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Evaluasi Sensitivitas Antibiotik dengan Demam Neutropenia Sulaiman Hamid; Pudjo Hagung Widjajanto; Ida Safitri Laksono
Sari Pediatri Vol 15, No 4 (2013)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Latar belakang. Pemberian antibiotik sangat penting untuk menurunkan angka kematian pasien demam neutropenia. Di sisi lain, penggunaan antibiotik jangka panjang akan mengubah pola patogen dan uji sensitivitas terhadap antibiotik.Tujuan. Mencari pola patogen, menilai sensitivitas cefotaxime dan gentamicin sebagai antibiotik lini pertama, dan mendapatkan antibiotik alternatif pada demam neutropenia.Metode. Penelitian potong lintang dilakukan pada anak demam neutropenia yang dirawat di Bangsal Onkologi Anak RSUP Dr. Sardjito periode Januari 2004 sampai Desember 2009. Kriteria inklusi adalah demam (didefinisikan sebagai suhu tubuh â‰¥38,3oC atau â‰¥38,0oC pada dua kali pengukuran selang 1 jam), neutropenia (absolute neutrophil count/ANC <500 sel/mm3 atau <1000 sel/mm3 yang diperkirakan akan turun menjadi <500 sel/mm3 dalam 48 jam), dan hasil biakan positif. Uji sensitivitas dinilai dengan menggunakan disc diffusion method.Hasil. Terdapat 205 episode neutropenia dari 188 subjek, 135 episode di antaranya mengalami demam neutropenia (rerata ANC 520/mm3). Biakan positif 42 (31%) subjek, 30 (70%) dari biakan yang positif merupakan bakteri Gram negatif. Pseudomonas aeruginosa (19%) dan Escherichia coli (19%) merupakan patogen terbanyak dijumpai pada biakan. Hasil uji sensitivitas antibiotik invitro, gentamicin sensitif pada 45% biakan sedangkan cefotaxime 29%.Kesimpulan. Bakteri Gram negatif merupakan penyebab utama demam neutropenia. Sensitivitas cefotaxime lebih rendah apabila dibandingkan dengan antibiotik yang lain. Cefpirome, cefepime dan ampicillin-sulbactam direkomendasikan untuk menggantikan cefotaxime sebagai obat yang dikombinasikan dengan gentamicin pada pengobatan demam neutropenia.

Terapi Cairan Prarujukan dan Skor PELOD sebagai Prediktor Mortalitas Sindrom Syok Dengue Anak Eka Permata Sari; Pudjo Hagung Widjajanto; Nurnaningsih - -
Sari Pediatri Vol 18, No 5 (2017)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp18.5.2017.357-62

Latar belakang. Sindrom syok dengue (SSD) merupakan kondisi kegawatan yang dapat meningkatkan morbiditas dan mortalitas. Manajemen cairan yang tidak adekuat di pelayanan kesehatan prarujukan merupakan salah satu faktor yang berkontribusi terhadap mortalitas pada SSD. Skor Pediatric Logistic Organ Dysfunction (PELOD) dapat digunakan sebagai prediktor mortalitas SSD.Tujuan. Menilai hubungan dan mortalitas terapi cairan prarujukan dengan skor PELOD dalam 24 jam pertama di Pediatric Intensive Care Unit (PICU). Metode. Penelitian rancangan kohort retrospektif pada anak SSD yang dirawat di RSUP Dr. Sardjito bulan April 2011 â€“ Maret 2016. Subjek dengan serologi dengue positif baik yang datang sendiri ke IGD ataupun rujukan dilakukan penilaian skor PELOD. Analisis bivariat chi-square digunakan untuk menilai hubungan terapi cairan prarujukan, skor PELOD dan mortalitas.Hasil. Terdapat 159 subyek berusia 1 bulan â€“ 18 tahun. Hubungan bermakna terdapat pada skor PELOD â‰¥20 terhadap mortalitas SSD (p<0,05). Namun, tidak terdapat hubungan antara resusitasi cairan prarujukan dengan skor PELOD dan mortalitas (p>0,05). Kelebihan cairan prarujukan meningkatkan kematian 2,8 kali meskipun secara statistik tidak bermakna (p=0,06).Kesimpulan. Resusitasi prarujukan tidak berpengaruh terhadap mortalitas SSD anak. Skor PELOD â‰¥20 memiliki mortalitas yang tinggi pada SSD anak. Kelebihan cairan prarujukan meningkatkan mortalitas SSD.Â

