Page 174 - Abstract Book KONIKA 18

Emergency & Pediatric Intensive Care

P-EPIC-026
Transient Delirium in A Child with Covid-19: A Case Report

Indra Saputra , Silmi Kaffah 2
1
Department of Child Health, Faculty of Medicine, Universitas Sriwijaya/Dr. Mohammad Hoesin General Hospital
1
2
and Hermina Private General Hospital, Basuki Rahmat , Palembang, South Sumatera, Indonesia
Abstract
Background There is a growing understanding that SARS-CoV-2 infection has negative impacts on
neurological functions. To date, the manifestations of Covid-19 are known to be diverse and the pathobiology
of SARS-CoV-2 neurotropism is not fully known yet. Under-recognition of Covid-19 neurological features
may devote to negative acute and long-term complications which lead to devastating poor outcome.
Objective To describe the neurological manifestations of Covid-19 infection in children and present a
neurological covid-19 case which had swift favorable outcome in pediatric patients. Case A 13-year-old
boy was admitted to the emergency department with agitation and a history of five days remittent fever,
intermittent headache, and non-projectile vomiting. One hour in the ED, he got worse with deeper level of
impaired consciousness (GCS 10, E-3, M-4, V-3). Neurological examination showed meningeal signs (neck
stiffness and Lasègue), while cardiopulmonary and abdominal examination were unremarkable. Laboratory
analysis showed lymphopenia (6%) and elevated makers of inflammation (C-reactive protein 23,1 mg/L),
nevertheless analysis of kidney function, serum electrolytes, and liver function test all proved normal. The
chest X-ray and head CT scan were normal. The patient tested PCR positive for SARS-CoV-2 infection (CT-
value 20.22). After 24 hour treatment of Covid-19 protocol, he regained conscious and had stable condition.
The patient had a good recovery with no sequelae. Conclusion Pediatric neurological manifestations of
SARS-CoV-2 infection are usually atypical. Growing evidence was presented and prompted comprehensive
management was needed to prevent devastating sequalae.
Keywords: neurological manifestations; SARS-CoV-2; transient delirium

P-EPIC-027
Necrotizing Soft Tissue Infection Leading for Sepsis
in Pediatric Intensive Care Unit

Ririe Fachrina Malisie , Selvi Nafianti1, Ade Rahmat Yulianto , Hafaz Zakky Abdillah ,
2
1,2
1,2
Hariadi Edi Saputra , King Chandra 2
2
1
2
Child Health Department Medical Faculty Universitas Sumatera Utara and PICU Murni Teguh Memorial Hospital ,
Medan, North Sumatera, Indonesia
Abstract
Background Necrotizing soft tissue infection (NSTI) is rare but life-threatening bacterial infection lead
to rapid necrosis of soft tissue, deep subcutaneous and fascia. The cause of death is multiple organ failure
resulting from overwhelming sepsis. Mortality and morbidity of NSTI from several reports were up until
80%. Objective To emphasis the serial cases of NSTI in tertiary level of Pediatric Intensive Care Unit during
2019-2021. Cases There were five cases have been identified as NSTI in PICU. The distribution of age was
8 months to 2 years (average 17.4 months). All of the patients have comorbidities included cancer, cyanotic
heart disease and varicella. Most of them have severe critical condition presented with painful and rapidly
progressive skin lesions superficial, bullae, spreading erythema and tissue necrosis. The diagnosis of skin
infection was based on clinical and bacteriological investigations. Gram negative bacteria (Pseudomonas
aeruginosa and Aeromonas sobria) was found in blood culture. Immediate debridement, appropriate empiric
antimicrobial therapy and intensive care treatment were the major prognostic determinants of survivor.
Early recognition and aggressive debridement of necrotic tissue were decreased mortality. Two third of the
cases were died as result of multiple organ failure. Collaboration between paediatric intensivist and surgeon
should be the cornerstone of NSTI management. Conclusion Necrotizing soft tissue infection progresses
rapidly and need prompt decision, aggressive surgical intervention also close monitoring to treat the sepsis
and prevent mortality.
Keywords: necrotizing soft tissue infection; PICU

126 KONIKA XVIII Abstract Book