Respiratory Rate Oxygenation (ROX) index as predictor of high flow nasal cannula in pediatric patients in pediatric intensive care unit

BACKGROUND

High-flow nasal cannula (HFNC) is often used in pediatric populations with respiratory distress. In adults, the respiratory-rate oxygenation (ROX) index is used as a predictor of HFNC therapy; however, children have age-associated differences in respiratory rate, thus may not be applicable to children. This study aims to find the reliability of ROX index and modified P-ROX index as predictors of HFNC therapy failure in pediatric patients.

METHODS

Subjects in this analytical cross-sectional study were taken from January 2023 until November 2023 in Cipto Mangunkusumo Hospital. Inclusion criteria are children aged 1 month to 18 years with respiratory distress and got HFNC therapy. Receiver operating characteristics (ROC) analysis was used to find mP-ROX index cutoff value as a predictor of HFNC failure. The area under curve (AUC) score of mP-ROX index was assessed at different time point.

RESULTS

A total of 102 patients, with 70% of the population with pneumonia, were included in this study. There are significant differences in the ROX index between the successful and failed HFNC group therapy (p < 0.05). This study suggests that mP-ROX index is not useful as predictor of HFNC therapy in pediatrics. While ROX index < 5.52 at 60 min and < 5.68 at 90 min after HFNC initiation have a sensitivity of 90% and specificity of 71%, sensitivity of 78% and specificity of 76%, respectively.

CONCLUSION

mP-ROX index is not useful as a predictor of HFNC therapy in pediatrics. Meanwhile, ROX index at 60 min and 90 min after initiation of HFNC is useful as a predictor of HFNC failure.

Emerging progressive atypical acute kidney injury in young children linked to ethylene glycol and diethylene glycol intoxication

BACKGROUND

There had been a sudden surge of unusually severe and rapidly progressing acute kidney injury (AKI) incidence in Indonesia since August 2022 which did not correspond to the rise of COVID-19 incidence. We suspected this was related to ethylene glycol (EG) and diethylene glycol (DEG) intoxication. This study is aimed at describing the clinical and laboratory characteristics of AKI related to D(EG) intoxication in order to spread awareness of the possibility of intoxication in cases of rapidly progressing AKI with unknown etiology.

METHODS

We conducted a cross-sectional study by collecting secondary data from the pediatric AKI registry at a national referral hospital in Jakarta, Indonesia. Data on children admitted from January to November 2022 with diagnosis of stage 3 AKI based on KDIGO criteria were included. Data regarding demographics, symptoms prior to anuria, laboratory results, infection panel including COVID-19 status, treatment administered, and mortality were analyzed.

RESULTS

Sixteen patients tested positive for EG and DEG, all with history of consuming syrup-based medications. High anion gap metabolic acidosis was observed in majority of patients with mean pH 7.33 ± 0.07 and mean anion gap 15.6 ± 7.8 mEq/L. No patient had high osmolal gap (mean osmolal gap 3.46 ± 4.68). One deceased patient, who had kidney biopsy performed, showed severe damage and calcium oxalate crystals in the kidney tissue. Mortality was recorded in six patients (37.5%).

CONCLUSION

Careful history taking of patient's clinical course, including consumption of syrup-based medications and laboratory findings, might aid clinicians to establish a working diagnosis of D(EG) intoxication without needing to wait for blood toxicology test. Early diagnosis and therapy are crucial to prevent substantial mortality.

International Care programs for Pediatric Post-COVID Condition (Long COVID) and the way forward

BACKGROUND

Pediatric Post-COVID-Condition (PPCC) clinics treat children despite limited scientific substantiation. By exploring real-life management of children diagnosed with PPCC, the International Post-COVID-Condition in Children Collaboration (IP4C) aimed to provide guidance for future PPCC care.

METHODS

We performed a cross-sectional international, multicenter study on used PPCC definitions; the organization of PPCC care programs and patients characteristics. We compared aggregated data from PPCC cohorts and identified priorities to improve PPCC care.

