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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 11 Documents
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Search results for , issue "Vol 56 No 4 (2016): July 2016" : 11 Documents clear
Impact of an antimicrobial resistance control program: pre- and post-training antibiotic use in children with typhoid fever Elfrida A. Rachmah; Maftuchah Rochmanti; Dwiyanti Puspitasari
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (251.992 KB) | DOI: 10.14238/pi56.4.2016.205-10

Abstract

Inappropriate use of antibiotics may lead to antimicrobial resistance. In 2012, Dr. Soetomo Hospital conducted training for pediatric residents on the proper use of antibiotics to limit antimicrobial resistance.Objective To evaluate the impact of a rational, antibiotic-use training program for pediatric residents on their antibiotic prescriptions for patients with typhoid fever.Methods A cross-sectional, analytic study was conducted. We collected data from children with typhoid fever who were hospitalized in Dr. Soetomo Hospital, pre- and post-training on antibiotic prescriptions. Children with other known bacterial infections or who were discharged on request were excluded. Antibiotic prescriptions were evaluated using Gyssens algorithm based on the local protocol. Chi-square test was used to compare the quality of antibiotic prescriptions, before (year 2012) and after (year 2013) the training.Results Forty-nine patients with 67 prescriptions in 2012 and 34 patients with 48 prescriptions in 2013 fulfilled the inclusion criteria. Patients’ ages ranged from 1-18 years. Diagnoses of uncomplicated and complicated typhoid were found in 74% and 26% of subjects, respectively. First line (chloramphenicol, thiamphenicol, ampicillin, trimetroprim and sulfametoxazol) and second line (ceftriaxone and cefixime) use were 72% and 28%, respectively. All patients were discharged in good condition. Appropriate use of antibiotics was noted in 61% of subjects in 2012 and in 81% of subjects in 2013 (P=0.036). The most common type of error in 2012 and 2013 was dosage imprecision (25% and 17%, respectively).Conclusion Training on appropriate use of antibiotics significantly improved the quality of antibiotics prescribed in children with typhoid fever in Dr. Soetomo Hospital.
The risk of urinary tract infection in children with nephrotic syndrome Patricia Y. Gunawan; Adrian Umboh
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (206.119 KB) | DOI: 10.14238/pi56.4.2016.238-41

Abstract

Background Urinary tract infections (UTI) may affect any part of the urinary system: the kidneys, ureters, bladder, or urethra. Nephrotic syndrome (NS) is the most common glomerular disorder in childhood, comprising a group of symptoms that include proteinuria, hypoalbuminemia, hypercholesterolemia, and edema. The prevalence of UTI in NS patients is high, around 25-66.7%. The increased prevalence of UTI in NS is due to immunoglobulin loss, defective T cell function, the presence of ascites, and relative malnutrition.Objective To study the risk of UTI in children with NS.Methods We performed a retrospective study of NS and UTI patients from January 2004 to December 2013 in the Division of Nephrology at Prof. Dr. R.D. Kandou Hospital, Manado. Data was collected from medical records. Diagnosis of UTI was made based on urine culture results. Diagnosis of NS was made based on the group of symptoms mentioned above. Analysis was done using Chi-square test with SPSS version 22 software.Results Of 74 NS patients, 34 (46%) had UTIs. During the same study period, 117 patients had UTIs. NS was more common in boys (64.9%), while NS with UTI was more common in girls (67.6%). The most common organisms causing UTI in NS patients were Eschericia coli and Citrobacter diversus (23% each). Imipenem and amikacin were most commonly used antibiotics to which the bacteria were sensitive. Increased risk of UTI was significant in children with NS (OR 1.8; P=0.03).Conclusion Children with NS are at significantly increased risk of UTIs.
Prognostic value of nitric oxide in pediatric septic shock Ari L. Runtunuwu; Jeanette I. Ch. Manoppo; Dasril Daud; Irawan Yusuf; Idham Jaya Ganda
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi56.4.2016.211-4

Abstract

Background Nitric oxide (NO) play a key role in the pathogenesis of septic shock. Nitrit oxide metabolite is reported as a good predictor for shock although its role as mortality predictor in sepsis still controversial.Objective To assess the serum nitric oxide (NO) levels and outcomes in pediatric patients with septic shock.Methods We conducted a prospective cohort study from January 2013 to April 2014 in Pediatric Intensive Care Unit (PICU) Prof. Dr. R. D. Kandou Hospital, Manado. Subjects were patients aged 1 month-12 years diagnosed with septic shock. We measured initial serum NO and observed its outcomes in all subjects.Results A total of 37 patients with septic shock met the study criteria. Nineteen children were male (51.4%). Seventeen subjects died and 20 subjects survived. The mean age of subjects with septic shock was 37.3 (SD 14.2) months. The mean serum NO level was significantly higher in the group who died [33.2 μM; 95% CI 23.6 to 42.7] than in the group who survived [13.8 μM; 95%CI 11.6 to 15.9] (P<0.01). The serum NO cut-off point for predicting mortality was 16.15 µM. For NO levels of more than 16.15 µM, the positive predictive value was 72.2% and negative predictive value was 78.9% (OR 9.750; 95%CI 2.154 to 44.138).Conclusion In pediatric patients with septic shock, serum NO levels are significantly higher in those who died than in those who survived. Serum nitric oxide level can be used to predict outcomes of patients with septic shock.
The relationship between thrombocytopenia and intraventricular hemorrhage in neonates with gestational age Idha Yulandari; Lily Rundjan; Muzal Kadim; Pustika Amalia; Haryanti F. Wulandari; Setyo Handryastuti
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (303.481 KB) | DOI: 10.14238/pi56.4.2016.242-50

