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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 6 (2019): November 2019" : 9 Documents clear

Laurence-Moon-Bardet-Biedl Syndrome: A case report Md. Mozammel Haque; Kamrunnaher Shultana; Tahmina Binte Matin; Md. Shohidul Islam Khan; Abdullah Al Baki
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Laurence-Moon-Bardet-Beidl syndrome is a rare ciliopathic and pleiotropic human autosomal recessive genetic disorder.1 In 1886, Laurence and Moon explained a case of a 7-year-old female with rod-cone dystrophy, hypogenitalism, mental retardation, obesity, and polydactyly. In 1920, Bardet described a 4-year-old female patient presented with rod-cone dystrophy, obesity, polydactyly (11 toes), and mental retardation.1 Two years after Bardet's report, Biedl highlighted the complete scenario of clinical signs which includes skull abnormalities, anal atresia, mental deficiency, and gastrointestinal conflicts.1 Since these discoveries, symptoms such as obesity, hypogonadism, retinal pigment defects, psychological hindrance, and polydactylismin in several conditions as combinations, frequently in children with normal parents (cousin marriages) has been termed as Laurence-Moon-Bardet-Biedl syndrome (LMBBS).1

Heated, humidified high-flow nasal cannula vs. nasal CPAP in infants with moderate respiratory distress Adhi Teguh Perma Iskandar; Risma Kerina Kaban; Mulyadi M Djer
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Background Respiratory distress is the most common cause of morbidity in premature babies in the delivery room. Nasal continuous positive airway pressure (nCPAP) is widely used as the preferred modality of treatment, although it may cause nasal trauma. Heated, humidified high-flow nasal (HHHFN) cannula is an alternative oxygen therapy, yet the safety and efficacy has not been widely studied. Objective To compare the safety and efficacy of HHHFN and nCPAP in premature babies with gestational age > 28 to < 35 weeks and moderate respiratory distress. Methods We conducted a randomized, non-inferiority, clinical trial using HHHFN vs. nCPAP as a treatment for moderate respiratory distress within 72 hours after they had been used. The efficacy endpoints were treatment failure, length of device use, length of Kangaroo Mother Care (KMC), and full enteral feeding time. Safety assessment included pain score, nasal trauma, and systemic complications. Results No differences were found in terms of incidence of endotracheal intubation within < 72 hours of HHHFN (20%) compared to nCPAP (18%) (P=0.799). However, there was a significant difference in moderate nasal trauma in nCPAP (14%) compared to HHHFN (0%)(P=0.006). There were no significant differences of blood gas analysis results, full enteral feeding time, length of KMC, length of device use, and rate of complications (bronchopulmonary dysplasia/BPD, intraventricular hemorrhage/IVH, patent ductus arteriosus/PDA, necrotizing enterocolitis/NEC and late onset neonatal sepsis/LONS) between the nCPAP and HHHFN groups. Conclusion The HHHFN is not inferior to nCPAP in terms of the safety and efficacy as primary non-invasive therapy in premature babies of gestational age > 28 to < 35 weeks with moderate respiratory distress . Compared to nCPAP, HHHFN induced lower nasal trauma.

Triiodothyronin (T3) as a parameter of mortality in sepsis patients in the PICU Sri Wahyuni Djoko; Nyoman Budi Hartawan; Bagus Ngurah Putu Arhana; Eka Gunawijaya; Anak Agung Ngurah Ketut Putra Widnyana; Dyah Kanya Wati
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Background Thyroid hormone stimulates the regulation of Î²-adrenergic receptors in order to increase the inotropic effect of the heart myocardium. Euthyroid sick syndrome is a disorder of non-metabolic thyroid function, which is characterized by a decrease in triiodothyronine (T3) levels in patients with non-thyroid systemic disease, such as sepsis. Low serum T3 hormone level is a potentially high-risk factor for mortality from sepsis. Objective To assess for a relationship between decreased serum T3 levels and mortality in pediatric sepsis patients admitted in the PICU. Methods This study used a nested case-control design. The subjects were children aged 1 month-18 years who were diagnosed with sepsis in the pediatric intensive care unit at Sanglah Hospital, Denpasar, Bali, from September 2017 to January 2019. Results A total of 90 children were included, of whom 44 died and 46 survived. Median age was 10.5 (IQR 44) months in subjects who died and 9 (IQR 50) months in those who survived. The majority of subjects in both groups had well-nourished nutritional status. Bivariate analysis revealed that significantly more subjects who died had low serum T3 (â‰¤1 ng/dL), PELOD-2 score â‰¥5, than subjects who survived. Multivariate analysis revealed that serum T3 Â£1 ng/dL (OR 55.1; 95%CI 9 to 334.8; P<0.001) and PELOD-2 score Â³5 (OR 6.5; 95%CI 1.6 to 26.7; P=0.01) were significant risk factors for sepsis mortality. Conclusion Low serum T3 level and high PELOD-2 score are risk factors for death in sepsis.