RESULTS

Ten PPCC care programs and six COVID-19 follow-up research cohorts participated. Aggregated data from 584 PPCC patients was analyzed. The most common symptoms included fatigue (71%), headache (55%), concentration difficulties (53%), and brain fog (48%). Severe limitations in daily life were reported in 31% of patients. Most PPCC care programs organized in-person visits with multidisciplinary teams. Diagnostic testing for respiratory and cardiac morbidity was most frequently performed and seldom abnormal. Treatment was often limited to physical therapy and psychological support.

CONCLUSIONS

We found substantial heterogeneity in both the diagnostics and management of PPCC, possibly explained by scarce scientific evidence and lack of standardized care. We present a list of components which future guidelines should address, and outline priorities concerning PPCC care pathways, research and international collaboration.

IMPACT

Pediatric Post-COVID Condition (PPCC) Care programs have been initiated in many countries. Children with PPCC in different countries are affected by similar symptoms, limiting many to participate in daily life. There is substantial heterogeneity in diagnostic testing. Access to specific diagnostic tests is required to identify some long-term COVID-19 sequelae. Treatments provided were limited to physical therapy and psychological support. This study emphasizes the need for evidence-based diagnostics and treatment of PPCC. The International Post-COVID Collaboration for Children (IP4C) provides guidance for guideline development and introduces a framework of priorities for PPCC care and research, to improve PPCC outcomes.

Predicting Factors for Mortality in Patients After the Modified Blalock-Taussig Shunt Procedure in Developing Countries: A Retrospective Study

Background

Blalock-Taussig (BT) is a palliative procedure that preserves blood circulation to the lungs and alleviates cyanosis in patients with congenital heart diseases and reduced pulmonary blood flow. BT shunt remains a routinely performed procedure in developing countries before definitive surgery. However, evidence on predictor factors of mortality after this procedure is still scarce in Indonesia. This study evaluated the predictive factors of mortality after the BT shunt procedure.

Methods

This retrospective study evaluated the medical record data of all postoperative BT shunt patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from 2016 to 2020. We performed univariate and multivariate analyses to identify the predictors of in-hospital mortality.

Results

The total subjects in this study were 197 children, 107 (54.3%) boys and 90 (45.7%) girls. The median values for age and body weight at the time of surgery were 20 months (11 days - 32 years) and 7.9 (2.7-42) kg. The most prevalent diagnosis was the Tetralogy of Fallot, found in 80 (40.6%) patients. In-hospital postoperative mortality was 20.8% (41 patients). Based on multivariate analysis, predictors associated with mortality were weight <4.25 kg (OR 20.9; 95% CI 7.4-59.0; p < 0.0001) and emergency procedures (OR 3.5; 95% CI 1.3-9.5; p = 0.016).

Conclusion

The mortality rate after BT shunt at PJT Rumah Sakit Cipto Mangunkusumo was 20.8%. Based on multivariate analysis, weight <4.25 kg and emergency procedures are two predictors of mortality in BT shunt.

The Comparison of Cerebral Oxygenation among Mechanically Ventilated Children Receiving Protocolized Sedation and Analgesia versus Clinician's Decision in Pediatric Intensive Care Unit

Introduction

Adequate sedation and analgesia are two crucial factors affecting recovery of intensive care patients. Improper use of sedation and analgesia in intensive care patients may adversely lead to brain oxygen desaturation. This study aims to determine cerebral oxygenation as measured by near-infrared spectroscopy (NIRS) and inotropic interventions received among mechanically ventilated children in the pediatric intensive care unit (PICU).

Methods

This study is a nested case - control study in the PICU of Indonesian tertiary hospital. Children aged 1 month to 17 years on mechanical ventilation and were given sedation and analgesia were included in the study. Subjects were divided into two groups according to the protocol of the main study (Clinical Trial ID NCT04788589). Cerebral oxygenation was measured by NIRS at five time points (before sedation, 5-min, 1, 6, and 12 h after sedation).

