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All Journal Sari Pediatri Paediatrica Indonesiana AcTion: Aceh Nutrition Journal journal of Basic Medical Veterinary Narra J Journal of Health and Nutrition Research Narra X
Nora Sovira, Nora
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Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Chemistry Health Professions Immunology & microbiology Materials Science & Nanotechnology Medicine & Pharmacology Nursing Physics Public Health Veterinary

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Journal : Paediatrica Indonesiana

 1 
Neutrophil lymphocyte ratio and severity of acute kidney injury in septic children Kowita, Nurul Huda; Sovira, Nora; Safri, Mulya; Ismy, Jufitriani; Haris, Syafruddin; Herdata, Heru Noviat; Bakhtiar, Bakhtiar
Paediatrica Indonesiana Vol. 63 No. 6 (2023): November 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.6.2023.492-8

Abstract

Background Acute kidney injury (AKI) in sepsis is associated with an inflammatory process in kidney microcirculation and may increase morbidity and mortality in children. The neutrophil lymphocyte ratio (NLR) is an inflammatory biomarker of the inflammatory process in sepsis. Objective To determine the role of NLR in predicting the severity of AKI and to describe the demographic and laboratory characteristics, as they relate to outcomes of pediatric patients with AKI and sepsis. Methods This cross-sectional study was conducted in the PICU at Dr. Zainoel Abidin General Hospital (RSUDZA), Banda Aceh, Aceh. Medical record data were obtained from critically ill children with sepsis and AKI. Chi-square test was used to compare the proportions of each variable. We also calculated odds ratios to evaluate the AKI severity, PELOD-2 score, and patient outcomes. Spearman's analysis was used to look for a possible correlation between NLR and AKI severity in septic children. Results Seventy-one subjects with sepsis and AKI were included. Subject characteristics were as follows: 63.4% males, 63.4% < 1 year of age, 56.3% with respiratory problems as a primary disease, 38% with AKI injury stage, and 54.9% subjects with PELOD-2 score ?10. There was no significant correlation between AKI severity and mortality (OR 3.04; 95%CI 0.990 to 9.378; P=0.052). Subjects with a PELOD-2 score ?10 had a 47.6 times higher chance of mortality in septic children with AKI compared to those with PELOD-2 scores <10. There was no correlation between NLR and AKI severity (r=0.019; P=0.878). Conclusion There is no correlation between NLR and AKI severity. Sepsis accompanied by AKI may increase the risk of mortality in children. Septic children with more severe AKI tends to be less survive.
Risk factors for acute kidney injury in children with critical illness Chalisah, Lilis; Sovira, Nora; Amna, Eka Yunita; Anidar, Anidar; Haris, Syafruddin; Bakhtiar, Bakhtiar
Paediatrica Indonesiana Vol. 64 No. 5 (2024): September 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.5.2024.398-404

Abstract

Background Acute kidney injury (AKI) is an acute functional kidney disorder that increases morbidity and mortality in children. The mortality rate for critically ill patients accompanied by AKI is quite high and is influenced by the degree of AKI, the severity of the disease, and organ function disorders. Understanding the risk factors of developing AKI in children with critical illness can help prevent AKI. Objective To determine the risk factors for AKI in children with critical illness. Methods This retrospective cohort study included 255 children aged 1 month to 18 years admitted at the pediatric intensive care unit (PICU) of dr. Zainoel Abidin Regional Public Hospital, Banda Aceh, Aceh, from January to December 2022 using medical record data. Bivariate and multivariate analyses were performed. Results Acute kidney injury occurred in 68 (26.7%) patients. Based on pRIFLE criteria, 34 (50%) patients had AKI in the failure stage. Risk factors for AKI in children with critical illness were in descending order of RR: sepsis (RR 14.3; 95%CI 11.68 to 18.66; P=0.000), mechanical ventilation (RR 12.13; 95%CI 8.75 to 15.98; P=0.000), respiratory disorders (RR 2.51; 95%CI 2.06 to 4.02; P=0.003), congenital heart disease (RR 2.08; 95%CI 2.00 to 3.05; P=0.004), CNS disorders (RR 1.24; 95%CI 1.02 to 2.49; P=0.048), nephrotoxic drug use (RR 1.41; 95%CI 1.24 to 3.08; P=0.000), and age 1 month to 5 years (RR 0.072; 95%CI 0.16 to 0.32; P=0.010). Conclusion Sepsis is a risk factor for AKI in children with critical illness, followed by mechanical ventilation use, respiratory disorders, nephrotoxic drug use. Age <5 years is a protective factor.
Treatment duration and dosage of valproic acid and subclinical hypothyroidism incidence in pediatric epilepsy patients Carolina, Infra Yunita; Anidar, Anidar; Andid, Rusdi; Yusuf, Sulaiman; Darussalam, Dora; Sovira, Nora
Paediatrica Indonesiana Vol. 64 No. 6 (2024): November 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.6.2024.469-72

