The effectiveness of Lactobacillus reuteri on serum bilirubin levels in neonatal hyperbilirubinemia with phototherapy

Background Hyperbilirubinemia occurs in 60% of full term and 80% of premature infants. Phototherapy is the main treatment, but it has side effects, sometimes requires hospitalization, and causes the baby to be separated from the mother. Underdeveloped gut microflora and increased enterohepatic circulation in newborns contribute to increased serum bilirubin levels in early life. Objective To assess the efficacy of adding probiotic L. reuteri on phototherapy in full-term neonates with hyperbilirubinemia. Methods In this double-blind, randomized clinical trial, full term infants with hyperbilirubinemia at Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia, were randomly assigned to either an intervention or control group. All subjects received phototherapy. The intervention group was also given five drops of L. reuteri once a day orally before phototherapy started, while the control group received a placebo. Bilirubin levels after 24-hour phototherapy were evaluated in both groups. Results A total of 42 term neonates met the inclusion criteria. The intervention group had a significantly greater decrease in total serum bilirubin (TSB) level (6,517 mg/dL) than did the control group (4,434 mg/dL) (P<0.001), as well in indirect bilirubin levels in the intervention group had decrease 6.40 mg/dL while in the control group 4.43 mg/dL after 24 hours of phototherapy (P<0.001). Conclusion In full-term neonates with hyperbilirubinemia who underwent 24-hour phototherapy, adding probiotic L. reuteri leads to a significantly greater reduction in total and indirect bilirubin levels compared to the control group

Hubungan Terapi Asam Valproat dengan Peningkatan Berat Badan pada Anak Epilepsi di Rumah Sakit Umum Daerah Zainoel Abidin Banda Aceh

Latar belakang. Epilepsi merupakan salah satu penyebab peningkatan morbiditas yang secara signifikan menurunkan kualitas hidup pada populasi anak di seluruh dunia. Terapi asam valproat sebagai anti-epilepsi jangka panjang untuk mencegah serangan berulang. Pemberian asam valproat dapat memberikan efek menambah nafsu makan dan meningkatkan berat badan pasien. Tujuan. Penelitian ini bertujuan untuk mengetahui pengaruh terapi asam valproat dengan peningkatan berat badan anak epilepsi setelah tiga dan enam bulan terapi berdasarkan kelompok usia dan jenis kelamin. Metode. Studi ini dilakukan di Rumah Sakit Umum Daerah dr. Zainoel Abidin Banda Aceh dengan desain potong lintang. Evaluasi kenaikan berat badan dilakukan pada bulan ke-3 dan ke-6 setelah pemberian terapi asam valproat. Hasil. Sebanyak 70 subjek pasien epilepsi yang memenuhi kriteria inklusi dengan rerata usia empat tahun delapan bulan didominasi jenis kelamin perempuan (54,3%). Terjadi peningkatan berat badan setelah tiga bulan terapi dengan dosis asam valproat 20-25 mg/kgBB dengan p = 0,002 dan terjadi peningkatan berat badan setelah enam bulan terapi dengan p = <0,001 pada kelompok usia. Kesimpulan. Hubungan terapi asam valproat dan peningkatan berat badan hanya signifikan pada setelah enam bulan terapi berdasarkan kelompok umur. Dengan demikian, peningkatan berat badan adalah hal yang normal sesuai dengan pertambahan usia anak