Results

Thirty-nine of the 69 subjects were categorized into the protocol group and the rest were in the control group. A decrease of >20% NIRS values was found among subjects in the protocol group at 5-min (6.7%), 1-h (11.1%), 6-h (26.3%), and 12-h (23.8%) time-point. The mean NIRS value was lower and the inotropic intervention was more common in the control group (without protocol), although not statistically significant.

Conclusion

This study found that mechanically ventilated children who received sedation and analgesia based on the protocol had a greater decrease of >20% NIRS values compared to the other group. The use of sedation and analgesia protocols must be applied in selected patients after careful consideration.

The role of cardiac power and lactate clearance as an indicator of resuscitation success among pediatric patients with shock in the intensive care unit of Cipto Mangunkusumo Hospital

BACKGROUND

Shock in children remains the primary cause of mortality and morbidity worldwide. Furthermore, its management outcome is improved using many hemodynamic parameters, such as cardiac power (CP) and lactate clearance (LC). Cardiac power is a contractility index based on the measurement of flow and pressure, and it is a relatively new hemodynamic parameter with limited studies. In contrast, LC has been proven useful as a target outcome in shock resuscitation. This study aims to explore the values of CP and LC in pediatric shock and their association with clinical outcomes.

METHODS

This prospective observational study was conducted on children (1 month-18 years old) with shock at Cipto Mangunkusumo Hospital, Indonesia, from April to October 2021. We measured CP using ultrasonic cardiac output monitoring (USCOM®) and serum lactate levels at 0, 1, 6, and 24 h post-initial resuscitation. Subsequently, the variables were described and analyzed with the resuscitation success, length of stay, and mortality.

RESULTS

A total of 44 children were analyzed. There were 27 (61.4%), 7 (15.9%), 4 (9.1%), 4 (9.1%), and 2 (4.5%) cases of septic, hypovolemic, cardiogenic, distributive, and obstructive shock, respectively. Within the first 24 h post-initial resuscitation, CP and LC had an increasing trend. Compared to children who had successful resuscitation, those who did not have successful resuscitation had similar CP at all time points (p > 0.05) and lower LC at 1 and 24 h post-initial resuscitation (p < 0.05). Lactate clearance was an acceptable predictor of resuscitation success (area under the curve: 0.795 [95% CI: 0.660-0.931]). An LC of 7.5% had a sensitivity, specificity, positive predictive value, and negative predictive value of 75.00%, 87.5%, 96.43%, and 43.75%, respectively. Lactate clearance in the first hour post-initial resuscitation had a weak correlation (r=-0.362, p < 0.05) with hospital length of stay. We found no difference in CP and LC among survivors compared to nonsurvivors.

CONCLUSIONS

We found no evidence that CP was associated with resuscitation success, length of stay, or mortality. Meanwhile, higher LC was associated with successful resuscitation and shorter length of stay at the hospital, but not mortality.

Vascular Reactivity Index and PELOD-2 as a mortality predictor in paediatric septic shock: a single-centre retrospective study

BACKGROUND

The mortality rate for children with septic shock is stil quite high in low-income and middle-income countries (31.7%). One of the most widely used scoring systems to assess mortality in sepsis or septic shock is Paediatric Logistic Organ Dysfunction 2 (PELOD-2). However, it requires various laboratory evaluations. A non-invasive, fast and easy method is needed to assess the mortality of children with septic shock at an early stage. Therefore, this study aims to evaluate the ability of Vascular Reactivity Index (VRI) compared with PELOD-2 score as a predictor of mortality in children with septic shock based on vascular response to vasoactive agents.

METHODS

A retrospective cohort study was conducted using data from children aged 1 month to 18 years with septic shock treated in the ER and paediatric intensive care unit (PICU) of the tertiary hospital from 2017 to 2021. The serial haemodynamic data were analysed including Systemic Vascular Resistant Index (SVRI) and the cardiac index from ultrasound cardiac output monitoring device was recorded in the first and sixth hours after the diagnosis of septic shock. The VRI was determined by dividing SVRI/Vasoactive Inotropic Score (ie, accumulated doses of dopamine, dobutamine, epinephrine, milrinone, vasopressin and norepinephrine). The receiver operating curve was used to calculate the area under the curve (AUC), sensitivity and specificity of each cut-off point.

