Paediatrica Indonesiana
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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Effect of intravenous gentamicin on urinary calcium excretion in newborns
Kurniawan Tan;
Adrian Umboh;
Ari Runtunuwu
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi55.4.2015.185-8
Background Studies in newborns and animals have shown that gentamicin increases urinary calcium excretion. New recommendation for gentamicin in newborns is administered intravenously 36-48 hourly. Subsequent to this new recommendation, there have been no further studies on the effects of extended gentamicin dosage on urinary calcium excretion in newborns.Objective To assess the effect of intravenous gentamicin on urinary calcium excretion in newborns.Methods This pretest – posttest study was done in the Neonatology Division of Prof. DR. R. D. Kandou Hospital, Manado, from August to November 2013. Subjects were full-term newborns who received intravenous gentamicin every 36 hours and whose parents provided informed consent. We excluded newborns with asphyxia and cardiovascular shock, also those who received diuretics or steroids. Urine spot collection was done before, after the first dose, and after the second dose of intravenous gentamicin. Urinary calcium and creatinine levels were measuerd. Urine calcium excretion was defined as the ratio of urinary calcium to creatinine level.Results Of 28 newborns, there were 16 males and 12 females. The median of urine calcium creatinine ratio before intravenous gentamicin was 0.021 (range 0.004 to 0.071) mg/mg. After first dose of gentamicin, the median ratio was 0.043 (range 0.009 to 0.156) mg/mg, and after the second dose of gentamicin, the median ratio was 0.144 (range 0.015 to 1.160) mg/mg.Conclusion There is a significant increase in urinary calcium excretion after the first and second doses of intravenous gentamicin. Furthermore, a cumulative effect of gentamicin on urinary calcium excretion is observed after the second dose.Â
Risk of nutritional status on diarrhea among under five children
Wiliam Jayadi Iskandar;
I wayan Sukardi;
Yati Soenarto
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi55.4.2015.235-8
Background Diarrhea is still the leading cause of children’s mortality worldwide and the main cause of malnutrition. Meanwhile, malnourished children are proven to have more severe, prolonged, and frequent episodes of diarrhea, making them a vicious circle.Objective To investigate the risk of nutritional status on diarrheal severity and duration as well as length of hospital stay.Methods We conducted a cross sectional study involving 176 under five children who admitted to Mataram Province Hospital with acute diarrhea since January until December 2013. We analyzed data using logistic regression model.Results Most subjects were infants (median 12 months, range 1-53), male (56.8%), well-nourished (85.8%), admitted with acute watery diarrhea (97.2%), mild-to-moderate dehydration (71.6%), diarrhea severity score ≥11 (74.4%), duration of diarrhea ≤7 days (96.6%), and length of stay <5 days (73.3%). Logistic regression model indicated significant risk of nutritional status on length of hospital stay (adjusted OR 2.09, 95% CI 1.06 to 6.38), but neither diarrheal severity (adjusted OR 1.03, 95% CI 0.38 to 2.80) nor duration of diarrhea (adjusted OR = 1.17, 95% CI = 0.13 to 10.89) indicated significant risks. However, malnourished children had more severe (76% versus 74.2%) and longer duration (4% versus 3.3%) of diarrhea than well-nourished children.Conclusion Nutritional status is the risk for length of hospital stay in under-five children admitted with acute diarrhea. [
Skin prick test reactivity in atopic children and their number of siblings
Beatrix Siregar;
Lily Irsa;
Supriatmo Supriatmo;
Sjabaroeddin Loebis;
Rita Evalina
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi55.4.2015.189-93
Background Some studies have shown that low birth order is a risk factor for developing atopy, although these results remain inconclusive. Those studies put forth the hygiene hypothesis, which states that early childhood infections in siblings may protect against atopy. Hence, an inverse relationship between family numbers and atopy was found. Atopy may be diagnosed from a history of atopy in an individual or his family, and can be confirmed by specific IgE for allergens or positive skin prick tests.Objective To assess for an association between skin prick test reactivity in atopic children and their number of siblings.Methods A cross-sectional study was conducted in May to June 2010 in elementary school children at the Kampung Baru District, Medan Regency, North Sumatera. Subjects were divided into two groups. Group I had children with < 3 siblings and group II had children with ≥ 3 siblings. Skin prick tests were done in 7 to 10-year-old children with a history of asthma, allergic rhinitis and atopic dermatitis. Skin prick test reactivity results were analyzed by Chi-square test.Results A total of 192 subjects were enrolled in this study, with 96 subjects in each group. Positive skin prick tests were significantly higher in subjects with <3 siblings than in those with >3 siblings (75% and 53.1%, respectively; P=0.003).Conclusion Atopic children with <3 siblings had more positive skin prick tests than children with >3 siblings.
