Gangguan Koagulasi pada Sepsis

Sepsis pada anak memiliki angka morbiditas dan mortalitas yang tinggi. Gangguan koagulasi berat pada sepsis berhubungan dengan meningkatnya mortalitas. Telah banyak informasi mengenai perkembangan mekanisme aktivasi koagulasi dan inflamasi sebagai respon terhadap infeksi berat. Pada sepsis, gangguan koagulasi terjadi akibat pembentukan trombin oleh tissue factor, gangguan mekanisme antikoagulan dan penghentian sistem fibrinolisis. Pengetahuan tersebut sangat berguna untuk mengembangkan terapi dan intervensi terhadap pasien dengan sepsis yang disertai gangguan koagulasi berat. Pemberian terapi seperti antikoagulan, antitrombin, dan rekombinan protein C, rekombinan TFPI masih memerlukan bukti yang mendukung untuk dapat digunakan pada pasien anak

Acute kidney injury and mortality in critically ill children

Background Mortality from acute kidney injury (AKI) can be as high as 60% in critically ill children. This high mortality rate is influenced by the severity of primary diseases, organ dysfunction, and the stage of acute kidney injury. Objective To assess for an as sedation between AKI and mortality in critically ill children hospitalized in the pediatric intensive care unit (PICU). Methods A cross-sectional study was conducted from April to July 2012. All patients aged 1 month to 18 years who were hospitalized in the PICU for more than 24 hours were included. Urine output and serum creatinine levels were evaluated daily. Patients were categorized according to the pediatric risk, injury, failure, loss, and end stage renal disease (pRIFLE) criteria. Chi square, Fisher's exact, Mann-\X'hitney U, and Kruskal-Wallis tests were used to assess for an association between AKI, mortality, pediatric logistic organ dysfunction (PELOD) score, and length of PICU stay. AP value of < 0.05 was considered as statistically significant. Results During the study period, 57 children were admitted, consisting of 25 (43.9%) females and 32 (56.1 %) males, with a median age of 43 months. The prevalance of AKI was 31.5% (18/57) and classified into stages: risk 13/18, injury 3/18, and failure 2/18. The mortality rate for AKI was 16. 7%. There was no association between AKI and mortality (P=0.592). The PELOD scores were found to be similar among patients (SD 11.3 2 vs. SD 12.23; P=0.830), and there was no association between AKI and length of PICU stay (P=0.819). Conclusion There is no association between AKI and mortality in critically ill children admitted in PICU

Comparison of quinine-doxycycline and quinine-clindamycin for falciparum malaria in children

Objective To compare the efficacy of quinine-doxycycline to quinine-clindamycin combination, as treatment for uncomplicated falciparum malaria in children. Methods This randomized open labelled controlled trial was conducted from July to August 2007 at Mandailing Natal, Sumatera Utara Province. The subjects were 8 – 18 year old children with positive Plasmodium falciparum from the peripheral blood smear. Simple randomization was performed to determine subject study into two groups of treatment, one group received quinine-clindamycin and the other received quinine-doxycycline treatment. The parasitemia was counted on day 0, 2, 7 and 28. We also observed the adverse effects of the antimalarial combination. Results Two hundred and forty six children who fulfilled the inclusion criteria were divided into two groups. All subjects completed the study. Cure rate achieved 100% from peripheral blood smear examination at the second day observation and showed no recrudescence at day 28th. (P=0.0001). During 28 days follow up, there were 21 (17.6%) patients suffered from headache, 18 (14.6%) vomit and 40 children (32.5%) suffered from tinnitus in quinine-doxycycline combination, compared to quinine-clindamycin combination group only 4 (3.3%) suffered from headache, 1 (0.8%) suffered from tinnitus and there was no vomiting experience in any patient (P < 0.0001). Conclusion Combination of quinine with either clindamycin or doxycycline are effective as an alternative antimalarial treatment. The combination of quinine-clindamycin is well tolerated than the combination of quinine-doxyciline, and this combination may be particular value for young children and pregnant women, as these two groups cannot receive doxycycline

PELOD score, serum procalcitonin, and lactate levels in pediatric sepsis

Background Sepsis remains a major cause of morbidity and mortality among critically ill children in the pediatric intensive care unit (PICU). Procalcitonin and lactate have been used as biomarkers of sepsis, as they have been correlated with disease severity, organ failure and death. The Pediatric Logistic Organ Dysfunction (PELOD) score is a tool to assess the severity of organ dysfunction in critically ill children. Objective To investigate the correlation between PELOD score and procalcitonin and lactate levels in pediatric sepsis. Methods A cross-sectional study was conducted in children with sepsis who were admitted to the PICU from April to July 2012. Sepsis was defined as systemic inflammatory response syndrome (SIRS), as a result of suspected or proven infection. Proven infection was defined as positive culture findings (blood, urine or other specimens) and/or serum procalcitonin >=2 ng/mL. Spearman’s test was used to assess for correlations between PELOD scores and procalcitonin as well as lactate levels. Results Thirty-two patients were analyzed, consisting of 18 males and 14 females with an age range of 1-432 months (median 21 months). There was no statistically significant correlation between procalcitonin level and PELOD score (r=- 0.186, 95%CI -0.502 to 0.174, P=0.308) nor between lactate level(r=-0.069, 95%CI -0.408 to 0.287, P=0.709) and PELOD score. Conclusion Serum procalcitonin and lactate levels are not correlated with PELOD scores in children with sepsis

Red cell distribution width and mortality in pediatric sepsis

Background Red cell distribution width (RDW) is a hematological parameter routinely obtained as part of the complete blood count. Recently, RDW has emerged as a potential independent predictor of clinical outcomes in adults with sepsis. However, RDW as a mortality predictor in pediatric populations has not been well established. Objective To determine the relationship between RDW value and mortality outcomes in pediatric sepsis patients. Methods We performed a cross-sectional study of 40 consecutive pediatric patients with sepsis admitted to the PICU from December 2013 to March 2014. All patients’ RDW were collected within 24 hours of sepsis diagnosis. We determined the association between RDW and hemoglobin (Hb) using Spearman’s correlation. The RDW values of 11.5-14.5% were considered to be normal while those > 14.5% were considered to be elevated. We compared mortality and PICU length of stay (LoS) between the normal and elevated RDW groups using Chi-square and Mann-Whitney tests. Results The median age of patients was 34 months (range 2 months to 17 years). There were 28 (70%) male subjects. Subjects’ median RDW was 14.8% (range 11.2-27.8%) and was not correlated with Hb (r=0.056; P=0.73). Mortality rates in the normal and elevated RDW groups were 40% and 45%, respectively. There were no significant associations between RDW group and mortality (P=0.749) or PICU LoS (P=0.350). Conclusion Unlike in adults, RDW values are not correlated with mortality in pediatric sepsis patients