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All Journal 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 FKUI/RS Dr. Cipto Mangunkusumo, Jakarta

Author-ID : 3210434

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

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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.

REPRESENTATION OF ERYTHROCYTES IN PIGLET (Sus scrofa) POST HYPOVOLEMIC SHOCK WITH NORMO AND HYPERVOLEMIA RESUSCITATION OF CRYSTALLOID FLUID Gunanti Gunanti; Ahmad Arif Amin; Antonius H. Pudjiadi; Najma Hayati
Jurnal Kedokteran Hewan Vol 14, No 1 (2020): March
Publisher : Universitas Syiah Kuala

The aim of this study is to evaluate the representation of erythrocytes, which is the count of erythrocytes; hemoglobin concentration, hematocrit value, and platelet count in piglet (Sus scrofa) after hypovolemic shock with normal and hypervolemia resuscitation of crystalloid fluid. This study uses nine male castrated piglets 6-8 weeks of age. The piglets are given treatments such catheter installation, shock induction, normovolemia resuscitation, and hypervolemia resuscitation. The fluid for resuscitation is crystalloid fluid, NaCl 0.9%. Blood sample is taken in baseline, normovolemia condition, and hypervolemia condition. The sample is analyzed using hematology blood analyzer and is tested using T-Paired. Total erythrocytes count after normovolemia resuscitation is 3.07x106/µL, while after hypervolemia resuscitation the erythrocytes count decrease until 2.86x106/µL. Hemoglobin concentration after normovolemia resuscitation is 9.4 g/dL, while after hypervolemia resuscitation hemoglobin concentration decreases to 8.64 g/dL. Hematocrit count from piglets after normovolemia resuscitation is 28 %, while it decreases after hypervolemia resuscitation to 25.89%. Platelet count after normovolemia resuscitation is 297.22x103/mm3 and decreases to 263.89x103/mm3 after hypervolemia resuscitation. Evaluation of the erythrocytes index shows that the piglets suffer anemia. Hypovolemic shock and normal, and hypervolemia resuscitation cause the significant decreases in all erythrocytes indexes except the platelet count.

Effects of the COVID-19 pandemic on emotional and behavioral problems and sleep problems in adolescents Medise, Bernie Endyarni; Reza, Maulana Okta; Devaera, Yoga; Soebadi, Amanda; Chozie, Novie Amelia; Pudjiadi, Antonius H
Paediatrica Indonesiana Vol. 63 No. 5 (2023): September 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.5.2023.383-8

Background The asynchrony rapid phase of cognitive, physical and emotional development occurring in adolescence may result in various issues such as risk-taking behavior, psychosocial and emotional problems. School closure during the COVID-19 pandemic has caused a tremendous change in adolescent lifestyle and habits, including sleep patterns. causing added challenges to adolescents’ emotional and behavioral problems. Objective To identify the association between sleep disorders with emotional and behavioral problems during the COVID-19 pandemic in urban and rural adolescents. Methods We conducted a cross-sectional study among adolescents aged 12-18 years from November to December 2021 in two provinces, DKI Jakarta and Riau Islands. We recruited students consecutively from randomly selected junior and senior high schools. We used the Strengths and Difficulties Questionnaire (SDQ) and the Pittsburgh Sleep Quality Index (PSQI) to screen for emotional and behavioral problems and for sleep disorders, respectively. The questionnaires were sent electronically to each subject after obtaining parental consent. Results There were 400 subjects included in our study, of which 64% were female. The prevalences of COVID-19 amongst subjects in urban and rural areas were COVID-19 12.5% and 5.5%, respectively. Emotional and behavioral disorders as well as sleep disorders were more common in rural than urban areas (13 vs. 11.5% and 50.5% vs. 38%; P=0.012, respectively). Sleep disorders were associated with the SDQ subscales of emotional symptoms [PR 4.88 (95%CI 2.97 to 8.03); P<0.01), conduct problems [PR 3.71 (95%CI 1.53 to 9.04); P=0.02), hyperactivity/inattention [PR 6.05 (95%CI 2.58 to 16.17); P<0.01], and peer relationship problems [PR 3.28 (95%CI 1.33 to 8.09); P<0.01). Conclusion Sleep disorders among adolescents during COVID-19 pandemic were associated with emotional and behavioral problems. Adolescents who live in rural areas were more likely to have sleep disorders, emotional and behavioral problems.

