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"Keempat kasus serial yang dipaparkan ini bertujuan untuk menganalisis dukungan nutrisi yang optimal dalam komposisi dan cara pemberian yang tepat. Pengambilan keempat kasus serial ini dilakukan berdasarkan karakteristik pasien gagal jantung anak yang berusia 5?17 tahun di rawat salah satu RS. Dukungan nutrisi menggunakan perhitungan rumus Schoefield (BB?TB) dikalikan faktor stress, dengan komposisi protein 2?2,5 gr/kg BB/hari, lipid 25?30%, karbohidrat 55?65%. Hasil analisis dari keempat kasus didapatkan rerata pencapaian asupan lebih dari 90% kebutuhan energi basal pada hari perawatan ke-3, dan saat pulang (hari ke-7) dengan rerata asupan dapat mencapai > 80% kebutuhan energi total, meskipun dua pasien terdapat penurunan asupan akibat syok. Keempat kasus tidak mendapatkan suplementasi berupa mikronutrien dan nutrien spesifik yang seharusnya. Monitoring dan evaluasi yang diberikan meliputi klinis, balans cairan, toleransi asupan, dan analisis asupan. Dukungan nutrisi yang optimal disertai cara pemberian yang tepat memberikan toleransi asupan yang baik disertai perbaikan klinis pasien gagal jantung anak.

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The four cases serial presented is aimed to analyze support optimal nutrients in composition and the way of administering proper. Retrieval the four cases serial was made based on characteristic patient heart failure children ages 5?17 years treated one of the hospital. Nutrition support using the calculation formula of the Schoefield (WH) multiplied factor stress, with the composition of protein 2? 2,5 gr / kg BW/d, lipid 25?30 %, carbohydrates 55?65 %.

The results of the analysis of the four cases it brings average achievement of intake of more than 90% basal energy needs on the day of treatment, and at home (7th day) with average intake can reach > 80% of the total energy needs, although two patients there is a decrease in intake due to shock. The four cases did not get the nutrients and micronutrients supplementation in the form of specific that should. Monitoring and evaluation provided include clinical, fluid balance, tolerance intake, analysis of intake. The optimal nutritional support with the right way of giving tolerance a good intake is accompanied by clinical heart failure patient improvement."

"[ABSTRAKLatar belakang: Luaran pasca-bedah jantung penting diketahui untuk menilai kinerja pelayanan bedah jantung anak, sehingga kualitas pelayanan dapat ditingkatkan.Tujuan: Mengetahui luaran jangka pendek (mortalitas, komplikasi pasca-bedah berat lain, dan komplikasi pasca-bedah yang berat) pada anak yang dilakukan bedah jantung. Selain itu, ingin mengetahui faktor risiko terjadinya komplikasi berat pasca-bedah jantung dan membuat sistem skor dari faktor-faktor risiko tersebut.Metode: Setiap anak dengan penyakit jantung yang dilakukan operasi jantung di RSUPN Dr Cipto Mangunkusumo Jakarta sejak April 2014 sampai Maret 2015 diikuti setiap hari sampai pasien pulang atau meninggal. Data demografis, mortalitas, morbiditas atau komplikasi pasca-bedah jantung, dan faktor risiko terjadinya morbiditas pasca-operasi yang berat diambil dari rekam medis. Pasien yang sudah pulang dari rumah sakit, dalam waktu 30 hari pasca-operasi dihubungi untuk mendapatkan data kondisi pasien dalam waktu tersebut (hidup atau meninggal).Hasil: Selama penelitian didapatkan 258 anak dilakukan bedah jantung. PJB terbanyak yang dilakukan bedah jantung adalah ventricle septal defect (28,7%) dan tetralogy of Fallot (24,4%). Komplikasi pasca-bedah jantung terjadi pada 217 (84,1%) anak dan komplikasi berat terjadi pada 49 anak (19%). Komplikasi pasca-bedah jantung terbanyak adalah hipokalsemia pada 163 (63,2%) anak, hiperglikemia 159 (61,6%), low cardiac output syndrome 52 (20,2%), aritmia 48 (18,6%), sepsis 45 (17,4%), dan efusi pleura 39 (15,1%). Komplikasi berat meliputi in-hospital mortality terjadi pada 33 (12,7%) anak dan mortalitas dalam waktu 30 hari pasca-bedah jantung terjadi pada 35 (13,6%) anak, henti jantung 13 (5%), operasi jantung ulang 10 (3,9%), dan gagal organ multipel 19 (7,4%). Faktor risiko yang berhubungan dengan meningkatnya komplikasi pasca-bedah jantung yang berat adalah peningkatan kadar laktat darah [OR 30,7 (IK 95% 8,1-117,6)], PJB sianotik [OR 4,4 (IK 95% 1,2-15,8), dan pemakaian inotropik yang tinggi [OR 7,8 (IK 95% 1,6-38,9)]. Skor faktor risiko ≥ 3 mampu memprediksi anak yang mengalami komplikasi berat pasca-bedah jantung dengan sensitivitas skor 93,9% dan spesifisitas skor 84,2%, dan area di bawah kurva receiver operating characteristic (ROC) adalah 0,94.Simpulan: Mortalitas di rumah sakit pasca-bedah jantung anak sebesar 12,7% dan mortalitas 30 hari pasca-bedah 13,6%. Komplikasi berat lain pasca-bedah 13,6%. Faktor risiko yang berhubungan dengan meningkatnya komplikasi pasca-bedah jantung yang berat adalah peningkatan kadar laktat darah, PJB sianotik, dan pemakaian inotropik tinggi pasca-bedah jantung. Skor faktor risiko ≥ 3 mampu memprediksi anak yang mengalami komplikasi berat pasca-bedah jantung dengan sensitivitas skor 93,9% dan spesifisitas skor 84,2%.

