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All Journal Jurnal Veteriner Jurnal Ilmu Kedokteran (Journal of Medical Science) Journal of the Medical Sciences (Berkala Ilmu Kedokteran) The Indonesian Biomedical Journal Sari Pediatri Paediatrica Indonesiana Narra J Jurnal Kedokteran Hewan

Antonius H. Pudjiadi

Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia

Author-ID : 3210434

Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Veterinary

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Articles

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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

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 Pearsonâ€™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.

Thyroid hormone profile and PELOD score in children with sepsis Agung G. Tanurahardja; Antonius H. Pudjiadi; Pramita G. Dwipoerwantoro; Aman Pulungan
Paediatrica Indonesiana Vol 54 No 4 (2014): July 2014
Publisher : Indonesian Pediatric Society

Background Thyroid hormonal dysfunction, also known aseuthyroid sick syndrome or nonthyroidal illness, can be seenin sepsis. There have been few studies on thyroid hormonedysfunction in septic children, as well as on a relationshipbetween their thyroid hormone profiles and pediatric logisticorgan dysfunction (PELOD) scores. Procakitonin (PCT) is oneof the sepsis biomarker.Objective To evaluate the thyroid hormone profile in childrenwith sepsis as well as to assess for a correlation between the thyroidlevels and PELOD scores, PCT levels, and patient outcomes.Methods This cross-sectional study included children aged 1- 18years admitted to the pediatric intensive care unit (PICU) with aprimary diagnosis of sepsis. PELOD scores and thyroid hormonallevels were assessed once during the first 24 hours after PICUadmission.Results Thirty subjects were included in the study. The medianvalues ofT3, free T4, and TSH were 45 (range 17 -133) ng/dL,0.81 (range 0.3-1.57) ng/dL, and 1.36 (range 0.05-7.78) Î¼IU/L,respectively. The T3, free T4, and TSH levels were decreased in97%, 50% and 40% of the subjects. There were no significantdifferences between low and normal to high TSH with regards tothe PELOD score (P=0.218), PCT level (P=0.694), or patientoutcomes (P=0.55). The risk of death increased by 15 timesamong the subjects with PELOD score ~20 compared to thosewith PELOD score <20 (OR 15; 95%CI: 1.535 to 146.545;P=0.012).Conclusion Thyroid hormones are decreased in septic childrenwith the majority having low T3. A high PELOD score is stronglycorrelated with mortality and can be used as a prognostic parameterfor septic children in the PICU, but there is no correlation withdecreased TSH.

Pulse pressure variation and systolic pressure variation in mechanically ventilated children Johnny Nurman; Antonius H. Pudjiadi; Arwin A. P. Akib
Paediatrica Indonesiana Vol 51 No 1 (2011): January 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.1.2011.34-40

Background In mechanically ventilated patients, changes in breathing patterns may affect the preload, causing stroke volume fluctuation. Pulse pressure variation (PPV) and systolic pressure variation (SPV) are dynamic means of the hemodynamic monitoring in ventilated patients. No study on PPV and SPY in children has been reported to date.Objective To study changes in PPV and SPY values in mechanically ventilated children.Method A descriptive crossô€sectional study was done at the Pediatric Critical Care Unit (PICU), Cipto Mangunkusumo Hospital, Jakarta. Subjects were mechanically ventilated children aged > 12 months. Echocardiography was performed in all patients to determine the cardiac index. Arterial pressure was measured by connecting an arterial line to a vital signs monitor. PPV and SPV were calculated using the standard formulas. Bivariate correlation tests were performed between cardiac index and PPV and between cardiac index and SPV. Receiver operator characteristic (ROC) curve analysis was done to determine the optimum PPV and SPV cut-off points to predict normal cardiac index (2:3.5 L/minute/m2).Results Eighteen patients were enrolled in the study, yielding 48 measurements. Mean cardiac index was 2.9 (SD 1-2.6) L/minute/m2. Median PPV was 18.9 (range 4.1-45.5)% and SPV was 12.1 (range 3.8- 18.9)%. We found strong negative correlations between PPY and cardiac index (r= ; p = ) and SPY and cardiac index (r= ; p = ). To predict nonnal cardiac index, the optimum cut-off point was 11.4% for PPV (100% sensitivity, 100% specificity) and 9.45% for SPV (91.7% sensitivity, 100% specificity).Conclusion In mechanically ventilated children, cardiac index is negatively correlated with PPV and SPV.

