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All Journal Sari Pediatri Journal of Maternal and Child Health
Sri Lilijanti Widjaja, Sri Lilijanti
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Health Professions Medicine & Pharmacology Public Health

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Increased Plasma Caspase-3 in Children with Down Syndrome is Associated with an Increasing Risk of Pulmonary Hypertension Prasanti, Damayanti Ika; Widjaja, Sri Lilijanti; Rokhayati, Evi
Journal of Maternal and Child Health Vol. 8 No. 1 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (34.549 KB) | DOI: 10.26911/thejmch.2023.08.01.03

Abstract

Background: Pulmonary hypertension (PH) is the one of the comorbidities in children with Down syndrome. The pathogenesis of this pulmonary hypertension remains to be investigated, although endothelial dysfunction and apoptotic activity are among the proposed mechanisms. Caspase-3 is a key regulator of apoptosis and appears to be an attractive predictor of pulmonary hypertension in children with Down syndrome. Subjects and Method: A cross-sectional observational clinical study was performed in Dr. Moe­wardi General Hospital in Surakarta-Indonesia between January and March 2021 involving clini­cally diagnosed children with Down syndrome. Sampling method was using a consecutive sampling. The independent variable was plasma caspase-3 level and the dependent variable were the presence of pulmonary hypertension and congenital heart defects (CHD). Clinical data documentation, blood collection and echocardiography were performed on enrollment day. We first determined the plasma level of caspase-3 in 36 children with Down syndrome and CHD (n=18) or without CHD (n=18) and further determined the risk of having pulmonary hypertension using the plasma caspase-3 level. We also determined the biomarker performance of caspase-3 using a receiver-operating characteristic (ROC) analysis Results: Children with Down syndrome with PH had a higher plasma caspase-3 compared to those without PH (p<0.001). In those with both CHD and PH, the plasma caspase-3 level was also high although not statistically significant (p=0.145). The highest plasma caspase-3 level was observed in subjects with PH without CHD (p<0.01). Relative risk and ROC analysis demonstrated that increased plasma caspase-3 level increased the risk to have PH 5 times (RR=5.00, 95% CI 1.74 to 14.34; p<0.001) and predicted the incidence of PH in children with Down syndrome (AUC 0.88, CI 0.76 to 0.99). Conclusion: An elevation in plasma caspase-3 level of Down syndrome children is associated with the increasing risk of having PH regardless the presence of CHD. Keywords: pulmonary hypertension; down syndrome; caspase-3; pathogenesis; apoptosis. Correspondence: Damayanti Ika Prasanti. Department of Pediatrics, Faculty of Medicine, Universitas Sebelas Maret / Dr. Moewardi General Hospital. Jl. Kolonel Sutarto 132, Surakarta 57126, Indonesia. Email: damayanti_ip@yahoo.com. Mobile: 081215683462.
Hubungan Penggunaan Alat Medis Invasif dengan Kejadian Infeksi Organisme Resisten Multidrug pada Pasien Anak Setyawan, Hanif Hary; Umma, Husnia Auliyatul; Widjaja, Sri Lilijanti
Sari Pediatri Vol 27, No 5 (2026)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp27.5.2026.309-15

Abstract

Latar belakang. Peningkatan prevalensi organisme resisten multidrug (MDRO) menjadi tantangan besar dalam pelayanan kesehatan anak, terutama di unit perawatan intensif. Penggunaan alat medis invasif, seperti ventilator, kateter vena sentral (CVC), dan kateter urin, diduga sebagai faktor risiko infeksi MDRO.Tujuan. Penelitian ini bertujuan untuk menyelidiki hubungan antara penggunaan alat medis invasif dan kejadian infeksi MDRO pada pasien anak.Metode. Penelitian kasus–kontrol dilakukan di ruang perawatan intensif anak RSUD Dr. Moewardi, Surakarta, periode Juli 2022 hingga Juni 2023. Data diperoleh dari rekam medis pasien anak usia 1 bulan hingga 18 tahun yang menjalani kultur dan uji kepekaan antibiotik. Sebanyak 80 pasien diikutsertakan, terdiri atas 40 kasus dengan infeksi MDRO dan 40 kontrol tanpa infeksi MDRO. Variabel yang dianalisis meliputi penggunaan ventilasi mekanik invasif, CVC, kateter urin, dan klinis.Hasil. Analisis multivariat menunjukkan bahwa penggunaan ventilasi mekanik invasif berhubungan signifikan dengan infeksi MDRO (aOR=4,27; IK95%:1,21-15,03; p=0,024). Meskipun pada analisis bivariat kateter urin menunjukkan hubungan signifikan (p=0,044), namun pada model akhir multivariat tidak ditemukan hubungan bermakna baik pada kateter urin (p=0,828) maupun CVC (p=0,937). MDRO yang paling sering ditemukan adalah organisme penghasil Extended-Spectrum Beta-Lactamase (ESBL) (42,5%), Acinetobacter baumannii resisten karbapenem (CRAB) (22,5%), dan Staphylococcus aureus resisten metisilin (MRSA) (22,5%).Kesimpulan. Penggunaan ventilasi mekanik invasif merupakan faktor risiko signifikan terjadinya infeksi MDRO pada pasien anak. Strategi untuk meminimalkan penggunaan alat invasif serta kepatuhan ketat terhadap protokol pencegahan infeksi sangat penting guna menekan kejadian infeksi MDRO di ruang perawatan intensif anak.
Co-Authors Evi Rokhayati Husnia Auliyatul Umma, Husnia Auliyatul Prasanti, Damayanti Ika Setyawan, Hanif Hary