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Paediatrica Indonesiana

paediatrica-indonesiana
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Published by Ikatan Dokter Anak Indonesia

ISSN : 00309311 EISSN : 2338476X DOI : -

Core Subject : Health,

Health Professions Medicine & Pharmacology

Paediatrica Indonesiana is a medical journal devoted to the health, in a broad sense, affecting fetuses, infants, children, and adolescents, belonged to the Indonesian Pediatric Society. Its publications are directed to pediatricians and other medical practitioners or researchers at all levels of health practice throughout the world.

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Search results for , issue "Vol 53 No 1 (2013): January 2013" : 11 Documents clear

Risk factors of bronchiolitis I Gde Doddy Kurnia Indrawan; IB Subanada; Rina Triasih
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Background Bronchiolitis peak incidence is in children aged 2 -6months. History of atopy in parents, non-exclusive breastfeeding,exposure to cigarette smoke, and infants living in crowded areasmay be risk factors for bronchiolitis. Gestational of age at birth isalso influences the mortality oflower respiratory tract infection.Objective To evaluate the following conditions as possiblerisk factors for bronchiolitis: history of atopy, non-exclusivebreastfeeding, preterm infants, exposure to cigarette smoke, and2:: 6 persons residing in the home.Methods A sex-matched case-control study was conductedby collecting data from medical records at Sanglah Hospital,Denpasar. The case group subjects met the diagnostic criteriafor bronchiolitis and were aged 1-24 months. The control groupincluded patients with diagnoses unrelated to the respiratorysystem. Data was analyzed using bivariate (Mc.N emar) andmultivariate methods (logistic regression) with 95% confidenceintervals and statistical significance value of P <0 .05.Results There were 96 subjects in our study, consisted of 48subjects in the case group and 48 in the control group. Thecase and control groups were similar in baseline characteristics.The presence of history of atopy (OR 34.7; 95%CI 3 to 367,P=0.003), non-exclusive breastfeeding (OR 4.3; 95%CI 1.4 to13, P=0.010), exposure to cigarette smoke (OR 3; 95%CI 1 to9.2, P=0.047), and 2:: 6 persons living in the home (OR 7.9;95%CI 2.6 to 24, P<0.0001) were found to be significant riskfactors for bronchiolitis, while the preterm infants seem notsignificant as a risk factor of bronchiolitis (OR3; 95%CI 0.31 to78.99, P=0.625).Conclusion History of atopy, non-exclusive breastfeeding,exposure to cigarette smoke, and 2:: 6 persons living in the homeare found to be risk factors, while preterm infants seem not a riskfactor for bronchiolitis.

Antibiotics on incidence of infection in neonates with meconium-stained amniotic fluid M. Sholeh Kosim; N. P. Noerpramana; Asril Aminullah; Suharyo Hadisaputro
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Background The effectiveness of antibiotics for preventinginfection in neonates with meconium-stained amniotic fluid(MSAF) remains unclear. Not all neonates with MSAF developmeconium aspiration syndrome (MAS) or neonatal infection.Furthermore, neonatal infection diagnosis may be difficult dueto lack of symptoms. As such, clinical manifestations, laboratoryresults, and infection markers are important for diagnosis.Objective To evaluate antibiotic use on the incidence ofinfectionin neonates with MSAF.Methods This double-blind randomized controlled clinical trialwas performed at Dr. Kariadi Hospital, Semarang, Indonesia fromOctober 2009 to March 2010. Subjects were newborns with MSAFwho were diagnosed by two observers (Kappa test intraobserveragreement was 0.74) and with feces metabolites found in theiramniotic fluid. Sixty-nine newborns were divided into groups Iand II, comprised of 35 and 34 subjects, respectively. Group Isubjects (control group) were not given antibiotics, while groupII subjects (treatment group) were given combination antibioticsof ampicillin (50 mg;kg BW) and gentamicin (8 mg;kg BW), assingle doses. Neonatal infection diagnosis was based on clinicalmanifestations, laboratory results (leucocyte count, blood culture,and I: T ratio), and the following infection markers: procalcitonin(PCT), interleukin-6 (IL-6), tumor necrosis tumor-a (TNF-a),and C-reactive protein (CRP). Chi-square and Fischer's exacttests were used for statistical analyses.Results We found no significant differences in the incidence ofneonatal infection between those who received and those whodid not receive antibiotics, based on clinical manifestations, thefirst and second examination of laboratory marker (P=0.53),examinations of CRP, IL-6, TNF-a, and PCT either as singlemarkers or combinations of 2, 3, or 4 markers (P> 0.05) , as wellas mortality rate (P=0.30).Conclusion There is no significant difference in the incidenceof infection in neonates with MSAF who received prophylactic antibiotics compared to those who did not receive antibiotics.

