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Paediatrica Indonesiana
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.
Arjuna Subject : -
Articles 2,118 Documents
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The association between maternal malaria infection and poor birth outcomes in a remote community in Papua, Indonesia Tri Wahyudi Iman Dantara; Deddy Christian Aritonang
Paediatrica Indonesiana Vol 63 No 1 (2023): January 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1.2023.1-6

Abstract

Background Sikari is a remote district in Papua, Indonesia, which is malaria-endemic. Malaria infection during pregnancy has been linked to poor birth outcomes. Objective To evaluate for an association between malaria infection in pregnancy and birth outcome. Methods This cohort study compared the outcomes of newborns from mothers infected with malaria during pregnancy vs. uninfected controls. We included clinical data of 82 pregnant women from January to December 2020 at the Batavia Public Health Center, Sikari District, Mamberamo Raya, Papua. Malaria diagnosis was established based on the World Health Organization (WHO) criteria and positive rapid diagnostic tests. The maternal and infant characteristics analyzed were years of formal education, antenatal care (ANC) visits, gestational age, obstetric history, diagnosis of malaria, birth weight, APGAR score, and newborn mortality. Results Forty-six mothers (56.1%) were diagnosed with malaria during pregnancy, of whom 33 (71.7%) had tropical malaria, 7 (15.2%) had tertian malaria, and 6 (13.0%) had mixed malaria. Malaria infections of any type were associated with an increased risk of preterm birth (OR 5.34; 95%CI 1.10 to 25.91; P=0.04), low birth weight (LBW) (OR 49.00; 95%CI 28.62 to 838.89; P=0.00), newborn mortality (OR 13.86; 95%CI 0.76 to 251.37; P=0.04), and low 5-minute APGAR score (OR 23.65; 95%CI 1.34 to 416.61; P=0.03). Tropical malaria was associated with a higher risk of preterm birth (OR 5.44; 95%CI 1.06 to 27.86; P=0.04), LBW (OR 15.22; 95%CI 1.82 to 127.02; P=0.01), newborn mortality (OR 14.09; 95%CI 0.75 to 265.48; P=0.04), and low APGAR (OR 24.33; 95%CI 1.34 to 440.77; P=0.03). Mixed malaria was associated with a higher risk of LBW (OR 35.00; 95%CI 2.73 to 449.10; P=0.01) and low APGAR score (OR 40.56; 95%CI 1.67 to 985.39; P=0.02). Conclusion Malaria infections are associated with an increased risk of preterm birth, low birth weight, newborn mortality, and low 5-minute APGAR scores.
Pediatric residents’ burnout in Indonesia: a national survey during the pandemic Annang Giri Moelyo; Ardi Findyartini; Bambang Tridjaja; Aryono Hendarto
Paediatrica Indonesiana Vol 63 No 1 (2023): January 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1.2023.22-8

Abstract

Background The uncertain and somewhat chaotic clinical learning environment during the COVID-19 pandemic may potentially trigger burnout in pediatric residents. Objective To investigate the prevalence of burnout in pediatric residents in Indonesia during the COVID-19 pandemic and to identify potential risk factors associated with burnout. Methods This analytic observational study was conducted between April and June 2020. A questionnaire-based survey using an Indonesian translation of the Maslach Burnout Inventory-Human Services Survey was conducted online across 15 pediatric training institutions treating COVID-19 patients in Indonesia. Results were interpreted in accordance with the inventory guidelines. The chi-square test was used to analyze for possible associations between each subscale and gender, marital status, training stage, as well as institution of origin. One-way ANOVA of each subscale was performed on pediatric training institutions located in different regions. Results Of 983 respondents (82% average response rate), the prevalences of high emotional exhaustion and high depersonalization were 28.0% and 15.8%, respectively, while more than half of respondents (50.2%) had a low sense of personal accomplishment. Most respondents felt more exhausted than depersonalized. The location of pediatric training institution (Java or outside Java) was the only significant factor associated with burnout (P=0.003). Conclusion In the early stages of the pandemic, more than half of pediatric residents in Indonesia had a low sense of personal accomplishment. The only significant factor associated with burnout among was the location of training institution (Java or outside Java), suggesting a potential role of differences in hospital situation and clinical learning environment during the pandemic between Java and outside Java.
Blood pressure to height ratio for screening hypertension among Indonesian adolescents Partini Pudjiastuti Trihono; Jeanne Laurensie Sihombing; Rismala Dewi
Paediatrica Indonesiana Vol 63 No 1 (2023): January 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1.2023.7-12

