Kelahiran bayi kurang bulan menjadi penyebab morbiditas dan mortalitas perinatal. Bayi yang lahir bayi kurang bulan memiliki risiko kematian yang lebih tinggi, risiko penyakit, dan masalah pertumbuhan lainnya dibandingkan dengan bayi normal. Penelitian ini bertujuan untuk mengetahui faktor yang terkait dengan kelahiran bayi kurang bulan. Jenis penelitian adalah observasional dengan rancangan potong lintang retrospectif. Populasi adalah seluruh ibu yang melahirkan di RSUP Sanglah Denpasar bulan Agustus-Oktober 2015 dan tercatat pada rekam medik rumah sakit. Dua ratus tiga puluh satu bayi lahir di RSUP Sanglah memenuhi kriteria penelitian, masing-masing tujuh puluh satu bayi kurang bulan dan seratus enam puluh bayi cukup bulan. Analisis data dilakukan secara univariat dan bivariat dengan menggunakan uji statistik dengan tingkat kemaknaan P < 0,05. Dari analisis multivariat didapatkan bahwa usia ibu [RP 6,7 (IK 95% 2,89 sampai 15,75), P=0,001], ketuban pecah dini [RP 10,8 (IK 95% 3,88 sampai 30,03), P=0,001],kehamilan bayi ganda [RO 14,8 (IK 95% 4,94 sampai 44,18), P=0,001], anemia [RP 5,5 (IK 95% 1,34 sampai 22,72), P=0,018], preeklamsia/eklamsia [RP 5,2 (IK 95% 1,58 sampai 17,23), P=0,007] dan infeksi saluran kemih [RP 9,8 (IK 95% 2,94 sampai 32,85), P=0,001]. sebagai faktor yang terkait dengan kelahiran bayi kurang bulan. Dari penelitian ini dapat disimpulkan usia ibu, ketuban pecah dini, kehamilan bayi ganda, anemia selama kehamilan, preeklamsia/eklamsia dan infeksi saluran kemih merupakan faktor yang terkait dengan kejadian kelahiran bayi kurang bulan.

Growth failure is a common feature of children with HIV-1 infection. Clinical efficacy of highly active antiretroviral therapy (HAART) in children has been well documented in developed countries, but only few data from developing countries. Highly active antiretroviral therapy shows improvement clinical outcome, immune status, growth parameters in HIV infected children, therefore, decrease  morbidity, death and improve quality of life children infected with HIV. The objective of this study was to determine nutritional status improvement of child with HIV-1 infection in 12 months HAART in Sanglah Hospital Denpasar. A retrospective cohort study was conducted at Allergy-Immunology Division/ Department of Child Health, Udayana University Medical School/Sanglah Hospital Denpasar in July 2013. The growth differences before and after HAART was analyzed by paired t-test using SPSS program. A total of 31 children were analyzed. Generally, rerata parameters of nutritional status were increased at any period of measurement. Changes of nutritional status is seen by comparing the nutritional status parameters within a period of 3 months up to 12 months of observation. There were increasing in the mean of weight/age (W/A) from baseline (-2.30) to 12 weeks (-1.61) (mean difference 0.69; 95% CI 0.37 to 1.00; P<0.001), from 12 weeks (-1.61) to 24 weeks (-1.34) (mean difference 0.27; 95% CI 0.09 to 0.45; P=0.003), from 24 weeks (-1.34) to 36 weeks (-1.09) (mean difference 0.25; 95% CI 0.05 to 0.45; P=0.016) and from 36 weeks (-1.09) to 48 weeks (-1.02) (mean difference 0.07; 95% CI -0.07 to 0.20; P=0.351). The mean of height/age (H/A) were also increasing from baseline (-2.85) to 12 weeks (-2.60) (mean difference 0.25; 95% CI 0.01 to 0.50; P=0.049), from 12 weeks (-2.60) to 24 weeks (-2.22) (mean difference 0.38; 95% CI 0.01 to 0.76; P=0.047), from 24 weeks (-2.22) to 36 weeks (-1.76) (mean difference 0.46; 95% CI 0.15 to 0.77; P<0.001), but from 36 weeks (-1.76) to 48 weeks (-1.84) were decreasing (mean difference -0.08; 95% CI -0.31 to 0.14; P<0.001). It can be concluded that HAART has a positive effect on children's growth in 12 months of observation in the form of an increase in generally W/A and H/A from time to time.

Dengue shock syndrome (DSS) represents severe clinical manifestation of dengue virus infection. Morbidity and mortality still high because dengue virus infection is endemic in Indonesia. Despite its high morbidity and mortality there still no study describing the clinical manifestation and outcome of DSS in Sanglah hospital. Objective of this study was to describe clinical characteristics and outcome of pediatric patients with DSS at Sanglah hospital in 2014. This study was a retrospective study performed at Sanglah hospital. Subjects were pediatric patients with DSS that diagnosed and treated from January 2014 until December 2014. Total samples were 88 patients with DSS and 9 (10%) died. We found 13 patients (15%) that admitted to hospital without any sign of shock but then progress to DSS. Forty-one (47%) patients were assessed as compensated shock and 34 (39%) as decompensated shock. Dengue shock syndrome patients mostly had secondary dengue infection (96%). The prevalence of DSS at Sanglah hospital in 2014 is 88/279 (31,5%). Presentation of shock occurred mostly in fever day 4 and 5. Dengue shock syndrome more likely occurred in secondary dengue infection. The mortality rate was still high, 9/88 (10%).

