Why Do We Miss A Congenital Heart Disease? - Pediatricians’ Point Of View

Why Do We Miss A Congenital Heart Disease? - Pediatricians’ Point Of Vie

Lung function test in children with left-to-right shunt congenital heart disease

Background Increased pulmonary blood flow may lead to abnormal lung function in children with left-to-right (L to R) shunt congenital heart disease. This condition has been linked to considerable mortality and morbidity, including reduced lung function. Objective To assess for lung function abnormality in children with L to R shunt congenital heart disease. Methods We conducted a cross-sectional study involving children aged 5-18 years and diagnosed with L to R shunt congenital heart disease at Dr. Sardjito Hospital from March to May 2017. Subjects underwent spirometry tests to measure forced expiratory volume-1 (FEV-1), forced vital capacity (FVC), and forced expiratory volume-1 (FEV-1)/forced vital capacity (FVC). Results Of 61 eligible subjects, 30 (49.2%) children had atrial septal defect (ASD), 25 (41%) children had ventricular septal defect (VSD), and 6 (9.8%) children had patent ductus arteriosus (PDA). Spirometry revealed lung function abnormalities in 37 (60.7%) children. Restrictive lung function was documented in 21/37 children, obstructive lung function in 11/37 children, and mixed pattern of lung function abnormality in 5/37 children. Pulmonary hypertension was found in 21 children. There was no significant difference in lung function among children with and without pulmonary hypertension (P=0.072). Conclusion Abnormal lung function is prevalent in 60.7% of children with L to R shunt congenital heart disease, of which restrictive lung function is the most common. There was no significant difference in lung function among children with and without pulmonary hypertension

Long-term exposure to PM2.5 and fasting plasma glucose in non-diabetic adolescents in Yogyakarta, Indonesia

Background: Indonesia is facing serious air pollution. However, very few studies have been conducted to examine the health risks of air pollution in Indonesia, particularly for adolescents. Objective: To assess the association between long-term exposure to ambient particles with a diameter of <2.5 mm (PM2.5) and fasting plasma glucose (FPG) in adolescents. Methods: A cross-sectional study was conducted in 482 adolescents aged 14e18 years in Yogyakarta, Indonesia in 2016. We finally included 469 (97.30%) participants who had no missing data for data analysis. We collected individual data on socio-demographics, behavioral habits, and health information through standardized questionnaires. Satellite-based PM2.5 concentrations from 2013 to 2016 were assigned based on participants’ residential addresses. The association between PM2.5 and FPG was examined using a generalized linear regression model while FPG was modeled as a continuous variable. An ordered logistic regression model was used to assess the relationship between PM2.5 and FPG categories. Results: Every 1 mg/m3 increase in PM2.5 was associated with a 0.34 mg/dL [95 confidence interval (95% CI): 0.08 mg/dL, 0.59 mg/dL] increase in FPG levels. Comparing with the low FPG level (under 86 mg/dL), every 1 mg/m3 increase in PM2.5 was associated with a 10.20% (95% CI: 1.60%, 19.80%) increase in the odds of impaired fasting glucose (IFG) (100e125 mg/dL). Stratified analyses indicated greater effects on participants with hypertension [odds ratio (OR) ¼ 1.30, 95% CI: 1.09, 1.57] and those had higher physical activities (OR ¼ 1.36, 95% CI: 1.09, 1.57). Adolescents’ sex, obesity status and different cutoff points of FPG did not modify the association between the exposure to PM2.5 and FPG levels. Conclusion: Long-term exposure to PM2.5 was associated with increased FPG levels in Indonesian nondiabetic adolescents.Wenhua Yu, Dian Caturini Sulistyoningrum, Danijela Gasevic, Rongbin Xu, Madarina Julia, Indah Kartika Murni, Zhuying Chen, Peng Lu, Yuming Guo, Shanshan L

Reducing nosocomial infection and improving rational antibiotic use in children in Yogyakarta, Indonesia

