Roni Naning

Correlation between nosocomial pneumonia and ventilated patients in pediatric intensive care unit

Background NP (NP) especially YAP (ventilator-associated pneu- monia) is the most common infection in intensive care unit, which correlates with the increasing of morbidity and mortality. There are some risk factors for development ofNP, the most important one is duration of mechanical ventilator and reintubation. Objective To determine the correlation between NP and use of mechanical ventilator in pediatric intensive care unit (PICU). Methods A matched case control study was conducted at Dr. Sardjito Hospital on all patients admitted to the PICU from 2004 until 2006. Case group was defined as all patients who had NP; age and sex matched control group included all patients not diagnosed as NP. Statistical analysis was done by using chi-square and t-tests as appropriate. Logistic regression analysis was done to determine the role of risk factors. Results One-hundred and forty-one patients were included in this study. The incidence of NP was 25. 7%. There was associa- tion between using mechanical ventilator (OR 1.08; 95%CI 1.07; 8.20, P=0.036) and duration of using mechanical ventilator more than four days (OR 1.75, 95%CI 1.87;18.02) with development of NP. There was a significant difference in event free survival of NP between those using mechanical ventilator group and those not using mechanical ventilator group (P<O.OOl). Conclusion There is an association between the use of mechani- cal ventilator and duration of use of mechanical ventilator more than four days with the development of NP

The relationship between contact to cat and the development of asthma in children

Background Data suggesting history of direct or indirect contact to cats are either protective, has no effect or increase risk of sensitization and asthma development. Objective To determine the relationship between childhood contact to cat and the development of asthma in children. Methods A case control study was conducted in Denpasar since December 2006 until Juli 2008. In this study, subjects with asthma (cases group) were selected for comparisons to a series of healthy subjects without asthma (controls group). Forty-seven subjects (3-12 years) with asthma were recruited and matched (age and sex) with 4 7 healthy and non asthma controls. Data were collected using two kinds of questionnaires, i.e: ISAAC, ATS 78, and Robertson modification questionnaire from Medical School, University of Indonesia, which had been validated to determine asthma and asthma risk factors questionnaire. Data were analyzed as univariate by using chi-square or Fishers exact test, and multivariate analysis by stepwise logistic regression model. Results Result of univariate analysis showed that there were seven significant risk factors of asthma. Using multivariate analysis, contact to cat was significant risk factor for asthma [OR: 4.5 (95% CI 1.3 to 16.0), P= 0.020]. Other significant risk factors were; contact to cockroach [OR: 11.7 (95% CI 2.6 to 51.6), P= 0.001], use of kapok mattress [OR: 6.4 (95% CI 1.4 to 29.0), P= 0.015], passive smoker [OR: 4.7 (95% CI 1.3 to 17.0), P= 0.018], and atopic history [OR: 9.2 (95% CI 2.3 to 36.7), P= 0.002]. Conclusions There was a relationship between childhood contact to cat and the development of asthma in children. Risk factors that statistically significant were; contact to cockroach, use of kapok mattress, passive smoker, and history of allergy in study subject.

Relationship between bottle feeding in supine position in infants and the presence of asthma among preschoolers

Background Asthma is a common chronic respiratory disease. The risk factors of asthma are allergic factors, familial atopy, race, gender, and smoking during pregnancy. Other risk factors are gastroesophageal reflux and micro-aspiration which cause bronchospasm and bronchial hyperreactivity due to repeated airway irritation. Objective To determine the association between bottle feeding given in supine position before sleep time in the first year of life with asthma in 4 to 7 years old. Methods A case control study was conducted on pediatric patients from Sardjito Hospital and Muhammadiyah kindergarten, Yogyakarta. Two structured questionnaires were used; the first identified the case group (asthma) and control group (nonasthma), whereas the second one identified whether the subjects had bottle feeding in supine position in the first year of life or not. Results 122 subjects were studied, 62 subjects in asthma group and 60 in control group. In asthma group, feeding in supine position before sleep time in the first year had OR of 2.45 (95% CI 1.21 to 6.93), whereas regurgitation when bottle-feeding in supine position had OR of 4.53 (95% CI 1.54 to 13.16). Sudden cry when bottle-feeding in supine position had OR of 5.02 (95% CI 1.69 to 15.71). Asthma in the family increased risk of asthma [OR 3.12 (95% CI 1.16 to 6.50)] and atopicfamily has OR 3.25 (95% CI 1.01 to 6.27). Conclusion Bottle feeding in supine position before sleep time during first year oflife is associated with occurrence of asthma in preschool children.