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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 9 Documents

Search results for , issue "Vol 57 No 3 (2017): May 2017" : 9 Documents clear

Using N-terminal pro-B-type natriuretic peptide to diagnose cardiac abnormalities in children with dyspneaen with dyspnea Zakaria Mukalla; Ria Nova; Legiran Legiran; Yangtjik Yangtjik
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background. Dyspnea could be caused by various reason, one of which is the presence of cardiac abnormality. Physical examination sometimes difficult to distinguish breath caused by heart abnormalities, especially small children, so we need another way to find out.Objective. To evaluate whether the examination of NT-proBNP levels can be used as a screening tool to diagnose cardiac abnormality in children presenting with dyspnea.Methods. A Cross sectional study was conducted from August to October 2015 on pediatric patients aged 1 month to 18 years presenting with dyspnea in pediatric ward Mohammad Hoesin Hospital Palembang. All subjects performed blood sampling for NT-proBNP examination and echocardiography to assess the presence of cardiac abnormalities. The diagnostic value analyzed by ROC curve, and determined the optimal cut-off point, sensitivity and specificity.Â Result. We obtained 58 subjects with median age 9.5 (1-180) months, consisted of 39 subjects with cardiac abnormalities and 19 subjects without cardiac abnormality. There is a significant difference (p = 0.002) of NT-proBNP levels in both groups with a medianÂ 1,775 (189-9,000) pg/ml vs 759 (245-9,000) pg/ml. In ROC curve analysis, AUC value was 0.75, and at the optimal cut-off point 1,235 pg/ml, sensitivity was 74.4% and specificity was 73.7%.Conclusion. The level of NT-proBNP can be used to diagnose cardiac abnormalities in children presenting with dyspnea.

Serum ferritin, serum nitric oxide, and cognitive function in pediatric thalassemia major Septiana Nur Qurbani; Lelani Reniarti; Alex Chairulfatah
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background Hemolysis and repeated blood transfusions in children with thalassemia major cause iron overload in various organs, including the brain, and may lead to neurodegeneration. Hemolysis also causes decreased levels of nitric oxide, which serves as a volume transmitter and slow dynamic modulation, leading to cognitive impairment.Objective To assess for correlations between serum ferritin as well as nitric oxide levels and cognitive function in children with thalassemia major.Â Methods This analytical study with cross-sectional design on 40 hemosiderotic thalassemia major patients aged 6âˆ’14 years, was done at the Thalassemia Clinic in Dr. Hasan Sadikin Hospital, Bandung, West Java, from May to June 2015. Serum ferritin measurements were performed by an electrochemiluminescence immunoassay; serum nitric oxide was assayed by a colorimetric procedure based on Griess reaction; and cognitive function was assessed by the Wechsler Intelligence Scale for Children test. Statistical analysis was done using Spearmanâ€™s Rank correlation, with a significance value of 0.05.Results Abnormal values in verbal, performance, and full scale IQ were found in 35%, 57.5% and 57.5%, respectively. Serum nitric oxide level was significantly correlated with performance IQ (P=0.022), but not with verbal IQ (P=0.359) or full scale IQ (P=0.164). There were also no significant correlations between serum ferritin level and full scale, verbal, or performance IQ (P=0.377, 0.460, and 0.822, respectively).Conclusion Lower serum nitric oxide level is significantly correlated to lower cognitive function, specifically in the performance IQ category. However, serum ferritin level has no clear correlation with cognitive function.

