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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 59 No 4 (2019): July 2019" : 9 Documents clear

Predictive factors of ketoacidosis in type 1 diabetes mellitus Listianingrum Listianingrum; Suryono Yudha Patria; Tunjung Wibowo
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Background Diabetic ketoacidosis (DKA) is an acute complication in type 1 diabetes mellitus (DM) and a significant cause of morbidity and mortality in developing countries. Diabetic ketoacidosis can be prevented by good management of the disease. Risk factors from previous studies that increase the DKA incidence were peripubertal age, female gender, low socio-economic status, low parental education status, DKA at the first diagnosis of type 1 DM, infection, psychological problems, poor metabolic control, and non-compliance with insulin treatment. Objective To determine whether sex, age, socio-economic status, parental education level, DKA at the initial diagnosis of type 1 DM, infection, psychological problems, poor metabolic control, and failing to take insulin as needed were predictive of DKA in type 1 DM patients. Methods We conducted a retrospective cohort study using medical records from type 1 DM patients aged 0-20 years, at the Department of Child Health, Dr. Sardjito Hospital, Yogyakarta, from January 2011 to May 2017. We assessed for the incidence and predictors of DKA. Logistic regression analysis was done to determine which factors increased DKA incidence. Results A total of 57 type 1 DM patients were recruited, with DKA incidence of 37 (65%). Five (8.8%) DKA patients died. Multivariate analysis revealed that infection (OR 5.23; 95%CI 1.47 to 19.68; P=0.014) and DKA at the first diagnosis of type 1 DM (OR 5.37; 95%CI 1.40 to 19.52; P=0.011) were significant risk factors for DKA. Conclusion Infection and DKA at the first diagnosis of type 1 DM are significant predictors of increased DKA incidence.

Acute hematogenous osteomyelitis in children: a case series Komang Agung Irianto; Adhinanda Gema; William Putera Sukmajaya
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Background Chronic osteomyelitis is still a major cause of morbidity and disability in children living in developing countries. Neglect of acute osteomyelitis and its progression to chronic osteomyelitis leads to significant morbidity. This report is the first series to describe such cases in Indonesia. Objective To describe 12 pediatric cases of chronic osteomyelitis in order to remind clinicians about the debilitating complications of musculoskeletal infection. Methods This report is a case series of 12 children with chronic osteomyelitis admitted to dr. Soetomo General Hospital, Surabaya, East Java, in 2011-2017. We acquired data from medical records. The patients' quality of life was measured using the Child Health Assessment Questionnaire Disability Index (C-HAQ-DI). Results The patients' mean age was eight years and they were predominantly male. The most common infection location was the femur (7/12). Microbial cultures were positive in 9/12 of cases, predominantly with Staphylococcus aureus. Erythrocyte sedimentation rate (ESR) was elevated in 11 patients. All patients were diagnosed late, with an average delay of presentation to Orthopedics of 10.5 months. Most of patients experienced mild to moderate disability after the disease, as assessed by the C-HAQ-DI. Conclusion Diagnosis of osteomyelitis in children is quite difficult, given the lack of specific diagnostic tests. Delayed diagnosis and inappropriate treatment may result in long-term morbidity and disability. Clinicians should have an increased awareness of the clinical features of osteomyelitis, including unusual presentations such as calcaneal osteomyelitis.

