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Correlation between nasal peak inspiratory flow (NIPF) and peak expiratory flow (PFE)
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Posters / Paediatric Respiratory Reviews 11S1 (2010) S79–S115
Conclusion: Atypical or prolonged respiratory symptoms should alert the physician, and clinical and radiological findings should be carefully evaluated for a possible foreign body aspiration. P96N Cardiac tamponade in tuberculous pericarditis: A case report N. Kaswandani, D.B. Setyanto, B. Supriyatno. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Pericarditis is an uncommon manifestation of TB. Pericarditis TB may cause pericardial effusion that leads to cardiac tamponade. Objective: To present the diagnosis and management cardiac tamponade in pericarditis TB. Case illustration: A 17 years-old boy came to Ciptomangunkusumo Hospital with the chief complaint of progressively worsen dyspnea since 3 days before admission. The patients also complained the occurrence of a nodule at the superior chest. The nodule was soft and firmed no tenderness and no redness. Since 2 weeks before admission he felt fever, productive cough and decreased appetite. History of TB contact was the neighbor with pulmonary TB. Physical examination found that he was severely ill with dyspnea, fever and pale. The chest examination found a fluctuative mass without inflammation. His heart sound was soft and diminished, but no gallop or murmur. Breath sound was weak at the right field. The chest radiography showed cardiomegaly and hyllar lymp node enlargement while the echocardiography showed massive pericardial effusion and collapse of the right atrium. The patients was diagnosed as cardiac tamponade et causa massive pericardial effusion/pericarditis TB, chest wall TB, anemia and undernourished. The patient was performed pericardiocentesis and anti TB drugs RHZE plus prednisone was given. Pericardial fluid analysis showed exudates with polimorphonuclear dominant and positive AFB. The patient was discharged in 3rd week in a good condition. Discussion: The diagnosis of cardiac tamponade pericarditis TB in this patient was supported by clinical findings, chest X-ray and echocardiography. Pericardiocentesis and pericardial drainage which was immediately performed improved the clinical condition of the patient. Anti TB treatment was given as WHO recommendation for AFB positive category. Conclusion: Percarditis TB can accumulate the massive fluid that leads to cardiac tamponade. An immediate pericardial drainage will improve the clinical condition of the patient. P97N Clinical features of respiratory diseases in children with HIV N. Kaswandani, D.B. Setyanto, N.N. Rahajoe. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Respiratory diseases are the most common opportunistic infection in HIV positive children. Diagnosis of certain disease such as tuberculosis is difficult in HIV-positive children due to the less specific symptoms and less sensitive tuberculin skin test. Objective: To define the prevalence of respiratory diseases and to know the clinical feature of respiratory diseases in children with HIV. Methods: Cross-sectional study carried out in Ciptomangunkusumo Hospital Jakarta. The subjects were all patients with HIV diagnosed January 2005-July 2009. Result: We investigated 186 HIV-infected children with the aged 31.5±2.64 months. Tuberculosis was the most frequent respiratory diseases (39.2%), followed by upper ARI (25.3%), pneumonia (17.2%) and otitis media (14.5%). Fifty-nine (31.7%) subjects has a good nutritional status, while 88 (47.3%) were moderate malnourished and 39 (21%) subjects were severe malnourished. Subjects were mostly (56%) in severe immunosupression status. Contacts with adult TB were found in 54 (29%) subjects. Most children (53.2%) complained of chronic recurrent cough. Chronic fever, difficulty in
