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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 2,127 Documents
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Diagnostic performance of electrical cardiometry (ICON®) parameters in predicting fluid responsiveness in critically ill pediatric patients Kurniawan Taufiq Kadafi; Rizki Dzakiyah Sholikhah, Wanda; Muhammad Reva Aditya; Saptadi Yuliarto; Charity Monica; Abdul Latief; Antonius Hocky Pudjiadi
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

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Abstract

Background  Fluid resuscitation with appropriate and adequate amounts is very important in treating critically ill children, so reliable hemodynamic monitoring methods are needed to prevent fluid overload. Contractility index (ICON) is a novel, non-invasive index of left ventricular (LV) function, and contractility related to the electrical cardiometry device (ICON®). ICON® offers a non-invasive hemodynamic monitoring method to assess volume status, but its validity in predicting fluid response in the Indonesian pediatric population remains unknown. Objective To determine the diagnostic performance of ICON-derived parameters, especially change of cardiac output (ΔCO) and change in contractility index (ΔICON), in predicting fluid response, using change of stroke volume (ΔSV)  as a reference standard. Methods A cross-sectional study was conducted in pediatric emergency and intensive care settings. Children aged 1 month to 18 years requiring fluid resuscitation were included. Hemodynamic parameters were measured using ICON® before and after a 10 mL/kg fluid bolus of crystalloid. Fluid responsiveness was defined as a >10% increase in ΔSV. Changes in parameters were analyzed using paired statistical tests. ROC analysis was used to assess the diagnostic accuracy of CO and ICON. Results Sixty-three subjects were analyzed. Significant median changes were observed after fluid bolus administration based on pre- and post-bolus comparison in change of heart rate (ΔHR: –8 bpm, P<0.001), change of systolic blood pressure (ΔSBP: +3 mmHg, P=0.042), change of diastolic blood pressure (ΔDBP: +2 mmHg, P=0.012), change of mean arterial pressure (ΔMAP: +0.67 mmHg, P=0.009). The ROC analysis showed that CO had the highest AUC (0.878), with a cut-off of 5.35%, sensitivity of 78.3%, and specificity of 87.2%. The ICON showed moderate accuracy (AUC 0.757), with a 0.45% cut-off, 69.6% sensitivity, and 71.8% specificity. Conclusion Electrical cardiometry (ICON®) demonstrated measurable changes in objective hemodynamic parameters following fluid bolus administration in critically ill children. Among ICON-derived parameters, a 5.35% increase in CO showed the best predictive performance for fluid responsiveness, while ICON showed moderate diagnostic value. These findings support the clinical utility of electrical cardiometry as a non-invasive tool to guide volume management in pediatric critical care.
Perfusion index and lactate clearance as microcirculation parameters in pediatric post-cardiac correction surgery Prawira, Yogi; Silawati, Trisna; Kaswandani2, Nastiti
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

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Abstract

Background Congenital heart disease (CHD) is a common congenital anomaly in children, with corrective cardiac surgery using cardiopulmonary bypass (CPB) being the definitive treatment. However, post-operative morbidity and mortality remain high, requiring effective hemodynamic monitoring in the cardiac intensive care unit (CICU). Blood lactate levels are traditionally used to assess microcirculation, while non-invasive methods like the perfusion index (PI) have gained interest for real-time monitoring. Objective To determine the correlation between PI and blood lactate levels in pediatric patients following corrective cardiac surgery. Methods A prospective cohort study was conducted in the cardiac intensive care unit (CICU) at Cipto Mangunkusumo Hospital from September to October 2024. Thirty-four pediatric patients aged 1 month to 18 years who underwent corrective cardiac surgery were included. PI and lactate levels were measured at one, four, and eight hours post-operation. Results The median age of participants was 21.5 (IQR 10.25–79.5) months. Non-cyanotic CHD was the most common diagnosis (58%), and 67.6% of cases involved CPB. Low cardiac output syndrome occurred in 17.6% of subjects. Lactate levels decreased significantly over time (P<0.001), while PI showed an increasing trend. Correlation analysis revealed a significant negative correlation between PI <1.4 and lactate levels at the fourth (r =-0.455; P=0.038) and eighth hours (r=-0.515; P=0.017). Conclusion  PI has a significant negative correlation with lactate levels and may serve as a useful non-invasive parameter for microcirculation monitoring in pediatric patients after corrective cardiac surgery.
Red-cell distribution width and immature to total ratio as predictors of sepsis mortality in preterm neonates Aziz, Abdul; Hidayah, Dwi; Widiretnani,  Septin
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