RESULTS

A total of 68 subjects fulfilled the inclusion and exclusion criteria, the median age was 54 months with a range of 2-204 months and the mortality rate was 47%. The majority of the patients who died were found in the high cardiac index and low SVRI group (17.6%). Moreover, the optimum cut-off point of VRI was obtained to predict mortality in septic shock of 32.1, with 87.5% sensitivity and 88.9% specificity. The AUC for predicting death using VRI was 95% (95% CI 90% to 100%, p<0.001) and PELOD-2 92.6% (95% CI 96.4% to 98.8%, p<0.001).

CONCLUSION

The VRI <32.1 may potentially be used to predict mortality in children with septic shock and its predictive ability is as good as PELOD-2. The assessment of VRI is faster and easier than PELOD-2.

Faktor - Faktor yang Memengaruhi Terjadinya Laringomalasia pada Anak dengan Penyakit Refluks Gastroesofageal

Latar belakang. Penyakit refluks gastroesofageal (PRGE) merupakan komorbiditas tersering pada pasien dengan laringomalasia. Banyak studi yang sudah membuktikan adanya hubungan antara PRGE dengan laringomalasia. Namun, sejauh ini belum ada studi yang mempelajari faktor-faktor yang memengaruhi terjadinya laringomalasia pada pasien dengan PRGE. Tujuan. Mengetahui proporsi laringomalasia pada anak dengan PRGE dan faktor-faktor yang memengaruhi (prematuritas, orang tua dengan riwayat dispepsia, pola makan dan disfungsi neurologis) terjadinya laringomalasia pada anak dengan PRGE. Metode. Merupakan studi prognostik dengan desain potong lintang pada 88 anak dengan diagnosis PRGE yang diambil dari rekam medis RSCM mulai dari tahun 2017 hingga 2020. Analisis data menggunakan chi-square/Fisher and logistic regression.Hasil. Proporsi laringomalasia didapatkan 12,5%. Tidak ada faktor yang memengaruhi terjadinya laringomalasia pada anak dengan PRGE. Namun, penelitian ini melihat adanya kecenderungan terjadinya laringomalasia pada subyek dengan pajanan asap rokok, adanya asupan makanan/minuman tengah malam, palsi serebral, dan pola makan yang tidak sesuai dengan feeding rule. Kesimpulan. Adanya kecenderungan terjadinya laringomalasia pada subyek dengan pajanan asap rokok, adanya asupan makanan/minuman tengah malam, dan pola makan yang tidak sesuai dengan feeding rule.

Parents' Perspectives Toward School Reopening During COVID-19 Pandemic in Indonesia-A National Survey

Background

All sectors are affected due to COVID-19 pandemic occurring worldwide, including the education industry. School closure had been taking place for more than a year in Indonesia. Despite the controversies, Indonesian government had decided to begin school reopening.

Objectives

This study aims to assess parental readiness for school reopening, and factors affecting parental attitude toward school reopening.

Methods

A cross-sectional study using online questionnaire distributed via official Indonesian Pediatric Society (IPS) official social media account collected between March and April 2021. The questionnaire contained the general characteristics of study participants, parents' knowledge, and perspectives on COVID-19, and health protocols for school reopening.

Results

A total of 17,562 responses were collected, of which 55.7% parents were ready to send their children to school should school reopens. Factors significantly contribute to parental decision to keep their child at home were: presence of vulnerable population at home [OR = 1.18 (1.10–1.27), p < 0.001], children with comorbidities [OR = 2.56 (2.29–2.87), p < 0.001], perception of COVID-19 as a dangerous disease [OR = 28.87 (14.29–58.33), p < 0.001], experience with COVID-19 positive cases in the community [OR = 1.75 (1.61–1.90), p < 0.001], COVID-19 related death in the community [OR = 2.05 (1.90–2.21), P < 0.001], approval for adult COVID-19 vaccination [OR = 1.69 (1.53–1.87), p < 0.001], and ownership of private transportation [OR = 1.46 (1.30–1.66), p <0.001].

