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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 56 No 5 (2016): September 2016" : 10 Documents clear

Mortality rates in pediatric septic shock Desy Rusmawatiningtyas; Nurnaningsih Nurnaningsih
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Septic shock remains a major cause of morbidity and mortality in children admitted to the intensive care unit. Recent investigations from developed countries have reported mortality rates of 20-30%. Few studies have reported mortality rates from pediatric septic shock in intensive care settings in developing countries with limited resources.Â Objective Â To determine the current mortality rates for pediatric patients with septic shock in a developing country.Methods A retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at DR. Sardjito General Hospital. Medical records and charts were reviewed and recorded for diagnoses of septic shock, from November 1st, 2011 to June 30th, 2014. Results Â A database of all PICU admissions was assembled, and cases with diagnoses of septic shock were reviewed. The final data consisted of 136 patients diagnosed with septic shock. Septic shock was defined as a clinical suspicion of sepsis, manifested by hyperthermia or hypothermia, and accompanied by hypoperfusionÂ The overall mortality rate for the study cohort was 88.2%.Â The median age of patients was 16 months, with 52.2% males. Median initial PRISM III and PELOD scores were 10 and 22, respectively. The median length of PICU stay was 4 days. A total of 48.5% of the subjects were in need of crystalloid and colloid fluid at a median amount of 40 mL/kg. The median time required to complete the initial resuscitation was 60 minutes. Mechanical ventilator support in the first 24 hours was required in 79.4% of the cases. Fluid overload of > 10% (FO>10%) was found in 58.8% of the subjects.Conclusion The mortality rate in pediatric septic shock in our hospital is very high. There is a higher incidence of fluid overload in the non-survival group .

Nutritional status of infants with cow's milk allergy who consume breast milk vs. hypoallergenic formula Mulya Safri; Aulia Rahman Putra; Vidya Chatmayani Mulya
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Infants with CMA are prone to suffer malnutrition because of the inability to absorb nutrients due to bowel inflammation. Breast milk and hypoallergenic formula is the best nutritional intake in CMA infants.Objective To compare the nutritional status of CMA infants who were consumed breast milk and hypoallergenic milk.Methods We conducted a cross-sectional study included a total of 63 CMA infants aged 3-6 months collected by consecutive sampling. Infantâ€™s nutritional status measured by anthropometric exam were divided into well-nourished (-2 to 2 SD) or malnourished (<-2 or >2 SD). Type of milk consumption were asked directly to parents/caregivers through interviews.Results Most of our subject are well-nourished (75%). The number of CMA infants who were consumed breast milk or hypoallergenik milk is not a lot of difference, 51% vs 49%, respectively. There is no significant difference between the nutritional status of CMA infants who consumed breast milk and hypoallergenic milk (P=0.61).Conclusion because there were no differences between the nutritional status of CMA infants who consumed breast milk and hypoallergenic milk. Therefore it is recommended giving breast milk or hypoallergenic milk for the first 6 months of life to reduce cowâ€™s milk protein exposure.

Associations of maternal body composition and nutritional intake with fat content of Indonesian mothersâ€™ breast milk Ardesy Melizah Kurniati; Diana Sunardi; Ali Sungkar; Saptawati Bardosono; Neng Tine Kartinah
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Breast milk is the best sole food for infants in their first six months of life. Breast milk fat content accounts for the largest part of infantsâ€™ energy and may be influenced by many factors, including maternal factors, which may vary in different settings. So far, there has been no published data about the breast milk fat content of Indonesian mothers, including whether it is affected by their body composition or nutritional intake.Objective To investigate breast milk fat content of Indonesian mothers and its associations with maternal body composition and nutritional intake. Method This cross-sectional study was conducted at Budi Kemuliaan Mothersâ€™ and Childrenâ€™s Hospital. Breast milk specimens were collected from 48 nursing mothers, centrifuged, and tested by creamatocrit for fat content. A 24-hour food recall was performed to evaluate maternal macronutrient intake. Maternal body composition was evaluated by bioelectric impedance analysis. Univariable correlations between breast milk fat content and either energy and macronutrient intake were assessed using the Spearman rho test.Results All nursing mothers had breast milk fat content within clinically normal range [mean 59.4 (SD 15.9) g/L]. There was no significant correlation between milk fat content and maternal body fat (r = -0.03, P=0.840), total body water (r = 0.09 P=0.509), or muscle mass (r = 0.08, P=0.577). Milk fat content seemed to weakly correlated with maternal fat intake, although it was not statistically significant (r = 0.27, P=0.065).Conclusion Breast milk fat content at one-month post delivery appears not associated with with maternal body composition. It seems to weakly correlate with maternal fat intake but findings need to be confirmed in larger studies with adjustment for confounding variables.Â

