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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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Articles 11 Documents

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Search results for , issue "Vol 55 No 2 (2015): March 2015" : 11 Documents clear

Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country? Eva M. Marwali; Sekarpramita Darmaputri; Dadang H. Somasetia; Sudigdo Sastroasmoro; Nikolaus A. Haas; Michael A. Portman
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Background Most children undergoing cardiac surgery forcongenital heart disease (CHD) in developing countries aremalnourished. Malnutrition is known as a co-morbidity factorthat might predict and influence outcomes after surgery.Objectives To evaluate the effect of malnutrition and otherassociated risk factors on post-operative outcomes in childrenwith CHDs underwent cardiac surgery.Methods We conducted a retrospective cohort study in a singlecenter tertiary pediatric cardiac intensive care unit (PCICU)in Indonesia. Our cohort included all children between 5 and36 months of age undergoing congenital heart surgery withcardiopulmonary bypass from November 2011 until February2014. Outcomes measured were the length of intubation and thelength of ICU stay. Variables for potential influence investigatedwere the nutritional status, age, gender, type of cardiac anomaly(acyanotic vs. cyanotic), Aristotle score, cardiopulmonary bypasstime, aortic cross-clamp time, and Pediatric Risk of Mortality(PRISM) III score.Results Out of 249 patients included, 147 (59%) showedmalnourishment on admission. Malnourished patients weresignificantly younger in age, presented with an acyanotic heartdefects, and had higher PRISM III score. Additionally, they alsohad a longer mechanical ventilation time and ICU stay thanthose with a normal nutritional status. After adjusting for variousvariables using a multiple logistic regression model it could bedemonstrated that a higher Z-score for weight to age was asignificant protective factor for the intubation time of more than29 hours with an odds ratio of 0.66 (95% CI 0.48 to 0.92, P =0.012). Non-malnourished patients had a 49% significantly higherchance for extubation with a hazard ratio of 1.49 (95% CI 1.12to 1.99, P= 0.007).Conclusion Malnourishment is clearly associated in a linearfashion with longer mechanical ventilation and ICU stay. As one ofsignificant and potentially treatable co-morbidity factors, preventionof malnourishment by early diagnosis and optimal timing for surgeryis important.

Procalcitonin for detecting community-acquired bacterial pneumonia Devi Gusmaiyanto; Finny Fitry Yani; Efrida Efrida; Rizanda Machmud
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Background Pneumonia is a major cause of morbidity andmortality in children under five years of age. Pneumonia can be ofbacterial or viral origin. It is difficult to distinguish between thesetwo agents based on clinical manifestations, as well as radiologicaland laboratory examinations. Furthermore, bacterial cultures taketime to incubate and positive results may only be found in 10-30%of bacterial pneumonia cases. Procalcitonin has been used as amarker to distinguish etiologies, as bacterial infections tend toincrease serum procalcitonin levels.Objective To determine the sensitivity, specificity, positivepredictive value and negative predictive value of procalcitoninin community-acquired bacterial pneumonia.Method This cross-sectional study was conducted in thePediatric Health Department of Dr. M. Djamil Hospital, Padang.Subjects were selected by consecutive sampling. Procalcitoninmeasurements and PCR screening were performed on bloodspecimens from 32 pneumonia patients and compared.Results Of the 32 subjects, most were boys (56.25%), under 5years of age (99%), and had poor nutritional status (68.75%).Using a cut-off point of 0.25 ng/mL, procalcitonin level hada sensitivity of 92%, specificity 50%, positive predictive valueÂ 88%, and negative predictive value 60% for diagnosing bacterialÂ pneumonia. Using a cut-off point of 0.5 ng/mL, procalcitonin levelÂ had a specificity of 46%, specificity 83%, positive predictive valueÂ 91%, and negative predictive value 25%.Conclusion A cut-off point of 0.25 ng/mL of procalcitonin levelÂ may be more useful to screen for bacterial pneumonia than a cutoffÂ point of 0.5 ng / mL. However, if the 0.25 ng/mL cut-off pointÂ is used, careful monitoring will be required for negative results,Â as up to 40% may actually have bacterial pneumonia. [PaediatrIndones. 2015;55:65-9.].

