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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 2,114 Documents
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Comparative analysis of COVID-19 incidence and neutralizing antibody response after primary COVID-19 vaccination and heterologous booster doses in adolescents vs. adults: the Indonesian experience Karyanti, Mulya Rahma; Satari, Hindra Irawan; Munasir, Zakiudin; Hadinegoro, Sri Rezeki; Widyahening, Indah Suci; Sasmono, R Tedjo
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.316-24

Abstract

Background The Indonesian COVID-19 immunization program has provided primary doses of a COVID-19 vaccine to adolescents and adults, while booster doses were given to adults only. Evaluation of this program is crucial to determine if boosters should be recommended for adolescents. Objective To compare COVID-19 incidence and SARS-CoV-2 IgG neutralizing antibody levels after COVID-19 vaccination in adolescents given a primary dose vs. adults given a primary dose and a booster. Methods: In this cross-sectional study, participants were given questionnaires on their COVID-19 history and evaluated for SARS-CoV-2 IgG neutralizing antibody titers. We included healthy individuals aged 12 years or older who resided in Jakarta and consented to participate, had received primary COVID-19 vaccine doses, and for adults, booster doses. Participants were stratified into two age groups, adolescents (12-17 years) and adults (18 years and above). We compared the incidence of COVID-19 and SARS-CoV-2 antibody titers between the two age groups. Results Out of 419 participants who met the inclusion criteria, 159 had blood specimens drawn for measurement of SARS-CoV-2 antibody titers. Before the widespread administration of the vaccine, the incidence of COVID-19 in was 4.9% in adolescents vs. 10.2% in adults (P=0.036). After widespread vaccination, the incidence of COVID-19 remained lower in adolescents than in adults (2.2% vs. 8.8%, respectively; P=0.005). The median SARS-CoV-2 antibody titer post-COVID-19 vaccination was 97.85 (range 46.46-98.23) U/mL in adults vs. 96.78 (range 22.08-98.23) U/mL in adolescents (P<0.05). Conclusion While the incidence of COVID-19 was significantly lower in vaccinated adolescents than in vaccinated adults, titers of SARS-CoV-2 IgG neutralizing antibody in adolescents were significantly lower compared to that of adults.
Diagnostic performance of digital and traditional stethoscopes for detecting pneumonia-associated crackles in pediatric pneumonia patients Udin, Muchammad Fahrul; Anggarkusuma, Michelle Vanessa; Pareira, Raymundus Florentino Mariano; Sajidah, Farah; Raziq, Muhammad Abdul; Bulain, Stanley; Amar, Nasim; Lestari, Hotma; Yusuf, Muhammad; Olivianto, Ery; Mulia, Rizki Hari
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.331-6

Abstract

Background Advancements in healthcare technology have enabled the development of digital stethoscopes, enhancing auscultation in telemedicine practices. By remotely capturing and transmitting respiratory sounds, these devices improve physical examinations as well as the diagnosis and monitoring of respiratory diseases, particularly in remote or underserved areas. Objective To evaluate the sensitivity and specificity of a piezoelectric sensor-based digital stethoscope compared to a conventional stethoscope in detecting crackles associated with pediatric pneumonia. Methods This prospective comparative study involved 30 randomly selected pediatric pneumonia patients. Two pediatric pulmonologists independently assessed breath sounds in six lung areas using both digital and conventional stethoscopes. Findings were compared to evaluate the digital stethoscope’s sensitivity and specificity in detecting crackles, with the conventional stethoscope serving as the reference standard. Results The digital stethoscope demonstrated high sensitivity (>90%) and specificity (>90%) in detecting crackles, comparable to the conventional stethoscope. Examiner 1 achieved a sensitivity of 93.16%, a specificity of 97.10%, and an accuracy of 94.62%, while Examiner 2 achieved a sensitivity of 90.43%, a specificity of 91.55%, and an accuracy of 90.86%. The study highlights the potential of digital stethoscopes in telemedicine applications, particularly for pediatric respiratory assessments. Conclusion The digital stethoscope shows good diagnostic performance and may be a viable tool for remote auscultation. Its use may improve access to diagnostics in underserved areas or when in-person exams are difficult.
Bacterial patterns and antibiotic sensitivity among neonatal sepsis patients in Dr. H. Abdul Moeloek Hospital, Lampung Ervina, Leni; Busman, Hendri; Berawi, Khairunnisa; Irawan, Bambang; Azizah, Nailul; Yolanda, Jennifer Ester
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.297-306

