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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 2,127 Documents

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Duration and dose of antiepileptic drugs and serum calcium levels in children Arinta Atmasari; Masayu Rita Dewi; Aditiawati Aditiawati; Masagus Irsan Saleh
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society

Background Antiepileptic drugs (AEDs) may affect calcium metabolism through several mechanisms. Much evidence has confirmed that carbamazepine and valproic acid, as the most widely used AEDs in epileptic children, leads to decreased serum calcium levels. This effect was suggested to be time and dose dependent. However, correlations between AEDs and calcium levels in Indonesian epileptic children have not been well studied.Objective To investigate possible correlations between total calcium levels and durations of therapy as well as doses of carbamazepine and valproic acid.Methods This analytical, cross-sectional study was performed from March to May 2015 in the Neuropediatric Outpatient Ward of Mohammad Hoesin Hospital, Palembang, South Sumatera. A total of 60 epileptic children taking carbamazepine and or valproic acid monotherapy were included and grouped accordingly. A single blood test was done for every participant to measure total serum calcium level. Correlation between daily dose or duration of AED with calcium level was assess using the Spearman-rho test.Results The mean total serum calcium levels in the carbamazepine and valproic acid groups were 9.48 (SD 0.83) mg/dL and 9.58 (SD 0.63) mg/dL, respectively. There was a statistically significant moderate correlation between the duration of carbamazepine therapy and total calcium level (r = 0.36; P=0.001). The cut-off point for duration of therapy was 23 months. There were no significant correlations between total calcium level and mean daily carbamazepine dose, nor between total calcium level and duration and dose of valproic acid therapy.Conclusion Longer duration of carbamazepine therapy is associated with low total serum calcium level, but carbamazepine dose is not. In addition, duration and dose of valproic acid are not associated with low total serum calcium level.

Blood pressure-to-height ratio for diagnosing hypertension in adolescents Kristina Ambarita; Oke Rina Ramayani; Munar Lubis; Isti Ilmiati Fujiati; Rafita Ramayati; Rusdidjas Rusdidjas
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society

Background Diagnosing hypertension in children and adolescents is not always straightforward. The blood pressure-to-height ratio (BPHR) has been reported as a screening tool for diagnosing hypertension.Objective To evaluate the diagnostic value of blood pressure-to-height ratio for evaluating hypertension in adolescents.Methods A cross-sectional study was conducted among 432 healthy adolescents aged 12-17 years in Singkuang, North Sumatera from April to May 2016. Blood pressure tables from the National High Blood Pressure Education Program (NHBPEP) Working Group on High Blood Pressure in Children and Adolescents were used as our standard of comparison. Sex-specific systolic and diastolic blood pressure-to-height ratios (SBPHR and DBPHR) were calculated. ROC curve analyses were performed to assess the accuracy of BPHR for discriminating between hypertensive and non-hypertensive adolescents. Optimal thresholds of BPHR were determined and validated using 2x2 table analyses.Results The accuracies of BPHR for diagnosing hypertension were > 90% (P<0.001), for both males and females. Optimal SBPHR and DBPHR thresholds for defining hypertension were 0.787 and 0.507 in boys, respectively, and 0.836 and 0.541 in girls, respectively. The sensitivities of SBPHR and DBPHR in both sexes were all >93%, and specificities in both sexes were all >81%. Positive predictive values for SBPHR and DBPHR were 38.7% and 45.2% in boys, respectively; and 55.9% and 42.4% in girls, respectively; negative predictive values in both sexes were all >97%, positive likelihood ratios in both sexes were all >5, and negative likelihood ratios in both sexes were all <1.Conclusion Blood pressure-to-height ratio is a simple screening tool with high sensitivity and specificity for diagnosing hypertension in adolescents.

A hematologic scoring system and C-reactive protein compared to blood cultures for diagnosing bacterial neonatal sepsis Deddy Eka Febri Liestiadi; Emil Azlin; Selvi Nafianti
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society

