Background:Evaluating outcome and identifying predictors of major complications among children undergoing cardiac surgery are essential to improve care. We evaluated short-term outcomes of postcardiac surgery and predictors of major complications in a national referral hospital in Indonesia.Methods:A prospective cohort study was conducted from April 2014 to March 2015 on all children undergoing cardiac surgery. Participants were followed up from the time of surgery until hospital discharge and 30-day mortality. We performed univariate and multivariate logistic regression using STATA 12-1 to identify predictors of postsurgical major complications.Results:A total of 257 patients (median age: 36 months) were recruited; 217 (84.1%) had complications, including low cardiac output syndrome (19.8%), arrhythmia (18.6%), sepsis (17.4%), and pleural effusion (14.8%). Forty-nine (19%) patients had major complications, including cardiac arrest (5%), need for emergency chest opening (3.9%), and multiple organ failure (7.4%). 12.8% died during hospital stay, and 30-day mortality was 13.6%. Predictors of major complications were cyanotic congenital heart disease (odds ratio [OR]: 4.6, 95% confidence interval [CI]: 1.5–14.2), longer duration of cardiopulmonary bypass (CPB, OR: 4.4, 95% CI: 1.5–13.4), high inotropes (OR: 13.1, 95% CI: 3.2–54.2), and increase in lactate >0.75 mmol/L/h or more in the first 24 h (OR: 37.1, 95% CI: 10.1–136.3).Conclusion:One-fifth of children undergoing cardiac surgery experienced major complications with around 13% mortality. Cyanotic congenital heart disease, longer duration of CPB, high inotropes on leaving operating theater, and increase in blood lactate are associated with major complications in children after cardiac surgery.

The concomitant measurements in cardiac index changes after the passive leg raising maneuver can be helpful in predicting who might have an increase in cardiac index with subsequent fluid resuscitation.

Background The incidence of COVID-19 is still rapidly increasing, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aims to describe the characteristics of pediatric COVID-19 cases with fatal outcomes in Indonesia's tertiary referral hospital. Methods This is a cross-sectional study with data collected from the medical records of COVID-19 patients 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, of which 20 (40%) patients with positive tests for SARS-CoV-2 had a fatal outcome. The fatality was higher in patients ≥10 years old, categorized with severe disease upon admission, with PaO 2 /FiO 2 ratios of ≤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 COVID-19 cases. One patient met the criteria of multisystem inflammatory syndrome in children (MIS-C). Conclusion Our work highlights the high mortality rate in pediatric patients positive for the COVID-19 test. Further studies are needed to understand better the role of SARS-CoV-2 in elaborating the mechanisms leading to death in children with comorbidities.