Abstract

Background Neonatal infections cause more than 550,000 deaths each year worldwide. Sepsis is a serious neonatal infection, defined as a severe form of infection that causes organ dysfunction. The incidence of neonatal sepsis in Dr. H. Abdul Moeloek Hospital, Lampung increased by 25% from 2017 to 2018 and by 30% from 2018 to 2019. Inappropriate use of antibiotics as therapy can lead to bacterial resistance to the medication. Understanding the most common bacterial patterns and using the guidance of antibiotic sensitivity tests can help health workers determine the empirical antibiotics needed to achieve optimal management, especially in neonatal sepsis patients. Objective To identify bacteria and their antibiotic sensitivity patterns in neonatal sepsis patients at Dr. H. Abdul Moeloek Hospital, Lampung between January and June 2024. Method  Descriptive study was conducted using medical record data from neonates suspected of having sepsis in Dr. H. Abdul Moeloek Hospital Lampung between January and June 2024. Blood culture data and antibiotic sensitivity testing was obtained from medical records. Results Of 65 blood culture of neonates suspected of having sepsis, 31 results were positive (47.6%). The most common microorganisms found were Klebsiella pneumoniae (23%), Burkholderia cepacia (19%), Acinetobacter baumannii (10%), Pseudomonas aeruginosa (10%), Enterococcus faecium (10%) Staphylococcus aureus (10%), Staphylococcus epidermidis (6%), Enterococcus faecalis (6%), Escherichia coli (3%), and Enterobacter cloacae (3%). Based on the sensitivity data calculated using weighted averages, ciprofloxacin (64.7%) and tigecycline (61.1%) showed highest sensitivity across more than five bacterial species. In contrast, ampicillin/sulbactam (96.0%), gentamicin (94.2%), and ceftriaxone (87.7%) had the highest resistance rates. Conclusion The most common bacteria causing neonatal sepsis were Klebsiella pneumoniae and Burkholderia cepacia. Among more than five bacterial species, the highest overall sensitivity was observed to ciprofloxacin and tigecycline, while the highest resistance rates were observed to ampicillin/sulbactam, gentamicin, and ceftriaxone.
Analysis of stool SCFA levels in weaning infants, the timing of weaning, and dietary intake Leliana, Vidya; Sareharto, Tun Paksi; Pratiwi, Rina
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.279-85

Abstract

Background Short-chain fatty acids (SCFA) are metabolites of polysaccharides that cannot be digested by microbiota. Differences in SCFA profiles depend on infant diet and intestinal microbiota. The timing of weaning period from breast milk or formula to solid foods affects the transitional microbiome of the gut. Indonesian Pediatric Society recommend the weaning period at at 6 months old. Objective To analyze for differences in stool SCFA levels in weaning infants according to timing of weaning to introductory solid foods and dietary intake. Methods This cross-sectional study was conducted from February to August 2023 in Semarang Primary Health Care Unit. Subjects were infants aged 4-6 months, who underwent fecal SCFA laboratory analysis consisting of acetate, propionic, butyric, and valeric acids, and total SCFA levels, as well as carbohydrate, protein, lipid, and fiber intake assessment through a 3-day food recall processed with Nutrisurvey software of subjects who transitioned to solids before 6 months vs. at 6 months of age. We compared stool SCFA levels in the two groups using T-test analysis. Results Of 50 infants, 23 children (46%) started weaning from breast milk or formula to food at 6 months of age, and 27 children (54%) started weaning before 6 months of age. In this study, there were no significant differences in SCFA levels between those who started at 6 months and before 6 months (P>0.05). There was a weak positive correlation (r = +0.281) between protein intake and propionic acid level (P=0.0481) in all subjects. Conclusion There is no significant difference in SCFA level between starting the weaning period at 6 months and before. However, there is a positive correlation between protein intake and propionic acid, when the analysis was done on all subjects.
Stress levels and menstrual cycles in high school adolescents Saldinar, Alena Briliantyas; Athiah, Medina; Hasanah, Yulisnawati; Nurwanny, Raissa; Aditiawati, Aditiawati
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.325-30

