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All Journal Medicina E-Jurnal Medika Udayana Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Sari Pediatri Paediatrica Indonesiana Molecular and Cellular Biomedical Sciences (MCBS) Bali Journal of Anesthesiology Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education ISM (Intisari Sains Medis) : Jurnal Kedokteran Review of Primary Care Practice and Education (Kajian Praktik dan Pendidikan Layanan Primer) Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management) Journal of Public Health and Pharmacy Jurnal Kedokteran Meditek Jurnal ARSI : Administrasi Rumah Sakit Indonesia
Dyah Kanya Wati
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Social Sciences Other

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Journal : Paediatrica Indonesiana

 1 
Factors associated with failure to wean children from mechanical ventilators Dyah Kanya Wati; Antonius Pudjiadi; Abdul Latief
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (107.807 KB) | DOI: 10.14238/pi53.2.2013.59-64

Abstract

Background Patients with failure to wean from mechanicalventilators in 48 hours have increased risk of morbidity, howeveronly a few protocols can be used for children.Objective To assess possible factors associated with failure towean from mechanical ventilators in the pediatric intensive careunit (PICU).Methods This cross sectional study performed from June 2011 toJune 2012 had 124 subjects with 79 patients who were successfullyweaned and 45 patients who fail to be wean ed from mechanicalventilators. Data was analyzed by 2x2 contingency tables. Resultswith P value <0.05 were further analysis by logistic regressionmultivariate analysis.Results Factors associated with failure to wean from mechanicalventilators were abn ormal electrolyte (P= 0.001) and acidbase status (P <0.001), lower ratio between tidal volume(TV)/inspiration time (IT) (P<0.001), lower mechanical load(P <0.001), and longer duration of mechanical ventilator use(P<0.001). Multivariate analyses revealed that the significantrisk factors for failure to wean were TV/IT (OR6.0; 95%CI3.5 to7.5; P= 0.001) , mechanical load (OR 11.5, 95%CI 10.3 to 15.5;P= 0.002), and duration of mechanical ventilator use (OR 12.5;95%CI 8.5to 14.9; P=0.026).Conclusions Lower ratio of TV /IT and mechanical load, as wellas longer duration of ventilator use are factors associated withfailure to wean from a mechanical ventilator.
AIDS in a three-year old girl Dyah Kanya Wati; Bagus Ngurah Putu Arhana; Dewi Kumara Wati; Tuti Parwati Merati
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 (236.961 KB) | DOI: 10.14238/pi46.6.2006.281-4

Abstract

The acquired immunodeficiency syndromein children was first recognized in 1982, oneyear after the initial description in adults.WHO estimates that 2 million children hadbeen infected with human immunodeficiency virus(HIV) by the year 2000. Pediatric AIDS threatenschild survival in developing countries. At the endof 1999, 34.3 million individuals were estimated tobe infected globally, of which 1.3 million (3.8%)were children below 15 years old. Until September2005, no children with HIV AIDS in Indonesia wasfound.Approximately 80% of children acquired HIV-1infection from vertical maternal transmission; the restare infected from contaminated blood products,infected organs, breastfeeding, or sexual abuse.Two general patterns of congenital infection arerecognized. Twenty percent of infected infants developearly disease, while the rest progress slowly, developinginto AIDS in adolescents. The most successfulapproach in the management of children with HIVrequires a multidisciplinary team approach.
Triiodothyronin (T3) as a parameter of mortality in sepsis patients in the PICU Sri Wahyuni Djoko; Nyoman Budi Hartawan; Bagus Ngurah Putu Arhana; Eka Gunawijaya; Anak Agung Ngurah Ketut Putra Widnyana; Dyah Kanya Wati
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (246.333 KB) | DOI: 10.14238/pi59.6.2019.298-302