Abstract

Background Pediatric hypertension is an emerging health issue due to its increasing prevalence. Age-, gender-, and height-specific blood pressure percentiles have been widely used as a primary tool for detection of hypertension in the pediatric population. However, this method is too complicated to be used in general pediatric practice. The blood pressure to height ratio has been proposed as a practical tool to detect hypertension in children. Objective To evaluate the accuracy of blood pressure to height ratio to be used as a tool for screening high blood pressure in Indonesian adolescents. Methods This diagnostic test study using data from the 2013 Indonesia Basic Health Research (Riset Kesehatan Dasar/RISKESDAS) report included 39,057 adolescents aged 15-18 years with complete data on age, gender, weight, height, and blood pressure. Blood pressure values were classified using the 2017 American Academy of Pediatrics (AAP) hypertension clinical guidelines. Blood pressure to height ratio was calculated as mmHg/cm body height. A receiver-operator characteristics (ROC) curve analysis was performed to assess the accuracy of systolic blood pressure to height ratio (SBPHR) and diastolic blood pressure to height ratio (DBPHR) for screening high blood pressure in adolescents. The optimal cut-off points, sensitivity, and specificity of SBPHR and DBPHR were calculated. Results The optimal cut-off points for defining elevated blood pressure in male adolescents aged 13-18 years were SBPHR 0.69 for male adolescents (sensitivity 96%, specificity 80%) and DBPHR 0.46 (sensitivity 97%, specificity 84%). In female adolescents, the optimal cut-offs were SBPHR 0.72 (sensitivity 97%, specificity 82%) and DBPHR 0.48 (sensitivity 98% and specificity 79%). Conclusion Blood pressure to height ratio is a practical method with high sensitivity and specificity for detecting elevated blood pressure in Indonesian adolescents aged 15 to 18 years.
Scoring model to predict early-onset bacterial sepsis at Dr. Mohammad Hoesin Hospital, Palembang Lilik Fitriana; Afifa Ramadanti; Indrayady Indrayady
Paediatrica Indonesiana Vol 63 No 1 (2023): January 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1.2023.29-36

Abstract

Background Early-onset bacterial neonatal sepsis (bacterial EONS) is one of the most common causes of death and illness in newborns. Assessment of risk factors is important to identify infants who are more susceptible to bacterial EONS. A scoring model based on maternal and infant risk factors would be useful for predicting bacterial EONS. Objective To develop a scoring model to predict bacterial EONS by examining maternal and neonatal risk factors. Methods This diagnostic test study was conducted at Mohammad Hoesin Hospital, Palembang between January-September 2021 using various maternal and infant risk factors. Subjects were newborns suspected of having early-onset bacterial sepsis with birth weight >1000 grams. The potential risk factors evaluated consisted of premature rupture of membranes >18 hours, greenish-thick-and-foul-smelling amniotic fluid, maternal body temperature >38°C, maternal leukocytosis >15.000/?L, gestational of <37 weeks, birth weight of <2500 grams, and APGAR score of <7 at 1 minute. One hundred sixty-two subjects were selected consecutively. Analyses included odds ratio, logistic regression test, and ROC curve to assess sensitivity and specificity of each risk factor. Results Premature rupture of membranes >18 hours, greenish-thick-and-foul-smelling amniotic fluid, male sex, and gestation of <37 weeks were risk factors for bacterial EONS. In the multivariate analysis, premature rupture of membranes >18 hours had an OR of 5.94 (95%CI 1.69 to 20.86, P=0.005), greenish-thick-and-foul-smelling amniotic fluid had an OR of 3.74(95%CI 1.16 to 12.02, P=0,027), male sex had an OR of 4.28 (95%CI 1.14 to 16.02, P=0.031), and gestation of <37 weeks had an OR of 3.1 (95%CI 0.82 to 11.72, P=0.094). In the scoring model, each of these four risk factors were assigned a score of 2 (for maternal risk factors) and 1 (for neonatal risk factors). Using a cut-off score of 2.5 to predict bacterial EONS, the scoring system had a sensitivity of 80% and specificity of 47%. Conclusion Our scoring model of maternal and infant risk factors can be used to screen for possible bacterial EONS at an earlier stage of illness, although with limited specificity.
Role of vitamin D3 on IL-17 expression in colon and improvement of colonic mucosa in an inflammatory bowel disease mice model Fiona Paramitha; Satrio Wibowo
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.1-7

