High Prevalence of Myocardial Bridging Detected in an Indonesian Population Using Multi-Detector Computed Tomography.

Background and Objectives: Myocardial bridging (MB) is still not yet considered a significant finding in Indonesia both radiographically and clinically. Hence, this article aims to assess the prevalence of MB using multi-detector computed tomography (MDCT) and look at factors contributing to stenosis amongst patients with MB. Materials and Methods: This study is cross-sectional in a single centre, with consecutive sampling, looking at all patients who underwent a multi-detector computed tomography (MDCT) scan from February 2021 until February 2023. GraphPad Prism version 9.0.0 for Windows (GraphPad Software, Boston, MA, USA) was used to analyse the results. Results: There are 1029 patients with an MB, yielding a prevalence of 44.3% (95%CI 42.3-46.4). The left anterior descending vessel is the most commonly implicated, with 99.6%. Among those with stenosis, the middle portion of the bridging vessel is the most common site of stenosis (n = 269), followed by the proximal portion (n = 237). The severity of stenosis is more often moderate, with 30-50% (n = 238). Females (odds ratio [OR] of 1.8, 95%CI 1.4-2.3; p-value < 0.0001), older age (t-value 5.6, p-value < 0.0001), symptomatic patients (OR 1.4, 95% CI 1.1-1.9; p-value = 0.013), and higher mean coronary artery calcium score (t-value 11.3, p-value < 0.0001) are more likely to have stenosis. The degree of stenosis is significantly higher in the proximal stenosis group than in the middle stenosis group (t-value 27, p-value < 0.0001). Conclusions: Our research demonstrates that MB may prevent atheromatosis of the coronary segment distal to the MB and predispose the development of atherosclerosis in the section proximal to the bridge.

An Insight into Indonesia's Challenges in Implementing Newborn Screening Programs and Their Future Implications.

Due to high entry barriers, countries might find it daunting to implement the NBS program, especially those just trying to start it. This review aims to discuss Indonesia's barriers that hinder newborn screening (NBS) implementation while discussing the future implications. Literature in Pubmed and Google Scholar was scoured with keywords such as "Newborn Screening", "Neonatal Screening", "Indonesia", "Asia Pacific", "Barriers", and "Challenges". We also searched for relevant references in those published articles. Grey literature, such as state regulations, informative webinars on the topics by experts regarding current situations, and press releases by the Indonesian Minister of Health (MoH), was also searched. Newborn screening is no longer considered just a laboratory test but an array of well-harmonized systems that must be orchestrated well. Some of the barriers Indonesia faces in implementing NBS are a lack of prevalence data, ethical issues, infrastructure, cost-benefit analysis, logistical issues, government support, patient issues, a lack of commitments, and a lack of healthcare workers, specialization, and training. Government support with professional advocates and support groups, proper infrastructure, and a single-payer system for NBS programs are necessary to accelerate NBS programs in Indonesia.

Inferior vena cava to aorta ratio in dehydrated pediatric patients: a systematic review and meta-analysis.

BACKGROUND: Dehydration due to acute diarrhea is among the leading causes of mortality. However, advancements in management and technology do not help clinicians differentiate dehydration degrees. Ultrasound using the inferior vena cava to aorta (IVC/ Ao) ratio is a promising noninvasive technique to identify significant pediatric dehydration. PUSPOSE: Therefore, this systematic review and meta-analysis aimed to examine the diagnostic parameters of the IVC/Ao ratio for predicting clinically significant dehydration in pediatric patients. METHODS: We searched the MEDLINE, PubMed, Cochrane Library, ScienceDirect, and Google Scholar databases for studies of pediatric patients (≤18 years old) who presented with signs and symptoms of dehydration due to acute diarrhea, gastroenteritis, or vomiting. The inclusion criteria were cross-sectional, case-control, cohort, and randomized controlled trial study design and publication in any language. We then conducted a meta-analysis using the midas and metandi commands from Stata software. RESULTS: Five studies of 461 patients were included. The combined sensitivity was 86% (95% confidence interval [CI], 79%-91%), while the specificity was 73% (95% CI, 59%-84%). The area under the curve was 0.89 (95% CI, 0.86-0.91). The positive likelihood ratio (LR+) was 3.2 (95% CI, 2.1-5.1) with a 76% posttest probability, while the negative likelihood ratio (LR-) was 0.18 (95% CI, 0.12-0.28) with a 16% posttest probability. The combined negative predictive value was 0.83 (95% CI, 0.75-0.91), while the positive predictive value was 0.75 (95% CI, 0.68-0.82). CONCLUSION: The IVC/Ao ratio was insufficient to exclude or confirm significant dehydration in pediatric patients. More studies are needed, especially multicenter, adequately powered diagnostic research, to will help establish the usefulness of the IVC/Ao ratio.