Correlation between tumor necrosis factor-alpha and septic shock in children Khrisanti Dinata; Ari L. Runtunuwu; Jose M. Mandei; Julius H. Lolombulan
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Background The crucial role cytokines play in the pathophysiologyof sepsis is widely accepted. Infection stimulates the productionof cytokines in various cell types. Tumor necrosis factor-alpha(TNF-a) is one of the most extensively investigated cytokines inexperimental and clinical sepsis. Tumor necrosis factor-alpha hasbeen shown to mediate lethality in experimental sepsis.Objective To evaluate for a possible correlation between TNF-alevel and septic shock in children.Methods This cross-sectional study was conducted in Manadofrom June to September 2011. A total of 40 patients with arecent diagnosis of sepsis or septic shock were included. Plasmaspecimens were collected from subjects for measurement ofTNF-a concentration. Logistic regression analysis was used toassess the correlation between TNF-a level and sepsis, as well asthe probability of shock in children with sepsis, with P<0.05 asstatistically significant.Results There was a strong positive correlation betweenTNF-a level and the probability of shock in children with sepsis(regression coefficient = 0. 78, P = 0.002).Conclusions There is a strong positive correlation betweenTNF-a level with the probability of shock in children with sepsis.Higher plasma level ofTNF-a is associated with higher probabilityof septic shock.

Association between hyperglycemia and organ dysfunction in shock patients Sheila Noberta; Silvia Triratna; Aditiawati Aditiawati; Syarif Husin
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Background Hyperglycemia is an important marker of bothpoor clinical outcomes and high mortality rate in critically illpatients. Glucose toxicity results in cell damage that leads toorgan dysfunction.Objective To evaluate for an association between hyperglycemiaand the incidence of organ dysfunction in shock patients.Methods This cross-sectional study was conducted in thepediatric intensive care unit (PICU) of Dr. Moh. HoesinHospital, Palembang from June to November 2011. Subjectswere consecutively-enrolled, shock patients without a historyof diabetes mellitus. Illness severity and organ dysfunction weredetermined by pediatric risk of mortality (PRISM) III score andpediatric logistic organ dysfunction (PELOD) scores, respectively.Hyperglycemia was defined as a blood glucose level 2: 110 mg/dL.Statistical analysis was performed with SPSS version 15.Results Mean age of subjects was 2.30 (SD 2.93) years. MeanPRISM III score was 15 .11 (SD 5 .63). Prevalence of hyperglycemiawas 80.0%. Mean glucose level was 179.51 (SD 86.84) mgldL.Mean PELOD score was 16.02 (SD 13.87). Organ dysfunction wasobserved in 86.7% of subjects. The most common organ dysfunctionobserved in our subjects was liver dysfunction (73.3%). Therewas a significant association between hyperglycemia and organdysfunction (OR43.750;95%CI 4.036 to474.252, P=0.001). Theblood glucose level cutoff points indicative of organ dysfunction,PRISM III score 2: 8, and PELOD score 2: 20.5 were 114.5 mg/dL, 129 mgldL, and 166 mg/dL, respectively.Conclusion There is an association between hyperglycemia andorgan dysfunction. The upper limit blood glucose level indicative oforgan dysfunction is 114.5 mg/dL. A glucose level of 129 mgldL maybe considered to be a warning to start blood glucose monitoring. Alevel above 166 mgldL may be used to indicate the necessity of startinginsulin therapy intervention.

Renal manifestations in tuberous sclerosis patients: two case reports Oke Rina Ramayani; Rosmayanti Rosmayanti; Rafita Ramayati; Rusdidjas Rusdidjas
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Tuberous sclerosis (TS) is a neurocutaneous disorder, characterized bymental retardation, epilepsy, and facialangiofibromas. The incidence has beenestimated to be 1 case per 6000 live births.Although rare, this disorder is a cause of mentalretardation with severe epilepsy.1 Scientists havefound manifestations of this disorder not only inbrain and skin, but also in the eyes, heart, lungs, andkidneys, so it has been renamed tuberous sclerosiscomplex (TSC).

