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Risk factors contributing to weaning failure from continuous positive airway pressure to high flow nasal cannula in neonates with respiratory distress syndrome Putra, Najih Rama Eka; Dadiyanto, Dwi Wastoro; Sahyuni, Riza; Rini, Arsita Eka; Muryawan, Heru; Suswihardhyono, Adhie Nur Radityo
Paediatrica Indonesiana Vol. 64 No. 1 (2024): January 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.1.2024.77-85

Abstract

Background Respiratory distress syndrome (RDS) is one of the most frequent causes of mortality and morbidity in neonates. High flow nasal canule (HFNC) is a step ladder modality of alternative oxygen therapy for weaning to reduce the workload of breathing and the need for intubation. Objective To identify the risk factors contributing to weaning failure from continuous positive airway pressure (CPAP) to HFNC in neonates with RDS. Methods This study was a retrospective observational study in neonates aged less than 36 weeks weighing less than 2500 grams who underwent CPAP to HFNC weaning from 2019 to 2021 in Dr. Kariadi Hospital, Semarang, Central Java, Indonesia. Results There were 108 patients included in this study. Our bivariate analysis found significant differences in gestational age, age at the start of weaning, body weight at the start of weaning, FiO2 levels, history of maternal chorioamnionitis, patent ductus arteriosus (PDA), anemia, apnea of prematurity (AOP), and sepsis in neonates with RDS. Multivariate analysis showed that the most dominant factors were FiO2 levels of more than 25% at the start of weaning (OR11.16; 95%CI 1.83 to 63.12; P=0.009), anemia (OR 7.70; 95%CI 1.39 to 42.67; P=0.019), AOP (OR 19.64; 95%CI 4.27 to 90.35; P<0.001), and sepsis (OR 10.93; 95%CI 2.37 to 45.53; P=0.002) Conclusion FiO2 setting of more than 25% at the start of weaning, anemia, AOP, and sepsis produce a significant probability of HFNC weaning failure.
Profil Klinis, Laboratorium, Radiologis dan Luaran Pasien COVID-19 Pada Anak di RSUP Dr. Kariadi Semarang Anam, Moh Syarofil; Wistiani, Wistiani; Sahyuni, Riza; Hapsari, Maria Magdalena Diah Endang Apriani Harry
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (284.14 KB) | DOI: 10.36408/mhjcm.v7i1A.459

Abstract

Latar belakang Kasus COVID-19 pada anak menunjukkan karakteristik klinis yang bervariasi, meskipun umumnya ringan dapat menjadi sumber penularan dan memunyai dampak terhadap kesehatan secara umum. Tujuan Melaporkan karakteristik klinis, laboratorium, gambaran radiologis dan luaran pasien COVID-19 pada anak di RSUP Dr. Kariadi Semarang Metode Penelitian retrospektif, dengan data dari rekam medis pasien terduga COVID-19 di RSUP dr Kariadi Semarang pada periode Maret – April 2020. Kriteria inklusi pasien usia 0-18 tahun terduga COVID dirawat di rumah sakit, dan dilakukan pemeriksaan PCR dengan spesimen swab. Data yang dikumpulkan adalah demografi, manifestasi klinis, laboratorium, gambaran radiologis, penyakit komorbid, dan luaran. Analisis data menggunakan SPPS for window 12.0 version. Hasil Enam puluh satu pasien yang terduga COVID, 41 kasus dilakukan analisis dengan temuan hasil positif pada 5 (12%) kasus, laki-laki 22 (53,7%) dan perempuan 19( 46,3%) dengan median usia 36 bulan (rentang 3-214 bulan), gejala utama batuk 38 (92,7%), demam 37 (90,2%), dan ronkhi 25 (61%). Pada kelompok kasus COVID positif batuk dijumpai pada 5/5 pasien, demam 3/5 pasien, ronkhi 2/5 pasien. Seluruh pasien dari kelompok COVID positif pulang perbaikan, dan 4 kasus dari kelompok COVID negatif meninggal. Kadar lekosit dan limfosit kelompok COVID positif dan negatif berturut-turut dengan nilai signifikansi p 0,62 dan p 0.72, gambaran radiologis antar kelompok p 0,56 Simpulan Tidak didapatkan perbedaan karakteristik riwayat epidemiologis, gejala dan tanda klinis, laboratorium, foto rontgen toraks serta luaran antar kelompok pasien COVID-19 positif dan negatif.
Seorang Anak Perempuan Probable Covid-19 dengan Keterlibatan Ginjal (Laporan kasus) Mellyana, Omega; Latifah, Nur; Trixie, Marcella; Mardiana, Frederika; Anam, Moh Syarofil; Sahyuni, Riza; Wistiani, Wistiani
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (379.092 KB) | DOI: 10.36408/mhjcm.v7i1A.480