Abstract

Background Epilepsy is a central nervous system disorder characterized by abnormal electrical activity in the brain.1 Prolonged administration of valproic acid at therapeutic doses can disrupt thyroid function, leading to subclinical hypothyroidism. This condition is marked by elevated thyroid stimulating hormone (TSH) levels, with normal serum free T4 (FT4) levels.2 Objective To investigate for possible associations between valproic acid therapy duration and dosage with the incidence of subclinical hypothyroidism in pediatric epilepsy patients. Methods This analytical, cross-sectional study included children aged 4 months to 18 years treated at the Pediatric Clinic of RSUD Dr. Zainoel Abidin, Banda Aceh, from September to November 2023. Subjects diagnosed with epilepsy and treated with valproic acid for at least 3 months were included in this study and underwent FT4 and TSH examinations. Results Forty-four children met the study criteria. Subclinical hypothyroidism occurred in 5 (11.4%) subjects during valproic acid therapy. Chi-square analysis revealed no significant association between therapy duration ?1 year (OR 1.286; 95%CI 0.193 to 8.568; P=1.00) or therapy dose ?20-40 mg/kg/day (OR 3.429; 95%CI 0.351 to 33.518; P=0.37) with subclinical hypothyroidism incidence. Conclusion Neither the duration nor the dosage of valproic acid therapy were significantly associated with the incidence of subclinical hypothyroidism in children with epilepsy.
Urinary neutrophil gelatinase-associated lipocalin to predict acute kidney injury in children with critical illness Fajri, Rizky; Sovira, Nora; Haris, Syafruddin; Dimiati, Herlina; Bakhtiar, Bakhtiar; Amna, Eka Yunita
Paediatrica Indonesiana Vol. 65 No. 1 (2025): January 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.1.2025.47-53

Abstract

Background Acute kidney injury (AKI) can increase mortality in children with critical illness. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker for early prediction of AKI in children. Objective To determine the diagnostic value of uNGAL as a predictor of AKI in children with critical illness. Methods This observational cross-sectional study was conducted in the Emergency Room, Pediatric Intensive Care Unit, and Pediatric Ward of Zainoel Abidin Public Hospital, Banda Aceh, Indonesia, between August and December 2023. Subjects were 40 children aged 1 month to 18 years with critical illness. uNGAL levels were measured on the first day of admission. Blood urea and creatinine levels were measured on the first and third days of admission. We calculated the diagnostic sensitivity and specificity of uNGAL to predict AKI. The optimal uNGAL cut-off point for this purpose was determined using receiver operating characteristic (ROC) curve analysis. Result In the majority of patients (29/40; 72.5%) critical illness occurred at the ages of 5 to 18 years. The most common primary diseases were central nervous system disorders in 14/40 (35%) patients, gastrointestinal infection in 6/40 (15%) patients, and malignancy in 5/40 (12.5) patients. Median uNGAL levels were significantly elevated in subjects with renal impairment [17.37 (range 6.13-29.70) ng/mL] compared to those with normal renal function [4.87 (range 0.32-29.49) ng/mL] (P=0.0001). The optimal uNGAL cut-off point was >9.99 ng/mL, with an AUC of 0.842, 81% sensitivity, and 78.9% specificity to predict AKI. The OR of AKI in children with uNGAL levels >9.99 ng/mL was 10.66 (95%CI 2.30 to 49.30; P=0.003). Conclusion Urinary neutrophil gelatinase-associated lipocalin (uNGAL) can be used as a predictor of acute kidney injury in children with critical illness.
Risk factors of mortality in children with acquired prothrombin complex deficiency at Dr. Zainoel Abidin General Hospital,Banda Aceh Munawarah, Syifa; Sovira, Nora; Anidar, Anidar; Herdata, Heru Noviat; Edward, Eka Destianti; Ismy, Jufitriani
Paediatrica Indonesiana Vol. 65 No. 3 (2025): May 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.3.2025.253-9

