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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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Short-term outcomes following congenital heart surgery in children with Down syndrome Tri Yanti Rahayuningsih; Sukman Tulus Putra; Piprim Basarah Yanuarso; Zulham Effendy
Paediatrica Indonesiana Vol 63 No 3 (2023): May 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.3.2023.181-8

Abstract

Background Children with Down syndrome (DS) differ from typical children because of many genetic-related aspects that may affect outcomes after congenital heart surgery. To date, there have been no studies on outcomes after congenital heart surgery on pediatric DS patients in Indonesia. Objective To determine outcomes and mortality in DS patients who underwent heart surgery at Dr. Cipto Mangunkusumo Hospital, Jakarta. Methods A prospective and retrospective cohort study was conducted in DS patients aged <15 years who underwent heart surgery from July 2007 to April 2015. The control group were patients in the same age range without DS who underwent heart surgery for various types of heart defects. Results There were 57 DS and 43 non-DS patients during study period. The types of heart defects found in DS patients were atrioventricular septal defect (AVSD) and ventricular septal defect (VSD) in 18/57 (31.6%) patients each, tetralogy of Fallot (12/57; 21%), atrial septal defect (ASD) (4/57; 7%), patent ductus arteriosus (PDA) (4/57; 7%) and transposition of the great arteries with VSD (TGA-VSD) (1/57; 1.8%). DS patients showed an increased incidence of preoperative PH (63.1%) compared to non-DS patients (25.6%). Median duration of surgery was longer in DS [2.9 (range 0.5-5.8) hours] than in non-DS [2.2 (range 0.7-4.7) hours]. DS patients have a longer mean cardiopulmonary bypass duration [79.5 (SD 33.9) minutes] compared to non-DS [59.9 (SD 23.6) minutes], longer mean aortic cross-clamp duration [45.3 (SD 23.7) minutes] compared to non-DS [34.8 (SD 15.7)]. There were significant differences in the incidence of preoperative pulmonary hypertension, surgical time, duration of cardiopulmonary bypass (CPB), and length of the aortic cross-clamp in DS patients compared to non-DS (P<0.05). Median length of ICU stay was 1.9 (range 0.6 to 34) days in DS and 1 (range 0.3 to 43) day in non-DS patients (P=0.373). Median duration of mechanical ventilation [19.9 (range 3-540) vs. 8 (range 3-600) hours (P=0.308)], rate of pulmonary complications [14/57 (24.6%) vs. 6/43 (14%) patients (P=0.216)], and incidence of sepsis [16/57 (28.1%) vs. 6/43 (14%) patients (P=0.143)] were not significantly different between DS and non-DS patients. However, complete atrioventricular (AV) block only occurred in DS patients [6/57 (10.5%)]. In the DS group, 5/57 (8.8%) patients died. There was no mortality in the non-DS group. Conclusion Morbidity and mortality after cardiac surgery in were higher in DS than in non-DS patients. DS patients may have problems related to preoperative PH, AV block, longer surgical time, duration of CPB, and aortic cross-clamp compared to non-DS.
Risk factors of immature retina on the first screening for retinopathy of prematurity Wedi Iskandar Kartamihardja; Gilang Mutiara; Yanuar Zulkifli Harun; Maulya Listrianti; Bestari Yuniah; Mayasari Kuntoyo
Paediatrica Indonesiana Vol 63 No 3 (2023): May 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.3.2023.189-94

