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Journal : Paediatrica Indonesiana

Hyperlactacemia in critically ill children: comparison of traditional and Fencl-Stewart methods Hari Kushartono; Antonius H. Pudjiadi; Susetyo Harry Purwanto; Imral Chair; Darlan Darwis; Abdul Latief
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (563.506 KB) | DOI: 10.14238/pi47.1.2007.35-41

Abstract

Background Base excess is a single variable used to quantifymetabolic component of acid base status. Several researches havecombined the traditional base excess method with the Stewartmethod for acid base physiology called as Fencl-Stewart method.Objective The purpose of the study was to compare two differentmethods in identifying hyperlactacemia in pediatric patients withcritical illness.Methods The study was performed on 43 patients admitted tothe pediatric intensive care unit of Cipto MangunkusumoHospital, Jakarta. Sodium, potassium, chloride, albumin, lactateand arterial blood gases were measured. All samples were takenfrom artery of all patients. Lactate level of >2 mEq/L was definedas abnormal. Standard base excess (SBE) was calculated fromthe standard bicarbonate derived from Henderson-Hasselbalchequation and reported on the blood gas analyzer. Base excessunmeasured anions (BE UA ) was calculated using the Fencl-Stewartmethod simplified by Story (2003). Correlation between lactatelevels in traditional and Fencl-Stewart methods were measuredby Pearson’s correlation coefficient .Results Elevated lactate levels were found in 24 (55.8%) patients.Lactate levels was more strongly correlated with BE UA (r = - 0.742,P<0.01) than with SBE (r = - 0.516, P<0.01).Conclusion Fencl-Stewart method is better than traditionalmethod in identifying patients with elevated lactate levels, so theFencl-Stewart method is suggested to use in clinical practice.
Comparison of serial blood lactate level between dengue shock syndrome and dengue hemorrhagic fever (evaluation of prognostic value) M. Tatang Puspanjono; Abdul Latief; Alan R. Tumbelaka; Sudigdo Sastroasmoro; Hartono Gunardi
Paediatrica Indonesiana Vol 47 No 4 (2007): July 2007
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (538.111 KB) | DOI: 10.14238/pi47.4.2007.150-5

Abstract

Background Dengue shock syndrome (DSS) mortality is still high.Monitoring of blood lactate level is important to evaluate shock.Objectives The study were to review the difference between bloodlactate level of DSS and that of dengue hemorrhagic fever (DHF),to correlate blood lactate level with hypoxia state as shock riskfactors (PaO 2 , oxygen saturation, and anion gap) and to determinethe cut-off point of blood lactate level to predict shock.Methods The study was carried out at the Department of ChildHealth, Medical School, University of Indonesia, CiptoMangunkusumo Hospital, Jakarta, from January until July 2006.Three mL venous blood specimen was collected from all subjectsfor peripheral blood, blood gasses, serology, and blood lactateexaminations. This study consisted of a retrospective cohort anda cross sectional method. Data were analyzed with Chi-squaretest. Continous data tested using Mann-Whitney method. Toknow the correlation between blood lactate level and shock riskfactors we use logistic regression test.Results In DSS group, 73% shows hyperlactatemia (lactate =2mmol/L). Conversion of lactate means between two groups issignificantly different from day one to day two and three. Therewas a negative correlation between lactate level and pO 2 andoxygen saturation. Oxygen saturation is the only value that hasclinical correlation. Regressions analysis can be applied using Y= 7.05–0.05 X equation. The cut-off point of lactate level asmarker for shock by using ROC curve is 32.015 mmol/L with 70%sensitivity and 83.3% specificity.Conclusions Hyperlactatemia in DSS can be considered as a signfor unappropriate treatment of shock. Blood lactate level can beused as a biochemical marker for tissue hypoxia, to assess severityof the disease, as monitoring of treatment, and has prognosticvalue of DHF cases.
Profile of children with increased intracranial pressure on mannitol treatment Sander D Teddy; Abdul Latief; Bambang Madiyono
Paediatrica Indonesiana Vol 44 No 4 (2004): July 2004
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (304.86 KB) | DOI: 10.14238/pi44.4.2004.148-52

Abstract

Background Early recognition of increased intracranial pressure(IIP) and well-monitored management are determining indicatorsfor treatment outcome. As far as we know, data of children with IIPon mannitol treatment has not been available.Objective To elicit the profile of IIP patients who received mannitolat the Department of Child Health, Cipto Mangunkusumo Hospital,Jakarta.Methods This was a cross-sectional study. Data were obtainedfrom medical records of patients with increased intracranial pres-sure who received mannitol at the Department of Child Health,Cipto Mangunkusumo Hospital, Jakarta between July 2001 to Oc-tober 2003Results Fifty-four IIP patients with mannitol treatment were included.Forty-two (78%) were under-five years old. Thirty-six subjects (67%)were boys; 30 (56%) were undernourished. Central nervous systeminfections (meningitis and encephalitis) were the most frequent causesof IIP. Most of the head CT scan revealed cerebral edema, hydroceph-alus, and cerebral hemorrhage. Fifty subjects (93%) had decline of con-sciousness; most of them were somnolent. Improvement in conscious-ness was identified in 31 subjects, in which 21 subjects reached fullconsciousness. Vomiting, which was found in 25 subjects (46%), sub-sided after mannitol administration. Behavioral changes were found in49 subjects (91%); 32 subjects still had persistent behavioral changesafter mannitol administration. Large and protruding fontanel was foundin 7/22 subjects, cerebral nerve paralysis in 23 subjects (43%) andpapillary edema in 6 of 34 subjects who underwent funduscopy. Duringthe treatment with mannitol, fever was found in 5 subjects, vomiting in 2subjects, skin edema and tachycardia each in 1 subject. Metabolic aci-dosis was found in 6/13 subjects, hyponatremia and hypokalemia in 16and 13 out of 30 subjects respectively. Death occurred in 9 subjects(17%).Conclusion In IIP patients, the administration of mannitol has atendency to improve consciousness, vomiting, and behavioral orpersonality changes. The high incidence rate of electrolyte imbal-ances and metabolic acidosis during the treatment indicated theneed of periodic monitoring to detect early disorders.
Adverse events following immunization of combined diphtheria, whole-cell pertussis, tetanus, and hepatitis B (DPwT/HB) vaccine Diana Mettadewi Jong; Alan R Tumbelaka; Abdul Latief
Paediatrica Indonesiana Vol 44 No 6 (2004): November 2004
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (362.89 KB) | DOI: 10.14238/pi44.6.2004.209-14