weight gain and anorexia were occurred in 37.8%, 41.2%, and 31.4% subjects respectively. Sixty-five children (34.9%) had lymph node enlargement. We identified 86 subjects performed TST and 13 of them (15%) showed indurations 5 mm and more. Chest radiograph found infiltrates in most subject (37.2%), followed by combination of hillar lymph node enlargement and infiltrates (36%). Atelectasis and consolidation were found in 3 patients. Conclusion: The prevalence of TB in children with HIV was 39.2%. The most common symptoms were chronic recurrent cough, fever and difficulty in weight gain. Tuberculin skin test was positive in some children with HIV. P98N Comparison of PCR and tuberculin skin test for TB diagnosis in children D.B. Setyanto, N. Kaswandani, N.N. Rahajoe. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Diagnosis of TB in children is difficult due to the less specific symptoms and difficulties in obtaining the specimen. Tuberculin skin test has been used widely to investigate the infection of TB in children, but it still has the weakness in certain subjects. Polymerase Chain Reaction (PCR) is currently used to support the diagnosis TB, but it still limited data in children. Objective: To compare the accuracy of PCR and TST in diagnosis TB in children. Method: It was a diagnostic study to evaluate the accuracy of PCR in diagnosing childhood TB. The patient aged 0–15 years were recruited and evaluated for TB. The subjects did the TST, PCR and AFB direct smear and culture. The specimens were obtained from sputum or gastric lavage. The gold standard was the positive result of smear and/or culture of Mycobacterium tuberculosis. Result: One hundred and twenty-five subjects were evaluated for TB. The positive AFB and/or culture were found in 27 subjects. Among 27 confirmed TB patients, TST were positive in 16 subjects (sensitivity 59.3%) while PCR were positive in 15 subjects (sensitivity 55.6%). The specificity, PPV and NPV of TST were 56.1%, 27.1% and 83.3% respectively while the specificity, PPV and NPV of PCR were 63.3%, 36.6% and 83.8% respectively. Conclusion: For diagnosing TB in children, PCR did not show the superiority in diagnostic values compared to Tuberculin Skin Test. The larger study in children is needed to have the more powerful result. P99N Correlation between nasal peak inspiratory flow (NIPF) and peak expiratory flow (PFE) C.A.C. Leandro, C.D.C. Ibiapina. Universidade federal de Minas Gerais pediatrician – Belo Horizonte, Brazil Keywords: Rhinitis, nasal, flow, children
Statement of the purpose of the study: The present work has as an objective correlate the measures of the expiratory flow peak (PFE), with the nasal peak inspiratory flow (NIPF ), in a healthy pediatric population. Description of the methods used: A concurrent cohort study was carried out in public schools in Brasil, with 300 randomly selected patients aged six to sixteen in a healthy pediatric population. Correlations between NIPF and PFE were obtained from linear regression using the Pearson’s correlation coefficient (r). Summary of the results: Moderate but statistically significant correlation between PFE and NIPF was found (r = −0.394; p ≤ 0.001) Conclusion: The results indicate a moderate correlation between NIPF and PFE. The PFE value is a predictable informative of the NIPF and that the bigger the PEF is, the bigger is the NIPF. Reflections and Concrete proposals for action: The asthma and the allergic rhinitis are sickness of extreme importance in the public health, and their prevalency excites the global world. Objective measures as the peak of the nasal inspiratory flow (NIPF) and the
Posters / Paediatric Respiratory Reviews 11S1 (2010) S79–S115
peak of the expiratory flow (PFE) help in the patient’s evaluation. These methods give supplementary information as for the presence and the obstruction dimension of the aerial ways and allow the comparison between upper and lower airways. P100N The role of lung surgery in a low income country: The indications, surgical course, complications and short-term outcome and also comparing HIV-infected to HIV-uninfected D. Rhode1 , P. Goussard1 , S. Kling1 , A. Vanker1 , J.T. Janson2 , B. Barnard2 , G.J. Rossouw2 , R.P. Gie1 . 