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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 9 Documents

Search results for , issue "Vol 56 No 6 (2016): November 2016" : 9 Documents clear

Persistent proteinuria as an indicator of renal disease in HIV-infected children Yuni Hisbiiyah; Risky Vitria Prasetyo; Dwiyanti Puspitasari; Ninik Asmaningsih Soemyarso; Ismoedijanto Moedjito; Mohammad Sjaifullah Noer
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

Background Persistent proteinuria (microalbuminuria) has been reported to be a precursor of HIV-related renal disease. Screening allows for early management in order to prevent the progression of renal disease and decrease morbidity and mortality associated with chronic kidney disease in HIV. Several studies have been done on renal manifestation in HIV-infected children from American and African regions, but similar studies from Asia are lacking.Objective To determine the prevalence of persistent proteinuria in HIV-positive children on antiretroviral therapy (ARV) in Dr. Soetomo Hospital, Surabaya.Methods A cross-sectional study on children with HIV and treated with Â highly active antiretroviral therapy (HARRT) was done from August 2014 to February 2015. Microalbuminuria was measured by the ratio of urine albumin to creatinine (ACR), while proteinuria was measured by dipstick. Measurements were performed 3 times in 4-8 weeks. All subjects underwent complete evaluation of blood tests, serum creatinine, blood urea nitrogen (BUN), CD4 counts, and urinalysis. Data were analyzed using Chi-square and logistic regression tests.Results Of 38 children on HARRT enrolled in this study, 2 subjects developed acute kidney injury (AKI), 4 subjects were suspected to have urinary tract infection (UTI), and 1 subject was suspected to have urinary tract stones. The prevalence of persistent microalbuminuria was 2.6%. There was no correlation between immunological status, WHO clinical stage, or duration of ARV and the incidence of persistent proteinuria (P>0.05).Conclusion The prevalence of persistent proteinuria is Â lower in younger HIV-infected children at a non-advanced stage and HIV-infected children with normal immunological status who are on HAART. We provide baseline data on the renal conditions of HIV-infected children in the era of HAART, before tenovofir is Â increasingly used as an antiretroviral therapy regimen in Indonesia.

Comparison of serum aminotranferases in overweight and obese children Ayu Shintia Shanti; I Gusti Lanang Sidiartha
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

Background Obesity has become a global issue. Non-alcoholic fatty liver disease is a metabolic complication of obesity, and indicated by elevated serum aminotransferases.Objective To compare serum aminotransferase levels in overweight and obese children.Methods This cross-sectional study was conducted from August to October 2015. A total of 82 subjects aged 6-10 years met the study criteria. Blood specimens and data concerning lifestyle and family history using questionnaires were collected. Subjects were divided into three groups based on BMI: overweight, obese, and severely obese. Comparisons of serum aminotransferase levels were analyzed by Kruskal-Wallis and post hoc tests, with P values < 0.05.Results The median serum alanine aminotransferase (ALT) levels in overweight, obese, and severely obese subjects were 14 (IQR 6-42) U/L, 15 (IQR 11-44) U/L, and 23 (IQR 9-59) U/L, respectively (P=0.031). The median serum aspartate aminotransferase (AST) levels in overweight, obese, and severely obese subjects were 22 (IQR 17-36) U/L, 22 (IQR 16-32) U/L, and 24 (IQR 15-41) U/L, respectively (P=0.049). Post hoc analysis revealed that median serum ALT levels were significantly higher in the severely obese group than in the overweight group [-8.982 (95% CI -14.77 to -3.20; P=0.003)], as well as in the obese group [-5.297 (95% CI -10.58 to -0.02; P=0.049)]. In addition, the median serum AST level was significantly higher in the severely obese group than in the obese group [-2.667(95% CI -5.27 to -0.07; P= 0.044)].Conclusion Median serum ALT and AST levels are significantly higher in severely obese children than in obese and overweight children.Â

Diabetic ketoacidosis with acute kidney injury in prepubertal children: a report on two cases Dwi Andriyani; Afriyan Wahyudhi; Shirley Leonita Anggriawan
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

Type 1 diabetes mellitus is a result of autoimmune damage, in which environmental factors are thought to trigger the autoimmune destruction of pancreatic ÃŸ-cells.1,2 Worldwide, an estimated 65,000 children under 15 years of age develop type 1 diabetes mellitus each year.3 Approximately 30% of children who present with newly-diagnosed type 1 diabetes have diabetic ketoacidosis (DKA).4 Himawan et al. reported a DKA prevalence of43.6% in girls.5 The long-term effects of diabetes mellitus include retinopathy, chronic kidney disease (nephropathy), neuropathy, and dyslipidemia.2

Scoring system to distinguish between rotavirus and non-rotavirus diarrhea in children Atika Akbari; Hasri Salwan; Achirul Bakri; Erial Bahar
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