Hubungan Kelainan Kongenital Anomali Gastrointestinal pada Neonatus dan Kematian

Latar belakang. Kelainan kongenital anomali gastrointestinal merupakan kelainan defek morfologik saluran cerna yang dijumpai sejak bayi baru lahir. Tujuan. Mengetahui hubungan kelainan kongenital anomali gastrointestinal dan kematian neonatus. Metode. Studi potong lintang retrospektif dengan penelusuran rekam medis Departemen Ilmu Kesehatan Anak, RSUD Dr.Zainoel Abidin Banda Aceh sejak bulan Januari 2010-Desember 2011. Hubungan antar variabel dianalisis menggunakan uji X 2 dengan tingkat kemaknaan p<0,05. Hasil. Penelitian ini mendapatkan 79 pasien dengan kelainan kongenital anomali gastrointestinal yang terdiri atas bayi laki-laki 74,7% dan bayi perempuan 25,3%. Jenis penyakit kongenital anomali gastrointestinal yang didapat adalah atresia esofagus (2,5%), atresia duodenum (1,3%), atresia yeyunum (2,5%), penyakit Hirschsprung (29,1%), omfalokel (10,1%), gastroskisis (6,3%), volvulus (2,5%), dan malformasi anorektal (45,6%). Pasien dengan kelainan kongenital anomali gastrointestinal dijumpai 27,8% kasus meninggal. Hasil uji statistik Pearson Chi squaremenunjukkan bahwa usia gestasi, berat lahir serta jenis penyakit berhubungan bermakna dengan hasil luaran klinis (p<0.05). Kesimpulan. Didapatkan 27,8% kematian neonatus dengan kelainan kongenital anomali gastrointestinal di NICU RSUD Dr Zainoel Abidin, Banda Aceh. Usia gestasi, berat lahir dan jenis penyakit berhubungan dengan kematian neonatus dengan kelainan kongenital anomali gastrointestina

Faktor Risiko yang Memengaruhi Luaran Klinis Malformasi Anorektal pada Neonatus di RSUD Dr. Zainoel Abidin, Banda Aceh

Latar belakang. Malformasi anorektal merupakan salah satu masalah dan penyebab kematian pada neonatus di ruang NICU RSU Dr Zainoel Abidin Banda Aceh. Tujuan.Mengetahui faktor risiko yang memengaruhi luaran klinis pada neonatus dengan malformasi anorektal di RSUD Dr.Zainoel Abidin, Banda Aceh. Metode. Studi cross sectional dengan penelusuran rekam medis di Departemen Ilmu Kesehatan Anak RSUD Dr. Zainoel Abidin, Banda Aceh sejak bulan Januari 2009-Desember 2011. Pengaruh variabel faktor risiko dengan luaran malformasi anorektal dianalisis dengan uji multivariat regresi logistik. Batas kemaknaan apabila p<0,05 dengan interval kepercayaan 95%. Hasil. Malformasi anorektal letak intermediat mempunyai peluang 0,148 kali lebih kecil memengaruhi luaran klinis pada neonatus (p=0,024, RP=0,148, 95% CI=0,04-0,62). Sembilan kasus (19,6%) malformasi anorektal yang berhubungan dengan satu atau lebih anomali atau sindrom. Hasil analisis multivariat regresi logistik diperoleh hasil bahwa malformasi anorektal letak tinggi berhubungan bermakna dan mempunyai peluang 24 kali lebih besar dibandingkan malformasi anorektal letak intermediat yang memengaruhi luaran klinis pada neonatus (p=0,021, RP=24,0; 95% CI=1 615-356 635). Kesimpulan. Malformasi anorektal letak tinggi merupakan faktor risiko yang mempengaruhi luaran klinis pada neonatus

Intravenous Paracetamol and Patent Ductus Arteriosus Closure

Background: Standard medical treatments for patent ductus arteriosus (PDA) closure are, including indomethacin/ibuprofen and surgical ligation. Nowadays, a new strategy to close PDA is the use of paracetamol. The present study aimed to describe the use of intravenous (IV) paracetamol for PDA closure in neonates who present a contraindication to ibuprofen or ibuprofen failure with no possibility to perform surgical ligation due to major instability.Methods: The present study was conducted from January to December 2017 in the neonatal intensive care unit of Dr. Zainoel Abidin Hospital and Harapan Bunda Hospital, Banda Aceh, Indonesia, on neonates with hemodynamic significant PDA (hsPDA). All the subjects received IV paracetamol (15 mg/kg every 6 h) for 3 days. Thereafter, the ductus was evaluated by echocardiography on the 5th day after the regiment.Results: A total of 72 neonates were diagnosed with hsPDA and their average of gestational age was 34.26 weeks and their average of birth weight was 1945.69 g for 39 (54.2%) female neonates, 33 (45.8%) male neonates, 45 (62.5%) premature infants, and 27 (37.5%) full-term infants. About 26 (36.1%) infants had a closed PDAs on the 5th days of evaluation, 11 (15.3%) infants had regiment twice for closed PDA at the 10th days of evaluation, and 35 (48.6%) neonates had more closed PDA after three or four regiments. Successful closure with paracetamol was achieved in 51(70.8%) neonates, while 21 (29.2%) neonates failed the PDA closure.Conclusion: Based on the findings of the present study, IV paracetamol appears to be reasonably effective for PDA closure in both preterm and term infants. This should be the first-line of therapy choice when there are contraindications for the treatment with ibuprofen

