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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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Search results for , issue "Vol 55 No 6 (2015): November 2015" : 11 Documents clear

Blood pressure and lipid profiles in adolescents with hypertensive parents Julia Fitriany; Rafita Ramayati; Supriatmo Supriatmo; Rusdidjas Rusdidjas; Oke Rina; Rosmayanti Siregar
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background Adolescent hypertension is a significant health problem of increasing prevalence and causes high morbidity and mortality. It is found primarily in young males, with a familial history of hypertension and/or cardiovascular disease. Examination of lipid profiles has been used to detect the risk of hypertension in adolescents. Objective To compare blood pressure and lipid profiles in adolescents with and without a parental history of hypertension. Methods This cross-sectional study was conducted from January to February 2012 on students from a senior high school in the Toba Samosir District, North Sumatera. Sixty-eight adolescents were included, aged 15 to 18 years. Group I comprised 34 adolescents with hypertensive parents, and group II comprised 34 adolescents with normotensive parents. Subjects were selected based on questionnaires. Subjectsâ€™ blood pressures were measured at rest. Three measurements were made in intervals of 10-15 minutes, then averaged for both systolic and diastolic blood pressures. Lipid profiles were measured using the CardioCheck cholesterol test after subjects had fasted for 12 hours. Results The median systolic blood pressures (SBP) in groups I and II were 110 mmHg (range 93.3-123.3) and 106.7 mmHg (range 96.7-123.3), respectively, (P=0.584). The median diastolic blood pressures (DBP) were 73.3 mmHg (range 66.7-83.3) and 71.7 mmHg (range 63.3-80.0), respectively, (P=0.953). Total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels in group I were significantly higher than those levels in group II [median total cholesterol: 162.0 (range 158-170) vs. 159.0 (range 150-170), respectively; (P=0.001); and mean LDL-C: 103.5 (SD 3.72) vs. 99.1 (SD 4.63), respectively; (P=0.001). Multivariate analysis revealed a correlation of moderate strength between parental history of hypertension and increased LDL-C (P<0.001) in adolescents. Conclusion Adolescents with and without familial history of hypertension have no significant median blood pressure differences. However, adolescents with hypertensive parents have This study was presented at Pertemuan Ilmiah Tahunan V (PIT V/The 5th Child Health Annual Scientific Meeting) Bandung, October 15â€“17, 2012. From the Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera, Indonesia. Reprint requests to: Dr. Julia Fitriany, Department of Child Health, University of North Sumatera Medical School/H. Adam Malik Hospital, Jl. Bunga Lau No.17, Medan 20136. Tel +6261 8361721 â€“ +6261 8365663. Fax. +6261 8361721. E-mail: julia_fitriany@yahoo.com. Adolescent hypertension is an important health problem of increasing prevalence that affects morbidity and mortality.1 The prevalence of hypertension in adolescents has increased due to several factors such as obesity, a sedentary lifestyle, smoking, stress, sleep disorders and increased intake of high-calorie foods, sodium, alcohol, and caffeine.2 In the pediatric population, essential hypertension, also known as primary hypertension, mostly afsignificantly higher median total cholesterol and mean LDL-C. Furthermore, we find a correlation between parental history of hypertension and increased LDL-C in adolescents.