Abstract

Background Immature retina is characterized by peripheral retinal avascularity. Retinal development is influenced by risk factors that affect retinal maturity. Objective To identify risk factors for immature retina on the first retinopathy of prematurity (ROP) screening at the Neonatology Care Unit, Al-Islam Hospital, Bandung, in 2013-2021. Methods This case-control, retrospective, observational study was performed by evaluating medical records of preterm infants screened for ROP. The subjects were divided into two groups, immature retina and mature retina. We recorded potential risk factors including gestational age (GA), birth weight (BW), birth weight for gestational age, respiratory distress syndrome (RDS), oxygen therapy >7 days, asphyxia, sepsis, multiple transfusion, apnea of prematurity (AOP), patent ductus arteriosus (PDA), and bronchopulmonary dysplasia (BPD) and analyzed them for potential associations with retinal development. Results On the first ROP screening of 203 premature infants, 5 (2.5%) had ROP, 90 (44.6%) had immature retinas, and 107 (53.0%) had mature retinas. Bivariate logistic regression analysis showed significant relationships between immature retina (P<0.05), GA (OR=0.575; P=0.000), BW (OR=0.997; P=<0.001), gestational age maturity (OR=2.639; P=0.006), RDS (OR=1.809; P=0.042), oxygen therapy of >7 days (OR=4.494; P=0.002), sepsis (OR=2.028; P=0.034), multiple transfusions (OR=4.656; P=0.000), AOP (OR=2.553; P=0.002), PDA (OR=2.119; P=0.030). Multivariate regression analysis revealed a significant simultaneous relationship between all the risk factors and immature retina, with a Nägelkerke R2 value of 0.421. Conclusion GA, BW, gestational age maturity, oxygen therapy of >7 days, sepsis, multiple transfusions, AOP, and PDA are significant risk factors of immature retina, be it independently or simultaneously.
Effects of lung recruitment maneuvers using mechanical ventilator on preterm hemodynamics Adhi Teguh Perma Iskandar; Ahmad Kautsar; Anisa Rahmadhany; Risma Kerina Kaban; Bambang Supriyatno; Joedo Prihartono; Dewi I. Santoso; Tetty Yuniarti; Najib Advani; Mulyadi M. Djer; Fiolita I. Sutjipto
Paediatrica Indonesiana Vol 63 No 3 (2023): May 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.3.2023.173-80

Abstract

Background Lung recruitment maneuvers (LRMs) are a strategy to gradually increase mean positive airway pressure (MAP) to expand the alveoli, leading to decreased pulmonary vascular resistance and increased cardiac output (CO). However, the hemodynamic impact of LRM using assist control volume guarantee (AC-VG) ventilator mode done in preterm infants born at 24 to 32 weeks’ gestation, especially in the first 72 hours of life, remains unknown. Objective To determine the effect of LRM on right- and left cardiac ventricular output (RVO and LVO), ductus arteriosus (DA) diameter and its pulmonary hypertension (PH) flow pattern, as well as superior mesenteric artery (SMA) flow. Method This randomized, controlled, single-blinded clinical trial was performed in 24-32-week preterm neonates with birth weights of >600 grams. Subjects were allocated by block randomization to the LRM and control groups, each containing 55 subjects. We measured RVO, LVO, DA diameter, PH flow pattern, and SMA resistive index (RI) at 1 and 72 hours after mechanical ventilation was applied. We analyzed for hemodynamic differences between the two groups. Results During the initial 72 hours of mechanical ventilation, there were no significant differences between the control vs. LRM groups in mean changes of LVO [41.40 (SD 91.21) vs. 15.65 (SD 82.39) mL/kg/min, respectively; (P=0.138)] or mean changes of RVO [65.56 (SD 151.20) vs. 70.59 (SD 133.95) mL/kg/min, respectively; (P=0.859)]. Median DA diameter reduction was -0.08 [interquartile range (IQR) -0.55; 0.14] mm in the control group and -0.10 (IQR -0.17 to -0.01) mm in the LRM group (P=0.481). Median SMA resistive index was 0.02 (IQR -0.16 to 0.24) vs. 0.01(IQR -0.20 to 0.10) in the control vs. LRM group, respectively. There was no difference in proportion of pulmonary hypertension flow pattern at 72 hours (25.4% vs. 20% in the control vs. LRM group, respectively) (P=0.495). Conclusion When preterm infants of 24-32 weeks gestational age are placed on mechanical ventilation, LRM gives neither additional hemodynamic benefit nor harm compared to standard ventilator settings.
Spinal muscular atrophy with severe scoliosis: a case report Dikahayu Alifia Anugrah; Sunartini Sunartini; Mohammad Juffrie
Paediatrica Indonesiana Vol 63 No 4 (2023): July 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.4.2023.315-20

