Latar belakang. Duktus arteriosus persisten (DAP) pada bayi kurang bulan (BKB) dapat menimbulkan gangguan hemodinamika sehingga perlu segera ditutup. Salah satu cara penutupan adalah dengan obat penghambat siklooksigenase (COX), khususnya ibuprofen. Mengingat efek samping yang ditimbulkan ibuprofen, parasetamol yang bekerja menghambat peroksidase mulai diperkenalkan sebagai alternatif dengan efektifitas setara dan efek samping yang minimal. Tujuan. Membandingkan efektifitas dan keamanan antara parasetamol intravena dan ibuprofen oral untuk penutupan DAP pada BKB. Metode. Uji klinis terbuka, acak terkontrol pada bayi dengan usia gestasi ≤37 minggu yang dikonfirmasi DAP dengan menggunakan ekokardiografi. Dilakukan randomisasi blok untuk menerima parasetamol intravena atau ibuprofen oral. Hasil utama yang dinilai adalah respon terapi penutupan duktus arteriosus (DA), efek samping yang timbul, dan kejadian reopening. Hasil. Penutupan DAP terjadi pada 33 dari 36 (91,6%) BKB yang mendapat parasetamol intravena dan 29 dari 40 (72,5%) yang mendapat ibuprofen oral (p=0,03). Pada kelompok ibuprofen, efek samping yang timbul berupa trombositopenia (28,5%) dan perdarahan saluran cerna (25,7%), sedangkan pada kelompok parasetamol intravena tidak dijumpai efek samping. Reopening terjadi hanya pada satu bayi di kelompok ibuprofen oral. Kesimpulan. Parasetamol intravena lebih efektif dan lebih aman dibandingkan ibuprofen oral untuk penutupan DAP pada BKB. Sari Pediatri 2015;17(4):279-84. Kata kunci: duktus arteriosus persisten, bayi kurang bulan, parasetamol intravena, ibuprofen oral The Comparison of Effectiveness and Safety between Intravenous Paracetamol and Oral Ibuprofen for Persistent Ductus Arteriosus in Preterm InfantsOktaviliana Sari,* Ria Nova,* Herman Bermawi,* Erial Bahar** Background. Persistent ductus arteriosus (PDA) in preterm infants can cause hemodynamic disturbances, that it must be closed immediately. PDA can be closed using cyclooxygenase inhibitor agents (COX), mainly ibuprofen. Because the side effects, intravenous paracetamol, a peroxidase inhibitor was recently introduced as an alternative terapy for ductal closure with similar effectiveness and minimal side effects. Objectives. To compare the effectiveness and safety of intravenous paracetamol and oral ibuprofen for PDA closure in preterm infants.Methods. An open label randomized controlled study was done in seventy six preterm infants (gestational age ≤37 weeks) with echocardiographically confirmed PDA. Infant were randomly assigned to received either intravenous paracetamol or oral ibuprofen. The main outcome was the success of ductal closure and secondary outcomes were adverse effects and reopening. Results. PDA closure was achieved in 33 of 36 (91.6%) infants receiving intravenous paracetamol and in 29 of 40 (72.5%) infants receiving oral ibuprofen (p=0.03). In the ibuprofen group, thrombocytopenia and gastrointestinal bleeding were found in 28.5% and 25.7% infants respectively, while in the paracetamol group, no adverse effect was observed. There ...

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 Heart failure affects morbidity and mortality in

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Background Rheumatic heart disease (RHD) causes premature deaths every year worldwide. Low socioeconomic level is considered to be a risk factor facilitating the transmission of airway infections due to Streptococcus pyogenes. Subclinical RHD is a stage of RHD in which heart valve abnormalities have occurred according to the WHO or WHF classification but without any complaints to the subject. Echocardiography is used to screen subclinical RHD in several countries. Objective To estimate the prevalence, risk factors, and echocardiographic features of subclinical RHD in children. Methods This cross-sectional study was conducted on 250 elementary school children in Palembang, South Sumatera. We interviewed subject's parents about family characteristics, environment, and history of recurrent sore throat. Subjects underwent anthropometric examination, auscultation, and echocardiography. Diagnosis of RHD was based on World Health Organization (WHO) and World Heart Federation (WHF) criteria. Results Of 250 subjects, 132 (53.8%) were girls. Subjects’ age range was 5-14 years. The prevalence of subclinical RHD was 8% (95%CI 4.8 to 11.6). Of the 20 subclinical RHD subjects, 15 (75%) met the possible RHD criteria, 5 (25%) met the probable RHD criteria, and none met the definite RHD criteria. Multivariate analysis showed that household crowding (OR 8.135; 95%CI 1.048 TO 63.143; P=0.045), history of recurrent sore throat within the previous 6 months (OR 6,476; 95%CI 1.79 to 23.427; P=0.004) and age > 10 years (OR 3.167, 95%CI 1.184 to 8.471; P=0.022) significantly increased the risk of subclinical RHD. Conclusion The prevalence of subclinical RHD in elementary school children in Palembang was 8%. For echocardiographic features, most cases met the WHO/WHF possible RHD criteria. Factors significantly associated with the incidence of subclinical RHD are age > 10 years, household crowding, and history of recurrent sore throat in the previous 6 months.