Abstract

Background Around 15.5 million (34.9%) adolescents in Indonesia experience stress. Most of the stress in adolescents comes from internal and external academic demands. One of the negative impacts of stress is the disruption of hormonal mechanisms in the female reproductive system, which can affect the menstrual cycle. Objective To analyze the relationship between stress level and menstrual cycle in adolescent girls aged 15 - 17 years who have menses  ≥ 2 years. Methods This study used primary data from instruments such as the Depression Anxiety Stress Scale (DASS 42) questionnaire modified by Damanik and the menstrual cycle questionnaire by Aldiba filled on Google forms by 1,565 adolescents from four high schools in Palembang City. We also excluded adolescents with conditions that could potentially bias the study, such as endocrine diseases (pituitary tumors and Cushing's syndrome), athletes with intensive physical activity, use of hormonal drugs, and abnormalities in nutritional status. Results A total of 281 of 961 respondents who met the inclusion criteria were randomly selected through a stratified proportional random sampling method. Of those who reported experiencing stress, 27% experienced moderate stress. The majority of subjects experienced menstrual cycle disorders (55.5%). Adolescents with moderate stress level and above had a greater percentage of menstrual cycle disorders compared to adolescents who did not experience stress (P=0.039). Severe levels of stress were significantly associated with menstrual cycle irregularities (P=0.025) Conclusion Stress levels are significantly associated with menstrual cycle irregularities among high school adolescents in Palembang City.
Elephantiasis and nodular scabies coinfection: a rare case report Armiyanti, Yunita; Shodikin, Muhammad Ali; Tohari, Achmad Ilham
Paediatrica Indonesiana Vol. 65 No. 5 (2025): September 2025
Publisher : Indonesian Pediatric Society

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Abstract

Indonesia  is a tropical country and  home to many infectious diseases. Two of them are filariasis and scabies. The coinfection of filarial infection and scabies may cause severe morbidity for the patient, especially children. There has been no reported coinfection or management between these two diseases. An 11-year-old boy was brought to the pediatrics division of Dr. Soebandi Hospital with diffuse enlargement of the left lower extremity and scrotum, along with non-pitting edema, itching, and nodular skin lesions all over the body. It is important to consider holistic approaches to prevent further morbidity and disability.
Quality of life in episodic hypoxic children after emergency department or PICU hospitalization Yuniar, Irene; Julianti, Julianti; Gunardi, Hartono; Dewi, Rismala; Wiguna, Tjhin; Lubis, Munar
Paediatrica Indonesiana Vol. 65 No. 5 (2025): September 2025
Publisher : Indonesian Pediatric Society

