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All Journal Sari Pediatri Paediatrica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia
Evita Karianni Bermanshah
Department Of Child Health, Faculty Of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Public Health

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KASUS KATETER DIALISIS PERITONEAL YANG TERPUNTIR PADA SEORANG ANAK Cahyani Gita Ambarsari; Farhan Haidar Fazlur Rahman; Evita Karianni Bermanshah; Agustina Kadaristiana
Majalah Kedokteran Indonesia Vol 70 No 2 (2020): Journal of the Indonesian Medical Association Majalah Kedokteran Indonesia Volum
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.1234/jinma.v70i2.175

Abstract

Tujuan: Komplikasi mekanik akibat dialisis peritoneal (DP) dapat terjadi karena komplikasi operasi insersi kateter Tenckhoff maupun komplikasi non-operatif, yaitu saat perawatan kateter dialisis jangka panjang. Laporan kasus ini bermaksud untuk menekankan komplikasi non-operasi pada DP dengan menyajikan laporan kasus terpuntirnya kateter eksternal.Metode: Dilaporkan seorang anak perempuan berumur 11 tahun dengan gagal ginjal yang menjalani dialisis peritoneal mandiri berkesinambungan (DPMB) di Rumah Sakit Cipto Mangunkusumo dan mengalami peritonitis berulang. Hasil: Kateter eksternal terpuntir tanpa masalah pada aliran masuk, aliran keluar, maupun ultrafiltrasi. Skor exit-site 4 dan terdapat gaping. Rontgen dan ultrasonografi abdomen menunjukkan kateter dan kedua cuff berada dalam posisi yang benar. Pasien sering menarik-narik dan memutar-mutar selang kateter dialysis peritoneal (DP). Selain itu, ibu pasien sering melibatkan pengasuh yang tidak terlatih untuk merawat kateter DP dan tidak memfiksasi kateter. Selama perawatan inap, pelatihan diberikan kembali kepada semua pengasuh yang terlibat dalam perawatan kateter harian. Peritonitis teratasi dengan gentamisin intraperitoneal selama 14 hari. Kami menyimpulkan bahwa kateter terpuntir dan peritonitis berulang diakibatkan oleh perpaduan trauma mekanik, perawatan kateter dan exit-site nya yang buruk, serta pelatihan perawatan kateter DP yang suboptimal. Kesimpulan: Kepatuhan perawatan kronik kateter PD oleh pengasuh yang terlatih dengan melibatkan pasien, serta memfiksasi kateter eksternal penting untuk mencegah komplikasi non-operasi pada DP.
Superior mesenteric artery blood flow in infants of very preterm and very low birthweight and its related factors Evita Karianni Bermanshah Ifran; Wresti Indriatmi; Tetty Yuniarti; Nadjib Advani; Saleha Sungkar; Dewi Irawati Soeria Santoso; Rinawati Rohsiswatmo; Yvan Vandenplas; Badriul Hegar
Paediatrica Indonesiana Vol 63 No 2 (2023): March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.2.2023.80-7

Abstract

Abstract Background Significant hemodynamic changes in preterm infants during early life could have consequences, especially on the intestinal blood flow. Alteration of superior mesenteric artery (SMA) blood flow may lead to impairment in gut function and feeding intolerance. Objectives To assess SMA blood flow velocity in very preterm and/or very low birth weight (VLBW) infants in early life and to elucidate the factors influencing them. Methods This is a cross-sectional study conducted in NICU at Cipto Mangunkusumo Hospital, Jakarta. Superior mesenteric artery (SMA) blood flow was evaluated by peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) measurement using Color Doppler US at < 48 hours after birth. Maternal and neonatal data that could be potentially associated with SMA blood flow were obtained. Bivariate analyses were conducted with a P value of < 0.05 considered significant. Results We examined 156 infants eligible for the study. PSV, EDV, and RI of SMA blood flow were not related to both gestational age and birth weight. Infant with small for gestational age (SGA) showed significantly lower EDV median [15.5 (range 0.0-32.8) vs 19.4 (range 0.0-113.0)] and higher RI [0.80 (range 0.58-1.00) vs 0.78 (range 0.50-1.00)] compared to appropriate for gestational age (AGA). Infants born from mother with preeclampsia showed lower PSV median [(78.2 (range 32.0-163.0) vs 89.7 (range 29.2-357.0)]) and EDV [16.2 (range 0.0-48.5) vs 19.4 (range 0.0-113.0)] compared to without PE, while absent/reverse end-diastolic velocity (AREDV) revealed a lower EDV median [16.9 (range 0.0 – 32.4) vs 19.4 (range 0.0 – 113.0)] compared to no AREDV. Furthermore, infants with hs-PDA showed lower EDV median [16.2 (range 0.0-113.0) vs 19.4 (range 0.0-71.1)] but higher RI median [0.80 (range 0.50-1.00) vs 0.78 (range 0.55-1.00)] compared to non hs-PDA. No difference in SMA blood flow across other factors was observed.
Ultrasound vs. standard radiography to determine peripherally-inserted central catheter tip location Thimoty, James; Ifran, Evita Karianni B.; Rohsiswatmo, Rinawati
Paediatrica Indonesiana Vol. 64 No. 2 (2024): March 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.2.2024.126-31

