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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 4 (2017): July 2017" : 9 Documents clear

Procalcitonin vs. the combination of micro-erythrocyte sedimentation rate and C-reactive protein for diagnosing neonatal bacterial sepsis Afifa Ramadanti; Renya Hiasinta; Herman Bermawi; Erial Bahar
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Given the high rates of mortality and morbidity in neonatal sepsis, rapid, easy-to-use, and inexpensive biomarkers with high sensitivity and specificity are needed to diagnose neonatal sepsis. Procalcitonin is often used as a predictor in identifying neonatal sepsis, but C-reactive protein (CRP) and micro-erythrocte sedimentation rate (m-ESR) may also be valid biomarkers of neonatal sepsis.Objective To compare the accuracy of procalcitonin to the combination of CRP and m-ESR, as well as to find cut-off points for the three tests, in diagnosing bacterial neonatal sepsis.Methods Subjects were neonates hospitalized from July to October 2016 in Mohammad Hoesin Hospital, Palembang with sepsis at clinical presentation and healthy neonates with sepsis risk factors. All subjects underwent complete blood counts, CRP, m-ESR, blood cultures, and Â procalcitonin examinations.Results Ninety-four infants were included, of whom 26 had proven sepsis. The combined values of m-ESR and CRP had 85% sensitivity, 59% specificity, and 66% accuracy. A procalcitonin (PCT) cut-off point of 9.7ng/mL showed 100% sensitivity, 96% specificity, and 97% accuracy level, which were significantly higher than the combined values of m-ESR and CRP.Conclusion The combined values of m-ESR (13 mm/hour) - CRP (17 mg/dL) and procalcitonin alone (2ng/mL) are both valid for the diagnosis of bacterial neonatal sepsis, but the accuracy of procalcitonin at 9.7ng/mL is significantly greater.Â

Intravenous paracetamol and patent ductus arteriosus closure in preterm infants Rizky Adriansyah; Nikmah S. Idris; Mulyadi M. Djer; Sukman T. Putra; Rinawati Rohsiswatmo
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Indomethacin and ibuprofen are the drugs of choice for closure of patent ductus arteriosus (PDA) in preterm infants. However, intravenous preparations are of limited availability in Indonesia. Circumstantial evidence has shown that intravenous paracetamol may be an alternative therapy for PDA closure in premature infants.Objective To evaluate the effect of intravenous paracetamol on PDA closure in preterm infants.Methods A before-and-after study was conducted between May and August 2014 in Cipto Mangunkusumo General Hospital, Jakarta in preterm infants with hemodynamically significant PDAs, as established by echocardiography using the following criteria: duct diameter >1.4 mm/kg, left atrium to aorta ratio >1.4, and mean velocity in the left pulmonary artery >0.42 m/s or mean diastolic velocity in the left pulmonary artery >0.2 m/s. Subjects, aged 2 and 7 days, received intravenous paracetamol (15 mg/kg every six hours) for 3 days. Paired T-test was used to compare pre-intervention PDA diameter to those assessed at 24 hours after the intervention and at 14 days of life.Results Twenty-nine subjects had a mean gestational age of 30.8 weeks and mean birth weight of 1,347 grams. Nineteen (65.5%) patients had closed PDAs at the day 14 evaluation, 1 experienced PDA reopening, and 9 had failed PDA closure. No liver toxicity was identified. Mean duct diameters before, 24 hours after the intervention, and at 14 days of life were 3.0, 0.9, and 0.6 mm, respectively (P<0.0001).Conclusion Intravenous paracetamol seems to be reasonably effective for PDA closure in preterm infants.