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Abstract

Background Studies on long–term outcomes of hypoxic children after being hospitalized are limited, even though hypoxia is known to affect their quality of life (QoL). Objective To assess the QoL of children with episodic hypoxia following hospitalization in the emergency department (ED) and Pediatric Intensive Care Unit (PICU). Methods A prospective cohort design study targeting pediatric patients aged 2–7 years with critical illness was conducted at Dr. Cipto Mangunkusumo Hospital. Inclusion criteria are hypoxia patients receiving oxygen therapy, defined from the ratio of partial arterial oxygen pressure and inspired oxygen (PaO2/FiO2). The PedsQLTM questionnaire was used to assess QoL at the time of admission and 3 months after hypoxia event. Patients with cerebral palsy, mental retardation, chromosomal abnormalities, liver transplantation, and length of stay ≤24 hours were excluded. Data distribution in numerical form was analyzed using the Kolmogorov–Smirnov test. Results Forty-six children with a median age of 4 (2–7) years had decreased QoL at 3 months after episodic hypoxia, based on PedsQLTM scores. The physical, emotional, and social domains were significantly decreased (P<0.01) compared to QoL at the time of admission. Prior to admission, 78.3% of children had already experienced impaired QoL. Conclusion Children with episodic hypoxia demonstrated a decline in QoL at 3 months after hypoxia event based on PedsQLTM scores. Specifically, the physical, emotional, and social domains were significantly decreased compared to at the time of admission.  
Antibiotic use in children before and after an e-learning intervention Rosyady, Maulana; Karyanti, Mulya Rahma; Chozie, Novie Amelia
Paediatrica Indonesiana Vol. 65 No. 5 (2025): September 2025
Publisher : Indonesian Pediatric Society

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Abstract

Background Antibiotic resistance is a global health threat. E-learning can be used to increase the knowledge of medical staff and the effectiveness of antibiotic use. Objective To evaluate the impact of e-learning intervention for pediatric doctors and residents on antibiotic use in pediatric patients. Methods This single-arm intervention study involved all pediatric doctors and residents from the Department of Child Health, Faculty of Medicine at Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital (FMUI-CMH). Staff and residents underwent e-learning intervention on the topic of antimicrobial stewardship (AMS) via the E-learning Management System Universitas Indonesia (EMAS UI) website, followed by comparison of their pre- and post-intervention knowledge. The appropriate use of antibiotics pre- and post-intervention at October and December 2022, respectively, by was assessed by Gyssen's flowchart. Results A total of 135 (54.4%) antibiotic uses in the pre-intervention period and 170 (72.24%) in the post-intervention period were considered appropriate. A significantly greater proportion of subjects received appropriate antibiotic use after the intervention compared to before (95%CI 0.363 to 0.795; P=0.002). Forty-two out of 56 pediatricians and 119 out of 123 pediatric residents participated in the e-learning program. There was a significant improvement in knowledge levels between the pre- and post-intervention periods among pediatricians, with more passing the post-intervention assessment compared to the pre-intervention assessment (1 vs. 29, respectively; P=0.001). Similarly, a significant increase was observed among pediatric residents (10 vs. 66, respectively; P=0.001). Conclusion There was a significant increase in appropriate antibiotic use in pediatric patients at CMH after pediatric doctors and residents underwent e-learning interventions.
The frequency and distribution of pediatric healthcare-associated infections in children Murni, Indah Kartika; Wirawan, Muhammad Taufik; Patmasari, Linda; Laksanawati, Ida Safitri
Paediatrica Indonesiana Vol. 65 No. 5 (2025): September 2025
Publisher : Indonesian Pediatric Society