Abstract

Spinal muscular atrophy (SMA) is an autosomal recessive neurodegenerative disease that causes general weakness, muscle atrophy, and poor muscle movement. This condition is due to a homozygous disruption of the survival motor neuron (SMN) 1 survival gene due to deletion, conversion, or mutation.1
Factors associated with cognitive and communication delay in children aged 0 to 3 years using the Battelle-Developmental Inventory, 2nd edition Florentina Febrina; Veronika Cendana Pinasthika Lawalata; Yetty Ramli
Paediatrica Indonesiana Vol 63 No 4 (2023): July 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.4.2023.282-9

Abstract

Background The first years of life are crucial in cognitive and communication development. Delayed functional development impedes children’s future academic and occupational performance. Therefore, early detection is important for effective resolution in order to minimize further impairment. Objective To evaluate cognitive and communication developmental delay in children under 3 years of age in Jakarta using the Battelle Developmental Inventory, 2nd edition (BDI-2). Methods A cross-sectional study was conducted in Jakarta in 2020, including children aged under 3 years of age without chronic medical conditions that hinder cognitive and speech function. We collected subjects’ demographic characteristics, evaluated their communication and cognitive development using the BDI-2, and analyzed for risk factors of delays. Results Of 121 children, 34 (28.1%) had cognitive delay and 21 (17.4%) had communication delay. Bivariate analysis revealed that male gender (P=0.048) and non-exclusive breastfeeding (P=0.003) were significantly associated with communication delay, while only male gender was associated with cognitive delay (P=0.015). Multivariate analysis revealed that significant risk factors for communication delay were male gender (P=0.043) and non-exclusive breastfeeding (P=0.023). Conclusion Male gender and non-exclusive breastfeeding are significant risk factors for delayed communication development, and only male gender was a significant risk factor for cognitive delay. Socioeconomic status, primary caregiver, and breastfeeding duration, were not found to be risk factors for delays.
The combination of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio improves accuracy of neonatal sepsis diagnosis Rocky Wilar; Beatrice Koesmarsono; Stefanus Gunawan
Paediatrica Indonesiana Vol 63 No 4 (2023): July 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.4.2023.213-8

Abstract

Background Neonatal sepsis remains a challenging issue, due to sophisticated and time consuming tests needed to confirm a diagnosis. Objective To assess the applicability of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as diagnostic markers in neonatal sepsis. Methods This cross-sectional study was conducted in the Neonatology Ward of Kandou General Hospital, Manado, North Sulawesi. Neonates with suspected sepsis were included by consecutive sampling. We measured NLR and PLR form hematology profiles and differential count. Diagnosis of neonatal sepsis was based on positive blood cultures. A receiver operating characteristic (ROC) curve analysis was done to assess the NLR and PLR cut-off points. Chi-square test was used to analyze the diagnostic value of NLR and PLR. Results A total of 176 full term neonates with suspected sepsis were included in the study. Of these, 84 (47.7%) subjects were confirmed with neonatal sepsis and 92 (52.3%) were non-sepsis. The mean NLRs were 5.9 (95%CI 2.0 to 13.6) in the sepsis group and 1.6 (95%CI 0.2 to 3.2) in the non-sepsis group. A NLR of 3.0 was determined as the predictive cut-off value of neonatal sepsis (sensitivity 94%, speci?city 97.8%, and area under the ROC curve 0.995). NLR can effects on neonatal sepsis diagnosis by 61% . The mean PLRs were 79.9 (95%CI 44.0 to 155.8) in the sepsis group and 44.0 (95%CI 9.7 to 91.8) in the non-sepsis group. A PLR of 60.4 was determined as the predictive cut-off value of neonatal sepsis (sensitivity 86.9%, speci?city 87%, area under ROC curve 0.928). PLR can effects on neonatal sepsis diagnosis by 47.5%. When NLR and PLR were combined, they can improve accuracy of neonatal sepsis diagnosis about 72.2%. Conclusion Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) can be used in combination as adjunct diagnostic tests for neonatal sepsis workups.
Incidence and risk factors of nephritis in childhood Henoch-Schonlein purpura Yaulia Yanrismet; Eka Laksmi Hidayati; Zakiudin Munasir; Klara Yuliarti; Afifa Fahriyani
Paediatrica Indonesiana Vol 63 No 4 (2023): July 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.4.2023.304-14

