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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 2,127 Documents

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Effect of methotrexate and doxorubicin cumulative doses on superoxide dismutase levels in childhood acute lymphoblastic leukemia Khalida Fetriyani Ningsih; Sri Mulatsih; Sasmito Nugroho
Paediatrica Indonesiana Vol 55 No 5 (2015): September 2015
Publisher : Indonesian Pediatric Society

Background Acute lymphoblastic leukemia (ALL) is the mostcommon malignancy in children. Chemotherapeutic drugs forALL such as methotrexate (Mtx) and doxorubicin producereactive oxygen species (ROS), a type of free radical. The ROScan reduce levels of antioxidants in the body, including superoxidedismutase (SOD). Decreased SOD levels can cause DNA, lipid,and protein damage, which in turn may lead to adverse effectsand treatment failure.Objective To determine the effect of Mtx and doxorubicincumulative doses on SOD levels in children with ALL.Methods We conducted a retrospective cohort study in childrenwith ALL who underwent chemotherapy in Dr. Sardjito Hospitalin October 2011 who had completed the induction phase. Riskfactors for decreased SOD levels were analyzed by Cox regressionand hazard ratio, with a significant level of P <0.05.ResultsÂ Of 40 patients enrolled, Mtx â‰¥ 3000 mg/m2 significantlydecreased SOD levels (HR 9.959; 95%CI 2.819 to 35.183; P=0.001). However, doxorubicinÂ â‰¥90 mg/m2 did not significantlydecrease SOD levels (HR 0.59 95%CI 0.194 to 1.765; P=0.34).Conclusion Methotrexate is associated with decreased SOD levelsin children with ALL. However, doxorubicin is not associated withdecreased SOD levels in the same patient population.

Host factors related to pneumonia in children under 5 years of age Wiharjo Hadisuwarno; Retno Asih Setyoningrum; Pirlina Umiastuti
Paediatrica Indonesiana Vol 55 No 5 (2015): September 2015
Publisher : Indonesian Pediatric Society

Background Pneumonia has been one of the serious problems for children under five in Indonesia. Imbalanced interactions among host factors, agents, and environments influence incidence of pneumonia. Objective To determine the risks of the host related to the incidence of pneumonia in children aged 3-59 months in Pediatrics Department, Dr. Soetomo General Hospital during 2011-2012. Methods This was a case control study on medical records of patients with respiratory infections in Pediatrics Department, Dr. Soetomo General Hospital. We grouped patients with pneumonia as the case group and patients with other respiratory infections as the control group. The data were statistically processed to calculate odds ratios and P values. Results There were 326 subjects reviewed, 163 in the case group and 163 in the control group. Host factors that increased the risk of pneumonia were: low birth weight (OR=3.10; 95%CI 1.34 to 6.86), inadequate exclusive breastfeeding (OR=1.7; 95%CI 1.09 to 2.64), malnutrition (OR=3.44; 95%CI 2.12 to 5.58) and incomplete immunization in a certain period of age (OR=2.70; 95%CI 1.72 to 4.24). Existed comorbidity was unrelated to the incidence of pneumonia (OR=1.53; 95%CI 0.86 to 2.71). Conclusion Low birth weight, inadequate exclusive breastfeeding, malnutrition, and incomplete immunization in a certain period of age increase the risk of pneumonia.

Lead poisoning and cystatin-C in children Yuri Yuri; Praisilia Riani Najoan; Stefanus Gunawan; Adrian Umboh
Paediatrica Indonesiana Vol 55 No 5 (2015): September 2015
Publisher : Indonesian Pediatric Society

Background Lead pollution is a global problem both in developed and developing countries. Lead poisoning is associated with decreased glomerular filtration rate (GFR) and is a risk factor for acute kidney injury (AKI). Serum cystatin-C is a more precise test of GFR than serum creatinine level, as serum cystatin-C levels rise earlier than serum creatinine, when GFR decreases. Objective To assess for a possible correlation between lead poisoning and cystatin-C levels in children. Methods We conducted a cross-sectional study in children aged 6-11 years with a history of lead poisoning from elementary schools in Talawaan District, North Minahasa Regency from July to October 2013. Cystatin-C and blood lead levels (BLL) were measured in all subjects. Spearmanâ€™s rho test was used to analyze a potential correlation between BLL and cystatin-C level. Results This study included 41 children, comprising 21 boys and 20 girls. Their median age was 8.50 (range 6.8-10.7) years. Elevated levels of cystatin-C did not exceed normal values, however, we found a positive correlation between BLL and cystatin C (r=0.419, P=0.006). Conclusion There is a positive correlation between BLL and cystatin C level in children with lead poisoning. Regular monitoring of BLL, medical intervention, and an epidemiological study to help find the sources of contamination are needed for children with lead poisoning.