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Abstract

Background Healthcare-associated infections (HAIs) are major contributors to increased morbidity, mortality, and healthcare costs. Ongoing epidemiological surveillance of nosocomial infection is needed to accurately assess their burden and inform prevention strategies. Objective To determine the frequency and distribution of HAIs. Methods A 26-month prospective cohort study (February 2016 to April 2018) was carried out at Dr Sardjito Hospital, a tertiary hospital in Indonesia, where pediatric patients hospitalized in the wards and pediatric ICU were monitored daily. HAIs were defined according to the criteria set by the Centers for Disease Control and Prevention. Results Out of 1,855 patients enrolled in the study period, 314 (16.9%) had HAI with an incidence density rate of 20.1 infections per 1,000 patient-days (416/20,672). The incidence of nosocomial urinary tract infection (UTI) was 4.3% (82/1,855) and the catheter-associated urinary tract infection (CAUTI) incidence density rate was 16.5 CAUTIs/1,000 patient-days (36/2,179). The incidence of nosocomial pneumonia, which includes both hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), was 3.2% (59/1,885), while the specific incidence rate of VAP was 5.1 per 1,000 patient-days (14/1,359). The incidence of nosocomial bloodstream infection was 1.9% (36/1,855) and the central line-associated bloodstream infection (CLABSI) incidence rate was 4.4 CLABSIs/1,000 patient-days (5/1,121). The incidences of surgical site infection, phlebitis, nosocomial upper respiratory infection, and nosocomial gastroenteritis were 0.2% (3/1,855), 0.9% (17/1,855), 2.9% (54/1,855), and 3.4% (63/1,855), respectively. Conclusion One-sixth of children in our hospital developed HAIs, with an incidence rate of 20.1 HAI/1,000 days. The most common HAI was CAUTI, followed by VAP and CLABSI.
Early enteral nutrition administration and time to achieve resting energy expenditure in critically ill children Yulman, Annisa Rahmania; Pudjiadi, Antonius Hocky; Tridjaja, Bambang; Kadim, Muzal; Prawitasari, Titis
Paediatrica Indonesiana Vol. 65 No. 5 (2025): September 2025
Publisher : Indonesian Pediatric Society

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Abstract

Background Malnutrition in critically ill children remains a significant concern, as a standardized nutritional support protocol has yet to be developed. Resting energy expenditure (REE) is recommended as a parameter for determining the fulfillment of energy needs in critically ill children, which should ideally be achieved within 72 hours. To achieve these energy needs, enteral nutrition (EN) is believed to have a lower mortality rate and a shorter length of stay compared to parenteral nutrition (PN). Objective  To evaluate the factors associated with delayed EN initiation and late achievement of REE.  Methods Data consisting of age, sex, nutritional status, timing of EN initiation, time required to achieve REE targets, PELOD-2 score, use of ventilators, duration of ventilation, hemodynamic status, use of inotropes and inotropic score, use of sedation, gastrointestinal symptoms, procedures performed during treatment, and technical issues were collected retrospectively from medical records from 2017 – 2018 in the Pediatric Intensive Care Unit (PICU) at Dr. Cipto Mangunkusumo Hospital. The REE was calculated using Schofield formula based on age and sex. These data were used to compare the proportion of the subjects receiving early EN (<48 hours) and delayed EN (>48 hours) and those who achieved REE <72 hours and delayed REE (>72 hours). Multivariate analysis was performed to determine which factors affecting late EN initiation and delayed REE achievement using logistic regression analysis. Results Of 203 subjects, 63.1% received early EN and 67.5% achieved REE at ≤72 hours. Delayed EN was associated with post-abdominal surgery (OR 10.89; 95%CI 4.31 to 27.50; P<0.001), ventilator use (OR 4.60; 95%CI 1.78 to 11.90; P=0.004), inotrope use (OR 4.18; 95%CI 1.56 to 11.17; P=0.002), gastrointestinal symptoms (OR 3.41; 95%CI 1.59 to 7.29; P=0.002), and abnormal nutritional status (OR 2.49; 95%CI 1.09 to 5.72; P=0.031). The REE >72 hours was associated with late EN (OR 20.62; 95%CI 6.48 to 65.65; P<0.001), enteral intolerance after receiving EN (OR 14.77; 95%CI 4.40 to 49.6; P<0.001), and PELOD-2 score ≥7 (OR 3.98; 95%CI 1.01 to 15.66; P=0.048). Conclusion The prevalence of EN and REE within 72 hours in the PICU is quite encouraging. Factors contributing to delayed EN administration include post-abdominal surgery, ventilator use, inotrope use, gastrointestinal symptoms, and abnormal nutritional status.  Delayed EN >48 hours, enteral intolerance after receiving EN, and PELOD-2 score >7 were the factors contributing to delayed REE achievement. However, these delays can be reduced by developing a comprehensive enteral feeding protocol. The factors influencing delayed EN and late REE achievement are an important basis for designing enteral feeding protocols to improve the clinical outcomes of critically ill children in the PICU.

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