Lung ultrasound in diagnosing neonatal respiratory distress syndrome: a meta-analysis Hanum Ferdian; Dian Ibnu Wahid; Samad Samad; Anggun Esti Wardani; Guntur Surya Alam; Annang Giri Moelyo
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Background Neonatal respiratory distress syndrome (NRDS) is commonly diagnosed by clinical sign and symptoms, blood gas analysis, and chest x-ray. In the past, lung ultrasound (LUS) was not standard for NRDS examination. Many studies show that ultrasound diagnostic tool for NRDS is accurate, reliable, low cost, easy to use, and safe because due to no ionizing radiation. Objective To determine the sensitivity and specificity of LUS in diagnosing NRDS. Methods This meta-analysis study was conducted LUS as a diagnostic tool for NRDS. Inclusion criteria were all studies from PubMed, Embase, and The Cochrane Library, without any limitation on published journals, as well as using keywords or search terms of ultrasound, neonatal, and respiratory distress syndrome. Statistical analysis was undertaken using MedCalcÂ® version 18.2 software. Results Seven studies with a total of 580 patients met the inclusion criteria. Proportional meta-analysis obtained random effects models, with total sensitivity of LUS was 97.2% (95% CI for I2 74.24 to 92.88; P<0.0001) and specificity of LUS was 94.8% (95% CI for I2 88.60 to 98.03; P<0.00001). Conclusion Lung ultrasound should be considered as a diagnostic tool for NRDS because it is high in sensitivity and specificity, inexpensive, safe, as well as limited radiation exposure.

Comparison of nutritional status among children with biliary atresia according to age at the time of Kasai procedure Febricilla Citra Pratiwi; Titis Widowati; Endy Paryanto Prawirohartono
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Background Recent studies revealed better outcomes among children with biliary atresia (BA) who underwent Kasai procedure at 60 to 90 days of age. Delayed Kasai procedure has a high risk of complications, including nutritional deficits which lead to malnutrition. Objective To determine the nutritional status of children with BA according to age at the time of Kasai procedure. Methods Using medical records, we conducted a retrospective study in children with BA based on magnetic resonance cholangiopancreatography (MRCP) or intraoperative cholangiography, who were admitted between 2015 to 2017 and underwent Kasai surgery at Dr. Sardjito General Hospital, Yogyakarta. Nutritional status was evaluated on the day before Kasai procedure, and classified into 4 groups of subjects based on age at the time the children underwent Kasai procedure (<60 days, 60-90 days, >90-120 days, and >120 days). Normal distribution data was analyzed with Saphiro-Wilk test and mean T-test was used to compare mean age at the time of Kasai procedure between groups of well-nourished and malnourished subjects. Results A total of 39 children with BA underwent Kasai procedure. Of 3 children who underwent Kasai procedure at <60 days of age, 2 were well-nourished and 1 was malnourished. Of the 12 children who underwent Kasai procedure at 60-90 days of age, 6 were well-nourished and 6 were malnourished. Of the 7 children who underwent Kasai procedure at >90-120 days of age, 4 were well-nourished and 3 were malnourished. Of 17 children who underwent Kasai procedure at >120 days of age, 5 were well-nourished and 12 were malnourished. The means of age at the time of Kasai procedure were higher in malnourished subject than well-nourished. Conclusion The highest prevalence of malnourishment is seen in children with biliary atresia who underwent Kasai procedure at >120 days of age.

Diagnostic value of mean platelet volume in neonatal sepsis Kristopher May Pamudji; I Made Kardana
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Background Neonatal sepsis is a severe disease with potentially serious impacts if not treated early. However, the symptoms and clinical signs are not specific. Several studies have been conducted to find early infection markers for detection of neonatal sepsis, but without satisfactory results. Mean platelet volume (MPV) is a new marker of infection that has good potential for diagnosing neonatal sepsis. Objective To assess the diagnostic value of MPV in early detection of neonatal sepsis. Methods This retrospective study with diagnostic testing was done with data collected from medical records of neonates with neonatal sepsis who were admitted to the Neonatology Department in Sanglah Hospital, Denpasar from December 2018 to March 2019. Mean platelet volume cut-off point was determined using a receiver-operating characteristic (ROC) curve. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MPV in neonatal sepsis were determined using a 2x2 table. Results Of 82 subjects, 55 subjects were male (67%). Positive blood culture results were found in 25 subjects (30%). Mean platelet volume with a cut-off point of 7.44 fL had 80% sensitivity, 84.2% specificity, 69% PPV, and 90.6% NPV. Conclusion Mean platelet volume with a cut-off point of 7.44 fL can be used to diagnose neonatal sepsis with a sensitivity of 80% and specificity of 84.2%.