A systematic review and meta-analysis of prevalence of vitamin D deficiency among Indonesian pregnant women: a public health emergency.

OBJECTIVE: There are few in-depth investigations or meta-analyses determining the prevalence of vitamin D insufficiency in expectant Indonesian mothers. This systematic review and meta-analysis aims to determine this prevalence. DATA SOURCES: We searched information using the following databases: MEDLINE, PubMed, Google Scholar, Cochrane Library, ScienceDirect, Neliti, Indonesia Onesearch, Indonesian Scientific Journal Database, bioRxiv, and medRxiv. STUDY ELIGIBILITY CRITERIA: The inclusion criteria included cross-sectional studies or observational studies published in any language, studying Indonesian pregnant women whose vitamin D levels were measured. METHODS: Vitamin D deficiency in this review was defined as serum 25-hydroxyvitamin D <50 nmol/L, whereas vitamin D insufficiency was defined as serum 25-hydroxyvitamin D between 50 and 75 nmol/L. The analysis was done using Stata software with the Metaprop command. RESULTS: The meta-analysis included 6 studies involving 830 pregnant women aged 27.6-30.6 years. Prevalence of vitamin D deficiency among Indonesian pregnant women was 63% (95% confidence interval, 40-86; I2, 98.9%; P<.0001). The prevalence rates of vitamin D insufficiency and hypovitaminosis D were 25% (95% confidence interval, 16-34; I2, 83.37%; P<.01) and 78% (95% confidence interval, 60-96; I2, 96.81%; P<.01), respectively. The mean serum vitamin D level was 40.59 nmol/L (95% confidence interval, 26.04-55.13; I2, 99.57%; P<.01). CONCLUSION: Pregnant women in Indonesia are at risk for vitamin D deficiency, which constitutes a public health issue. Possible unwanted consequences, including preeclampsia and small-for-gestational-age newborns, are more likely to occur when vitamin D deficiency in pregnant women is left untreated. However, more studies are needed to prove these relationships.

Serum pentraxin-3 in diagnosing acute appendicitis in patients with acute abdominal pain: A systematic review and meta-analysis of diagnostic test accuracy.

BACKGROUND: Acute appendicitis is one of many common reasons for acute abdominal pain, and its exact diagnosis is still debatable amongst clinicians. This systematic review and meta-analysis of diagnostic test accuracy aim to look at serum pentraxin-3 performance in diagnosing acute appendicitis in patients with acute abdominal pain. METHODS: This systematic review is registered on the International Prospective Register of Systematic Reviews (CRD42022338296). The primary outcome of this study is to examine the sensitivity, specificity, and post-test probability of serum pentraxin-3 (the index test) in patients with acute appendicitis. We searched various academic databases such as Pubmed, MEDLINE, Cochrane Library, Science Direct, Google Scholar, ScieLO, MedRxiv, BioRxiv, and Research Square. Two independent authors reviewed, selected the articles, and extracted the data. The analysis was done using STATA software using the "midas" and "metandi" commands. RESULTS: Five articles fulfilled our inclusion criteria with 520 patients, and 27.5% of them were children. The combined sensitivity is 90.3% (95% confidence interval 78.6-95.9), and the combined specificity is 91.2% (95% confidence interval 22.1-99.7). The area under the curve is 0.94 (95% confidence interval 0.92-0.96). Fagan's Nomogram showed that the positive likelihood ratio is 10.38 (95% confidence interval 0.38-284.76) with an 87% post-test probability, while the negative likelihood ratio is 0.11 (95% confidence interval 0.04-0.27) with a 7% post-test probability. The combined negative predictive value is 0.89 (95% confidence interval 0.81-0.98), and the positive predictive value is 0.90 (95% confidence interval 0.81-0.98). CONCLUSION: Serum pentraxin-3 could only be used as a confirmation test for acute appendicitis but not exclude it.