Abstract

Background Thyroid hormone stimulates the regulation of β-adrenergic receptors in order to increase the inotropic effect of the heart myocardium. Euthyroid sick syndrome is a disorder of non-metabolic thyroid function, which is characterized by a decrease in triiodothyronine (T3) levels in patients with non-thyroid systemic disease, such as sepsis. Low serum T3 hormone level is a potentially high-risk factor for mortality from sepsis. Objective To assess for a relationship between decreased serum T3 levels and mortality in pediatric sepsis patients admitted in the PICU. Methods This study used a nested case-control design. The subjects were children aged 1 month-18 years who were diagnosed with sepsis in the pediatric intensive care unit at Sanglah Hospital, Denpasar, Bali, from September 2017 to January 2019. Results A total of 90 children were included, of whom 44 died and 46 survived. Median age was 10.5 (IQR 44) months in subjects who died and 9 (IQR 50) months in those who survived. The majority of subjects in both groups had well-nourished nutritional status. Bivariate analysis revealed that significantly more subjects who died had low serum T3 (≤1 ng/dL), PELOD-2 score ≥5, than subjects who survived. Multivariate analysis revealed that serum T3 £1 ng/dL (OR 55.1; 95%CI 9 to 334.8; P<0.001) and PELOD-2 score ³5 (OR 6.5; 95%CI 1.6 to 26.7; P=0.01) were significant risk factors for sepsis mortality. Conclusion Low serum T3 level and high PELOD-2 score are risk factors for death in sepsis.
Full outline of unresponsiveness score as a predictor of outcomes in critically ill pediatric patients Novita Purnamasari Assa; Dyah Kanya Wati; Ida Bagus Subanada; Soetjiningsih Soetjiningsih; Made Kardana; Made Sukmawati
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (222.985 KB) | DOI: 10.14238/pi60.2.2020.77-82

Abstract

Background Mortality predictions are very important for improving service quality in the pediatric intensive care unit (PICU). The full outline of unresponsiveness (FOUR) is a new coma scale and is considered capable of predicting mortality and outcome. Objective To assess the ability of FOUR scores to predict outcomes of critically ill patients in the PICU. Methods This prospective cohort study included children aged 1 months - 18 years who were admitted to the PICU. Subjects were assessed by FOUR, grouped into score < 9 or score >9, and followed until outcomes were obtained. Bivariate analysis to assess the risk of death was made by cross-tabulation and the strength of the association in the form of risk ratio by Chi-square test. Multivariate analysis was done by logistic regression test. Results Of 94 subjects, 47 had FOUR scores <=9 and 47 subjects had FOUR >9. Bivariate analysis revealed that PICU patients with FOUR score <=9 had a higher risk of death than those with FOUR score >9 (RR 12.5; 95%CI 3.1 to 49.8; P<0.0001). Multivariate analysis revealed that FOUR score, length of stay <=7 days, and non-surgical disease significantly increased the risk of mortality in PICU patients (by 42.8 times, 8.9 times, and 5.9 times, respectively). Conclusion The FOUR scores have good ability to predict the outcomes of critically ill pediatric patients. A FOUR score <=9 at the beginning of treatment is significantly associated with the outcome of mortality during treatment in the PICU.
Pediatric Index of Mortality 3 score as a predictor for the outcomes of critically ill patients Gusti Ayu Nyoman Yulia Sitta Dewi; Dyah Kanya Wati; Made Gede Dwi Lingga Utama; Ketut Suarta Suarta; I Wayan Darma Artana; Made Sukmawati
Paediatrica Indonesiana Vol 60 No 6 (2020): November 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.6.2020.328-33

Abstract

Background The ability to predict mortality in critically ill patients is important for assessing patient prognosis, evaluating therapy, and assessing intensive care unit quality. The Pediatric Index of Mortality (PIM) 3 is a scoring system to predict outcomes in order to assist clinical decision-making. Objective To assess the ability of PIM 3 to predict outcomes of critically ill PICU patients.Methods This prospective cohort study included 150 children aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU), Sanglah Hospital, Denpasar, Bali. Subjects were grouped into two based on ROC curve PIM score ≥48 and <48. The PIM 3 score was consisted of 10 variables, with a re-diagnosis classification of the PIM 2 score. Bivariate analysis was conducted to both groups to find the distribution of mortality in both groups, followed by homogenity test on variables gender, age, nutritional status, lenght of stay and mechanical ventilation. Variables which made the cut on bivariate test were included in multivariate analysis.Results The optimal PIM 3 score limit in predicting mortality was ≥48, with area under the curve (AUC) 76% (95%CI 0.69 to 0.85). Multivariate analysis revealed a 2.48 times increased risk to mortality in patients with PIM 3 score ≥48 (95%CI 1.6 to 3.7). In addition, PICU length of stay ≤7 days was a significant risk factor for mortality. Conclusion The PIM 3 has a good ability to predict the outcome of critically ill PICU patients. Critically ill patients with PIM 3 score ≥48 have a higher risk of mortality compared to those with PIM 3 < 48.
Occurence and risk factors of tuberculosis infection in orphanage children in Bali Clearesta, Kartika Eda; Mayangsari, Ayu Setyorini Mestika; Wati, Dyah Kanya; Purniti, Ni Putu Siadi; Suwarba, I Gusti Ngurah Made; Artana, I Wayan Dharma
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/pi64.2.2024.152-9

