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All Journal Archives of The Medicine and Case Reports Scientific Journal of Pediatrics
I Wayan Sucipta
Department of Otorhinolaryngology and Head/Neck Surgery, Faculty of Medicine, Universitas Udayana/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Indonesia
Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Diagnostic Accuracy of the LittlEARS Auditory Questionnaire Against Auditory Steady-State Response for Detecting Hearing Loss in Infants Aged 6–24 Months Pande Agus Parta Prananda; I Made Wiranadha; Ni Luh Sartika Sari; I Dewa Arta Eka Putra; I Gde Ardika Nuaba; I Wayan Sucipta
Scientific Journal of Pediatrics Vol. 3 No. 2 (2025): Scientific Journal of Pediatrics
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjped.v3i2.269

Abstract

Introduction: Hearing loss is among the most common congenital conditions in childhood, yet most affected infants in Indonesia are identified late because objective audiometry is centralized and preverbal infants show few overt signs. This study aimed to determine the diagnostic accuracy of the parent-completed LittlEARS Auditory Questionnaire against the auditory steady-state response (ASSR) for detecting hearing loss in infants aged 6–24 months. Methods: In this single-center, cross-sectional diagnostic-accuracy study, 28 children aged 6–24 months (median 9.0 months; 71.4% male) attending a tertiary otorhinolaryngology clinic were enrolled by consecutive sampling. Parents independently completed the Indonesian LittlEARS, and each child underwent ASSR as the reference standard (hearing loss >25 dB HL across 0.5–4 kHz). Diagnostic indices were computed with Wilson 95% confidence intervals (CI); agreement, likelihood ratios, receiver-operating-characteristic analysis, and Firth penalized logistic regression were performed. Results: ASSR confirmed hearing loss in 19 children (67.9%), of whom 18 had bilateral loss. Referenced to ASSR, LittlEARS yielded a sensitivity of 89.47% (95% CI 68.6–97.1), specificity 77.78% (95% CI 45.3–93.7), positive predictive value 89.47%, negative predictive value 77.78%, and accuracy 85.71% (95% CI 68.5–94.3). Agreement was substantial (Cohen kappa 0.673), the positive likelihood ratio 4.03 and negative likelihood ratio 0.14, and the area under the curve 0.836 (95% CI 0.688–0.985). A suspected-hearing-loss result independently predicted ASSR-confirmed loss (adjusted odds ratio 13.98, 95% CI 1.68–116.25; p=0.015; Nagelkerke R2=0.469). Conclusion: The LittlEARS questionnaire is an accurate, low-cost screening adjunct for early childhood hearing loss but, given moderate specificity, a positive screen should be confirmed by objective audiometry.
Bronchoscopic Resolution of Refractory Atelectasis in a Toddler with Polymicrobial MDR Pneumonia: A Case Report I Wayan Sucipta; Eka Putra Setiawan; Komang Andi Dwi Saputra; Freddy Stanza Purba
Archives of The Medicine and Case Reports Vol. 7 No. 1 (2026): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v7i1.840

Abstract

Pediatric acute respiratory distress syndrome (PARDS) complicated by ventilator-associated pneumonia (VAP) poses significant management challenges, particularly when caused by multidrug-resistant organisms such as Stenotrophomonas maltophilia and Pseudomonas aeruginosa. A frequent and deleterious complication is plate-like atelectasis, which may prove refractory to conservative management due to anatomical constraints in the pediatric airway and biofilm formation. A 23-month-old male presented with severe PARDS and polymicrobial VAP. Despite extubation to High-Flow Nasal Cannula (HFNC), the patient developed persistent right upper lobe plate-like atelectasis refractory to aggressive physiotherapy and targeted antibiotic therapy with Levofloxacin and Ceftazidime for 21 days. On Day 75 of illness, a flexible bronchoscopy was performed. Intraoperative findings revealed hyperemic mucosa without macroscopic mucus plugging. However, the procedure, involving saline lavage and suctioning, resulted in immediate recruitment. Within 24 hours, the respiratory rate decreased from 45 to 24 breaths per minute, and the SpO2/FiO2 ratio improved significantly from 185 to 310, allowing weaning from respiratory support. In conclusion, in toddlers with multidrug-resistant VAP, atelectasis may persist due to biofilm-mediated micro-obstruction rather than macroscopic plugging. Flexible bronchoscopy is a safe and effective therapeutic adjunct in these cases, facilitating distal airway recruitment and breaking the cycle of chronic infection.
Co-Authors Eka Putra Setiawan Freddy Stanza Purba I Dewa Arta Eka Putra I Gde Ardika Nuaba I Made Wiranadha Komang Andi Dwi Saputra Ni Luh Sartika Sari Pande Agus Parta Prananda