Brain Magnetic Resonance Imaging in Indonesian Patients with Cerebral Palsy

Purpose Cerebral palsy (CP) is a neurological health problem that affects children around the world and warrants particular attention. Magnetic resonance imaging (MRI) can be used to visualize brain disorders, as it provides a clear view of the brain’s anatomy, including the location of any damage or structural abnormalities. The objective of this study was to obtain a detailed MRI representation of patients with CP. Methods This study employed a retrospective design involving the examination of medical records. It included CP patients aged between 1 and 16 years who had undergone brain MRI examinations. The Gross Motor Function Classification System scale was used to classify limitations in functional motor ability among these patients. The brain MRI results were categorized as either normal or abnormal. Results Of 60 CP cases, 50% were classified as severe, with the remaining cases considered mild to moderate. Epilepsy was present in 66.7% of patients with severe CP. The most common type of CP, among both mild-to-moderate and severe cases, was quadriplegia. Gray matter lesions on brain MRI were more common in severe than mild-to-moderate cases, while vascular insult lesions and brain malformations were less frequent. A significant difference was observed in the severity of CP when a gray matter lesion was present on MRI. Conclusion Most children with CP exhibited abnormal results on brain MRI. Lesions of the white and gray matter were the most frequently observed. MRI plays a crucial role in understanding the underlying pathological brain abnormalities in CP

Effect of Hemodynamic Significant Patent Ductus Arteriosus on Tissue Oxygenation in Preterm Infants using Near-Infrared Spectroscopy.

Abstract Background: Hemodynamic significant Patent Ductus Arterisous (hsPDA) is one of the main complications of preterm birth; however, its management needs further research and development. Ductal stealing results in pulmonary hyperperfusion which potentially causes oxygenation disorders and leads to target organ disruptions (i.e. cerebral, abdominal, and renal). Therefore, monitoring tissue oxygenation is essential for detecting organ disorders. Previous studies revealed that near-infrared spectroscopy (NIRS), as a non-invasive method, showed promising results in monitoring tissue oxygenation. This study aimed to analyze the difference in regional oxygen saturation (rSO2) between premature babies with and without hsPDA. Methods: This cross-sectional study was conducted on preterm infants aged 3-7 days with 24-336/7 weeks of gestation. hsPDA diagnosis was carried out using echocardiography; defined as >1.5 mm diameter of ductus arteriosus and >1.4 left pulmonary artery and aorta (La/Ao) ratio. The cerebral (rcSO2), abdomen (raSO2), and renal oxygen saturation (rrSO2) were measured through NIRS monitoring. The statistical analysis was conducted using SPSS software (Version 21.0). Results: There were 11 out of 52 infants categorized as hsPDA. The mean±SD birth weight, mean±SD gestational age, and mean±SD ductus diameter in hsPDA was determined at 1213±293 gram; 30.72±2.01 weeks, and 2.84±0.93 mm, respectively. There was no significant difference between the hsPDA and non hsPDA groups in terms of rcSO2 (75.27±9.14% and 79.03±9.11%; P=0.238), raSO2 (65.60±11.07% and 67.48±10.17%; P=0.594), and rrSO2 (76.41±14.98% and 82.61±10.41%; P=0.218). Conclusion: Based on the obtained results, the existence of hsPDA doesn't affect the oxygenation in cerebral, abdominal, and renal tissues in preterm babies. Moreover, the decision should be made regarding the optimal time for ductal closure

First Unprovoked Seizure in Indonesian Children

Abstract Introduction: First unprovoked seizure (FUS) in children is a frightening health problem that often to be taken to emergency room. EEG is absolutely required to determine seizure activity in the brain. It can differentiate seizures from nonepileptic paroxysmal events. This study aims to determine the EEG description of children who experience FUS. Methods: This study used a retrospective observational method using medical records. All patients in the category of children aged 0 months to 18 years old who came with their FUS and had recorded an EEG, were included. EEG recording is done as soon as possible and a maximum of 2 days after the seizure occurs. Data were analyzed using descriptive statistics and presented in tables and graphs. Result: The clinical characteristics of FUS show that the majority of boys (61.3%) are older than 5 years old (52.8%). The types of seizures that appear are more generalized seizures and mostly the duration is less than 5 minutes. A few patients have anemia. Abnormal EEG interpretation results reached 53.8% with around 68% of them showing epileptiform discharge. Classification of abnormal EEG indicates more on focal slowing, centrotemporal sharp wave, and BECTS activity. Conclusion: FUS in Indonesia mostly reported in boys. Generalized seizures were commonly seen. EEG interpretation is mostly abnormal that commonly showing epileptiform discharge. Most of the EEG abnormal classifications that lead to epileptiform activity are focal slowing. This can be a considerable of the possibility of recurrent seizure in later life