Melatonin level and sleep disorders in adolescents
Andre Inigo;
Hesti Lestari;
Nurhayati Masloman;
Julius Lolombulan
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi55.4.2015.215-8
Background Sleep disorder is defined as a disturbance in the quality and time of sleep. Decreased melatonin levels have been noted in people with sleep disorders. Melatonin is a neurohormone, produced mainly by the pineal gland, as well as a small part of the retina. Its function is to maintain normal circadian rhythms and it is related to sleep regulation in humans.Objective To assess for a relationship between melatonin levels and sleep disorders in adolescents.Methods We conducted a cross-sectional study on students of two secondary schools in Tuminting, Manado, North Sulawesi, from May to June 2013. Subjects were obtained by consecutive sampling for a total of 44 adolescents aged 12-15 years. Subjects filled questionnaires, underwent wrist actigraphy, and provided blood specimens for examination of melatonin levels. We used descriptive and logistic regression analyses to assess for relationships between variables.Results Thirty (68.2%) subjects experienced sleep disorders. There was a significant association between decreased melatonin levels and the higher incidence of sleep disturbances (P = 0.02).Conclusion There is a correlation between melatonin levels in adolescents with sleep disorders. Decreased melatonin levels are associated with sleep disorders.
Corticosteroids and obesity in steroid-sensitive and steroid-resistant nephrotic syndrome
Nina Lestari;
Neti Nurani;
Madarina Julia
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi55.4.2015.194-8
Background Children with nephrotic syndrome need high-dose corticosteroids to achieve remission. Studies have estimated a 35-43% risk of obesity in these patients after corticosteroid treatment.Objective To determine the prevalence of obesity in children who received corticosteroids for nephrotic syndrome, and to compare the risk of obesity in children with steroid-sensitive nephrotic syndrome (SSNS) and steroid-resistant nephrotic syndrome (SRNS).Methods We performed a retrospective cohort study in 50 children with SSNS or SRNS who received corticosteroid treatment. Obesity was defined to be a BMI-for-age Z-score above +2.0 SD, according to the WHO Growth Reference 2007. Central obesity was defined to be a waist-to-height ratio > 0.50.Results The overall prevalence of obesity was 22%, with 29% and 14% in the SSNS and SRNS groups, respectively. The overall prevalence of central obesity was 50%, with 54% and 46% in the SSNS and SRNS groups, respectively. The cumulative steroid doses in this study were not significantly different between the SSNS and SRNS groups. There were also no significant differences between groups for risk of obesity (RR 2.53; 95%CI 0.58 to 10.99) or central obesity (RR 1.39; 95%CI 0.45 to 4.25).Conclusion In children with nephrotic syndrome who received corticosteroids, the prevalence of obesity is 22% and of central obesity is 50%. In a comparison of SSNS and SRNS groups, cumulative steroid dose as well as risks of obesity and central obesity do not significantly differ between groups.
Developmental performance in small for gestational age children with and without catch-up growth
Hesti Lestari;
Suryani As’ad;
Irawan Yusuf;
Adrian Umboh;
Andi Dwi Bahagia Febriani
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi55.4.2015.199-202
Background Infants born small for gestational age (SGA) have an increased risk of developmental delay. The influence of catch-up growth on developmental function remains unknown.Objective To compare the development of SGA children with and without catch-up growth.Methods We conducted a cross-sectional study in Manado from March to July 2013. Subjects were children aged 2-3 years, that born SGA from March 2010 to June 2011 in Prof. Dr. R.D. Kandou Hospital. Catch-up growth was defined as height-for-age more than -2SD on the 2006 WHO growth chart, and subjects were classified into the with and without catch-up growth groups. Developmental status was assessed using the Ages and Stages Questionnaire (ASQ) 3rd edition, through interviews with parents. We compared the developmental status between the with and without catch-up growth groups used Mann-Whitney test with a significance level of P < 0.05.Results Of the 112 SGA children, 66 (58.9%) had catch-up growth and 46 (41.1%) did not. The SGA children with catch up growth had significant better development performances of gross motor, fine motor, and problem solving. The mean ASQ centiles of the with and without catch-up groups were 55.15 (SD 7.843) [95%CI 53.52 to 57.08] and 48.80 (SD 11.264) [95%CI 45.46 to 52.15] in gross motor, respectively; 42.5 (SD 13.163) [95%CI 39.26 to 45.74] and 32.93 (SD 14.475) [95%CI 28.64 to 37.23] in fine motor, respectively; 46.74 (SD 13.112) [95%CI 43.52 to 49.97] and 40.98 (SD 11.480) [95%CI 37.57 to 44.39] in problem solving, respectively.Conclusion Small for gestational age children with catch-up growth have significantly better gross motor, fine motor, and problem-solving performance than those without catch-up growth.
