The incidence of coronavirus disease 2019 (COVID-19) is still increasing rapidly, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aimed to describe the characteristics of children with COVID-19 with fatal outcomes in a tertiary referral hospital in Indonesia. This cross-sectional study used data collected from the medical records of patients with COVID-19 admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from March to October 2020. 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, and 20 (40%) had a fatal outcome. The fatality rate was higher in patients aged ≥10 years, categorized with severe disease upon admission, PaO₂/FiO₂ ratio ≤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 cases. One patient met the criteria of multisystem inflammatory syndrome in children. Our work highlights the high mortality rate in paediatric patients with positive SARS-CoV-2 polymerase chain reaction test. These findings might be related to or co-incided with COVID-19 infection. Further studies are needed to improve understanding of the role of severe acute respiratory syndrome coronavirus-2 in elaborating the mechanisms leading to death in children with comorbidities.

BACKGROUND The pediatric peritoneal dialysis (PD) program in Cipto Mangunkusumo Hospital, Indonesia was started in 2014. However, there has been no published data on the patients’ outcome. This study was aimed to report the characteristics and outcomes of a continuous ambulatory peritoneal dialysis (CAPD) program for children. METHODS This retrospective study was conducted in Cipto Mangunkusumo Hospital as a national referral hospital. Data were collected from medical records of patients aged ≤18 years with end-stage renal disease who underwent CAPD in 2014–2019. The baseline characteristics, PD-related infection rate, as well as patient and technique survivals were analyzed. RESULTS Out of 60 patients who underwent CAPD, 36 (60%) were boys on the age range of 4 months–18 years. The mean follow-up duration was 12 (95% confidence interval [CI] = 9.4–15.3) months. The number of PD related infections increased along with the growing number of patients on CAPD. The peritonitis rate was 0.42 episodes per year at risk, and the most common etiology was alpha-hemolytic Streptococcus (5/24, [20.8%]). The 1- and 3-year technique survival rates were 60.3% (95% CI = 44.5–72.9) and 43.9% (95% CI = 23.2–62.9). The 1- and 3-year patient survival rates were 69.6% (95% CI = 52.5–81.5) and 58% (95% CI = 31.2–77.5). CONCLUSIONS In this unit, CAPD could be performed in children as young as 4 months of age. The peritonitis rate was relatively low which was likely caused by skin-derived microorganisms. Both technique survival and patient survival were also relatively low.

Objectives. To identify parameters that can improve the effectiveness of COVID-19 screening in the pediatric population according to the demographic, clinical, and epidemiological characteristics of pediatric patients screened for COVID-19 at our hospital. Methods. A cross-sectional study of suspected and confirmed pediatric patients (0–18 years old) with COVID-19 using data from the electronic medical records of Dr. Cipto Mangunkusumo Central Hospital from March to December 2020. Results. From 1,018 data of suspected COVID-19 pediatric patients, there were 94 (9.2%) confirmed cases of COVID-19. The proportions of children with travel history ( ), positive contact history ( ), fever ≥38°C ( ), cough ( ), and abdominal pain ( ) were significantly higher in the confirmed COVID-19 group compared to the non-COVID-19 group. Conclusions. A majority of the confirmed COVID-19 pediatric patients have travel and positive contact history, along with symptoms of fever, cough, and abdominal pain. However, these are nonspecific symptoms that may also be misdiagnosed as other diseases. Improving access and turnaround time of the RT-PCR test is mandatory, as no specific screening variables have been identified.

Wasp stings occur frequently in developing countries and often lead to fatal outcomes due to the effects of wasp venom. Hemolysis and rhabdomyolysis often complicate wasp stings and result in acute kidney injury (AKI). We report a case of multiple wasp stings leading to AKI and multiple organ dysfunction syndrome (MODS) in a 9-year-old Indonesian girl. Kidney biopsy revealed acute tubular necrosis and acute interstitial nephritis. Despite delayed admission, she recovered in 33 days after 3 days of intravenous steroid administration, eight sessions of intermittent hemodialysis, and two sessions of plasma exchange (PE). Complete recovery of kidney function, indicated by normal diuresis, normal estimated glomerular filtration rate, and negative albuminuria, was reached within 12 weeks. This case showed that immediate admission following multiple wasp stings (particularly >10 stings) to initiate early dialysis is important to promptly remove toxins and preserve kidney function. The case also showed that PE can be beneficial in cases of hemolysis and rhabdomyolysis complicated by MODS.

Background: Very preterm birth rate was 10.8% of all preterm in Asia. Early aggressive nutritional strategies in very preterm neonates is important for catching up growth; however, preterm kidneys have fewer, immature functional nephrons. Studies have showed that high protein intake induces nephron hypertrophy, proteinuria, and glomerular sclerosis through single nephron glomerular hyperfiltration (SNGHF), which leads to glomerulotubular injury. Aim: to analyse the correlation between protein intake and glomerulotubular injury in very preterm neonates. Method: A prospective cohort study was conducted in neonatal units of two hospitals in Jakarta. Urine samples were taken three times at post-natal ages 0-48 hours (T1), 72 hours (T2), and 21 days (T3) for determining the urinary neutrophil gelatinase-associated lipocalin to creatinine (uNGAL/Cr) ratio. Protein intake were given in accordance with local guideline while considering the clinical condition of participants. Protein levels from formula milk were recorded daily from 14-21 days of age, while breastmilk protein was measured twice by using a human milk analyser. Urinary NGAL (uNGAL) was tested with an ELISA. Glomerulotubular injury was defined as a uNGAL/Cr ratio ≥1 SD (22.74 ng/mg) at post-natal age 21 days. High protein intake was defined as average protein intake ≥ 3 g/kg/day. Results: Fifty-nine very preterm neonates were recruited, of which 39 completed the study. Glomerulotubular injury was found in 9 of 39 participants (23%). The proportion of glomerulotubular injury in very preterm neonates who had received high protein intake vs low protein intake was 5 of 29 vs 4 of 10 participants, respectively. The median of uNGAL/Cr ratio was not significantly different in the high vs low protein intake group (3.54 (range: 0.69-89.16) ng/mg vs (6.88 (range: 0.32-66.64)) ng/mg, respectively. The uNGAL/C ratio was not correlated with protein intake. However, it was inversely correlated with gestational age and birth weight. Conclusions: The proportion of glomerulotubular injury in very preterm neonates given high protein diet was 5 of 29. The uNGAL/Cr ratio was increased at the post-natal age of 72 hours and decreased in 21 days in both high and low protein intake groups. High protein intake was not correlated with glomerulotubular injury.