Paediatrica Indonesiana
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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Effect of oral administration of probiotics on intestinal colonization with drug-resistant bacteria in preterm infants
Abdullah Kurt;
Deniz Anuk Ince;
AyÅŸe Ecevit;
Özlem Kurt Azap;
Zafer Ecevit;
Ersin Öğüş;
Ali UlaÅŸ TuÄŸcu;
Aylin Tarcan
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi57.2.2017.91-8
Background Oral administration of probiotics in newborn preterm infants has been shown to be helpful, especially ın reducıng the incidence of necrotizing enterocolitis and overall mortality rates.Objective To evaluate the effect of probıotıc supplementation on ıntestınal colonization by antibiotic-resistant microorganisms in preterm infants receiving antibiotics in a neonatal intensive care unit (NICU).Methods The prospective, randomized trial was performed ın preterm infants who were hospitalized in the NICU at Baskent University Ankara Hospital between January 2011 and February 2012. A total of 51 infants were enrolled and randomly assigned to one of two groups: Group 1 (n=27) received probiotic therapy and Group 2 (n=24) did not receive probiotics. The probiotic used was Lactobacillus reuteri (Biogaia® AB, Sweden). Subjects underwent weekly nasal swab and stool cultures for a maxımum of 6 weeks, and at the tıme of dıscharge ıf thıs was prıor to 6 weeks. All posıtıve cultures were further tested for culture-specıfıc ıdentıfıcatıon and antıbıotıc suceptibility.Results  A total of 607 cultures were evaluated. Posıtıve cultures were found ın 37.9% from Group 1 and 35.2% from Group 2. Intestınal colonızatıon by antıbıotıc-resıstant bacterıa dıd not sıgnıfıcantly dıffer between groups (P>0.05).                                                                                                                         Conclusions Oral supplementation with probiotics do not prevent the intestınal colonization of antibiotic-resistant microorganisms in preterm NICU patıents who receıved antıbıotıc treatment.
Third trimester maternal 1,25-dihydroxyvitamin D and neonatal birth weight
Yusrawati Yusrawati;
Meldafia Idaman;
Nur Indrawati Lipoeto
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi57.2.2017.67-9
AbstractBackground The main cause of neonatal mortality is low birth weight. Active form of vitamin D (1,25-dihydroxyvitamin D) increase the efficiency of calcium and phosphorous absorption in intestinal. Deficiency 1,25-dihydroxyvitamin D in pregnant woman was hipothesized relates with low birth weight in neonate.Objective To determine the relationship between maternal 1,25-dihydroxyvitamin D level and neonatal birth weight.Methods This was an observational study with cohort design to 47 women in the third trimester pregnancy. This study was cond ucted on August to December 2014. Subjects were taken from Ibu dan Anak Hospital, Padang, West Sumatera. Maternal blood from antecubital vein was examined for 1,25-dihydroxyvitamin D concentration using enzyme-linked immunosorbent assay (ELISA). Neonatal birth weights were measured right after delivery. Data were analyzed by Pearson’s correlation and linear regression tests.Results A positive correlation was found between maternal 1,25-dihydroxyvitamin D level and neonatal birth weight (R=0.910; R2=0.821; P=0.000). The 1,25-dihydroxyvitamin D level had an 82.1% contribution to the baby’s birth weight, while other factors not assessed in this study had less of an effect.Conclusion There was positive correlation between maternal 1,25-dihydroxyvitamin D levels in the third trimester of pregnancy and neonatal birth weight
Duration of watching TV and child language development in young children
Silva Audya Perdana;
Bernie Endyarni Medise;
Erni Hernawati Purwaningsih
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi57.2.2017.99-103
Background Many factors contribute to language development in children. About 5-8% of children in Indonesia experience delayed language skills. Young children need appropriate stimulation for optimal development. Children who watch television (TV) for long periods of time may receive less two-way interaction, the appropriate stimulation for learning. As such, shorter duration of the appropriate stimulation may impede language development in small children.Objective To assess for an association between duration of watching TV and language development in young children.Methods This cross-sectional study was done with primary data collected from questionnaires. Subjects, aged 18 months to 3 years, were from a Jakarta-area community health center (Puskesmas) Jatinegara and the Pediatric Growth and Development Clinic, Cipto Mangunkusumo Hospital, Jakarta. Their language development was tested using the Developmental Pre-screening Questionnaire (Kuesioner Pra Skrining Perkembangan, KPSP) and the Early Language Milestone (ELM Scale 2) test.Results From a total of 84 subjects, 47 (56%) had normal and 37 (44%) had delayed language development. Duration of watching TV was categorized as <4 hours per day or >4 hours per day. Children who watched TV >4 hours/day (OR 4.4; 95%CI 1.68 to 11.7; P=0.002), and children who watched both Indonesian and English language TV programs (OR 14.7; 95%CI 1.77 to 123.0; P=0.004) had higher risk of language delay. Other variables such as sex, first age exposed to TV, use of gadgets, and TV in the bedroom had no significant associations with delayed language development.Conclusion Children who watch TV >4 hours/day had four times higher risk of developing language delay. In addition, those who watch TV programs in both Indonesian and English, also have a 14.7 higher risk of delayed language development.