Effect of the modified Atkins diet on NLRP3, caspase-1, IL-1β, and IL-10 in patients with tetralogy of Fallot undergoing open-heart surgery: A randomized controlled trial Yanuarso, Piprim B.; Djer, Mulyadi M.; Hendarto, Aryono; Pudjiadi, Antonius H.; Rachmadi, Lisnawati; Wibowo, Heri; Advani, Najib; Murni, Indah K.; Kekalih, Aria; Sukardi, Rubiana; Dilawar, Ismail; Susanti, Dhama S.; Supriatna, Novianti
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2138

Cardiopulmonary bypass in tetralogy of Fallot (TOF) corrective surgery induces hyperinflammation by activating NLRP3, caspase-1, and interleukin-1β (IL-1β), subsequently triggering an interleukin-10 (IL-10) response. Despite its known metabolic and anti-inflammatory effects, the impact of the modified Atkins diet (MAD) in pediatric cardiac surgery remains unexplored, with no studies on its use in TOF patients undergoing open-heart surgery. The aim of this study was to assess the effect of MAD on the expression of NLRP3, caspase-1, IL-1β, and IL-10, in TOF patients undergoing open-heart surgery. A double-arm, randomized-controlled trial was conducted with 44 TOF patients. The treatment group (n=22) received the MAD, a low-carbohydrate, high-fat regimen with unrestricted fat and protein intake for at least 14 days preoperatively, while the control group (n=22) followed a standard diet without carbohydrate restriction. Blood plasma and infundibulum heart tissues were collected for analysis. Whole blood samples were collected using a winged infusion needle before the intervention, an Abbocath infusion needle after 14 days of intervention, and a syringe without a needle connected to an arterial line in patients undergoing open-heart surgery at 6, 24, and 48 hours post-surgical correction. Infundibulum heart tissues were collected during the open-heart surgery. This study demonstrated significant differences in NLRP3 protein expression (p=0.015), caspase-1 protein expression (p=0.001), and IL-10 levels between before intervention and 6-, 24-, and 48-hours post-surgery in the MAD group compared to the control group. In contrast, no significant differences in IL-10 levels were observed in the control group between before intervention and 48 hours post-surgery (p=0.654). In conclusion, MAD may modulate perioperative inflammation in TOF patients undergoing open-heart surgery by downregulating NLRP3 and caspase-1 expression while sustaining IL-10 levels. Despite reduced NLRP3 and caspase-1 expression, unchanged IL-1β levels indicate alternative regulatory mechanisms.

Early enteral nutrition administration and time to achieve resting energy expenditure in critically ill children Yulman, Annisa Rahmania; Pudjiadi, Antonius Hocky; Tridjaja, Bambang; Kadim, Muzal; Prawitasari, Titis
Paediatrica Indonesiana Vol. 65 No. 5 (2025): September 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.5.2025.390-8

