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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 60 No 1 (2020): January 2020" : 9 Documents clear

Long-term follow up of a tuberous sclerosis patient: evaluation of anti-epileptic drugs and self- management support therapy Anindya Diwasasri; Retno Danarti; Retno Sutomo; Sunartini Hapsara
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Tuberous sclerosis (TSC) (OMIM 191100) is an inherited, autosomal dominant disorder affecting multiple organ systems.1 A genetic mutation in one of the tumor suppressor gene (TSG) alleles causes tumor growth in various organ systems. Tuberous sclerosis can be found in people of all races, and does not differ in men and women, with an incidence 1 in 6,000 births and prevalence of 1 in 20,000.1-3 Although the prevalence is quite high, diagnosing this disorder is often difficult and delayed due to diverse disease manifestations and varied age at onset.

Cystatin C level and amikacin use in neonatal sepsis Putu Diah Pratiwi; I Wayan Dharma Artana; Ni Putu Veny Kartika Yantie; Hendra Santoso; I Gusti Ngurah Sanjaya Putra; Gusti Ayu Putu Nilawati; Ni Nyoman Metriani Nesa
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Background Amikacin is the antibiotic of choice for eradicating bacteria in neonatal sepsis because of its effectiveness against Gram-negative bacteria. However, this drug has nephrotoxic effects. Monitoring kidney function in neonates is very important because amikacin can interfere with development of the kidney. Several studies have shown that serum cystatin C levels were closer to glomerular filtration rate (GFR) values â€‹â€‹compared to serum creatinine levels. Objective To evaluate cystatin C levels before and after administration of amikacin in neonates with sepsis. Methods This prospective cohort study was conducted in one group with a pretest and posttest design. Thirty neonatal sepsis patients who received amikacin therapy at Sanglah General Hospital, Denpasar, Bali, were included by consecutive sampling. Their cystatin C levels were measured before and after receiving amikacin therapy. Data were normally distributed and analyzed by paired T-test, with a value of P<0.05 considered to be significant. Results The mean difference was 0.23 [1.57 (SD 0.29) vs. 1.80 (SD 0.28)] mg/L with P value < 0.001. There was different value of cystatin c level before and after amikacin therapy with deviation standard 0.25 with P<0.001 (alfa 5%). Conclusion Cystatin C levels are significantly higher in neonates with sepsis after administration of amikacin.

Predictors of prolonged stay in the pediatric intensive care unit Yudha Fadhol Arafah; Indah Kartika Murni; Desy Rusmawatiningtyas
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Background Prolonged stay in the pediatric intensive care unit (PICU) reflects not only disease severity and patient health status, but also the performance and quality of patient care. Objective To to determine whether surgical procedure, severe malnourishment, cardiovascular condition, sepsis, and ventilator use were the predictors of prolonged PICU stay. Methods This nested, case-control study was conducted with secondary data from medical records of pediatric inpatients at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. We included pediatric patients aged 1 month-18 years treated in the PICU between 1 January - 31 December 2018. Predictors of prolonged stay were identified including surgical procedures, severe malnourishment, cardiovascular conditions, sepsis, and ventilator use. Logistic regression was used to identify independent predictors. Results Subjects' overall median age was 3.12 (IQR 0.76-18.8) years and the male to female ratio was 1:1. Median duration of ventilator use was 4 (IQR 1-21) days. The most common diagnosis was neurological disease (26.7%). Multivariate analysis showed that surgical procedure (OR 5.75; 95%CI 2.06 to 14.61) was statistically significant as an independent predictor of prolonged PICU stay. Conclusion Surgical procedure is the significant predictor of prolonged stay in PICU.

Electrocardiogram abnormalities in obese adolescents Elizabeth Joan Salim; Eka Gunawijaya; Ni Putu Veny Kartika Yantie
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Background Obesity in adolescents is a known risk factor for cardiovascular disease mortality and sudden cardiac death. Obesity is associated with a wide variety of electrocardiogram (ECG) abnormalities. Objective To assess prevalence and describe the ECG abnormalities in obese adolescents. Methods This cross-sectional study was conducted at Children’s Cardiology Clinic – Integrated Heart Center of Sanglah General Hospital, Denpasar, Bali, by recording ECGs of obese adolescents aged 11-15 years from several junior high schools from December 2016 to April 2017. The inclusion criteria were obese adolescents aged 11 to 15 years, who were willing to participate in the study and provided informed consent. Results A total of 78 ECGs of obese adolescents (60% male) were selected. Subjects’ mean weight and age were 82.6 (SD 15.2) kg and 13.2 (SD 1) years, respectively. Pre-hypertension was found in 25 (32%) subjects, while hypertension was found in 18 (23%) subjects. There were 29 (37%) subjects with abnormal ECGs. Sinus tachycardia was present in 13 (17%) subjects, and sinus arrhythmia was identified in 11 (14%) subjects. Eight (10%) patients experienced prolongation of QTc interval and 5 (6%) patients presented with prolongation of PR interval. There were no shifts of the P wave, QRS wave and T wave axes, changes of P wave morphology, low QRS voltage, T wave flattening, ventricular enlargement, or ST segment changes found in this study. Conclusion The prevalence of cardiac abnormalities based on ECG examination in obese adolescents is 37%, consisting of heart rhythm abnormalities, prolonged PR interval, and prolonged QTc interval.

