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All Journal Sari Pediatri Paediatrica Indonesiana International Archives of Medical Sciences and Public Health
Piprim Basarah Yanuarso, Piprim Basarah
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, Jakarta
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Sildenafil for pulmonary hypertension due to left-toright shunt after corrective procedure Dyahris Kuntartiwi; Piprim Basarah Yanuarso; Sudigdo Sastroasmoro
Paediatrica Indonesiana Vol 55 No 5 (2015): September 2015
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (105.217 KB) | DOI: 10.14238/pi55.5.2015.257-62

Abstract

Background Pulmonary arterial hypertension (PAH) is a common complication seen in those with a left-to-right shunt congenital heart defect (CHD). Corrective procedures by surgery or catheterization are the therapies of choice for reversible PAH. Since morbidity and mortality due to PAH after correction is high, sildenafil has been used as a selective vasodilator of the pulmonary artery, in order to decrease pulmonary arterial pressure. Objectives To evaluate the effect of sildenafil on pulmonary arterial pressure and clinical outcomes after left-to-right shunt CHD corrective procedures. Methods Left-to-right shunt patients aged < 18 years scheduled for corrective treatment were randomized in a double-blind fashion, to receive either oral sildenafil or placebo, given on days 3 to 30 after the corrective procedure. Clinical and pulmonary arterial pressures were evaluated by echocardiography before, 3 days after, and 30 days after the corrective procedure. Results From July 2013 to June 2014, 36 patients were included in the study: 17 in the placebo and 19 in the sildenafil groups. There were no differences in pulmonary arterial pressure or in clinical outcomes after corrective procedure between the two groups. There were no adverse events during the treatment. Conclusion Sildenafil has little effect on decreasing pulmonary arterial pressure, as most of our subjects seem to have hyperkinetic PAH. As such, pulmonary arterial pressure returns to normal soon after corrective procedures.
Prostaglandin E2 and patent ductus arteriosus in premature infants Mochammading Mochammading; Risma Kerina Kaban; Piprim Basarah Yanuarso; Mulyadi Djer
Paediatrica Indonesiana Vol 56 No 1 (2016): January 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (305.498 KB) | DOI: 10.14238/pi56.1.2016.8-14

Abstract

Background Patent ductus arteriosus (PDA) is a congenital heart disease most commonly occurring in premature infants. Spontaneous ductus arteriosus (DA) closure in premature infants has been suggested to be associated with duct lumen maturity and the DA sensitivity to prostaglandin E2 (PGE2).Objective To assess for a possible correlation between serum PGE2 levels and PDA size in premature infants.Methods This observational study using repeated measurements on premature infants with PDA detected at days 2-3 of life was undertaken in Cipto Mangunkusumo Hospital and Fatmawati Hospital, Jakarta, from April to May 2014. The PDA was diagnosed using 2-D echocardiography and PGE2 levels were measured by immunoassay. Pearson’s correlation test was used to evaluate a possible correlation between PGE2 level and DA diameter.Results Thirty-three premature infants of median gestational age 31 (range 28-32) weeks and median birth weight 1,360 (range 1,000-1,500) grams were enrolled. Almost two-thirds of the subjects were male. Almost all (30/33) subjects had spontaneous DA closure before the age of 10 days. Subjects’ mean DA diameter was 2.9 (SD 0.5) mm with maximum flow velocity of 0.2 (SD 0.06) cm/sec, and left atrial-to-aortic root ratio (LA/Ao) of 1.5 (SD 0.2). Their mean PGE2 levels at the ages of 2-3, 5-7, and after 10 days were 5,238.6 (SD 1,225.2), 4,178.2 (SD 1,534.5), and 915.2 (SD 151.6) pg/mL, respectively. The PGE2 level at days 2-3 was significantly correlated with DA diameter (r = 0.667; P < 0.001), but not at days 5-7 (r = 0.292; P = 0.105) or at day 10 (r = 0.041; P = 0.941).Conclusion There is a strong, positive correlation between the PGE2 level and DA diameter in preterm infants at 2-3 days of age. However, there is no significant correlation between PGE2 level and persistence of PDA.
Laporan kasus berbasis bukti: Pemberian Benzathine Penicillin G Setiap 3 Minggu Dibandingkan 4 Minggu untuk Pencegahan Infeksi Streptokokus pada Anak dengan Penyakit Jantung Rematik Muhammad Yusra Firdaus; Piprim Basarah Yanuarso
Sari Pediatri Vol 24, No 1 (2022)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp24.1.2022.56-61