Abstract

Background Henoch-Schönlein Purpura (HSP) is the most common systemic vasculitis disease in children. It is characterized by involvement of the skin, joints, gastrointestinal tract, and kidney. Kidney manifestations may progress to severe nephritis, even lead to end-stage kidney disease. Objective To identify the incidence and risk factors of nephritis in childhood HSP. Methods A retrospective cohort study was performed to evaluate clinical, demographic, laboratory, and therapeutic parameters of HSP patients aged 0-18 years between 2011-2019 at Dr. Cipto Mangunkusumo Hospital, Jakarta. Diagnoses of HSP were made according to the 2008 EULAR/PRES/PRINTO criteria. Wefollowed subjects’ medical records for at least 3 months after disease onset to observe incidence and risk factors of Henoch-Schönlein nephritis (HSN).Results There were 112 HSP patients (aged 2-17 years) included in this study. HSN was found in 40 out of 112 patients (35.7%). Nephritis developed within the first 4 weeks for a majority of cases. Multivariate analysis showed that persistent purpura (OR 3.306; 95%CI 1.315 to 8.315; P=0.011) and acute phase leukocytosis(OR 2.585; 95%CI 1.047 to 6.385; P=0.039) were significantly associated risk factors for HSN. We found that corticosteroid use did not reduce the risk of HSN. The accumulation of several risk factors was associated with the likelihood of developing HSN. Conclusion Persistent purpura and acute phase leukocytosis are independent risk factors for HSN. Therefore, blood tests are needed to estimate the risk of HSN. Early corticosteroid therapy do not reduce the risk of kidney impairment.
Intelligence quotient (IQ) outcome in children with early-treated congenital hypothyroidism: a systematic review and meta-analysis Whyra Pratama Said; Karina Sugih Arto; Winra Pratita; Sufitni Sufitni
Paediatrica Indonesiana Vol 63 No 4 (2023): July 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.4.2023.290-7

Abstract

Background Congenital hypothyroidism (CH) is the most common congenital endocrine disorder in childhood and is one of the most preventable causes of intellectual disability (ID). Late initiation of thyroid hormone substitution therapy has a negative impact on intellectual abilities in CH patients. Objective To compare Intelligence Quotient (IQ) between children with CH who underwent early treatment among the children without CH. Methods We performed online literature searches of ScienceDirect, Pubmed, Cochrane Library, and Google Scholar. We included clinical studies that examined IQ scores in patients with early-treated CH and without CH. Review Manager 5.4 was used to perform the meta-analysis. Results Twelve studies comparing pediatric patients with and without CH were included in this meta-analysis, for a total of 808 patients. Based on data analysis, IQ levels of verbal IQ [mean difference (MD) -9.05; (95%CI -14.51 to -3.59); (P<0.00001)], performance IQ [MD -11.70; (95%CI -17.41 to -5.99); (P<0.00001)], and total IQ [MD -10.78; (95%CI -14.03 to -7.54); (P<0.00001)]. While verbal, performance, total, of the early-treated CH group were within the normal range, they were each significantly lower than those in the non-CH group. Conclusion This meta-analysis reveals that IQ scores in early-treated CH subjects were within normal limits, but significantly lower than that of normal controls.
Neonatal outcomes from in vitro fertilization-conceived pregnancies Ashfahani Imanadhia; Risma Kerina Kaban; Adhi Teguh Perma Iskandar; Reynaldo Rahima Putra; Ressa Hana Natasa
Paediatrica Indonesiana Vol 63 No 4 (2023): July 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.4.2023.238-44