Abstract

Background Inflammatory bowel disease (IBD) is an inflammation due to a Th1/Th2 regulatory imbalance and a Th17/Treg transformation imbalance which then releases inflammatory mediators, such as interleukin-17. The administration of vitamin D has the potential to prevent the inflammation in IBD. Objective To evaluate a possible role of vitamin D3 in reducing IL-17 expression and colonic mucosal repair in an IBD mice model. Methods The study used male BALB/c mice, 8-10 weeks old, weighing 20-25 grams, divided randomly into five groups with 8 mices in each group. The experimental mice were given 5% dextran sulfate sodium (DSS) on days 1-7 to induce colitis, and then were given vitamin D3 on days 8-14. Group 1 was the control group; Group 2 was given 5% DSS; Group 3 was given 5% DSS and vitamin D3 0.2 mcg/25 g body weight; Group 4 was given 5% DSS and vitamin D3 0.4 mcg/25 g body weight; and Group 5 was given 5% DSS and vitamin D3 0.6 mcg/25 g body weight. On day 15, the mice underwent euthanasia and colonic retrieval. Parameters assessed were IL-17 expression (immunohistochemical, with monoclonal antibody against IL-17) and colonic histology improvement, using the mouse colitis histology index (MCHI) score. Results The IL-17 expression measured by immunohistochemistry increased significantly in only 5% DSS group. There was a significant decrease in MCHI scores in the groups given vitamin D3, where the greater the dose of vitamin D3 given, the lower the MCHI score. Interleukin-17 expression had positive strong correlation with MCHI (r=0.985; P=0.002) Conclusion The improvement of colonic mucosal damage based on MCHI score was significant in groups given vitamin D3. There is a significant correlation between IL-17 reduction and colonic mucosal repair in IBD mice.
Difference in outcomes of pediatric septic shock after fluid resuscitation according to the Ultrasound-guided Fluid Resuscitation (USFR) and American College of Critical Care Medicine (ACCM) protocols: A randomized clinical trial Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Nelly Pramita Septiani; Irene Ratridewi; Savitri Laksmi Winaputri
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.49-56

Abstract

Background Sepsis is a major cause of morbidity and mortality in children. The American College of Critical Care Medicine (ACCM) protocol currently in use in the management of septic shock carries a risk of fluid overload. With the use of ultrasonographic monitoring, the Ultrasound-guided Fluid Resuscitation (USFR) protocol may reduce the incidence of fluid overload and mortality. Objective To assess the difference in outcomes of fluid resuscitation in pediatric septic shock using the USFR vs. ACCM protocols. Methods This randomized clinical trial involved 36 subjects randomized equally into the USFR and ACCM groups. After randomization, each subject was given fluid resuscitation starting at 20 mL/kg and repeated every 5-10 minutes as needed, according to the ACCM protocol. After fluid resuscitation was given, patients in the ACCM group were evaluated for clinical signs, liver span, and rhonchi, whereas those in the USFR group underwent USCOM examination for cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI). After 60 minutes, subjects in both groups were re-assessed for clinical signs, USCOM, pulmonary edema using lung ultrasound score (LUS), and liver span. Subjects were blinded as to the protocol they received. We compared 24-hour and 72-hour mortality rates, clinical improvement of shock at 60 minutes, cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI), as well as pulmonary edema and hepatomegaly, between the two groups. Results At 60 minutes after resuscitation, there were significant differences between the ACCM and USFR groups in the proportion of clinical improvement (0/18 vs. 5/18, P=0.016), pulmonary edema (15/18 vs. 4/18, P<0.001), and hepatomegaly (16/18 vs. 5/18, P<0.001). Mortality rates at 24 hours and 72 hours in the ACCM vs. USFR groups were 17% vs. 12% (P=0.199) and 78% vs. 39% (P=0.009), respectively. Conclusion The USFR protocol reduces the occurrence of fluid overload and leads to a lower mortality rate at 72 hours compared to the ACCM fluid resuscitation protocol.
Factors associated with infection and mortality in neonates following abdominal surgery Brigitta R. V. C. Corebima; Eko Sulistijono; Widanto Widanto; Cheah Fook Choe
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.8-13

