Background Delayed diagnosis of congenital heart disease (CHD) causes significant morbidity and mortality. We aimed to determine the proportion of delayed diagnosis of CHD and factors related to the delayed diagnosis. Methods A prospective cohort study with mixed-methods was conducted in Dr. Sardjito Hospital, Yogyakarta, Indonesia. Patients aged < 18 years with newly diagnosed CHD and echocardiography confirmed CHD were included. Data were recorded from medical records and interviews from direct caregivers. Logistic regression was used to identify independent factors associated with the delay. Results A total of 838 patients were included with median age of 2.9 years (0–17.7 years), with female predominance (54.2%, n = 454). The proportions of delayed diagnosis were 60.8% (510), 54.9% (373) and 86.2% (137) in all children with CHD, acyanotic and cyanotic CHD, respectively. Delayed diagnosis by doctor was the most common cause, followed by delayed diagnosis related to midwifery care, financial, referral/follow-up, and social factors. In multivariate analysis, cyanotic CHD, residence outside the city, non-syndromic, low family income, normal labour and at term gestation at birth were independently associated with the delay. At diagnosis, heart failure and pulmonary hypertension occurred in 414 (49.4%) and 132 (15.8%) children with CHD, respectively. Conclusions Six in ten children with CHD were diagnosed with significant delay. Delayed diagnosis by doctor was the most common cause. Children with cyanotic CHD, residence outside the city, non-syndromic, low family income, normal labour and at term gestation at birth were independently associated with the delay. Comorbid complications in delayed diagnosis of CHD were prevalent.

Background:The alternative device to close perimembranous ventricular septal defect (pmVSD) has been searched for better result, less complications and applicable for infants. However, the ideal device is still unavailable. We aimed to evaluate the effectiveness and outcome of transcatheter pmVSD closure using the KONAR-multi functional occluder (MFO).Methods: Clinical, procedural, follow-up data of pmVSD patients with symptom of heart failure or evidence of significant left to right shunt, growth failure, recurrent respiratory tract infection, and history of endocarditis who underwent transcatheter closure using the MFO were prospectively evaluated. Results:Between January 2016 and December 2017, there were complete records of 132 pmVSD children closed using MFO from eleven centers in Indonesia. The median of age was 4.5 (0.3-17.4) years; weight 14.8 (3.5-57) kg, defect size at the smallest part 3.4 (1.0-8.1) mm, flow ratio 1.6 (1.3-4.9), mean pulmonary artery pressure 18 (7-79) mmHg, fluoroscopy time 18 (3.8-91) and procedural time 75 (26-290) minutes. A retrograde approach was done in 41 (31%) patients. Procedures succeeded in first 2 Kuswiyanto et al.

Background Congenital heart disease (CHD) is associated with high morbidity and mortality, especially among those with undernutrition. Evaluating risk factors associated with undernutrition is important to improve clinical outcomes. We aimed to evaluate the outcome and factors associated with undernutrition among children with CHD. Material and methods A prospective cohort study was conducted among children with CHD at Dr. Sardjito Hospital, Yogyakarta, Indonesia during February 2016 to June 2018. Clinical and demographic data were collected at the time of diagnosis. Multivariate logistic regression analysis was used to identify independent factors associated with undernutrition using odds ratio (OR) and 95% confidence interval (CI). Significance was set as p<0.05. Results We recruited 1,149 children with CHD, of those, 563 (49%) were underweight, 549 (47.8%) were stunting, and 361 (31.4%) were wasting. In the multivariate analysis, cyanotic CHD, delayed diagnosis, congestive heart failure, pulmonary hypertension, syndrome, young maternal age, history of low birth weight, and being first child were independently associated with undernutrition. Underweight and stunting were significantly associated with increased mortality with OR of 3.54 (95% CI: 1.62–7.74), p<0.001 and OR 3.31 (95% CI: 1.65–6.64), p<0.001, respectively. Conclusions About half of the children with CHD were categorized with undernutrition. An increased risk of undernutrition was associated with cyanotic CHD, delayed diagnosis, congestive heart failure, pulmonary hypertension, syndrome, low birth weight, and being first child. Underweight and stunting were significantly associated with increased risk of death.

Asthma is a major health problem affecting millions of children worldwide. The prevalence of asthma in children tends to increase annually in the world. Therefore, identification of the prognostic factors for episodic asthma is important to perform early prevention of asthma attacks in children. The study was performed to identify the prognostic factors for frequent episodic asthma in children. This was a retrospective cohort study involving asthmatic children who attended the Emergency Unit or Outpatient Clinic of the Department of Pediatrics, Dr. Sardjito General Hospital, Yogyakarta. The inclusion criteria were asthmatic children aged over 7 years, suffering from asthma over 2 years and getting agreement from their parents as expressed by signed an informed consent. The exclusion criteria were children with other chronic obtructive pulmonary diseases beside asthma and children with cardiovascular diseases. Subjects were grouped into two groups i.e. Case Group and Control Group. The Case Group was children with frequent episodic asthma while the Control Group was children with infrequent episodic asthma. Prognostic factors for episodic asthma were then gathered by giving a questionnaire to their parents. Regression analysis was used to evaluate the relationship between prognostic factors and episodic asthma. A total of 94 subjects comprising 37 (36.4%) subjects with frequent episodic asthma and 57 (63.6%) subjects with infrequent episodic asthma were involved in the study. Furthermore, response to initial theraphy was significantly associated with frequent episodic asthma (RR= 8.64; 95%CI= 0.47-2.50; p=0.001). Whereas, nutritional status, patients age when asthma diagnosed, exclusive breastfeeding, maternal education, exposure of secondhand smoke and welfare were not (p>0.05). In conclusion, the initial therapy is prognostic factors for frequent episodic asthma in children. ABSTRAKAsma merupakan masalah kesehatan utama yang mempengaruhi jutaan anak di dunia. Prevalensi asma pada anak cenderung naik setiap tahun di dunia. Oleh karena itu identifikasi faktor prognostik terjadinya serangan asma penting untuk melakukan tindakan pencegahan dini terhadap serangan asma pada anak. Penelitian ini dilakukan untuk mengkaji faktor prognostik terjadinya asma pada anak. Penelitian ini merupakan penelitian kohort retrospektif yang melibatkan anak penderita asma yang berkunjung ke Unit Kedaruratan atau Klinik Rawat Jalan, Bagian Anak, RSUP Dr. Sardjito, Yogyakarta. Kriteria inklusi adalah anak penderita asma lebih dari 7 tahun, menderita asma lebih dari 2 tahun dan mendapatkan persetujuan dari orang tuanya dengan menandatangani surat pernyataan persetujuan. Kriteria eksklusi adalah anak pederita asma dengan gangguan paru obstruktif dan kardiovaskuler. Subjek dikelompokkan menjadi 2 kelompok yaitu Kelompok Kasus dan Kelompok Kontrol. Kelompok Kasus adalah anak yang sering mendapatkan serangan asma dan Kelompok Kontrol adalah anak yang jarang mendapatkan serangan asma. Faktor prognosis diperoleh melalui kuesioner terhad...