Plain abdominal radiograph appearance in children with abdominal pain

Background Abdominal pain is a common condition in children. Plain abdominal radiograph is recommended routinely in the evaluation of children with abdominal pain. Methods A retrospective study was done to evaluate radiographic abnormalities in children with abdominal pain at the Department of Child Health Cipto Mangunkusumo Hospital from January 1, 1994 to December 31, 1998. Results Of the 76 patients with abdominal pain, there were 38 females and 38 males. Forty-five patients were in the >5-12 years age group. Thirty-five out of 76 patients showed radiographic abnormalities. The most common radiographic abnormality was stones (found in 13 patients), followed by uneven distribution of bowel air in 8 patients. Conclusion A plain abdominal radiograph is still required as a diagnostic tool for children with abdominal pain, especially in the acute stage

Cakupan Imunisasi Dasar Anak Usia 1-5 tahun dan Beberapa Faktor yang berhubungan di Poliklinik Anak Rumah Sakit Ibu dan Anak (RSIA) Banda Aceh

Latar belakang. Program pengembangan imunisasi sudah berjalan sejak tahun 1974 untuk penyakit-penyakit yang dapat dicegah dengan imunisasi (PD3I), yaitu satu kali imunisasi BCG, empat kali imunisasi polio, tiga kali imunisasi DPT, tiga kali imunisasi hepatitis B, dan satu kali imunisasi campak sebelum berumur 12 bulan. Sasaran yang hendak dicapai Kementerian Kesehatan Republik Indonesia tahun 2010-2014 adalah meningkatkan cakupan imunisasi dasar lengkap bayi usia 0-11 bulan menjadi 90%. Saat ini berdasarkan Riset Kesehatan Dasar (Riskesdas) tahun 2010, cakupan imunisasi dasar lengkap secara nasional baru mencapai 53,8%, sedangkan Propinsi Aceh baru mencapai 37,0%. Tujuan. Mengetahui cakupan imunisasi dasar anak balita usia 1-5 tahun, alasan imunisasi yang tidak lengkap, serta mengetahui hubungan antara pendidikan orangtua dan pendapatan keluarga dengan kelengkapan imunisasi. Metode. Penelitian potong lintang menggunakan kuesioner dengan subjek orangtua anak usia 1-5 tahun yang berkunjung ke Poliklinik Anak RSIA Banda Aceh selama kurun waktu 8 minggu (12 Desember 2011 sampai 27 Januari 2012). Cakupan bayi dengan imunisasi dasar lengkap adalah persentase bayi umur <12 bulan yang telah mendapat imunisasi dasar lengkap. Hubungan antara 2 kelompok variabel dianalisis dengan uji Chi-squaredan Kolmogorov-Smirnov. Hasil.Seratus tiga anak diikutsertakan dalam penelitian. Cakupan imunisasi dasar pada anak usia 1-5 tahun 86 (83,5%) lengkap, 16 (15,5%) tidak lengkap, dan 1 (1%) tidak pernah diimunisasi. Alasan tidak pernah diimunisasi atau tidak melengkapi imunisasi adalah ibu cemas akan efek samping 12 (70,6%), 4 (23,5%) sering sakit, dan 1 (5,9%) orangtua beralasan imunisasi haram. Terdapat hubungan yang bermakna antara sebaran pendidikan ibu dengan kelengkapan imunisasi dasar (p<0,05). Kesimpulan.Cakupan imunisasi dasar pada subjek penelitian 83,5%. Terdapat hubungan yang bermakna antara sebaran pendidikan ibu dengan kelengkapan imunisasi dasar (p<0,05)

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology