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All Journal Medical Journal of Indonesia Sari Pediatri Paediatrica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia International Archives of Medical Sciences and Public Health Cermin Dunia Kedokteran
Irene Yuniar, Irene
Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas RS Dr. Cipto Mangunkusumo, Jakarta
Religion Biochemistry, Genetics & Molecular Biology Education Environmental Science Health Professions Medicine & Pharmacology Public Health

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Effects of probiotic on gut microbiota in children with acute diarrhea: a pilot study Dion Darius Samsudin; Agus Firmansyah; Eka Laksmi Hidayati; Irene Yuniar; Mulya Rahma Karyanti; Rosalina Dewi Roeslani
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 (483.346 KB) | DOI: 10.14238/pi60.2.2020.83-90

Abstract

Background Acute diarrhea is a common health problem in Indonesia. During acute diarrhea, changes in gut microbiota are marked by decrease beneficial microbes Bifidobacterium and Lactobacillus, and increased pathogenic bacteria Enterobacter and Clostridium. Such microbial imbalances are known as dysbiosis. Treatment with probiotics may help repair dysbiosis, quicken healing time, and decrease complications. Objective To assess for dysbiosis during acute diarrhea, and determine if it can be normalized by probiotic treatment. Methods This placebo-controlled, unblinded clinical trial was performed in Budhi Asih District Hospital, Jakarta, from January to March 2018. Twenty-four children age 6-24 months with acute diarrhea and 12 healthy children were enrolled. First fecal specimen was collected for all subjects and analyzed using non-culture real time PCR to count the population of Lactobacillus, Bifidobacterium, Enterobacter, Clostridium, and all bacteria. Children with diarrhea were assigned to probiotic or placebo treatment for 5 days and the second fecal specimen was analyzed two weeks after the diarrhea subsided. Results Prior to treatment, significant higher amounts of Lactobacillus were observed in children with acute diarrhea than in healthy controls [median (interquartile range/IR): 1.52x103 (1.22x104) vs. 6.87x10 (2.41x102), respectively; proportion in percentage (from total bacteria population): 0.044% vs. 0.003%, respectively]. However, median (IR) Clostridium was significantly higher in healthy controls than in children with acute diarrhea [2.37x102 (4.64x103) vs. 4.67 (1.50x102), respectively (P<0.05), with proportion of 0.01% vs. 0.0001%, respectively]. Children who received probiotics had significantly higher count of Bifidobacterium compared to the placebo group [1.94x104 (4.97x104) vs. 1.74x103 (2.08x107), respectively, with proportion of 0.394% vs. 0.081%, respectively]. Conclusion This pilot study do not find evidence of dysbiosis in children with acute diarrhea. Group who received probiotic had higher Bifidobacterium count compared towards those who received placebo.
The clinical and biomarker approach to predict sepsis mortality in pediatric patients Irene Yuniar; Mulya Rahma Karyanti; Nia Kurniati; Desti Handayani
Paediatrica Indonesiana Vol 63 No 1 (2023): January 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1.2023.37-44

Abstract

Background Sepsis is a leading cause of pediatric morbidity and mortality. The prevalence of sepsis mortality in Indonesia varies between 22.5 to 52%. Objective To identify the clinical criteria for predicting sepsis mortality and evaluate the performance of the PELOD-2 score. Methods This retrospective cohort study included pediatric patients admitted to the emergency department or pediatric intensive care unit (PICU) of Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2015 to May 2020. Demographic characteristics (age and sex), clinical manifestations [nutritional status, presence of shock, need for intubation, source of infection, inotrope use, mean arterial pressure, pulse rate, respiratory rate, and Glasgow Coma Scale (GCS) score], laboratory [leukocyte, platelet, neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte count ratio (NLCR), procalcitonin, C-reactive protein (CRP), and lactate profile], PELOD-2 score, and mortality data were recorded as outcomes. Results We analyzed data from 241 sepsis subjects. The overall mortality rate was 65%. Shock [OR 3.2 (95%CI 1.80 to -5.55, P<0.001)], GCS <9 [OR 2.4 (95%CI 1.30 to 4.23, P=0.005)], inotrope use [OR 3.1 (95%CI 1.74 to 5.5, P<0.001)], CRP >33.5 mg/L [OR 2.5 (95%CI 1.14 to 5.35, P=0.02)], and lactate level >2.85 [OR 2.1 (95%CI 1.02 to 4.56, P=0.04)] were considered significant predictors of mortality. A PELOD-2 cut-off score of >8 had optimal sensitivity (81.2%) and specificity (72.9%) to predict mortality, with an OR of 11.6 (95%CI 5.72 to 23.5, P<0.001). Conclusion Shock, GCS score, inotrope use, CRP, and lactate level can serve as clinical biomarkers to predict mortality in pediatric sepsis. A PELOD-2 score of >8 can predict mortality with reasonably good sensitivity and specificity.
Faktor Risiko Terjadinya Acute Kidney Injury pada Pasien Anak dengan Acute Respiratory Distress Syndrome Natalia, Selina; Setiawan, Devina June; Yuniar, Irene; Tambunan, Taralan
Sari Pediatri Vol 26, No 5 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp26.5.2025.321-7

Abstract

Latar belakang. Terjadinya acute kidney injury (AKI) pada pasien acute respiratory distress syndrome (ARDS) merupakan kondisi serius yang dapat meningkatkan mortalitas pasien anak di Unit Perawatan Intensif Anak (PICU). Tujuan. Mengidentifikasi faktor risiko yang berperan dalam peningkatan kejadian AKI pada pasien anak sakit kritis usia <18 tahun dengan ARDS.Metode. Penelusuran literatur melalui database PubMed, Cochrane, dan Goggle Scholar tanggal 10-12 Oktober 2024. Hasil. Terdapat satu studi yang sahih dengan subjek penelitian pasien anak dengan ARDS yang mendapatkan ventilasi mekanis. Faktor risiko yang diteliti memiliki hasil yang bermakna meliputi, rasio P/F yang lebih rendah, penggunaan inotropik, penggunaan diuretik, indeks oksigenasi (OI) yang lebih tinggi, positive end-expiratory pressure (PEEP) yang lebih tinggi, dan mean airway pressure (MAP) yang lebih tinggi. Kesimpulan. Pasien anak sakit kritis usia <18 tahun dengan ARDS memiliki risiko yang lebih tinggi untuk mengalami AKI, yang berhubungan dengan derajat keparahan ARDS. Beberapa faktor yang dapat meningkatkan risiko terjadinya AKI pada anak dengan ARDS antara lain rasio P/F yang lebih rendah, penggunaan inotropik, penggunaan diuretik, OI yang lebih tinggi, PEEP yang lebih tinggi (>8 cmH2O), dan MAP yang lebih tinggi.
Safety and immunogenicity of the CoV2-Bio in a healthy population aged 18 years and older in Indonesia Maria, Suzy; Olfriani, Ciho; Koesnoe, Sukamto; Sekartini, Rini; Soedjatmiko; Medise, Bernie Endyarni; Yuniar, Irene; Indawati, Wahyuni; Wirahmadi, Angga; Sari, Rini Mulia; Adi, Nuri Purwito; Retnaningdyah, Windri
Medical Journal of Indonesia Vol. 34 No. 1 (2025): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.247476

