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INDONESIA
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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Evaluation of performance of Indonesian Sepsis National Guidelines (PNPK) 2021 in diagnosing pediatric bacterial sepsis asiyani, Lilis siti; Rusmawatiningtyas, Desy; Indrawanti, Ratni Indrawanti; Arguni, Eggi Arguni; Wibowo, Tunjung Wibowo; Nurnaningsih, Nurnaningsih Nurnaningsih
Paediatrica Indonesiana Vol. 64 No. 3 (2024): May 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.3.2024.258-63

Abstract

Background Sepsis remains one of the causes of child morbidity and mortality worldwide. The reference standard diagnosis of sepsis is blood culture, but its false negative is relatively high. Therefore, a validated triage tool is needed for rapid diagnosis. In Indonesia, diagnosis and management of pediatric sepsis are based on Indonesian Sepsis National Guidelines 2021. Objective To evaluate the performance of Indonesian Sepsis National Guidelines 2021 in diagnosing pediatric bacterial sepsis in PICU. Methods This cross-sectional study was conducted in the PICU unit of Dr. Sardjito Hospital, Yogyakarta, using subject’s the medical records. All patients with suspected bacterial infection who were admitted to the PICU, had complete evaluation of PELOD-2 score, and the blood culture results were included in this study. Sepsis was assessed with Indonesian Sepsis National Guidelines 2021. Performance analysis of the guidelines was conducted with SPSS version 25, by assessing sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and likelihood ratio. Results Two hundred subjects were enrolled in this study, of whom 52.5% were males. Most subjects aged under one year (40.5%), and the most common infection was respiratory system (49%). A total of 63.5% were referral cases, with the length of stay in the previous hospital more than 48 hours (69.7%). There were 77% of subjects had antibiotics treatment at the previous hospital. As for outcomes, 63.5% survived and 36.5% died. The positivity rate of blood culture in this study was 19%. Performance evaluation of Sepsis Indonesian Sepsis National Guidelines 2021 revealed sensitivity 28.95%, specificity 87.65%, accuracy 76.5%, positive predictive value 35.48%, negative predictive value 84.02%, positive likelihood ratio 2.34 (95%CI 1.28 to 4.32) and negative likelihood ratio 0.81 (95%CI 0.7 to 0.94). Conclusion Indonesian Sepsis National Guidelines 2021 (PNPK Sepsis 2021) has low sensitivity and high specificity in diagnosing bacterial sepsis.
Risk factors of mortality in septicemic extramural neonates: an experience from resource limited setting of central India Meshram, Rajkumar Motiram; Kadu, Kalyani S
Paediatrica Indonesiana Vol. 64 No. 3 (2024): May 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.3.2024.209-17

Abstract

Background: Sepsis is responsible for 30-40% neonatal deaths which can be attributed to various maternal, neonatal and sociocultural risk factors. Objective: To recognize the clinical and laboratory risk factors of mortality in extramural neonatal sepsis. Material and methods: Prospective observational study was conducted for duration of one year on extramural neonates with suspected sepsis. Maternal, neonatal and sociocultural factors were analyzed. Results: Average duration of hospital stay was shorter in non-survival compared to survival neonates (p=0.01). On univariate analysis preterm (p<0.001), weight<2500gms (p=0.01), home delivery (p=0.004) by Traditional Birth Attendant (p=0.003) , unbooked mother (p=0.03), peripartum febrile illness (p=0.02) and Premature rupture of membrane > 18 hours were the significant risk factors of mortality. Those neonates admitted with lethargy (p=0.04), hypothermia (p=0.01), respiratory distress (p<0.001), convulsion (p<0.0001), Jaundice (p=0.006), Apgar score <5at 1minute (p=0.01) , prolonged CFT (P<0.001), previously hospitalized (p<0.001) ,required mechanical ventilation (p=0.01),had thrombocytopenia (p=0.02), positive CRP (P<0.001), hypoglycemia (p=0.04), oxygen saturation ?90% (p=0.04), abnormal CSF/chest radiograph finding (p=0.002) had significantly higher mortality. Delivery conducted by traditional birth attendant, neonates travelled more than 80km, prematurity, bottle feed, h/o previous hospitalization, h/o lethargy, hypothermia, convulsions, prolonged CFT and isolation of micro-organisim were the independent risk factors of mortality in extramural neonates with sepsis Conclusion: Delivery conducted by traditional birth attendant, neonates travelled more than 80km, prematurity, bottle feed, h/o previous hospitalization, h/o lethargy, hypothermia, convulsions, prolonged CFT and isolation of micro-organisim were the independent risk factors of mortality in extramural neonates with sepsis.
Cortisol levels associated with mortality in children with critical illness: a systematic review Tolibin, Restu Triwulandani; Widiretnani, Septin; Moelyo, Annang Giri
Paediatrica Indonesiana Vol. 63 No. 6 (2023): November 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.6.2023.472-82