Severe sepsis criteria, PELOD-2, and pSOFA as predictors of mortality in critically ill children with sepsis Anindita Wulandari; Pudjiastuti Pudjiastuti; Sri Martuti
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Background Sepsis is one of the main causes of death in infants and children. Currently, it is defined as a life-threatening organ dysfunction, caused by an inflammatory response of infection. Several organ dysfunction assessment methods are available, but they are not uniformly used. Objective To compare the accuracy of three mortality predictor tools: severe sepsis criteria, pediatric logistic organ dysfunction (PELOD)-2, and pediatric sequential organ failure assessment (pSOFA), in critically ill children with sepsis. Methods This prospective cohort study was conducted in the pediatric intensive care unit (PICU) and pediatric high care unit (HCU) of dr. Moewardi Hospital, Surakarta, Central of Java. All patients who met the systemic inflammatory response syndrome (SIRS) criteria were included in our study. The exclusion criteria were congenital anomalies of heart or kidney, malignancy, or hematological abnormalities. The data were taken from laboratory and physical examinations by the physicians on duty. The outcome assessed was mortality. Results Of 30 subjects, the mean age was 22.22 (SD 29.36) months; the most common infection source was the respiratory tract, followed by gastrointestinal tract and central nervous system. Most subjects were treated in the PICU and had a mean length of stay of 8.70 (SD 11.91) days. Severe sepsis and PELOD-2 were not significant predictors of death. However, pSOFA score was a statistically significant predictor of mortality, with odds ratio 10.11 (95%CI 1.054 to 97.002; P=0.039). Conclusion Pediatric SOFA (pSOFA) is a better predictor of mortality compared to PELOD-2 and SIRS-severe sepsis. A pSOFA score â‰¥ 2 increases the risk of mortality by 10.11-fold.

Current management of children with acute otitis media: a feasibility survey for a pragmatic study Respati Wulansari Ranakusuma; Amanda R. McCullough; Elaine M. Beller; Christopher B. Del Mar; Eka Dian Safitri; Yupitri Pitoyo; Widyaningsih Widyaningsih
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Background Acute otitis media (AOM) is a common self-limiting infection where antibiotics confer limited benefit. Other treatments, such as anti-inflammatory agents have been proposed as an alternative to antibiotics, but no high-quality clinical trials have tested this. Objective To identify current AOM management practices among Indonesian clinicians. We also required this information for our proposed corticosteroids clinical trial for AOM. Methods This cross-sectional study surveyed a convenience sample of general practitioners (GPs), pediatricians, and Ear-Nose-Throat (ENT) specialists in Jakarta, Depok, and Bekasi. We addressed their current AOM management practices and willingness to participate in a future trial on corticosteroids. Results We distributed 2,694 questionnaires through conferences, primary care/hospital visits, and by mail-list group. Of 492 questionnaires received (response rate 18%), 352 were from eligible clinicians. Most clinicians diagnosed AOM by using an otoscope (64-91%). Tympanometry was used by a quarter of ENT specialists. Amoxicillin-clavulanate was the most common antibiotic for AOM, prescribed by pediatricians and ENT specialists, whilst most GPs prescribed amoxicillin. Clinical scenarios indicated most ENT specialists (88%) would prescribe antibiotics and most pediatricians (54%) would choose expectant observation by withholding antibiotics for mild AOM. Almost half of clinicians would consider using corticosteroids in a trial. Conclusion Most clinicians would prescribe antibiotics for mild AOM. However, slightly over half of pediatricians would solely choose expectant observation. Adequate numbers of potential participating clinicians, who would consider using corticosteroids, make our proposed corticosteroids trial for AOM feasible. We found gaps between clinical practice and evidence requiring further investigation to improve AOM management in Indonesia.

Chronic kidney disease and emotional-behavioral disorders in adolescents Benny Sugiarto; Meita Dhamayanti; Dedi Rachmadi Sambas
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Background Chronic kidney disease (CKD) is characterized by progressive renal injury with inevitable functional deterioration. This functional loss is usually slow, progressive, and irreversible. Chronic kidney disease profoundly influences the daily routines of pediatric patients and their families, requiring significant psychosocial adaptation by both patients and families. Objective To assess for potential associations between CKD and emotional/behavioral disorders in adolescents. Methods This cross-sectional study was done at the Pediatric Nephrology Outpatient Department, Hasan Sadikin Hospital, Bandung, West Java. The consecutive sampling included all patients who fulfilled the following criteria: (1) aged 10-18 years, (2) diagnosed with CKD at least 3 months prior to the study, and (3) whose parents provided informed consent. The Strengths and Difficulties Questionnaire (SDQ) was used to assess emotional/behavioral disorders. Socio-demographic and clinical data were collected from medical records and interviews with parents. Chi-square and Mann-Whitney tests were used in the statistical analyses. Results A total of 75 subjects with CKD participated in the study. The majority of the subjects were female (53%) and <14 years old (55%). Emotional/behavioral disorders were found in 24 subjects (32%). There were no significant correlations between age, gender, paternal and maternal education level, duration of illness, or treatment with emotional/behavioral problems. However, later stage of CKD was significantly associated with prosocial problems, based on the SDQ assessment. Conclusion Late stage CKD is significantly associated with prosocial problems of the SDQ scales.

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