Abstract

Latar belakang. Infeksi Streptococcus yang memicu demam rematik dapat mendasari terjadinya penyakit jantung didapat pada anak. Demam rematik dapat dicegah baik dari pencegahan primordial, primer, dan sekunder. Anak dengan penyakit jantung rematik dapat dicegah keparahan penyakitnya dengan mencegah terjadinya infeksi Streptococcus berulang atau pencegahan sekunder. Pencegahan sekunder dianjurkan oleh World Health Organization (WHO) adalah dengan pemberian Benzathine Penicillin G (BPG) setiap 3 – 4 minggu. Tujuan. Mengetahui apakah pemberian BPG setiap 3 minggu dapat mengurangi peristiwa infeksi Streptococcus pada anak dengan penyakit jantung rematik dibanding pemberian setiap 4 minggu.Metode. Penelusuran pustaka database elektronik, yaitu Pubmed, ScienceDirect, Cochrane, dan Google Scholar dengan kata kunci “rheumatic heart disease”, “AND” “benzathine penicillin g”, “AND”, “streptococcal infection”, “AND”, “children”.Hasil. Diperoleh satu studi systematic review dan satu studi kohort yang sesuai. Kedua studi menunjukkan bahwa pemberian BPG setiap 3 minggu mengurangi kejadian infeksi Streptococcus daripada pemberian setiap 4 minggu dengan nilai NNT berturut-turut 6 dan 8. Kesimpulan. Pemberian BPG setiap 3 minggu terbukti dapat menurunkan kejadian infeksi Streptococcus pada pasien dengan penyakit jantung rematik.
Short-term outcomes following congenital heart surgery in children with Down syndrome Tri Yanti Rahayuningsih; Sukman Tulus Putra; Piprim Basarah Yanuarso; Zulham Effendy
Paediatrica Indonesiana Vol 63 No 3 (2023): May 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.3.2023.181-8

Abstract

Background Children with Down syndrome (DS) differ from typical children because of many genetic-related aspects that may affect outcomes after congenital heart surgery. To date, there have been no studies on outcomes after congenital heart surgery on pediatric DS patients in Indonesia. Objective To determine outcomes and mortality in DS patients who underwent heart surgery at Dr. Cipto Mangunkusumo Hospital, Jakarta. Methods A prospective and retrospective cohort study was conducted in DS patients aged <15 years who underwent heart surgery from July 2007 to April 2015. The control group were patients in the same age range without DS who underwent heart surgery for various types of heart defects. Results There were 57 DS and 43 non-DS patients during study period. The types of heart defects found in DS patients were atrioventricular septal defect (AVSD) and ventricular septal defect (VSD) in 18/57 (31.6%) patients each, tetralogy of Fallot (12/57; 21%), atrial septal defect (ASD) (4/57; 7%), patent ductus arteriosus (PDA) (4/57; 7%) and transposition of the great arteries with VSD (TGA-VSD) (1/57; 1.8%). DS patients showed an increased incidence of preoperative PH (63.1%) compared to non-DS patients (25.6%). Median duration of surgery was longer in DS [2.9 (range 0.5-5.8) hours] than in non-DS [2.2 (range 0.7-4.7) hours]. DS patients have a longer mean cardiopulmonary bypass duration [79.5 (SD 33.9) minutes] compared to non-DS [59.9 (SD 23.6) minutes], longer mean aortic cross-clamp duration [45.3 (SD 23.7) minutes] compared to non-DS [34.8 (SD 15.7)]. There were significant differences in the incidence of preoperative pulmonary hypertension, surgical time, duration of cardiopulmonary bypass (CPB), and length of the aortic cross-clamp in DS patients compared to non-DS (P<0.05). Median length of ICU stay was 1.9 (range 0.6 to 34) days in DS and 1 (range 0.3 to 43) day in non-DS patients (P=0.373). Median duration of mechanical ventilation [19.9 (range 3-540) vs. 8 (range 3-600) hours (P=0.308)], rate of pulmonary complications [14/57 (24.6%) vs. 6/43 (14%) patients (P=0.216)], and incidence of sepsis [16/57 (28.1%) vs. 6/43 (14%) patients (P=0.143)] were not significantly different between DS and non-DS patients. However, complete atrioventricular (AV) block only occurred in DS patients [6/57 (10.5%)]. In the DS group, 5/57 (8.8%) patients died. There was no mortality in the non-DS group. Conclusion Morbidity and mortality after cardiac surgery in were higher in DS than in non-DS patients. DS patients may have problems related to preoperative PH, AV block, longer surgical time, duration of CPB, and aortic cross-clamp compared to non-DS.
Nilai Diagnostik Neutrophil Gelatinase-Associated Lipocalin Urin, Kelainan Urinalisis, dan Kombinasi Keduanya pada Infeksi Saluran Kemih Anak Usia 2–5 Tahun Estetika, Citra; Pardede, Sudung O.; Munasir, Zakiudin; Supriyatno, Bambang; Prawitasari, Titis; Yanuarso, Piprim Basarah
Sari Pediatri Vol 26, No 3 (2024)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp26.3.2024.137-45