Abstract

Background The outcomes of neonatal surgical cases has steadily improved in the last decade. However, limited local data are available in Indonesia regarding the contributing factors and outcomes of surgical procedures in neonates. Objective To determine the incidence of infection and mortality in neonatal surgical cases in Saiful Anwar Hospital, Malang, East Java, Indonesia. Methods This retrospective cohort study included neonates who underwent abdominal surgery over a period of 20 months from January 2021 to August 2022. Data collected included subjects’ basic demographics, primary surgical diagnoses, associated congenital anomalies, pre-operative conditions, and referral status. These parameters were analyzed in relation to the incidence of infection and mortality in the 30 days after surgical procedure. Results Of fifty-four neonates in this study, the most common neonatal surgical conditions were anorectal malformation, followed by necrotizing enterocolitis and Hirschsprung’s disease. The mortality rate at 30 days was 48%. The most common associated factors were sepsis (OR 0.778; 95%CI 0.233 to -1.167; P=0.041), pre-operative respiratory failure/hemodynamic instability (OR 2.129; 95%CI 1.039 to 3.126; P<0.001), and delayed referral (OR 0.295; 95%CI 0.074 to 1.177; P=0.048). Other factors such as age at presentation, gender, gestational age, birth weight, referral patient vs. those born in our hospital, associated congenital anomalies, and emergency procedures were not associated with mortality. The survival time in the sepsis group [17.30 (1.68-13.98) days] was significantly lower than in the non-sepsis group [25.95 (1.63-22.76) days] (P< 0.001). Conclusion Sepsis, pre-operative respiratory failure/hemodynamic instability, and delayed referral are risk factors for mortality in neonates following abdominal surgery. Identification of these risk factors and early intervention are important to improve outcomes.
Risk factors of late onset sepsis caused by extended spectrum beta-lactamase (ESBL) - producing bacteria in preterm infants Irene Ratridewi; Savitri Laksmi Winaputri; Eko Sulistijono; Fireka Imsa Sastia Juniantika
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.21-28

Abstract

Background High incidence of late-onset sepsis (LOS) in preterm infants contributes to neonatal morbidity. Therapeutic outcomes of LOS have deteriorated as a result of increased antibiotic resistance problems, mainly from ESBL isolates. Controlling risk factors is important in reducing morbidity and mortality as well as providing guidance for antibiotic selection. Objectives To determine the risk factors of LOS due to ESBL-producing bacteria in preterm infants. Methods This is a retrospective study. The inclusion criteria was neonates diagnosed with late-onset neonatal sepsis by clinical signs and a positive blood culture. The blood culture result and characteristics patients as secondary data were extracted from medical records within the hospital facilities and the institutional database of the Neonatology Department of Universitas Brawijaya (January 2019 to March 2021). Statistical analysis was done to compare characteristics of the patients in the ESBL positive group to those in the ESBL negative group to assess the potential risk factors. Results Among 124 preterm infants with LOS, 62 of them were ESBL-positive case subjects and the other 62 were non-ESBL-producing control subjects. Gram-negative bacteria were the most common pathogens identified, with 96% (n=59) of them being the ESBL-producing strain, predominated by Klebsiella pneumoniae (n=56). Factors significantly correlated with the occurrence of LOS-ESBL included prior history of invasive procedures (OR 3.13; 95%CI 1.45 to 6.73; P=0.00), central access insertion (OR 9.54; 95%CI 3.7 to 24.2; P=0.00), and parenteral nutrition (OR 6.03; 95%CI 2.77 to 13.16; P=0.00). Central access insertion had the strongest influence (Exp(B) 6.98; P= 0.00). Conclusion Prior invasive procedures, central access insertion, and parenteral nutrition had significant correlations with the occurrence of LOS-ESBL in preterm infants. Central access insertion is a predictive factor for LOS-ESBL.
Combination of red cell distribution width and procalcitonin as diagnostic biomarkers of neonatal sepsis in preterm infants Irene Ratridewi; Savitri Laksmi Winaputri; Eko Sulistijono; Brigitta I. R. V. Corebima; Achmad Yunus
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.29-34