Abstract

Background The prevalence of thrombocytopenia in neonates ranges from 22 to 35%, and one of the most feared complica­tions is intraventricular hemorrhage (IVH). Previous research in Cipto Mangunkusumo Hospital (CMH), Jakarta reported a high incidence of IVH (43.47%) in infants with a gestational age of <35 weeks. Intraventricular hemorrhage causes disturbances in neurological development and can be fatal. In Indonesia, re­search on the relationship between thrombocytopenia and IVH has been limited.Objective To study the relationship between thrombocytopenia and IVH in neonates with gestational age <35 weeks and assess for a correlation between the severity of thrombocytopenia and the severity of IVH.Methods This cross-sectional study was performed by reviewing medical records in the Neonatology Division of the Child Health Department, University of Indonesia, CMH. Subjects were neonates hospitalized from January 2012 to December 2014 with IVH. Subjects were categorized into either mild to moderate IVH (grade ≤2) or severe IVH (grade >2). Thrombocyte counts were recorded on the same day as the diagnosis of IVH.Results The risk of severe IVH was 28.2% in neonates with thrombocyte counts <100,000/uL, and 10.4% in neonates without thrombocytopenia (P=0.014). Multivariate analysis revealed that gestational age <32 weeks and the use of respira­tory support (ventilator and high frequency oscillatory ventila­tion) had significant associations with severe IVH. However, multivariate analysis did not show a significant relationship between thrombocytopenia and severe IVH (correlation coef­ficient = 0.21).Conclusion Thrombocytopenia is not significantly associated with the incidence of severe IVH based on multivariate analysis. Also, the severity of thrombocytopenia has no correlation with the severity of IVH.
Body mass index, atopy, and allergic diseases Afnita Lestary; Lily Irsa; Tiangsa Sembiring; Rita Evalina; Meiviliani Sinaga
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (399.382 KB) | DOI: 10.14238/pi56.4.2016.221-5

Abstract

Background Prevalence of atopy, allergic diseases, and obesity are increasing. Atopy is an individu and/or familial tendency to sensitization in response to ordinary exposure to allergens. Studies on association of BM I with atopy and allergic diseases in children were limited, with inconclusive results. Objective To assess associations of BM I with atopy and allergic diseases in chidren. Methods A cross-sectional was conducted in school children aged 6-12 years in Lhokseumawe City, Aceh, June 2012. Children were assessed for BMI, skin prick test, and International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Statistical analyses included Chi-square, Fisher exact, and logistic regression. Results The subjects consisted of 137 (85.6%) normoweight, 12 (7.5%) overweight, and 11 (6.9%) obesity. Skin prick test results were positive in 44 (27.5%) and negative in 116 (72.5%) subjects. Allergic manifestations were allergic rhinitis (AR) 17 (10.6%), bronchial asthma 6 (3.8%), and atopic dermatitis (AD) 3 (1.9%). There was significant association of obesity with atopy, compared with normoweight (OR=3.78; 95%CI 1.08 to 13.19; P=0.037), but no significant association found when family history of atopy also assesed. There was significant association of obesity with bronchial asthma (OR=9.92; 95%CI 1.46 to 67.18; P=0.004) and AR (OR=6.49; 95%CI 1.64 to 25.66; P=0.015), compared with normoweight children. Significant association of overweight with atopy and allergic disease were not found. Conclusion Obese children are more likely to have atopy, bronchial asthma, and allergic rhinitis, but overweight and normoweight children are not.
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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (247.592 KB) | DOI: 10.14238/pi56.4.2016.193-8

Abstract

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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (323.171 KB) | DOI: 10.14238/pi56.4.2016.199-204

Abstract

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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (224.693 KB) | DOI: 10.14238/pi56.4.2016.226-9

Abstract

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 ≥III was a significant risk factor for mortality in chidren with Wilms tumor (OR 62.8; 95%CI 5.6 to 70.5). Age ≥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 ≥III is a risk factor for mortality in children with Wilms tumor. 
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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (346.772 KB) | DOI: 10.14238/pi56.4.2016.230-7

Abstract

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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (260.194 KB) | DOI: 10.14238/pi56.4.2016.251-6

Abstract

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 ≥5 may be used to determine which patients are in critically ill condition requiring treatment in PICU.

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