Quantitative NS1 antigen and the severity of dengue virus infections Ni Made Adi Purnami; Mohammad Juffrie; Made Gde Dwi Lingga Utama
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Background Dengue infection is one of the main cause ofmorbidity and mortality in children in Indonesia. Since it is knownthat earlier treatment and supportive therapies can decreased casefatality rate from dengue hemorrhagic fever (DHF), identificationof children who have risks to develop to DHF must be quicklyidentified, mainly in areas of endemic.Objective To find a correlation between increased quantitativesecreted nonstructural protein-1 (sNS1) with clinical course ofsevere dengue infections.Methods This was a cross-sectional study conducted on childrenwith dengue infections in Tropical Infections Division of ChildHealth Department, Sanglah Hospital, Denpasar. Detection ofthe dengue antigen was made by examining sNS1 quantitativeimmuno-assay. Analysis correlation of Spearman test was used tolook the relationship between increased quantitative sNS1 withclinical course of severe dengue infections.Results There was a positive relationship between quantitativesNS1 and clinical course of severe dengue infections with a valueof r = 0.903, P=0.001. Increased sNS1 level had a positivecorrelation with more severe dengue infections.Conclusions Quantitative sNS1 titer has a strong positivecorrelation with clinical course of severe dengue infections.

Relationship between childhood blood pressure and birth weight Sri Rahayu; Rusdidjas Rusdidjas; Rafita Ramayati; Oke Rina Ramayani; Rosmayanti Siregar
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

cardiovascular mortality and morbidity. Some studies havereported a significant relationship between elevated blood pressurein children with low birth weight.Objective To assess blood pressure differences in primary schoolstudents who had low and normal birth weights.Methods This cross-sectional study was conducted in 170children aged 6 to 12 years in March 2011 at a Medan primaryschool, North Sumatera. Blood pressure was measured with astandard mercury sphygmomanometer. A parental questionnairewas used to collect information on birth weight. Data wereanalyzed by studentâ€™s T-test for numerical data and Spearmanâ€™scorrelation test for a relationship between blood pressure andbirth weight.Results The subjects consisted of 85 children with low birth weightand 85 children with normal birth weight. The mean systolic (SBP)and diastolic blood pressures (DBP) were significantly higherin children with low birth weight than those with normal birthweight [SBP: 106.7 vs. 99.8 mmHg, respectively, (P=0.0001); andDBP: 69.2 vs. 63.5 mmHg, respectively, (P=0.0001)]. There wererelationships between elevated SBP and DBP and low birth weight,as indicated by correlation coefficient [r=-0.365 and r=-0.425,respectively, (P=0.0001)].Conclusion Blood pressure is significantly higher in children withlow birth weight than in those with normal birth weight. Birthweight was inversely related both to systolic and diastolic bloodpressure.

Hemoglobin profiles of siblings of thalassemia patients Muhammad Riza; Septin Widiretnani
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Background Thalassemia and hemoglobinopathies are themost common inherited disorders in many areas of the world,including South East Asia. The siblings of thalassemia major is agroup of high risk to carry the gene of thalassemia. Determiningthe carrier is useful for early treatment planning and preventionto the next child.Objective To determine carrier status among siblings ofthalassemia patients using a capillary electrophoresis system.Methods A cross-sectional study on the siblings of thalassemiamajor patients was performed from January 2011 to February2012 at Dr. Moewardi Hospital. Complete blood counts wereperformed in the siblings. Subjects with mean corpuscular volume(MCV) <80 fl and mean corpuscular hemoglobin (MCH) <27pg were subjected to analize hemoglobin fraction by capillaryelectrophoresis.Results Of the 26 subjects, there were 12 males and 14 females.The mean age was 9.38 (SD 6.8) years (range 1 to 29 years). Fromthe siblings, 10 were identified as normal, 5 were identified as ÃŸthalassemia carriers and 5 were hemoglobin E (HbE) carriers. Sixsiblings were diagnosed with ÃŸ thalassemia/ HbE.Conclusion There are high occurrence of the two common typesof thalassemia carriers (ÃŸ and HbE) in our small group of subjectswho had a family history of thalassemia. Most of the siblingsof thalassemia had low MCV and MCH.Â

