusion and decrease systolic blood pressure

Transcatheter Closure of Perimembranous Ventricular Septal Defect Using the Lifetech Konar-Multi Functional Occluder: Early to Midterm Results of the Indonesian Multicenter Study.

Background: The alternative device to close perimembranous ventricular septal defect (pmVSD) has been searched for better result, less complications and applicable for infants. However, the ideal device is still unavailable. We aimed to evaluate the effectiveness and outcome of transcatheter pmVSD closure using the KONAR-multi functional occluder (MFO). Methods: Clinical, procedural, follow-up data of pmVSD patients with symptom of heart failure or evidence of significant left to right shunt, growth failure, recurrent respiratory tract infection, and history of endocarditis who underwent transcatheter closure using the MFO were prospectively evaluated. Results: Between January 2016 and December 2017, there were complete records of 132 pmVSD children closed using MFO from eleven centers in Indonesia. The median of age was 4.5 (0.3-17.4) years; weight 14.8 (3.5-57) kg, defect size at the smallest part 3.4 (1.0-8.1) mm, flow ratio 1.6 (1.3-4.9), mean pulmonary artery pressure 18 (7-79) mmHg, fluoroscopy time 18 (3.8-91) and procedural time 75 (26-290) minutes. A retrograde approach was done in 41 (31%) patients. Procedures succeeded in first attempt in 126 (95.4%), failed in three and migration in three patients. Six of eight infants with congestive heart failure were closed successfully. Of 126 patients with successful VSD closure, 12 months follow-up were completed in all patients. The rate of complete occlusion at 1 month, 3 months, 6 months and 12 months after intervention were 95.2%, 97.6%, 99.2%, and 99.2%, respectively. New-onset aortic regurgitation and moderate tricuspid regurgitation developed only in five and three patients. Neither complete atrioventricular block, nor other complications occurred. Conclusion: Transcatheter closure of pmVSD using the MFO is safe, effective, and feasible in infants and children.

Risk Factors of Daunorubicine Induced Early Cardiotoxicity in Childhood Acute Lymphoblastic Leukemia: A Retrospective Study.

BACKGROUND: Daunorubicine, a type of anthracycline, is a drug commonly used in cancer chemotherapy that increases survival rate but consequently compromises with cardiovascular outcomes in some patients. Thus, preventing the early progression of cardiotoxicity is important to improve the treatment outcome in childhood acute lymhoblastic leukemia (ALL). OBJECTIVE: The present study aimed to identify the risk factors in anthracycline-induced early cardiotoxicity in childhood ALL. METHODS: This retrospective study was conducted by observing ALL-diagnosed children from 2014 to 2019 in Dr. Soetomo General Hospital. There were 49 patients who met the inclusion criteria and were treated with chemotherapy using Indonesian Childhood ALL Protocol 2013. Echocardiography was performed by pediatric cardiologists to compare before and at any given time after anthracycline therapy. Early cardiotoxicity was defined as a decline of left ventricle ejection fraction (LVEF) greater than 10% with a final LVEF < 53% during the first year of anthracycline administration.  Risk factors such as sex, age, risk stratification group, and cumulative dose were identified by using multiple logistic regression. Diagnostic performance of cumulative anthracycline dose was evaluated by receiver operating characteristic (ROC) curve. RESULTS: Early anthracycline-induced cardiotoxicity was observed in 5 out of 49 patients. The median cumulative dose of anthracycline was 143.69±72.68 mg/m2. Thirty-three patients experienced a decreasing LVEF. The factors associated with early cardiomyopathy were age of ≥ 4 years (PR= 1.128; 95% CI: 1.015-1.254; p= 0.001), high risk group (PR= 1.135; 95% CI: 1.016-1.269; p= 0.001), and cumulative dose of ≥120 mg / m2 (CI= 1.161; 95% CI:1.019-1.332). CONCLUSION: Age of ≥ 4 years, risk group, and cumulative dose of ≥120 mg/m2 are significant risk factors for early cardiomyopathy in childhood ALL.

HLA-DRB1 allele distribution among children with rheumatic heart disease in Haji Adam Malik Hospital Medan, Indonesia.

Rheumatic heart disease (RHD) is influenced by genetic factor, microorganism's virulence, and environmental factor. The aim of this study was to determine human leukocyte (HLA)-DRB1 allele among children with RHD in Medan, Indonesia. Methods An observational study was conducted at the Department of Child Health, Haji Adam Malik Hospital Medan from April to June 2017. Inclusion criteria were children aged 5-18 years diagnosed with RHD. Children with concomitant congenital heart disease were excluded. HLA-DRB1 alleles were analyzed using the PCR sequence-specific priming (SSP) technique. Statistical analysis was done using computer software. Results A total of 62 children were enrolled. The mean age of children was 12.6 (SD 3.44) years; 33 (53.2%) were male. The most dominant allele was HLA-DRB1*12, followed by HLADRB1*15. Conclusion It is proven in this research that RHD is influenced by genetic factor with HLA-DRB1*12 allele found to be the most common allele in children with RHD in Medan, Indonesia.

Long-term outcome of coronary artery dilatation in Kawasaki disease.

BACKGROUND: Kawasaki disease (KD) is an acute systemic vasculitis syndrome with a high incidence of coronary aneurysms in untreated children. The majority of aneurysms resulting from KD are known to regress with time. AIMS: This study aimed to determine the course and outcome of coronary artery dilatation in patients with KD and ascertain whether there are any differences in the outcomes in the different branches. SETTING AND DESIGN: This is a retrospective cohort study of patients diagnosed with KD with midterm follow-up data. METHODS: Serial echocardiography was performed in all KD patients with coronary dilatation for 1-10½ years. The Kaplan-Meier curve was used for statistical analysis. RESULTS: There were 154 patients with coronary dilatation studied. The frequency of coronary dilatation in acute phase was 33.3% and decreased to 7.9% 6-8 weeks later. Each patient could have dilatations at more than one branch, so the total number of dilatations was 245. The median time needed for regression was 2.6 months (mean: 10.5 months) while the median of follow-up duration was 41 months (mean: 23 months). Small- and medium-sized dilatations had more favorable outcomes compared to the giant ones. Location of dilatation did not influence the outcome. CONCLUSIONS: The majority (77.4%) of small- and medium-sized dilatations regress within 2 years, but giant aneurysms tend to persist. The outcome of coronary dilatation is determined by the diameter and not by the location. Regression rate is faster in smaller dilatations. Left main coronary artery is the most frequent location for dilatation.