Conclusion

We identified several factors affecting parental perception on school reopening during COVID-19 pandemic that should be addressed. This study can be used for policy-maker to make further recommendations and health educations prior to school reopening in Indonesia.

Clinical Features of Multisystem Inflammatory Syndrome in Children Associated with COVID-19 in Indonesia

BACKGROUND

While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is increasing, reported cases in Asian countries are still low, particularly in Indonesia. This study aimed to describe the characteristics of patients with MIS-C in a tertiary referral hospital in Indonesia.

METHODS

This is a cross-sectional study with collected data of patients with MIS-C admitted to Dr. Cipto Mangunkusumo from March 2020 to April 2021.

RESULTS

The first case of MIS-C was detected 5 months after the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive admitted patients for COVID-19 were diagnosed with MIS-C during the study period. Of these 13 patients, 2 patients (15%) had a fatal outcome. Subjects were predominantly male, and the median age was 7.58 years (IQR 12.3) years. Most patients required mechanical ventilation (7 out of 13 patients) and intubation (8 out of 13 patients). Patients who needed intubation usually needed mechanical ventilation. All inflammatory markers, white blood cells, neutrophil counts, and all coagulation factor parameters (except for normal prothrombin time and activated partial prothrombin time) were elevated. The median time to MIS-C diagnosis was 2 days in the survivor group (n = 11) compared to 8.5 days in the non-survivor group (n = 2). Compared to the non-survivor group, those who survived spent more days in the hospital, received vasopressors earlier, and did not require mechanical ventilation as early as the non-survivors.

CONCLUSIONS

Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between the two groups.

Corrigendum on: Pediatric COVID-19: Report from Indonesian pediatric society data registry

[This corrects the article DOI: 10.3389/fped.2021.716898.].

Mortality in children with positive SARS-CoV-2 polymerase chain reaction test: Lessons learned from a tertiary referral hospital in Indonesia

Background

The incidence of coronavirus disease 2019 (COVID-19) is still increasing rapidly, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aimed to describe the characteristics of children with COVID-19 with fatal outcomes in a tertiary referral hospital in Indonesia.

Methods

This cross-sectional study used data collected from the medical records of patients with COVID-19 admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from March to October 2020.

Results

During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, and 20 (40%) had a fatal outcome. The fatality rate was higher in patients aged ≥10 years, categorized with severe disease upon admission, PaO₂/FiO₂ ratio ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase and presepsin levels were found in all fatal cases. One patient met the criteria of multisystem inflammatory syndrome in children.

Conclusion

Our work highlights the high mortality rate in paediatric patients with positive SARS-CoV-2 polymerase chain reaction test. These findings might be related to or co-incided with COVID-19 infection. Further studies are needed to improve understanding of the role of severe acute respiratory syndrome coronavirus-2 in elaborating the mechanisms leading to death in children with comorbidities.

Pediatric COVID-19: Report From Indonesian Pediatric Society Data Registry

Background: Indonesia has a high number of COVID-19 cases and mortalities relative to not only among the Asia Pacific region but the world. Children were thought to be less affected by the virus compared to adults. Most of the public data reported combined data between adults and children. The Indonesian Pediatric Society (IPS) was involved in the COVID-19 response, especially in the area of child health. One of IPS's activities is collecting data registries from each of their chapters to provide a better understanding of COVID-19 in children. Objective: The objective of this study was to share the data of suspected and confirmed COVID-19 cases in children from IPS's COVID-19 data registry. Method: This is a retrospective study from the IPS's COVID-19 registry data. We collected the data of COVID-19 in children during March to December 2020 from each of the IPS chapters. We analyzed the prevalence, case fatality rate (CFR), age groups, diagnosis, and comorbidities of the children diagnosed with COVID-19. Result: As of December 21, 2020, there were 35,506 suspected cases of children with COVID-19. In total, there were 522 deaths, with a case fatality ratio (CFR) of 1.4. There were 37,706 confirmed cases with 175 fatalities (CFR 0.46). The highest mortality in confirmed COVID-19 cases was from children ages 10-18 years (42 out of 159 cases: 26%). The most common comorbidity and diagnosis found were malignancy (17.3%) and respiratory failure (54.5%). Conclusion: The CFR of confirmed COVID-19 cases in children in Indonesia is high and should be a major public concern.

