Factors Influencing the Decision of Parents to LP in Pediatric with CNS Infection

Lumbal Puncture (LP) is a procedure that can help to diagnosed CNS infection in children. The procedure of LP is a common invasive procedure, but sometimes it had refused by the parents. Furthermore, it can cause a delayed in the diagnosis and affected the prognosis. The subject was the parents of pediatric patients with CNS infection. We have a questionnaire and using Chi-square and Fisher exact test to analyze factors that influenced the parent’s decision of LP procedure. From the parents of 50 children with CNS infection, 19 parents (38%) were refused the LP procedure. Father’s education was related to the refusal of LP procedure with PR 6.64 (95%CI; 8.95-788.08). Mother’s education was related to the refusal of LP procedure with PR 7.69 (95%CI; 3.19-16.24). There was the significant result of the parent's education with the decision of LP procedure

Thyroid Hormone Profile in Children with Sepsis: Does Euthyroid Sick Syndrome Exist?

BACKGROUND: Alterations in peripheral thyroid hormone metabolism play an eminent role in the development of the euthyroid sick syndrome. Altered solvation may also lead to changes in peripheral thyroid hormones. Data on thyroid hormones in critically ill children remain unclear. AIM: This study was aimed to evaluate thyroid hormone profile in children with sepsis as well as to assess the association between thyroid level and sepsis outcome. METHODS: An observational cohort study was conducted in 80 children with sepsis from October 2015 to January 2016 in Haji Adam Malik General Hospital. T3 and T4 level were measured on day 1 and after > 72 hours of sepsis diagnosed. RESULTS: We recorded length of stay in PICU, patient outcome and analysed the relationship with the chi-square test. Level of T3 and T4 were decreased on day 1 in pediatric sepsis. Of 80 subjects, 57 (71.2%) with low-level T3 and 41 (51.2%) with low T4 were found. The relationship between T3 and T4 level on day 1 with the length of stay were not found (P = 0.500; P = 0.987). There were a significant relationship between level of T3 and T4 with outcome (P = 0.0001; OR 24.706; P = 0.014; OR 3.086). Subject with normal T3 and T4 level had 24 and 3 times life chances compare to lower level. CONCLUSION: The Euthyroid Sick Syndrome in children with sepsis does exist. There was a significant relationship between T3 and T4 level on day 1 with patient outcome

Triiodothyronine levels and mortality in children with sepsis and septic shock

Background Sepsis is the most common cause of death in infants and children. It can cause hormonal imbalances, such as euthyroid sick syndrome (ESS), which may increase the risk of death. Objective To evaluate a possible correlation between the level of triiodothyronine (T3) and mortality in children with sepsis and septic shock. Methods An observational cohort study was conducted on 80 children with sepsis and septic shock from October 2015 until January 2016 in Haji Adam Malik General Hospital, Medan. Subjects underwent PELOD score and T3 examination on the first day admitted in Haji Adam Malik General Hospital. Chi-square test was used to analyze for a correlation between the T3 values and mortality.  Results Of the 80 consecutive subjects, 39 (48.75%) had low T3 level on the first day. Of these 39 children, 36 (92.3%) died. Subjects with low T3 level had a 6.31 times higher risk of mortality(PR 6.31;  95%CI 2.99 to 13.28; P<0.001). Of the 31 subjects with high PELOD score, 23 (74.2%) had decreased T3 (PR=2.27; 95%CI 1.45 to 3.57; P<0.001). Conclusion Low T3 level has significant relationship with mortality in children with sepsis and septic shock