Background Neonatal sepsis is the leading cause of death after pneumonia. Definitive bacterial sepsis diagnoses are made by blood culture results, which require a lengthy time. C-reactive protein (CRP) levels and a hematologic scoring system by Rodwell et al. are rapid tests that may be useful for diagnosing neonatal sepsis.Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Objective To determine the diagnostic value of CRP measurement and a hematologic scoring system compared to blood culture as the gold standard for diagnosing neonatal sepsis. Methods A cross-sectional study was conducted from April to August 2015 in the Neonatology Ward of Haji Adam Malik Hospital, Medan. A total of 43 neonates who were clinically suspected to have sepsis underwent CRP, hematologic scoring, and blood cultures. The IT ratio and procalcitonin indices were also examined. Diagnostic values were analyzed by a 2x2 table.Results Fourteen percent from all sample had positive bacterial culture. The CRP measurements had a sensitivity of 92.8%, specificity of 62%, positive predictive value (PPV) of 54.1%, negative predictive value (NPV) of 94.7%, positive likelihood ratio (PLR) of 2.44, and negative likelihood ratio (NLR) of 0.11. The hematologic scoring system had a sensitivity of 100%, specificity of 82.7%, PPV of 73.6%, NPV of 100%, PLR of 5.78, and NLR of 0. Procalcitonin and IT ratio show a good value of sensitivity and NPV, respectively. Conclusion The hematologic scoring system has better specificity than CRP measurement as compared to blood culture. However, both tests have good sensitivity for diagnosing neonatal sepsis.

Glycated hemoglobin HbA1c, waist circumference, and waist-to-height ratio in overweight and obese adolescents Elysa Nur Safrida; Neti Nurani; Madarina Julia
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society

Background Central obesity has been associated with a high risk of insulin resistance. Waist circumference and waist-to-height ratio are anthropometric indices for determining central obesity and have been associated with increased blood pressure, cholesterol, and insulin levels. In adults, fat distribution around the waist is a valid predictor of glycated hemoglobin (HbA1c)levels, and is currently recommended by experts as a diagnostic tool for diabetes. Central obesity measurement has advantages over fasting blood glucose and oral glucose tolerance tests, as it is simple and inexpensive to perform.Objective To assess for correlations between HbA1c level and waist circumference as well as waist-to-height ratio and to assess factors potentially associated with HbA1c levels in overweight and obese adolescents.Methods This cross-sectional study was done in four junior high schools in Yogyakarta, which were obtained by cluster sampling. Overweight and obese students who were generally healthy were included in the study. Subjects underwent waist circumference and waist-to-height ratio measurements, as well as blood tests for HbA1clevels.Results Sixty-seven children participated in the study, with 48 girls (71.6%) and 19 boys (28.4%). Waist circumference and HbA1c levels were not significantly associated (r=0.178; P=0.15). However, waist-to-height ratio and HbA1c levels had a weak positive correlation (r=0.21; P=0.04). Linear regression analysis revealed that waist-to-height ratio had a significant association with HbA1c level (P=0.02), but age, sex, and nutritional status did not.Conclusion Waist-to-height ratio is correlated with HbA1c levels in overweight and obese adolescents.

Risk factors for miliary tuberculosis in children Clarissa Cita Magdalena; Budi Utomo; Retno Asih Setyoningrum
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society

Background Miliary tuberculosis (TB) is a fatal form of tuberculosis with severe clinical symptoms and complications. The mortality rate from this disease remains high, therefore, it is important to identify the risk factors for miliary TB for early detection and treatment.Objective To identify risk factors for miliary tuberculosis in children.Methods A case-control study of children aged 0-14 years with miliary TB was conducted in Dr. Soetomo Hospital from 2010 to 2015. Data were taken from medical records. Case subjects were children with miliary TB, and control subjects were children with pulmonary TB . Patients with incomplete medical records were excluded. Case subjects were identified from the total patient population; control subjects were included by purposive sampling, with case:control ratio of 1:1. Potential risk factors were age, nutritional status, BCG immunization status, and history of contact with TB patients. Statistical analyses were done with Chi-square and logistic regression tests. P values < 0.05 were considered to be statistically significant.Results A total of 72 children were analyzed, with 36 case and 36 control subjects. Nutritional status had a significant associatation with miliary TB in children (OR 3.182; 95%CI 1.206 to 8.398; P=0.018) in both bivariate and multivariate analyses. The probability of a child with moderate or severe undernutrition developing miliary TB was 76.09%. Other factors were not significantly associated with miliary TB.Conclusion Nutritional status is significantly associated with miliary TB in children, and moderate or severe undernutrition increases the risk for developing miliary TB.