1 Division of Paediatric pulmonology, Department of Paediatrics and Child health, Tygerberg Children’s Hospital – Tygerberg, South Africa; 2 Cardiothoracic surgery department, Tygerberg Academic Hospital, Stellenbosch University – Tygerberg, South Africa Introduction: Thoracic surgery in paediatric pulmonology patients are not well described, especially in the developing world, especially in communities with a high incidence of tuberculosis (TB) and HIV. Aim: To define the role and outcome of thoracic surgery in children in a low income country. To compare the indications and outcome of children infected with HIV to those uninfected. Methodology: Retrospective descriptive study done in Tygerberg Children’s hospital from 2004–2007. All patients 0 to 16 years that underwent thoracic surgery for lung disease were included. Thoracotomies for lung biopsies were excluded. Results: 85 patients were included and 52 patients (61%) were male. 22 % (n = 12) were HIV infected of which 58% received HAART. The indications were intrathoracic tuberculosis 41%, empyema 22%, bronchiectasis 10%, congenital pulmonary lesions 9%, neoplasms 7%, vascular lesions 6% and hydatid disease 5%. Lobectomies were done in 14%, bullectomy.9% and pneumonectomy 4%. The most common indication in both HIV-infected (n = 6) and uninfected (n = 32) were TB gland enucleation (45%). 13% needed pre-operative ventilation. 62% of patients were ventilated post-operatively with 58% being HIV positive. The median ventilation period and PICU stay was 0.5 days and 2 days respectively. The mean ventilation period between HIVuninfected and HIV-infected were 1.8 and 1.2 days respectively and PICU stay had means of 3.6 days (HIV-uninfected) and 3.4 days (HIV-infected). 19% developed complications in PICU. No mortality was reported during the intra-operative period but 5% (n = 4) had died up till 3 month follow up. Conclusion: Intrathoracic tuberculosis was the most common indication for thoracotomy in our paediatric patients with lobectomy the most common operation. HIV-infected children had a good prognosis with no statistical difference in course and short-term outcome between HIV-infected and uninfected patients. Thoracic surgery should not be withheld from HIV infected children. P101N Risk factors and underlying diseases for fatal severe pneumonia S. Sudarwati, C.B. Kartasasmita, R. Ghrahani, D.A. Wulandari, A.U. Suardi, H.M. Nataprawira. Department of Child Health, Faculty of Medicine, Universitas Padjadjaran – Bandung, Indonesia Childhood pneumonia is the leading cause of mortality in children in Indonesia. Many fatal pneumonia was accompanied by underlying diseases. This study conducted to know the risk factors affected morbidity and the case histories and clinical manifestation of children death due to severe pneumonia. This case series study was done in Hasan Sadikin General Hospital, in Bandung, Indonesia from January to December 2008. All children (452) hospitalized with severe pneumonia during 2008 were enrolled in the study consist of 225 (49.7%) boys and 227 (50.3%) girls, 301 (67%) age < 12 months, 129 (28%) age 12-<60 months and 22 (5%) age ≥60 months. Unconcious level was found in 26 (5.8%) and cyanosis in 26 (5.8%). Of all children, 185 (41%) were mild and moderate malnutrition and 66 (15%) were severe
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malnutrition, 35 (8%) are premature gestational age at birth, severe dyspnea in 183 (41%), crackles in 448 (99%), wheezing 88 (19.5%), hepatomegaly in 190 (42%), anemia in 253 (56%), leucocytosis in 234 (52%). The chest X-ray shows infiltrate in 419 (92%), consolidation in 21 (4.6%), 9 (2%) with effusion. During observation, children deaths due to severe pneumonia were 34 (13 boys and 21 girls). The mean age was 7.74 months (median 4 months), ranged from 1–5 months, 20 (59%) age <6 months, 10 (29%) age 6 to <12 months, 1(3%) age 12 to <24 months, 2 (6%) age 24 to <36 months, 1 (3%) age 36 to <60 months. Median duration of illness before seek care was 2 days. The main signs and symptoms were fever 71%, difficulty breathing 94%, cyanosis 23%. The laboratory examination shows 88% with leucocytosis, all of the chest X-ray shows infiltrate. The underlying diseases were 42% congenital heart disease, 12% cerebral palsy, 6% HIV infection, 9% tuberculosis. The mean length of stay before deaths was 7.99 days. The percentage of death in children with underlying diseases was 82%, in children without underlying diseases was 18%. P102N The impact of directly observed treatment short-course (DOTS) strategy of pediatric tuberculosis treatment on altering body weight in Hasan Sadikin hospital, Indonesia H.M. Nataprawira, H.P. Yanuarti. Faculty of Medicine, University of Padjadjaran – Hasan Sadikin Hospital, Department of Child Health – Bandung, Indonesia Keywords: DOTS, pediatric TB