Abstract

Background Tuberculosis (TB) is an infectious disease that is still a common threat worldwide, especially in pediatric populations. TB transmission occurs particularly when the transmitter has no obvious manifestation of the disease. There is a higher incidence of TB infection in children than in the general population, especially in high risk populations such as children in orphanages. However, the incidence of TB infection in orphaned children in Indonesia, including Bali, is unknown. Objective To describe the incidence and risk factors for TB infection in children in orphanages in Bali. Methods This case-control study was conducted in 12 orphanages in Bali. Subjects were divided into a case group comprised of children with TB infection, and a control group comprised of those without TB infection. TB infection was diagnosed by positive tuberculin test without clinically confirmed TB. Results A total of 175 children were recruited as subjects. There were 49 (28.0%) children with TB infection. Bivariate analysis revealed significant associations between density, humidity, ventilation/room area ratio, and area of ??origin with TB infection. Multivariate analysis showed that ventilation/room area ratio and room humidity of ?73% were independently positive correlated with TB infection. Natural lighting and BCG scar were not significantly different between groups. Conclusion The occurence of TB infection in children residing in orphanages in Bali is high (28%). The risk factors identified independently are lower ventilation and higher room humidity.
Neurological manifestations in patients with multisystem inflammatory syndrome in children (MIS-C) in the post-COVID-19 era Wati, Dyah Kanya; Suparyatha, Ida Bagus Gede; Hartawan, I Nyoman Budi; Manggala, Arya Krisna; Artini, Ni Wayan Noni; Aurelya, Anira Rema
Paediatrica Indonesiana Vol. 65 No. 3 (2025): May 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.3.2025.239-44