Vitamin D deficiency is a public health emergency among Indonesian children and adolescents: a systematic review and meta-analysis of prevalence.

PURPOSE: This study aimed to describe the prevalence of vitamin D deficiency in Indonesian children and adolescents. METHODS: This was a meta-analysis of prevalence using the Hartung-Knapp-Sidik-Jonkman method with a random effects model. A prediction interval was used to estimate true effects. We searched PubMed, MEDLINE, Cochrane Library, Science Direct, Google Scholar, and 3 Indonesian databases (Indonesian Scientific Journal Database, Neliti, and Indonesia One Search). We included cross-sectional or case-control studies that provided data on the prevalence of vitamin D deficiency. We excluded case reports, case series, cohort studies, or studies outside Indonesia. We computed point prevalence by dividing the number of children with hypovitaminosis D by the total number of subjects in that study. This review was registered with PROSPERO (International Prospective Register of Systematic Reviews) (CRD42022329814). RESULTS: Of 1,397 manuscripts identified, 7 were included in this review. A total of 5,870 children were included in this meta-analysis, ranging in age from 6 months to 19 years. The prevalence of hypovitaminosis D in Indonesia was calculated as 33% (95% confidence interval [CI], 9-56) and was higher in females (60% [95% CI, 58-62]) than in males (40% [95% CI, 38-42]). Mean serum vitamin D level was 22.74 ng/mL (95% CI, 16.95-30.51) with a prediction interval of 15.96 ng/mL to 29.52 ng/mL. CONCLUSION: Vitamin D deficiency is a public health emergency in Indonesia. Strategies to detect and treat vitamin D deficiency in Indonesian children and adolescents should be implemented immediately.

Clinical factors predicting rotavirus diarrhea in children: A cross-sectional study from two hospitals.

BACKGROUND: Rotavirus is still a significant contributing morbidity and mortality in pediatric patients. AIM: To look at clinical signs and symptoms and laboratory findings that can predict rotavirus gastroenteritis compared to non-rotavirus gastroenteritis. METHODS: This was a cross-sectional study with medical records obtained from December 2015 to December 2019. Inclusion criteria for this study include all hospitalised pediatric patients (0-18 years old) diagnosed with suspected rotavirus diarrhea. The receiver operating curve and Hosmer-Lemeshow test would be used to assess the final prediction findings' calibration (goodness of fit) and discrimination performance. RESULTS: This study included 267 participants with 187 (70%) rotavirus-diarrhea cases. The patients were primarily male in both rotavirus (65.2%) and non-rotavirus (62.5%) groups. The median age is 1.33 years old (0.08-17.67 years old). Multivariate analysis shows that wet season (ORadj = 2.5; 95%CI: 1.3-4.8, Padj = 0.006), length of stay (LOS) ≥ 3 days (ORadj = 5.1; 95%CI: 1.4-4.8, Padj = 0.015), presence of abdominal pain (ORadj = 3.0; 95%CI: 1.3-6.8, Padj = 0.007), severe dehydration (ORadj = 2.9; 95%CI: 1.1-7.9, Padj = 0.034), abnormal white blood cell counts (ORadj = 2.8; 95%CI: 1.3-6.0, Padj = 0.006), abnormal random blood glucose (ORadj = 2.3; 95%CI: 1.2-4.4, Padj = 0.018) and presence of fecal leukocytes (ORadj = 4.1, 95%CI: 1.7-9.5, Padj = 0.001) are predictors of rotavirus diarrhea. The area under the curve for this model is 0.819 (95%CI: 0.746-0.878, P value < 0.001), which shows that this model has good discrimination. CONCLUSION: Wet season, LOS ≥ 3 d, presence of abdominal pain, severe dehydration, abnormal white blood cell counts, abnormal random blood glucose, and presence of fecal leukocytes predict rotavirus diarrhea.

Prevalence and Determinants of COVID-19 Vaccine Acceptance in South East Asia: A Systematic Review and Meta-Analysis of 1,166,275 Respondents.