Prognostic factors of death in children admitted to pediatric intensive care unit, Cipto Mangunkusumo Hospital, Jakarta, Indonesia Antonius Hocky Pudjiadi; Meri Yanti; Aland Roland Tumbelaka
Paediatrica Indonesiana Vol 42 No 11-12 (2002): November 2002
Publisher : Indonesian Pediatric Society

Background The primary goal of intensive care is to prevent mortality in patients with reversible critical illness, while preserving or improving functional outcome. It follows that the capability to estimate patient's risk of death is extremely important.Objective To identify the prognostic factors of death, evaluate the probability of death by using Pediatric Index of Mortality (PIM) model, and develop the new model for predicting probability of death in children admitted to PICU in accordance with characteristic of patients in the study unit.Methods Design Retrospective study. Setting Pediatric intensive care unit of Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Patient Two hundreds and sixty five consecutive admissions, <18 years old, during one year period.Results Logistic regression of 18 variables identified 6 prognostic factors of death (P<0.05): age, consciousness level, heart rate, platelet count, PaO2/FiO2, and use of mechanical ventilation at the first hour in PICU. PIM model predicted 17.9 deaths and this study model predicted 113.2 deaths from 200 subjects (56 died) in this study, with the area under ROC curve was 0.82 for PIM model and 0.83 for this study model.Conclusion Both PIM model and this study model cannot predict mortality in this study unit accurately. It may due to the different characteristics between sample in this study and sample from which the PIM model was derived, or the lack of sample and variable in this study

Correlation of Interleukin-8, Pediatric Logistic Organ Dysfunction score and factors associated with systemic inflammatory response after cardiopulmonary bypass in children who have undergone open-heart surgery Ririe F Malisie; Antonius H Pudjiadi; Fathema D Rachmat; Jusuf Rachmat
Paediatrica Indonesiana Vol 50 No 4 (2010): July 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi50.4.2010.245-51

Background Cardiopulmonary bypass (CPB) provides a complex set of non-physiologic circumstances, induces systemic release of pro-inflammatory cytokines and initiates systemic inflammatory response. IL-8 is an important activator of neutrophil with chemotactic effect and are proposed to be major mediator of inflammation. The majority of general intensive care unit scoring system does not adequately address the specific characteristics of cardiac surgery patients. None of the study had been published the validation of PELOD score setting in pediatric cardiac intensive care unit (CICU).Objectives To evaluate the correlation between interleukin-8 (IL-8), Pediatric Logistic Organ Dysfunction (PELOD) score and factors associated with systemic inflammatory response after bypass (SIRAB) in children undergone cardiopulmonary bypass surgery.Methods A quasi-experimental study was conducted on children who have undergone cardiac surgery requiring CPB. There were 21 eligible children, two were excluded. Blood samples from mixed vein and coronary sinus were taken before, during and after surgery. The plasma level of IL-8 analyzed at 3 time points: baseline (before) CPB, at reperfusion period and 3 hours after aortic cross clamp-off. Cumulative organ dysfunctions were analyzed by PELOD score.Results The plasma level of IL-8 highly increase at the reperfusion period. IL-8 plasma level correlated with bypass-time (r > 0.49, p=0.003) and aortic cross clamp-time (r > 0.55, P=.014). Moderate association between age and PELOD score (r > 0.47, P=0.041). The correlations were significant between age and mechanical ventilation time support (r > 0.47, P=0.03), age and length of stay in CICU (r > 0.44, P=0.05). No correlation between IL-8 plasma level and PELOD score.Conclusion There was no correlation between IL-8 plasma level and PELOD score. IL-8 plasma level correlated with aortic cross clamp-time in children who undergo cardiopulmonary bypass surgery.

Flavobacterium meningosepticum Colonization in Pediatric Intensive Care Unit Antonius H. Pudjiadi
Paediatrica Indonesiana Vol 39 No 9-10 (1999): September - October 1999
Publisher : Indonesian Pediatric Society

During a period of one month 2 infants was infected by Flavobacterium meningosepticum. The ages of the patients were 3 days and 5 months. The organisms were resistant to many antibiotics. The pathogens were isolated from the bronchial secretion and considered a nosocomial infection. The primary source of infection could not be identified. We suspect that the humidifiers or ventilators are the source of infections.

New PELOD-2 cut-off score for predicting death in children with sepsis Ni Made Rini Suari; Abdul Latief; Antonius H. Pudjiadi
Paediatrica Indonesiana Vol 61 No 1 (2021): January 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.1.2021.39-45