Abstract

Background Diagnosis of neonatal sepsis is still challenging. Several diagnostics test have been developed to help diagnose of neonatal sepsis, but sometimes it could not be done routinely in limited facilities. Procalcitonin (PCT) and red cell distribution width (RDW) have been reported to have correlations with the risk of developing sepsis. Objective To evaluate the diagnostic value of combined of PCT and RDW as markers for neonatal sepsis in preterm infants. Methods A cross sectional study was conducted in the neonatal ward, Syaiful Anwar hospital, Malang, East Java. The subjects were preterm infants with neonatal sepsis. Blood culture were taken as the gold standard and RDW and PCT levels were assessed as the comparison. All of the test were performed at the begining of the study. The incidence of sepsis was reported as the main outcome. The data obtained were processed and analyzed using the receiver operating characteristic (ROC) method to obtain the area under curve (AUC) value. Results Fifty-five preterm infants presenting neonatal sepsis were enrolled in this study. The combination of RDW and PCT showed AUC 0.814 (P=0.199) with sensitivity and specificity 78.9% and 80.6%, respectively in diagnosing neonatal sepsis compared to blood culture. Conclusion Combination of RDW and PCT as markers of sepsis in preterm infants have good sensitivity and specificity.
Use of hemodynamic and laboratory monitoring tools to reduce the risk of mortality from pediatric septic shock Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Ika Maya Suryaningtias; Irene Ratridewi; Savitri Laksmi Winaputri
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.35-48

Abstract

Background Early recognition of septic shock in terms of clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters is a fundamental challenge in the emergency room and intensive care unit for early identification, adequate management, prevention of disease progression, and reduction of mortality risk. Objective To evaluate for possible correlations between survival outcomes of post-resuscitation pediatric septic shock patients and parameters of clinical signs, macrocirculatory hemodynamics, as well as microcirculatory laboratory findings. Methods This prospective, study was conducted in the PICU at Saiful Anwar Hospital, Malang, East Java. Inclusion criteria were children diagnosed with septic shock according to the 2005 Surviving Sepsis Campaign (SSC) criteria, aged >30 days-18 years, who were followed up for 72h after resuscitation. The measured variables such as cardiac index (CI), systemic vascular resistance index (SVRI), stroke volume index (SVI) were obtained from ultrasonic cardiac output monitor (USCOM). Blood gas and lactate were obtained from laboratory findings. Heart rate, pulse strength, extremity temperature, mean arterial pressure (MAP), systolic blood pressure (SBP), capillary refill time (CRT), Glasgow coma scale (GCS), and diuretic used were obtained from hemodynamic monitoring tools. Survival outcomes of post-resuscitation pediatric septic shock patients were noted. Results There was a significant correlation between the outcomes of the pediatric septic shock patients 72h after fluid resuscitation and clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters. After the 6th hour of observation, strong pulse was predictive of survival, with 88.2% area under the curve (AUC). At the 12th hour of observation, MAP >50th percentile for age was predictive of survival, with 94% AUC. Conclusion For pediatric patients with septic shock, the treatment target in the first 6 hours is to improve strength of pulse, and that in the first 12 hours is to improve MAP >50th percentile for age to limit mortality.

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