Prevalence of hepatitis and its correlation with serum ferritin and aminotransferase levels among thalassemia major patients in Indonesia Pustika Amalia Wahidiyat; Felix Liauw; Nitish Basant Adnani; Siti Ayu Putriasih
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Thalassemia major patients who undergo routine transfusion have an increased risk of acquiring transfusion-transmitted infections (TTI), including hepatitis B and C. These diseases have serious implications and may affect the serum ferritin and aminotransferase levels of thalassemia major patients.Objectives To identify the prevalence of hepatitis B and/or C infections among thalassemia major patients and to evaluate its correlation with serum ferritin and aminotransferase levels.Methods This was across-sectional study conducted at the Thalassemia Center of Dr. Cipto Mangunkusumo Hospital in Jakarta, Indonesia. The subjects were screened for hepatitis B and C infections, and their serum ferritin and aminotransferase levels were also measured.Results In total, 621 subjects were included in the study, among which 5 subjects tested positive for hepatitis B surface antigen (HBsAg) (0.8%), 111 subjects tested positive for anti-HCV (17.8%), and 5 subjects tested positive for both HBsAg and anti-HCV (0.8%). The subjects who tested positive for hepatitis B, hepatitis C, or both showed significantly higher values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum ferritin compared to their negative counterparts. Moreover, serum ferritin showed a positive, moderate correlation with both AST and ALT.Conclusion This study shows a significant association between hepatitis and serum ferritin as well as aminotransferase levels. Early detection and early management of hepatitis B and C infections is warranted to minimize the occurrence of liver damage in thalassemia major patients.Â

Irrational use of antibiotics and clinical outcomes in children with pneumonia Yusuf Yusuf; Indah Kartika Murni; Amalia Setyati
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Pneumonia is a major cause of morbidity and mortality in children under five. Antibiotic treatment must be started immediately in children with pneumonia. The irrational use of antibiotics may increase morbidity and mortality in children with pneumonia.Obejctive To determine the prevalence of the irrational use of antibiotics and clinical outcomes in children with pneumonia.Methods We conducted a cross-sectional study in children with pneumonia who were admitted to the Pediatric Ward or PICU at Dr. Sardjito Hospital, Yogyakarta, from December 2010 to February 2013. Data were obtained from subjectsâ€™ medical records. Children with malnutrition, congenital heart defects, sepsis, shock, central nervous system disorders, syndromes, or other concomitant infections were excluded.Results Of 46 children who fulfilled the inclusion criteria, 13 (28.3%) used antibiotics irrationally and 7 (15.2%) died. Most subjects were aged less than 1 year (25 subjects, 54.3%) and 1 - < 5 years (18 subjects, 39.1%). The female to male ratio was 1:1. Most cases were referred from other hospitals (23 subjects, 50%). Twenty-eight (60.9%) subjects stayed in hospital > 7 days. Ampicillin was the most common first-line, empirical antibiotic used (32 subjects, 69.6%). Blood cultures were obtained in 20 (43.5%) patients, yielding no growth in 16 subjects, coagulase-negative staphylococci (CONS) in 3 subjects, and Pseudomonas aeruginosa in 1 subject. The irrational use of antibiotics was significantly associated with mortality in a univariate analysis [PR 6.35; (95%CI 1.40 to 28.69); P=0.006]. Conclusion The irrational use of antibiotics is common among children with pneumonia and is significantly associated with mortality.

Waist circumference and insulin levels in obese children Vina Paramitha Cempaka; I Gusti Lanang Sidiartha
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Childhood obesity is one of the most serious public health challenges of the 21st century. Its prevalence has increased at an alarming rate. Overweight and obese children are prone to obesity in adulthood and to developing non-communicable diseases (NCDs) like diabetes and cardiovascular diseases at a younger age. Increased waist circumference has been shown to contribute to the risk of metabolic syndrome in obese adults.Objective To assess for a correlation between waist circumference and insulin level in obese children.Methods In this cross-sectional study, obese children aged 6-10 years were included by consecutive sampling. We excluded children with infectious disease, malignancy, dyslipidemia, type 2 diabetes mellitus, or those who had not fasted before the blood draw. Subjects underwent waist circumference and fasting blood glucose measurements. Serum insulin levels were examined by enzyme-labeled chemiluminescent immunometric assay,after subjects had fasted for 10-14 hours. Data were analyzed by correlation analysis.Results Subjects had a mean waist circumference of 80.2 cm (SD 7.2) and mean insulin level of 10.70 (SD 7.5). ÂµIU/mL Pearsonâ€™s correlation test revealed a significant, moderately positive correlation between waist circumference and elevated insulin level (r=0.45; P=0.006).Conclusion Waist circumference and insulin level have a significant, moderate, positive correlation in obese children. As such, waist circumference may be a simple method for early detection of hyperinsulinemia, as a risk factor for metabolic syndrome.