Abstract

Background Multisystem inflammatory syndrome in children (MIS-C) is an emerging condition associated with the COVID-19 pandemic. It occurs in approximately 2-8% cases of COVID-19, sometimes leading to shock, multiorgan failure, and the need for intensive care. Neurological manifestations are uncommon and sometimes overlap with previous comorbidities. Objective To explore the neurological manifestations in critically ill children with MIS-C. Methods This cross-sectional study included children aged <18 years, diagnosed with MIS-C according to World Health Organization (WHO) criteria and admitted to the pediatric intensive care unit (PICU) at a tertiary hospital in Bali, Indonesia. Retrospective data were extracted from electronic medical records covering January 2022 to December 2023. Demographic characteristics, clinical manifestations, treatments, and outcomes were collected and analyzed using SPSS. Patient were grouped based on the presence or absence of neurological symptoms for comparison. Results There were 47 children diagnosed with MIS-C; 78.7% of them were critically ill and treated in our intensive care unit. Thirty-seven subjects were included in the study. The most common symptom was fever (83.8%). Neurological manifestations were found in 12 children (32.4%), most commonly decreased consciousness (58.3%), followed by seizures (25.0%), hemiparesis (8.3%), and behavioral changes (8.3%). When comparing subjects with vs. without neurological symptoms, those with neurological manifestations had higher proportions of invasive mechanical ventilation (58.3% vs. 36.0%, respectively), combined use of intravenous immunoglobulin and methylprednisolone (83.3% vs. 64.0%, respectively), and mortality (58.3% vs. 28.0%, respectively). Conclusion Neurological  manifestations, particularly decreased consciousness, were common in critically ill MIS-C patients. These patients exhibited higher rates of invasive ventilation and mortality, emphasizing the need for early recognition and targeted management.
Association of sepsis severity with serum ferritin in the pediatric intensive care unit Susanto, Yohanes; Wati, Dyah Kanya; Artana, I Wayan Dharma; Wati, Ketut Dewi Kumara; Widnyana, Anak Agung Ngurah Ketut Putra; Adnyana, I Gusti Agung Ngurah Sugitha
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background Sepsis remains a leading cause of pediatric intensive care unit (PICU) admissions in Indonesia. Serum ferritin is a potential biomarker for sepsis severity that requires validation. Objective To evaluate the association between serum ferritin and sepsis severity in children. Methods In this cross-sectional study, we consecutively enrolled children with sepsis (aged 1 month to 18 years) with lactate-excluded PELOD-2 scores of ≥7 admitted to the PICU of a tertiary referral hospital. Severe sepsis was defined as a PELOD-2 score of ≥11. Serum ferritin levels were measured at the time of PELOD-2 assessment. We determined the optimal ferritin cut-off point for severe sepsis by ROC analysis and performed bivariate and multivariate analyses to assess the association of ferritin level with sepsis severity. Results Among 74 subjects, 48.6% had severe sepsis. Serum ferritin concentration showed excellent discriminative power for severe vs. non-severe sepsis, with an area under curve (AUC) of 80% (95%CI 69.7-90.4%; P<0.001). The optimal serum ferritin cut-off level was 1,473.88 ng/mL, with a sensitivity of 80.6% and specificity of 78.9%. Severe sepsis was strongly correlated with elevated ferritin [bivariate prevalence ratio (PR) 3.8 (95%CI 2.0 to 8.2; P<0.001); adjusted PR 3.9 (95%CI 1.7 to 8.6; P=0.001)]. Conclusion Serum ferritin may serve as a biomarker for severe sepsis in children with good discriminative performance and may be useful for risk stratification of pediatric sepsis.
Co-Authors Abdul Latief Abdul Latief Adnyana, I Gusti Agung Ngurah Sugitha Anak Agung Ngurah Ketut Putra Widnyana Andreliano Yosua Rompis Andy Halim Anlidya Permatasari Gunawijaya Antonius Pudjiadi Antonius Pudjiadi Artini, Ni Wayan Noni Arya Krisna Manggala Aurelya, Anira Rema Ayu Setyorini Mestika Mayangsari Bagus Ngurah Putu Arhana BNP Arhana Cempaka, Putu Mas Vina Paramitha Clearesta, Kartika Eda Defranky Theodorus Derryl Komala Putra Desak Made Widiastiti Arga Dewi Sutriani Mahalini Djoko, Sri Wahyuni Eka Gunawijaya Estina, Vania Catleya Fajaryani, Putu Ayu Putri Felicia Anita Wijaya Gusti Ayu Nyoman Yulia Sitta Dewi Haning, Joy Aprianis Harsika Sari, Ni Wayan Diah Intan I Gde Doddy Kurnia Indrawan I Gede Deden Susma Sugara I Gede Wikania Wira Wiguna I Gusti Ayu Putu Eka Pratiwi I Gusti Ayu Sri Darmayani I Gusti Lanang Sidiartha I Gusti Ngurah Made Suwarba I Gusti Ngurah Made Suwarba I Gusti Ngurah Sanjaya Putra I Made Bakta I Made Jawi I Made Kardana I Made Karma Setiyawan I Nengah Gandi Karyadi I Nyoman Budi Hartawan I NYOMAN MANTIK ASTAWA I Wayan Darma Artana I Wayan Dharma Artana I Wayan Dharma Artana, I Wayan Dharma I Wayan Gustawan Ida Bagus Gede Suparyatha Ida Bagus Subanada Jumantini, Ni Komang Pasek Nurhyang Ketut Dewi Kumara Wati Ketut Suarta Ketut Suarta Suarta Ketut Tuti Parwati Merati Ketut Wulan Ari Kartika Ardhaputri Khema Metta Wijaya Komang Ayu Witarini Komang Diah Kurnia Kesumaputri Komang Diah Kurnia Kesumaputri Luh Putu Diah Virayanti Luh Putu Putri Sanjiwani Made Gede Dwi Lingga Utama Made Gede Dwi Lingga Utama Made Michel Kresnayasa Made Pande Lilik Lestari Made Sukmawati Made Wiryana Manggala, Arya Krisna Maria Elisabeth Sylvinna Wasi Elannor Maria Pricilla Siboe Nelvina Ginting Ni Luh Sri Apsari Ni Made Ary Sarasmita Ni Putu Siadi Purniti Novita Purnamasari Assa Nyoman Gina Henny Kristianti Pande Made Nova Armita Sari, Pande Made Nova Putri, Ni Kadek Dwi Pramana Putu Andrie Setiawan Putu Aryani Putu Diah Pratiwi Putu Diah Pratiwi Putu Indah Budi Apsari Putu Nandika Tungga Yudanti Mahardani Putu Nandika Tungga Yudanti Mahardani Putu Nandika Tungga Yudanti Mahardani Retayasa Retayasa Ryan Tan Silvia Sudarmadji Siska Permanasari Sinardja Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Sukarta, Ni Kadek Yusthiani Sukmapermata, Bunga Suparyatha, Ida Bagus Gede Susanto, Yohanes Sutriani Mahalini, Dewi Visakha Karuna Wijaya Wayan Sulaksmana Sandhi Parwata