Screening for nutritional risk in hospitalized children: comparison of two instruments Dwi Novianti; Tiangsa Sembiring; Sri Sofyani; Tri Faranita; Winra Pratita
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background Malnutrition in hospitalized children has negative impact on morbidity, mortality, length of stay, and health-care cost. A simple screening tool is needed to detect hospital malnutrition risk in children.Objective To compare the level of agreement of the Screening Tool for Malnutrition in Pediatrics (STAMP) and Pediatric Nutritional Risk Score (PNRS) with anthropometric measurements, as screening tools for hospital malnutrition in children.Methods A cross-sectional study was conducted from February to July 2014 in the Pediatric and Surgery Wards at H. Adam Malik Hospital, Medan, North Sumatera. Inclusion criteria were children aged 2 to 18 years who were hospitalized for more than 72 hours. Subjects were screened using STAMP and PNRS, and underwent anthropometric measurement on admission. The weight measurements were repeated on the 3rd and 7th days, and just before discharge. The STAMP and PNRS results were compared in terms of level of agreement with anthropometric measurements. Data were analyzed by Kappa value and Spearmanâ€™s correlation test.Results A total of 127 children were screened with both instruments. The PNRS had slight agreement with hospital malnutrition prevalence (Îº=0.175; P=0.028), while STAMP had notÂ (Îº=0.080; P=0.193). Both screening tools had weak positive correlations with length of stay, but the correlation was stronger for PNRS than for STAMP (r=0.218; P=0.014 vs. r=0.188; P=0.034, respectively). The prevalence of hospital malnutrition was 40.9%.Â Conclusions The PNRS screening tool has slight agreement with anthropometric measurement for identifying hospital malnutrition risk in children.

The immunogenicity and safety of the new, Indonesian DTwP-HB-Hib vaccine compared to the DTwP/HB vaccine given with the Hib vaccine Novilia Sjafri Bachtiar; Kusnandi Rusmil; Sunarjati Sudigdoadi; Cissy B Kartasasmita; Hadyana Hadyana
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background Haemophilus influenzae type b (Hib) causes infection with predominant manifestations of pneumonia, meningitis, and other invasive diseases, occurring primarily in children aged under 2 years, particularly in infants.Â The World Health Organization (WHO) and Indonesian Technical Advisory Group for Immunization recommend to include the Hib vaccine into the national immunization program. The newly developed DTwP-HB-Hib combination vaccine is anticipated to be the preferred choice for Hib vaccine introduction; it is efficient, simple, and has higher coverage.Objective To evaluate the immunogenicity and safety of a new, combined Bio Farma DTwP-HB-Hib vaccine, compared to the registered Hib monovalent vaccine given simultaneously with the local DTwP-HB vaccine, when used as the primary vaccination of Indonesian infants.Methods A prospective, randomized, open-label, phase II study was conducted on the DTwP-HB-Hib vaccine compared to the Hib (registered) vaccine given simultaneously with the DTwP-HB vaccine, in Bandung from July 2011 to January 2012. Infants were serially vaccinated at 6-11, 10-15, and 14-19 weeks. Serological assessments were done prior to the first vaccine dose and 28 days after the third dose. Safety was assessed from the time of first injection until 1 month after the last injection.Results Of 220 healthy infants enrolled, 211 completed the study, with 105 receiving the combined vaccine and 106 the two separate vaccines. All vaccines were well tolerated. No differences in rates of local and systemic reactions were seen between the two methods of administration. No serious adverse events were considered to be related to the vaccines. In the DTwP-HB-Hib primary-vaccination group, at least 98% of the infants reached protective levels of antibodies (seropositivity) against the antigens employed in the vaccines while 96% in the control group.Conclusion The DTwP-HB-Hib combined vaccine is immunogenic and safe, as well as comparable to the Hib vaccine given simultaneously with to the DTwP-HB vaccine.

The pediatric index of mortality 3 score to predict mortality in a pediatric intensive care unit in Palembang, South Sumatera, Indonesia Destiana Sera Puspita Sari; Indra Saputra; Silvia Triratna; Mgs. Irsan Saleh
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background For critically ill patients in the pediatric intensive care unit (PICU), a scoring system is helpful for assessing the severity of morbidity and predicting the risk of mortality. The Pediatric Index of Mortality (PIM) 3 score consists of ten easy simple variables, so that the probability of death can be assessed prior to undergoing advanced therapies. The PIM 3 score in inexpensive and comprised of routine laboratory variables performed in PICU patients. In Indonesia, studies to validate the PIM 3 score have been limited.Objective To evaluate the PIM 3 score for predicting the probability of death in the PICU, Dr. Mohammad Hoesin Hospital (MHH), Palembang.Methods A prospective, cohort study was performed in the PICU, MHH, Palembang, from February to April 2016. The PIM 3 score was calculated within 2 hours of patients admission to the PICU by an Â android calculator application. PIM3 score and mortality were analyzed by Mann-Whitney test; calibration was performed by Hosmer-Lameshow goodness of fit test, discrimination was done by receiver operating characteristic (ROC) curve analysis; and standardized mortality ratio (SMR) was calculated.Results During the study period there were 81 PICU patients, 69 children were included, ranging in age from 1,5 to 187 months. The overall mortality rate was 40,58%. The most common illnesses in our subjects were malignancy (17,4%), post non-thoracic surgery (14,5%), dengue shock syndrome (14,5%), respiratory disease (13%), and neurological disease (11,6%). Subjectsâ€™ PIM3 scores ranged from 1,02% to 58,84%, with means of 26,08% in non-survivors and 13,05% in survivors. The SMR was 2,24, indicating that death was underpredicted. The AUC of 0,771 (95% CI of 0,651 to 0,891) indicated that the PIM3 score had good discrimination.Conclusion In Mohammad Hoesin Hospital, Palembang, South Sumatera, the PIM 3 can be used to predict mortality in PICU patients, but the score should be multiplied by a factor of 2.24. This recalibration is needed due to the presumed lower standard of care at this hospital compared to that of the originating PIM 3 institutions in developed countries.