Focused group discussion with health care staff improves breastfeeding rates in hospitalized infants Agnes Yunie Purwita Sari; Rosalina Dewi Roeslani; Rinawati Rohsiswatmo
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Improving breastfeeding in sick infants is essential. During the neonatal care, health care staff play an important role in promoting breastfeeding. Therefore, it is important to study in depth how healthcare staff can improve breastfeeding practice in sick neonates.Objective To compare breastfeeding rates in sick infants before and after a focused group discussion (FGD) of health care staff on how to improve breastfeeding.Methods This study was an operational study using FGD and in-depth interviews as an intervention. A fish bone diagram was used to assess problems that may prevent mothers from breastfeeding their sick infants. Breastfeeding achievement was compared before and after the FGD.Results Of 257 sick infants, 177 subjects were in the before FGD group and 80 subjects were in the after FGD group. Significantly more after FGD subjects were breastfed during hospitalization than before FGD subjects [97.5% vs. 82.9%, respectively; (x2 =9.43; P=0.002)]. Breastfeeding initiation within 0-4 hours of birth was also significantly higher in the after FGD group [10 (12.5%) vs. 6 (3.5%), respectively; (x2 = 52.5; P<0.001)]. The solutions for breastfeeding problems were: 1) support of hospital management, 2) support of healthcare workers for breastfeeding mothers, 3) support of husbands and families for breastfeeding mothers, 4) financial support, 5) other factors such as level of care and consistent FGD events, and 6) a prospective cohort study.Conclusion The FGD with health care staff significantly increases breastfeeding achievement during infant hospitalization, and accelerated breastfeeding initiation. A fish bone diagram is used to effectively assess the problems with breastfeeding programs for sick babies.

Diagnostic value of newborn foot length to predict gestational age Mutia Farah Fawziah; Bambang Soebagyo; Dwi Hidayah
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Â Identification of gestational age, especially within 48 hours of birth, is crucial for newborns, as the earlier preterm status is detected, the earlier the child can receive optimal management. Newborn foot length is an anthropometric measurement which is easy to perform, inexpensive, and potentially efficient for predicting gestational age.Objective Â To analyze the diagnostic value of newborn foot length in predicting gestational age.Methods Â This diagnostic study was performed between October 2016 and February 2017 in the High Care Unit of Neonates at Dr. Moewardi General Hospital, Surakarta. A total of 152 newborns were consecutively selected and underwent right foot length measurements before 96 hours of age. The correlation between newborn foot length to classify as full term and gestational age was analyzed with Spearmanâ€™s correlation test because of non-normal data distribution. The cut-off point of newborn foot length was calculated by receiver operating characteristic (ROC) curve and diagnostic values of newborn foot length were analyzed by 2 x 2 table with SPSS 21.0 software.Results There were no significant differences between male and female newborns in terms of gestational age, birth weight, choronological age, and newborn foot length (P>0.05). Newborn foot length and gestational age had a significant correlation (r=0.53; P=0.000). The optimal cut-off newborn foot length to predict full term status was 7.1 cm. Newborn foot length below 7.1 cm had sensitivity 75%, specificity 98%, positive predictive value 94.3%, negative predictive value 90.6%, positive likelihood ratio 40.5, negative likelihood ratio 0.25, and post-test probability 94.29%, to predict preterm status in newborns.Conclusion Â Newborn foot length can be used to predict gestational age, especially for the purpose of differentiating between preterm and full term newborns.