Correlation between chest x-ray findings and outcomes of patients with mechanical ventilation Indah Nurhayati; Muhammad Supriatna; Kamilah Budhi Raharjani; Eddy Sudijanto
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Background Most infants and children admitted to the pediatricintensive care unit (PICU) have respiratory distress and pulmonarydisease as underlying conditions. Mechanical ventilation may beused to limit morbidity and mortality in children with respiratoryfailure.Objective To assess a correlation between chest x-ray findingsand outcomes of patients with mechanical ventilation.Methods This retrospective study was held in Dr. KariadiHospital, Semarang, Indonesia. Data was collected from themedical records of children admitted to the PICU from Januaryto December 2010, who suffered from respiratory distress andused mechanical ventilation. We compared chest x-ray findings tothe outcomes of patients. Radiological expertise was provided byradiologists on duty at the time. Chi-square and logistic regressiontests were used for statistical analysis.Results There were 63 subjects in our study, consisting of 28 malesand 35 females. Patient outcomes were defined as survived or died,43 subjects ( 68%) and 20 subjects (3 2%), respectively. Chest x-rayfindings revealed the following conditions: bronchopneumonia48% (P=0.298; 95%CI 0.22 to 1.88), pleural effusion 43%(P=0.280; 95%CI 0.539 to 4.837) , pulmonary edema 6%(P=0.622; 95%CI 0.14 to 14.62) and atelectasis 3% (P=0.538;95%CI 0.03 to 7 .62). None of the chest x-ray findings significantlycorrelated to patient outcomes.Conclusion Chest x-ray findings do not correlate to patientoutcomes in pediatric subjects with mechanical ventilation inthe PICU of Dr. Kariadi Hospital, Semarang, Indonesia.

Obesity and academic performances in adolescents Nina Herlina; Julistio TB Djais; Kusnandi Rusmil
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Background Adolescence is a phase of dynamic developmentin human life, marked by rapid physical growth, in addition tomental, emotional, and social development. Adolescent obesityhas been related to metabolic disease, in addition to psychologicaldisorders, which may lead to a negative impact on academicperformances.Objective To assess academic performances in adolescents withobesityMethods A cross-sectional study was conducted in Junior HighSchool No. 14 in Bandung from December 2010 to July 2011.Subjects were aged 12 to 14 years, and were divided into two groups:obese or good nutritional status. Statistical analysis using Fisher'sexact test was performed to assess the association of obesity andacademic performances. T-test was used to compare subjects' meanmathematics and English performances in the two groups.Results There were 24D students who met the inclusion criteria.Since there were 40 obese subjects in the first group, we randomizedthe remaining students to obtain 40 subjects with good nutritionalstatus for the second group. Best academic performances inmathematics and English was obtained mostly by subjects in thegood nutrition group (38/40 and 39/40, respectively). Statisticalanalysis revealed a significant association of lower performances inmathematics (mean difference -2.8; 95%CI -5 to -0.6; P=0.043)and English (mean difference -1.9; 95%CI -3.5 to -0.2; P=0.001)to obesity. We also found a significant association of bettermathematics (P=0.001) and English performances (P=0.004)to the father's occupation. Additional English lessons were notassociated with higher English performances in the obese group(mean difference 0.2; 95%CI -2.9 to 3 .2; P=0.885).Conclusion Obese adolescents tend to have poorer academicperformances compared to those with good nutritional status.