Abstract

Background In vitro fertilization (IVF) shows potential to improve pregnancy success, especially for infertile couples. This technique has some risks for neonates in the perinatal period and may affect their future health. Objective To investigate the characteristics and clinical outcomes of neonates from IVF-conceived pregnancies. Methods This retrospective study was conducted in neonates from IVF-conceived pregnancies from January to December 2021 at Bunda Women’s and Children’s Hospital, Jakarta. We gathered data from medical records about maternal age and morbidity, gravidity, gestational age, method of delivery, multiple gestation, also neonates’ significant profiles like prematurity, birth weight, Apgar score, and morbidities in perinatal period. We would like to investigate the characteristics and clinical outcomes of neonates born from IVF-conceived pregnancies program. Results There were 361 neonates whose mothers underwent IVF included in this study. Most mothers were ?35 years (70.9%) and on their first pregnancy (69.2%). Maternal complicating factors were premature contractions (16.6%), premature rupture of membranes (8.3%), and twin pregnancy (31.5%). About 98.6% of deliveries were performed by caesarean section and from IVF-conceived pregnancies program most 61.2% neonates were born at full term gestation (61.2%). Preterm deliveries occurred at a mean gestational age of 34.4 (SD 2.4) weeks. Subjects’ mean birth weight was 2,800.2 (SD 640.3) grams, with 26.3% in the low-birth-weight category. Most neonates (93.0%) were appropriate weight for gestational age and had good Apgar scores in the first minute (92.2%) and fifth minute (99.7%). However, 24.3% of neonates needed intensive care (NICU) with morbidities. The longest length of NICU stay was 100 days, with mortality of 7.9% of NICU-treated infants. Conclusion In our setting, most neonates from the IVF program were born with good outcomes, although preterm birth rate, low birth weight, need for NICU care, and mortality rate were quite high. Further study is needed to evaluate long-term outcomes of IVF neonates.
Accuracy of NADAS criteria to establish diagnosis in children with suspected congenital heart disease Rahmawati Rahmawati; Rizky Adriansyah; Yunnie Trisnawati; Juliandi Harahap; Pertin Sianturi; Ayodhia Pitaloka Pasaribu
Paediatrica Indonesiana Vol 63 No 4 (2023): July 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.4.2023.267-73

Abstract

Background The majority of congenital heart disease is diagnosed during evaluation of a murmur detected either during a routine follow-up or while assessing an intercurrent illness. NADAS criteria might be useful as a screening test to differentiate pathologic from innocent murmurs. Objective To assess the accuracy of NADAS criteria in diagnosing pathology in children with suspected congenital heart disease. Methods This diagnostic study included children aged 1 month - 12 years who visited the Outpatient Pediatric Cardiology Clinic at Haji Adam Malik General Hospital, Medan, North Sumatera. Inclusion criteria from history and physical examination were recurrent acute respiratory illness (ARI), poor nutritional status, failure to thrive, cardiac murmurs, and/or a history of cyanosis. Results Seventy children underwent NADAS screening, of whom 60 had CHD. In the <5-year age group, 63.3% had heart disease. All patients had poor nutritional status, both CHD and non-CHD patients. All CHD patients had an abnormal electrocardiogram (ECG), while 88.33% had a history of recurrent ARI, 80% had abnormal chest x-ray, and 55% had abnormal S2 heart sound on auscultation. A grade 3 or higher systolic murmur was found in 78.33% of patients who had CHD. There were 55 children who had a NADAS score of 3 or higher, of which 53 children with CHD and 2 children non CHD (1 of the 2 children non CHD showed only 3 minor criteria of the NADAS score and had infantile fibrosarcoma). The other 15 children had a NADAS score of less than 3 with 7 children with CHD and 8 children without CHD. Conclusion The NADAS criteria can be used as a screening test to diagnose disease in children suspected of having CHD for cut-off score at 3 (1 major + 2 minor), with 87.14% accuracy, 88.33% sensitivity, 80% specificity, and 0.883 AUC value.

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