Prognostic factors of severe dengue infections in children

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Illustration by Halodoc

Dengue disease is still a major health problem in Indonesia. According to the 2009 Guidelines, Dengue fever is a mosquito-borne disease and caused by one of four serotype dengue viruses. Severe dengue is characterized either by plasma leakage, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Understanding the prognostic factors in severe dengue will give early warning to physicians thus decreasing the morbidity and mortality and also improving the treatment and disease management.

Subject eligible between two months until 18 years old in two hospitals, namely RSUD Dr. Soetomo and Suwandhi Hospital Surabaya. All patients did immunoglobulin tests to confirm dengue virus infection.

Univariate and multivariate analyzes were performed for 40 children diagnosed with mild and 27 severe dengue. The significant elements were excess body weight, abdominal pain, fluid in the lungs, enlarged liver, low white blood cells, low platelets, decreased albumin levels, increased liver function, impaired blood clotting function. After all, these elements were analyzed together, four things were found as the most influential factors: excess body weight, vomiting, liver enlargement, and blood clotting disorders.

The number of patients with severe dengue in children is relatively insignificant compared to all dengue infection sufferers. However, this group is the one that has died the most or experienced various problems. In Indonesia, health facilities have difficulties in handling this group. Early referral or raising extra precautions should be taken early to reduce the risk of deterioration and death.

Handling children with severe dengue is not easy. Thus, adequate facilities and infrastructure are also needed. A predictive factor would be helpful to identify patients.

Data around the world shows that children with obesity are more likely to be hospitalized. 50% of children with severe dengue who died in RSUD Dr. Soetomo weighs more. Thousands of toddlers in Indonesia suffer from the double burden of nutrition problems, malnutrition, and lack of nutrition. Some experience obesity, some other stunting, or malnutrition.

Persistent vomiting is one warning sign that had correlated with severe dengue in children. Vomiting was often found in dengue patients, especially in children. Vomiting could cause fluid imbalance and also difficulty in assessing the hydration state of the patient. The fourth aspect is blood clotting disorders. One of the risks of dengue virus infection is bleeding. Bleeding requires a proper blood clotting function to restore the condition. Children with blood clotting disorders are one of the groups most at risk.

With the four things above, doctors have a better consideration to prioritize patients and reduce the risk of worsening and reduce mortality.

Authors: Senja Baiduri, Dominicus Husada, Dwiyanti Puspitasari, Leny Kartina, Parwati S. Basuki, Ismoedijanto

Detail information: (Prognostic Factors of Severe Dengue Infections in Children)

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