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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 2,163 Documents
 213   214   215   216   217 
Identifying primary immunodeficiency through the evaluation of severe, persistent, unusual, and recurrent infections in Indonesian children Muktiarti, Dina; Hendarto, Aryono; Munasir, Zakiudin; Wulandari, Dewi; Satari, Hindra Irawan; Werdhani, Retno Asti; Kumara Wati, Ketut Dewi
Paediatrica Indonesiana Vol. 66 No. 2 (2026): March 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Primary immunodeficiency (PID) is widely underdiagnosed in countries with high rates of infection and limited diagnostic facilities, such as Indonesia. It remains challenging to distinguish PID from other conditions predisposing children to severe, persistent, unusual, and recurrent (SPUR) infection. Such conditions include secondary immunodeficiency caused by human immunodeficiency virus (HIV) infection, allergic diseases, and chronic diseases with structural or anatomical abnormalities. Objective To evaluate children with SPUR infections for PID and to compare the clinical characteristics of children with PID to those with other underlying conditions. Methods We conducted a cross-sectional, analytic study of children aged 0-18 years presenting with SPUR infections at 10 hospitals in Jakarta, Indonesia, from July 2024 to September 2025. Clinical assessment and laboratory investigations, including immunological tests, were performed to identify the underlying cause of SPUR infections. Children were classified as healthy, PID, secondary immunodeficiency (HIV), allergy, or chronic disease/anatomical abnormalities. Results Two hundred fifty-four subjects (53% male) with a median age of 26 months were included in our study. Most of them had a history of pneumonia (72.1%), diarrhea (31.1%), and pulmonary tuberculosis (27.9%). Thirty-three (13%) subjects were diagnosed with PID, with the majority being male (60.6%). The most common PID found was antibody deficiency (27.3%), followed by immunodeficiencies combined with associated or syndromic features (24.2%), and immunodeficiencies affecting cellular and humoral immunity (21.2%). Median age of onset in the PID group was 12 (3–24) months. Severe malnutrition was most common in children with HIV. Gender, parental consanguinity, and adverse events following live vaccines did not differ significantly across groups. Conclusion The prevalence of PID among children with SPUR infection in this study was 13%, with the most common classification being antibody deficiency.
Outcome of rheumatic heart disease with history of sydenham chorea: a case report Sondang Hazewinkel Suringa Siagian; Agung Triono; Sasmito Nugroho
Paediatrica Indonesiana Vol. 66 No. 3 (2026): May 2026
Publisher : Indonesian Pediatric Society

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Abstract

Rheumatic heart disease (RHD) is an important health problem in adolescents and is associated with a decreased quality of life due to impaired physical and emotional functioning.  Poor physical condition is often related to recurrent episodes of acute rheumatic fever (ARF), which contribute to the progression of RHD. Children with history of Sydenham chorea have a recurrence rate of 20% within months after the first episode, and could present without any other ARF symptoms.
Diagnosing neglected pertussis in two pediatric case reports during the covid era: how is the prognosis Astalitha Lorel Tania; Retno Nurhayati
Paediatrica Indonesiana Vol. 66 No. 3 (2026): May 2026
Publisher : Indonesian Pediatric Society

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Abstract

Pertussis, caused by Bordetella pertussis, is a re-emerging and highly contagious respiratory infection that causes whooping cough in infants and older children. During the COVID-19 pandemic, diagnosis of pertussis has become more challenging because its respiratory manifestations often overlap with those of COVID-19. We report two cases of pertussis in children of different ages admitted to the pediatric ward of Aisyiyah Bojonegoro Hospital during the COVID-19 pandemic. The first case involved a 4-years-9 month-old boy who presented with persistent cough accompanied by a characteristic whooping sound for five days. The second case involved a 5-month-29-day-old girl who had experienced cough and low-grade fever for 21 days, marking her second episode of similar symptoms. Both patients were diagnosed with pertussis. These cases aim to describe and compare the clinical manifestations and outcomes of pertussis in children of different age groups. They also highlight the diagnostic challenges of pertussis during the COVID-19 pandemic in a region where pertussis remains a re-emerging disease. Pertussis in children may be underdiagnosed and underreported. Therefore, clinicians should consider pertussis in the differential diagnosis of children presenting with prolonged cough.