Despite its importance in guiding public health decisions, studies on COVID-19 vaccination acceptance and its determinants in South East Asia (SEA) are lacking. Therefore, this study aims to determine the prevalence of COVID-19 vaccine acceptance and the variables influencing the vaccine's acceptance. This review is registered under PROSPERO CRD42022352198. We included studies that reported vaccination acceptance from all SEA countries, utilising five academic databases (Pubmed, MEDLINE, Cochrane Library, Science Direct, and Google Scholar), three Indonesian databases (the Indonesian Scientific Journal Database, Neliti, and Indonesia One Search), two pre-print databases (MedRxiv and BioRxiv), and two Thailand databases (ThaiJo and Thai-Journal Citation Index). The analysis was conducted using STATA 17.0 with metaprop commands. The prevalence for COVID-19 vaccination acceptance in SEA was 71% (95%CI 69-74; I2 99.87%, PI: 68.6-73.5). Myanmar achieved the highest COVID-19 vaccination acceptance prevalence, with 86% (95%CI 84-89), followed by Vietnam with 82% (95% CI 79-85; I2 99.04%) and Malaysia with 78% (95%CI 72-84; I2 99.88%). None of the ten determinants studied (age, sex, education, previous COVID-19 infections, smoking and marriage status, health insurance, living together, chronic diseases, and healthcare workers) were significantly associated with acceptance. This result will be useful in guiding vaccination uptake in SEA.

Autopsy findings of pediatric COVID-19: a systematic review.

Background: Little is known how COVID-19 is affecting children. Autopsies help gain an understanding of the pathophysiology of new and developing diseases. Numerous post-mortem studies had been conducted in adults with COVID-19, but few in children. Thereby, this systematic review aims to investigate the autopsy findings from pediatric COVID-19 patients. Results: There were a total of 15 patients from eight studies. COVID-19 mainly affects the heart and lungs. Pathology findings from the heart of COVID-19 pediatric patients include diffuse inflammatory infiltrate, myocarditis, cardiomyocyte necrosis, pericarditis, and interstitial edema. Histopathology abnormalities observed in the lungs are diffuse alveolar damage, cytopathic changes, thrombi in arterioles and septal capillaries, lung congestion, focal acute hemorrhage and edema, focal exudative changes, and mild pneumocyte hyperplasia. In addition, pathological findings from other organs, such as the liver, kidney, brain, bone marrow, lymph node, skin, spleen, muscle, colon, parotid gland, and adrenal of COVID-19 pediatric patients are also included in this review. Conclusion: Cardiomyocyte necrosis, interstitial edema, lung congestion, and diffuse alveolar damage are the most significant pathologic findings of the heart and lung in pediatric COVID-19 patients. More studies are needed to elucidate the pathophysiology of SARS-CoV-2 in autopsy findings and to determine the exact cause of death since it could be related to COVID-19 or other comorbidities.

COVID-19 vaccination acceptance in Jambi City, Indonesia: A single vaccination center study.

Background: Indonesia has not met its vaccination rate target, falling short of 25% in 2021. This study aims to assess all the contributing factors towards vaccine acceptance, hesitance, and refusal in a single vaccination center in Jambi, Indonesia. Materials and methods: We collected primary data from respondents directly through a structured questionnaire. This was a cross-sectional study with total sampling. We included adults vaccinated for the first dose with CoronaVac in Puskesmas Putri Ayu. The data was collected between March 15th and June 3rd, 2021. Multivariate logistic regression analysis was done to analyse the predictive models. Results: There are 522 respondents included in this study. Nearly half of the respondents are male (52.1%) and mostly in the age category of 36-45 years old (21.1%). A total of 443 respondents (84.9%) are "vaccine acceptance," while the rest constitutes "vaccine hesitance and refusal." Multivariate analysis reveals that respondents who obtain permission from work or school to get vaccinated are more likely to be "vaccine acceptance" with an odds ratio (OR) of 1.76 (95% confidence interval [CI] 1.08-2.91; p-value 0.025), and respondents with ≥ 2 comorbidities are less likely to be "vaccine acceptance" with an OR of 0.09 (95% CI 0.01-0.64; p-value 0.015). Conclusions: There is a high vaccine acceptance in this study. Difficulties in getting a work permit and the presence of ≥ 2 comorbidities decrease the willingness to be vaccinated for COVID-19.