Background Malnutrition in critically ill children remains a significant concern, as a standardized nutritional support protocol has yet to be developed. Resting energy expenditure (REE) is recommended as a parameter for determining the fulfillment of energy needs in critically ill children, which should ideally be achieved within 72 hours. To achieve these energy needs, enteral nutrition (EN) is believed to have a lower mortality rate and a shorter length of stay compared to parenteral nutrition (PN). Objective To evaluate the factors associated with delayed EN initiation and late achievement of REE. Methods Data consisting of age, sex, nutritional status, timing of EN initiation, time required to achieve REE targets, PELOD-2 score, use of ventilators, duration of ventilation, hemodynamic status, use of inotropes and inotropic score, use of sedation, gastrointestinal symptoms, procedures performed during treatment, and technical issues were collected retrospectively from medical records from 2017 – 2018 in the Pediatric Intensive Care Unit (PICU) at Dr. Cipto Mangunkusumo Hospital. The REE was calculated using Schofield formula based on age and sex. These data were used to compare the proportion of the subjects receiving early EN (<48 hours) and delayed EN (>48 hours) and those who achieved REE <72 hours and delayed REE (>72 hours). Multivariate analysis was performed to determine which factors affecting late EN initiation and delayed REE achievement using logistic regression analysis. Results Of 203 subjects, 63.1% received early EN and 67.5% achieved REE at ≤72 hours. Delayed EN was associated with post-abdominal surgery (OR 10.89; 95%CI 4.31 to 27.50; P<0.001), ventilator use (OR 4.60; 95%CI 1.78 to 11.90; P=0.004), inotrope use (OR 4.18; 95%CI 1.56 to 11.17; P=0.002), gastrointestinal symptoms (OR 3.41; 95%CI 1.59 to 7.29; P=0.002), and abnormal nutritional status (OR 2.49; 95%CI 1.09 to 5.72; P=0.031). The REE >72 hours was associated with late EN (OR 20.62; 95%CI 6.48 to 65.65; P<0.001), enteral intolerance after receiving EN (OR 14.77; 95%CI 4.40 to 49.6; P<0.001), and PELOD-2 score ≥7 (OR 3.98; 95%CI 1.01 to 15.66; P=0.048). Conclusion The prevalence of EN and REE within 72 hours in the PICU is quite encouraging. Factors contributing to delayed EN administration include post-abdominal surgery, ventilator use, inotrope use, gastrointestinal symptoms, and abnormal nutritional status. Delayed EN >48 hours, enteral intolerance after receiving EN, and PELOD-2 score >7 were the factors contributing to delayed REE achievement. However, these delays can be reduced by developing a comprehensive enteral feeding protocol. The factors influencing delayed EN and late REE achievement are an important basis for designing enteral feeding protocols to improve the clinical outcomes of critically ill children in the PICU.

Diagnostic performance of electrical cardiometry (ICON®) parameters in predicting fluid responsiveness in critically ill pediatric patients Kurniawan Taufiq Kadafi; Rizki Dzakiyah Sholikhah, Wanda; Muhammad Reva Aditya; Saptadi Yuliarto; Charity Monica; Abdul Latief; Antonius Hocky Pudjiadi
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

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

Background Fluid resuscitation with appropriate and adequate amounts is very important in treating critically ill children, so reliable hemodynamic monitoring methods are needed to prevent fluid overload. Contractility index (ICON) is a novel, non-invasive index of left ventricular (LV) function, and contractility related to the electrical cardiometry device (ICON®). ICON® offers a non-invasive hemodynamic monitoring method to assess volume status, but its validity in predicting fluid response in the Indonesian pediatric population remains unknown. Objective To determine the diagnostic performance of ICON-derived parameters, especially change of cardiac output (ΔCO) and change in contractility index (ΔICON), in predicting fluid response, using change of stroke volume (ΔSV) as a reference standard. Methods A cross-sectional study was conducted in pediatric emergency and intensive care settings. Children aged 1 month to 18 years requiring fluid resuscitation were included. Hemodynamic parameters were measured using ICON® before and after a 10 mL/kg fluid bolus of crystalloid. Fluid responsiveness was defined as a >10% increase in ΔSV. Changes in parameters were analyzed using paired statistical tests. ROC analysis was used to assess the diagnostic accuracy of CO and ICON. Results Sixty-three subjects were analyzed. Significant median changes were observed after fluid bolus administration based on pre- and post-bolus comparison in change of heart rate (ΔHR: –8 bpm, P<0.001), change of systolic blood pressure (ΔSBP: +3 mmHg, P=0.042), change of diastolic blood pressure (ΔDBP: +2 mmHg, P=0.012), change of mean arterial pressure (ΔMAP: +0.67 mmHg, P=0.009). The ROC analysis showed that CO had the highest AUC (0.878), with a cut-off of 5.35%, sensitivity of 78.3%, and specificity of 87.2%. The ICON showed moderate accuracy (AUC 0.757), with a 0.45% cut-off, 69.6% sensitivity, and 71.8% specificity. Conclusion Electrical cardiometry (ICON®) demonstrated measurable changes in objective hemodynamic parameters following fluid bolus administration in critically ill children. Among ICON-derived parameters, a 5.35% increase in CO showed the best predictive performance for fluid responsiveness, while ICON showed moderate diagnostic value. These findings support the clinical utility of electrical cardiometry as a non-invasive tool to guide volume management in pediatric critical care.