Challenges and strategies in pediatric oncology palliative care in low-middle income countries: a systematic review Sri Mulatsih; Clements Nicodhemus Garuda Nagara; Petra Gusti Parikesit; Ardhinta Bellano Septarda; Alvina Terencia; Devie Kristiani
Paediatrica Indonesiana Vol. 66 No. 3 (2026): May 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Annually, over 400,000 children aged 0–19 are diagnosed with cancer, with low-middle income countries (LMICs) facing lower cure rates and higher mortality. Most Asian nations, especially in Southeast Asia, have limited palliative care services due to funding, workforce, regulatory, and medication access challenges. Objective To enhance pediatric oncology palliative care in LMICs by identifying barriers and effective strategies across diverse settings. Methods A systematic literature review was conducted in accordance with PRISMA guidelines, utilizing six major databases—PubMed, ScienceDirect, Cochrane Library, Lippincott Home, Sage Journals, and Google Scholar—to identify studies published from January 2015 until February 2025. We used the PICO framework and specific keywords to find studies. Results A total of 484 records were initially identified across multiple databases. From the final seven studies included, the main challenges of pediatric oncology palliative care in LMICs are limited access to healthcare facilities, resource scarcity, and difficulties surrounding end-of-life care. To address these issues, frequently adopted strategies include enhancing human resource capacity through training, establishing multidisciplinary teams, adapting policies and cultural approaches for integrated management, as well as developing affordable, and accessible interventions. Conclusion This systematic review identified the primary problems of pediatric oncology palliative care in LMICs, a shortage of adequately trained personnel, policy limitations, as well as cultural, financial, and social obstacles impeding effective care delivery. These findings highlight the need for comprehensive, culturally sensitive, and resource-conscious approaches to enhance the quality and accessibility of pediatric palliative care in similar settings.
The association of exclusive breastfeeding with early child development: secondary analysis of a cohort study using the deuterium oxide dose-to-mother technique Sofa Rahmannia; R Siti Amalia; Mia Miranda; Aly Diana
Paediatrica Indonesiana Vol. 66 No. 3 (2026): May 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background The World Health Organization (WHO) recommends exclusive breastfeeding during the first six months of life to support optimal growth and development. Evidence from Indonesia on how exclusive breastfeeding affects various developmental domains remains limited, particularly those using objective methods to assess breastfeeding practices. Objective To examine the association between exclusive breastfeeding during early infancy and child developmental outcomes across multiple domains in an Indonesian cohort. Methods This study used secondary data from a cohort study 221 mother–infant pairs in Bandung and Sumedang, Indonesia. Breastfeeding status at 2 and 5 months was determined in the parent cohort using the deuterium oxide dose-to-mother (DTM) method. Child development was assessed at 2, 5, 12, and 18 months using the Ages and Stages Questionnaire, Third Edition (ASQ-3), across five domains: communication, gross motor, fine motor, social, and problem-solving. Outcomes were classified as age-appropriate or not. Nutritional status and morbidity were also assessed and considered as potential covariates. Results Exclusive breastfeeding at five months was associated with improved fine motor development at 18 months (OR 3.3; 95%CI 1.5 to 7.6; P=0.003). No associations were observed for communication, gross motor, social, or problem-solving domains. Nutritional status and sociodemographic factors did not show significant confounding effects in bivariate analysis. Conclusion Exclusive breastfeeding during early infancy was associated with improved fine motor development at 18 months in this Indonesian cohort. These findings support ongoing efforts to promote exclusive breastfeeding as part of early childhood development strategies.
Role of serum hepcidin in neonatal sepsis detection: a systematic review Citra Yulia Sari; Selia Cahyani; Pisi Nopita Wigati; ,Muhammad Sidiq; Basra Ahmad Amru; Almerveldy Azaria Dohong; Farah Elena; Masayu Amanda Ledika
Paediatrica Indonesiana Vol. 66 No. 3 (2026): May 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Neonatal sepsis is a severe, life-threatening condition and major cause of infant mortality, especially in developing nations. Diagnosing newborn sepsis presents significant challenges due to the nonspecific symptoms. While blood cultures serve as the diagnostic gold standard, they exhibit lengthy processing times and inconsistent reliability. Hepcidin, an iron-regulating hormone with antimicrobial properties, is increasingly recognized as a promising early sepsis biomarker in neonates. Objective The objective of this study is to evaluate the diagnostic performance of serum hepcidin through a systematic review of the literature. Methods Following PRISMA protocols, PubMed, ScienceDirect, SAGE Journals, ClinicalTrials.gov, and Google Scholar were systematically searched for relevant studies conducted from 2010-2025. Observational studies assessing hepcidin levels in septic neonates were examined, with emphasis on diagnostic metrics including the Area Under the Receiver Operating Characteristic Curve (AUC), sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Study selection and risk-of-bias assessment were conducted independently by two reviewers using the Joanna Briggs Institute criteria. Results Among 3,047 screened publications, four studies using case-control and prospective cohort designs, comprising 481 neonates, were included. Hepcidin diagnostic thresholds for septic newborns ranged between 92-105 ng/mL, with AUC values of 0.79-0.93. Sensitivity reached 100% maximum, specificity peaked at 94%, and both PPV and NPV ranged from 87-95%. Conclusion Serum hepcidin has been identified as an early biomarker for neonatal sepsis, exhibiting diagnostic accuracy. Despite these findings, further validation and methodological standardization are essential before widespread clinical adoption