Abstract

BACKGROUND According to the WHO Target Product Profiles for COVID-19 Vaccines, vaccine development should be indicated for active immunization in all populations, in conjunction with other control measures to curtail the pandemic. Several RBD-based COVID-19 vaccines are being evaluated and have shown advantages. CoV2-Bio was developed based on the wild-type SARS-CoV-2 RBD amino acid sequence, representing residues of the spike protein of the Wuhan-Hu-1 isolate. This study aimed to evaluate the safety and immunogenicity of CoV2-Bio when compared to CoronaVac. METHODS This was an observer-blinded, randomized controlled prospective study of safety and immunogenicity of the CoV2-Bio in healthy adult population. A total of 54 healthy participants were randomized to receive either 3 doses of CoV2-Bio or 2 doses of CoronaVac, and 1 dose of placebo, administered 28 days apart. Participants were followed up for safety and immunogenicity. IgG antibody titers (ELISA) and neutralization assay against Wuhan and Delta strains were evaluated at baseline, Days 28, 56, and 84. We assessed seropositive rate, seroconversion, and GMT as parameters. RESULTS Both vaccines were well tolerated and induced good antibody response. The incidence rate and intensity of local and systemic adverse events did not differ between vaccine and control groups. The vaccine group showed a larger proportion of seroconversion (4-fold increase antibody) (87.5% versus 46.2%, p = 0.001) and higher GMT (305.9 AU/ml versus 102.4 AU/ml, p<0.001) when compared to control group. CONCLUSIONS 3 doses of the CoV2-Bio are safe and immunogenic in healthy adult population. 3 doses of the CoV2-Bio COVID-19 vaccine produce a better immunogenicity profile compared to CoronaVac.
Quality of life in episodic hypoxic children after emergency department or PICU hospitalization Yuniar, Irene; Julianti, Julianti; Gunardi, Hartono; Dewi, Rismala; Wiguna, Tjhin; Lubis, Munar
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/pi65.5.2025.357-63

Abstract

Background Studies on long–term outcomes of hypoxic children after being hospitalized are limited, even though hypoxia is known to affect their quality of life (QoL). Objective To assess the QoL of children with episodic hypoxia following hospitalization in the emergency department (ED) and Pediatric Intensive Care Unit (PICU). Methods A prospective cohort design study targeting pediatric patients aged 2–7 years with critical illness was conducted at Dr. Cipto Mangunkusumo Hospital. Inclusion criteria are hypoxia patients receiving oxygen therapy, defined from the ratio of partial arterial oxygen pressure and inspired oxygen (PaO2/FiO2). The PedsQLTM questionnaire was used to assess QoL at the time of admission and 3 months after hypoxia event. Patients with cerebral palsy, mental retardation, chromosomal abnormalities, liver transplantation, and length of stay ≤24 hours were excluded. Data distribution in numerical form was analyzed using the Kolmogorov–Smirnov test. Results Forty-six children with a median age of 4 (2–7) years had decreased QoL at 3 months after episodic hypoxia, based on PedsQLTM scores. The physical, emotional, and social domains were significantly decreased (P<0.01) compared to QoL at the time of admission. Prior to admission, 78.3% of children had already experienced impaired QoL. Conclusion Children with episodic hypoxia demonstrated a decline in QoL at 3 months after hypoxia event based on PedsQLTM scores. Specifically, the physical, emotional, and social domains were significantly decreased compared to at the time of admission.  
Peran Saturasi Oksigen Serebral yang Diukur Menggunakan Near-Infrared Spectroscopy (NIRS) dalam Mengevaluasi Luaran Resusitasi pada Anak dengan Renjatan Irene Yuniar; Arifah Nur Shadrina
Majalah Kedokteran Indonesia Vol 71 No 4 (2021): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.71.4-2021-367

Abstract

Shock in children remains public health importance and causes significant morbidity and mortality worldwide. Hypoperfusion in shock results in decreased oxygen delivery to the tissues, causing a shift from more efficient aerobic pathways to anaerobic metabolism, which results in lactate as the end product. Unlike blood lactate measurement, near-infrared spectroscopy (NIRS) monitoring system is safe and easy to use in measuring tissue oxygenation non-invasively. However, NIRS monitoring has yet to be validated against a standard measure of regional oxygenation. The primary objective of this article is to review the role of cerebral oxygen saturation (rSO2) measured by NIRS in evaluating the outcome of pediatric shock resuscitation.
Efektivitas Target Saturasi Oksigen Konservatif dibandingkan Liberal pada Bayi Sakit Kritis dengan Pneumonia Berat yang Menjalani Ventilasi Mekanik Invasif Irene Yuniar; Alima Mawar Tasnima; Subhika Laksmi; Cristal Audrey; Muhammad Miqbel
Sari Pediatri Vol 28, No 1 (2026)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp28.1.2026.64-72

