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Paediatrica Indonesiana

paediatrica-indonesiana
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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.

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Articles 2,118 Documents

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Comparison of absolute neutrophil count between premature and term infants Ahmad Faisal; Guslihan D Tjipta; Bidasari Lubis; Dachrul Aldy
Paediatrica Indonesiana Vol 44 No 5 (2004): September 2004
Publisher : Indonesian Pediatric Society

Background Neutrophils are very important in the body defenseagainst bacterial infection. Absolute neutrophil count (ANC) couldbe used for the recognition of early-onset bacterial sepsis inneonates.Objective The aim of this study was to compare the value of ANCbetween premature and term infants, to assess the prevalence ofearly-onset neutropenia in premature infants and its relationshipwith prematurity, and to find out the correlation between gesta-tional age and ANC.Methods A cross-sectional study was conducted during Februaryto May 2003. Subjects were newborn infants with gestational ageof less than 37 weeks who were born in Adam Malik and PirngadiHospitals, Medan. Newborn infants with severe asphyxia (5-minuteApgar score of less than 4), fever, seizure, and maternalhypertension were excluded. Complete blood count was done bymeans of automatic cell counter (Micros (R) , Germany). Term healthyinfants were used as control subjects.Results ANC differed significantly between both groups (p=0.0001).The prevalence of early-onset neutropenia in premature infantswas 9% (95%CI 0.065;0.21). Prematurity was related with theincidence of neutropenia with a prevalence ratio of 1.1. Therewas a weak positive correlation between gestational age andANC with an r-value of 0.49 (p=0.0001).Conclusions ANC in premature infants differs from that in terminfants. The prevalence of early-onset neutropenia in prematureinfants was 9% (95%CI 0.065;0.21). Prematurity is related with theincidence of early-onset neutropenia in newborn infants. There isa correlation between gestational age and ANC

Puberty onset in rural and urban children Hariadi Edi Saputra; Hakimi Hakimi; Melda Deliana; Siska Mayasari Lubis; Karina Sugih Arto
Paediatrica Indonesiana Vol 57 No 1 (2017): January 2017
Publisher : Indonesian Pediatric Society

Background Accelerated pubertal onset has been reported in recent years. Environmental factors are assumed to influence this condition.Objective To assess differences in pubertal onset between children in rural and urban areas, as well as to evaluate body mass index (BMI) and socioeconomic status that affect pubertal onset.Methods This cross-sectional study was conducted in July 2010 at junior high schools in Mandailing Natal and Medan, North Sumatera. Data were collected with purposive sampling of children aged 8 to 13 years. Sexual maturity was assessed by Tanner stage and risk factors was determined by questionnaires. The comparison between pubertal onset in rural and urban areas was assessed by Mann-Whitney U test. The relationships between nutritional status, socioeconomic status, sexual maturity, and pubertal onset were assessed by Spearmanâ€™s correlation.Results Eighty-four subjects (38 boys and 46 girls) from a rural area and 87 subjects (40 boys and 47 girls) from an urban area participated in this study. There were significant differences in mean pubertal age of onset between subjects living in rural vs. urban areas, for both girls and boys [girls: 10.2 vs. 9.5 years, respectively (P=0.008); boys: 11.7 vs. 10.1 years, respectively, (P=0.001)]. We found weak negative correlations between BMI and pubertal onset in boys (r=-0.246; P=0.03) and in girls (r=-0.548; P=0.001). We also found weak negative correlations between socioeconomic status and Â pubertal onset in boys (r=-0.406; P=0.0001) and in girls (r=-0.575; P=0.001).Conclusion Pubertal onset is faster in girls and boys who lived in an urban area. Â There are negative correlations between BMI and socioeconomic status with pubertal onset.