Background: One of the five elements of Directly Observed Treatment, Short-Course (DOTS) strategy for tuberculosis (TB) control is regular supply of good quality drugs for short-course treatment. With TB diagnosis and effective treatment, patients will gain weight appropriately based on their age group. So far, no study evaluates one of the clinical parameter of TB in children that is, increasing appropriate body weight based on age group (0–3 months, 3–6 months, 6–12 months, 1–3 years, 3–6 years, and >6 years). Objective: To describe the clinical impact of DOTS strategy on altering body weight for outpatient TB children. Methods: A prospective observational study was conducted since January 2008 until October 2009 to 527 outpatients TB children diagnosed using the Indonesian Pediatric TB Scoring System. Patients were recruited for analysis who started TB treatment lasting up to May 2009 and completed in October 2009. They were characterized by age, sex, nutritional status, TB contact history, chest X-ray, Mantoux test, history of prolong fever and cough, enlargement of lymph node or joint and or result of histopathologic findings and form of TB drugs administered. We did not perform any microbiological examination for TB. Logistic regression measurement was done to describe the impact of therapy through body weight alteration during treatment. Results: Until October 2009, 107 (20%) children were dropped out and 13 (2.5%) referred for having TB treatment to other health facilities, respectively. Two hundred ninety (70%) out of the 414 children who were successfully observed for 6 months therapy completed the treatment. Of the 527 patients, 244 (59%) patients received fixed dose combination (FDC), while the rest of children received others TB drugs form available. One hundred ninety-five (67%) gained weight appropriately while one hundred and one (24%) patients gained inappropriately. From the logistic regression measurement test, analysis of the body increment found that the body weight relatively increased along the increment of the age (p = 0.00005) Conclusions: Eventhough we cannot confirm TB diagnosis, however, its was likely true as most of the children showed gain weight appropriately. We still faced problems of patient dropped-out and their treatment adherence and TB drugs availability are not known.
Posters / Paediatric Respiratory Reviews 11S1 (2010) S79–S115
Conclusion: Atypical or prolonged respiratory symptoms should alert the physician, and clinical and radiological findings should be carefully evaluated for a possible foreign body aspiration. P96N Cardiac tamponade in tuberculous pericarditis: A case report N. Kaswandani, D.B. Setyanto, B. Supriyatno. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Pericarditis is an uncommon manifestation of TB. Pericarditis TB may cause pericardial effusion that leads to cardiac tamponade. Objective: To present the diagnosis and management cardiac tamponade in pericarditis TB. Case illustration: A 17 years-old boy came to Ciptomangunkusumo Hospital with the chief complaint of progressively worsen dyspnea since 3 days before admission. The patients also complained the occurrence of a nodule at the superior chest. The nodule was soft and firmed no tenderness and no redness. Since 2 weeks before admission he felt fever, productive cough and decreased appetite. History of TB contact was the neighbor with pulmonary TB. Physical examination found that he was severely ill with dyspnea, fever and pale. The chest examination found a fluctuative mass without inflammation. His heart sound was soft and diminished, but no gallop or murmur. Breath sound was weak at the right field. The chest radiography showed cardiomegaly and hyllar lymp node enlargement while the echocardiography showed massive pericardial effusion and collapse of the right atrium. The patients was diagnosed as cardiac tamponade et causa massive pericardial effusion/pericarditis TB, chest wall TB, anemia and undernourished. The patient was performed pericardiocentesis and anti TB drugs RHZE plus prednisone was given. Pericardial fluid analysis showed exudates with polimorphonuclear dominant and positive AFB. The patient was discharged in 3rd week in a good condition. Discussion: The diagnosis of cardiac tamponade pericarditis TB in this patient was supported by clinical findings, chest X-ray and echocardiography. Pericardiocentesis and pericardial drainage which was immediately performed improved the clinical condition of the patient. Anti TB treatment was given as WHO recommendation for AFB positive category. Conclusion: Percarditis TB can accumulate the massive fluid that leads to cardiac tamponade. An immediate pericardial drainage will improve the clinical condition of the patient. P97N Clinical features of respiratory diseases in children with HIV N. Kaswandani, D.B. Setyanto, N.N. Rahajoe. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Respiratory diseases are the most common opportunistic infection in HIV positive children. Diagnosis of certain disease such as tuberculosis is difficult in HIV-positive children due to the less specific symptoms and less sensitive tuberculin skin test. Objective: To define the prevalence of respiratory diseases and to know the clinical feature of respiratory diseases in children with HIV. Methods: Cross-sectional study carried out in Ciptomangunkusumo Hospital Jakarta. The subjects were all patients with HIV diagnosed January 2005-July 2009. Result: We investigated 186 HIV-infected children with the aged 31.5±2.64 months. Tuberculosis was the most frequent respiratory diseases (39.2%), followed by upper ARI (25.3%), pneumonia (17.2%) and otitis media (14.5%). Fifty-nine (31.7%) subjects has a good nutritional status, while 88 (47.3%) were moderate malnourished and 39 (21%) subjects were severe malnourished. Subjects were mostly (56%) in severe immunosupression status. Contacts with adult TB were found in 54 (29%) subjects. Most children (53.2%) complained of chronic recurrent cough. Chronic fever, difficulty in
weight gain and anorexia were occurred in 37.8%, 41.2%, and 31.4% subjects respectively. Sixty-five children (34.9%) had lymph node enlargement. We identified 86 subjects performed TST and 13 of them (15%) showed indurations 5 mm and more. Chest radiograph found infiltrates in most subject (37.2%), followed by combination of hillar lymph node enlargement and infiltrates (36%). Atelectasis and consolidation were found in 3 patients. Conclusion: The prevalence of TB in children with HIV was 39.2%. The most common symptoms were chronic recurrent cough, fever and difficulty in weight gain. Tuberculin skin test was positive in some children with HIV. P98N Comparison of PCR and tuberculin skin test for TB diagnosis in children D.B. Setyanto, N. Kaswandani, N.N. Rahajoe. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Diagnosis of TB in children is difficult due to the less specific symptoms and difficulties in obtaining the specimen. Tuberculin skin test has been used widely to investigate the infection of TB in children, but it still has the weakness in certain subjects. Polymerase Chain Reaction (PCR) is currently used to support the diagnosis TB, but it still limited data in children. Objective: To compare the accuracy of PCR and TST in diagnosis TB in children. Method: It was a diagnostic study to evaluate the accuracy of PCR in diagnosing childhood TB. The patient aged 0–15 years were recruited and evaluated for TB. The subjects did the TST, PCR and AFB direct smear and culture. The specimens were obtained from sputum or gastric lavage. The gold standard was the positive result of smear and/or culture of Mycobacterium tuberculosis. Result: One hundred and twenty-five subjects were evaluated for TB. The positive AFB and/or culture were found in 27 subjects. Among 27 confirmed TB patients, TST were positive in 16 subjects (sensitivity 59.3%) while PCR were positive in 15 subjects (sensitivity 55.6%). The specificity, PPV and NPV of TST were 56.1%, 27.1% and 83.3% respectively while the specificity, PPV and NPV of PCR were 63.3%, 36.6% and 83.8% respectively. Conclusion: For diagnosing TB in children, PCR did not show the superiority in diagnostic values compared to Tuberculin Skin Test. The larger study in children is needed to have the more powerful result. P99N Correlation between nasal peak inspiratory flow (NIPF) and peak expiratory flow (PFE) C.A.C. Leandro, C.D.C. Ibiapina. Universidade federal de Minas Gerais pediatrician – Belo Horizonte, Brazil Keywords: Rhinitis, nasal, flow, children