Abstract

Latar belakang. Terapi oksigen merupakan salah satu terapi yang paling sering diberikan pada perawatan intensif anak. Namun, target saturasi oksigen perifer (SpO?) yang optimal pada anak dengan ventilasi mekanik invasif masih belum pasti. Hipoksemia berisiko penghantaran oksigen yang inadekuat, sedangkan hiperoksia dapat menimbulkan stres oksidatif, disfungsi endotel, dan vasokonstriksi. Kami melaporkan seorang bayi sakit kritis dengan pneumonia berat yang memerlukan ventilasi mekanik invasif serta menggunakan telaah bukti terstruktur untuk menentukan target SpO?.Tujuan. Mengetahui durasi organ support, durasi penggunaan ventilasi mekanik invasif, dan mortalitas pada penggunaan target SpO? konservatif (SpO? 88–92%) dibandingkan dengan target SpO? liberal (SpO? >94%).Metode. Penulusuran literatur menggunakan Cochrane Library®, PubMed®, EBSCOhost®, Google Schoolar®, dan ClinicalKey®. Kata kunci yang digunakan adalah “children”, “oxygen saturation”, “critically ill OR mechanical ventilation” dan “mortality OR organ support duration OR mechanical ventilation duration”.Hasil. Dua studi memenuhi kriteria eligibilitas dan valid. Penelitian pertama yang dilakukan pada 2040 subyek di Inggris melaporkan penggunaan ventilasi mekanik invasif pada anak sakit kritis dengan target SpO2 konservatif menunjukkan durasi organ support atau kematian dalam 30 hari pertama yang lebih rendah dibandingkan dengan target SpO2 liberal dengan probability index 0,53 (IK95% 0,5–0,55; p=0,04). Penelitian kedua yang dilakukan pada 119 subyek menunjukkan bahwa tidak ada perbedaan yang signifikan durasi penggunaan ventilasi mekanik invasif (median difference=0,10, IK95% -1,64–1,64, p=1,0), durasi subyek tidak menggunakan ventilator dalam 30 hari (median difference=0,10, IK95% -1,6–1,6, p=1,0), durasi perawatan di PICU (median difference=1,0, IK95% -0,8–2,9, p=0,29), durasi cardiovascular support (median difference=0, IK95% -0,5–0,5, p=1,0), mortalitas di PICU (risk ratio/RR=0,98, IK95% 0,26–3,72, p=0,97) antara kelompok dengan target SpO2 konservatif dan liberal.Kesimpulan. Pada anak sakit kritis, penggunaan ventilasi mekanik invasif dengan target SpO2 konservatif menunjukkan luaran yang lebih baik dalam parameter durasi organ support hingga 30 hari atau kematian serta durasi penggunaan ventilasi mekanik, dibandingkan dengan target oksigenasi liberal (SpO2 >94%).
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 Abdul Latief Abdul Latief Abdul Latief Adam Adam Agus Firmansyah Alima Mawar Tasnima Antonius H. Pudjiadi Arifah Nur Shadrina Bernie Endyarni Medise Corry Wawolumaya Cristal Audrey Desti Handayani Dion Darius Samsudin Eka Laksmi Hidayati, Eka Laksmi Harningtyas Jasmin Hartono Gunardi I Nyoman Budi Hartawan Imam D Imam N Irawan Mangunatmadja Jose M. Mandei Julia Fitriany Julianti Julianti, Julianti Kuntjoro Harimurti Muhammad Aini Muhammad Miqbel Mulya Rahma Karyanti, Mulya Rahma Mulyadi M. Djer Munar Lubis Nanda Asyura Rizkyani Natalia, Selina Nia Kurniati Nina Dwi Putri Novie Amelia Chozie Nuri Purwito Adi Nycane Nycane oedjatmiko oedjatmiko Olfriani, Ciho Partini P Trihono Piprim Basarah Yanuarso, Piprim Basarah Retnaningdyah, Windri Rina Amalia C. Saragih Rini Mulia Sari Rini Sekartini Rismala Dewi Rosalina Dewi Roeslani, Rosalina Dewi Setiawan, Devina June Soedjatmiko Sonya Leonardy Low Subhika Laksmi Suci Fitrianti Sudung O Pardede Sudung O. Pardede Sukamto Koesnoe Suzy Maria Taralan Tambunan Taralan Tambunan Taralan Tambunan Tjhin Wiguna Vembricha Nindya Manusita Wahyuni Indawati Wirahmadi, Angga Yoga Devaera