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All Journal Sari Pediatri Paediatrica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia
Yogi Prawira, Yogi
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Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Public Health

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Predictors of pediatric Henoch-Schönlein purpura recurrence Santoso, Dara Ninggar; Kurniati, Nia; Hendarto, Aryono; Chozie, Novie Amelia; Prawira, Yogi; Marsubrin, Putri Maharani Tristanita
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.307-15

Abstract

Background Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children and is usually self-limited with a favorable prognosis. However, recurrence in children is associated with a poorer prognosis, i.e., a higher risk of progressing to chronic kidney disease (CKD) as a long-term complication. In Indonesia, the recurrence rate of HSP and its predictors in children have not been well established . Objective To estimate the incidence of recurrent HSP and determine its predictors in children at Dr. Cipto Mangunkusumo National General Hospital (RSCM). Methods A retrospective cohort review of medical records followed children aged <18 years at RSCM for 6 months after HSP diagnosis based on the the European League Against Rheumatism (EULAR)/ Paediatric Rheumatology European Society (PRESS)/Paediatric Rheumatology International Trials Organization (PRINTO) criteria. Multivariate, Cox logistic regression, and Kaplan-Meier analyses were performed. Results This study included 116 children aged 2–17 years with HSP. Twenty-six (22.4%) of the subjects experienced recurrence, with an incidence of 3.56 per 100,000 person-years. The only statistically significant predictor for recurrence was  the presence of infection after the first episode of HSP (HR 11.301; 95%CI 4.327 to 29.519; P<0.001). The cumulative survival of subjects with infection for recurrence over 6 months  was  51%, with mean 5.3 months survival duration (95%CI 4.76 to 5.99; P< 0.0001). Chronic kidney disease, a long-term complication of HSP, was noted in 22 (19%) participants. Conclusion Recurrence of HSP was  observed in 22.4% of our subjects within 6 months follow up. However, subjects with a history of infection after their first episode of HSP resolution should be notified about the possibility of recurrence. Chronic kidney disease occurred in 22 participants (19%), possibly becoming a long-term complication of HSP.
Penggunaan Protokol Penyapihan Sedasi dalam Mencegah Sindrom Putus Obat pada Anak yang Sakit Kritis Kadaristiana, Agustina; Djer, Muljadi M; Prawira, Yogi
Sari Pediatri Vol 26, No 1 (2024)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp26.1.2024.54-62

Abstract

Latar belakang. Sedasi merupakan obat esensial pada perawatan anak sakit kritis, tetapi penggunaan jangka panjang dapat menimbulkan sindrom putus obat. Sampai saat ini belum ada pedoman penyapihan sedasi di unit intensif anak. Tujuan. Mengetahui peran protokol penyapihan sedasi dalam menurunkan kejadian sindrom putus obat. Metode. Penelusuran literatur dilakukan melalui PubMed, Cochrane Library, dan Embase untuk mencari artikel yang relevan. Hasil. Tiga studi memenuhi kriteria eligibilitas, yaitu dua uji klinis terandomisasi dan satu kohort prospektif. Masing-masing memiliki protokol penyapihan sedasi yang berbeda. Meskipun tingkat keabsahannya lemah, penggunaan protokol penyapihan sedasi menggunakan titrasi dan konversi obat bermanfaat dalam menurunkan sindrom putus obat, mempersingkat durasi penyapihan sedasi, dan lama rawat.Kesimpulan. Protokol penyapihan sedasi yang mudah digunakan dengan obat-obatan yang ada di Indonesia perlu dikembangkan.
Tinjauan Sindrom Inflamasi Multisistem pasca COVID-19 pada Anak Prawira, Yogi; Nicodemus, Nicodemus
Majalah Kedokteran Indonesia Vol 72 No 4 (2022): 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.72.4-2022-800