Background Distinguishing rotavirus from non-rotavirus diarrhea is helpful for managing the illness. However, definitively diagnosing rotavirus diarrhea from serology is difficult and expensive.Objectives To distinguish between the clinical manifestations of rotavirus and non-rotavirus diarrhea, and to assess the accuracy of using such clinical manifestations to predict the type of diarrhea in children.Methods A cross-sectional study was performed from April to October 2015 in all children less than five years of age who presented with acute diarrhea at the Pediatric Outpatient Clinic of the Department of Child Health and Emergency Department, Dr. Mohammad Hoesin and Bari Hospitals, Palembang, South Sumatera. Clinical manifestations were collected from history and physical examinations; stool specimens were examined by immunochromatography. Clinical parameters were analyzed by multivariate analysis, and scores given to each significant parameter. The accuracy of the scoring system based in these parameters was analyzed by means of receiver-operating characteristic (ROC) area under the curve (AUC).Results Of 184 children, 92 had rotavirus and 92 had non-rotavirus diarrhea. Multivariate analysis showed 3 clinical parameters commonly seen in the rotavirus diarrhea cases: male sex (OR 2.718; 95%CI 1.373 to 5.382), cough (OR 3.500; 95%CI 1.788 to 6.582), and yellow-greenish stool (OR 4.009; 95%CI 2.061 to 7.797). A scoring system was constructed based on the parameters: male (score of 1), cough (score of 2), and yellow-greenish stool (score of 3). From ROC analysis, the AUC was 0.755. Using a cut-off score of > 3, the sensitivity was 81.5%, specificity 51.1%, and PPV 62.5%.Conclusion Cough, yellow-greenish stool, and male are significant parameters for differentiating rotavirus from non-rotavirus diarrhea. A scoring system from these parameters is sensitive for predicting rotavirus vs. non-rotavirus diarrhea in children less than five years of age.

Red cell distribution width and mortality in pediatric sepsis Trina Devina; Munar Lubis; Erna Mutiara; Gema Nazri Yanni; Rina Amalia C. Saragih; Yunnie Trisnawati; Aridamuriany Dwiputri Lubis; Putri Amelia
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

Background Red cell distribution width (RDW) is a hematological parameter routinely obtained as part of the complete blood count. Recently, RDW has emerged as a potential independent predictor of clinical outcomes in adults with sepsis. However, RDW as a mortality predictor in pediatric populations has not been well established.Objective To determine the relationship between RDW value and mortality outcomes in pediatric sepsis patients.Methods We performed a cross-sectional study of 40 consecutive pediatric patients with sepsis admitted to the PICU from December 2013 to March 2014. All patientsâ€™ RDW were collected within 24 hours of sepsis diagnosis. We determined the association between RDW and hemoglobin (Hb) using Spearmanâ€™s correlation. The RDW values of 11.5-14.5% were considered to be normal while those > 14.5% were considered to be elevated. We compared mortality and PICU length of stay (LoS) between the normal and elevated RDW groups using Chi-square and Mann-Whitney tests.Results The median age of patients was 34 months (range 2 months to 17 years). There were 28 (70%) male subjects. Subjectsâ€™ median RDW was 14.8% (range 11.2-27.8%) and was not correlated with Hb (r=0.056; P=0.73). Mortality rates in the normal and elevated RDW groups were 40% and 45%, respectively. There were no significant associations between RDW group and mortality (P=0.749) or PICU LoS (P=0.350).Conclusion Unlike in adults, RDW values are not correlated with mortality in pediatric sepsis patients.Â

Correlation of heart failure severity and N-terminal pro-brain natriuretic peptide level in children Yasmien Mahrani; Ria Nova; Masagus Irsan Saleh; Kemas Yakub Rahadianto
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

Background Â Heart failure affects morbidity and mortality in children with heart disease. There is no single, specific test to diagnose heart failure. The modified Ross Reithmann scoring system has been used to classify heart failure severity, but it is limited due to its subjectivity. The N-terminal pro-brain natriuretic peptide (NT-proBNP) is secreted by the ventricles during heart failure. It has been suggested as a possible marker for diagnosing heart failure.Objective To investigate the correlation between heart failure severity and plasma NT-proBNP concentration in children aged one month to 14 years.Methods A cross-sectional study was performed in the Pediatrics Department of Mohammad Hoesin Hospital from July to September 2015 on children with congestive heart failure, aged one month to 14 years. Heart failure severity was assesed using the modified Ross Reithmann scoring system. Plasma NT-proBNP measurements were done in all subjects. Statistical analysis was done by Spearmanâ€™s test.Results Â Subjectsâ€™ median plasma NT-proBNP concentration was 1,703 pg/mL (range 310-9,000 pg/mL). The NT-proBNP level and severity of heart failure had a significant, positive correlation (r=0.87; P<0.001). The NT-proBNP minimum levels in subjects with mild, moderate and severe heart failure were 310 pg/mL, 1,251 pg/mL, and 2,610 pg/mL, respectively.Conclusion Plasma NT-proBNP level has a significant, positive correlation with the severity of heart failure in children. As such, NT-proBNP level may be useful as a biochemical marker for the diagnosis and grading of the severity of heart failure in children.