Meningitis dapat terjadi pada bayi dengan klinis sepsis dengan prevalens hampir mencapai 50%. Prosedur pungsi lumbal untuk mendiagnosis meningitis pada bayi klinis sepsis masih kontroversi. Keterlambatan diagnosis menyebabkan ketidaktepatan tatalaksana yang berakibat pada meningkatnya morbiditas, mortalitas dan gejala sisa neurologis. Tujuan penelitian ini adalah untuk mengetahui prevalens dan faktor-faktor yang mempengaruhi meningitis neonatal pada bayi dengan klinis sepsis. Penelitian ini merupakan penelitian potong lintang dengan rancangan diskriptif analitik, dilakukan di ruang NICU RSUP Sanglah Denpasar sejak bulan Juli 2015-Juni 2016. Semua bayi usia 0-28 hari yang menderita sepsis secara klinis dilakukan prosedur pungsi lumbal untuk mengetahui adanya meningitis. Analisis bivariat dengan uji Fisher Exact dan analisis multivariat dengan regresi logistik dilakukan untuk mengetahui faktor-faktor yang berhubungan dengan meningitis. Nilai P <0,05 adalah signifikan secara statistik. Kami mendapatkan prevalens meningitis neonatal pada klinis sepsis adalah 68,8%. Laki-laki (68,2%), bayi kurang bulan (<37 minggu) (90,9%), berat lahir <2500 gram (86,4%), dan bayi dengan penyakit penyerta pneumonia neonatal (72,7%) lebih banyak mengalami meningitis. Bayi kurang bulan (Exp(B)10, 95% CI 1,48-67,554, P=0,018) adalah faktor yang paling berpengaruh terhadap kejadian meningitis. Disimpulkan bahwa prevalensi meningitis neonatal pada bayi dengan klinis sepsis di ruang NICU RSUP Sanglah adalah 68,8% dengan faktor risiko adalah bayi kurang bulan. Pungsi lumbal dapat dipertimbangkan untuk rutin dilakukan pada bayi kurang bulan dengan klinis sepsis.

Langerhans cell histiocytosis (LCH) is a rare disease  of unknown etiology. It can occur at any age but is more frequent in the pediatric population at young age. Because of its infiltration nature, the disease varies widely in clinical manifestation from localized to a multisystem involvement. Owing to  the relative rarity of the condition and varies in clinical presentation, it remains a disease in which the diagnosis is often delayed or missed. Jaundice in LCH is a manifestation of liver disfunction. However, a case of cholestasis has been very rare described. We report an 18-months-old boy with LCH involving multiple systems whose present earlier as cholestasis and recurent fever. The patient was diagnosed following a clinical manifestation of LCH and skin biopsy that revealed Langerhans cells. The patient was in partial remission following chemotherapy  and died  at fourth months of chemotherapy. In conclusion, any patient presenting to pediatric clinic with jaundice must be rule out the possibility of liver involvement in LCH. Jaundice might be an earlier clinical manifestation of liver disease in LCH and can be a clue for diagnosis. Early diagnosis and proper management would contribute to a better outcome. 

Background and objectives

Increase of blood pressure during hemodialysis (HD) is associated with adverse outcomes, while cause of the increase in blood pressure during HD is still under debate.  It has been suggested that stimulation of RAAS by hypovolemia due to excessive ultrafiltration (UF) during HD is the main risk factor of IDH. We tested the hypothesis wether IDH is associated with measured UF volume during hemodialysis.

Methods

Forty eight stable patients who were on chronic HD were enrolled in a case-control cohort study. Thirty patients on maintenance HD without IDH (controls) and 18 with IDH (post HD systolic BP increase ≥10 mmHg than pre HD systolic BP on minimal four from six consecutive HD sessions). We have done a physical examination and past medical history review for all subjects. We also collected current monthly laboratory results. At each subsequent dialysis treatment from six consecutive HD sessions, we collect data of  ultrafiltrasion volume during HD, standardized BP measured (after 5 minutes of rest) were done by nurse pre-, during dialysis and postdialysis.

Results

We found 37.5% of subject had IDH. Between group we found predialytic systolic and diastolyc BP were similar, but average postdialysis systolic BP was higher on  IDH group. Mean of UF volume  is higher among IDH patients than controls (3.46±0.65Lvs 2.37±0.77L). Using logistic regression we found significant association between mean of UF volume and IDH (OR = 0.14 (95% CI 0.05-0.43 , p=0.001),   In IDH patients 88.9% had excessive UF (UF ≥ 3 L), but in control group only 13.3% had excesive UF. There was significant and strong correlation between excessive ultrafiltration and intradialytic hypertension (p=0.00), odds ratio 11.2  (95% CI : 2.8-43.3).

Conclusions  

Intradialytic hypertension is associated with excessive UF during hemodialysis.