Co-Authors A. Pratiwi Abdul Latief Abdul Latief Abdul Latief Abdul Latief Abdul Latief Abdul Latief Abdul Latief Abdul Latief Abdul Latief Abdul Latief Latief Agnes Pratiwi Agung G. Tanurahardja Ahmad Arif Amin Aland Roland Tumbelaka Albert Daniel Solang Aman Bhakti Pulungan, Aman Bhakti Aman Pulungan Amanda Soebadi Amir Thayeb Angelina Arifin Annisa Rahmania Yulman Aria Kekalih Arwin A. P. Akib Aryono Hendarto Badriul Hegar Bambang Supriyatno Bambang Tridjaja AAP, Bambang Tridjaja Bernie Endyarni Medise Brastho Bramantyo Charity Monica Damayanti R. Syarif Darlan Darwis Desy Dewi Saraswati Dharma Mulyo Dharma Mulyo Diana Aulia Dilawar, Ismail Doddy Kurnia Indrawan Dyah Kanya Wati E.M. Dady Suyoko Emi Yulianti Evita B. Ifran Evita Kariani B. Ifran Fathema D Rachmat Galih Satria Kusumanto Gunanti . Gunanti Gunanti Hardiono Pusponegoro Hari Kushartono Henny Rosita Iskandar Henny Rosita Iskandar Heri Wibowo Hindra I. Satari Hindra I. Satari, Hindra I. Hotber Pasaribu I Nyoman Budi Hartawan Idham Amir Idham Amir Imral Chair Irawan Mangunatmadja Irene Yuniar, Irene Johnny Nurman Jose M. Mandei Jusuf Rachmat Juwita, Erlin Kurniawan Taufiq Kadafi Lina Haryanti Lisnawati Rachmadi Magdalena E Sahetapy Mardjanis Said Melpa Susanti Purba Meri Yanti Moh. Supriatna Moh. Supriatna Moh. Supriatna Moh. Supriatna Muhammad Reva Aditya Mulya Rahma Karyanti, Mulya Rahma Mulyadi M. Djer Munar Lubis Munasir, Zakiudin Murni, Indah K. Muzal Kadim Nahari Arifin Najib Advani Najma Hayati Nathanne Septhiandi Ni Made Rini Suari Nia Kurniati Nina Dwi Putri Nindya Permata Novie Amelia Chozie Nursakina, Yosilia Piprim B. Yanuarso, Piprim B. Pramita G. Dwipoerwantoro Pramita Gayatri, Pramita Pudjiastuti Pustika Amalia R. Irma Rachmawati Raden Roro Soesatyoratih Rahmayanti, Siti Ratih Puspita Reza, Maulana Okta Rina A.C. Saragih, Rina A.C. Rina Amalia C. Saragih Ririe F Malisie Rismala Dewi Rizki Dzakiyah Sholikhah, Wanda Ronald Chandra Rosalina D Roeslani Rubiana Sukardi, Rubiana Saptadi Yuliarto Saptawati Bardosono Setyo Handryastuti Siti Aizah Lawang Siti Munawaroh Sri Martuti Sri Martuti Sri Martuti Sudung O Pardede, Sudung O Sudung O. Pardede Sudung O. Pardede Supriatna, Novianti Susanti, Dhama S. Susetyo Harry Purwanto Taralan Tambunan Tartila Fathan Tatang M. Puspandjono Titis Prawitasari, Titis Tsaniya, Ireska Vimaladewi Lukito Y. Suryatin Yoga Devaera Yuliatmoko Suryatin Yusrina Istanti Yusrina Istanti Yusrina Istanti

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