Abstract

Background Critically ill patients, including those with sepsis, have increased cortisol levels due to activation of the hypothalamic-pituitary-adrenal (HPA) axis or critical illness-related corticosteroid insufficiency (CIRCI). Objective To evaluate for a possible association between cortisol levels and mortality from sepsis in pediatric patients by systematic review of the literature. Methods A systematic review was conducted on studies involving critically ill children, including those with sepsis. We included studies published between 2011-2020 analyzing data on cortisol levels (total serum cortisol, serum-free cortisol, salivary cortisol, real-time free cortisol, basal serum cortisol and post-adrenocorticotropin hormone (ACTH) stimulation test, or basal salivary cortisol and post-ACTH stimulation test), the predictive score for mortality (Pediatric Logistic Organ Dysfunction/PELOD), Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), Vasotropic Inotropic Score (VIS), or Pediatric Critical Illness Score (PCIS)], mortality (non-survivor percentage), and CIRCI percentage as an outcome in patients with critical illness, sepsis, and septic shock. Results Twenty-one observational studies were included in our systematic review, with a total of 2,212 subjects, 916 of whom had sepsis. Nineteen studies indicated a positive association between elevated cortisol levels and mortality in critically ill children, but 2 studies stated that there was no association with the CIRCI percentage of 32.3 and 84.3% respectively. The mortality percentage of critically ill patients with elevated cortisol levels and sepsis were 25.81 (2.7-60)% and 35.31 (6-60)%, respectively. The percentages of CIRCI in critically ill and sepsis patients were 21.91 (0-84.3)% and 21.35 (0-84.3)%, respectively. Conclusion Cortisol levels may increase or decrease in critically ill children. Elevated cortisol levels are associated with mortality in septic children. The effect of CIRCI on mortality in critically ill children cannot be concluded.
Comparative assessment of cognitive function of asthmatic and non-asthmatic children in Ilorin, Nigeria Mohammed, Salihu Sheni; Ibraheem, Rasheedat Mobolaji; Abdulkadir, Mohammed Baba; Adeboye, Muhammed Akanbi Nurudeen; Gobir, Aishatu Ahmed; Johnson, Wahab Babatunde Rotimi
Paediatrica Indonesiana Vol. 64 No. 2 (2024): March 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.2.2024.97-105

Abstract

Background The presence of asthma in children may negatively impact their cognitive function, possibly due to intermittent hypoxia from repeated acute exacerbations, sleep deprivation, and school absenteeism. However, conflicting reports abound on cognitive performance among children with asthma. Objective To assess and compare the cognitive function of asthmatic and non-asthmatic children in Ilorin, Nigeria. Methods This cross-sectional study compared the cognitive performance scores of 66 children with asthma aged 6-17 years, and the corresponding scores of 66 healthy age- and gender-matched children without asthma. Data obtained included sociodemographic, anthropometric, and clinical details. Cognitive function was assessed with the Raven's Progressive Matrices (RPM) psychometric test. Results The male: female ratio was 1.3:1. The median RPM score of 50.0 [interquartile range (IQR) 25.0-75.0] in children with asthma was significantly higher than that of non-asthmatic children [32.5 (IQR 10.0-50.0)]; (P=0.016). A significantly higher proportion of asthmatic subjects (74.2%) were in the high grade RPM score category compared to the non-asthmatic children’s concomitant proportion (57.6%). Asthmatic subjects were twice as likely to belong to the high grade RPM score category than their non-asthmatic counterparts (OR=2.12; 95%CI 1.02 to 4.44; P=0.043). There was no significant association between RPM score grade and clinical severity of asthma in the subject population (P=0.554). Conclusion Children with asthma perform better in cognitive function assessment, using RPM test, compared to their non-asthmatic counterparts in Ilorin, Nigeria.
Clinical and laboratory effects of exchange transfusion in pediatric acute lymphoblastic leukemia with hyperleukocytosis Lazuwardi, Rasya Azka; Andarsini, Mia Ratwita; Hernaningsih, Yetti
Paediatrica Indonesiana Vol. 63 No. 6 (2023): November 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.6.2023.464-71