CD4+ T-cell, CD8+ T-cell, CD4+ /CD8+ ratio, and apoptosis as a response to induction phase chemotherapy in pediatric acute lymphoblastic leukemia May Fanny Tanzilia; Andi Cahyadi; Yetti Hermaningsih; Endang Retnowati; I Dewa Gede Ugrasena
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background Acute lymphoblastic leukemia (ALL) is a neoplastic disease resulting from somatic mutation in the lymphoid progenitor cells, often occuring in children aged 2-5 years, predominantly in males. Results from the induction phase of chemtherapy are used to measure success, but the failure remission rate is still high. Increased apoptosis of cancer cells, as induced by CD4+ and CD8+T-cells, is an indicator of prognosis and response to chemotherapy.Objective To assess for correlations between CD4+, CD8+, or CD4+/CD8+ ratio to the chemotherapy induction phase response (i.e., apoptosis) in pediatric ALL patients.Methods This observational analytical cohort study was done in 25 pediatric ALL patients. Whole blood (3 mL) with EDTA anticoagulant were used to measure absolute counts of CD4+, CD8+, and CD4+/CD8+ ratio. Peripheral blood mononuclear cells (PBMC) were examined for apoptosis. The principle of CD4+, CD8+ examination was bond between antigens on the surface of the leukocyte in the blood with fluorochrome labeled antibodies in the reagents, while the principle of apoptosis examination was FITC Annexin V will bonds with phosphatidylserine that moves out of the cell when the cell undergoes apoptosis, then intercalation with propidium iodide (PI). All examination were detected by flow cytometry BD FACSCalibur.Results Subjects were 25 newly-diagnosed, pediatric ALL patients (64% males and 36% females). Most subjects were 3 years of age (20%). Numbers of CD4+ and CD8+ cells, as well as CD4+/CD8+ were significantly decreased after chemotherapy. However, apoptosis was not significantly different before and after chemotherapy (P=0.689), There were significant negative correlations between apoptosis and CD4+ (P=0.002; rs=-0.584), and CD8+ (rs=-0.556; P=0.004), before chemotherapy. In addition, CD4+-delta and apoptosis-delta also had a significant positive correlation (rs=0.478; P=0.016). However, no correlation was found between the CD4+/CD8+ ratio and apoptosis, before or after chemotherapy.Conclusion There are significantly lower mean CD4+, CD8+, and CD4+/CD8+ ratio after chemotherapy than before. Also, there are significant correlations between CD4+-delta and apoptosis-delta, as well as between apoptosis and CD4+, CD8+, and CD4+/CD8+, before chemotherapy. CD4+, CD8+, and CD4+/CD8+ can be used to predict apoptosis before chemotherapy. In addition, CD4+-delta can be used to predict apoptosis-delta as a response to induction phase chemotherapy in pediatric ALL.

Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants Made Sukmawati; Rinawati Rohsiswatmo; Rulina Suradi; Pramita Gayatri
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background Feeding intolerance is a common condition that affects preterm infants. Erythromycin is a prokinetic agent used to treat feeding intolerance, but its efficacy remains inconclusive.Objective To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in preterm infants.Methods This prospective, randomized controlled trial in preterm infants was conducted at Sanglah Hospital, Denpasar, Bali, from June 2015 to January 2016. Eligible infants were randomized to receive either 12.5 mg/kg/dose oral erythromycin or a placebo, every 8 hours. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were body weight at full enteral feeding and length of hospital stay.Results Of 62 initial subjects, 3 infants dropped out of the study. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline characteristics of the two groups were similar, with mean of gestational ages of 31.4 (SD 1.7) weeks in the erythromycin group and 32.4 (SD 2.2) weeks in the placebo group. The median times to reach full enteral feeding did not significantly differ between the two groups, with 10 (SD 5.3) days in the erythromycin group vs. 8 (SD 6.5) days in the placebo group (P=0.345). Also, median body weights at full enteral feeding and lengths of hospital stay were not significantly different between the two groups.Conclusion Erythromycin of 12.5 mg/kg/dose every 8 hours as prophylactic treatment does not significantly enhance feeding tolerance in preterm infants. Median body weights at full enteral feeding and length of hospital stay are not significantly different between the erythromycin and placebo groups.

Behavioral parent training for ADHD children: a mixed methods study Hari Wahyu Nugroho; Mei Neni Sitaresmi; Indria Laksmi Gamayanti
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background Management of ADHD requires multimodal treatments. Parental participation is one of the most important factors for effective ADHD treatment.Objective To investigate the effectiveness of behavioral parent training combined with routine clinical care, in reducing ADHD symptoms in children.Methods Quantitative and qualitative methods were combined in this study. This study was conducted at 3 growth and developmental clinics in Central of Java, on June-July 2016. The quantitative aspect was assessed by comparing ADHD quotient scores at pre- and post-intervention, while the qualitative aspect by intensive parental interviews. Parents of children with ADHD were randomized with block random sampling. In the treatment group, parents received behavioral training for 7 weeks, along with weekly routine clinical care for their children. The control group received only routine clinical care of the children. Six parents in the treatment group were randomly selected for intensive interviews.Results A total of 67 parents with their children were involved. Both groupsâ€™ ADHD quotient scores improved post-intervention. The treatment group ADHD quotient score was reduced from 120.53 to 116.41 (effect size Cohenâ€™s d 0.68). The control group ADHD quotient score was reduced from 121.74 to 119.83 (effect size Cohenâ€™s d 0.23). Mean difference post-intervention in both group was not significant (p=.161). After behavioral parent training, communication between parents and children increased and parentsâ€™ capability in directing their childrenâ€™s daily activity increased.Conclusion Behavioral parent training can not enhacing effectiveness of routine clinical care to reduce ADHD symptoms in children.

The effect of cyanotic and acyanotic congenital heart disease on childrenâ€™s growth velocity Dewi Awaliyah Ulfah; Endang Dewi Lestari; Harsono Salimo; Sri Lilijanti Widjaya; Bagus Artiko
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Background Congenital heart disease (CHD) can lead to failure to thrive. Decreased energy intake, malabsorption, increased energy requirements, and decreased growth factors (growth hormone/insulin-like growth factor 1 axis) are related to malnutrition and growth retardation in children with CHD.Objective Tocompare the impact of cyanotic and acyanotic CHD on childrenâ€™s growth velocity (using the 2009 WHO growth velocity chart).Methods This study was conducted in patients less than 24 months of age with CHD in the Pediatric Cardiology Specialist Unit Dr. Moewardi Hospital, Surakarta, Central Java, from December 2016 to February 2017. Subjectsâ€™ weights were evaluated at the beginning of the study and two months later. Data were compared to the WHO Growth Velocity chart and analyzed by Chi-square test.Results Of 46 patients with CHD (23 cyanotic, 23 acyanotic), 10 patients (21.7%) were identified with failure to thrive, i.e., < 5th percentile. Significantly more children with acyanotic CHD were in the >5th percentile for growth velocity than were children with cyanotic CHD (OR 5.600; 95%CI 1.038 to 30.204; P=0.032). Acute upper respiratory tract infection was not significantly associated with growth velocity (OR 2.273; 95%CI 0.545 to 9.479; P=0.253).Conclusion Children with cyanotic CHD have 5.6 times higher risk of failure to thrive than children with acyanotic CHD.

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