Abstract

Latar belakang. Infeksi saluran kemih (ISK) pada anak memiliki manifestasi klinis yang tidak khas sehingga sulit untuk diagnosis dini. Biakan urin memerlukan waktu hingga lima hari sehingga dapat menyebabkan keterlambatan terapi serta tingginya komplikasi ISK. Kelainan urinalisis yang saat ini digunakan masih memiliki spesifisitas yang rendah. Tujuan. Mengetahui nilai diagnostik Neutrophil gelatinase-associated lipocalin (NGAL) urin, kelainan urinalisis, dan kombinasi keduanya untuk mendiagnosis dini ISK pada anak usia 2-5 tahun.Metode. Uji diagnostik menggunakan biakan urin sebagai baku emas dengan desain potong lintang pada anak berusia 2-5 tahun dengan tersangka ISK dan dirawat di Rumah Sakit Dr. Cipto Mangunkusumo.Hasil. Pemeriksaan NGAL urin diketahui memiliki sensitivitas 85,7% (IK95%: 63,6-96,9%), spesifisitas 74,3% (IK95%: 57,8-86,9%), positive predictive value 64,3% (IK95%: 50,6–75,9%), dan negative predictive value 90,6% (IK95%: 76,9-96,5%) pada anak dengan minimal satu kelainan urinalisis. Pemeriksaan NGAL urin hanya meningkatkan spesifisitas kelainan urinalisis berupa leukosituria saja dan tidak meningkatkan spesifisitas pada yang telah memiliki tiga kelainan urinalisis. Kesimpulan. Neutrophil gelatinase-associated lipocalin urin tidak dianjurkan untuk meningkatkan spesifisitas urinalisis dalam diagnosis ISK pada anak usia 2–5 tahun. Gabungan tiga kelainan urinalisis tanpa NGAL urin sudah memiliki spesifisitas yang baik. Perlu dilakukan penelitian biomarker lain untuk mendiagnosis dini ISK dengan lebih baik.
PRESEPSIN AS A POTENTIAL BIOMARKER OF SEPSIS IN PEDIATRIC PATIENTS UNDERGOING OPEN-HEART SURGERY Fitriany, Julia; Djer, Mulyadi M; Chozie, Novie Amelia; Yanuarso, Piprim Basarah; Putri, Nina Dwi; Yuniar, Irene
International Archives of Medical Sciences and Public Health Vol. 7 No. 1 (2026): International Archives of Medical Sciences and Public Health
Publisher : Pena Cendekia Insani

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53806/iamsph.v7i1.1418

Abstract

Sepsis after pediatric open-heart surgery is rare but highly lethal. Diagnosis is challenging because sepsis symptoms often overlap with post operative inflammatory responses. This study assessed presepsin as a biomarker for postoperative sepsis in children with congenital heart disease. In this prospective diagnostic accuracy study at Cipto Mangunkusumo National Central Hospital, Jakarta, 49 children undergoing open-heart surgery were enrolled. Plasma presepsin and procalcitonin (PCT) levels were measured on postoperative day 1 (T1) and day 3 (T3). Diagnostic performance was evaluated using ROC analysis. Presepsin levels were higher in septic than non-septic patients at T1 (415 vs. 141.5 pg/mL) and T3 (624 vs. 75.9 pg/mL), with a significant difference at T3 (p = 0.001). Presepsin was unrelated to surgical complexity but was associated with 7-day mortality (p = 0.013). At T3, presepsin showed better diagnostic accuracy than PCT (AUC 0.945 vs. 0.895). Optimal cutoffs were 404 pg/mL (T1) and 203.5 pg/mL (T3). PCT levels declined over time in septic patients. Presepsin is a promising biomarker for detecting postoperative sepsis in pediatric open-heart surgery patients, demonstrating diagnostic performance comparable to or superior to PCT, particularly on postoperative day 3. Serial monitoring may facilitate earlier identification of septic complications.
Co-Authors Bambang Supriyatno Citra Estetika Dyahris Kuntartiwi Irene Yuniar Irene Yuniar, Irene Julia Fitriany Mochammading Mochammading Muhammad Yusra Firdaus Mulyadi M. Djer Munasir, Zakiudin Nina Dwi Putri Nina Dwi Putri Novie Amelia Chozie Risma Kerina Kaban Sudigdo Sastroasmoro Sudung O. Pardede, Sudung O. Sukman Tulus Putra Titis Prawitasari, Titis Tri Yanti Rahayuningsih Zulham Effendy