Perbandingan Penggunaan Heated Humidified High Flow Oxygen Therapy dan Low Flow Oxygen Therapy pada Pasien dengan Hipoksemia: Tinjauan Kasus Berbasis Bukti

Latar belakang. Selama ini, penggunaan low flow oxygen therapy sebagai terapi pada pasien dengan hipoksemia memiliki angka kegagalan terapi yang tinggi dan toleransi pasien yang rendah. Literatur menunjukkan bahwa heated humidified high flow oxygen therapy dapat memperbaiki oksigenasi, angka keberhasilan terapi, dan kenyamanan pasien.Tujuan. Membandingkan efek penggunaan heated humidified high flow oxygen therapy dengan low flow oxygen therapy.Metode. Penelusuran literatur secara terstruktur dilakukan melalui Pubmed®, ScienceDirect®, Proquest®, dan EBSCO®.Hasil. Didapatkan dua studi acak terkontrol dan satu studi pendahuluan yang relevan. Ketiga studi menunjukkan bahwa heated humidified high flow oxygen therapy memiliki angka keberhasilan terapi yang lebih tinggi daripada low flow oxygen therapy dengan nilai NNT berturut-turut 5,55, 5,00, dan 9,09. Tidak ada perbedaan durasi rawat inap, kecepatan pernapasan, dan saturasi oksigen yang signifikan pada ketiga studi tersebut.Kesimpulan. Penggunaan heated humidified high flow oxygen therapy terbukti aman dan meningkatkan angka keberhasilan terapi pada pasien dengan hipoksemia.

Sildenafil Sebagai Pilihan Terapi Hipertensi Pulmonal Pascabedah Jantung Koreksi Penyakit Jantung Bawaan pada Anak

Definisi hipertensi pulmonal (HP) pada anak dan dewasa adalah sama, yaitu bila mean pulmonary arterialpressure 􀁲25 mmHg saat istirahat atau 􀁲30 mmHg saat aktivitas. Pada anak pascabedah koreksi penyakitjantung bawaan (PJB), HP berat merupakan komplikasi yang sangat dikhawatirkan, dengan angka kejadiansekitar 2%. Sildenafil telah digunakan secara luas pada pasien HP dewasa, baik sebagai terapi tunggalmaupun kombinasi. Makalah ini bertujuan untuk mengevaluasi pemberian sildenafil pada anak denganHP pascabedah jantung koreksi. Kedua pasien dirujuk ke RS Dr Cipto Mangunkusumo, Jakarta (RSCM)dengan keluhan tampak biru, sesak terutama saat menetek, dan berat badan sulit naik. Saat itu keduapasien didiagnosis memiliki kelainan jantung bawaan berupa transposisi arteri besar (TGA), defek septumventrikel (VSD) dan HP. Operasi koreksi total (arterial switch dan penutupan VSD) dilakukan pada saatpasien pertama berusia 3 bulan 10 hari dan pasien kedua berusia 4 bulan 22 hari. Kedua pasien mendapatinhalasi nitric oxide (iNO), inhalasi iloprost, dikombinasikan dengan sildenafil oral, dengan dosis awal 0,5mg/kg berat badan (BB) per kali tiap 6 jam dengan pemantauan tekanan arteri berkala. Pasien pertamadipulangkan pada hari ke-23 pascabedah dan mendapat sildenafil oral dengan penurunan dosis bertahapdalam kurun waktu 6 bulan. Pasien kedua dipulangkan pada hari ke-12 pascabedah dan masih mendapatterapi sildenafil oral dengan dosis yang sama sampai hari ini. Pada kedua pasien tidak dilaporkan kejadianefek samping. Sebagai kesimpulan sildenafil efektif dalam memperbaiki hemodinamika pembuluh darahpulmonal dan bekerja secara sinergik dengan iNO. Sildenafil oral merupakan terobosan terapi yang menarikdan cukup efektif karena mudah pemberiannya dan memiliki efek samping minimal.