© 2013 Dr. Indah Kartika MurniBackground: Nosocomial infections cause significant morbidity and mortality in developed and developing countries. Prevention of nosocomial infection is central to providing high quality, safe healthcare. Transmission of microorganisms between patients by healthcare workers and irrational antibiotic use have been identified as preventable etiological factors for nosocomial infections. Aims: To develop multifaceted infection control and antibiotic stewardship programs and evaluate the effectiveness of these measures on nosocomial infection, antibiotic use, hand hygiene compliance, and mortality. Methods: An uncontrolled before-and-after study was conducted over 27 months involving around 2600 patients at the Dr Sardjito teaching hospital in Yogyakarta, Indonesia. Patients who were admitted to the PICU and general paediatric wards for more than 48 hours were included. All eligible children were observed daily to see whether they fulfilled criteria for nosocomial infections. The assessment of nosocomial infections was made based on the United States Centers for Disease Control and Prevention (CDC) criteria. Irrational antibiotic use was assessed when patients presented with community-acquired infection or were treated with antibiotics. The standard for empirical antibiotic prescribing was on the recommendations contained in the WHO Pocketbook of Hospital Care for Children. Hand hygiene compliance was observed directly among the healthcare workers using the “Five moments for hand hygiene” observation form. In the pre-intervention period, the proportion of nosocomial infection, irrational antibiotic use and hand hygiene compliance were prospectively collected over 12 months. The multifaceted intervention, including hand hygiene campaigns, antibiotic guidelines based on the WHO Pocketbook of Hospital Care for Children, and other elementary infection control practices, was implemented over 3 months. The means of intervention included lectures, trainings, outreach visit, reminders, audit and performance feedback. In the post-intervention period, identical data collection was prospectively collected over 12 months as outlined in the pre-intervention period. The outcome measures in the pre-and-post intervention periods were compared. The 2 statistics or Fisher Exact Test were used to analyze the various proportions by comparing the pre-intervention and the post-intervention period. A probability value < 0.05 was considered to denote statistical significance. The relative risk (RR) reduction and its confidence interval (CI) were also provided to compare the effect of the interventions between both periods. Results: This study found a large burden of nosocomial infection in children in Indonesia. The incidence of nosocomial infection was 22.6% (277/1227) and mortality in children with nosocomial infection was 24.5% (68/277). A multifaceted intervention on infection control and antibiotic stewardship was effective in reducing nosocomial infection and improving rational use of antibiotics. In all wards combined, compliance with the interventions lead to a reduction of nosocomial infections, from 277/1227 (22.6%) to 123/1419 (8.6%) [RR (95%CI) 0.38 (0.31-0.46)]. Irrational antibiotic use declined from 336/780 episodes of antibiotic use (43%) to 182/882 episodes of antibiotic use (20.6%) [RR (95%CI) 0.46 (0.40-0.55)]. Hand hygiene compliance increased from 319/1690 observed episodes of patient care (18.9%) to 1125/1789 observed episodes of patient care (62.9%) [RR 3.33 (95%CI) (2.99-3.70)]. Risk of in-hospital mortality decreased from 127/1227 (10.4%) to 114/1419 (8%) [RR (95%CI) 0.78 (0.61-0.97)]. Conclusions: Multifaceted interventions, including hand hygiene campaigns and antibiotic stewardship, are effective in reducing nosocomial infections, improving rational use of antibiotics, improving hand hygiene compliance, and reducing mortality in children in Yogyakarta, Indonesia

Irrational use of antibiotics and clinical outcomes in children with pneumonia

Background Pneumonia is a major cause of morbidity and mortality in children under five. Antibiotic treatment must be started immediately in children with pneumonia. The irrational use of antibiotics may increase morbidity and mortality in children with pneumonia. Obejctive To determine the prevalence of the irrational use of antibiotics and clinical outcomes in children with pneumonia. Methods We conducted a cross-sectional study in children with pneumonia who were admitted to the Pediatric Ward or PICU at Dr. Sardjito Hospital, Yogyakarta, from December 2010 to February 2013. Data were obtained from subjects’ medical records. Children with malnutrition, congenital heart defects, sepsis, shock, central nervous system disorders, syndromes, or other concomitant infections were excluded. Results Of 46 children who fulfilled the inclusion criteria, 13 (28.3%) used antibiotics irrationally and 7 (15.2%) died. Most subjects were aged less than 1 year (25 subjects, 54.3%) and 1 - 7 days. Ampicillin was the most common first-line, empirical antibiotic used (32 subjects, 69.6%). Blood cultures were obtained in 20 (43.5%) patients, yielding no growth in 16 subjects, coagulase-negative staphylococci (CONS) in 3 subjects, and Pseudomonas aeruginosa in 1 subject. The irrational use of antibiotics was significantly associated with mortality in a univariate analysis [PR 6.35; (95%CI 1.40 to 28.69); P=0.006]. Conclusion The irrational use of antibiotics is common among children with pneumonia and is significantly associated with mortality

Tricuspid regurgitation pressure gradient to diagnose pulmonary hypertension: a diagnostic accuracy study

Background Pulmonary hypertension carries significant morbidity and mortality in children. Early diagnosis and management may improve outcomes in children with pulmonary hypertension. Heart catheterization, a gold standard for diagnosing pulmonary hypertension, is an invasive procedure and not widely available. Echocardiography can be used as an alternative diagnostic tool for pulmonary hypertension. Objective To determine the diagnostic value of tricuspid regurgitation pressure gradient on echocardiography compared to heart catheterization to diagnose pulmonary hypertension in children. Methods This diagnostic test study was done with medical re-cord data of children with acyanotic congenital heart disease who underwent cardiac catheterization and echocardiography procedures from January 2018 to December 2020 at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Data were analyzed to obtain sensitivity, specificity, positive and negative predictive values, as well as positive and negative likelihood ratios. Results A total of 98 children with acyanotic congenital heart disease were included. The sensitivity and specificity of the tri-cuspid regurgitation pressure gradient to determine pulmonary artery pressure compared to heart catheterization were 64.4 and 54.5, respectively. The positive likelihood ratio was 1.42. The pre-test and post-test probability of this study were 88.7 and 91.7, respectively. Conclusion Tricuspid regurgitation pressure gradient measured using echocardiography has poor sensitivity and specificity to diagnose pulmonary hypertension. Paediatr Indones. 2022;62:367-72; DOI: https://doi.org/10.14238/pi62.6.2022.367-72 . © 2022, Indonesian Pediatric Society Publishing House. All rights reserved