Terapi Leukemia Mieloblastik Akut Anak: ProtokolAra-C, Doxorubycinedan Etoposide $'(YV0RGLÃ€NDVLNordic Society of Pediatric Hematology and Oncology(m-NOPHO) Eddy Supriyadi; Ignatius Purwanto; Pudjo Hagung Widjajanto
Sari Pediatri Vol 14, No 6 (2013)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Latar belakang. Pengobatan leukemia mieloblastik akut (LMA) telah banyak mengalami kemajuan. Di negara maju, keberhasilan pengobatan sudah mencapai 65%, sementara di Indonesia diperkirakan masih di bawah 10%.Tujuan.Mengetahui profil LMA mengevaluasi keberhasilan pengobatan. Metode.Dilakukan analisis terhadap catatan medis pasien LMA yang dirawat di bangsal anak Rumah Sakit Sardjito Jogjakarta pada tahun 1999-2011. Diagnosis ditetapkan berdasarkan analisis morfologi dan sitokimia terhadap apus sumsum tulang dan atau darah tepi. Analisis survivaldilakukan terhadap pasien yang diberi pengobatan dengan protokol ADE atau m-NOPHO. Hasil.didapatkan 210 pasien berumur 0â€“17 tahun yang didiagnosis LMA. Enampuluh delapan mendapat kemoterapi, 46 (32%) dengan protokol ADE, 91 (64%) dengan protokol m-NOPHO, dan 5 (4%) pasien diobati dengan protokol lain. Event Free Survival (EFS)setelah lima tahun pada pasien yang mendapat kemoterapi adalah 2,4%, pasien sesudah 4 tahun dengan protokol m-NOPHO (3,7% Â± 2,3%), sedangkan semua pasien yang menggunakan protokol ADE meninggal sebelum 1,5 tahun pengamatan (p=0,005).Kesimpulan.Tingkat keberhasilan pengobatan LMA di RS Dr. Sardjito masih sangat rendah. Pengobatan dengan protokol m-NOPHO mempunyai tingkat keberhasilan yang lebih baik dibandingkan protokol ADE.

Risk factors for the failure to achieve normal albumin serum levels after albumin transfusion in neonates Nadya Arafuri; Pudjo Hagung Widjajanto; Ekawaty L. Haksari
Paediatrica Indonesiana Vol 56 No 3 (2016): May 2016
Publisher : Indonesian Pediatric Society

Background Albumin transfusion for the treatment of neonatal hypoalbuminemia may reduce morbidity. In conditions with disrupted endothelial integrity (e.g., sepsis and critical illness), the administered albumin may leak into the interstitial space, hence, serum albumin levels may fall below expected levels after transfusion. To date, few studies have been done to evaluate the risk factors for failure to achieve normal neonatal albumin levels after transfusion.Objectives To determine the risk factors for failure to achieve normal neonatal albumin levels after transfusion.Methods We performed a case-control study in the Neonatal Ward of Dr. Sardjito Hospital from 2007 to 2012. Normal albumin level was defined as above 3 g/dL. The case group included neonates with post-transfusion albumin levels <3 g/dL and the control group included those with post-transfusion albumin â‰¥3 g/dL. Subjects received intravenous transfusions of 25% or 20% albumin according to the clinical standard of the Neonatal Ward of Dr. Sardjito Hospital. Neonates with very low birth weight, severe birth trauma, burn injuries, severe bleeding, or incomplete medical records were excluded. The data were analyzed with logistic regression test.Results From January 2007 to December 2012, 124 neonates were enrolled in the study. Multivariate analysis showed that low albumin levels before transfusion (OR 12.27; 95%CI 2.17 to 69.30), presence of critical illness (OR 4.01; 95%CI 1.49 to 10.79), diagnosis of sepsis (OR 3.56; 95%CI 1.36 to 9.32), and the >24-hour interval between albumin examination and transfusion (OR 0.06; 95%CI 0.01 to 0.37) were significant risk factors affecting the failure to achieve normal albumin levels.Conclusions Failure to achieve normal albumin levels after transfusion in neonates was significantly associated with low albumin level prior to transfusion, critical illness, sepsis, and >24-hour interval between transfusion and post-transfusion albumin examination.[Paediatr Indones. 2016;56:129-33.].