Implementing Yogyakarta Pediatric Cancer Registry for 16 years Sri Mulatsih; Adnina Hariningrum; Ignatius Purwanto; Rizki Oktasari
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Background A hospital-based cancer registry can be used as a guide to decision-making. Considering the limited cancer registry data in the population, the Yogyakarta Pediatric Cancer Registry (YPCR) is one of the pioneers of hospital-based pediatric cancer registries in Indonesia. The YPCR was started in 2000 in Dr. Sardjito Hospital. Objective To describe the characteristics of childhood cancer and the outcomes by analyzing overall survival (OS) and event-free survival (EFS) based on data from Yogyakarta Pediatric Cancer Registry. Methods Data were collected from the YPCR for the period of 2000 to 2016. Childhood cancers were classified into 12 groups based on the 3rd edition International Classification for Childhood Cancer (ICCC). Incidence, frequency, and distribution of cases were grouped by sex, age, and patientsâ€™ place of residence. Incidence was further analyzed using SPSS software. Kaplan-Meier test was used to analyze OS and EFS. Results Within the study period, 2,441 children aged 0-18 years were diagnosed with cancer. The highest incidence was found in the 1-5-year age group. The most common diagnoses found were leukemia, myeloproliferative disorders, and myelodysplastic disease (58%); lymphoma and reticuloendothelial neoplasm (8%); retinoblastoma (6%); soft tissue and other extra-osseous sarcomas (5%); as well as neuroblastoma and other peripheral nervous cell tumors (5%). The OSs of acute lymphoblastic leukemia (ALL), high risk ALL (HR-ALL), and standard risk (SR-ALL) were 31.8%, 18.5%, and 43.9%, respectively. The EFSs of ALL, HR-ALL, and SR-ALL were 23.9%, 14.7%, and 32.4%, respectively. For solid tumors, the OS was 13.7% and EFS was 6.4%. Conclusion The number of new cases of childhood cancer has increased in the last few years. The Yogyakarta Pediatric Cancer Registry (YPCR), which serves as a hospital-based pediatric cancer registry, has an important role to evaluate clinical and non-clinical aspects of childhood cancer.

Fluid overload and length of mechanical ventilation in pediatric sepsis Winda Paramitha; Rina Triasih; Desy Rusmawatiningtyas
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Background Children with sepsis often experience hemodynamic failure and would benefit from fluid resuscitation. On the other hand, critically ill children with sepsis have a higher risk of fluid accumulation due to increased capillary hydrostatic pressure and permeability. Therefore, fluid overload may result in higher morbidity and mortality during pediatric intensive care unit (PICU) hospitalization. Objective To evaluate the correlation between fluid overload and the length of mechanical ventilation in children with sepsis admitted to the PICU. Methods Our retrospective cohort study included children aged 1 month-18 years with sepsis who were admitted to the PICU between January 2013 and June 2018 and mechanically-ventilated. Secondary data was extracted from subjectsâ€™ medical records. Data analyses used were independent T-test and survival analysis. Results Of 444 children admitted to the PICU, 166 initially met the inclusion criteria. Of those, 17 children were excluded due to congenital heart disease. Subjects' median age was 19 months and median PELOD-2 score was 8. Eighteen children (12.1%) had positive fluid balance in the first 48 hours. Median mechanical ventilation duration was 5 days. Fluid overload was significantly correlated with length of mechanical ventilation (P=0.01) and PICU mortality (RR=2.06; 95%CI 2.56 to 166; P=0.001). Neither length of PICU stay nor extubation failure were significantly correlated to fluid overload. Conclusion Fluid overload was significantly correlated with length of mechanical ventilation and may be a predictor of mortality in children with sepsis in the PICU.

Growth of HIV-exposed infants from birth to 6 months in the prevention of mother-to-child transmission program Maria Priskila; Ketut Dewi Kumarawati; Ni Putu Siadi Purniti
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Background Human immunodeficiency virus (HIV) infection is a global health issue. Most cases of HIV infection in children are acquired through transmission from HIV-infected mothers. Maternal HIV infection affects infant growth. Objective To evaluate the first six months of growth in HIV-exposed infants born to mothers in the prevention of mother-to-child transmission (PMTCT) program. Methods This prospective cohort study was done in 40 HIV-exposed infants born in Sanglah General Hospital, Bali. Subjects' underwent weight and length measurements at birth and monthly for 6 months. Data analyses used were repeated ANOVA test with Bonferonni post-hoc analysis for normally distributed data and Friedman test with Wilcoxon post-hoc analysis for abnormally distributed data. Correlations between birth weight and length to weight and length at 6 months of age were analyzed with Spearman's test. Results Subjects' mean birth weight was 2,900 (SD 546) grams and median birth length was 48 (range 36-52) cm. Subjects' body weight and length increased monthly throughout the measurement period (P<0.001). There was a strong negative correlation between birth weight and infant weight gain at 6 months of age (r=-0.678), and a moderate negative correlation between birth length and infant length gain at 6 months of age (r=-0.564). Conclusion HIV-exposed infants born to mothers in the PMTCT program have a significant body weight and body length growth in the first 6 months of life, and followed general WHO weight and length curves for age.