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ABSTRACTBackground: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%.;Background: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%., Background: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%.]"

"ABSTRAKLatar belakang: Epidemi infeksi human immunodeficiency virus (HIV) masih terus berlangsung di seluruh dunia. Infeksi HIV telah diketahui memengaruhi berbagai sistem organ termasuk jantung. Komplikasi jantung akibat infeksi HIV bersifat multifaktorial dan berperan pada morbiditas dan mortalitas anak. Seiring peningkatan ketersediaan anti retroviral therapy (ART), angka kesintasan pasien juga meningkat. ART selain mempunyai efek kardioprotektif melalui mekanisme penekanan replikasi virus, juga mempunyai efek kardiotoksik. Hingga saat ini belum ada studi pada anak yang membandingkan antara kelompok pasien yang belum mendapatkan terapi (ART-naïve) dan yang telah mendapatkan terapi (ART-exposed).Tujuan: Mendapatkan data prevalens komplikasi jantung pada anak dengan infeksi HIV, baik ART-naïve maupun ART-exposed. Komplikasi jantung yang diteliti antara lain kardiomiopati dilatasi, hipertensi pulmonal, efusi perikardial, dan kelainan elektrokardiografi (EKG).Metode: Penelitian studi potong lintang dilakukan pada 106 anak dengan infeksi HIV usia 1-18 tahun yang datang ke Poliklinik Alergi dan Imunologi Departemen Ilmu Kesehatan Anak RSCM Pengambilan data dilakukan dengan menggunakan data sekunder dari penelitian kohort berjudul ''Cardiovascular Consequences of Paediatric HIV infection: Early Life Cardiovascular Risk and Immediate Cardiac Complications'' yang dilakukan dari bulan Juni 2013 hingga September 2015. Hasil: Komplikasi jantung ditemukan pada 75 (70,8%) anak dengan infeksi HIV, dengan 34 (68%) anak dari kelompok ART-naive dan 41 (73,2%) dari kelompok ART-exposed. Prevalens kardiomiopati dilatasi dan efusi perikardial lebih tinggi secara bermakna pada kelompok ART-naïve (p=0,024; p=0,002), sedangkan prevalens hipertensi pulmonal lebih tinggi secara bemakna pada kelompok ART-exposed (p=0,004). Tidak ditemukan perbedaan bermakna prevalens kelainan EKG antara dua kelompok tersebut.Simpulan: Prevalens komplikasi jantung pada anak dengan infeksi HIV adalah 70,8% dengan prevalens pada anak ART-naive sebesar 68% sedangkan pada anak ART-exposed sebesar 73,2%."