Delayed diagnosis of congenital hypothyroidism in an adolescent results in avoidable complications: a case report
Indra Ihsan;
Eka Agustia Rini
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi57.2.2017.108-16
Delayed diagnosis of congenital hyporhyroidism (CH) remains a serious problem. A retrospective analysis of 1,000 CH cases in Turkey found a mean age of 49 months at the time of clinical diagnosis. Only 3.1% of cases were diagnosed during the neonatal period and 55.4% were diagnosed after 2 years of age.1 In Cipto Mangunkusumo Hospital, Jakarta, 53% cases were diagnosed at 1-5 years, 3.3% at 6-12 years, and 6.7% after 12 years of age, while the remainder were diagnosed at < 1 year of age.2 The majority of affected children exhibit signs and symptoms that are highly non-specific, as most infants with CH are asymptomatic at birth, and only 5% of cases can be diagnosed based on clinical examination during the first day of life.3 The other factors that contribute to delayed diagnosis are uneducated parents, who do not notice or dismiss the importance of mild/moderate deviations in physical and mental growth, as well as constipation, feeding difficulties, or other vague, non-specific symptoms in infancy. Parents are often unaware of the importance of early diagnosis and commencement of therapy for CH.4
Hepatitis B seroprotection in children aged 10-15 years after completion of basic hepatitis B immunizations
Novie Homenta Rampengan;
Sri Rezeki Hadinegoro;
Mulya Rahma Karyanti
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi57.2.2017.76-83
Background The prevalence of hepatitis B viral (HBV) infection in Indonesia is high. The most effective way to control HBV infection is by hepatitis B (HB) immunization. Many studies reported that hepatitis B surface antibody (anti-HBs) seroprotection declines in children > 10 years of age. In addition many factors can influence anti-HBs titer.Objective To measure anti-HBs titer and evaluate possible factors associated with anti-HBs titer.Methods This cross sectional  study was conducted in children 10-15 years of age from ten schools at Tuminting District, Manado, North Sulawesi, from October to November 2014. All subjects had completed the hepatitis B immunization scheme. By stratified random sampling, 105 children were selected as subjects. Data was analyzed with SPSS version 22.Results. From 48 schools, we selected 10 schools from which to draw a total of 105 children, but only 23 (21.9%) children had detectable anti-HBs . Of all subjects, 76 (72.4%) were female, 78 (74.3%) had good nutritional status, and 98 (93.3%) had birth weight ≥2,500 grams. Data from immunization record books showed that 26 (24.8%) subjects received the HB-1 vaccination at ≤7 days of age and 45 (42.9%) subjects had a ≥2 month interval between the HB-2 and HB-3 vaccinations. Multivariate analysis showed that administration of HB-1 at ≤7 days of age  and a ≥2 month interval between HB-2 and HB-3  had significant associations with anti-HB seroprotection in children.Conclusion A low proportion of subjects who had completed the hepatitis B immunization scheme had detectable anti-HBs titer (21.9%). Administration of HB-1 at ≤7 days of age and a ≥2-month interval between HB-2 and HB-3 vaccinations are important factors in anti-HB seroprotection in children aged 10-15 years.
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
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DOI: 10.14238/pi57.2.2017.104-7
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
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DOI: 10.14238/pi57.2.2017.84-90
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
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DOI: 10.14238/pi57.2.2017.70-5
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.                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
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DOI: 10.14238/pi57.2.2017.57-62
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
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DOI: 10.14238/pi57.2.2017.63-6
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.