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Abstract

Background Preterm neonates are susceptible to various complications and may require invasive procedures that increase the risk of sepsis, which is the third leading cause of mortality in children. Routine laboratory results, such as red-cell distribution width (RDW) and immature to total neutrophil (I/T) ratio, may be useful as predictors of mortality in neonatal sepsis patients. These laboratory markers have undergone limited testing as mortality predictors in preterm neonates with sepsis. Objective To analyze the predictive ability of RDW and I/T ratio on sepsis mortality in preterm neonates. Methods This prospective cohort study included 42 preterm neonates (gestational age 28-36 weeks + 6 days), with birth weight appropriate to gestational age. The diagnosis of sepsis was established based on the high probable sepsis (HPS) and probable sepsis (PRS) criteria scores. RDW and I/T ratio values were obtained at the time of the sepsis diagnosis. Neonatal mortality was defined as death occurring within the first 28 days of life. Receiver operating characteristic (ROC) curve was used to analyze for associations between mortality and the laboratory markers. Results The median RDW in preterm neonates who died was 16.5% (range 14.0-32.7%). This was relatively similar to the median RDW value in preterm neonates who lived (16.25%; range 14.6-34.3%). ROC curve analysis revealed an area under curve (AUC) of 0.541 (95%CI 0.359 to-0.722; P=0.656). The median I/T ratio in preterm neonates who died was 0.13 (range 0.03-0.22), which was similar to the median I/T ratio in preterm neonates who lived (0.15; range 0.11-8.20). The AUC value was 0.387 (95%CI 0.214 to -0.559; P=0.213). Conclusion The RDW and I/T ratio values cannot be used as predictors of sepsis mortality in preterm neonates.
Therapeutic reassessment of first-line antiepileptic drugs in pediatric patients unresponsive to second-line agents: a randomized trial in Jakarta Perdani, Roro Rukmi Windi; Arozal, Wawaimuli; Mangunatmadja, Irawan; Kaswandani, Nastiti; Handryastuti, Setyo; Medise, Bernie Endyarni; Wardani, Amanda Saphira; Thandavarayan, Rajarajan Amirthalingam; Oswari, Hanifah; Lee, Hee Jae
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

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Abstract

Background Epilepsy has a significant incidence in children, with 20-25% resistance to standard antiepileptic drugs (AEDs). Drug-resistant epilepsy (DRE) refers as the failure of two or more AEDs, either as monotherapies or in combination, to achieve seizure freedom, which includes the absence of all seizure types, even auras. Treatment algorithms for children with epilepsy range from starting with the lowest effective dose to using add-on or substitution therapy of AEDs. It usually started from using first-line AEDs (valproic acid, phenytoin, phenobarbital, carbamazepine) with titrated dose based on the patient condition, if seizure persist, another first-line AEDs may be added or substituted. Second-line AEDs (topiramate, levetiracetam, oxcarbazepine) are introduced when seizure persist despite optimal doses of first-line drugs with good compliance. Epilepsy treatment response is a dynamic process, not a fixed state. In some cases, repeating the medication cycle remains an option, as patient may initially appear drug-resistant but later respond to treatment. Thus, first-line AEDs may also serve as substitution therapy in children unresponsive to second-line agents as studies show comparable effectiveness between the two regimens. Objective To evaluate the efficacy and safety of first-line AEDs as substitution therapy (intentional replacement of patient’s current medication) in children resistant to second-line AEDs. Methods This 12-week, open-label, multicenter, randomized controlled trial was conducted in 91 epileptic children. Children aged 1 – 18 years with DRE, were randomized into the intervention (patients who received substitution therapy:  one AEDs was changed to first-line of AEDs) and control (patients who got standard therapy: one AEDs was changed to second-line of AEDs) groups. The primary outcome was the difference in the proportion of responders between the two groups. Secondary outcomes were analyzing the different improvements in quality of life (QoL), EEG feature, and time to achieve seizure reduction in both groups. The QoL was assessed by Quality of Life in Childhood Epilepsy Questionnaire 55 (QOLCE-55) to assess cognitive, emotional, social, and physical functions. Results There were no significant differences in the proportion of responders between the substitution therapy group (62.5%) and the standard therapy group (68.4%). Both groups experienced substantial reductions in seizure frequency, ranging from 78% to 80%. For further analysis, the average difference of seizure frequency before and after intervention was statistically significant in each group, it was P=0.000 in substitution group and P=0.00 in standard group. The analysis of quality of life showed the mean of total score in both groups was low even though the score was higher in the substitution group. For spesific function of quality of life, the cognitive and social function, was improved significantly in the group p<0.05). However, there were no significant differences of EEG improvement, seizure duration, time to achieve seizure frequency reduction, or adverse effects between the two groups. Conclusions First-line AEDs have comparable efficacy as second-line AEDs with mild to moderate adverse effects in DRE children. Thus, the repeated use of first-line AEDs as substitution therapy might be an option for children who resistant to second line AEDS.
Association of sepsis severity with serum ferritin in the pediatric intensive care unit Susanto, Yohanes; Wati, Dyah Kanya; Artana, I Wayan Dharma; Wati, Ketut Dewi Kumara; Widnyana, Anak Agung Ngurah Ketut Putra; Adnyana, I Gusti Agung Ngurah Sugitha
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