Agreement between the Denver II and Parentsâ€™ Evaluation of Developmental Status tests, with and without the assistance of a table of categorical responses Arief Priambodo; Meita Dhamayanti; Eddy Fadlyana
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Among standardized developmental screening tools, the Denver II is commonly used by Indonesian pediatricians, but the Parentâ€™s Evaluation of Developmental Status (PEDS) test has gained in popularity. The Denver II test is filled by physicians, while the PEDS test is meant to be filled by parents. From a practical standpoint, however, parents often require assistance from doctors when filling out the PEDS forms. Hence, the advantage of the PEDS test over the Denver II test is not fully realized.Objective To compare the agreement between Denver II and PEDS tests, with and without parental use of a table of categorical responses taken from the PEDS manual.Methods We conducted a cross-sectional study in children aged 6 months to 5 years in Bandung from November 2015 to March 2016. Subjects were divided into two groups using block randomization. One group of subjectsâ€™ parents filled the PEDS questionnaires with the assistance of a table of categorical responses taken from the PEDS manual, while the other group of subjectsâ€™ parents filled PEDS forms without this table. All subjects underwent Denver II screening by pediatricans. The agreement between the PEDS and Denver II results were assessed by Kappa score.Results Of 254 children, 239 were analyzed. Kappa scores between the Denver II and PEDS tests were 0.05 (95%CI: -0.10 to 0.20) without the table of categorical responses, and -0.06 (-0.23 to 0.10) with the table of categorical responses.Conclusion Agreement between the Denver II and PEDS tests is poor. The table of categorical responses does not increase the agreement between Denver II and PEDS.

Iron profiles of preterm infants at two months of chronological age Henny Adriani Puspitasari; Endang Windiastuti; Aryono Hendarto
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Preterm infants are vulnerable to iron deficiency (ID) due to lack of maternal iron stores, repeated phlebotomy, and the bodyâ€™s increased demand for iron during growth. The risk of ID increases at 2 months of age, when hemoglobin (Hb) levels start to decrease. Adequacy of body iron level is assessed by ferritin, serum iron (SI), transferrin saturation (Tfsat), total iron-binding capacity (TIBC), and Hb measurements. Objective To describe iron profiles in preterm infants at 2 months of chronological age (CA). Methods This cross-sectional study was conducted in 2-month-old infants, born at 32-36 weeks of gestational age, and who visited the Growth and Development Clinics at Cipto Mangunkusumo, Fatmawati, or Budi Kemuliaan Hospitals. Parental interviews and medical record reviews were done during the clinic visits. Complete blood count, blood smear, SI, TIBC, Tfsat, and ferritin level tests were performed. Results Eighty-three subjects were enrolled in this study. Most subjects were male (51%) and born to mothers >20 years of age (93%). Subjectsâ€™ birth weights ranged from 1,180 g to 2,550 g. The prevalence of iron deficiency anemia (IDA) was 6% and that of ID was 10%. The lowest Hb level found in IDA infants was 6.8 g/dL, while the lowest ferritin level was 8.6 ng/mL. Median values for the other tests were as follows: SI 48 Âµg/dL, TIBC 329Âµg/dL, and Tfsat 17%. Subjects with IDA were all male (5/5), mostly achieved more than twice their birth weight (4/5), were non-iron supplemented (3/5), born to mothers with low educational background (3/5), and of low socioeconomic status (3/5). Conclusion The prevalence of IDA is 6% and that of ID is 10%. Most subjects with ID and IDA have low SI, high TIBC, low Tfsat, and low ferritin level. Most of the all-male IDA subjects weigh more than twice their birth weight, are non-iron supplemented, and born to mothers with low educational background and low socioeconomic status.