Lactate clearance as a predictor of mortality in neonatal sepsis Felix Nathan Trisnadi; Ekawaty Lutfia Haksari; Tunjung Wibowo
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Background Neonatal sepsis remains the leading cause of neonatal deaths. Therefore, efforts should be made to reduce its mortality. Lactate clearance can be used as a marker of onset of hypoxia and microcirculation disorders, as well as to predict patient outcomes.Objective To assess the use of lactate clearance to predict mortality from neonatal sepsis.Methods We conducted a prospective cohort study in the levels 2 and 3 of neonatal care unit, Department of Child Health, Dr. Sardjito General Hospital, Yogyakarta, from October to November 2011. We enrolled 40 neonatal sepsis patients, who were divided into either the high or low lactate clearance groups. All neonates were followed up until they were discharged from the hospital, as to whether they survived or died. We performed blood lactate measurements early on following their diagnosis of sepsis, and after the subsequent six hours following the first antibiotic administration. Logistic regression for the multivariate analysis and ROC curves for the accurate analysis of predictive outcome factors were performed.Results More deaths occurred in neonates with low lactate clearance at six hours (48%) than in those in the high lactate clearance group (7%). Low lactate clearance at six hours was a significant predictor of mortality (RR 15.1; 95%CI 1.7 to 133), whereas the ROC analysis showed moderate accuracy.Conclusion Lactate clearance at six hours may be used as a predictor of mortality in infants with neonatal sepsis.

Gut wall integrity in exclusively breastfed vs. formula-fed infants Nur Hayati; Muzal Kadim; Irawan Mangunatmadja; Soepardi Soedibyo; Evita Bermansyah Ifran; Hikari Ambara Sjakti
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Background Breast milk has bioactive substances that modulate gastrointestinal maturation and maintain mucosal integrity of the gut in infants. Markers that are both non-invasive and reliable, such as fecal alpha-1 antitrypsin (AAT), calprotectin, and secretory immunoglobulin A (sIgA) have been used to assess gut integrity in adults. Higher AAT levels may imply greater enteric protein loss due to increase intestinal permeability of immaturity gut.Objective To assess and compare gut integrity of exclusively breastfed (BF) and exclusively formula fed (FF) infants aged 4-6 months.Methods Subjects were 80 healthy infants (BF=40; FF=40), aged 4-6 months who visited the Pediatric Polyclinic at St. Carolus Hospital, and lived in Pasar Minggu or Cempaka Putih Districts, Jakarta. The fecal AAT was analyzed by an ELISA method. Mann-Whitney and unpaired T-test were used to analyze possible correlations between feeding type and gut integrity.Results The BF group had significantly higher mean fecal AAT than the FF group (P=0.02). Median sIgA levels were not significantly different between groups (P=0.104). The FF group had a higher mean fecal calprotectin level but this difference was also not significant (P=0.443). There was a significant correlation between breastfeeding and mean fecal AAT level (P=0.02), but no significant correlation with calprotectin (P=0.65) or sIgA (P=0.26).Conclusion The breastfed group shows better mucosal integrity compared to the formula fed group. Higher mean fecal AAT level in the BF group is related to the AAT content of breast milk. Therefore AAT content of BF group is actually lower than formula fed group which shows greater mucosal integrity in BF group.

Risk factors for mortality in children with Wilms tumor Yuni Purwanti; Sutaryo Sutaryo; Sri Mulatsih; Pungky Ardani Kusuma
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Background Wilms tumor is the most common renal malignancy in children (95%) and one of the leading causes of death in children, with high mortality rates in developing countries. Identifying risk factors for mortality is important in order to provide early intervention to improve cure rates.Objective To identify risk factors for mortality in children with Wilms tumor.Methods We performed a case-control study of children (0-18 years of age) with Wilms tumor admitted to Dr. Sardjito Hospital between 2005 and 2012. The case group consisted of children who died of Wilms tumor, whereas the control group were children who survived. Data were collected from medical records. Statistical analyses using Chi-square and logistic regression tests were done to determine odds ratios and 95% CI of the potential risk factors for mortality from Wilms tumor.Results Thirty-five children with Wilms tumor were admitted to Dr. Sardjito Hospital during the study period. Nine (26%) children died and 26 survived. Stage â‰¥III was a significant risk factor for mortality in chidren with Wilms tumor (OR 62.8; 95%CI 5.6 to 70.5). Age â‰¥2 years (OR 1.4; 95%CI 0.1 to 14.3) and male sex (OR 1.2; 95%CI 0.1 to 10.8) were not significant risk factors for mortality.Conclusion Stage â‰¥III is a risk factor for mortality in children with Wilms tumor.Â

Neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in children after cardiac surgery Meta Herdiana Hanindita; Riskky Vitria Prasetyo; Ninik Asmaningsih Soemyarso; I Ketut Alit Utamayasa; Paul Tahalele
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Background Acute kidney injury (AKI) is still diagnosed by measuring the estimated creatinine clearance (eCCl), despite the fact that it may not change until 50% or more of kidney function has been lost. AKI after cardiac surgery is related to prolonged intensive care, decreased quality of life, and increased long term mortality. Neutrophil gelatinase-associated lipocalin (NGAL) represents an early biomarker of AKI, which may be useful for assessing AKI in cardiac patients.Objective To determine the validity of urinary and plasma NGAL as biomarkers for AKI in children after cardiac surgery.Methods Subjects were children who underwent cardiac surgery in Dr. Soetomo Hospital, Surabaya, Indonesia from August 2013 to January 2014. Serial urine and blood samples were analyzed for NGAL before surgery, as well as at 2h, 4h, 12h, and 24h after surgery. The AKI was established based on pRIFLE criteria. Estimated creatinine clearance (eCCl) was calculated from the estimated glomerular filtration rate (eGFR), according to age by the traditional Schwartz formula. Serum creatinine was assayed by the Jaffe method before surgery, as well as at 12h, 24h, 48h, and 72h after surgery.Results Of 20 subjects, 5 developed AKI. Urinary and plasma NGAL increased markedly at 2h postoperatively, as compared to eGFR which showed a rise at 12-48 h after cardiac surgery. Analysis of 2h post-operative urinary NGAL at a cut off value of 11.270ng/mL yielded an area under the curve (AUC) of 1.00 (95%CI 2.63 to 12.13), with sensitivity and specificity of 100% each for AKI. In addition, 2h post-operative plasma NGAL at a cut off value of 8.385 ng/mL yielded an AUC of 1.00 (95%CI 3.71 to 12.15) with sensitivity and specificity of 100% each for AKI.Conclusion Urinary and plasma NGAL are valid as early biomarkers for AKI in children after cardiac surgery.

Validation of the Pediatric Early Warning Score to determine patient deterioration from illness Lenny Elita; Silvia Triratna; Erial Bahar
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Background Patients who enter the emergency room (ERER) present with a variety of conditions, ranging from mild to critical. As such, it may be hard to determine which patients are in need of intensive care unit treatment. The Pediatric Early Warning Score (PEWS) has been used to identify signs of critical illness in pediatric patients.Objective To validate the PEWS system for assessing signs of critical illness in pediatric patients at Dr. Mohammad Hoesin Hospital, Palembang.Methods Subjects were children aged 1 month to 18 years who received treatment in the ERER and Pediatrics Ward inDr. Mohammad Hoesin Hospital in March to April 2015. Assessment with PEWS was based on vital sign examinations. Scores ranged from 0 to 9. The PEWS was generally taken twice, first in the ER , then after 6 hours in the ward. We obtained the cut-off point, sensitivity, and specificity of PEWS, in terms of need for pediatric intensive care unit (PICU) treatment.Results One hundred fifty patients were included in this study. Patients with PEW score of 5 or greater in the ER were relatively more likely to be transferred to the PICU, with a sensitivity of 94.4% and a specificity of 82.5%. The cut-off point obtained from the ROC curve was score 4.5 with AUC 96.7% (95%CI 93.4 to 99.9%; P<0.001).Conclusion A PEWS score of cut-off â‰¥5 may be used to determine which patients are in critically ill condition requiring treatment in PICU.