Ferric sodium edetate therapy in children with iron deficiency anemia Christie Moningkey; Max F.J. Mantik; Vivekenanda Pateda
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Background Iron deficiency anemia (IDA) is frequentlyfound in school-aged children. The main treatments for IDAare overcoming the causal factors and iron supplementation.Noncompliance in taking iron tablets and the possibility of ironabsorbtion or transport difficulties, can reduce efficacy of daily oraliron supplementation. Because excess iron storage in the intestinalcells can lead to mucosal blockage, twice weekly oral iron therapymay be considered instead of daily dosage.Objective To compare the effects of daily vs. twice weekly ferricsodium edetate (NaFeEDTA) on hemoglobin (Hb), hematocrit(Ht), mean corpuscular volume (MCV), mean corpuscularhemoglobin (MCH), and mean corpuscular hemoglobinconcentration (MCHC) levels on children with IDA.MethodsWe conducted an open-label, randomized, prospectivestudy in 36 children with IDA aged 5-11 years. Subjects weredivided into two groups. For a one-month period, group I receiveddaily iron therapy (NaFeEDTA) and group II received twiceweekly iron therapy. Examinations of Hb, Ht, MCV, MCH, MCHCwere performed before and after iron therapy.Results There were no significant differences in Hb, Ht, MCV,MCH or MCHC levels after therapy between the daily and twiceweekly NaFeEDTA groups (P > 0.05).Conclusion Twice weekly NaFeEDTA therapy is as effective asdaily NaFeEDTA administration in children with IDA.

Efficacy of synbiotic treatment in children with acute rotavirus diarrhea Made Ratna Dewi; Yati Soenarto; I Putu Gede Karyana
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Background Diarrhea is one of the major causes of morbidityand mortality in children throughout the world, mostly due torotavirus infection. In daily practice, we routinely use the WorldHealth Organization Five steps for managing acute diarrhea.Thispractice has shown great success in diarrhea management, butconcerns remain on reducing the duration of diarrhea to preventcomplications. Synbiotics can reduce the severity of diarrhea.However, there has been limited data on synbiotic therapy fortreating acute rotavirus diarrhea in children.Objective To compare the durations of acute rotavirus diarrheatreated with synbiotics vs. placebo.Methods This study was a randomized, double-blind, clinical trial,performed at the Pediatric Gastrohepatology Division, Sanglahand Wangaya Hospitals in Denpasar. Subjects were children aged6 to 59 months with acute rotavirus diarrhea. Rotavirus wasdiagnosed by immune chromatography assay. The synbiotic groupreceived probiotic comprised of Lactobacillus sp., Streptococcus sp.,Bifidobacterium sp. (total viable count 1.00x109 CFU per dose), andprebiotic consisted of 990.00 mg fructooligosacharide (FOS). Theplacebo consisted of lactose monohydrate packaged similarly as thesynbiotics. Subjects orally ingested 1 pack per day for 5 days.Results Seventy children with acute rotavirus diarrhea wasinvolved in this study. The median duration of diarrhea in thesynbiotic group was 50.0 (SE 1.1); 95%CI 47.9 to 52.1 hours, whilethat of the placebo group was 63.0 (SE 5.9); 95%CI 51.4 to 74.6hours. Based on Kaplan-Meier survival analysis, the duration ofdiarrhea in the synbiotic group was significantly shorter than thatof the placebo group (log-rank test P <0.0001).Conclusion In children with acute rotaviral diarrhea, synbioticreduces the duration of diarrhea compared to placebo.

Soluble transferrin receptor as an indicator of iron deficiency and febrile seizures Salma Salma; Rita Arifin; Erial Bahar; Rini Purnamasari
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Background Iron deficiency (ID) has a high incidence inIndonesia, and is a risk factor for febrile seizures. The most suitableassay to detect iron deficiency in the presence of inflammationhas not yet been defined. An indicator of ID unaffected byinflammation is needed, soluble transferrin receptor (sTfR) maybe such an indicator.Objective To evaluate ID as a risk factor for febrile seizures inchildren with inflammation by sTfR measurements.Method We conducted an age-matched, case-control study,focused on children experiencing on acute illnesses at the time.Subjects were 80 children matched by age (40 in the case groupwith febrile seizures, and 40 in the control group who were febrilewithout seizures) aged 3 months to 5 years in Mohammad HoesinHospital, Palembang from February to August 2013. Subjectsâ€™clinical data and sTfR levels were recorded. Risk factors wereanalyzed with odd ratios and 95% confident intervals. ThesTfR level cut-off point as a predictor of febrile seizures was alsodefined. Other risk factors were analyzed with multivariate logisticregression test.Results Mean sTfR levels were 41.36 (SD 2.04) nmol/L in thecase group and 33.09 (SD 1.02) nmol/L in the control group.Multivariate analysis revealed ID and iron deficient anemia(IDA), as measured by sTfR levels, to be risk factors for febrileseizures (adjusted OR=3.9; 95%CI 1.41 to 10.8; P=0.007 andOR 3.27; 95%CI 1.21 to 8.84; P=0.017, respectively). The sTfRlevel cut-off point that could be used as a predictor of febrileseizures was 37nmol/L.Conclusion Iron deficiency as measured by increased sTfR isa risk factor for febrile seizures in children.

