No abstract

Background: The ingenuity to predict the progression to severe dengue is crucial in managing dengue patients. The previous meta-analysis has been performed on adults, and none has been performed specifically on children. We conducted a systematic review and meta-analysis to determine the clinical manifestations and laboratory parameters associated with the progression to severe dengue according to WHO criteria. Methods: We focused on searching six medical databases for studies published from Jan 1, 2000, to Dec 31, 2020. The meta-analysis used random-effects or fixed-effects models to estimate pooled effect sizes. We also assessed the heterogeneity and publication bias. This study was registered with PROSPERO, CRD42021224439. Results: We included 49 of papers in the systematic review, and we encased the final selected 39 papers comprising 23 potential predictors in the meta-analyses. Among 23 factors studied, seven clinical manifestations demonstrated association with disease progression in children, including neurological signs, gastrointestinal bleeding, clinical fluid accumulation, hepatomegaly, vomiting, abdominal pain, and petechiae. Six laboratory parameters are associated during the early days of illness, including elevated hematocrit, elevated aspartate aminotransferase [AST], elevated alanine aminotransferase [ALT], low platelet count, low albumin levels, and elevated activated partial thromboplastin time. Dengue virus serotype 2 (DENV-2) and secondary infections were also associated with severe disease progression. Conclusion: This finding supports the use of the warning signs described in the WHO 2009 guidelines. In addition, monitoring serum albumin, AST/ALT levels, identifying infecting dengue serotypes, and immunological status could improve the risk prediction of disease progression. Keywords: children, dengue, risk prediction, severity, warning sign.

Background The main parameter used to determine renal function in newborns is serum creatinine. Fetal growth restriction during pregnancy can cause the baby to be born small-for-gestational age. Serum creatinine levels in newborns are affected by muscle mass, gestational age, as well as the number of nephrons and kidney development. Objective To determine the usefulness of serum creatinine levels as an estimate of glomerular filtration rate in small-for-gestational age and appropriate-for-gestational age newborns. Methods This cross-sectional study was conducted in May-June 2018. The subjects were full term newborn infants consisting of small-for-gestational age and appropriate-for-gestational age groups (16 subjects each), born in Bandung City Regional Public Hospital. Serum creatinine level was tested by the Jaffe method. The estimated glomerular filtration rate was calculated based on serum creatinine, infant height, and a proportionality constant using the original Schwartz method, eGFR = [k * height]/SCr. Results Of 32 subjects, there were 17 spontaneous deliveries, 14 males, and 18 females. Mean serum creatinine levels in the small-for-gestational age and appropriate-for-gestational age groups were 0.94 (SD 0.36; 95%CI 0.75 to 1.14) mg/dL and 0.69 (SD 0.18; 95%CI 0.60 to 0.79) mg/dL (mean difference 0.25; 95%CI 0.05 to 0.46; P=0.009), respectively. The median estimated glomerular filtration rates (eGFR) in the small-for-gestational age and appropriate-for-gestational age groups were 25.69 mL/min/1.73m2 and 30.10 mL/min/1.73m2 (median difference 4.42; 95%CI 2.04 to 15.8; P=0.008), respectively. There was a weak negative correlation between serum creatinine and birth weight (r=–0.344; P=0.027). Conclusion Serum creatinine levels in small-for-gestational age newborns are significantly higher than in appropriate-for-gestational age newborns.