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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina Sari Pediatri Paediatrica Indonesiana Medicinus : Jurnal Kedokteran ISM (Intisari Sains Medis) : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Jurnal Ilmiah Permas: Jurnal Ilmiah STIKES Kendal Jurnal Prima Medika Sains Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Kedokteran Meditek
I Wayan Bikin Suryawan
Bagian/SMF Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Udayana/RSUP Sanglah, Denpasar
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Veterinary

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Re-evaluating WHO Warning Signs in Pediatric Dengue: Abdominal Pain, Not Vomiting, is Associated with Plasma Leakage Cynthia Cynthia; Andreas Eric; I Kadek Suarca; I Wayan Bikin Suryawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1382

Abstract

Background: Dengue virus infection represents a significant cause of morbidity and mortality in pediatric populations across endemic regions. The progression to severe disease is characterized by a critical phase of plasma leakage. The World Health Organization (WHO) has established warning signs to aid in clinical triage, yet the independent clinical significance of these signs, particularly abdominal pain and vomiting, requires more precise clarification to optimize patient management. Methods: This study was a retrospective, cross-sectional analysis conducted at Wangaya General Hospital in Denpasar, Indonesia. Electronic medical records of 172 pediatric patients hospitalized with a diagnosis of dengue between January and May 2024 were reviewed. The primary outcome was significant plasma leakage, defined as a hematocrit increase of 20% or more from the admission baseline. Bivariate and multivariate logistic regression analyses were performed to determine the association of abdominal pain and vomiting with plasma leakage, controlling for the confounding effects of age, gender, and the day of fever at assessment. Results: In the multivariate logistic regression model, the presence of abdominal pain was independently and significantly associated with an increased likelihood of plasma leakage (Adjusted Odds Ratio [aOR]: 2.15, 95% Confidence Interval [CI]: 1.05–4.41; p=0.036). Conversely, the association for vomiting was not statistically significant after adjustment for confounders (aOR: 1.25, 95% CI: 0.65–2.42; p=0.508). The co-occurrence of both symptoms was also identified as a significant indicator of plasma leakage in the adjusted model (aOR: 2.09, 95% CI: 1.01–4.34; p=0.047). Conclusion: In this retrospective analysis of a hospitalized pediatric study, abdominal pain emerged as a robust independent correlate of significant plasma leakage, whereas vomiting did not. This differential association suggests that abdominal pain should be weighted more heavily in the clinical assessment of children with dengue as a key indicator of ongoing or impending hemoconcentration. These findings, while limited by their retrospective nature, can help refine clinical risk assessment in resource-constrained settings.
Korelasi Neutrofil-Limfosit Rasio dengan Kadar C-Reaktif Protein sebagai Biomarker Sepsis Neonatus pada Bayi Prematur di Rumah Sakit Wangaya Denpasar Sriwaningsi, Lina; Bikin Suryawan, I Wayan; Suarca, I Kadek
Sari Pediatri Vol 27, No 2 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp27.2.2025.89-95