Efficacy of sputum induction from lower respiratory tract in children Madeleine Ramdhani Jasin; Darmawan Budi Setyanto; Sri Rezeki Hadinegoro; Lisnawati Lisnawati; Pramita Gayatri; Nia Kurniati
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Background Although sputum is a good specimen for variousexaminations, such as cytology and microbiological culture,sputum induction (SI) is not a routine procedure in children.Objective To identify the efficacy of SI to obtain specimen fromlower respiratory tract in children, identify side effects of SI, andthe results of microbiological examination.Methods A cross sectional study was performed in children (aged1 month to 18 years) who underwent SI. Sputum induction wasperformed by inhalation with hypertonic solution, consisted ofsalbutamol for 15 minutes continued with NaCl 3% solutionfor another 15 minutes. Sputum specimens were examined fornumber of alveolar macrophage cell, surfactant protein A (SP-A)concentration, also acid-fast bacili smear, and M. tuberculosisculture, or aerobic microbial culture.Results Forty subjects with lower respiratory tract infectionparticipated in this study, and SI was succesfully performed inall subjects. Youngest subject was 2 month old, the eldest was 16year 7 month old. Median duration of SI was 45 minutes, andmajority of volume was 3 or 4 mL. Side effects were nosebleeds(40%) and vomiting (2.5%). Macrophage alveolar more than 5cells in one specimen was found in 97.5% subjects. Surfactantprotein A examination was performed in 30 specimens, and SP-Awas detected in all specimens (median concentration 264.528 pg/mL). Culture for M. tuberculosis was positive in 1 of 27 subjects,while acid fast bacili smear was negative in all examined subjects.Aerobic microbial culture was positive in 5 of 13 subjects.Conclusions Sputum induction has good efficacy in obtaininglower respiratory tract specimen and it is safe to perform inchildren. Specimen from sputum induction yields good positiveresult for aerobic microbial cultures.

Bacterial pneumonia score to identify bacterial pneumonia Ied Imilda; Finny Fitry Yani; Didik Hariyanto; Darfioes Basir
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Background Pneumonia is caused by either bacterial or viraletiologies, with similar symptoms in children. The bacterialpneumonia score (BPS) is a clinical assessment comprised ofseveral investigations: age, assessment of axillary temperature,absolute neutrophil count, band neutrophil percentage, andinterpretation of radiological examination. The score will use todifferentiate the etiology of pneumonia.Objective To determine the sensitivity, specificity, positivepredictive value, and negative predictive value of BPS inidentifying bacterial pneumonia in children.Methods This diagnostic study was performed at Dr. M. DjamilHospital, Padang, West Sumatera where subjects were selected byconsecutive sampling. Fifty-seven patients were diagnosed withpneumonia. Three patients suffered from ventricular septal defects,8 patients refused to provide blood specimens and 3 patientsâ€™chest X-rays could not be interpreted, hence, 43 subjects wereincluded in the study. Chest X-rays were interpreted by a pediatricpulmonology consultant. Leukocyte and differential counts wereperformed by a clinical pathology consultant. Subjectsâ€™ BPS scoreswere compared to multiplex PCR examinations of blood specimens,as the gold standard.Result Of 43 subjects, 27 (62.79%) were male. Subjectsâ€™ mean age was 29.3 (SD 21.5) months. Twenty (46.51%) subjects had good nutritional status, 4 (9.31%) subjects had axillary temperature â‰¥39Â°C, and 22 (51.16%) subjects had absolute neutrophil counts â‰¥8.000/mm3. Bacterial pneumonia score (BPS) had 69% sensitivity, 60% specificity, 42% positive predictive value, and 81% negative predictive value.Conclusion In this study, BPS has low sensitivity and specificityfor identifying bacterial pneumonia.

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