Combination of standard physical therapy with partial body weight supported treadmill training in children with spastic diplegic cerebral palsy

Standard physical therapy (SPT) with ground gait training is well recognized to improve the motor skill in cerebral palsy (CP) disease. Confirmation is required on achieving better gross motor function with partial body weight supported treadmill training (PBWSTT). The objective of the study is to analyze combination of SPT with PBWSTT for gross motor function children with spastic diplegic CP who able to walk. A prospective design was conducted in CP patients 2-7 years of age with Gross Motor Function Classification System (GMFCS) I-III and received physical therapy 2 times per week, 20 minutes per session, a total of 20 sessions. The treatment group is continued by PBWSTT for 20 minutes per session. Gross Motor Function Measure (GMFM)-66 of walking, running, and jumping (dimension E) is measured in pre and post-physical therapy. Data were analyzed descriptively. There were 10 subjects and divided into 5 subjects in the control and the rest in the treatment group. The mean age was 48.4 months and 63.4 months respectively. The Average score of GMFM-66 dimension E pre and post-SPT were 63.54 and 65.24, the difference is 1.7 (2.67%) from the initial score

Risk factors for mortality in children with cyanotic congenital heart disease associated with brain abscess

Brain abscess is a local infection within the brain parenchyma. Predisposing factors include cyanotic congenital heart disease (CHD). Identification of risk factors for mortality is important to determine the prognosis. A case-control study of children with cyanotic CHD associated with brain abscess was conducted in the pediatric ward of a hospital from January 2016 to December 2020. Data were collected from medical records with the case to controls ratio of 1:3.07. A total of 61 children were evaluated, 46 children survived and 15 children non-survived. From 11 risk factors evaluated, 6 risk factors had a significant different of mortality risk included the level of hemoglobin (p=0.07), leukocyte (p=0.063), Neutrophil-to-lymphocyte ratio (NLR) (p<0.001), peripheral oxygen saturation (SpO2) (p=0.00), multiple abscesses (p=0.008), brain abscess diameter (p<0.001). Multivariate logistic regression analyses revealed significant risk factors for mortality in cyanotic CHD children with brain abscesses were NLR (OR 13.62, 95%CI 2.123-87.319, p=0.006); SpO2 (OR 1.5, 95% CI 1.25-2, p=0.04); brain abscess diameter (OR 7.61, 95%CI 1.064-54.434, p=0.043). NLR, brain abscess diameter, and SpO2 were the risk factors in increasing mortality in cyanotic CHD children with brain abscess. The prevention of abscess cerebral development and cyanotic CHD management are needed to reduce the mortality

Echocardiographic Study in Preterm Infant with Hemodynamic Significant Patent Ductus Arteriosus. Sunny Mariana Samosir,

Abstract Background: Potential complications of hemodynamic significant patent ductus arteriosus (hsPDA) after birth include heart failure, need for respiratory support, renal disfunction, intraventricular hemorrhage, as well as long term altered growth and development. Nevertheless, clinical signs of patent ductus arteriosus (PDA) are not sensitive and specific enough. Therefore, echocardiography still remains the preferred method to evaluate the ductal patency in preterm infant. The present study aimed to evaluate the echocardiography characteristic in preterm infant with hsPDA. Methods: A cross-sectional study was conducted on preterm infants aged 3-7 days with 24-336/7 weeks of gestation. Data taken were demographic, clinical and echocardiography. Diagnosis of hsPDA was carried out by echocardiography; defined as >1.5mm diameter of ductus and >1.4 left pulmonal artery and aorta (La/Ao) ratio. The statistical analysis was undertaken using SPSS 21.0. Results: There were 11 out of 52 preterm infants diagnosed hsPDA. Mean birth weight was 1213±293 gram; Mean gestational age was 30.72±2.01 weeks. In hsPDA group, mean ductus diameter was 2.84±0.93 mm, mean La/Ao ratio was 1.56±0.26, and mean ejection fraction (EF) was 71.55±5.72%. Conclusion: Echocardiographic evaluation is important for addressing hsPDA in preterm infants