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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 1,922 Documents

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Corticosteroids for pediatric septic shock patients Irene Yuniar; Vembricha Nindya Manusita; Sonya Leonardy Low
Paediatrica Indonesiana Vol 59 No 2 (2019): March 2019
Publisher : Indonesian Pediatric Society

Background Septic shock remains a major cause of mortality and admission to the pediatric intensive care unit (PICU) in children. Management includes adequate fluid resuscitation, followed by catecholamine infusion, if needed. Corticosteroid therapy is advised for catecholamine-refractory shock, although this practice is controversial, as it was not beneficial in other studies. Objective To assess corticosteroid use in pediatric septic shock patients in Cipto Mangunkusumo Hospital. Methods This cross-sectional study included all patients aged 1 month-18 years with a diagnosis of septic shock during the study period of January 2014 to July 2018 admitted in PICU Dr. Cipto Mangunkuskumo Hospital, Jakarta. Data obtained from medical records were, age, sex, immunology status, port dâ€™entrÃ©e of sepsis, inotropic and vasopressor usage, mechanical ventilation, corticosteroid type, hospital length of stay (LOS), and mortality outcome. Results Of 217 children with septic shock, 12 patients (5.5%) received corticosteroid therapy. The most common corticosteroid given was hydrocortisone (80%), with a 2 mg/kg BW loading dose, followed by a continuous infusion dose of 2-50 mg/kg BW/day. Almost all patients (11/12) received corticosteroid therapy until they died. Median duration of corticosteroid use was 2 (range 1-7) days, median number of inotropes and vasopressors used was 3 (range 2-4) agents, median LOS was 3 (range 1-9) days, and mortality rate was 100%. Conclusion A small proportion of pediatric septic shock patients received corticosteroid therapy. Their mortality rate was 100%. Further clinical study is needed to evaluate the benefit of corticosteroid therapy in pediatric septic shock patients.

Risk factors for delayed speech in children aged 1-2 years Sabrina Tan; Irawan Mangunatmadja; Tjhin Wiguna
Paediatrica Indonesiana Vol 59 No 2 (2019): March 2019
Publisher : Indonesian Pediatric Society

Background Speech delay is one of the most common developmental delays in children. To minimize the negative outcomes of speech delay, risk factors should be explored to help in early patient diagnosis. Objectives To assess for associations between delayed speech in children aged 1 to 2 years and possible risk factors including gender, gestational age, birth weight, asphyxia during birth, head circumference, anterior fontanelle closure, gross motor development, duration of breastfeeding, caregiver identity, number of siblings, exposure to gadgets and television, and social interaction. Methods Parents of children aged 1 to 2 years who were treated at Dr. Cipto Mangunkusumo Hospital, and Klinik Anakku, Pondok Pinang in Jakarta from January 2018 to March 2018 were interviewed. Data were processed with SPSS Statistics for Mac and analyzed by Chi-square test and logistic regression method. Results Of 126 subjects, 63 children had speech delay and 63 children had normal speech development. Multivariate analysis revealed that the significant risk factors for delayed speech were delayed gross motor development (OR 9.607; 95%CI 3.403 to 27.122; P<0.001), exclusive breastfeeding for less than 6 months (OR 3.278; 95%CI 1.244 to 8.637; P=0.016), and exposure to gadgets and television for more than 2 hours daily (OR 8.286; 95%CI 2.555 to 26.871; P<0.001). Conclusion Delayed gross motor development, exclusive breastfeeding for less than 6 months, media exposure for more than 2 hours daily, and poor social interaction are risk factors for delayed speech development in children.

Age at menarche and early menarche among healthy adolescents Annang Giri Moelyo; Anindita Wulandari; Oktania Imas; Ulfa Puspita Rahma; Nurul Hidayah; Cempaka Kesumaningtyas; Fadhilah Tia Nur; Hari Wahyu Nugroho
Paediatrica Indonesiana Vol 59 No 1 (2019): January 2019
Publisher : Indonesian Pediatric Society

Background Menarche is an important indicator of female adolescents' health and also population health. Age at menarche tends to decrease in many countries. Early menarche that defined from the lowest quartile of age at menarche, associated with some physical and psychological problems. Objective To determine the mean age at menarche, the prevalence of early menarche among healthy adolescents in Surakarta and its association to nutritional status. Methods This cross-sectional study was conducted in 5 schools (3 junior and 2 senior high schools) in Surakarta, Central Java, Indonesia, from September 2016 to March 2018, by consecutive sampling technique. We included menarched healthy female students whose parent provided informed consent and without consuming any routine medication. Data were derived from self-reported questionnaire and measurements of body weight; body height; and body mass index (BMI) by calculated based on weight/height2(kg/m2). Results Of 835 eligible subjects, the mean age at menarche was 12.0 (SD 1.1) years (range 8.8-15.1 years) and the prevalence of early menarche was 11.1%. The peak of age at menarche were at 11,12, and 13 years (24.3%, 36.2%, and 23.9%, respectively) and almost 99.04% of subjects had menarche at 14 years old. The proportion of early menarche between subjects birth 1997-2001 and 2002-2007 were 8.4% and 16.1%. Early menarche associated with overweight-obese in adolescents (odd ratio 2.14; 95%CI 1.21 to 3.76). Conclusion The mean age at menarche of healthy adolescents in Surakarta is younger than other previous studies in Indonesia. Early menarche was significantly a risk for overweight/obese in adolescents.