Statement of the purpose of the study: The present work has as an objective correlate the measures of the expiratory flow peak (PFE), with the nasal peak inspiratory flow (NIPF ), in a healthy pediatric population. Description of the methods used: A concurrent cohort study was carried out in public schools in Brasil, with 300 randomly selected patients aged six to sixteen in a healthy pediatric population. Correlations between NIPF and PFE were obtained from linear regression using the Pearson’s correlation coefficient (r). Summary of the results: Moderate but statistically significant correlation between PFE and NIPF was found (r = −0.394; p ≤ 0.001) Conclusion: The results indicate a moderate correlation between NIPF and PFE. The PFE value is a predictable informative of the NIPF and that the bigger the PEF is, the bigger is the NIPF. Reflections and Concrete proposals for action: The asthma and the allergic rhinitis are sickness of extreme importance in the public health, and their prevalency excites the global world. Objective measures as the peak of the nasal inspiratory flow (NIPF) and the
Posters / Paediatric Respiratory Reviews 11S1 (2010) S79–S115
peak of the expiratory flow (PFE) help in the patient’s evaluation. These methods give supplementary information as for the presence and the obstruction dimension of the aerial ways and allow the comparison between upper and lower airways. P100N The role of lung surgery in a low income country: The indications, surgical course, complications and short-term outcome and also comparing HIV-infected to HIV-uninfected D. Rhode1 , P. Goussard1 , S. Kling1 , A. Vanker1 , J.T. Janson2 , B. Barnard2 , G.J. Rossouw2 , R.P. Gie1 . 1 Division of Paediatric pulmonology, Department of Paediatrics and Child health, Tygerberg Children’s Hospital – Tygerberg, South Africa; 2 Cardiothoracic surgery department, Tygerberg Academic Hospital, Stellenbosch University – Tygerberg, South Africa Introduction: Thoracic surgery in paediatric pulmonology patients are not well described, especially in the developing world, especially in communities with a high incidence of tuberculosis (TB) and HIV. Aim: To define the role and outcome of thoracic surgery in children in a low income country. To compare the indications and outcome of children infected with HIV to those uninfected. Methodology: Retrospective descriptive study done in Tygerberg Children’s hospital from 2004–2007. All patients 0 to 16 years that underwent thoracic surgery for lung disease were included. Thoracotomies for lung biopsies were excluded. Results: 85 patients were included and 52 patients (61%) were male. 22 % (n = 12) were HIV infected of which 58% received HAART. The indications were intrathoracic tuberculosis 41%, empyema 22%, bronchiectasis 10%, congenital pulmonary lesions 9%, neoplasms 7%, vascular lesions 6% and hydatid disease 5%. Lobectomies were done in 14%, bullectomy.9% and pneumonectomy 4%. The most common indication in both HIV-infected (n = 6) and uninfected (n = 32) were TB gland enucleation (45%). 13% needed pre-operative ventilation. 62% of patients were ventilated post-operatively with 58% being HIV positive. The median ventilation period and PICU stay was 0.5 days and 2 days respectively. The mean ventilation period between HIVuninfected and HIV-infected were 1.8 and 1.2 days respectively and PICU stay had means of 3.6 days (HIV-uninfected) and 3.4 days (HIV-infected). 19% developed complications in PICU. No mortality was reported during the intra-operative period but 5% (n = 4) had died up till 3 month follow up. Conclusion: Intrathoracic tuberculosis was the most common indication for thoracotomy in our paediatric patients with lobectomy the most common operation. HIV-infected children had a good prognosis with no statistical difference in course and short-term outcome between HIV-infected and uninfected patients. Thoracic surgery should not be withheld from HIV infected children. P101N Risk factors and underlying diseases for fatal severe pneumonia S. Sudarwati, C.B. Kartasasmita, R. Ghrahani, D.A. Wulandari, A.U. Suardi, H.M. Nataprawira. Department of Child Health, Faculty of Medicine, Universitas Padjadjaran – Bandung, Indonesia Childhood pneumonia is the leading cause of mortality in children in Indonesia. Many fatal pneumonia was accompanied by underlying diseases. This study conducted to know the risk factors affected morbidity and the case histories and clinical manifestation of children death due to severe pneumonia. This case series study was done in Hasan Sadikin General Hospital, in Bandung, Indonesia from January to December 2008. All children (452) hospitalized with severe pneumonia during 2008 were enrolled in the study consist of 225 (49.7%) boys and 227 (50.3%) girls, 301 (67%) age < 12 months, 129 (28%) age 12-<60 months and 22 (5%) age ≥60 months. Unconcious level was found in 26 (5.8%) and cyanosis in 26 (5.8%). Of all children, 185 (41%) were mild and moderate malnutrition and 66 (15%) were severe