Abstract

Background Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Emergency complications such as hyperleukocytosis can arise as the disease develops. Exchange transfusion is one of many cytoreductive modalities to resolve the condition. Objective To analyze the clinical and laboratory effects of exchange transfusion in childhood acute lymphoblastic leukemia patients with hyperleukocytosis. Methods This analytical retrospective cohort study with a pre- and post-test design used secondary medical record data. The obtained characteristics were the incidences of dyspnea, tachypnea, headache, intracranial bleeding, hepatomegaly, splenomegaly, lymphadenopathy, abdominal pain, fever, pallor, nausea/vomiting, and skin or mucosal bleeding; hemoglobin, white blood cell, and platelet counts; and serum potassium, sodium, calcium, phosphate, blood urea nitrogen, and creatinine levels. Results A total of 16 patients underwent exchange transfusion; they had significant reductions of the incidence of dyspnea, tachypnea, hepatomegaly, and pallor and significant improvement in the form of elevation of hemoglobin level and decrease in white blood cell counts (P<0.05 for all) compared to pre-treatment. The remainder of the variables were not significantly different between pre- and post-treatment, but a general decrease in all clinical manifestations except intracranial bleeding was observed. Conclusion Exchange transfusion has the beneficial effect of resolving hyperleukocytosis and its manifestations, although correction in laboratory outcomes that remained abnormal are still needed.
Neutrophil lymphocyte ratio and severity of acute kidney injury in septic children Kowita, Nurul Huda; Sovira, Nora; Safri, Mulya; Ismy, Jufitriani; Haris, Syafruddin; Herdata, Heru Noviat; Bakhtiar, Bakhtiar
Paediatrica Indonesiana Vol. 63 No. 6 (2023): November 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.6.2023.492-8

Abstract

Background Acute kidney injury (AKI) in sepsis is associated with an inflammatory process in kidney microcirculation and may increase morbidity and mortality in children. The neutrophil lymphocyte ratio (NLR) is an inflammatory biomarker of the inflammatory process in sepsis. Objective To determine the role of NLR in predicting the severity of AKI and to describe the demographic and laboratory characteristics, as they relate to outcomes of pediatric patients with AKI and sepsis. Methods This cross-sectional study was conducted in the PICU at Dr. Zainoel Abidin General Hospital (RSUDZA), Banda Aceh, Aceh. Medical record data were obtained from critically ill children with sepsis and AKI. Chi-square test was used to compare the proportions of each variable. We also calculated odds ratios to evaluate the AKI severity, PELOD-2 score, and patient outcomes. Spearman's analysis was used to look for a possible correlation between NLR and AKI severity in septic children. Results Seventy-one subjects with sepsis and AKI were included. Subject characteristics were as follows: 63.4% males, 63.4% < 1 year of age, 56.3% with respiratory problems as a primary disease, 38% with AKI injury stage, and 54.9% subjects with PELOD-2 score ?10. There was no significant correlation between AKI severity and mortality (OR 3.04; 95%CI 0.990 to 9.378; P=0.052). Subjects with a PELOD-2 score ?10 had a 47.6 times higher chance of mortality in septic children with AKI compared to those with PELOD-2 scores <10. There was no correlation between NLR and AKI severity (r=0.019; P=0.878). Conclusion There is no correlation between NLR and AKI severity. Sepsis accompanied by AKI may increase the risk of mortality in children. Septic children with more severe AKI tends to be less survive.
Risk factors associated with sepsis in children with acute lymphoblastic leukemia and febrile neutropenia Versary, An nieza Dea; Susanah, Susi; Alam, Anggraini
Paediatrica Indonesiana Vol. 64 No. 3 (2024): May 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.3.2024.270-6

Abstract

Background Children with acute lymphoblastic leukemia (ALL), especially those with febrile neutropenia, are susceptible to sepsis. Several factors have been associated with the occurrence of sepsis in children with leukemia. Objective To identify potential risk factors associated with sepsis in children with ALL and febrile neutropenia. Methods This cross-sectional study was done in children with ALL who sought treatment at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from January 2019 to March 2022. We recorded patients’ gender, age, nutritional status, absolute neutrophil count (ANC), co-infection, prophylactic antibiotic use, and phase of chemotherapy. Results Of 131 subjects, 57.3% were male and 42.8% were wasted. Subjects had a median age of six years old and median ANC of 230 cells/mm3. Furthermore, 48.9% of subjects had co-infections, 87.8% had not received prophylactic antibiotics, and 48.9% were in the induction phase of chemotherapy. Multiple logistic regression analysis revealed that older age [OR 1.16 (95%CI 1.04 to 1.29); ?=0.149; P=0.008] and co-infection [OR 12.9 (95%CI 5.01 to 33.21); ?=2.551; P<0.001] were significantly associated with sepsis in children with ALL and febrile neutropenia. Bronchopneumonia was the most common co-infection (72.5%). Conclusion Older age and co-infection are significantly associated with sepsis in children with ALL and febrile neutropenia.
Low-level red-light therapy as a novel modality for myopia control in children: A systematic review Dewi, Arlin Chyntia; Budihardja, Brigitta Marcia; Jutamulia, Jovita
Paediatrica Indonesiana Vol. 64 No. 1 (2024): January 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.1.2024.28-35