Umbilical arterial profiles as predictors of severity of hypoxic ischemic encephalopathy after perinatal asphyxia Jehangir Allam Bhat; Sajad Ahmad Sheikh; Roshan Ara
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Background: Perinatal hypoxic-ischemic encephalopathy (HIE) remains a major cause of neurodevelopmental impairment. Umbilical cord blood analysis provides an objective assessment of newborn metabolic status. Accordingly, it is recommended that physicians attempt to obtain venous and arterial samples when there is high risk of neonatal compromise. Objective To compare the predictive value of umbilical arterial blood pH, lactate and base deficit for subsequent development of severity of hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia and comparison of these parameters to determine which one is superior in predicting severity. Methods Umbilical cord arterial blood of newborns with perinatal asphyxia was tested for pH, lactate, and base deficit estimation. These newborns were evaluated in level III NICU and divided into two groups. Group 1 had no or signs and symptoms of HIE I and group 2 had signs and symptoms of HIE II/III. Values of pH, lactate, and base deficit were tabulated and analyzed by receiver-operating characteristic curves. Optimal cut-off values were estimated based on the maximal Youden index. Results Mean pH was significantly lower in group 2 than in group 1, while lactate and base deficit were significantly higher in group 2 than in group 1. Cut-off points for determining severity of HIE were pH <7.13, lactate >6.89 mg/dL, and base deficit >7 mEq/L. Sensitivity and specificity for these cut-off points were 100% and 91.49% for pH, 100% and 85.11% for lactate, and 82.4% and 91.76% for base deficit, respectively. Predictive abilities of all three parameters were similar in determination of HIE severity. Conclusion Umbilical arterial pH, lactate, and base deficit have excellent accuracy to predict the severity of HIE. All three parameters have similarly good predictive ability.

Detecting neurodevelopmental problems in children aged 1-5 years using the simple parent-reported screening tool in combination with primitive reflex assessment Nicholas Calvin; Yetty Ramli
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Background The Kuesioner Pra Skrining Perkembangan/DPsQ (Developmental Pre-screening Questionnaire/DPsQ) is a series of questions and instructions used as a developmental screening tool for children aged 3 months to 6 years. However, the DPsQ cannot fully detect the soft signs of future neurological disorders. However, the retained primitive reflex assessment as an adjunct to the DPsQ may be useful for such detection. Objective To determine whether assessing for retained primitive reflexes can add to the usefulness of DPsQ as a neurodevelopmental screen in children aged 1 to 5 years. Methods This cross-sectional study included children aged 1-5 years. Developmental screening was done using the DPsQ and retained primitive reflex assessment was performed using the Institute for Neuro-Physiological Psychology (INPP) screening and scoring guideline. Results Of 46 subjects, 56.8% of children with normal DPsQ scores had not retained primitive reflexes, while 88.9% of children with suspect DPsQ score had retained primitive reflexes. Hence, children with suspect DPsQ score had a 10.5 times higher chance of retaining primitive reflexes (OR 10.50; 95%CI 1.19 to 92.73; P=0.034). Furthermore, 66.7-77.8% of children with suspect DPsQ score had retained the Moro reflex, asymmetrical tonic neck reflex (ATNR), and symmetrical tonic neck reflex (STNR). Neither gender nor age were significantly associated with either suspect DPsQ score or the presence of retained primitive reflexes. Conclusion The DPsQ results correlate to integration of primitive reflexes, with 10.50 greater odds of children with ‘suspect’ DPsQ scores to have retained primitive reflexes. As such, retained primitive reflexes is not useful as a primary screen for future neurological problems. However, a high percentage of children (43.2%) with normal DPsQ scores also have retained primitive reflexes.