Abstract

Background  Acquired prothrombin complex deficiency (APCD) is a rare but life-threatening bleeding disorder in children. Intracranial hemorrhage (ICH) is the leading cause of death, with an estimated risk affecting 50–80% of cases. Key risk factors associated with mortality in APCD include onset of disease, presence of ICH, and the initial Glasgow Coma Scale (GCS) score. Routine intramuscular administration of vitamin K at birth has been shown to effectively prevent early and late-onset vitamin K deficiency bleeding. However, in settings where vitamin K prophylaxis is not administered or is delayed, the risk of APCD increases significantly. Despite these concerns, other potentially relevant clinical factors contributing to APCD outcomes remain under-investigated. Objective To identify risk factors associated with APCD mortality in children treated at Dr. Zainoel Abidin General Hospital, Banda Aceh. Methods This cross sectional study analyzing children diagnosed with APCD at Dr. Zainoel Abidin General Hospital from October 2022 to October 2024. Data were collected from the medical records of 30 children and analyzed using Chi-square and logistic regression tests. Results This study included 30 subjects, the majority of whom were male and aged 8 days to 6 months. Most of subject were born full term, delivered vaginally, and had birth weight ≥ 2.500 grams. Notably, 25/30 children did not receive vitamin K prophylaxis, 14/18 children were exclusively breastfed without vitamin K prophylaxis, and 25/30 children had good nutritional status. Late-onset APCD was observed in 14 out of 30 cases.  Intracranial vs extracranial hemorrhage was occurred in 21 vs 9 children. Initial GCS scores ≤ 8 at initiation of treatment were noted in 11/30 children. The mortality rate was occurred in 12/30 subjects (40%). Chi-square analysis revealed significant associations between increased mortality and late onset APCD (P=0.030), ICH (P=0.049), and initial GCS score ≤ 8 (P=0.009). Logistic regression analysis revealed initial GCS score was associated with the highest risk of mortality in APCD, with a 16-fold increase in risk (P=0.022; OR 15.9; 95%CI 1.5 to 168.9). Conclusion Intracranial hemorrhage, late-onset APCD, and initial GCS scores ≤ 8 are significantly associated with increased APCD mortality, with initial GCS emerging as the most influential risk factor.
Risk factors for poor initial response to valproic acid therapy in children with epilepsy Sari, Eva Devita; Anidar, Anidar; Amna, Eka Yunita; Andid, Rusdi; Yusuf, Sulaiman; Sovira, Nora
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.286-90