Fast food consumption and obesity: Relationship among elementary school students in Yogyakarta Djauhar Ismail; E. S. Herini; Pudjo Hagung; Tonny Sadjimin
Paediatrica Indonesiana Vol 39 No 5-6 (1999): May - June 1999
Publisher : Indonesian Pediatric Society

Excessive consumption of calories particularly those of fast foods incompanson to energy expenditure is considered to be an important cause of obesity in children both in developed and developing countries. The objective of this study was to measure the association between the pattern of consuming fast food and the incidence of obesity in elementary school students in an urban developing counUy setting. Across sectional study was conducted to students from 30 elementruy schools in Yogyakarta, lndonesra, who were selected by a population proportional multistage cluster random sampling. From the sample of 3575 parents, 3258 returned self fulfilled questionnaires, a response rate of 91.1%. There was a statistically significant assoctaion between obesity and the experience of consuming fast food (odds ratio ~ 2.82; 95%CI 2.08;3.82), the attitude towards fast food (odds ratio~ 1.88; 95%CI 1.31; 2.69) and the frequency of consumption of fast food (p < 0.001).

The outcomes of childhood acute lymphoblastic leukemia with hyperleukocytosis Din Alfina; Pudjo Hagung Widjajanto; Suryono Yudha Patria
Paediatrica Indonesiana Vol 58 No 4 (2018): July 2018
Publisher : Indonesian Pediatric Society

Background Hyperleukocytosis in childhood acute lymphoblastic leukemia (ALL) is an emergency in oncology. This condition showed high mortality and relapse rates, as well as low survival rate. The outcomes of this group of patients are not yet well studied. Objective To evaluate the characteristics and outcomes of childhood acute lymphoblastic leukemia (ALL) with hyperleukocytosis. Methods This was a retrospective cohort study. The patients were children less than 18 year of age who were diagnosed as ALL in Dr. Sardjito Hospital, Yogyakarta, from January 1st 2010 to November, 30th 2016. Event-free survival rate and overall survival rate were estimated for group of patients with the white blood cell (WBC) groups 50-200x109/L and >200x109/L using the Kaplan-Meier method. Results There were 705 children diagnosed as ALL during the study period, 129 (18%) with hyperleukocytosis and 111 of them met the inclusion criteria, consisted of 76 children in a group of WBC 50-200 x 109/L and 35 children in a group of WBC >200 x 109/L. Presentation at diagnosis: median age were 7 years (range 1 month-18 years), male was 1.5 higher than female, 92% of cases with lymphoid infiltration, 5% with CNS involvement, 40% had bleeding tendency, and 10% had clinical tumor lysis syndrome (TLS). Median WBC was 122 (range 53.4-876) x 109/L; mean Hb was 8 (SD 3) g/dL; median platelet count was 30 (range 1-221) x 109/L. Immunophenotyping was done in 23 patients, 5/23 (8%) was T cell. The patients in lower WBC group showed lower death (26% vs. 34%, P=0,389), higher two-year event-free survival (EFS) 68% vs. 45%, P=0.003, and overall survival (77% vs. 68%, P= 0.16), compared to patients in higher WBC group. Univariate and multivariate Cox regression analyses revealed that none of the variables was a significant prognostic factor for 2 years EFS or overall survival. Conclusion The group of children with ALL and hyperleukocytosis with lower WBC at diagnoses showed better outcomes than the higher WBC.

Impact of malnutrition on febrile neutropenia in children with acute lymphoblastic leukemia during induction phase chemotherapy Marshalla Agnes; Pudjo Hagung Widjajanto; Wahyu Damayanti
Paediatrica Indonesiana Vol 58 No 6 (2018): November 2018
Publisher : Indonesian Pediatric Society

Background Acute lymphoblastic leukemia (ALL) is the most common malignancy in children and adolescents. Febrile Neutropenia (FN) is a medical emergency on ALL that often leads to death. Nutrition status assessment on ALL patient is important because malnutrition can reduce the tolerance of chemotherapy, increase incidence of infection and decrease survival rate. Objectives To assess malnutrition as a risk factor for FN in children with ALL. Methods This case-control study was performed at Sardjito Hospital, Yogyakarta on patients aged 1 month to 18 years diagnosed with ALL and undergoing induction phase chemotherapy between January 2013 and December 2015. The case and control subjects were children with and without FN, respectively. Febrile neutropenia was confirmed by patients temperature above 38ÂºC at one measurement and a peripheral neutrophil count of less than 1,000/mm3. Malnutrition was defined as body weight-for-height was between -2 and <-3 standard deviation. Subjects were included using simple random sampling. Result Bivariate analysis showed a significant correlation between malnutrition and FN (OR 2.62; 95%CI 1.07 to 6.45; P=0.03). However, there was no inverse correlation between socioeconomic status and FN (OR 1.1; 95%CI 0.42 to 2.41; P=0.83). There was no correlation between nutritional status and duration of FN (P= 0.48). Conclusion Malnutrition is a risk factor for FN in children with acute lymphoblastic leukemia.