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Background Sepsis remains a leading cause of pediatric intensive care unit (PICU) admissions in Indonesia. Serum ferritin is a potential biomarker for sepsis severity that requires validation. Objective To evaluate the association between serum ferritin and sepsis severity in children. Methods In this cross-sectional study, we consecutively enrolled children with sepsis (aged 1 month to 18 years) with lactate-excluded PELOD-2 scores of ≥7 admitted to the PICU of a tertiary referral hospital. Severe sepsis was defined as a PELOD-2 score of ≥11. Serum ferritin levels were measured at the time of PELOD-2 assessment. We determined the optimal ferritin cut-off point for severe sepsis by ROC analysis and performed bivariate and multivariate analyses to assess the association of ferritin level with sepsis severity. Results Among 74 subjects, 48.6% had severe sepsis. Serum ferritin concentration showed excellent discriminative power for severe vs. non-severe sepsis, with an area under curve (AUC) of 80% (95%CI 69.7-90.4%; P<0.001). The optimal serum ferritin cut-off level was 1,473.88 ng/mL, with a sensitivity of 80.6% and specificity of 78.9%. Severe sepsis was strongly correlated with elevated ferritin [bivariate prevalence ratio (PR) 3.8 (95%CI 2.0 to 8.2; P<0.001); adjusted PR 3.9 (95%CI 1.7 to 8.6; P=0.001)]. Conclusion Serum ferritin may serve as a biomarker for severe sepsis in children with good discriminative performance and may be useful for risk stratification of pediatric sepsis.
Neutrophil-lymphocyte ratio and D-dimer to predict outcomes of length of hospitalization and mortality of COVID-19 in children Suryadi Nicolaas Napoleon Tatura; Susan Nathalia Budihardjo; Johny Lambert Rompis; David Soelingan Waworuntu; Vivekenanda Pateda
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

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Background Biomarkers such as the neutrophil-to-lymphocyte ratio (NLR) and D-dimer have proven predictive of mortality in adults with COVID-19, but their utility in pediatric patients remains underexplored. Objective To evaluate for associations between NLR and D-dimer with hospital length of hospitalization and mortality in children. Methods This retrospective cross-sectional study analyzed pediatric COVID-19 cases at Prof. Dr. R.D. Kandou Hospital, Manado (January 2021–September 2022). Children aged 1 month to 18 years with confirmed SARS-CoV-2 by RT-PCR were included. Children with incomplete data or immuno-compromised status were excluded. Data on demographics and laboratory parameters were analyzed using descriptive statistics, correlation, and linear regression Results This study included 65 pediatric COVID-19 patients, with a median age of 60 months and a balanced gender distribution. The median NLR was 1.3 (IQR 0.8–2.4), and the median D-dimer was 1.1 (IQR 0.4–11.0) mg/L. Three patients (5%) died, and the median length of hospitalization was 10 (IQR 7–16) days. No significant correlation was found between NLR and D-dimer (r=0.07; P=0.576). Similarly, NLR was not associated with length of hospital hospitalization (r=0.20; P=0.120) or with mortality (P=0.482). D-dimer levels, in contrast, demonstrated a strong positive association with length of hospitalization (r=0.59; P<0.001) but were not significantly correlated with mortality (P=0.316). Although not statistically significant, D-dimer levels tended to be higher in non-survivors compared to survivors. In regression analysis, higher D-dimer levels were independently associated with longer hospitalization duration (β=0.49; 95% CI 0.29 to 0.70; P<0.001) after adjusting for NLR, age, and platelet count. However, NLR showed no significant relationship with either hospitalization duration or mortality. Conclusion Pediatric COVID-19 patients showed normal NLR and elevated D-dimer levels. Elevated D-dimer is associated with prolonged hospitalization, but not with mortality.
Effectiveness of short-term modified Atkins diet and classic ketogenic diet in pediatric intractable epilepsy: a systematic review and meta-analysis Maulena, Ufik; Agustina, Nenden Nursyamsi; Mangunatmadja, Irawan
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

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Abstract

Background Dietary treatments such as the classic ketogenic diet (cKD) and the modified Atkins diet (MAD) have shown promise in the medical management of refractory epilepsy. Objective To investigate the efficacy of the modified Atkins diet and classic ketogenic diet in managing intractable epilepsy in children by systematic review and meta-analysis. Methods This systematic review followed the preferred reporting items for systematic review and meta-analysis (PRISMA). We carried out an overview on Google Scholar, Scopus, and PubMed to find pertinent studies. Only researches that directly compared cKD and MAD were included in this study. A random-effect model was used to calculate pooled effect sizes as risk ratios (RRs) with 95% confidence intervals (CIs). The primary outcome was seizure frequency reduction (SFR) >50%. Secondary outcomes included SFR >90% and seizure freedom. Results Of 1,013 articles screened, 7 studies with a total of 455 patients (214 on MAD and 241 on cKD) met the inclusion criteria. There were no significant differences in the proportion of patients with seizure frequency reduction (SFR >50% (RR 1.12; 95%CI 0.70 to 1.80; P=0.64), SFR >90% (RR 0.83; 95%CI 0.57 to 1.20; P=0.33, respectively), or those who were seizure free (RR 1; 95%CI 0.7 to 1.42; P=0.99, respectively). However, each study in our review revealed that both cKD and MAD groups achieved significantly more SFR >50%,  SFR >90%, and seizure-free than before the diet. No improvement were seen in these outcomes after diet intervention. Conclusion In managing refractory childhood epilepsy, the efficacy of cKD and MAD are not significantly different.

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