Page 401 - Abstract Book KONIKA 18

Respirology

P-RES-022
Hypercoagulation State in One Half Month Baby with COVID-19:
Case Report

Teo Wijaya, Fitriana Melinda, Peter Prayogo Hsieh, Kadek Suarca
Department of Child Health Wangaya Regional Hospital, Denpasar, Bali, Indonesia

Abstract
Background The COVID-19 pandemic outbreak is not over yet and the clinical appearance of patients
is increasingly varied due to the rapid mutation of the SARS-CoV-2 virus. SARS-CoV-2 infection can
release cytokine proinflammation which is can cause hypercoagulation state in patient. Objective To find
out the description of COVID-19 disease with high hypercoagulation. Case A 1.5-month-old baby came
brought by his mother to the ER at Wangaya General Hospital with a referral from another hospital positive
COVID-19 antigen result. The chief complaint is cough that had been felt for 10 days without shortness
of breath. Complaints accompanied by fever, diarrhea, nausea, vomiting after drinking milk and persistent
fever in the last 24 hours. It is known that the patient's parents are self-isolating at home and living with
the patient. From the results of laboratory examinations, it was found that there was a prolongation of the
coagulation time in the patient PT: 8.3 second, APTT:23.2 second, elevated D-Dimer: >10.000 ng/mL,
RT PCR positive COVID-19. Chest X-Ray showed pneumonia. The patient was given the anticoagulant,
antiviral, and supportive therapy. During observation in PICU, we found no signs of thrombosis. The patient
was hospitalized for 12 days and showed improvement. Conclusion One half month baby with confirmed
COVID-19 and hypercoagulation state admitted to pediatric ward, got therapy according to COVID-19
Indonesian guideline and recovered without any sequele.
Keywords: COVID-19; SARS-CoV-2; hypercoagulation; anticoagulant; D-Dimer

P-RES-023
Detecting Sleep Disorder Breathing
in Children with Mucopolysacchardiosis Type II : A Case Report

Valerie Sunhaji, Madeleine Ramdhani Jasin, Cut Nurul Hafifah
Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital,
Jakarta, Indonesia

Abstract
Background Mucopolysaccharidosis type II (MPS II) is a rare disease in which the body has enzyme deficiency
to break down glycosaminoglycans. It Involves multiple organs, one of which is the respiratory system that
can manifest as sleep disorder breathing. Objective To illustrate the importance of detecting sleep disorder
breathing in MPS II. Case A 5-year-old boy came to Cipto Mangunkusumo hospital for sleep evaluation
before enzyme replacement therapy. There was history of snoring since birth, irritable during sleep and
disrupted sleeping time. His sleeping habit usually started at 09.00 PM and woke up before 03.00 AM, or the
maximum length of sleep was only 5 hours. Initially, allergic rhinitis was considered as etiology of sleeping
problem however those did not resolve after several months of therapy. On further evaluation, there was
hypertrophy of adenoid and tonsil. He underwent adenoidectomy at age 3 years old then tonsillectomy a year
later. Snoring was persistent after adenoidectomy and resolved after tonsillectomy. Sleep test (polygraphy)
was performed a year later before enzyme replacement therapy, showing mild obstructive sleep apnea
syndrome (OSAS) and fragmented sleep. Further evaluation of adenoid was commented, concurrent with
internasal steroid. Subsequently, evaluation of sleeping condition is planned to take place regularly in the
patients. Conclusion Evaluation of sleep disorder breathing should be performed early in children with MPS
II with complaints of snoring. Polygraphy is an alternative to diagnose OSAS in children. Further evaluation
of etiology should involve tonsil and adenoid conditions.
Keywords: mucopolysaccharidosis; MPS II; obstructive sleep apnea syndrome; polygraphy

KONIKA XVIII Abstract Book 353