Background According to the most recent Sepsis-3 Consensus, the definition of sepsis is life-threatening organ dysfunction caused by dysregulated immune system against infection. Currently, one of the most commonly used prognostic scoring system is pediatric logistic organ damage-2 (PELOD-2) score. Objective To determine and validate the pediatric logistic organ dysfunction-2 (PELOD-2) cut-off score to predict mortality in pediatric sepsis patients. Methods A prospective cohort study was conducted in the intensive care units of Cipto Mangunkusumo Hospital, Jakarta. We assessed subjects with PELOD-2 and calculated the predicted death rate (PDR) using SFAR software. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate calibration and the area under the curve (AUC) of the receiver operating characteristic curve (ROC) to estimate discrimination. Results Of 2,735 children admitted to the emergency department, 52 met the inclusion criteria. Patients had various types of organ dysfunction: 53.8% respiratory, 28.8% neurological, 15.4% cardiovascular, 1.9% hematological. The mortality rate in this study was 38.5%. Mean PELOD-2 score was higher in patients who died than in those who survived [13.9 (SD 4.564) vs. 7.59 (SD 3.025), respectively, P=0.000]. The discrimination of PELOD-2 score with the lactate component had an AUC of 85.5% (95%CI 74.5 to 96.5), while PELOD-2 without lactate had an AUC of 85.4% (95%CI 74.5 to 96.3%). We propose a new PELOD-2 cut-off score to predict organ dysfunction and death of 10, with 75% sensitivity, 72% specificity, 62.5% PPV, and 82% NPV. PELOD-2 score > 10 had a moderate, statistically significant correlation to mortality (r=0.599; P<0.001). Conclusion A PELOD-2 score > 10 is valid for predicting life-threatening organ dysfunction in pediatric patients with sepsis.

Inflammatory and coagulation marker profiles in severe pediatric COVID-19 patients: a systematic review Tartila Fathan; Antonius Hocky Pudjiadi; Nina Dwi Putri; Nindya Permata; Yosilia Nursakina
Paediatrica Indonesiana Vol 62 No 6 (2022): November 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.6.2022.411-21

Background Children are susceptible to SARS-CoV-2 infection and often present mild manifestations. However, severe and critical cases have also been reported. The inflammation and coagulation marker profile pattern in these patients along with the white blood cell differential count in critical PICU cases with non-COVID-19 etiology is not entirely clear. Objective To evaluate the inflammation and coagulation profiles in children presenting with severe/critical SARS-CoV-2 infection. Methods A systematic search and review of scientific literature was conducted following the PRISMA guidelines using ProQuest, SCOPUS, EBSCOHost, ScienceDirect, Cochrane, EMBASE, and Pubmed databases. All relevant original studies until March 11, 2021, were included. The risk of bias was appraised using the Modified Newcastle Ottawa Scale and JBI Critical Appraisal Checklist tools. Results We identified 14 studies across 6 countries, including a total sample of 159 severe and critically ill pediatric COVID-19 patients. Most of the subjects showed normal leukocytes, but increased CRP, procalcitonin, ferritin, and IL-6. Studies on coagulation profiles showed normal thrombocytes, PT, aPTT, and inconsistent D-dimer results. Conclusion Inflammation and coagulation parameters in severe/critically ill children with COVID-19 are atypical. Several inflammatory markers were elevated, including CRP, ferritin, procalcitonin, and IL-6. However, the elevated marker values are still lower compared to non-COVID infection patients. Further investigation of the parameters need to be done in serial examination multicenter studies, which include control subjects.

Co-Authors Abdul Latief Abdul Latief Abdul Latief Abdul Latief Latief Agung G. Tanurahardja Ahmad Arif Amin Aland Roland Tumbelaka Aman Pulungan Amin, Ahmad Arif Amir Thayeb Angelina Arifin Aria Kekalih Arwin A. P. Akib Aryono Hendarto Badriul Hegar Bambang Supriyatno Bambang Tridjaja AAP, Bambang Tridjaja Damayanti R. Syarif Darlan Darwis Desy Dewi Saraswati Diana Aulia Dilawar, Ismail Doddy Kurnia Indrawan Dwi Putro Widodo E.M. Dady Suyoko Emi Yulianti Evita B. Ifran Evita Kariani B. Ifran Fathema D Rachmat Galih Satria Kusumanto Gunanti . Gunanti Gunanti Hari Kushartono Hayati, Najma Heri Wibowo Hindra I. Satari, Hindra I. Hindra Irawan Satari Hotber Pasaribu I Nyoman Budi Hartawan Idham Amir Idham Amir Imral Chair Irawan Mangunatmadja Irene Yuniar, Irene Johnny Nurman Jusuf Rachmat Lina Haryanti Lisnawati Rachmadi Mardjanis Said Melpa Susanti Purba Meri Yanti Mulya R. Karyanti Mulyadi M. Djer Mulyadi M. Djer Munar Lubis Murni, Indah K. Najib Advani Najma Hayati Ni Made Rini Suari Nia Kurniati Nina Dwi Putri Nindya Permata Piprim B. Yanuarso, Piprim B. Pramita G. Dwipoerwantoro Pramita Gayatri R. Irma Rachmawati Raden Roro Soesatyoratih Rina A.C. Saragih, Rina A.C. Ririe F Malisie Rismala Dewi Ronald Chandra Rubiana Sukardi, Rubiana Saptawati Bardosono Setyo Handryastuti Supriatna, Novianti Susanti, Dhama S. Susetyo Harry Purwanto Taralan Tambunan Tartila Fathan Tatang M. Puspandjono Vimaladewi Lukito Yosilia Nursakina Zakiudin Munasir

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