Serum vitamin D and vitamin D receptor gene FokI polymorphisms in children with tuberculosis Ariesta Karmila; Muhammad Nazir; Kiagus Yangtjik; Yuwono Yuwono
Paediatrica Indonesiana Vol 55 No 5 (2015): September 2015
Publisher : Indonesian Pediatric Society

Background Vitamin D deficiency and vitamin D receptor (VDR) gene polymorphisms are strongly associated with tuberculosis (TB) susceptibility in countries with four seasons. As a country with sufficient sunlight for vitamin D production in skin, the incidence of TB in Indonesia remains high. Objective To assess for possible associations between the incidence of tuberculosis and serum vitamin D level, as well as VDR FokI polymorphisms in children. Methods A case-control study was conducted at the Department of Child Health, Dr. Mohammad Hoesin Hospital, Palembang from November 2011 to April 2012. Subjects were children with TB (the case) and children without TB who had been exposed to TB in the home (the control). Serum vitamin D [1,25(OH)2D3 or calcitriol] level was measured by immunodiagnostic system (IDS) 1,25-dihydroxy vitamin D enzyme immunoassay (EIA) kit. The VDR FokI polymorphisms were identified by polymerase chain reaction (PCR) and restriction-fragment length polymorphism (RFLP) analysis. Results Sixty subjects was divided equally into the case and control groups. The mean serum calcitriol level in the case group was significantly lower than that of the control group [105.5 (SD 66.9) pmol/L vs. 162.9 (SD 52.9) pmol/L, respectively; (P=0.001)]. We found 9 subjects with calcitriol deficiency, 8 in the TB group and 1 in the healthy contact group (OR 10.5; 95%CI 1.2 to 90.7) The VDR FokI polymorphism was seen in 28 subjects in the case group and 22 in the control group (OR 5.0; 95%CI 0.9 to 26.4). Conclusion Vitamin D (calcitriol) deficiency and lower serum levels are associated with higher risk of TB in children. The VDR gene FokI polymorphism also contributes to susceptibility for TB.

Procalcitonin as a diagnostic tool for bacterial neonatal sepsis Nely Nelly; Guslihan Dasa Tjipta; Hakimi Hakimi; Bugis Mardina Lubis
Paediatrica Indonesiana Vol 55 No 5 (2015): September 2015
Publisher : Indonesian Pediatric Society

Background Bacterial sepsis is the main cause of morbidity and mortality in neonates. Early diagnosis and appropriate treatment can reduce the mortality rate. Blood culture is the gold standard for diagnosis of bacterial sepsis, but it requires 3-5 days for results. Since the disease may progress rapidly in neonates, a faster diagnostic test is needed. Measurement of procalcitonin levels may be a quick method to diagnose bacterial sepsis in neonates. Some studies found the sensitivity of procalcitonin to be between 92-100%. Objective To assess the use of procalcitonin as an early diagnostic tool for bacterial neonatal sepsis. Methods This diagnostic study was conducted from October 2011 to February 2012. Forty-three neonates in the Perinatology Unit at H. Adam Malik Hospital were suspected to have bacterial sepsis. They underwent routine blood counts, blood cultures, as well as C-reactive protein and procalcitonin measurements. Subjects were collected by consecutive sampling. The gold standard of sepsis was based on any microorganism found in blood culture. Results Of 43 neonates, 36 neonates had bacterial sepsis. We found that procalcitonin sensitivity was 100%, specificity 85.71%, positive predictive value 97.29% and negative predictive value 100%. The ROC curve showed a cut-off point of 0.929 (95%CI 0.713 to 0.953). Conclusion Procalcitonin is useful as an early diagnostic tool for bacterial neonatal sepsis.