Rituximab in steroid resistant nephrotic syndrome Agomoni Chaki; Farhana Rahman; Jahanara Arju; Abdullah- Al Mamun; Tahmina Jesmin; Sayed Saimul Huque; Afroza Begum; Habibur Rahman; Goam Muin Uddin; Ranjit Ranjan Roy
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Background Nephrotic syndrome (NS) is one of the most common glomerular disease in children, characterized by massive proteinuria, hypoalbuminemia, dyslipidemia and edema. Steroid-resistant nephrotic syndrome (SRNS) and steroid-dependent nephrotic syndrome (SDNS) present challenges in pharmaceutical management. Patient need several immunosuppressant for optimal control, each of which has significant side effect and difficult to get desired results. Rituximab (RTX) is a monoclonal antibody that targets B cells and has been shown to be effective for patients with SRNS and SDNS. Objective To see efficacy of RTX in pediatric patients with SRNS. Method This retrospective study took place in Pediatric Nephrology Department of Bangabandhu Sheikh Mujib Medical University from July 2017 to June 2019. Patients diagnosed with SRNS who were treated with RTX and followed up for 6 months were enrolled in this study. Primary endpoint was achievement of remission after rituximab infusion; secondary endpoint was relapse-free survival rate in 6 months period following rituximab infusion. Results Total 7 patients were recruited in this study. Among them 4 were male. Clinical and lab parameters of all patients before and after RTX were compared. Complete remission achieved in 4/7 patients, partial remission in 2/7 patients and no response in 1/7 patient. Mean number of relapse in 3 patients before RTX infusion was 3.67 (SD 0.57) and after 0.33 (SD 0.00) (P=0.038). Conclusion RTX is a biological agent that is effective and promising drug in children with SRNS. Rituximab is useful to induce and maintain remission.

Vascular endothelial growth factor (VEGF) expression in induction phase chemotherapy of acute lymphoblastic leukemia Dasril Daud; Merlyn Meta Astari; Nadirah Rasyid Ridha
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Background Leukemia is a hematolymphoid malignancy originating from bone marrow. The progression of hematolymphoid malignancies depends on new formation of vasculature, called angiogenesis. Angiogenesis is regulated by vascular endothelial growth factor (VEGF), which is secreted by paracrine and autocrine signaling mechanisms. Objective To evaluate VEGF expression in induction phase chemotherapy of acute lymphoblastic leukemia (ALL) patients. Methods This prospective, cohort study was conducted in ALL patients admitted to Dr. Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi, from October 2016 to October 2017. Subjectsâ€™ VEGF levels were measured at diagnosis and at the end of induction chemotherapy. Results VEGF levels were analyzed in 59 patients, 29 of whom were diagnosed with standard risk ALL and 30 patients with high risk ALL. VEGF levels were significantly decreased after induction phase chemotherapy in standard risk ALL and in high risk ALL subjects. There was no significant difference in VEGF levels before induction phase chemotherapy between the standard and high risk groups (P=0.405). There was also no significant difference in VEGF levels after induction phase chemotherapy between the two risk groups (P=0.094). Conclusion The VEGF level is significantly lower after ALL induction phase chemotherapy in both the standard risk and high risk ALL groups. However, there are no significant differences in VEGF levels between the standard and high risk groups before as well as after induction phase chemotherapy.

