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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) 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

Author-ID : 295459

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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Validitas Skala Nyeri Non Verbal Pain Scale RevisedSebagai Penilai Nyeri di Ruang Perawatan Intensif Anak Dyah Kanya Wati; Antonius Pudjiadi; Abdul Latief
Sari Pediatri Vol 14, No 1 (2012)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp14.1.2012.8-13

Latar belakang. Berdasarkan berbagai penelitian, diperlukan skala nyeri yang divalidasi untuk menilai nyeri di ruang perawatan intensif anak dari aspek respon otonom dan evaluasi bentuk intervensi tata laksana nyeri yang diberikan.Tujuan. Mengetahui validitas alat pengukur skala nyeri non verbal pain scale (NVPS) yang dapat dipakai di ruang perawatan intensif anak.Metode. Subyek penelitian yang diberikan intervensi nyeri melalui berbagai prosedur pemeriksaan atau terapi, dinilai respon nyeri melalui perekaman video. Respon dinilai selama 2-10 menit sebelum, selama, dan setelah intervensi nyeri diberikan. Sebagai baku emas digunakan skala nyeri Wong Baker pain scale(WBPS)Hasil. Dari 38 sampel yang dinilai didapatkan sensitifitas NVPSR 85%, spesifisitas 66%, nilai prediksi positif 96%%, negatif prediksi negatif 50%. Nilai korelasi antara skala NVPSR dan WBPS adalah 0,95 (p<0,05).Kesimpulan. Non verbal pain scale revised(NVPSR) memiliki korelasi yang kuat dengan WBPS dalam menilai nyeri pada anak. Sensitifitas yang cukup tinggi sebagai alat skrening nyeri namun memiliki spesifitas yang sedang sebagai alat diagnostik nyeri pada anak.

Pengaruh Menyusui, Glukosa 40% dan Memeluk Bayi terhadap Respon Nyeri pada Bayi Cukup Bulan (Suatu Uji Klinis) Dyah Kanya Wati; Soetjiningsih Soetjiningsih; Retayasa Retayasa
Sari Pediatri Vol 9, No 3 (2007)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp9.3.2007.207-12

Latar belakang. Berdasarkan berbagai penelitian acak, pemberian glukosa, menyusui dan stimulasimultisensoris merupakan penanganan yang dapat dipercaya manfaatnya sebagai bagian dari penanganannon farmakologis.Tujuan. Melihat respon nyeri pada bayi cukup bulan yang diimunisasi intrakutan dalam kondisi disusui,mendapatkan glukosa 40% atau dipeluk oleh ibunya.Metode. Subjek penelitian dibagi menjadi tiga kelompok. Kelompok A untuk menyusui, kelompok Buntuk glukosa 40% dan kelompok C untuk kelompok memeluk bayi. Pada saat penyuntikan, subjekdirekam dengan kamera video dan hasil rekaman dinilai untuk mengetahui respon nyerinya berdasarkanskala DAN (Douleur Aigue Nouveau-ne).Hasil. Dari 116 subjek didapatkan rerata hasil penilaian skala DAN 6,13 (SD 1,17) untuk kelompokmenyusui, 7,93 (SD 1,05) untuk kelompok bayi yang mendapatkan glukosa 40% dan 7,65 (SD 1,12)untuk kelompok memeluk bayi.Kesimpulan. Kelompok menyusui memiliki respon nyeri yang paling rendah secara bermakna. Menyusuimemberikan hasil yang berbeda bermakna dalam memberikan respon nyeri dibandingkan pemberian glukosa40% dan memeluk bayi pada bayi yang diimunisasi.

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

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.

Case Report: Poor Nutrition on the Patient's Cerebral Palsy Putu Aryani; I Nengah Gandi Karyadi; Dyah Kanyawati
Review of Primary Care Practice and Education (Kajian Praktik dan Pendidikan Layanan Primer) Vol 2, No 1 (2019): January
Publisher : Faculty of Medicine, Public Health, and Nursing

A 3-year-old boy was taken to a health center in the Karangasem regency, Bali, by his parents with complaints from the previous two weeks that the child could not sleep well, grew fussy because of the relapse of the seizure. Parents also complain that their children don't want to eat so him get thinner. Patient have been recorded since a year before suffering from malnutrition associated with their disability, namely cerebral palsy (CP). The patient has been diagnosed with CP since birth, where the patient was born twin, with very low birth weight (under 2500 grams), but his twin brother died when birth. Since the birth, the patient has been monitored by the puskesmas Nutrition Program Holder with weight has never increased.........