Predictive value of Score for Neonatal Acute Physiology and Perinatal Extension II for neonatal mortality in Sanglah Hospital, Denpasar, Indonesia I Gede Ketut Aryana; I Made Kardana; I Nyoman Adipura
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Neonatal mortality, which is largely caused by severe illness, is the biggest contributor to overall infant mortality. The World Health Organization (WHO) estimated that 4 million neonates die yearly worldwide, often due to severe infection and organ system immaturity. Neonates with severe illness require treatment in the neonatal intensive care unit (NICU), in which a reliable assessment tool for illness severity is needed to guide intensive care requirements and prognosis. Neonatal disease severity scoring systems have been developed, including Score for Neonatal Acute Physiology and Perinatal Extension II Â (SNAPPE II), but it has never been validated in our setting.ObjectiveTo study the prognostic value of SNAPPE II as a predictor of neonatal mortality in Sanglah Hospital, Denpasar, Indonesia.Methods This prospective cohort study was conducted in the NICU of Sanglah Hospital, Denpasar from November 2014 to February 2015. All neonates, except those with congenital anomaly, were observed during the first 12 hours of admission and their outcomes upon discharge from the NICU was recorded. We assessed the SNAPPE II cut-off point to predict neonatal mortality. The calibration of SNAPPE II was done using the Hosmer-Lemeshow goodness-of-fit test, and discrimination of SNAPPE II was determined from the receiver-operator characteristic (ROC) curve and area under the curve (AUC) value calculation.ResultsDuring the period of study, 63 children were eligible, but 5 were excluded because of major congenital abnormalities. The SNAPPE II optimum cut-off point of 37 gave a high probability of mortality and the ROC showed an AUC of 0.92 (95%CI 0.85 to 0.99). The Hosmer-Lemeshow goodness-of-fit test showed a good calibration with P = 1.0Conclusion The SNAPPE IIÂ has a good predictive ability for neonatal mortality in Sanglah Hospital, Denpasar, Indonesia.

Comparison of ventilation parameters and blood gas analysis in mechanically-ventilated children who received chest physiotherapy and suctioning vs. suctioning alone Monalisa Elizabeth; Chairul Yoel; Muhammad Ali; M. Sjabroeddin Loebis; Hasanul Arifin; Pertin Sianturi
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Chest physiotherapy and suctioning are routine methods for airway clearance in mechanically-ventilated children. However, chest physiotherapy has not been confirmed to affect ventilation parameters, such as tidal volume (TV), peak inflation pressure (PIP), peak inspiratory flow (PIF), and peak expiratory flow (PEF), as well as blood gas analysis (BGA) values in pediatric intensive care unit (PICU) patients.Objective To determine the efficacy of chest physiotherapy and suctioning vs. suctioning alone for improving the mechanical ventilation parameters and BGA.Methods This randomized, single-blind, clinical trial was conducted from November 2012 to June 2013 in the PICU at Haji Adam Malik Hospital, Medan. A total of 40 mechanically-ventilated pediatric patients were enrolled and divided into either the chest physiotherapy and suctioning group (24 subjects) or the suctioning alone group (16 subjects). Subjects underwent treatment, followed by monitoring of their ventilation parameters and blood gas analyses. Data were analyzed by independent t-test and Mann-Whitney test.Results Subjects comprised of 23 boys and 17 girls, with an age range of 1â€“204 months. After the respective treatments (chest physiotherapy and suctioning vs. suctioning alone), the ventilation parameters were as follows: median TV (60.0 vs. 56.5 mL, respectively; P=0.838), median PEF (10.4 vs. 10.8 I/s, respectively; P=0.838), median PIF (7.4 vs. 8.2 I/s, respectively; P=0.469), and mean PIP (17.3 vs. 15.6 cmH2O, respectively; P=0.23). The BGA values were: median pH (7.4 vs. 7.3, respectively; P=0.838), median pCO2 (38.4 vs. 36.2 mmHg, respectively; P=1.000), mean pO2 (136.6 vs. 139.2 mmHg, respectively; P=0.834), median HCO3 (20.4 vs. 22.7 mmol/L, respectively; P=0.594), median TCO2 (22.0 vs. 23.7 mmol/L, respectively; P=0.672), mean BE (-4.3 vs. -3.1 mmol/L, respectively; P=0.629), and median O2 saturation Â (98.5 vs. 98.3 %, respectively; P=0.967).Conclusion In mechanically-ventilated children in the PICU, ventilation parameters and BGA values are not significantly different between subjects who received both chest physiotherapy and suctioning and those who received suctioning alone.