Abstract

Background The use of a peripherally-inserted central catheter (PICC) has increased in preterm neonates to facilitate the administration of total parenteral nutrition. Standard radiography (thoracoabdominal X-ray) is the gold standard for determining the position of the PICC tip. However, radiography is not always accurate, influenced by the position of the extremities and anatomic variations, time-consuming procedural process, involves radiation, and is costly. Ultrasonography (USG) may serve as an easier, safer, less costly, and more real-time alternative in the neonatal intensive care unit (NICU) patients. Objective To assess the accuracy of USG use in determining PICC tip position compared to that of standard radiography. Methods This diagnostic study was conducted in the NICU at Dr. Cipto Mangunkusumo Hospital, Jakarta. The PICCs were placed using standard NICU procedure, then the tip position was evaluated using the USG immediately before standard radiography was performed. A 2x2 table was constructed to compare the diagnostic accuracy of the two modalities. Results A total of 29 neonates were included in our study. Subjects’ mean gestational age and weight were 31.7 weeks and 1,618.9 g respectively. Concordance of PICC tip positioning between standard radiography and USG occurred in 27 neonates (93.1%). USG had 88.89% sensitivity, 95% specificity, and 93.1% diagnostic accuracy. Conclusion USG has excellent diagnostic accuracy for confirmation of the PICC tip position.
Evaluasi Penggunaan Antibiotik dengan Seftriakson terhadap Kesembuhan Pasien Anak dengan Infeksi Saluran Kemih dan Pola Sebaran Bakteri Putri, Dewi Andini; Karyanti, Mulya Rahma; Tambunan, Taralan; Gayatri, Pramita; Bermanshah, Evita Karianni
Sari Pediatri Vol 26, No 5 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp26.5.2025.306-13

Abstract

Latar belakang. Pemberian antibiotik yang rasional untuk infeksi saluran kemih (ISK) mendukung proses kesembuhan, mencegah komplikasi, dan mencegah resistensi antibiotik.Tujuan. Mengevaluasi penggunaan antibiotik dengan alur Gyssens, menilai kesembuhan subjek yang diberi antibiotik sesuai Pedoman Penggunaan Antibiotik (PPAB), dan mengetahui faktor-faktor risiko yang memengaruhi kesembuhan ISK.Metode. Penelitian deskriptif dengan desain potong lintang yang dilakukan secara retrospektif pada pasien anak dengan ISK yang dirawat di RSCM.Hasil. Alur Gyssens menunjukkan antibiotik diberikan rasional pada 53% pasien. Etiologi bakteri pada ISK tersering adalah Escherichia coli, Enterococcus faecalis, dan Klebsiella pneumonia. Kesembuhan ISK berhubungan dengan pemberian antibiotik sesuai rekomendasi PPAB dibandingkan dengan pasien yang diberikan antibiotik lain (88% vs 74%, p = 0,05). Faktor risiko yang terbukti memengaruhi kesembuhan ISK adalah jenis kelamin laki-laki (p=0,04, adjusted OR 2,1 (IK 95% 1,03-4,30)) dan kondisi pasien tanpa komorbiditas (p<0,01, adjusted OR 5,7 (IK 95% 1,64-20,05)).Kesimpulan. Terapi sesuai PPAB memberikan angka kesembuhan yang lebih tinggi dibanding terapi antibiotik lain.
Kepatuhan Pengobatan Sebagai Faktor Proteksi terhadap Kualitas Hidup pada Anak dan Remaja dengan Penyakit Graves Ismail, Ismi Citra; Soesanti, Frida; Syarif, Badriul Hegar; Medise, Bernie Endyarni; Pulungan, Aman Bhakti; Bermanshah, Evita Karianni; Faizi, Muhammad
Sari Pediatri Vol 27, No 2 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp27.2.2025.73-81