Platelet counts in epileptic children receiving valproic acid Lilik Indrayati; Fadhilah Tia Nur; Bambang Soebagyo
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Background Epileptic seizures are a transient occurrence resulting from abnormal, excessive, or synchronous neural activity in the brain. Epilepsy requires long-term treatment, increasingly larger doses, and combination therapy. Anti-epileptic drugs (AEDs), especially valproic acid (VPA), are the main treatment of choice. Thrombocytopenia is the most common adverse event from AEDs. Objective To evaluate platelet counts in epileptic children receiving valproic acid monotherapy vs. polytherapy. Methods This analytic, observational, retrospective cohort study was conducted in children with epilepsy below 18 years of age and treated in Dr. Moewardi Hospital, Surakarta, Central Java. Subjects had received VPA treatment for at least 6 months, either as monotherapy or polytherapy. There were 40 subjects in each group (VPA monotherapy vs. VPA polytherapy). The exclusion criteria were patients who had thrombocytopenia and did not take valproic acid regularly. The data was taken from laboratory and the outcome assessed was decreasing of platelet count. Results Administration of VPA as monotherapy vs. polytherapy was not significantly associated with incidence of thrombocytopenia. However, duration of VPA use > 2 years was associated with significantly greater proportion of thrombocytopenia, with OR 33.0 (95%CI 4.157 to 261.962; P=0.001) compared to VPA use < 2 years. Similarly, VPA dose of >30 mg/kg/day was significantly associated with greater proportion of thrombocytopenia, with OR 4.081 (95%CI 1.337 to 12.458; P=0.013) compared to <30 mg/kg/day dosage. Conclusion Incidence of thrombocytopenia is not significantly different between VPA as a monotherapy and polytherapy. However, higher VPA dose and longer VPA duration are associated with higher proportion of thrombocytopenia.

Blood count to determine chronic inflammation severity in obese adolescents Martini Wongkar; Handoko Lowis; Sarah M. Warouw; Julius Lolombulan; Stefanus Gunawan
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Background Obesity is a growing public health problem of rapidly increasing prevalence in developing countries. Chronic low-grade inflammation plays a key role in the pathophysiology of obesity. Blood count values and ratios have been used as markers of inflammatory diseases. These parameters may be useful to determine the severity of chronic inflammation in obese children. Objective To determine if red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-to-lymphocyte ratio (PLR) can be useful for determining the severity of chronic inflammation in obese children. Methods This observational, analytic study was conducted in obese adolescents aged 14-18 years at senior high schools in Manado, North Sulawesi, from July to September 2018. Students with congenital anomalies, autoimmune diseases, history of asthma, or malignancy were excluded. Pearsonâ€™s correlation was used to analyze for potential relationships between obesity and red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-to-lymphocyte ratio (PLR). Results There was a negative relationship between obesity and MPV, but it was not statistically significant (r=-0.006; P=0.485). There were positive, but not significant relationships between obesity and RDW (r=0.139; P=0.192), NLR (r=0.155; P=0.166), PDW (r=0.02; P=0.45), and PLR (r=0.146; P=0.181). Conclusion The RDW, NLR, MPV, PDW, and PLR values are not significantly associated with severity of obesity in adolescents.

Mid-upper arm circumference measurement for severe malnutrition screening in underfives Stephanie Adelia; Johannes Capistrano Susanto
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Background Severe malnutrition in Indonesia remains abundant. Severe malnutrition has been assessed by several methods, including mid–upper arm circumference (MUAC) and weight-for-height z-score (WHZ). As a screening method, MUAC is expected to be useful for identifying malnutrition in communities. Objective To determine whether MUAC measurements can be used for screening severe malnutrition at the community level in Indonesia. Method A cross-sectional study was conducted in 853 children aged 6 – 59 months who came to an integrated health service post (Posyandu) in Semarang, Central Java. Anthropometric measurements were performed by cadres and researchers and included MUAC and WHZ. Statistical analysis was done by McNemar test; results with P values >0.05 indicated no significant difference. Sensitivity and specificity were determined by 2 x 2 tables. The MUAC cut-off values were determined by receiver-operating characteristic (ROC) curve. Results Eight hundred fifty-three out of 1,115 children met the inclusion criteria, consisting of 419 (49.1%) boys, with most over the age of 2 years (57.2%). Kappa test revealed good inter-rater reliability in measurements between the cadre and researchers (Kappa=0.726). There were significant differences between MUAC (by cadres) and below red line status as well as WHZ, between MUAC (by researchers) and WHZ, as well as MUAC (by cadre and researchers) with WHZ and height-for-age z-score/HAZ . Sensitivity, specificity, PPV, and NPV of MUAC (by cadre) were 12.5%, 99.9%, 75%, and 97.5%, respectively, while those by the researchers were 16.7%, 99.6%, 57%, and 97.6%, respectively. In this study, MUAC of 14 cm was the best cut-off for severe malnutrition. Conclusion The MUAC measurement of 14 cm can be used for screening severe malnutrition in underfives at community.

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