Antecedentes: Indonesia no ha alcanzado su objetivo de tasa de vacunación, por debajo del 25% en 2021. Este estudio tiene como objetivo evaluar todos los factores que contribuyen a la aceptación, la vacilación y el rechazo de la vacuna en un solo centro de vacunación en Jambi, Indonesia. Materiales y métodos: recopilamos datos primarios de los encuestados directamente a través de un cuestionario estructurado. Este fue un estudio transversal con muestreo total. Se incluyeron adultos vacunados para la primera dosis con CoronaVac en Puskesmas Putri Ayu. Los datos se recopilaron entre el 15 de marzo y el 3 de junio de 2021. Se realizó un análisis de regresión logística multivariante para analizar los modelos predictivos. Resultados: Hay 522 encuestados incluidos en este estudio. Casi la mitad de los encuestados son hombres (52,1%) y la mayoría se encuentran en la categoría de edad de 36 a 45 años (21,1%). Un total de 443 encuestados (84,9%) son "aceptación de la vacuna", mientras que el resto constituye "vacilación y rechazo a la vacuna". El análisis multivariado revela que los encuestados que obtienen permiso del trabajo o la escuela para vacunarse tienen más probabilidades de "aceptar la vacuna" con una razón de probabilidad (OR) de 1,76 (intervalo de confianza [IC] del 95%: 1,08-2,91; valour de p 0,025), y los encuestados con ≥ 2 comorbilidades tienen menos probabilidades de "aceptar la vacuna" con un OR de 0,09 (IC del 95%: 0,01-0,64; valour de p 0,015). Conclusiones: Existe una alta aceptación de la vacuna en este estudio. Las dificultades para obtener un permiso de trabajo y la presencia de ≥ 2 comorbilidades disminuyen la disposición a vacunarse contra el COVID-19.

Clinical Features of Multisystem Inflammatory Syndrome in Children Associated with COVID-19 in Indonesia.

BACKGROUND: While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is increasing, reported cases in Asian countries are still low, particularly in Indonesia. This study aimed to describe the characteristics of patients with MIS-C in a tertiary referral hospital in Indonesia. METHODS: This is a cross-sectional study with collected data of patients with MIS-C admitted to Dr. Cipto Mangunkusumo from March 2020 to April 2021. RESULTS: The first case of MIS-C was detected 5 months after the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive admitted patients for COVID-19 were diagnosed with MIS-C during the study period. Of these 13 patients, 2 patients (15%) had a fatal outcome. Subjects were predominantly male, and the median age was 7.58 years (IQR 12.3) years. Most patients required mechanical ventilation (7 out of 13 patients) and intubation (8 out of 13 patients). Patients who needed intubation usually needed mechanical ventilation. All inflammatory markers, white blood cells, neutrophil counts, and all coagulation factor parameters (except for normal prothrombin time and activated partial prothrombin time) were elevated. The median time to MIS-C diagnosis was 2 days in the survivor group (n = 11) compared to 8.5 days in the non-survivor group (n = 2). Compared to the non-survivor group, those who survived spent more days in the hospital, received vasopressors earlier, and did not require mechanical ventilation as early as the non-survivors. CONCLUSIONS: Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between the two groups.

Comparison of Indonesian Growth Reference Chart and World Health Organization Child Growth Standard in Detecting Stunting: A Systematic Review and Meta-analysis of 15,874 Children

Recognition of an overestimation of stunted children in Indonesia when using the World Health Organization Child Growth Standards (WHOCGS) led to the creation of the Indonesian Growth Reference Chart (IGRC) in 2005, with further improvement in 2018. This systematic review aimed to determine whether there is a difference in the diagnosis of stunting when using these two charts. This systematic review is registered in the PROSPERO database (CRD42021259934). Literature research was performed on PubMed, Science Direct, Medline, Scielo, Medrxiv, Research Square, SSRN, and Biorxiv to identify studies published from 2018 onwards that examined the comparison of IGRC and WHOCGS in detecting stunting. Three studies were included in this review. Pooled analysis showed that IGRC resulted in a lower prevalence of stunted and severely stunted children [risk ratio (RR): 0.28 (95% confidence intervals (CI): 0.15-0.51), p<0.0001, I2=97%]. Comparison between IGRC and WHOGCS for prevalence of normal height children showed that there was no difference, and this finding was not significant [RR: 1.56 (95% CI: 0.92-2.66), p=0.1, I2=100%], and the comparison for prevalence of tall children also showed that there was no difference when using IGRC or WHOGCS, and this finding was also insignificant [RR: 2.02 (95% CI: 0.78-5.20), p=0.14, I2=98%]. This meta-analysis showed that stunted and severely stunted Indonesian children are over-represented using WHOCGS. The difference between IGRC and WHOCGS has occurred because of the sample population, as IGRC includes children from all 33 provinces in Indonesia, better reflecting the growth of all children in Indonesia.