Recurrent abdominal pain in adolescents with anxiety and depression disorders Fastralina Fastralina; Sri Sofyani; M. Joesoef Simbolon; Iskandar Z. Lubis
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Background Anxiety and depression disorders in adolescentsmay affect their academic performances and social functioningat school. Adolescents with these disorders sometimes developrecurrent abdominal pain (RAP).Objective To assess the occurence of recurrent abdominal painamong adolescents with anxiety and depression disordersMethods We conducted a cross-sectional study from Augustto September 2009 in 12-18 year-old adolescents from 3 juniorhigh schools and 3 senior high schools in Secanggang Subdistrict,Langkat District, North Sumatera Province. We screened 960adolescents. Subjects were selected by consecutive samplingand instructed to fill the child behavior checklist (CBCL) andchildren's depression inventory (CDI) forms. Those with suspectedanxiety/depression (CBCL score 2: 12 for boys and 2: 14 for girls)and those with suspected depression (CDI score 2: 13) were thenexamined by a psychiatrist. Adolescents diagnosed with anxiety ordepression disorders were instructed to fill the RAP questionnairebased on Apley and Naish criteria.Results From the CBCL and CDI forms, 250 students weresuspected of having anxiety and/or depression. From these,144 students participated in this study. Of the 84 students withanxiety disorders, 60 (71.4%) students suffered from RAP. Ofthe 60 students with depression disorders, 31 (51 %) sufferedfrom RAP.Conclusion Adolescents with anxiety or depression are morelikely to have recurrent abdominal pain.

Significant clinical features in pediatric pneumonia Wisman Dalimunthe; Rini S Daulay; Ridwan M Daulay
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Background Pneumonia is the leading cause of childhood mortalityin the world. Although WHO develops an algorithm fordiagnosing pneumonia, many clinicians still under or overdiagnosethis disease.Objective To assess associations of cough, tachypnea, fever, andchest indrawing with pneumonia in children.Methods This cross-sectional study was conducted using medicalrecords of children aged less than 5 year old with one or more clinicalsigns of pneumonia such as cough, fever, tachypnea, and chestindrawing in Haji Adam Malik Hospital, Medan from January2009 to December 2011. Pneumonia was diagnosed by pediatricrespirologists based on history-taking, and physical, laboratoryand radiology examinations. Patients with incomplete datawere excluded. Data was analyzed by bivariate and multivariateanalyses.Results Of 420 subjects, the majority were aged 3 to 23 monthsand there were more boys than girls. Clinical signs assessed forwere cough (82.9%), tachypnea (31 %), fever (79.3%), and chestindrawing (40.2%). Age < 24 months (OR 2.563; 95% CI 1.497to 4.387), cough (OR 2.274; 95% CI 1.042 to 4.960), tachypnea(OR 2.249; 95% CI 1.282 to 3.947), and chest indrawing (OR6.993; 95% CI 4.017 to 12.173) were significant predictors forpneumonia.Conclusion Age less than 24 months, cough, tachypnea, andchest indrawing are significantly associated with pneumonia.

Prognostic factors and survivals of children with steroid-resistant nephrotic syndrome Partini Pudjiastuti Trihono; Nina Dwi Putri; Aman B Pulungan
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Background Children with steroid resistant nephrotic syndrome(SRNS) generally survive, although during the course of diseasetheir kidney function may decrease, leading to end-stage renaldisease (ESRD). There have been few studies reporting on thesurvivals of children with SRNS.Objectives To determine patient and kidney survival rates in childrenwith SRNS at the first, second, third, fourth, and fifth years; and toevaluate the effects of age at onset, initial kidney function, hypertension,and type of resistance, on the survivals of children with SRNS.Methods This retrospective cohort study was performed usingsecondary data obtained from medical records of patients with SRNS inDepartment of Child Health, Cipto Mangunkusumo Hospira~ between2004-2011. The outcomes of kidney survivals were defined in two ways:lack of doubling of base creatinine levels and lack of ESRD.Results There were 45 children with SRNS in our study. Their medianduration ofillness was 24 (range 12-95) months. Twenty percent of thesubjects died, 31.1 % had a doublingofbase creatinine levels, and 13.4%developed ESRD. Life survival rates of subjects at the first, second,third, fourth, and fifth years after diagnosis were 93 %, 84%, 80"/ri, 7 2%,and 61 %, respectively. Kidney survival rates determined by the lackof doubling of base creatinine levels at the first, second, third, fourthand fifth years were 92%, 72%, 56%, 42%, and 34%, respectively, whilekidney survival rates determined by the lack ofESRD were 97%, 88%,81 %, 70"/o, and 58%, respectively. Age at onset, initial kidney function,hypertension at onset, and type of resistance, did not significantly affectthe survivals of children with SRNS.Conclusion Children with SRNS are prone to develop a doublingof base creatinine levels and ESRD. Factors such as age, initialkidney function, hypertension at onset, and type ofresistance, donot significantly affect both, life and kidney survivals of childrenwith SRNS.

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