Abstract

Background The initial response in the first three months of valproic acid therapy is a prognostic factor for predicting treatment success, and it is considered to be poor if seizures persist during the three months of valproic acid treatment. Several factors might influence the initial response to valproic acid therapy, including gender, age, family history of epilepsy, electroencephalogram (EEG), head circumference, type of seizure, cerebral palsy, and pre-therapy seizure frequency. Objective To determine the risk factors for poor early response to valproic acid therapy in children with epilepsy. Methods This retrospective cohort study was conducted in children newly diagnosed with epilepsy. Data were collected from medical records of patients who had been treated at the Pediatric Polyclinic of dr. Zainoel Abidin Hospital for one year. Results Of 90 subjects, most were male (58; 64.4%) and aged three years or older (79; 87.8%). Forty-five (50%) patients had a family history of epilepsy. More than a quarter of the subjects (35; 38.9%) showed initial poor responses to valproic acid therapy. Bivariate analysis revealed risk factors for poor initial response to valproic acid therapy were age ≥ 3 years, family history of epilepsy, normal EEG, normal head circumference, generalized seizure type, cerebral palsy, and pre-therapy seizure frequency. However, multivariate analysis revealed that risk factors for poor initial response to valproic acid therapy in children with epilepsy that retained significance were family history of epilepsy (RR 6.58; 95%CI 1.67 to 25.95; P=0,001), abnormal EEG (RR 5.27; 95%CI 1.16 to 23.87; P=0,000), focal seizures (RR 7.10; 95%CI 1.15 to 43.80; P=0,000), and cerebral palsy (RR 62.62; 95%CI 3.93 to 996.45; P=0,001). Conclusion The risk factors for poor initial response to valproic acid therapy in children with epilepsy are family history of epilepsy, abnormal EEG, focal seizures, and cerebral palsy.
Risk factors for progression of chronic kidney disease in children with nephrotic syndrome Adrian, Riki; Sovira, Nora; Haris, Syafruddin; Andid, Rusdi; Darnifayanti, Darnifayanti; Yusuf, Sulaiman
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.291-6

Abstract

Background Nephrotic Syndrome (NS) is a progressive kidney disease in children that can lead to chronic kidney disease (CKD). Understanding the interactions between various risk factors is critical in developing new strategies to prevent the progression of CKD in pediatric patients with NS. Objective To determine the risk factors for the progression of CKD in children with nephrotic syndrome at Dr. Zainoel Abidin Public Hospital, Banda Aceh. Methods This analytical observational study with a cross-sectional approach was conducted from September 2021 to September 2023. Data were obtained from medical records of 52 children aged 2 to 18 years in the inpatient and outpatient wards of Dr. Zainoel Abidin Public Hospital, Banda Aceh who met the inclusion criteria. Bivariate analysis using the Chi-square and Fisher's tests and multivariate analysis using logistic regression test were performed. Results Of 52 subjects, most were male and over ten years of age; 53.8% of subjects had Stage 1 CKD. The majority of stage 3-5 of CKD cases had immunosuppressive toxicity and anemia, while the majority of all subjects had hyperfiltration and proteinuria. Risk factors for CKD progression in children with NS are Hypertension (OR 2.54; 95%CI 0.32 to 20.1; P=0.003), immunosuppressant toxicity with (OR 33.67; 95%CI 2.59 to 437.5; P=0.007) and anemia (OR 33.92; 95%CI 2.77 to 414.5; P=0.006). Conclusion Hypertension, immunosuppressant toxicity and anemia for CKD progression in children with NS.
Co-Authors Adrian, Riki Amna, Eka Yunita Andriyani, Dia Anidar Anidar, Anidar Bakhtiar Bakhtiar Carolina, Infra Yunita Chalisah, Lilis Darnifayanti, Darnifayanti Dewi, Teungku Puspa Dora Darussalam, Dora Edward, Eka D. Edward, Eka Destianti Fahrul Riza Fajar, Sukmawan Fajri, Fauzan Fajri, Rizky Fariyasni, Fariyasni Fiska, RR. Rima Aulia Gunawan, Aris Hasan, Denny I. Hasan, Denny Irmawati Haypheng, Te Herdata, Heru N. Herlina Dimiati, Herlina Heru Noviat Herdata, Heru Noviat Indirayani, Ima Ismy, Jufitriani Kowita, Nurul Huda Liza Salawati, Liza Maharani, Cut Rika Mulya Safri, Mulya Munawarah, Syifa Muslim Muslim Nadia, Nurul Nuriyanto, Alivia Rizky Pratiwi, Sari Novita Raihani, Rifa Rusdi Andid, Rusdi Safrizal Safrizal Sari, Eva Devita Sentosa, Sukmawan F. Srikandi, Mira Sulaiman Yusuf Syafruddin Haris, Syafruddin Thaib, Bakhtiar Thaib, T. M. Thaib, T.M. Thaib, Teuku Muhammad Zuhra, Sofi Alfia