Influence of initial treatment delay on overall survival and event-free survival in childhood acute lymphoblastic leukemia Irenne Purnama; Pudjo Hagung Widjajanto; Wahyu Damayanti
Paediatrica Indonesiana Vol 61 No 4 (2021): July 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.4.2021.217-22

Background Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Initial treatment delay is a modifiable prognostic factor that significantly affects overall survival (OS) and event-free survival (EFS) of childhood ALL in high-income countries. Nevertheless, the effect of delayed initial treatment in low-middle income countries had not been determined. Objective To analyze relationships between initial treatment delay with overall survival and event-free survival in children with ALL. Methods A retrospective study was conducted in children aged < 18 years newly diagnosed with ALL L1 and L2 from January 2013 until December 2018 at Dr. Sardjito Hospital, Yogyakarta. Initial treatment delay was defined as a time interval of more than 3 days between diagnosis and treatment. The outcomes of the study were OS and EFS. Negative events were defined as remission failure, relapse, dropping out, and death. Overall survival (OS) and event free survival (EFS) were analyzed by Kaplan-Meier and log-rank tests. Results Of 341 subjects, 188 (55.5%) underwent delayed initial treatment. There were no significant relationships between initial treatment delay and OS (HR 0.845; 95%CI 0.548 to 1.302; P=0.445) or EFS (HR=0.937; 95%CI 0.689 to 1.275; P=0.971). Multivariate analysis revealed that age was an independent prognostic factor for both OS (P<0.001) and EFS (P<0.001). Conclusion Initial treatment delay is not associated with OS or EFS. Age is an independent predictor for both OS and EFS.

Predictors of mortality in children with neuroblastoma Rusida Harjayanti Sanindya Arum; Kristia Hermawan; Pudjo Hagung Widjajanto; Sutaryo Sutaryo
Paediatrica Indonesiana Vol 63 No 2 (2023): March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.2.2023.73-9

Background Neuroblastoma is an extracranial solid tumor originating from neural crest cells which failed to properly migrate. Neuroblastoma is commonly found in children under 12 months of age. The survival rate of these patients is still relatively low, both in developed countries and Indonesia. Objective To determine whether age, sex, primary tumor location, degree of cell differentiation, and patient compliance are associated with the survival of children with neuroblastoma at Dr.Sardjito Hospital. Methods This retrospective cohort study included pediatric neuroblastoma patients at Dr. Sardjito Hospital, Yogyakarta, Central Java, between January 2012 to September 2020, however there has been no evaluation about survival of neuroblastoma. We collected secondary data from medical records and registration data of pediatric cancer patients in the Pediatric Hematology Oncology Department of Dr. Sardjito Hospital, we matched te data based on medicals records and manual data in the ward and olyclinic, which included age at diagnosis, sex, primary tumor location, degree of cell differentiation, and patient adherence to therapy. To confirm weather the information about survived or death, apart from medical record we do tracking by telephone to the parent. Results we do the observation and calculating based on our retrospective data , Of 54 pediatric neuroblastoma patients, 54% were female. The median length of observation was 13.25 months, with an incidence rate of 62/100 person-years and a median survival of 13 months from the time of diagnosis. The 5-year survival rate in our study was 21.3%. Multivariate analysis revealed that stage IV patients had higher risk of death (HR 10.9; 95%CI 1.47 to 81.01; P=0.02) compared to other stages. Sub-group follow-up analysis revealed no significant difference in stage IV male patients compared to female patients (HR 1.62; 95%CI 0.81 to 3.22; P=0.172). The survivial in group with primary tumor location outside the adrenal medulla and stage IV was not significantly different from patients whose tumor location was unknown (HR 2.45; 95%CI 0.71 to 8.43; P=0.155). The group whose primary tumor location was in the adrenal medulla did not have a significant difference in survival compared to patients whose primary tumor location was unknown (HR 2.09; 95%CI 0.84 to 5.22; P=0.114). Conclusion The predictor factors studied are not significantly associated with mortality in children with neuroblastoma.

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