Clinical, laboratory, and radiologic characteristics of confirmed avian influenza (H5N1)

This was a cross sectional study to determine the clinical, laboratory and radiologic characteristics of confirmed avian influenza (AI) (H5N1) infection among children and adults. This study was conducted at Sulianti Saroso Infectious Diseases Hospital (SS-IDH), Jakarta among subjects confirmed to have AI infection hospitalized during September 2005 to August 2010. The proportion of confirmed AI patients was 33 out of 321 suspected and probable cases (10.2%). Of 26 subjects analyzed (7 subjects was excluded due to loss of or incomplete medical records), the median ages were 7 years and 25 years in children and adults, respectively (range 1 - 39 years). Prominent clinical features were respiratory symptoms [productive cough (13/13 children; 12/13 adults), dyspnea (12/13 children; 13/13 adults)], and fever (12/13 children; 12/13 adults). Leukopenia was found in 9 subjects in each group. Four children and 7 adults had lymphopenia, while thrombocytopenia was found in 7 children and 10 adults. Two children had an increased ALT, while most adults had an increased AST (10/13) and/or ALT (8/13). Bilateral infiltrates found in most subjects on chest x-ray who had clinical deterioration. Of the 3 children who survived out of 13 children with AI, they all had less severe clinical features and no central nervous system involvement, lymphopenia, thrombocytopenia, or increased creatinine level. None of the adults survived.

Detection of childhood developmental disorders, behavioral disorders, and depression in a post-earthquake setting

Background Disasters, including earthquakes, may strike abruptly without warning. Children may develop psychological damage resulting from experiencing an overwhelmingly traumatic event. They may feel very frightened during a disaster and demonstrate emotional and behavioral problems afterwards.Objective To evaluate the presence of developmental disorders, behavioral disorders, and depression in children after the earthquake at Padang and Pariaman on September 30th, 2009.Methods This was a cross􀁘sectional study using the developmental pre screening questionnaire (KPSP), Pediatric Symptoms Checklist-17 (PSC-17), and Child Depression Inventory (CDI) in children after the Padang and Pariaman earthquake (September 30th, 2009), in Sungai Limau and Sungai Geringging District, Pariaman Region, West Sumatera. Our study was conducted October 15th to November 28th, 2009.Results There were 172 children screened using the KPSP. Forty-two (25%) children scored 7􀁘8 (reason for concern), 18 (10%) children scored <7 (suspected to have a developmental disorder), and the remainder scored as developmentally appropriate. Behavioral disorder screening was perfonned in 339 children using the PSC􀁘 17. Internalizing disorder alone was suspected in 58 (17%) children, externalizing disorder alone in 26 (7.7%), and attention􀁘defidt disorder alone in 5 (1.5%). Eight (2.4%) children were suspected to have both internalizing and attention􀁘defidt disorders, 4 (1.2%) children externalizing and attention􀁘defidt disorders, 22 (6.5%) children internalizing and externalizing disorders, and 15 (4.4%) children all three disorders. From 4 9 children who underwent depression screening using CDI, 15(30.6%) children were suspected to have depression. Conclusion After the Padang and Pariaman earthquake, we found 10% of subjects screened were suspected of having a developmental disorder. The most connnonbehavioral disorder found was internalizing disorder. Possible depression was found in 30.6% of children surveyed. Traumatized children are at risk for developing post traumatic stress disorder. 2011;5' :133-7].