Lactate clearance and mortality in pediatric sepsis Dedi K. Saputra; Ari L. Runtunuwu; Suryadi N. N. Tatura; Jeanette I. Ch. Manoppo; Julius H. Lolombulan
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Background Sepsis is a life-threatening condition often encountered in the pediatric intensive care unit. In the last five decades, despite the use of aggressive antibiotics and advances in intensive care medicine, the mortality rate of sepsis remains high. In 2005, the World Health Organization (WHO) estimated that 11 million children die annually due to sepsis, of these, 30,000 children under five years of age die daily. Serum lactate concentration is useful to evaluate the progression of sepsis in children. Lactate clearance can be used to evaluate the outcomes in sepsis management in children.Objective To evaluate the relationship between lactate clearance and patient mortality. We also attempted to assess the usefulness of lactate clearance as an early prognostic marker in pediatric sepsis.Methods This prospective cohort study was conducted at the Pediatrics Department of Prof Kandou General Hospital from November 2013 to April 2014. Consecutive sampling was undertaken on 45 children aged 1 month to 15 years who were diagnosed with sepsis according to the inclusion criteria. First lactate serum was measured immediately following patient admission to the PICU. The next serum lactate measurement was six hours after initial treatment in the PICU.Results The mean lactate clearance was higher in the survivorsâ€™ than in the non-survivorsâ€™ group (58.48%vs. 18.20%, respectively). Logistic regression analysis revealed a lactate clearance cutoff point of 34.7%, with sensitivity 87.50%, specificity 96.55%, positive predictive value 93.33%, and negative predictive value 93.33%. The formula used was y=1/{1+exp-(4.135-0.119 lactate clearance)}. Chi-square analysis of lactate clearance and mortality revealed an odds ratio (OR) of 196.0 (95%CI 16.34 to 2,351.53; P<0.001).Conclusion Higher lactate clearances significantly associate with lower mortality in children with sepsis.

Gastroesophageal reflux in children with chronic recurrent cough Mardjanis Said; Rianita Syamsu; Taralan Tambunan; Badriul Hegar
Paediatrica Indonesiana Vol 44 No 5 (2004): September 2004
Publisher : Indonesian Pediatric Society

Background Gastroesophageal reflux (GER) is reported to beone of the most common causes of chronic recurrent cough (CRC).In Indonesia, so far there is no published data concerning GER inchildren with CRC.Objectives To determine the prevalence of GER in children withCRC in general, and asthma in particular; and to describe the clini-cal profile associated with GER in these children.Methods This was a cross sectional study on children with CRCwho were investigated for GER using 24-hour esophageal pHmonitoring. GER was graded based on reflux index (RI) stated inpHmetry results i.e., mild (RI=5-10%), moderate (RI>10-20%), andsevere (RI>20%).Results Among 48 children with CRC, GER was detected in 22(46%) of them (mild GER in 14, moderate in 3, and severe in 5children). In 35 children with asthma, which is the most frequentcause of CRC in our hospital, GER was detected in 15. The preva-lence of GER increased parallel with the frequency of cough epi-sodes i.e., 10/27 in children with infrequent episodes of cough, 4/10 in children with frequent episodes of cough, and 8/11 in chil-dren with persistent cough. Clinical profiles associated with GERin these children were persistent/ frequent episodes of CRC andundernutrition.Conclusions The prevalence of GER in children with CRC was46%, and in those with asthma was 15/35. The clinical profilesassociated with GER are persistent/frequent episodes of CRCand undernutrition

Recurrent cerebral abscess in tetralogy of Fallot Wanty Sahli; J M Ch Pelupessy
Paediatrica Indonesiana Vol 44 No 5 (2004): September 2004
Publisher : Indonesian Pediatric Society

Tetralogy of Fallot (TF) classically consistsof the combination of right ventricularoutflow obstruction (pulmonary stenosis),ventricular septal defect (VSD), overridingaorta, and right ventricular hypertrophy. Thedegree of pulmonary stenosis and VSD determine thevariety of clinical manifestations.This type of congenital heart disease accountsfor about 10% of all congenital cardiac deformitiesand is the most common cyanotic lesion after thefirst year of life. Cerebral abscess is a serious com-plication in TF and is usually seen after the age of 2years.

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