Psychological factors affecting COVID-19 vaccine acceptance in Indonesia.

INTRODUCTION: Increasing the rate of vaccination is crucial in combating the COVID-19 pandemic. However, a survey of 112,888 Indonesians found that only 64.8% Indonesians were willing to be vaccinated, with 7.6% refusing all vaccines and 27.6% are unsure. Several factors were related to this vaccine hesitancy and refusal, such as cognitive reflection, trust in authoritative figures, and personality traits. This study aims to identify psychological determinants and other factors associated with vaccine hesitancy and vaccine refusal. This was a cross-sectional study with data collection done in March 2021 using a questionnaire. We collected demographic data, respondents' stance on vaccination, as well as their psychology measurement. IBM SPSS 26.0 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA) was used for statistical analysis. RESULTS: The data of 190 respondents were collected for this study. There are 165 respondents (86.8%) who belong to "vaccine acceptance", while 25 are "vaccine hesitance" or "vaccine resistance." Multivariate analysis shows that frequency of COVID-19 tests (p = 0.03), smoking status (p = 0.035), agreeableness trait (p = 0.001), trust in government (p = 0.04) and trust in scientist (p = 0.049) are significantly associated with the two population. CONCLUSION: Several demographic and psychological factors affect the COVID-19 vaccine acceptance. The government and other related parties should consider these factors when adjusting for future policies controlling the COVID-19 pandemic and increasing the vaccination rate.

Antecedents of Intention to Adopt Mobile Health (mHealth) Application and Its Impact on Intention to Recommend: An Evidence from Indonesian Customers.

INTRODUCTION: Mobile health (mHealth) applications gain popularity due to the increasing number of mobile phone usage and internet penetration, which might help some of Indonesia's medical issues. However, the uptake of mHealth applications is still low in Indonesia. This study is aimed at understanding the factors that drive individuals to adopt mHealth applications and their impact on the intention to recommend. METHODS: We applied a new model that combines three different theories with some other constructs: an extended unified theory of acceptance and use of technology, diffusion of innovation, and the internet customer trust model. The study used a cross-sectional study design with partial least squares causal modeling approach. RESULTS: There are 787 respondents in our study, with the majority of them being female, young adults. Our model could explain 53.2% of the variance of intention to adopt while explaining 48.3% of the variance of intention to recommend. Initial trust in mHealth platform (ß = 0.373, p = <0.001), facilitating conditions (ß = 0.131, p = <0.01), and performance expectancy (ß = 0.099, p = <0.05) are the top three most important drivers of intention to adopt mHealth applications. Lastly, importance-performance map analysis (IPMA) showed that the mHealth application's initial trust is the most important construct with a high-performance score. Discussion. Mobile health developers and managers need to improve initial trust in the mHealth platform, facilitating conditions, and performance expectancy when developing the applications. With a medium Q 2 predict, these factors can be applied out of the research context with medium predictive power.

Mortality in children with positive SARS-CoV-2 polymerase chain reaction test: Lessons learned from a tertiary referral hospital in Indonesia.

BACKGROUND: The incidence of coronavirus disease 2019 (COVID-19) is still increasing rapidly, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aimed to describe the characteristics of children with COVID-19 with fatal outcomes in a tertiary referral hospital in Indonesia. METHODS: This cross-sectional study used data collected from the medical records of patients with COVID-19 admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from March to October 2020. RESULTS: During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, and 20 (40%) had a fatal outcome. The fatality rate was higher in patients aged ≥10 years, categorized with severe disease upon admission, PaO2/FiO2 ratio ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase and presepsin levels were found in all fatal cases. One patient met the criteria of multisystem inflammatory syndrome in children. CONCLUSION: Our work highlights the high mortality rate in paediatric patients with positive SARS-CoV-2 polymerase chain reaction test. These findings might be related to or co-incided with COVID-19 infection. Further studies are needed to improve understanding of the role of severe acute respiratory syndrome coronavirus-2 in elaborating the mechanisms leading to death in children with comorbidities.