Abstract

Latar belakang. Penyakit Graves (PG) merupakan kelainan autoimun yang merupakan penyebab hipertiroid terbanyak pada anak dan remaja. Manifestasi PG dan proses pengobatan yang dilakukan pasien akan memberikan dampak pada kualitas hidup pasien. Kepatuhan pasien terhadap pengobatan akan memengaruhi keberhasilan pengobatan dan kualitas hidup.Tujuan. Penelitian ini dilakukan untuk mengetahui hubungan antara kepatuhan pengobatan dengan kualitas hidup pada pasien anak dan remaja dengan PG.Metode. Studi potong lintang terhadap 74 anak usia 5-18 tahun dengan PG. Pemilihan subjek secara consecutive sampling mulai Desember 2020 – Mei 2021. Kepatuhan pengobatan diukur dengan The Morisky Medication Adherence Scale (MMAS-8), kualitas hidup diukur dengan The Pediatric Quality of Life Inventory (PedsQLTM) Analisis hubungan antara kepatuhan pengobatan dengan kualitas hidup setelah menyesuaikan dengan variabel perancu dilakukan dengan metode regresi logistik.Hasil. Tingkat kepatuhan pengobatan tinggi pada pasien anak dan remaja dengan PG adalah 21,6 %. Prevalens kualitas hidup terganggu pada anak dan remaja dengan PG adalah 45,9% dan tidak ada beda antara laporan anak dan orangtua. Nilai adjusted OR kepatuhan pengobatan tinggi untuk terjadinya kualitas hidup terganggu setelah menyesuaikan dengan tingkat pendidikan ibu, tingkat pendapatan, usia, dan durasi sakit adalah 0,098 (IK95% = 0,016-0,580).Kesimpulan. Tingkat kepatuhan pengobatan tinggi merupakan faktor protektif dari terjadinya kualitas hidup terganggu pada anak dengan PG.
Kasus Kateter Dialisis Peritoneal yang Terpuntir pada Seorang Anak Cahyani Gita Ambarsari; Farhan Haidar Fazlur Rahman; Evita Karianni Bermanshah; Agustina Kadaristiana
Majalah Kedokteran Indonesia Vol 70 No 2 (2020): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.70.2-2020-175

Abstract

Objective: Mechanical complications of peritoneal dialysis (PD) may occur because of surgical complications when inserting a Tenckhoff catheter or non-surgical complications during chronic care of a PD catheter. We aim to highlight the latter by presenting a case report of twisted external catheter. Method: We report an 11-year-old Indonesian girl with end-stage renal disease on continuous ambulatory PD at Cipto Mangunkusumo Hospital who was hospitalized due to repeat peritonitis.Result: Upon examination, the external catheter seemed twisted without inflow, outflow, or ultrafiltration problems. Her exit score was 4 with gaping. Both abdominal X-ray and ultrasound showed that the catheter and its cuffs were properly placed. The patient frequently pulled and manipulated her PD catheter. Additionally, the catheter-site care procedure was frequently done by untrained caregivers and catheter fixation was also not performed. A retraining program for all involved caregivers was carried out. Peritonitis resolved after 14-day-treatment using intraperitoneal gentamicin. We determined that the twisted catheter and repeat peritonitis were due to a combination of mechanical trauma, poor chronic catheter-site care, and suboptimal PD catheter training. Conclusion: Maintaining compliance for chronic PD catheter exit-site care by well-trained caregivers and by patients themselves, as well as the external catheter fixation are important.
Co-Authors Agustina Kadaristiana Agustina Kadaristiana Aman Bhakti Pulungan, Aman Bhakti Badriul Hegar Badriul Hegar Syarif Bernie Endyarni Medise Cahyani Gita Ambarsari Cahyani Gita Ambarsari Farhan Haidar Fazlur Rahman Farhan Haidar Fazlur Rahman Ismi Citra Ismail, Ismi Citra James Thimoty Muhammad Faizi Mulya Rahma Karyanti, Mulya Rahma Nadjib Advani Pramita Gayatri, Pramita Putri, Dewi Andini Rinawati Rohsiswatmo Saleha Sungkar Santoso, Dewi Irawati Soeria Soesanti, Frida Taralan Tambunan Tetty Yuniarti Wresti Indriatmi Yvan Vandenplas