ObjectiveTo identify aetiologies of childhood community-acquired pneumonia (CAP) based on a comprehensive diagnostic approach.Design‘Partnerships for Enhanced Engagement in Research-Pneumonia in Paediatrics (PEER-PePPeS)’ study was an observational prospective cohort study conducted from July 2017 to September 2019.SettingGovernment referral teaching hospitals and satellite sites in three cities in Indonesia: Semarang, Yogyakarta and Tangerang.ParticipantsHospitalised children aged 2–59 months who met the criteria for pneumonia were eligible. Children were excluded if they had been hospitalised for >24 hours; had malignancy or history of malignancy; a history of long-term (>2 months) steroid therapy, or conditions that might interfere with compliance with study procedures.Main outcome(s) measure(s)Causative bacterial, viral or mixed pathogen(s) for pneumonia were determined using microbiological, molecular and serological tests from routinely collected specimens (blood, sputum and nasopharyngeal swabs). We applied a previously published algorithm (PEER-PePPeS rules) to determine the causative pathogen(s).Results188 subjects were enrolled. Based on our algorithm, 48 (25.5%) had a bacterial infection, 31 (16.5%) had a viral infection, 76 (40.4%) had mixed bacterial and viral infections, and 33 (17.6%) were unable to be classified. The five most common causative pathogens identified were Haemophilus influenzae non-type B (N=73, 38.8%), respiratory syncytial virus (RSV) (N=51, 27.1%), Klebsiella pneumoniae (N=43, 22.9%), Streptococcus pneumoniae (N=29, 15.4%) and Influenza virus (N=25, 13.3%). RSV and influenza virus diagnoses were highly associated with Indonesia’s rainy season (November–March). The PCR assays on induced sputum (IS) specimens captured most of the pathogens identified in this study.ConclusionsOur study found that H. influenzae non-type B and RSV were the most frequently identified pathogens causing hospitalised CAP among Indonesian children aged 2–59 months old. Our study also highlights the importance of PCR for diagnosis and by extension, appropriate use of antimicrobials.Trail registration numberNCT03366454

Latar belakang Kejadian kasus COVID-19 pada bayi belum banyak dilaporkan dan mekanisme penularan terhadap bayi baru lahir masih belum jelas. Tujuan Melaporkan perbedaan karakteristik bayi baru lahir dari ibu terkait COVID-19 di RSUP Dr. Kariadi Semarang Metode Penelitian retrospektif dengan data sekunder catatan medik bayi baru lahir dari ibu terkait COVID-19 di RSUP dr Kariadi Semarang pada periode April-Mei 2020 dengan kelompok pembanding bayi baru lahir dari ibu tidak terkait COVID-19. Kriteria inklusi semua bayi lahir dari ibu terkait COVID-19 dirawat di rumah sakit dan dilakukan pemeriksaan PCR dengan spesimen swab nasofaring. Data yang dikumpulkan adalah usia kehamilan, jenis kelamin, berat lahir, cara persalinan, usia ibu dan jenis minum yang diberikan pada bayi. Dilakukan uji beda menggunakan uji chi square dan shapiro wilk. Analisis data menggunakan program komputer SPSS. Hasil Dari 46 sampel penelitian terdiri dari 23 bayi lahir dari ibu terkait COVID-19 dan 23 bayi lahir dari ibu tidak terkait COVID-19 dilakukan analisis dengan hasil tidak terdapat perbedaan bermakna dari usia kehamilan, berat lahir, cara persalinan dan usia ibu. Pada kelompok bayi lahir terkait COVID-19 mayoritas lahir dengan jenis kelamin perempuan (74%) dan jenis minum yang diberikan sekitar 86% dengan susu formula. Tidak ada bayi yang mendapat ASI eksklusif pada bayi yang lahir dari ibu terkait COVID-19. Semua bayi yang lahir dari ibu terkait COVID-19 didapatkan hasil swab nasofaring negatif dan tidak menunjukkan gejala apapun sampai dengan pulang. Simpulan Tidak didapatkan perbedaan karakteristik usia kehamilan, berat lahir, cara persalinan dan usia ibu. Terdapat perbedaan karakteristik jenis kelamin dan jenis minum yang diberikan pada kedua kelompok penelitian. Keyword: bayi baru lahir, COVID-19   Background The incidence of COVID-19 cases in newborn has not