Hematological scoring system as an early diagnostic tool for neonatal sepsis Fathia Meirina; Bidasari Lubis; Tiangsa Sembiring; Nelly Rosdiana; Olga Siregar
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background Sepsis was the leading cause of death in babies by 30%-50% in developing countries. Early diagnosis of neonatal sepsis is still a difficult problem because of clinical features are not specific. Blood culture is the gold standard, but it takes several days and is expensive. The hematological scoring system (HSS) consists of hematologic parameters (leucocyte count, polymorphonuclear (PMN) cells, degenerative changes, and platelet count) for early diagnosis of neonatal sepsis. Objective To measure HSS as an early diagnostic tool for neonatal sepsis. Methods A cross sectional study was conducted in March to June 2013. Samples were collected by consecutive sampling. Fourty neonates suspected sepsis in neonatology unit H. Adam Malik Hospital, Medan, North Sumatera, underwent routine blood count, blood culture, and peripheral blood smear. Each hematologic parameters were analysed using the HSS of Rodwell et al. The hematologic parameters were total leucocyte count, total PMN cells, total PMN immature, I:T PMN ratio, I:M PMN ratio, degenerative changes, and platelet count. The total value revealed HSS score. Diagnostic study parameters were calculated. Results Ten of fourty neonates had sepsis based on blood culture results. The HSS score >=4 had sensitivity 80%, specificity 90%, with positive predictive value (PPV) 73%, negative predictive value (NPV) 93%, ROC curve showed cut off point 0.902 (95% CI 0.803 to 1.0). Conclusion Score HSS >=4 could be used as an early diagnostic tool for neonatal sepsis.

Superoxide dismutase levels and peak expiratory flow in asthmatic children Arie Kurniasih; Madarina Julia; Amalia Setyati
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background Asthma is a chronic inflammatory process which involve variety of cells such as inflammatory mediators, reactive oxygen species (ROS), and cytokines. The inflammatory process would be exacerbated in the presence of oxidative stress. Superoxide dismutase (SOD) is the first important enzyme to protect the respiratory tract against oxidative stress. The decreased of SOD has a correlation with increased of airway obstruction and bronchospasm. Objective To assess for a correlation between superoxide dismutase (SOD) levels and peak expiratory flow, as well as to determine the impact of SOD levels for predicting asthma attacks. Methods We conducted a prospective cohort study at Dr. Sardjito Hospital, Yogyakarta, between February and April 2011 involving asthmatic children aged 5-18 years. Subjectsâ€™ serum SOD levels and peak expiratory flow were measured at the same time point. We then performed a prospective study following up on the same subjects to find out if they had a recurrent asthma attack within one month of the tests. We also reassessed their peak expiratory flow one month after blood specimens were obtained. Results Thirty-nine patients were enrolled in this study. There was no significant correlation between SOD level and peak expiratory flow [r=0.289; 95%CI -0.025 to 0.47; P=0.074]. However, older age was significantly associated with higher peak expiratory flow (ô€‚=0.5; 95%CI 3.10 to 11.57; P=0.01). Lower levels of SOD increased the risk of asthma attacks in a month following the initial measurements (RR=5.5; 95%CI 1.6 to 18.9; P=0.009). Conclusion Superoxide dismutase (SOD) level is not significantly associated with peak expiratory flow. However, we find a relationship between older age and higher peak expiratory flow and a relationship between lower SOD levels and risk of asthma attacks within one month following the tests.

Immunization competence retention in medical students: a comparation between conventional lectures and lectures with simulations method Hartono Gunadi; Rini Sekartini; Retno Asti Werdhani; Ardi Findyartini; Muhammad Arvianda Kevin Kurnia
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background Immunization is recognized as one of the strategies to reduce vaccine preventable diseases. Competency related to immunization are consequently important for medical students and the medical school needs to assure the competence acquisition. Objective To assess competence related to immunization and its retention following lectures with simulations compared to lectures only. Methods A quasi-experimental study was conducted to the 5th year students of University of Indonesia Medical School during the Child Adolescent Health Module in 2012-2013. The intervention group had lectures with simulations and the control group had lectures only. Immunization knowledge was assessed with a 30 multiple choice question (MCA) items performed before and after the module. Competence retention was assessed by MCQ (knowledge) and OSCE (skills) 2-6 months afterwards. Results Sixty eight subjects for each group with similar characteristics were analyzed. There was significant difference after module MCQ score between two groups. Competence retention in 2-6 months after module completion was better in intervention group, both for the knowledge (median MCQ score of 70.00 (range 37-93) vs. mean score of 58.01 (SD 12.22), respectively; P<0.001) and skill (OSCE mean scores of 75.21 (SD 10.74) vs. 62.62 (SD 11.89), respectively; P < 0.001). Proportion of subjects in the intervention group who passed both the MCQ and OSCE were also significantly greater. Conclusion Lectures with simulations are proved to be more effective in improving medical studentsâ€™ immunization competence as well as its retention compared to lectures only approach.