"ABSTRAKPenyakit jantung bawaan (PJB) mengakibatkan morbiditas yang signifikan pada anak dan merupakan penyebab kematian utama dari antara kelainan kongenital lainnya. Usaha preventif PJB dengan cara identifikasi faktor risiko maternal diharapkan dapat menurunkan morbiditas dan mortalitas PJB.Tujuan. Penelitian ini bertujuan untuk mengetahui: (1) karakteristik (usia saat pertama kali terdiagnosis, jenis kelamin, status gizi, dan status ekonomi keluarga) penderita PJB anak di Poliklinik Kardiologi Ilmu Kesehatan Anak (IKA) Rumah Sakit Cipto Mangunkusumo (RSCM), (2) faktor risiko maternal yang diperkirakan mempengaruhi terjadinya PJB pada anak, yaitu: merokok aktif dan pasif selama kehamilan, diabetes melitus, obesitas, infeksi rubela saat kehamilan, usia saat kehamilan, dan pendidikan.Metode. Penelitian kasus kontrol dengan consecutive sampling dilakukan di Poliklinik Kardiologi IKA RSCM pada bulan Januari-Maret 2014. Pemeriksaan klinis, ekokardiografi, dan wawancara dilakukan terhadap 68 subjek PJB (kelompok kasus) dan 68 subjek anak sehat (kelompok kontrol).Hasil. Jumlah subjek penelitian sebanyak 136 subjek, dengan perbandingan kasus:kontrol adalah 1:1. Median (rentang) usia subjek saat diagnosis PJB adalah 5,5 (0,5-180) bulan, sebesar 80,9% terdiagnosis saat berusia kurang dari 1 tahun. Sebagian besar subjek PJB adalah perempuan (57,4%), mengalami malnutrisi (51,5%), dengan 7,4% di antaranya merupakan gizi buruk, dan memiliki status ekonomi keluarga menengah ke bawah (76,5%). Defek PJB non sianotik terbanyak adalah defek septum ventrikel (44,1%) dan PJB sianotik terbanyak adalah Tetralogi Fallot (14,7%). Faktor risiko maternal yang terbukti berhubungan bermakna dengan PJB anak adalah tingkat pendidikan ibu yang rendah. Faktor risiko merokok aktif dan pasif saat kehamilan, obesitas, dan usia ibu saat kehamilan tidak terbukti berhubungan dengan PJB anak, sedangkan faktor diabetes melitus dan infeksi rubela saat kehamilan tidak dapat dianalisis pada penelitian ini.Simpulan. Median (rentang) usia subjek saat diagnosis PJB adalah 5,5 (0,5-180) bulan, sebagian besar subjek terdiagnosis saat berusia kurang dari 1 tahun (80,9%). Sebagian besar subjek PJB adalah perempuan (57,4%), mengalami malnutrisi (51,5%), dan 7,4% di antaranya merupakan gizi buruk, dengan status ekonomi keluarga menengah ke bawah (76,5%). Faktor risiko maternal yang terbukti berhubungan bermakna dengan PJB anak adalah tingkat pendidikan ibu yang rendah.