The role of exclusive breastfeeding in prevention of childhood epilepsy Alexander Kurniadi; Elisabeth Siti Herini; Wahyu Damayanti
Paediatrica Indonesiana Vol 55 No 5 (2015): September 2015
Publisher : Indonesian Pediatric Society

Background Epilepsy affects 1% of children worldwide. The highest incidence is in the first year of life, and perinatal factors, such as hypoxic-ischemic injury, infection, and cortical malformation may play etiologic roles. Breast milk contains optimal nutrients for human brain in early life. Breastfeeding has been associated with lower risk of infections, better cognitive and psychomotor development. However, the role of breastfeeding in preventing childhood epilepsy remains unclear. Objective To evaluate an association between exclusive breastfeeding and childhood epilepsy. Methods A case-control study conducted from 1 May to 3 July 2013 involving children with epilepsy aged 6 months to 18 years who were attending pediatric outpatient clinic of Dr. Sardjito Hospital, Yogyakarta. Neurologically normal children, individually matched by age and sex, visiting the same clinic were considered as controls. Exclusion criteria were children with structural brain abnormality, history of epilepsy in family, and who had history of neonatal seizure, intracranial infection, febrile seizure, and head trauma before onset of epilepsy. History of breastfeeding was obtained by interviewing the parents. The difference of exclusively breastfeeding proportion between cases and controls was analyzed by McNemar test. Results The total number of participants was 68 cases and controls each. Subjects with epilepsy had lower proportion of exclusively breastfed (48.5%) compared with controls (54.4%), but the difference was not statistically significant (P=0.541). Exclusively breastfeeding showed no statistical significance in decreasing risk of epilepsy (OR=0.71; 95%CI 0.32 to 1.61). Conclusions Exclusive breastfeeding for 4-6 months has no effect against childhood epilepsy.

Comparison of the quality of life in cerebral palsy children with physical therapy more and less than 10 months Dewi Anggreany; Johannes Harlan Saing; Melda Deliana; Yazid Dimyati
Paediatrica Indonesiana Vol 55 No 5 (2015): September 2015
Publisher : Indonesian Pediatric Society

Background Cerebral palsy (CP) is the most common cause of severe physical disability in childhood. These limitations may cause lower level experience or quality of life (QoL). Physical therapy (PT) plays a central role in managing CP. Objective To compare QoL in CP children with PT more and less than 10 months and to compare gross motoric level before and after PT. Methods A cross sectional study was performed from June 2012 to March 2013 in Medan. Eligible population were four to twelve year old CP children who received PT. Subjects were divided into 2 group, group I was CP children with PT more than 10 months, group II was CP children with PT less than 10 months. Parents were asked to fill CP QOL questionnaires. To evaluate motor impairment level we used gross motor function classification system (GMFCS) that classified the motoric impairment into 5 levels. Data was analyzed by using independent T-test and MannWhitney U test with 95% confidence interval. Results There were 60 CP children divided into 2 groups of 30 children. The mean duration of PT in group I was 35.7 (SD 19.37) months and group II was 4.2 (SD 3.13) months. Gross motoric level in both group increased from GMFCS IV to GMFCS II in group I (P=0.0001) and from GMFCS IV to GMFCS III (P=0.002) in group II. The mean total CP QoL scores in group I and II were 79.63 (SD 5.73) and 47.71 (SD 6.85), respectively (P=0.0001). Conclusions Cerebral palsy children who received more than 10 months PT have higher QoL than children with less than 10 months PT. There was significant gross motor improvement after PT in both groups.

Immature-to-total neutrophil ratio as an early diagnostic tool of bacterial neonatal sepsis Darnifayanti Darnifayanti; Guslihan Dasa Tjipta; Rusdidjas Rusdidjas; Bugis Mardina Lubis
Paediatrica Indonesiana Vol 55 No 3 (2015): May 2015
Publisher : Indonesian Pediatric Society

Background Bacterial sepsis is the main cause of morbidity and mortality in neonates. Early diagnosis and appropriate treatment for the condition can reduce mortality rates. Blood cultures are the gold standard to diagnose bacterial sepsis, but they require 3-5 days for results, whilst the disease may progress rapidly in neonates. Examination of immature-to-total neutrophil ratio (I/T ratio) in peripheral blood smears is a quicker and less expensive method to diagnose bacterial sepsis in neonates. Some studies found the sensitivity of I/T ratio to be 88%-90% in predicting bacterial spesis.Objective To assess the usefulness of the I/T ratio as an early diagnostic tool for neonatal bacterial sepsis.Methods This cross-sectional study was conducted from February to March 2011. Subjects were collected by consecutive sampling. Fifty-three neonates suspected to have bacterial sepsis in the Perinatology Unit at H. Adam Malik Hospital were included. Subjects underwent routine blood examinations, C-reactive protein level measurements, blood cultures, and peripheral blood smears. All statistical analyses were conducted with SPSS (version 16.0 for Windows).Results Of the 53 subjects, 26 had bacterial sepsis based on blood cultures. The I/T ratio had a sensitivity of 88.46%, specificity 81.84%, positive predictive value 82.14%, and negative predictive value 88%. The receiver operating characteristic curve showed a cut-off point of 83.3 (95%CI 71.3 to 95.3)%.Conclusion The I/T ratio may be a good alternative to blood cultures as an early indicator of bacterial neonatal sepsis, as it is faster, less expensive and has good sensitivity and specificity.