Effectiveness of ferric sodium edentate supplementation in children with lead poisoning Praevilia Salendu; Nurhayati Masloman; Sarah M. Warouw
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Lead is a harmful toxin that affects human health worldwide, especially in children. Lead poisoning remains a global problem both in developed and developing countries. The Centers for Disease Control and Prevention (CDC) recommends nutritional intervention with iron supplementation to efficiently control high lead levels. Iron supplementation in the form of sodium ferric ethylene-diaminetera-acetic acid/ ferric sodium edentate (NaFeEDTA) is highly bioavailable.Objective To determine the effectiveness of ferric sodium edentate (NaFeEDTA) on lead levels in children woaj ;ead [pospmomg.Methods Â This interventional, analytical study, had a one group pretest-posttest design, and was done on children in four elementary schools in the Talawaan District, North Minahasa Regency from August to November 2014. Inclusion criteria were elementary students aged 6-9 years with lead poisoning (lead levels â‰¥ 10 Î¼g/dL) and good nutritional status. Subjects wereÂ given NaFeEDTA 115.4 mg (15 mg elemental iron) at a dosage of 3 mg/kgBW/day elemental iron given between meal times. Iron supplementation was given daily per oral route for 12 weeks.Â Descriptive analysis was used to analyze the characteristics of the study sample. Pre- and post-test analyses were done with paired T-tests. Significance level was P <0.05.Results In this study, 39 children met the inclusion criteria and consisted of 19 boys and 20 girls. Their mean age was 8.43 (SD 0.44) years. Pre-test and post-test blood lead levels was 36.18 Î¼g/dL and 5.22 Î¼g/dL, respectively.There was a significant reduction in mean blood lead levels after administration of NaFeEDTA (P <0.0001).Conclusion In children with lead poisoning, blood lead levels are significantly reduced after 12 weeks of NaFeEDTA supplementation.

Quality of life among obese and non-obese early adolescents Putu Vivi Paryati; I. G. Lanang Sidiartha; I. G. Ayu Trisna Windiani; I. G. A. N. Sugitha Adnyana
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Background Obesity in adolescents adversely affects both their psychological as well as their physical health.Objective To compare the quality of life between obese and non-obese early adolescents, using the PedsQL inventory.Methods A cross-sectional study was carried out on early adolescents aged 10-12 years among several elementary schools in Denpasar, Bali. Body mass index (BMI) percentiles for age and sex were categorized as obese (BMI â‰¥95th percentile) and non-obese (BMI <95th percentile). Data on quality of life were collected using PedsQL Generic Core Scales version 4.0 inventory, filled by the children and their parents separately.Results Total PedsQL score in obese and non-obese group were significantly difference in both reports [child report: mean difference of 9.59 (95%CI 7.14 to 12.05; P<0.05) and parent-proxy report: mean difference at 8.95(95%CI6.64 to 11.26; P<0.05)]. After classifying subjects into impaired and not impaired quality of life based on a total score cut-off <78 as well as other cut-off points for each domain, the individual domains of physical, social, and school function were also significantly associated with obesity (child report: P=0.02, P< 0.001, P=0.018, respectively, and parent-proxy report:P=0.007, P<0.001, P<0.001, respectively). However, emotional function was not significantly associated with obesity (P>0.05). After adjusting for age, gender, and parental education, obesity was significantly associated with PedsQL scores in the child report (OR 7.25; 95%CI 2.94 to 17.89; P<0.05) and the parent-proxy report (OR 10.87; 95%CI 3.83 to 30.84; P<0.05).Conclusion Obese early adolescents reported significantly poorer quality of life with regards to the physical, social, school function domains and total quality of life than those who were classified into non-obese.

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