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ABSTRACTCongenital heart defects (CHD) cause significant morbidities and are the leading cause of death among other congenital anomalies. Preventive measures with identification of maternal risk factors are expected to decrease morbidity and mortality rate in children due to CHD.Objectives. This study aimed to define: (1) characteristics (age at diagnosis, gender, nutritional status, and family’s economy status) of CHD patients in Pediatric Cardiology Clinic Cipto Mangunkusumo Hospital (CMH), (2) maternal risk factors that may influence CHD in children, namely: active and passive smoking in pregnancy, diabetes mellitus, obesity, rubella infection in pregnancy, age at pregnancy, and education.Method. Case-control study with consecutive sampling was performed in Pediatric Cardiology Clinic CMH in January-March 2014. Clinical examination, echocardiography, and interview were performed in 68 CHD subjects (case group) and 68 healthy subjects (control group).Results. Total subject in this study was 136, with ratio of case:control is 1:1. Median (range) of subject’s age at diagnosis was 5.5 (0.5-180) months, and 80.9% were diagnosed in the first year of age. Most of the subjects were female (57.4%), were malnourished (51.5%) with 7.4% were severe malnourished, and were from middle to low income family (76.5%). The most prevalent non cyanotic CHD was ventricle septal defect (44.1%), and the most prevalent cyanotic CHD was Tetralogy of Fallot (14.7%). Maternal risk factor that was significantly associated with CHD was low maternal education. Active and passive smoking in pregnancy, obesity, and maternal age at pregnancy were not associated with CHD, whereas diabetes mellitus and rubella infection in pregnancy could not be analyzed in this study.Conclusion. Median (range) of subject’s age at diagnosis was 5.5 (0.5-180) months, and mostly were diagnosed in the first year of age (80.9%). Most of the subjects were female (57.4%), were malnourished (51.5%) with 7.4% were severe malnourished, and were from middle to low income family (76.5%). Maternal risk factor that was significantly associated with CHD was low maternal education."

"Sekitar 1% anak terlahir dengan penyakit jantung bawaan (PJB). Sebagian akan memerlukan kateterisasi jantung baik diagnosis maupun terapeutik. Prosedur ini memerlukan kooperasi pasien dan imobilisasi sehingga dibutuhkan anestesia yang mungkin berulang. Penelitian ini bertujuan melihat efek anestesia umum terhadap fungsi kontraktilitas jantung anak dengan PJB. Kontraktilitas jantung dilihat dari fraksi ejeksi dan TAPSE yang diukur dengan ekokardiografi. Pengukuran dilakukan sebelum anestesia umum, 5 menit pascaintubasi dan akhir tindakan kateterisasi. Metode penelitian kohort observasional dengan consecutive sampling telah dilakukan. Analisis dilakukan terhadap 42 anak berusia 6 bulan hingga 18 tahun dengan PJB yang menjalani kateterisasi jantung dalam anestesia umum pada periode Juni – Agustus 2018. Uji T-test berpasangan dilakukan untuk analisis perubahan fraksi ejeksi dan TAPSE dan analisis multivariat untuk melihat pengaruh usia, jenis PJB, lama dan jenis tindakan kardiologi terhadap perubahan kontraksi. Perubahan fraksi ejeksi turun bermakna pada 5 menit pascaintubasi dan akhir tindakan kardiologi dan TAPSE turun bermakna hanya pada 5 menit pascaintubasi. Pengaruh usia, jenis PJB, lama dan jenis tindakan kardiologi tidak bermakna terhadap perubahan fraksi ejeksi dan TAPSE. Dengan demikian diharapkan kewaspadaan dalam penanganan pasien PJB, termasuk ketika memberikan informasi sebelum persetujuan tindakan medis (informed consent), dan jika memungkinkan menghindari tindakan anestesia umum yang berulang.

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Approximately 1% of children borned with congenital heart disease (CHD). Some will require cardiac catheterization which repeated anesthesia may be needed. This study aims to see the effect of general anesthesia on the cardiac contractility in children with CHD. Cardiac contractility seen from ejection fraction and TAPSE as measured by echocardiography. Measurements were taken before general anesthesia, 5 minutes post-intubation and at the end of the catheterization. An observational cohort with consecutive sampling was conducted. Analysis was carried out on 42 children aged 6 months to 18 years with CHD who underwent cardiac catheterization under general anesthesia in the period June - August 2018. Paired T-test was performed to analyze changes in ejection fraction and TAPSE and multivariate analysis to analyze the effect of age, type of CHD, duration and type of cardiology intervention. Ejection fraction decreased significantly at 5 minutes post-intubation and at the end of cardiology intervention and TAPSE decreased significantly only at 5 minutes post-intubation. Changes of contratility was not significant affected by age, type of CHD, duration and type of cardiology intervention. Therefore, alertness in handling patients with CHD is expected, including when providing information prior to informed consent, and if possible avoid repeated general anesthesia."