Diagnostic value of electrocardiography for ventricular septal defect Besse Sarmila; Burhanuddin Iskandar; Dasril Daud
Paediatrica Indonesiana Vol 59 No 2 (2019): March 2019
Publisher : Indonesian Pediatric Society

Background Congenital heart disease (CHD) in children requires attention from medical practitioners, because CHDs that are diagnosed early and treated promptly have good prognoses. Ventricular septal defect (VSD) is the most common type of congenital heart disease. Objective To compare the accuracy of electrocardiography (ECG) to echocardiography in diagnosing VSD. Methods This diagnostic study was conducted from November 2013 until July 2015. It involved patients with acyanotic CHDs who were suspected to have VSD at Dr. Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi. Results Of 114 children screened, 97 were included and analyzed. The frequency of positive VSD was 69.1% based on ECG, and 99% based on echocardiography. There was a significant difference between ECG and echocardiography (P=0.000). However, when small VSDs were excluded, there was no significant difference between the two diagnostic tools [(P=1.000), Kappa value was 0.66, sensitivity was 98.5%, specificity was 100%, positive predictive value (PPV) was 100%, and negative predictive value (NPV) was 50%]. Conclusion There were significant differences between the ECG and echocardiography, for diagnosing VSD. However, if small VSDs were not included in the analysis, there was no difference between the two examinations, suggesting that ECG might be useful for diagnosing VSD in limited facilities hospitals.

Clinical spectrum and outcomes of pediatric diphtheria Herry D. Nawing; Ninny Meutia Pelupessy; Herniati Alimadong; Husein Albar
Paediatrica Indonesiana Vol 59 No 1 (2019): January 2019
Publisher : Indonesian Pediatric Society

Background Although vaccination programs have succeeded in reducing the incidence of diphtheria, it remains a health problem in Asia, including Indonesia. Objective To investigate the clinical spectrum and outcomes of pediatric diphtheria in Wahidin Sudirohusodo Hospital. Methods This study was a retrospective review of childhood diphtheria medical records from January 2011 to December 2017 in Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi. Recorded data consisted of age, gender, nutritional and immunization statuses, signs and symptoms, throat swab culture results, complications, and outcomes. Results Of 28 subjects aged 9 months to 17.10 years, the majority were >5 years (57.1%) and male (60.7%). Subjectsâ€™ mean age was 6.15 years and 82.1% of cases were well nourished. Overall, 85.7% had received complete immunizations, while 14.3% were not immunized, having received neither basic nor booster vaccines. The presenting manifestations were fever, pseudomembranes, and sore throat in all subjects, enlarged tonsils (78.57%), dysphagia (67.86%), cough (57.14%), headache (57.14%), hoarseness (67.86%), bull neck (25%), and myocarditis (14.3%). Most subjects had hospital stays of >10 days (67.9%). Mortality was 14.3%, usually in those admitted with a late, deteriorating condition and dying before getting optimal treatment. Poor outcome was significantly associated with the lack of basic or booster immunizations, poor nourishment, bull neck, myocarditis, and hospital stays < 5 days (P<0.05 for all). Conclusion The clinical spectrum and outcomes of pediatric diphtheria in this study are relatively similar to reports from other hospitals. Mortality was mostly in patients who lack basic or booster immunizations, are poorly nourished, or have bull neck, myocarditis, or hospital stays < 5 days.

Correlation of serum level of albumin with platelet count and platelet aggregation assessed by adenosine diphosphate agonist in children with nephrotic syndrome Andar Laura Nainggolan; Sri Sudarwati; Dany Hilmanto
Paediatrica Indonesiana Vol 59 No 1 (2019): January 2019
Publisher : Indonesian Pediatric Society