Investigating the relationship between vitamin status and metabolic control in pediatric type 1 diabetes mellitus Esam Yahya; Hamza M. Aldgini; Entsar A. Saad; Rabia O. Alghazeer; Rana R. El Sadda
Paediatrica Indonesiana Vol. 66 No. 3 (2026): May 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Type 1 diabetes mellitus (T1DM) in children is characterized by persistent hyperglycemia, oxidative stress, and nutritional deficiencies that may worsen disease progression and complications. Fat-soluble vitamins and their binding proteins play key roles in antioxidant defense and immune modulation, yet their status in pediatric T1DM populations remains underexplored, particularly in North Africa. Objective To evaluate serum levels of vitamins A and D, along with their respective binding proteins: vitamin A-binding protein (VABP) and vitamin D-binding protein (VDBP), in Libyan children diagnosed with T1DM, and compare them with age- and sex-matched healthy controls. In addition, we aimed to investigate the relationship between vitamin A and D status, including their ratios to serum cholesterol, triglycerides, and glycemic control, as reflected by HbA1c levels. Methods In this case-control study, clinical and anthropometric data were collected from 90 Libyan children with T1DM and 90 age- and sex-matched healthy control group, including serum levels of vitamins A, D, and E, as well as the VABP and VDBP, which were measured using HPLC and ELISA. Lipid profiles were assessed, and vitamin-to-lipid ratios were calculated. Correlations with glycated hemoglobin (HbA1c) were evaluated using statistical modelling. Results Children with T1DM exhibited significantly higher mean HbA1c (9.2 (SD 1.1)% vs. 5.1 (SD 0.4)%, respectively; P<0.001), elevated triglycerides, and dyslipidemia compared with the control group. Mean serum concentrations of vitamin A [45.2 (SD 7.5) µg/dL], vitamin D [17.8 (SD 5.6) ng/mL], and vitamin E [11.2 (SD 1.3) mg/L], as well as VABP and VDBP, were significantly lower in the diabetic group (P<0.05 for all factors) compared to the non-diabetic control group. Lipid-adjusted vitamin ratios were consistently and significantly reduced, with the most pronounced deficits in vitamin A/cholesterol, vitamin D/triglyceride, and vitamin E/cholesterol (P<0.001). Significant inverse correlations were observed between HbA1c and both absolute vitamin levels and lipid-adjusted ratios. Conclusion Pediatric T1DM is associated with profound deficiencies in fat-soluble vitamins and their binding proteins, compounded by dyslipidemia that further reduces vitamin bioavailability. Lipid-adjusted vitamin ratios provide sensitive markers of metabolic imbalance and correlate with glycemic control. These findings support integrating nutritional assessment and targeted supplementation into routine T1DM management to improve metabolic regulation and mitigate long-term complications.
Early childhood social-emotional and cognitive development through associative play stimulation in preschool children with frequent gadget use Firdaus Firdaus; Norafisyah Makhdzir; Nur Hidaayah; Wesiana Heris Santy; Rahmadaniar Aditya Putri
Paediatrica Indonesiana Vol. 66 No. 3 (2026): May 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Rapid increases in gadget exposure among preschool children raise concerns about negative effects on socioemotional and cognitive development. Structured associative play, involving cooperative art and storytelling activities, may counter these impacts by enhancing social interaction among children and engagement with trained facilitators, emotional regulation, and cognitive stimulation. Global recommendations emphasize guided play and parental engagement to mitigate screen-related harms. Objective To evaluate the effects of a four-week associative play therapy program on socioemotional and cognitive development in preschoolers with frequent gadget use. Methods A randomized controlled trial was conducted at Kurnia Sari Kindergarten, Surabaya, involving 80 children aged 4–6 years with moderate to high gadget use (≥1 hour/day, parent-reported), who were randomly assigned to an associative play intervention (n=40) or a control group (n=40). The intervention, delivered twice weekly for 30-40 minutes, consisted of collaborative painting, collage making, storytelling, and literacy-based play. Socioemotional and cognitive outcomes were measured using observation tools adapted from the 2013 Indonesian National Curriculum (CVI=0.86; κ≈0.82). Data were analyzed using independent t-tests, with significance set at P<0.05. Results Children receiving associative play therapy demonstrated significantly higher mean socioemotional and cognitive scores compared to the control group (34.85 (SD 3.21) vs 28.40 (SD 3.76), P<0.001) and 36.10 (SD 3.04) vs 30.25 (SD 3.59), P<0.001), respectively. Both effects were large and clinically meaningful, supporting the efficacy of play-based interventions in early education. Conclusion A structured four-week associative play therapy significantly enhanced socioemotional and cognitive development among preschool children with moderate to high gadget use (≥1 hour/day). Incorporating associative play into early childhood curricula and community-based child health promotion, along with parental education, may help mitigate potential developmental risks associated with early and frequent gadget use. Parental education is also recommended to foster developmental resilience in the digital age.