Ventricular function and high-sensitivity cardiac troponin T in preterm infants with neonatal sepsis
Nusarintowati Ramadhina;
Rubiana Sukardi;
Najib Advani;
Rinawati Rohsiswatmo;
Sukman T. Putra;
Mulyadi M. Djer
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi55.4.2015.203-8
Background Hemodynamic instability in sepsis, especially in the neonatal population, is one of the leading causes of death in hospitalized infants. The major contribution for heart dysfunction in neonatal sepsis is the myocardial dysfunction that leads to decreasing of ventricular function. The combination of echocardiography and laboratory findings help us to understand the ventricular condition in preterm infants with sepsis.Objective To assess for a correlation between ventricular function and serum high-sensitivity cardiac troponin T (hs-cTnT) level in preterm infants with neonatal sepsis.Methods We prospectively studied 30 preterm infants with neonatal sepsis who were admitted to the neonatal intensive care unit (NICU) of Cipto Mangunkusumo Hospital from June 1 – August 31, 2013. The ventricular functions were measured using 2-dimensional echocardiography. The parameters of right ventricular (RV) function assessment were tricuspid annular plane systolic excursion (TAPSE) and RV myocardial performance index (MPI). For left ventricular (LV) performance, we assessed ejection fraction (EF), fractional shortening (FS), and LV-MPI. Serum hs-cTnT was measured and considered to be a marker of myocardial injury.Results Subjects had a mean gestational age of 31.5 (SD 2.18) weeks and mean birth weight of 1,525 (SD 437.5) g. The mean LV function measured by MPI was 0.281 (SD 0.075); mean EF was 72.5 (SD 5.09)%; and mean FS was 38.3 (SD 4.29)%. The RV function measured by TAPSE was mean 6.85 (SD 0.94) and that measured by MPI was median 0.255 (range 0.17-0.59). Serum hs-cTnT level was significantly higher in non-survivors than in survivors [282.08 (SD 77.81) pg/mL vs. 97.75 (24.2-142.2) pg/mL, respectively P =0.023]. There were moderate correlations between LV-MPI and hs-cTnT concentration (r=0.577; P=0.001), as well as between RV-MPI and hs-cTnT concentration (r=0.502; P=0.005). The positive correlation between LV and RV-MPI in neonatal sepsis was strong (r=0.77; P <0.001).Conclusion Left and right ventricular MPI show positive correlations with hs-cTnT levels. Serum hs-cTnT is significantly higher in non survivors. As such, this marker may have prognostic value for neonatal sepsis patients.