Prevalence of exclusive breastfeeding in Indonesia: a qualitative and quantitative study Elizabeth Yohmi; Nanis Sacharina Marzuki; Eveline Nainggolan; I Gusti Ayu Nyoman Partiwi; Badriul Hegar Sjarif; Hanifah Oswari
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background Breast milk is the best and most ideal food for babies because it contains all nutrition needed for their optimal growth and development. Babies who receive breast milk will have strong immune system, good brain development, and closer emotional bonding with their mothers. Considering the importance of breast milk, Indonesian government has been campaigning to endorse exclusive breastfeeding up to six months in the last four years. To date, there is no national data available to evaluate the exclusive breastfeeding program. Therefore, Indonesian Pediatric Society (IDAI) conducted a national survey on breastfeeding to investigate exclusive breastfeeding rate in Indonesia. Objective To find out the prevalence of exclusive breastfeeding in Indonesia. Methods This study included 22 provinces in Indonesia and targeted on mothers with infants aged 0-11 months. For the quantitative portion of the study we used simple random sampling design to get the prevalence from the population. For the qualitative interview data we used a stratified random sampling design to ensure that each infant age group was well represented. Survey location in each province was selected based on defining the capital city to be urban area and its sub-urban areas to be rural. This study was performed between October â€“ November 2010. Results We found that the prevalences of breastfeeding among baby 0-11 months was quite high which were 91%, 86%, and 72% in infants aged 0-3 months, 0-6 months, and 6-11 months, respectively. Interestingly, the prevalence of breastfeeding in urban area was higher than in rural area for infants aged 6-11 months. However, despite the high prevalence of giving breast milk, less than half of mothers gave breast milk exclusively, to babies aged 0-3 months and to those aged 0-6 months. The awareness to exclusively breastfeed was greater for urban mothers than for rural ones in those with infants aged 0-6 months. Mothers with high socioeconomic status had the highest prevalence of exclusive breastfeeding. The prevalence of breastfeeding without formula was still the highest up to 12 months but the role of giving formula was increasing especially in rural area. The prevalence of breast milk introduced as the first milk was around 60%. Java and Sumatra had lower prevalence of breast milk introduced as the first milk compared to Kalimantan and Sulawesi. We also found that mothers started giving solid food from an early age, especially in rural areas. With increasing age, the frequency of giving breast milk declined in both urban and rural areas. Conclusion The overall prevalence of exclusive breastfeeding up to 6 months of age in Indonesia was 49.8%. Maternal unemployment and high family socioeconomic status were associated with longer duration of breastfeeding.

PELOD score, serum procalcitonin, and lactate levels in pediatric sepsis Jufitriani Ismy; Munar Lubis; Erna Mutiara; Gema Nazri Yani; Yunnie Trisnawati
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background Sepsis remains a major cause of morbidity and mortality among critically ill children in the pediatric intensive care unit (PICU). Procalcitonin and lactate have been used as biomarkers of sepsis, as they have been correlated with disease severity, organ failure and death. The Pediatric Logistic Organ Dysfunction (PELOD) score is a tool to assess the severity of organ dysfunction in critically ill children. Objective To investigate the correlation between PELOD score and procalcitonin and lactate levels in pediatric sepsis. Methods A cross-sectional study was conducted in children with sepsis who were admitted to the PICU from April to July 2012. Sepsis was defined as systemic inflammatory response syndrome (SIRS), as a result of suspected or proven infection. Proven infection was defined as positive culture findings (blood, urine or other specimens) and/or serum procalcitonin >=2 ng/mL. Spearmanâ€™s test was used to assess for correlations between PELOD scores and procalcitonin as well as lactate levels. Results Thirty-two patients were analyzed, consisting of 18 males and 14 females with an age range of 1-432 months (median 21 months). There was no statistically significant correlation between procalcitonin level and PELOD score (r=- 0.186, 95%CI -0.502 to 0.174, P=0.308) nor between lactate level(r=-0.069, 95%CI -0.408 to 0.287, P=0.709) and PELOD score. Conclusion Serum procalcitonin and lactate levels are not correlated with PELOD scores in children with sepsis.