Abstract

Background Due to the COVID-19 pandemic causing a rise in digital technology use, online e-learning, and decreased outdoor time, the prevalence of myopia is expected to increase. Therefore, finding an effective strategy for myopia progression control is of high importance. Low-level red-light therapy (LLRT) has been proposed as a new modality in myopia progression control. Objective To assess the efficacy of LLRT for myopia control in children. Methods A comprehensive literature search of four online databases (PubMed, Cochrane, ProQuest, and WorldCat) was performed. We included original studies that assessed the efficacy of LLRT for myopia control in children and excluded animal studies, case reports, articles with no full-text available, and articles not in English. Risk of bias assessment was performed using different tools according to the study type. The main outcome measurements were changes in axial length (AL) and spherical equivalent refraction (SER). Results Three clinical studies, two randomized controlled trials and one retrospective cohort study, were reviewed. A total of 296 children in the treatment group were evaluated. Children using single-vision spectacle only or orthokeratology lenses were evaluated for comparison. All studies had reported significantly improved outcomes, with lower mean AL changes and greater SER improvement in the LLRT group compared to the control group (P<0.001 in all studies). Conclusion Although studies on LLRT are still limited, the treatment has shown promising results for myopia control in children. More studies to evaluate the efficacy of this new strategy are needed.
Quality of life of children with acute lymphoblastic leukemia Arifah, Siti; Pookboonmee, Renu; Patoomwan, Autchareeya; Kittidumrongsuk, Prasong; Andarsini, Mia Ratwita
Paediatrica Indonesiana Vol. 63 No. 5 (2023): September 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.5.2023.405-10

Abstract

Background Acute lymphoblastic leukemia (ALL) is the most common cancer in children worldwide, which requires long treatment. This condition and its subsequent treatment change the body's physiology, reducing children’s quality of life. Objective To describe the quality of life in children with acute lymphoblastic leukemia in Java, Indonesia. Methods This descriptive study with a cross-sectional approach included parents who had children with ALL at three referral hospitals in Java, Indonesia, between January 2021 and May 2022. We recruited 188 mothers or fathers who accompanied their children for follow-up visits or hospitalization. Children’s quality of life as the primary outcome was evaluated by parent proxy using the PedsQL 3.0 cancer module. Results Most parents were mothers (81.9%); parents’ ages ranged from 22 to 59 years. The mean age of children was 7.63 (SD 3.85) years, with 63.3% boys and 147 (78.2%) treated in maintenance phase during the study. The mean overall children’s QoL score was 84.37 and it classified as high (73.9% of subjects), no children had very low QoL. The lowest mean sub-scale QoL score was in procedural anxiety (72.25), whereas the highest sub-scale score was in communication (91.56). Conclusion There is an improvement in QoL of children with ALL in Indonesia. However, the procedural anxiety sub-scale requires more interventions to reduce anxiety and alleviate pain during invasive procedures.
Optic nerve sheath diameter and severity of central nervous infection Dewi, Anggun Puspita; Lukmanul Hakim, Dzulfikar Djalil; Rahayuningsih, Sri Endah; Risan, Nelly Amalia; Ghrahani, Reni; Adrizain, Riyadi
Paediatrica Indonesiana Vol. 63 No. 5 (2023): September 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.5.2023.411-7

Abstract

Background Central nervous system (CNS) infection affects the brain, and can cause cerebral edema, increased intracranial pressure (ICP), cerebral herniation, and death. Measurement of the optic nerve sheath diameter (ONSD) by ultrasound is a new, non–invasive examination to predict ICP, with high sensitivity and specificity.Objective To analyze for a possible association between ONSD measured by ultrasonographic examination and severity of CNS infection. Methods This cross–sectional study was performed in the Pediatric Department of Hasan Sadikin Hospital, Bandung, West Java. Subjects were chosen by consecutive sampling. We measured ONSD, examined clinical manifestations, as well as performed a cerebrospinal fluid (CSF) study and imaging of CNS infection. Data analysis was done by paired T–test and one–way ANOVA, followed by Tukey test on significant variables. Results Subjects consisted of 32 children with CNS infection. The most common clinical symptoms were fever, decreased consciousness, and nuchal rigidity. Bivariate analysis revealed strong positive associations between ONSD and Glasgow Coma Scale (GCS), increased protein levels in CSF, and type of CNS infection. Conclusion Larger ONSD is significantly associated with lower GCS, increases CSF protein, and particular CNS infections. The ONSD is also associated with meningitis tuberculosis grade III, with a higher mean ONSD of both eyes compares to other CNS infections. Hence, the higher the ONSD, the more severe the degree of CNS infection.

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