Abstract

Background Combined vaccine of diphtheria, whole-cell pertussis,tetanus, and hepatitis B (DPwT/HB) will reduce the number ofinjections to children and simplify the delivery logistics. The adverseevents following immunization (AEFI) of this vaccine have to beconcerned since the events may increase or decrease.Objectives To evaluate AEFI of DPwT/HB vaccine in healthy in-fants.Methods A descriptive prospective study of AEFI of three dosesof DPwT/HB vaccine was performed on 74 healthy infants agedtwo to six months at the Department of Child Health, CiptoMangunkusumo Hospital, from July 2000 to March 2001.Results Out of 74 infants, 68 received two doses and 67 completedthe study with a total of 209 doses. Of 209 doses, adverse eventswere reported following 126 doses (60.3%), consisted of systemic(60.3%) and local reactions (9.5%). The three most frequent AEFIiwere mild fever (44.5%), high fever (15.7%), irritability (31.5%).Most AEFI were coincidental (51.1%), occurred after more than72 hours (31.4%) and lasted less than 24 hours (17.7%). Sys-temic reactions were mostly found in 4-month-old infants (33.3%),while local reactions in 2-, 3-, and 5-month-old infants (25%),respectively.Conclusion Most AEFI were coincidental and resolved withoutany complication
The prevalence of atopic dermatitis history in asthmatic children Rifda Suryati; Arwin AP Akib; I Boediman; Abdul Latief
Paediatrica Indonesiana Vol 46 No 4 (2006): July 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.4.2006.164-9

Abstract

Background Atopic dermatitis (AD) is a risk factor of asthma. Thereis still limited information about its prevalence and characteristicsin asthmatic children.Objective To find out the prevalence of AD history in asthmaticchildren.Methods This was a cross-sectional study conducted at the De-partment of Child Health, Cipto Mangunkusumo Hospital, Jakarta,from July until December 2004. Patients with asthma who were ator less than 5 years of age were included in the study. The parentshad completed study questionnaire about asthma, AD, and someinformation about atopic family history, the food history in infantperiod and environment factors.Results Ninety children met the inclusion criteria. Male and femaleratio was 1.5:1. Most of subjects reported onset of asthma in 12-36 months of age. The history of AD was found in 26% of asth-matic children with quite similar number for both sexes. All sub-jects had atopic family history with asthma as the most commonmanifestation. The environment factors contributed to this eventwere mother’s diet containing allergen and smoking history in familyduring pregnancy and lactation period. More than half of subjectshad no breast-feeding. Solid food and formulated milk had beenearly-introduced.Conclusion History of AD is found in 26% asthmatic children.The percentage of characteristic distribution of factors which hadbeen assumed has a role in asthma and AD was similarly equalbetween subjects with and without history of AD
The role of hearing capability test as a screening test for the possibility of hearing disorder in children with speech delay Fatmawaty Fatmawaty; Hartono Gunardi; Ronny Suwento; Abdul Latief; Rulina Suradi; Irawan Mangunatmadja
Paediatrica Indonesiana Vol 46 No 6 (2006): November 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (307.364 KB) | DOI: 10.14238/pi46.6.2006.255-9

Abstract

Background Hearing disorder may cause speech delay so thatevery child with speech delay should undergo hearing test. Thegold standard for audiometric test is otoacustic emission (OAE)and brainstem evoked response audiometry (BERA). They havehigh sensitivity and specificity, but the availability is limited andexpensive. Hence, both tests are not available at the primary healthcare centers. In 1997, the Department of Health, Republic of Indo-nesia, established a simple subjective test instrument, i.e. the hear-ing capability test (HCT).Objective To asses the accuracy of HCT compared to the goldstandard hearing tests (OAE and/or BERA).Methods This study was a cross sectional study on 89 childrenaged less than 5 years who had speech delay and came to theGrowth and Development Outpatient Clinic or the General Outpa-tient Clinic, Pediatric Neurology Clinic of the Department of ChildHealth, Cipto Mangunkusumo (CM) Hospital; and Center for EarCare and Communicative Disorders (CECCD), Department of ENT,CM Hospital, during March to August 2005.Results HCT sensitivity and specificity were 92.9% and 27.7%,respectively. Positive predictive value (PPV), negative predictivevalue (NPV), positive likelihood ratio (PLR), and negative likehoodratio (NLR) were 84%, 50%, 1.9, and 0.7, respectively.Conclusion The sensitivity and specificity of HCT as a screeningtest of hearing disorder in children with speech delay were 93%and 28%, respectively. Based on this result, HCT should only beused as screening test and not as a diagnostic test