Electroencephalogram abnormalities in full term infants with history of severe asphyxia Susanti Halim; I Gusti Nyoman Made Suwarba; I Made Kardana
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background An electroencephalogram (EEG) is an electroimaging tool used to determine developmental and electrical problems in the brain. A history of severe asphyxia is a risk factor for these brain problems in infants. Objective To evaluate the prevalence of abnormal EEGs in full term neonates and to assess for an association with severe asphyxia, hypoxic ischemic encephalopathy (HIE), and spontaneous delivery. Methods This cross-sectional study was conducted at the Pediatric Outpatient Department of Sanglah Hospital, Denpasar, from November 2013 to January 2014. Subjects were fullterm infants aged 1 month who were delivered and/or hospitalized at Sanglah Hospital. All subjects underwent EEG. The EEGs were interpreted by a pediatric neurology consultant, twice, with a week interval between readings. Clinical data were obtained from medical records. Association between abnormal ECG and severe asphyxia were analyzed by Chi-square and multivariable logistic analyses. Results Of 55 subjects, 27 had a history of severe asphyxia and 28 were vigorous babies. Forty percent (22/55) of subjects had abnormal EEG findings, 19/22 of these subjects having history of severe asphyxia, 15/22 had history of hypoxic-ischemic encephalopathy (HIE), and 20/22 were delievered vaginally. There were strong correlations between the prevalence of abnormal EEG and history of severe asphyxia, HIE, and spontaneous delivery. Conclusion Prevalence of abnormal EEG among full-term neonates referred to neurology/growth development clinic is around 40%, with most of them having a history of severe asphyxia. Abnormal EEG is significantly associated to severe asphyxia, HIE, and spontaneous delivery.

Plasma digoxin levels and ejection fraction in pediatric heart failure Nafrialdi Nafrialdi; Sake Juli Martina; Mulyadi Djer; Melva Louisa
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background Digoxin has long been prescribed in children with heart failure, but its efficacy has not been evaluated. A previous study at the Department of Child Health, Dr. Cipto Mangunkusumo Hospital revealed that plasma digoxin levels, following a maintenance dose of 15 Î¼g/kg/d, were sub-therapeutic. Regarding its narrow margin of safety, the trend is to use digoxin in even lower dose. Thus, the drugâ€™s impact on cardiac performance need to be evaluated. Objective To evaluate whether a lower maintenance dose of digoxin (10 Î¼g/kg/d) is sufficient to achieve a therapeutic level and to assess for possible correlations between plasma digoxin level and left ventricular ejection fraction (LVEF) as well as fractional shortening (LVFS). Methods A cross-sectional study was conducted on 20 pediatric heart failure patients at the Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, from January to May 2012. Plasma digoxin levels were measured by ELISA method after one month or more of treatment; LVEF and LVFS were measured by echocardiography. Correlations between plasma digoxin level and LVEF or LVFS were analyzed by Spearmanâ€™s correlation test. The LVEF before and after digoxin treatment were compared by paired T-test. Results Thirteen out of 20 patients had plasma digoxin levels within therapeutic range (0.5-1.5 ng/mL; 95%CI 0.599 to 0.898) and 7 had sub-therapeutic levels (<0.5 ng/ mL; 95%CI 0.252 to 0.417). No significant correlations were observed between plasma digoxin level and LVEF (r=-0.085; P=0.722) or LVFS (r=-0.105; P=0.659). There was a significant increase in LVEF before [42.18 (SD 14.15)%] and after digoxin treatment [57.52 (SD 11.09)%], (P < 0.0001). Conclusion Most patients in this study have plasma digoxin levels within therapeutic range. There are no significant correlations between plasma digoxin level at the time point of measurement and LVEF or LVFS. However, an increase of LVEF is observed in every individual patients following digoxin treatment.