Abstract

Latar belakang: Kasus Probable Covid-19 adalah kasus penderita dengan gambaran klinis dan pemeriksaan penunjang yang meyakinkan Covid-19 namun tidak terkonfirmasi dengan pemeriksaan real-time polymerase chain reaction (RT-PCR). Kasus probable banyak menimbulkan kekhawatiran karena risiko penularan dan keraguan dalam tata laksana baik bagi dokter, perawat, dan penanggung jawab pasien. Tujuan penulisan artikel ini adalah untuk melaporkan kasus seorang anak dengan probable Covid-19 dan mendiskusikan kemungkinan diagnosis banding lain sebagai pemikiran di tengah pandemi Covid-19 guna pengelolaan pasien yang lebih optimal. Kasus: Anak perempuan 14 tahun 5 bulan dengan keluhan utama batuk selama dua minggu sebelum masuk rumah sakit, disertai demam, diare dan sesak. Selama perawatan, sesak makin bertambah. Tiga hari perawatan ditemukan oliguria, proteinuria, anemia, leukositosis, trombositopenia, hipersegmentasi neutrofil, limfopenia, peningkatan prokalsitonin, hipoalbuminemia dan penurunan fungsi ginjal (51 ml/menit/1,73 m2). Gambaran rontgen dada menunjukkan bronkopneumonia dan kardiomegali. MSCT dada terdapat gambaran konsolidasi dan ground glass appearance (GGO) di kedua paru mendukung ke arah Covid-19. Pada hari perawatan ke 16 anak mengalami gagal nafas, hemoptoe, penurunan kesadaran hingga meninggal. Swab RT-PCR 3 kali negatif (selama perawatan dan post mortem). Ringkasan : Infeksi Covid-19 adalah penyebab infeksi saluran nafas yang serius dan berat. Telah dilaporkan seorang anak perempuan 14 tahun 5 bulan yang meninggal karena Probable Covid-19. Di tengah pandemi Covid-19 ini seorang dokter perlu meningkatkan kewaspadaan yang tinggi terhadap infeksi virus atau bakteri lain untuk memperbaiki tata laksana dan luaran pada penderita. Kata kunci: Covid-19, probable, ground glass opacity, RT-PCR Background: Probable Covid-19 cases are patients with clinical features and convincing investigations for covid-19 but there is not confirmed by real time polymerase chain reaction (RT-PCR). Probable cases raise many concerns because of the risk of transmission and doubt in good management for the doctor / nurse in charge of the patient. The purpose of writing was to report the child with probable Covid-19 and provide a discussion of possible other differential diagnoses as thoughts in the midst of the Covid-19 pandemic for optimal management of sufferers. Case: A girl 14 years 5 months old had a cough for two weeks before admission, accompanied by fever, diarrhea and breathlessness. During treatment, the shortness of breath increased, three days of treatment found oliguria, proteinuria, hematuria, anemia, leukocytosis, thrombocytopenia, neutrophil hypersegmentation, lymphopenia, increased procalcitonin, hypoalbuminemia and decreased renal function (51 ml / min / 1.73 m2). Chest x-ray of bronchopneumonia and cardiomegaly. In the finding of chest computed tomography scan showed consolidation and ground glass appearance (GGO) in both lungs supporting the diagnose of Covid-19. On the 16th day of treatment, the child suffered respiratory failure, hemoptoes, decreased consciousness until death. RT-PCR swabs were 3 times negative (during treatment and post mortem). Summary: Covid-19 is a serious and severe cause of respiratory tract infection. It has been reported that a girl of 14 years and 5 months who died of Probable Covid-19 has been reported. During the Covid-19 pandemic, a doctor may need to increase high awareness of other viral or bacterial infections to improve management and outcome of patients in the future. Key word: Covid-19, Children, Ground Glass Opacity, RT_PCR