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

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

Background Thyroid hormone stimulates the regulation of Î²-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 (â‰¤1 ng/dL), PELOD-2 score â‰¥5, than subjects who survived. Multivariate analysis revealed that serum T3 Â£1 ng/dL (OR 55.1; 95%CI 9 to 334.8; P<0.001) and PELOD-2 score Â³5 (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

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

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 â‰¥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 â‰¥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 â‰¥48 (95%CI 1.6 to 3.7). In addition, PICU length of stay â‰¤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 â‰¥48 have a higher risk of mortality compared to those with PIM 3 < 48.

The Effect of Carnitine Supplementation on Blood Ammonia Level in Epilepsy Children Treated with Valproic Acid: A Randomized Controlled Trial I Gusti Lanang Sidiartha; I Gusti Ngurah Made Suwarba; Dyah Kanya Wati; Ida Bagus Subanada
Molecular and Cellular Biomedical Sciences Vol 5, No 1 (2021)
Publisher : Cell and BioPharmaceutical Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21705/mcbs.v5i1.177

Background: Long-term use of valproic acid is associated with a high level of blood ammonia related to carnitine deficiency. This study investigates the effect of carnitine supplementation on blood ammonia levels in children with epilepsy who have been treated with valproic acid for more than six months.Materials and Methods: This was a randomized, double-blind, placebo-controlled trial study where children with epilepsy who were treated with valproic acid were randomly allocated to the carnitine supplementation and control group. All children were followed for month, and then measured for blood ammonia level. Blood ammonia levels of both groups were compared using an Independent t-test with a significant of p<0.05.Results: Total of 32 children with epilepsy were enrolled as subjects in this study, with 16 children in carnitine group, and 16 children in control group. Among the subjects, 50% were male and 50% were female, with a mean age of 6.5 years old. The average duration of epilepsy in the carnitine and control group were 41.7 months and 36.9 months, respectively (p=0.419). The duration of valproic acid therapy in the carnitine and control group were 33.1 months and 27.6 months, respectively (p=0.483). The level of blood ammonia in carnitine and control group were 44.6 mg/dL and 81.4 mg/dL, respectively (p=0.007).Conclusion: The level of blood ammonia in a carnitine group was significantly lower than in a control group. It is recommended to give carnitine supplementation in epileptic children treating with long-term valproic acid.Keywords: ammonia, carnitine, epilepsy, seizure, valproic acid

High Blood Ammonia Levels Associated with Long-term Valproic Acids Therapy in Epileptic Children I Gusti Lanang Sidiartha; I Gusti Ngurah Made Suwarba; Dyah Kanya Wati; Ida Bagus Subanada
Molecular and Cellular Biomedical Sciences Vol 4, No 2 (2020)
Publisher : Cell and BioPharmaceutical Institute

Background: Valproic acid is an effective drug for controlling seizure in children with epilepsy and it is usually used for treatment as long as two years or more. Blood ammonia level often increased in epileptic children who were treated with long-term valproic acid. The study was conducted to determine the relationship between blood ammonia level with valproic acid therapy in epileptic children.Materials and Methods: This is an observational study with cross-sectional approach. The subjects were 64 children with epilepsy, average age of 6.2 years old. Subjects were 33 boys and 31 girls. Blood ammonia level was examined using enzymatic glutamate dehydrogenase. Subjects were divided into 2 therapeutic groups based on the duration, doses and combination therapy of valproic acid. Subjects were recruited from Pediatric Neurology Clinic, Sanglah General Hospital, Bali, Indonesia, from May to December 2017. Comparison of blood ammonia level between groups were analyzed using an Independent t-test with significances if the p<0.05.Results: A significant difference of blood ammonia level was found between subjects who were treated with valproic acid less than 2 years and more than 2 years (45.7±16.4 mmol/L vs. 70.9±43.6 mmol/L; p=0.032). However, significant difference was not found between the groups according to the doses and combination therapy (p=0.450 and p=0.647, respectively).Conclusion: Blood ammonia level was significantly higher in epileptic children who used long-term valproic acid, hence it was recommended to check the blood ammonia level routinely.Keywords: ammonia, epilepsy, valproic, children

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 Suparyatha, Ida Bagus Gede Susanto, Yohanes Sutriani Mahalini, Dewi Visakha Karuna Wijaya Wayan Sulaksmana Sandhi Parwata

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