been widely reported and the mechanism of transmission to the newborn is unclear. Objective To report the characteristics of newborns from mothers related to COVID-19 at Kariadi Hospital Semarang. Method Retrospective study with secondary data on medical records of newborns from mothers related to COVID-19 at Kariadi Hospital in the April-May 2020 period with a comparison group of newborns from mothers not related to COVID-19. Criteria for inclusion of all infants born to mothers associated with COVID-19 were hospitalized and PCR examination carried out with nasopharyngeal swab specimens. Data collected were gestational age, sex, birth weight, mode of delivery, maternal age and type of dietary given to the baby. Analysis tests were performed using chi square test and Shapiro Wilk. Data analysis using SPSS computer programs Result Of the 46 study samples consisting of 23 babies born to mothers related to COVID-19 and 23 babies born to mothers not related to COVID-19 were analyzed with the results that there were no significant differences in gestational age, birth weight, mode of delivery and maternal age. In the group of babies born with COVID-19 the majority were born with a female sex (74%) and the type of dietary given was around 86% with formula milk. No baby gets exclusive breastfeeding for babies born to mothers related to COVID-19. All babies born to mothers related to COVID-19 obtained negative nasopharyngeal swab results and did not show any symptoms until discharge. Conclusion There were no differences in the characteristics of gestational age, birth weight, mode of delivery and maternal age. There were differences in the characteristics of the sexes and types of dietary given in the two study groups. Keyword: newborn, COVID-19

BackgroundDiscrimination of bacterial and viral etiologies of childhood community-acquired pneumonia (CAP) is often challenging. Unnecessary antibiotic administration exposes patients to undue risks and may engender antimicrobial resistance. This study aimed to develop a prediction model using epidemiological, clinical and laboratory data to differentiate between bacterial and viral CAP.MethodsData from 155 children with confirmed bacterial or mixed bacterial and viral infection (N = 124) and viral infection (N = 31) were derived from a comprehensive assessment of causative pathogens [Partnerships for Enhanced Engagement in Research-Pneumonia in Pediatrics (PEER-PePPeS)] conducted in Indonesia. Epidemiologic, clinical and biomarker profiles (hematology and inflammatory markers) were compared between groups. The area under the receiver operating characteristic curve (AUROC) for varying biomarker levels was used to characterize performance and determine cut-off values for discrimination of bacterial and mixed CAP versus viral CAP. Diagnostic predictors of bacterial and mixed CAP were assessed by multivariate logistic regression.ResultsDiarrhea was more frequently reported in bacterial and mixed CAP, while viral infections more frequently occurred during Indonesia’s rainy season. White blood cell counts (WBC), absolute neutrophil counts (ANC), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT) were significantly higher in bacterial and mixed cases. After adjusting for covariates, the following were the most important predictors of bacterial or mixed CAP: rainy season (aOR 0.26; 95% CI 0.08–0.90; p = 0.033), CRP ≥5.70 mg/L (aOR 4.71; 95% CI 1.18–18.74; p = 0.028), and presence of fever (aOR 5.26; 95% CI 1.07–25.91; p = 0.041). The model assessed had a low R-squared (Nagelkerke R2 = 0.490) but good calibration (p = 0.610 for Hosmer Lemeshow test). The combination of CRP and fever had moderate predictive value with sensitivity and specificity of 62.28 and 65.52%, respectively.ConclusionCombining clinical and laboratory profiles is potentially valuable for discriminating bacterial and mixed from viral pediatric CAP and may guide antibiotic use. Further studies with a larger sample size should be performed to validate this model.