Abstract

Coronavirus disease (COVID-19) caused by infection of severe respiratory syndrome coronavirus 2 (SARS-CoV-2) was first detected in December 2019. Since then, many countries have started reporting a series of cases in children post COVID-19 infection, with various clinical manifestations, i.e: persistent fever, cardiovascular shock, and hyperinflammation similar with Kawasaki disease and/or toxic shock syndrome. The terminology Pediatric Inflammatory Multisystem Syndrome Temporarily Associated with SARS-CoV-2 (PIMS-TS) was given by the Royal College of Paediatrics and Child Health (RCPH), hence commonly known as Multisystem Inflammatory Syndrome in Children (MIS-C) as named by the Centers for Disease Control (CDC) and the World Health Organization (WHO). Multisystem Inflammatory Syndrome in Children has a very wide spectrum of clinical signs and symptoms, with the most common symptoms reported is persistant fever, along with gastrointestinal, cardiovascular and dermatological symptoms. Fever is reported in 97-100% of patients. Gastrointestinal symptoms are the second most common symptom occurring in 70% of patients. Until now, the pathogenesis underlying the occurrence of MIS-C is still unknown. Multisystem Inflammatory Syndrome in Children case management requires multidisciplinary knowledge. Consensus or standard guideline for the management of MIS-C is a work in progress, but in general, the initial management includes intravenous immunoglobulin (IVIG) and corticosteroids.
Comparative diagnostic accuracy of ultrasound and chest radiography in ETT tip localization Widyaningtiar, Hapsari; Prawira, Yogi
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/pi65.5.2025.431-7

Abstract

Background Endotracheal intubation is a life-saving intervention, and accurate placement of the endotracheal tube (ETT) is crucial in pediatric patients due to anatomical variability. Ultrasound offers a practical and safe alternative to chest X-ray (CXR) for verifying ETT placement. Objective To compare the diagnostic accuracy of ultrasound compared to CXR in localizing the ETT tip in pediatric patients. Methods A cross-sectional study was conducted from January to April 2025 in the Pediatric Intensive Care Unit and Cardiac Intensive Care Unit at Dr. Cipto Mangunkusumo Hospital. The study included children aged 1 month to 18 years intubated with either cuffed or uncuffed ETTs. A CXR was performed immediately after intubation, followed by ultrasound within 24 hours. ETT position was assessed based on CXR findings and tracheal ring alignment on ultrasound. Results A total of 89 patients were enrolled. Ultrasound demonstrated sensitivity of 88.6%, specificity of 73.7%, overall accuracy of 85.4%, positive predictive value (PPV) of 92.5%, and negative predictive value (NPV) of 63.6%. The area under the receiver operating characteristic curve (AUC) was 0.811. The positive likelihood ratio (LR+) was 3.37, and the negative likelihood ratio (LR–) was 0.16. Multivariate analysis identified ultrasound as a significant predictor of accurate ETT placement [odds ratio (OR) 7.75; 95%CI 1.29 to 4.74; P<0.001]. Conclusion Ultrasound is a feasible, reliable and accurate alternative to CXR for verifying ETT tip positioning in pediatric intensive care settings.
Perfusion index and lactate clearance as microcirculation parameters in pediatric post-cardiac correction surgery Prawira, Yogi; Silawati, Trisna; Kaswandani2, Nastiti
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

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

Abstract

Background Congenital heart disease (CHD) is a common congenital anomaly in children, with corrective cardiac surgery using cardiopulmonary bypass (CPB) being the definitive treatment. However, post-operative morbidity and mortality remain high, requiring effective hemodynamic monitoring in the cardiac intensive care unit (CICU). Blood lactate levels are traditionally used to assess microcirculation, while non-invasive methods like the perfusion index (PI) have gained interest for real-time monitoring. Objective To determine the correlation between PI and blood lactate levels in pediatric patients following corrective cardiac surgery. Methods A prospective cohort study was conducted in the cardiac intensive care unit (CICU) at Cipto Mangunkusumo Hospital from September to October 2024. Thirty-four pediatric patients aged 1 month to 18 years who underwent corrective cardiac surgery were included. PI and lactate levels were measured at one, four, and eight hours post-operation. Results The median age of participants was 21.5 (IQR 10.25–79.5) months. Non-cyanotic CHD was the most common diagnosis (58%), and 67.6% of cases involved CPB. Low cardiac output syndrome occurred in 17.6% of subjects. Lactate levels decreased significantly over time (P<0.001), while PI showed an increasing trend. Correlation analysis revealed a significant negative correlation between PI <1.4 and lactate levels at the fourth (r =-0.455; P=0.038) and eighth hours (r=-0.515; P=0.017). Conclusion  PI has a significant negative correlation with lactate levels and may serve as a useful non-invasive parameter for microcirculation monitoring in pediatric patients after corrective cardiac surgery.
Co-Authors Aryono Hendarto Djer, Muljadi M Kadaristiana, Agustina Kaswandani2, Nastiti Marsubrin, Putri Maharani Tristanita Nia Kurniati Nicodemus, Nicodemus Novie Amelia Chozie Santoso, Dara Ninggar Silawati, Trisna Widyaningtiar, Hapsari