Survival of thalassemia patients at Dr. Cipto Mangunkusumo Hospital: a single center retrospective study Teny Tjitra Sari; Damayanti Angelina; Ludi Dhyani Rahmartani; Anna Mira Lubis; Pustika Amalia Wahidiyat
Paediatrica Indonesiana Vol. 66 No. 3 (2026): May 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Thalassemia is a serious health challenge around the world, especially in countries within the “Thalassemia belt,” including Indonesia. The effectiveness of treatment for thalassemia is often measured by how well patients survive and thrive. However, the information is still limited on the survival of thalassemia patients in Indonesia. Objective To evaluate factors related to mortality risk,  characteristics and age distribution of thalassemia patients at Dr. Cipto Mangunkusumo National Central General Hospital (CMNH), Indonesia. Methods Using patient medical records from the Thalassemia Center of CMNH, covering the years 2017 to 2023, we examined patient characteristics, age distribution, and survival rates. To understand survival over time, the Kaplan–Meier and Cox regression tests were used. Results The 562 thalassemia patients studied had an average age of 18.3 years and 286 (51%) were male. The majority of patients (55.8%) had β-thalassemia. Most patients were between 11 and 20 years old (38.6%), and nearly half of them (49%) received deferiprone as their iron chelation therapy. Patients with mean serum ferritin ≥ 2,500 ng/mL (87.7%) had lower survival than patients with mean serum ferritin < 2,500 ng/mL (12.3%), but the difference was not statistically significant [hazard ratio (HR) 1.23; 95%CI 0.29 to 5.16; P=0.779]. Conclusion At CMNH, most thalassemia patients were adolescents or young adults, and β-thalassemia was the most common subtype. Patients with mean serum ferritin ≥2,500 ng/mL had a higher estimated mortality risk than those with lower levels (HR 1.23; 95% CI 0.29–5.16), although the association was not statistically significant.
Factors influencing NT-proBNP levels in pediatric patients with thalassemia major Azizah Chairiani; Muhammad Riza; Bagus Artiko
Paediatrica Indonesiana Vol. 66 No. 3 (2026): May 2026
Publisher : Indonesian Pediatric Society

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Background Children with β-thalassemia major are at risk of early cardiac dysfunction due to chronic anemia and transfusion-related iron overload. NT-proBNP is a widely used biomarker for cardiac stress, yet its clinical correlates in pediatric thalassemia remain insufficiently defined. Objective To evaluate the relationship between NT-proBNP levels and clinical variables, including hemoglobin, ferritin, transfusion parameters, and nutritional status, in children with β-thalassemia major receiving routine transfusions. Methods A cross-sectional study was conducted on 68 pediatric patients at Dr. Moewardi General Hospital. NT-proBNP, hemoglobin, ferritin,  transfusion volume (mL/kg body weight) based on the most recent transfusion episode, anthropometric, and chelation data were collected. Correlation tests, multivariate bootstrapped linear regression, and logistic regression were used to identify clinical predictors of elevated NT-proBNP (≥125 pg/mL). Results Median NT-proBNP was 161.5 pg/mL, with 63.2% of participants exceeding the 125 pg/mL threshold. NT-proBNP showed a significant negative correlation with hemoglobin (ρ=–0.298; P=0.014) and a significant positive correlation with transfusion volume per kilogram (ρ=0.412; P<0.001). Ferritin, duration of transfusion, nutritional status, age, sex, and chelation dose were not significantly associated with NT-proBNP levels. In multivariate analysis, transfusion volume remained a significant positive predictor of higher NT-proBNP (B=9.33; P=0.033), whereas hemoglobin showed a non-significant negative trend (B=–23.52; P=0.093). Conclusion NT-proBNP elevation in pediatric β-thalassemia major is significantly associated with hemoglobin level and transfusion volume rather than iron overload indicators. NT-proBNP may serve as an early marker of cardiac strain, but imaging remains needed to distinguish from subclinical cardiomyopathy.

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