Background Nephrotic syndrome (NS) is the most common renal disease among children, and contributes to life-threatening complications such as thromboembolic disease. Platelets are considered to be important agents in thrombotic events among NS patients. The gold standard assessment for platelet aggregation is the use of adenosine diphosphate (ADP) agonist, however, it is expensive and not accessible in smaller health facilities. Thus, other thrombosis parameters are needed. Previous studies suggested that low albumin increased the risk of thrombosis in NS patients. Objective To assess for a possible correlation between albumin level and platelet count as well as platelet aggregation. Methods This cross-sectional study was conducted in children with nephrotic syndrome who were admitted to the Pediatric Nephrology Department in Dr. Hasan Sadikin General Hospital, Bandung, West Java, from November 2017 to March 2018. Subjects were selected by consecutive sampling. Serum albumin, platelet count, and platelet aggregation were measured. Statistical analysis was conducted by Spearmanâ€™s test. Results A total of 32 patients participated in the study, with mean age of 109 (SD 7.4) months. Most subjects were male (56%). Subjectsâ€™ mean serum albumin level was 2.06 (SD 1.23) g/dL; mean platelet count was 453,062.5 (SD 187,443.90)/mm3; and mean platelet aggregation values for ADP agonist concentrations of 10, 5, 2.5, and 1 mM were 86.8 (SD 8.63)%, 82.4 (SD 15.33)%, 66.6 (SD 24.90)%, 34.95 (SD 31.69)%, respectively. Partial correlation analysis revealed significant negative associations between albumin and platelet count as well as platelet aggregation assessed with 1 mM of ADP concentration (P<0.001), with Spearman correlation coefficients of -0.641 and -0.634, respectively. Conclusion Serum albumin level had a moderately negative correlation with platelet count and platelet aggregation value.

Intrinsic risk factors for gross motor delay in children aged 6-24 months Joanna Erin Hanrahan; Irawan Mangunatmadja
Paediatrica Indonesiana Vol 59 No 1 (2019): January 2019
Publisher : Indonesian Pediatric Society

Background. Gross motor is one of the skill domain with the highest parental concern as mastering it determines the autonomy of a child. Several internal risk factors including perinatal asphyxia, prematurity, low birth weight, wide fontanelle, and microcephaly have been studied in predicting gross motor delay with varied results. This study is made to arrange a strategic intervention on the prevention of delayed development. Objective. To evaluate perinatal asphyxia, gestation age <37 weeks, birth weight <2500 grams, microcephaly, and wide fontanelle as predictors of gross motor delay in children aged 6-24 months. Methods. A case control study design was used. Data collection was conducted by direct assessment of gross motor skill and parentsâ€™ interview in Cipto Mangunkusumo National Hospital and Anakku Clinic, South Jakarta. Children with gross motor delay were included in the case group and children with normal gross motor were included in the control group. Data was analyzed using bivariate and multivariate analysis with a statistical significance value of P<0.05 and 95% confidence intervals. Results. One hundred and twenty-six subjects were studied, with 63 children in the case group and 63 children in the control group. Baseline characteristics of subjects were similar between the two groups. Microcephaly and gestation age <37 weeks were predictors of gross motor delay [(aOR 4.613 (95% CI 95 2.023 to 10.521, P<0.001) and (aOR 3.668 (95% CI 1.153 to 11.673, P=0.028), respectively]. Conclusion. Microcephaly and gestation age <37 weeks are significant predictors of gross motor delay in children aged 6-24 months.

Waist circumference, body mass index, and skinfold thickness as potential risk factors for high blood pressure in adolescents Roslina Dewi; rafita ramayati; Nelly Rosdiana; Oke Rina Ramayani; Rosmayanti Siregar; Beatrix Siregar
Paediatrica Indonesiana Vol 59 No 2 (2019): March 2019
Publisher : Indonesian Pediatric Society

Background The prevalence of hypertension in children and adolescents has increased with the rising obesity epidemic. Recent studies have found that prevalence of hypertension was higher in obese children or adolescents than in the normal weight ones. Anthropometric measurements such as body mass index (BMI), waist circumference, and skinfold thickness have been used as criteria to determine obesity in children and adolescents. Increased waist circumference has been most closely related to increased blood pressure. Objective To compare waist circumference, BMI, and skinfold thickness as potential risk factors for hypertension in adolescents. Methods This cross-sectional study was conducted in May 2014 in three senior high schools in Medan, North Sumatera, and included 253 students with normal urinalysis test. All subjects underwent blood pressure, waist circumference, tricep- and subscapular-skinfold thickness (TST and SST), body weight, and body height measurements. The study population was categorized into underweight, normoweight, overweight, and obese, according to four different criteria: waist circumference, BMI, TST, and SST; all variables were analyzed for possible correlations with systolic and diastolic blood pressure. Results There were significant positive correlations between systolic blood pressure and waist circumference (OR 7.933; 95%CI 2.20 to 28.65; P=0.011) as well as BMI (OR 4.137; 95%CI 1.16 to 14.75; P=0.041). There were also significant correlations between diastolic blood pressure and waist circumference (OR 3.17; 95%CI 1.83 to 5.51; P=0.002), BMI (P=0.0001; OR=3.69), TST (OR 4.73; 95%CI 2.31 to 9.69; P=0.0001), and SST (OR 3.74; 95%CI 2.35 to 5.94; P=0.0001). Multivariate analysis showed that waist circumference was a predictive factor for systolic blood pressure (OR 9.667), but not for diastolic blood pressure. Conclusion Waist circumference is the strongest, significant, predictive factor for elevated systolic blood pressure; meanwhile BMI, SST, and TST could be predictive factors for elevated diastolic blood pressure.