Nutritional status and malaria infection in primary school-aged children
Washli Zakiah;
Tiangsa Sembiring;
Lily Irsa
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi55.4.2015.209-14
Background The most common nutritional problem affecting the pediatric population in developing countries is protein energy malnutrition (PEM). The nutritional problem may be caused by a variety of factors, most of which are related inadequate food intake and infection. One of the highest causes of morbidity and mortality in endemic areas is malaria. Malaria infection and nutritional status have been suggested to be interrelated.Objective To assess for a relationship between nutritional status and malaria infection in children.Methods This cross-sectional study was conducted in October and November 2010 in primary school children at Panyabungan City, North Sumatera Province. Peripheral thick and thin blood smear examinations were done to confirm the diagnosis of malaria. Participants were divided in two groups (malaria-infected and uninfected) by consecutive sampling. Nutritional status was determined by body weight and height measurements based on the 2000 Centers for Disease Control and Prevention (CDC) chart. The mild and moderate malnutrition classification was further sub-divided into stunted and wasted, based on the 2007 NCHS/WHO chart. Chi-square test was used to analyze the relationship between nutritional status and malaria infection.Results There were 126 children in each group. Significant differences in mild-moderate malnutrition were found between the malaria-infected and uninfected groups (23.8% vs. 46.8%, respectively; P= 0.011). There were also significant differences between the malaria-infected and uninfected groups with regards to chronic malnutrition type: stunted (20.0% vs. 37.3%, respectively; P=0.042) and stunted-wasted (6.7% vs. 28.8%, respectively; P= 0.008) in both groups of the children with mild-moderate malnutrition.Conclusion There are significantly more children with mild-moderate malnutrition in the uninfected group than in the malaria-infected group, furthermore, of those with mild-moderate malnutrition, there are significantly more stunted and stunted-wasted children who were uninfected than malaria-infected.
Poliovirus shedding after the first and second doses of trivalent polio vaccines in newborns
Viramitha K. Rusmil;
Meita Dhamayanti;
Sunarjati Soedigdo Adi;
Imam Megantara
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi55.4.2015.219-23
Background The trivalent oral polio vaccine (tOPV) produced by Bio Farma consists of three live, attenuated poliovirus serotypes (1, 2, and 3). The tOPV stimulates the formation of secretory IgA (sIgA) on the intestinal wall and lumen. The existence of sIgA is considered giving immunity in the intestines, it could prevent the spread of viral replication and thus inhibit the transmission of the polio virus.Objective To determine the differences in shedding after each of the first two tOPV immunizations in newborns.Methods This one-way repeated measure study was conducted in newborns from three primary health centers in Bandung, West Java. After administering tOPV to newborns, we assessed the shedding of poliovirus in their stool specimens at 30 days after the first dose and 7 days after the second dose. Data was analyzed using McNemar test with 95% confidence intervals (CI) to differentiate the shedding of poliovirus after the first and second doses.Results Of 150 children, 128 subjects completed the study. At 30 days after the first tOPV dose, 26 subjects (20.3%) were negative for shedding of poliovirus in stool specimens. Of the 102 subjects who had poliovirus isolated from their stools, the serotypes comprised of polio 1: 10.9%, polio 2: 14.8%, polio 3: 45.3%, polio 1 and 3: 3.1%, polio 2 and 3: 4.7%, and polio 1,2, and 3: 0.8%. At 7 days after the second tOPV dose, there was a significant increase in subjects negative for shedding of poliovirus (78 subjects; 60.9%). Statistical analysis revealed significantly decreased shedding of poliovirus in stool specimens between the first and second doses of tOPV (P<0.05 ).Conclusion There is a significantly decreased number of subjects with shedding of poliovirus in stool specimens 7 days after the second tOPV dose than at 30 days after the first tOPV dose.
Obesity and left ventricular mass in children
Mauliza Mauliza;
Muhammad Ali;
Melda Deliana;
Tina Christina L Tobing
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi55.4.2015.224-29
Background Obesity has negative effects on cardiac function during growth leading to increased heart size and mass, as a result of higher stroke volume and cardiac output.Objective To assess for a relationship between obesity and left ventricular mass (LVM) in children, as well as to assess for a correlation between the duration of obesity and LVM.Methods This cross-sectional study was conducted from October 2011 until February 2012 in Medan and included 30 obese and 30 normal weight children, aged 6 to 13 years. All subjects underwent complete echocardiography examinations to assess LVM and other left ventricular parameters. The Devereux formula was used to measure LVM.Results During the study, 65 children underwent echocardiography, but 5 were subsequently excluded. The left ventricular dimensions in the obese group were significantly higher compared to normal weight group with regards to interventricular septum at end diastole (IVSd), interventricular septum at end systole (IVSS), left ventricular internal diameter at end diastole (LVIDd), left ventricular internal diameter at end systole (LVIDs), left ventricular posterior wall thickness at end diastole (LVPWd), left ventricular mass (LVM), and left ventricular mass index (LVMI) (P=0.0001). Duration of obesity and LVM had a moderate, positive correlation (r=0.407).Conclusion There is significantly higher LVM in the obese group than in the normal weight group. The duration of obesity had a moderate, positive correlation to LVM.