Abstract

Latar belakang. Sepsis neonatus merupakan kondisi yang mengancam jiwa dengan angka kematian yang tinggi pada bayi prematur. Bayi prematur memiliki sistem kekebalan tubuh yang belum matang. Sampai saat ini, kultur darah masih menjadi pemeriksaan standar emas untuk mendiagnosis sepsis neonatus. Neutrofil-limfosit Rasio (NLR) diusulkan sebagai penanda inflamasi, mendeteksi, dan menentukan tingkat keparahan sepsis, sedangkan C-Reaktif Protein (CRP) paling banyak digunakan pada fase akut, tetapi parameter ini dibatasi oleh sensitivitas, spesifisitas, ketersediaan, dan biaya. Kami mencoba menganalisis NLR sebagai alternatif pada sepsis neonatus.Tujuan. Mengetahui nilai cut-off point Neutrofil-limfosit Rasio yang optimal sebagai prediktor sepsis neonatus pada bayi prematur di Rumah Sakit Umum Daerah Wangaya.Metode. Penelitian ini merupakan penelitian analitik observasional cross-sectional menggunakan data sekunder dari rekam medis bayi yang dirawat di perinatologi dan NICU/neonatal intensive care unit Rumah Sakit Umum Daerah Wangaya. Total 94 bayi yang memenuhi kriteria inklusi dan ekslusi. Data yang terkumpul disajikan secara deskriptif, dengan analisis bivariat dan analisis cut-off point menggunakan kurva ROC.Hasil. Berdasarkan sosiodemografi, bayi sepsis dengan berat badan lahir rendah sebanyak 81%, sebagian besar mengalami sepsis neonatorum awitan dini (SNAD) 73 bayi (77%). Nilai cut-off point NLR 3,52 dengan nilai AUC 85%, sensitivitas 81%, dan spesifisitas 81%. Sedangkan nilai cut-off point CRP dengan nilai AUC 71%, sensitivitas 68%, dan spesifisitas 67%. Terdapat hubungan nilai NLR dengan CRP pada sepsis neonatus bayi prematur p-value 0,00 (p=<0,05).Kesimpulan. Nilai cut-off point NLR dapat digunakan sebagai prediktor deteksi dini sepsis neonatus. Deteksi sepsis neonatus menjadi lebih baik bila dikombinasikan dengan CRP.
Co-Authors A.A Made Sucipta A.A Made Widiasa A.A. Made Sucipta A.A. Made Widiasa Adi Wirawan Alberto Afrian Alice Indradjaja, Alice Aman B Pulungan Anak Agung Made Sucipta Anak Agung Made Sucipta Anak Agung Made Sucipta Anak Agung Made Sucipta Anak Agung Made Sucipta Anak Agung Made Sucipta, Anak Agung Made Anak Agung Made Widiasa Anak Agung Made Widiasa Anak Agung Made Widiasa Andreas Eric Andrew Permana Suliarta Arimbawa * Ayu Setyorini Mestika Mayangsari Bambang Tridjaja AAP, Bambang Tridjaja Bella Kurnia Bella Kurnia Bella Kurnia Cahaiantari, Ni Putu Elis Callista Beatrice Christina, Jessica Chyntia Conchita Christal Yasadipura Cynthia Cynthia Cynthia Cynthia Cynthia Cynthia Cynthia Jodjana Dewi, Made Ratna Doddy Kurnia Indrawan Edbert Wielim Elien Yuwono Erica Lidya Yanti Gosal, Jessica H Salim I Dewa Gede Ugrasena I Gde Doddy Kurnia Indrawan, I Gde Doddy Kurnia I Gusti Amanda Jaya I Gusti Lanang Sidiartha I Kadek Serisana Wasita I Kadek Suarca I Kadek Suarca I Made Arimbawa IB Mahendra Ida Bagus Ramajaya Sutawan, Ida Bagus Ramajaya Ida Bagus Wiadnyana IKG Suandi IM Widiaskara Imanuel Yulius Malino Jeven Reggie Santoso Jose RL Batubara Kadek Suarca Kadek Suarca Ketut Ariawati Komang Tria Anggareni Lukman, Leni Made Cynthia Mahardika Putri Made Dwi Purnami Made Ratna Dewi Made Ratna Dewi Made Widiasa Mayland Margaretha Sunata Melisa Anggraeni Mustika, Putu Pradnyanita PT Pramitha Putri Widyastiti, Ni Nyoman Putu Andrie Setiawan Putu Pramitha Rahayu Regina Suriadi Ruby Kurniawan Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Sriwaningsi, Lina Stanley Haryono Suarca, I Kadek Sukarno, Theodora Sunartini Sunartini Suriadi, Regina Susan Natalia Budihardjo sutanti sutanti Valerie Michaela Wilhelmina Widiasa - Wielim, Edbert William Grandinata Soeseno