The CDC PNU-1 criteria for diagnosis of ventilator-associated pneumonia Hapsari Widya Ningtiar; Dwi Putri Lestari; Neurinda Permata Kusumastuti; Arina Setyaningtyas; Retno Asih Setyoningrum; Ira Dharmawati; Abdul Latief Azis
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Background Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in the pediatric intensive care unit (PICU), with mortality rates of up to 50%. Post-mortem pulmonary examination is considered to be the gold standard for diagnosis of VAP, but is impossible for routine application. The sensitivity and specificity of Clinical Pulmonary Infection Score (CPIS) are considered to be similar to the those of the gold standard, but the Centers for Disease Control and Prevention PNU-1 (CDC PNU-1) is simpler and not invasive, compared to the CPIS. Objective To evaluate the level of agreement between CDC PNU-1 and CPIS criteria in diagnosing VAP. Methods This cross-sectional study was conducted in the PICU at Dr. Soetomo Hospital, Surabaya from June to October 2018. Subjects were children aged 1 monthâ€“18 years who had been intubated for more than 48 hours. The VAP diagnoses were made by CDC PNU-1 and CPIS criteria. The level of agreement between the two methods was evaluated by Cohen's Kappa test using SPSS Statistics Base 21.0 software. Results hirty-six subjects were evaluated using CDC PNU-1 and CPIS criteria. Subjects' mean age was 3.5 (SD 4.7) years. Amongst 19 patients with VAP, 14 were diagnosed by CPIS criteria and 17 were diagnosed by CDC PNU-1 criteria. The level of agreement between the CDC PNU-1 and CPIS criteria was good (Kappa 0.61; 95%CI 0.31 to 0.83). The CDC PNU-1 had sensitivity 0.85, specificity 0.77, positive predictive value (PPV) 0.70, and negative predictive value (NPV) 0.89. Conclusion The CDC PNU-1 criteria has a good level of agreement with CPIS criteria in diagnosing VAP.

Levothyroxine use and thyroid gland volumes in children with autoimmune thyroiditis: a systematic review and meta-analysis Annang Giri Moelyo; Indah Suci Widyahening; Bambang Tridjaja
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Background Autoimmune thyroiditis may manifest as overt hypothyroidism, subclinical hypothyroidism, euthyroidism, or hyperthyroidism in children. Although there is no consensus on treating euthyroidism and autoimmune thyroiditis in children, some studies have demonstrated the efficacy of levothyroxine in reducing thyroid volume, improving thyroid function, and stabilizing the immunological process. Objective To determine the effect of levothyroxine on thyroid gland volume changes, thyroid function, and thyroid antibodies in euthyroid children with autoimmune thyroiditis. Methods We performed a literature search of electronic databases (the Cochrane Library, MEDLINE, EBSCO, ProQuest, clinicaltrials.gov, and other sources, as well as a non-electronic search (searching journals and conference proceedings by hand) to identify studies of euthyroid children with autoimmune thyroiditis published by August 2018. Only English-language articles were included in the search (electronic and non-electronic). Randomized controlled trials that compared levothyroxine with a control (placebo or no treatment) in euthyroid children with autoimmune thyroiditis were selected. The outcome measures were thyroid volume changes, thyroid function, and thyroid antibody levels in euthyroid children with autoimmune thyroiditis. Two authors independently extracted the data, assessed the risk of bias, and analyzed the pooled data from the included studies using a random effects model. The same authors performed a sensitivity analysis. Results We identified 57 studies. Of these, three studies, involving 97 subjects (51 subjects in an intervention group and 46 subjects in the control group) were selected for inclusion in a systematic review/meta-analysis. The meta-analysis revealed a significant difference in mean thyroid volume changes between the two groups (-1.10 SDs; 95%CI -1.56 to -0.64; P<0.0001; I2=6%). The mean difference in the thyroid-stimulating hormone (TSH) change of the two groups was -1.82 mU/L (95%CI -3.52 to -0.11; I2=87%; P=0.04). The standardized mean difference in free thyroxine (fT4) change of the two groups was 0.82 pmol/L (95%CI -1.14 to 2.78; I2=89%; P=0.41). Conclusion In euthyroid children with autoimmune thyroiditis, levothyroxine treatment reduces the thyroid volume better. The TSH level change in the intervention group is better than those in the control group. Levothyroxine treatment did not significantly improve free T4.

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