Risk factors for hearing loss in neonates Ni Luh Putu Maharani; Ekawaty Lutfia Haksari; I Wayan Dharma Artana
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background An estimated 6 of 1,000 children with live births suffer from permanent hearing loss at birth or the neonatal period. At least 90% of cases occur in developing countries. Hearing loss should be diagnosed as early as possible so that intervention can be done before the age of 6 months. Objective To determine risk factors for hearing loss in neonates. Methods We performed a case-control study involving 100 neonates with and without hearing loss who were born at Sanglah Hospital, Denpasar from November 2012 to February 2013. Subjects were consisted of 2 groups, those with hearing loss (case group of 50 subjects) and without hearing loss (control group of 50 subjects). The groups were matched for gender and birth weight. We assessed the following risk factors for hearing loss: severe neonatal asphyxia, hyperbilirubinemia, meningitis, history of aminoglycoside therapy, and mechanical ventilation by Chi-square analysis. The results were presented as odds ratio and its corresponding 95% confidence intervals. Results Seventy percent of neonates with hearing loss had history of aminoglycoside therapy. Multivariable analysis revealed that aminoglycoside therapy of 14 days or more was a significant risk factor for hearing loss (OR 2.7; 95%CI 1.1 to 6.8; P=0.040). There were no statistically significant associations between hearing loss and severe asphyxia, hyperbilirubinemia, meningitis, or mechanical ventilation. Conclusion Aminoglycoside therapy for >=14 days was identified as a risk factor for hearing loss in neonates.

Paternal and maternal age at pregnancy and autism spectrum disorders in offspring Luh Putu Rihayani Budi; Mei Neni Sitaresmi; I Gusti Ayu Trisna Windiani
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background The prevalence of autism spectrum disorders (ASDs) has increased 10 times over the past half century, while paternal and maternal age at pregnancy has also increased. Studies looking for an association between paternal or maternal age at pregnancy and ASDs in offspring have not been conclusive. Objective To assess for possible associations between paternal and maternal age at pregnancy and ASDs in offspring. Methods This case-control study had 50 case and 100 control subjects, each case was matched for age and gender to two controls. Case subjects were obtained by consecutive sampling of patients aged 18 months to 7 years who visited the Developmental Behavioral & Community Pediatrics Outpatient Clinic and private growth and development centers from January to April 2013, while control group were children of the same age range and same gender who visited pediatric outpatient clinic at Sanglah Hospital mostly due to acute respiratory tract infection, without ASDs as assessed by the DSM-IV-TR criteria. We interviewed parents to collect the following data: maternal and paternal age at pregnancy, childâ€™s birth weight, history of asphyxia, hospital admission during the neonatal period, pathological labor, maternal smoking during pregnancy, paternal smoking, and gestational age. Data analysis was performed with Chi-square and Fisherâ€™s exact tests. Results Multivariable analysis showed that higher paternal age at pregnancy was associated with ASDs in offspring (OR 6.3; 95%CI 2.0 to 19.3; P 0.001). However, there was no significant association between maternal age during pregnancy and the incidence of ASDs. Asphyxia and paternal smoking were also associated with higher incidence of ASDs in the offspring (OR 10.3; 95%CI 1.9 to 56.5; P 0.007 and OR 3.2; 95%CI 1.5 to 6.9; P 0.003, respectively). Conclusion Paternal age >=40 years increased the risk of ASDs in offspring by 6.3 times. In addition, paternal smoking increased the risk of ASDs in offspring by 3.2 times and asphyxia increased the risk of ASDs in offspring by 10.3 times.

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