Quality of sleep and hypertension in adolescents Arie Taufansyah P. Nasution; Rafita Ramayati; Sri Sofyani; Oke rRna Ramayani; Rosmayanti Siregar
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Adolescents with hypertension are at risk of morbidity and mortality due to cardiovascular problems in later life. Hypertension may be influenced by poor quality of sleep, so early detection of hypertension and ensuring good quality of sleep in adolescence is needed.Objective To assess for a possible association between poor sleep quality and hypertension in adolescents.Methods We conducted a cross-sectional study from January to March 2013 in Mustafawiyah Boarding School, Mandailing Natal, North Sumatera. Subjectsâ€™ quality of sleep was assessed by the Pittsburgh Sleep Quality Index (PSQI) questionnaire and their systolic and diastolic blood pressures were measured. Quality of sleep was categorized as either good or poor. Blood pressure was categorized as either normotensive or hypertensive. An association between poor sleep quality and hypertension was analyzed by Chi-square test.Results Two hundred forty adolescents participated in this study, of whom 210 (87.5%) subjects were normotensive and 30 (12.5%) subjects were hypertensive. We found higher systolic blood pressure [114.9 (SD 11.7) vs. 109.5 (SD 10.5) mmHg as well as diastolic blood pressure [74 (SD 9.1) vs. 69.9 (SD 7.5) mmHg in adolescents with poor sleep quality compared to Â those with good sleep quality (P=0.001).Conclusion Poor sleep quality is associated with hypertension in adolescents.

Visfatin levels in non-obese, obese, and insulin resistant adolescents Indra Ihsan; Eka Agustia Rini; Rismawati Yaswir
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Adipose tissue is not merely a site for energy storage, but is also the largest endocrine organ, secreting various adipocytokines. Plasma visfatin, an adipocytokine predominantly secreted from visceral adipose tissue, has insulin-mimetic effects, and has been closely linked to insulin resistance.Objective To compare plasma visfatin levels between obese and non-obese adolescents, as well as between obese adolecents with and without insulin resistance.Methods This cross-sectional study was conducted in students who attended three senior high schools in Padang. Subjects comprised 28 obese and 28 non-obese adolescents. The age of the subjects ranged from 14-18 years. Obesity criteria were based on body mass index (BMI) measurements. Fasting serum glucose level was measured by glucose hexokinase photometry and serum insulin was measured by chemiluminesence immunoassay. Plasma visfatin was measured by enzyme-linked immunosorbent assay (ELISA). The insulin resistance index was estimated from fasting serum insulin and glucose levels using the homeostatic model assessment for insulin resistance (HOMA-IR). Differences in the variables were tested using independent T-test and Mann-Whitney test, depending on the distribution of the variables.Results The mean plasma visfatin level was significantly higher in the obese than in the control group [2.55 (SD 1.54) vs. 1.61 (SD 0.64) ng/mL, respectively; (P=0.005)]. The insulin resistant group had significantly higher mean plasma visfatin level than the non-resistant group [3.61 (SD 1.59) vs. 1.96 (SD 1.18) ng/mL, respectively; (P=0.004)].Conclusion Obese adolescents with insulin resistance have signifcantly higher plasma visfatin levels compared to those without insulin resistance.

Effectiveness of amitriptyline for treating functional dyspepsia in adolescents Indra Mustawa; Supriatmo Supriatmo; Hakimi Hakimi; Atan Baas Sinuhaji
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Functional dyspepsia is common among adolescents. Pain reduces childrenâ€™s quality of life, psychosocial functioning, and school attendance. Amitriptyline is assumed to be one of the alternative treatments in functional dyspepsia.Objective To investigate the effectiveness of amytriptyline as a treatmentÂ forÂ functional dyspepsia in adolescents.Methods We conducted a randomized, single-blind, controlled trial from January to March 2011 in junior and senior high school students in Dobo City, Aru Island District, Maluku Province. Adolescents suffering from functional dyspepsia and who fulfilled the inclusion criteria were eligible for the study. Subjects were randomized into two groups. Each group received 10 mg (for body weight < 35 kg) or 20 mg (for body weight â‰¥ 35 kg) amitriptyline or placebo once per day for 28 days. Pain frequency was measured in terms of abdominal pain episodes per month, and duration was measured in minutes. Data were analyzed using t-test.Results Eighty-eight students participated in this study: the amitriptyline group (43 subjects) and the placebo group (45 subjects). There were no statistically significant differences between the amitriptyline and placebo groups in frequency (P=0.777; 95%CI -0.846 to 1.129) or duration (P=0.728) of abdominal pain after treatment.Conclusion Â Amitriptyline is not more effective than placebo for treating functional dyspepsia in adolescents.Â Â

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