Cowâ€™s milk exposure and atopic dermatitis after six months of age Surya Jayanti Kadek; Dewi Kumara Wati Ketut; Karyana Putu Gede
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

Background About 60% of individuals with atopic dermatitis (AD) develop their first manifestation during infancy. Cowâ€™s milk (CM) exposure is considered to be a risk factor for AD.Objective To evaluate for an association between cowâ€™s milk exposure and atopic dermatitis in infants > 6 months of age.Â Â Methods This cross-sectional study consisted of subjects from a previous study and new subjects recruited in order to meet the minimum required number of subjects. Our study population comprised 120 infants, born between 1 February and 30 November, 2012 in Sanglah Hospital, Denpasar. Subjects were divided into CM and non-CM groups and analyzed for their risk of AD. Subjects were included to CM group if they were fed with cowâ€™s milk/formulaÂ and included to non-CM group if they were breastfeed exclusively in the first six months of life. Other possible risk factors were assessed by multivariate analysis.Â Results One hundred twenty subjects were enrolled and analyzed (59 in the CM and 61 in the non-CM groups). The prevalence of AD was 30%. Multiple logistic regression analysis revealed a significant association between CM exposure and AD, with odds ratio (OR) 2.37 (95%CI 1.036 to 5.420; P=0.04). In addition, maternal diet including eggs and/or cowâ€™s milk during the breastfeeding period was significantly associated with AD in infants (OR 3.18; 95%CI 1.073 to 9.427; P=0.04).Conclusion Cowâ€™s milk exposure is significantly associated with atopic dermatitis in infantsÂ > six months of age.Â

Noise exposure at school and blood pressure in adolescents Fadhilah Ihsani; Rafita Ramayati; Muhammad Ali; Rusdi Djas; Oke Rina Ramayani; Rosmayanti Siregar; Beatrix Siregar
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

Background The increasing prevalence of primary hypertension has motivated researchers to identify influencing factors, one of which is noise. There have been few studies on a relationships between noise exposure and blood pressure in children, and none have dealt exclusively with adolescents.Objective To assess for an association between noise exposure at school and blood pressure in adolescents.Â Â Methods To identify noisy and quiet schools, the mean noise levels of 192 senior high schools in Medan were measured using sound level meters. One noisy school and one quiet school were randomly selected for inclusion (mean noise levels of Â 68.2 and Â 53.8 dB, respectively). Students from both schools underwent blood pressure measurements by mercury sphygmomanometer. Their Body weights and heights were obtained for body mass index calculations. Subjects filled questionnaires and their parents were interviewed regarding history of illnesses.Results Of the 271 adolescents recruited, 136 (50.2%) were from the noisy school. Adolescents from the noisy school had higher mean systolic and diastolic blood pressures [121.6 (SD 13.87) mmHg and 71.1 (SD 8.15) mmHg, respectively], than those from the quiet school [111.8 (SD 12.61) mmHg and 63.8 (SD 8.05) mmHg, respectively]. After adjusting for other factors, noise had a significant, moderate, positive association with systolic and diastolic blood pressures [Î² = 0.452; B = 6.21 (95% CI 3.86-8.55) mmHg; and Î² = 0.473; B = 4.18 (95% CI 2.41 to 5.94) mmHg, respectively].Conclusion Adolescents from a noisy school have a greater risk of higher systolic and diastolic blood pressures than those from a quiet school.

Comparison of urine neutrophil gelatinase-associated lipocalin to serum creatinine to assess kidney function in neonatal asphyxia Winston Leonardo Tanzil; Rocky Wilar; Max Frans Josef Mantik; Adrian Umboh; Suryadi Nicolaas Napoleon Tatura
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

Background Infants with neonatal asphyxia have multiorgan damage, such as to the kidneys (50%), central nervous system (28%), cardiovascular system (25%), and lungs (23%). Neonatal asphyxia reduces kidney perfusion, often leading to acute kidney injury (AKI) after asphyxia. Neutrophil gelatinase-associated lipocalin (NGAL) levels in the blood, urine and kidney tissue increased rapidly in AKI. Urinary NGAL is proposed to have better performance in diagnosing AKI than creatinine due to its earlier, rapid level increase and it is less invasive.Objective To compare urinary NGAL to serum creatinine as a marker to assess kidney function in neonatal asphyxia.Methods Diagnostic comparison study with cross-sectional design was performed at neonatal intensive care unit (NICU) of Prof. Dr. R. D. Kandou Hospital, Manado from November 2015 to February 2016. All subjects had neonatal asphyxia. Data were analyzed using descriptive analysis, receiver-operator characteristic (ROC) curve, and Z-test.Results Urinary NGAL with cut-off point of 652.24 ng/mL can predict AKI in neonates with asphyxia with 100% sensitivity, 75% specificity, 52.3% positive predictive value, and 100% negative predictive value. Chi-square test resulted in a value of x2 = 20.036, P=0.0001).This shows that urinary NGAL levels >652,24 ng/mL can predicts AKI by 20 times in infants with neonatal asphyxia. So, urinary NGAL performs better than serum creatinine, therefore it can replace serum creatinine as an alternative non-invasive diagnostic test for diagnosing AKI in infants with neonatal asphyxia.Conclusion The diagnostic value of urinary NGAL is higher than that of serum creatinine in assessing kidney function in neonatal asphyxia.Â

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