Social competence of 3 to 5-year-old children born with low birth weight Nurul Komariah
Paediatrica Indonesiana Vol 55 No 3 (2015): May 2015
Publisher : Indonesian Pediatric Society

Background Low birth weight (LBW) has long been used as an indicator of public health. Low birth weight is not a proxy for any dimension of other maternal or perinatal health outcomes. Low birth weight infants require special care, and have more chronic conditions, learning delays, and attention deficit hyperactivity disorders compared to infants of normal birth weight (NBW). Social competence is viewed as a primary component of healthy function and development and is an important predictor of academic and financial success.Objective To examine social competence of children aged 3-5 years born with low birth weight.Methods This cross-sectional study was undertaken in Palembang in 2012. Subjects consisted of children aged 3-5 years attended a preschool in the Seberang Ulu I District, Palembang, and were divided into two groups: low birth weight (LBW) and normal birth weight (NBW). Social competence was assessed by observation and Interaction Rating Scale (IRS) and Parenting Style questionnaire (PSQ). Chi-square analysis was used to compare social competence between the two groups. Multivariate regression logistic analysis was used to assess for the dominant factors that may affect a childâ€™s social competence.Results Low birth weight children aged 3 to 5 years had a 1.435 times higher risk of low social competence compared to normal birth weight children of similar age. (RP 1.435; 95%CI 1.372 to 13.507; P=0.019). Multivariate regression logistic analysis revealed that parenting style was a dominant factor affecting social competence.Conclusion Social competence in 3 to 5-year-old children born with low birth weight is lower compared to those with normal birth weight.

Vitamin D levels in epileptic children on long-term anticonvulsant therapy Fathy Pohan; Aryono Hendarto; Irawan Mangunatmadja; Hartono Gunardi
Paediatrica Indonesiana Vol 55 No 3 (2015): May 2015
Publisher : Indonesian Pediatric Society

Background Long-term anticonvulsant therapy, especially with enzyme inducers, has been associated with low 25-hydroxyvitamin D [25(OH)D] levels and high prevalence of vitamin D deficiency. However, there have been inconsistent results in studies on the effect of long-term, non-enzyme inducer anticonvulsant use on vitamin D levels.Objective To compare 25(OH)D levels in epileptic children on long-term anticonvulsant therapy and non-epileptic children. We also assessed for factors potentially associated with vitamin D deficiency/insufficiency in epileptic children.Methods This cross-sectional study was conducted at two pediatric neurology outpatient clinics in Jakarta, from March to June 2013. Subjects in the case group were epileptic children, aged 6-11 years who had used valproic acid, carbamazepine, phenobarbital, phenytoin, or oxcarbazepine, as a single or combination therapy, for at least 1 year. Control subjects were non-epileptic, had not consumed anticonvulsants, and were matched for age and gender to the case group. All subjectsâ€™ 25(OH)D levels were measured by enzyme immunoassay.Results There were 31 epileptic children and 31 non-epileptic control children. Their mean age was 9.1 (SD 1.8) years. Most subjects in the case group were treated with valproic acid (25/31), administered as a monotherapy (21/31). The mean duration of anticonvulsant consumption was 41.9 (SD 20) months. The mean 25(OH)D level of the epileptic group was 41.1 (SD 16) ng/mL, lower than the control group with a mean difference of 9.7 (95%CI 1.6 to 17.9) ng/mL. No vitamin D deficiency was found in this study. The prevalence of vitamin D insufficiency in the epileptic group was higher than in the control group (12/31 vs. 4/31; P=0.020). No identified risk factors were associated with low 25(OH)D levels in epileptic children.Conclusion Vitamin D levels in epileptic children with long-term anticonvulsant therapy are lower than that of non-epilepticÂ children, but none had vitamin D deficiency.

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