Risk factors of neonatal hypoglycemia Yuliana Yunarto; Gatot Irawan Sarosa
Paediatrica Indonesiana Vol 59 No 5 (2019): September 2019
Publisher : Indonesian Pediatric Society

Background Hypoglycemia is the most common metabolic issue in newborns and should be treated as soon as possible to prevent complications of neurologic impairment, mental retardation, developmental delay, and cardiovascular disorders. Objective To assess maternal, fetal, and neonatal factors for identifying infants at risk of developing neonatal hypoglycemia. Methods This case-control study was conducted in the Perinatal Unit of Dr. Kariadi Hospital, Semarang, Central Java. A total of 123 newborns with blood glucose <47 mg/dL comprised the case group and 123 newborns without hypoglycemia comprised the control group. Characteristics of infants, maternal age, maternal pregnancy-related conditions, as well as fetal and neonatal factors were recorded and analyzed for possible relationships with hypoglycemia. Results Out of 677 newborns, hypoglycemia was found in 123 (18.2%) infants (59 male, 64 female). In the case group, 58 (47.1%) were preterm, 38 (30.9%) very preterm, and 8 (6.5%) extremely preterm infants. Factors associated with neonatal hypoglycemia were prematurity (OR 6.537; 95%CI 3.543 to 12.063; P <0.001), low birth weight (OR 2.979; 95% CI 1.532 to 5.795; P<0.001), small for gestational age (OR 1.805; 95% CI 1.054 to 3.095; P=0.031), and birth asphyxia(OR 3.386; 95% CI 1.945 to 5.895; P<0.001). In multivariate regression analysis, prematurity and low birth weight remained the significant factors associated with neonatal hypoglycemia. Conclusion Prematurity and low birth weight are significant risk factors associated with neonatal hypoglycemia. Routine screening and monitoring of blood glucose is recommended for preterm newborns and infants with low birth weight

Cord blood bilirubin, albumin, and bilirubin /albumin ratio for predicting subsequent neonatal hyperbilirubinemia Jehangir Allam Bhat; Sajad Ahmad Sheikh; Roshan Ara
Paediatrica Indonesiana Vol 59 No 5 (2019): September 2019
Publisher : Indonesian Pediatric Society

Background Early discharge of healthy term newborns after delivery has become a common practice, because of medical and social reasons, as well as economic constraints. Thus, the recognition, follow-up, and early treatment of jaundice has become more difficult as a result of early discharge from the hospital. Since the dreaded complication of neonatal hyperbilirubinemia is kernicterus, an investigation which can predict the future onset of neonatal pathological jaundice is needed. Objective To investigate the predictability of neonatal hyperbilirubinemia by using cord blood bilirubin, albumin and bilirubin/albumin ratio. Methods This study was conducted on 300 healthy newborns. Umbilical cord blood was used to measure albumin and bilirubin. All infants were regularly followed up to 5th day of life. Neonates were divided into two groups: group A was consisted of neonates who developed jaundice which was in physiological range, while group B was consisted of neonates who developed neonatal hyperbilirubinemia (requiring phototherapy or other modality of treatment). Babies suspected to have bilirubin level which cross physiological limit on any day after birth were subjected to serum bilirubin measurement. Infants whose serum bilirubin level measurement revealed bilirubin levels crossing physiological values were sent to nursery for phototherapy. Results The incidence of neonatal hyperbilirubinemia was 11%. Statistically significant correlations between cord blood bilirubin, albumin, and bilirubin/albumin ratio to the development of neonatal hyperbilirubinemia were observed. On ROC analysis, cut-off points to predict significant hyperbilirubinemia in newborn were cord blood bilirubin >3 mg/dL (sensitivity 60.61%, specificity 97.63%), albumin <2.4 mg/dL (sensitivity 78.79%, specificity 98.13%), cord blood bilirubin/albumin ratio >0.98 (sensitivity 78.79%, specificity 95.51%). Conclusion Cord blood total bilirubin, albumin. and bilirubin/albumin ratio are excellent parameters to predict the occurrence of neonatal hyperbilirubinemia. However, cord blood albumin is better compared to cord blood bilirubin and bilirubin/albumin ratio.

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