Long term follow-up of multidrug resistant tuberculosis in a pubertal child Andri Kurnia Wahyudhi; Retno Asih Setyoningrum; Ahmad Suryawan
Paediatrica Indonesiana Vol 58 No 4 (2018): July 2018
Publisher : Indonesian Pediatric Society

Increasing awareness of the rising global rates of multidrug-resistant tuberculosis (MDR-TB) has led to a concerted international effort to confront this disease. Nonetheless, despite cure rates >80% in some programs, MDR-TB patients tend to have chronic disease and require prolonged therapy.1-3 Little is known about the long-term results and follow-up of patients with MDR-TB, include the recurrence rate and chronic disability in patients who have recovered from TB.4 There are many side effects and adverse reactions to drugs can occur during MDR-TB treatment. These could be physical and or psychological, as well as reversible or irreversible. Treatment of MDR-TB requires a combination regimen, consists of second and third-line anti-tuberculosis drugs which more toxic than first-line drugs. Additionally, MDR-TB treatment requires a long duration of treatment (18-24 months) and causes discomfort in the patient.5 In a cohort of 60 patients treated for MDR-TB, the most common side effects included gastritis (100%), dermatological disorders (43%), and peripheral neuropathy (16.7).6 While in a cohort of 75 patients, the incidence of depression, anxiety, and psychosis for MDR-TB treatments was 13.3%, 12.0%, and 12.0%, respectively.7 Aggressive and effective management are needed so the patient can tolerate the treatment and remain adhere the treatment.8 Long-term follow-up is required for the rehabilitation of disorders due to psychosocial sequelae. As such, psychosocial support can be benefit pediatric MDR-TB patients. Here, we present a case report on a two-year follow-up of a pubertal child with MDR-TB, focusing on medical aspects and her development.

The pediatric index of mortality 3 score to predict mortality in a pediatric intensive care unit in Palembang, South Sumatera, Indonesia Destiana Sera Puspita Sari; Indra Saputra; Silvia Triratna; Mgs. Irsan Saleh
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background For critically ill patients in the pediatric intensive care unit (PICU), a scoring system is helpful for assessing the severity of morbidity and predicting the risk of mortality. The Pediatric Index of Mortality (PIM) 3 score consists of ten easy simple variables, so that the probability of death can be assessed prior to undergoing advanced therapies. The PIM 3 score in inexpensive and comprised of routine laboratory variables performed in PICU patients. In Indonesia, studies to validate the PIM 3 score have been limited.Objective To evaluate the PIM 3 score for predicting the probability of death in the PICU, Dr. Mohammad Hoesin Hospital (MHH), Palembang.Methods A prospective, cohort study was performed in the PICU, MHH, Palembang, from February to April 2016. The PIM 3 score was calculated within 2 hours of patients admission to the PICU by an Â android calculator application. PIM3 score and mortality were analyzed by Mann-Whitney test; calibration was performed by Hosmer-Lameshow goodness of fit test, discrimination was done by receiver operating characteristic (ROC) curve analysis; and standardized mortality ratio (SMR) was calculated.Results During the study period there were 81 PICU patients, 69 children were included, ranging in age from 1,5 to 187 months. The overall mortality rate was 40,58%. The most common illnesses in our subjects were malignancy (17,4%), post non-thoracic surgery (14,5%), dengue shock syndrome (14,5%), respiratory disease (13%), and neurological disease (11,6%). Subjectsâ€™ PIM3 scores ranged from 1,02% to 58,84%, with means of 26,08% in non-survivors and 13,05% in survivors. The SMR was 2,24, indicating that death was underpredicted. The AUC of 0,771 (95% CI of 0,651 to 0,891) indicated that the PIM3 score had good discrimination.Conclusion In Mohammad Hoesin Hospital, Palembang, South Sumatera, the PIM 3 can be used to predict mortality in PICU patients, but the score should be multiplied by a factor of 2.24. This recalibration is needed due to the presumed lower standard of care at this hospital compared to that of the originating PIM 3 institutions in developed countries.