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malnutrition, 35 (8%) are premature gestational age at birth, severe dyspnea in 183 (41%), crackles in 448 (99%), wheezing 88 (19.5%), hepatomegaly in 190 (42%), anemia in 253 (56%), leucocytosis in 234 (52%). The chest X-ray shows infiltrate in 419 (92%), consolidation in 21 (4.6%), 9 (2%) with effusion. During observation, children deaths due to severe pneumonia were 34 (13 boys and 21 girls). The mean age was 7.74 months (median 4 months), ranged from 1–5 months, 20 (59%) age <6 months, 10 (29%) age 6 to <12 months, 1(3%) age 12 to <24 months, 2 (6%) age 24 to <36 months, 1 (3%) age 36 to <60 months. Median duration of illness before seek care was 2 days. The main signs and symptoms were fever 71%, difficulty breathing 94%, cyanosis 23%. The laboratory examination shows 88% with leucocytosis, all of the chest X-ray shows infiltrate. The underlying diseases were 42% congenital heart disease, 12% cerebral palsy, 6% HIV infection, 9% tuberculosis. The mean length of stay before deaths was 7.99 days. The percentage of death in children with underlying diseases was 82%, in children without underlying diseases was 18%. P102N The impact of directly observed treatment short-course (DOTS) strategy of pediatric tuberculosis treatment on altering body weight in Hasan Sadikin hospital, Indonesia H.M. Nataprawira, H.P. Yanuarti. Faculty of Medicine, University of Padjadjaran – Hasan Sadikin Hospital, Department of Child Health – Bandung, Indonesia Keywords: DOTS, pediatric TB
Background: One of the five elements of Directly Observed Treatment, Short-Course (DOTS) strategy for tuberculosis (TB) control is regular supply of good quality drugs for short-course treatment. With TB diagnosis and effective treatment, patients will gain weight appropriately based on their age group. So far, no study evaluates one of the clinical parameter of TB in children that is, increasing appropriate body weight based on age group (0–3 months, 3–6 months, 6–12 months, 1–3 years, 3–6 years, and >6 years). Objective: To describe the clinical impact of DOTS strategy on altering body weight for outpatient TB children. Methods: A prospective observational study was conducted since January 2008 until October 2009 to 527 outpatients TB children diagnosed using the Indonesian Pediatric TB Scoring System. Patients were recruited for analysis who started TB treatment lasting up to May 2009 and completed in October 2009. They were characterized by age, sex, nutritional status, TB contact history, chest X-ray, Mantoux test, history of prolong fever and cough, enlargement of lymph node or joint and or result of histopathologic findings and form of TB drugs administered. We did not perform any microbiological examination for TB. Logistic regression measurement was done to describe the impact of therapy through body weight alteration during treatment. Results: Until October 2009, 107 (20%) children were dropped out and 13 (2.5%) referred for having TB treatment to other health facilities, respectively. Two hundred ninety (70%) out of the 414 children who were successfully observed for 6 months therapy completed the treatment. Of the 527 patients, 244 (59%) patients received fixed dose combination (FDC), while the rest of children received others TB drugs form available. One hundred ninety-five (67%) gained weight appropriately while one hundred and one (24%) patients gained inappropriately. From the logistic regression measurement test, analysis of the body increment found that the body weight relatively increased along the increment of the age (p = 0.00005) Conclusions: Eventhough we cannot confirm TB diagnosis, however, its was likely true as most of the children showed gain weight appropriately. We still faced problems of patient dropped-out and their treatment adherence and TB drugs availability are not known.