CD4+ T-cell, CD8+ T-cell, CD4+ /CD8+ ratio, and apoptosis as a response to induction phase chemotherapy in pediatric acute lymphoblastic leukemia May Fanny Tanzilia; Andi Cahyadi; Yetti Hermaningsih; Endang Retnowati; I Dewa Gede Ugrasena
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background Acute lymphoblastic leukemia (ALL) is a neoplastic disease resulting from somatic mutation in the lymphoid progenitor cells, often occuring in children aged 2-5 years, predominantly in males. Results from the induction phase of chemtherapy are used to measure success, but the failure remission rate is still high. Increased apoptosis of cancer cells, as induced by CD4+ and CD8+T-cells, is an indicator of prognosis and response to chemotherapy.Objective To assess for correlations between CD4+, CD8+, or CD4+/CD8+ ratio to the chemotherapy induction phase response (i.e., apoptosis) in pediatric ALL patients.Methods This observational analytical cohort study was done in 25 pediatric ALL patients. Whole blood (3 mL) with EDTA anticoagulant were used to measure absolute counts of CD4+, CD8+, and CD4+/CD8+ ratio. Peripheral blood mononuclear cells (PBMC) were examined for apoptosis. The principle of CD4+, CD8+ examination was bond between antigens on the surface of the leukocyte in the blood with fluorochrome labeled antibodies in the reagents, while the principle of apoptosis examination was FITC Annexin V will bonds with phosphatidylserine that moves out of the cell when the cell undergoes apoptosis, then intercalation with propidium iodide (PI). All examination were detected by flow cytometry BD FACSCalibur.Results Subjects were 25 newly-diagnosed, pediatric ALL patients (64% males and 36% females). Most subjects were 3 years of age (20%). Numbers of CD4+ and CD8+ cells, as well as CD4+/CD8+ were significantly decreased after chemotherapy. However, apoptosis was not significantly different before and after chemotherapy (P=0.689), There were significant negative correlations between apoptosis and CD4+ (P=0.002; rs=-0.584), and CD8+ (rs=-0.556; P=0.004), before chemotherapy. In addition, CD4+-delta and apoptosis-delta also had a significant positive correlation (rs=0.478; P=0.016). However, no correlation was found between the CD4+/CD8+ ratio and apoptosis, before or after chemotherapy.Conclusion There are significantly lower mean CD4+, CD8+, and CD4+/CD8+ ratio after chemotherapy than before. Also, there are significant correlations between CD4+-delta and apoptosis-delta, as well as between apoptosis and CD4+, CD8+, and CD4+/CD8+, before chemotherapy. CD4+, CD8+, and CD4+/CD8+ can be used to predict apoptosis before chemotherapy. In addition, CD4+-delta can be used to predict apoptosis-delta as a response to induction phase chemotherapy in pediatric ALL.

Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants Made Sukmawati; Rinawati Rohsiswatmo; Rulina Suradi; Pramita Gayatri
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background Feeding intolerance is a common condition that affects preterm infants. Erythromycin is a prokinetic agent used to treat feeding intolerance, but its efficacy remains inconclusive.Objective To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in preterm infants.Methods This prospective, randomized controlled trial in preterm infants was conducted at Sanglah Hospital, Denpasar, Bali, from June 2015 to January 2016. Eligible infants were randomized to receive either 12.5 mg/kg/dose oral erythromycin or a placebo, every 8 hours. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were body weight at full enteral feeding and length of hospital stay.Results Of 62 initial subjects, 3 infants dropped out of the study. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline characteristics of the two groups were similar, with mean of gestational ages of 31.4 (SD 1.7) weeks in the erythromycin group and 32.4 (SD 2.2) weeks in the placebo group. The median times to reach full enteral feeding did not significantly differ between the two groups, with 10 (SD 5.3) days in the erythromycin group vs. 8 (SD 6.5) days in the placebo group (P=0.345). Also, median body weights at full enteral feeding and lengths of hospital stay were not significantly different between the two groups.Conclusion Erythromycin of 12.5 mg/kg/dose every 8 hours as prophylactic treatment does not significantly enhance feeding tolerance in preterm infants. Median body weights at full enteral feeding and length of hospital stay are not significantly different between the erythromycin and placebo groups.

Behavioral parent training for ADHD children: a mixed methods study Hari Wahyu Nugroho; Mei Neni Sitaresmi; Indria Laksmi Gamayanti
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background Management of ADHD requires multimodal treatments. Parental participation is one of the most important factors for effective ADHD treatment.Objective To investigate the effectiveness of behavioral parent training combined with routine clinical care, in reducing ADHD symptoms in children.Methods Quantitative and qualitative methods were combined in this study. This study was conducted at 3 growth and developmental clinics in Central of Java, on June-July 2016. The quantitative aspect was assessed by comparing ADHD quotient scores at pre- and post-intervention, while the qualitative aspect by intensive parental interviews. Parents of children with ADHD were randomized with block random sampling. In the treatment group, parents received behavioral training for 7 weeks, along with weekly routine clinical care for their children. The control group received only routine clinical care of the children. Six parents in the treatment group were randomly selected for intensive interviews.Results A total of 67 parents with their children were involved. Both groupsâ€™ ADHD quotient scores improved post-intervention. The treatment group ADHD quotient score was reduced from 120.53 to 116.41 (effect size Cohenâ€™s d 0.68). The control group ADHD quotient score was reduced from 121.74 to 119.83 (effect size Cohenâ€™s d 0.23). Mean difference post-intervention in both group was not significant (p=.161). After behavioral parent training, communication between parents and children increased and parentsâ€™ capability in directing their childrenâ€™s daily activity increased.Conclusion Behavioral parent training can not enhacing effectiveness of routine clinical care to reduce ADHD symptoms in children.

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