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Paediatrica Indonesiana
ISSN : 00309311     EISSN : 2338476X     DOI : -
Core Subject : Health,
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 60 No 2 (2020): March 2020" : 9 Documents clear
TUBERCULOUS PERICARDITIS IN ADOLESCENTS: A CASE SERIES Paramitha, Winda; Murni, Indah Kartika; Arguni, Eggi; Setyowireni, Dwikisworo
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

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Abstract

Tuberculosis (TB) is one of the major causes of childhood mortality, especially in endemic areas. In 2013, the World Health Organization (WHO) estimated 550,000 new cases and 80,000 deaths due to TB among children. Around 70-80% of the cases were pulmonary TB, while the rest were extra-pulmonary TB.1 Tuberculous pericarditis accounts for only 8% of all TB cases, however, tuberculosis is the main cause of pericarditis in high-TB-burden countries, including Indonesia.2 The mortality rate reached 17-40% and is affected by treatment adequacy.3 Without adequate therapy, the mean life expectancy is 3.7 months, with only 20% surviving to the sixth month.4 A 2004 study reported that successful treatment of TB in children depends on several factors, such as treatment compliance, timing and accuracy of diagnosis, concurrent human immunodeficency virus (HIV) infection and its clinical stage of disease, malnutrition, and drug resistance.5 Adolescents and young adults are at the highest risks of having TB.6 We report here on three cases of tuberculous pericarditis in adolescents and their outcomes following pericardiocentesis and medication.
ETIOLOGIES OF NEONATAL CHOLESTASIS AT A TERTIARY HOSPITAL IN BANGLADESH Benzamin, Md.; Khadga, Mukesh; Begum, Fahmida; Rukunuzzaman, Md.; Mazumder, Md. Wahiduzzaman; Lamia, Khan Nahid; Islam, Md. Saidul; Rahman, AZM Raihanur; Karim, ASM Bazlul
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Neonatal cholestasis is an important etiology of chronic liver disease in young children. It has a varied etiology. There is considerable delay in presentation and diagnosis of neonatal cholestasis in Bangladesh. Lack of awareness and knowledge among the pediatricians regarding etiological diagnosis and outcome of neonatal cholestasis is the reasons for poor outcome in major portion of cases in Bangladesh. Objective To evaluate the etiological spectrum of neonatal cholestasis. Methods This retrospective study was conducted at the Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. We reviewed medical records of children who were diagnosed with neonatal cholestasis. Complete diagnostic profiles of every cases with age of presentation, male-female ratio and final diagnosis were analyzed. Results A total of 114 children with neonatal cholestasis were evaluated. Subjects? male-female ratio was 1.92: 1.0, and mean age at hospitalization was 92.7 (SD 39.5) days. Biliary atresia was the most common etiology (47.4%), followed by idiopathic neonatal hepatitis/INH (21.9%). Other identified etiologies were, toxoplasmosis, others (syphilis, varicella-zoster, parvovirus b19), rubella, cytomegalovirus (CMV), and herpes/TORCH infection (8.61%), progressive familial intrahepatic cholestasis/PFIC (4.4%), galactosemia (4.4%), choledochal cyst (3.5%),  sepsis (1.8%), urinary tract infection/UTI (1.8%), hypothyroidism (1.8%), lipid storage disease/Niemann-Pick disease (0.9%), non-syndromic paucity of interlobular bile ducts (2.67%), and Caroli?s disease (0.9%). Conclusion  In Bangladesh, neonatal cholestasis cases are most often due to obstructive causes, particularly biliary atresia. Idiopathic (INH), infectious (primarily TORCH), metabolic, and endocrine causes followed in terms of frequency.
SERUM ZINC LEVEL AND PROGNOSIS OF NEONATAL SEPSIS Adnan, Chaliza; Artana, I Wayan Dharma; Suarta, Ketut; Sidiartha, I Gusti Lanang; Gustawan, I Wayan; Yantie, Ni Putu Veny Kartika
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background The prognosis of neonatal sepsis can be influenced by various risk factors, one of which is a deficiency of zinc micronutrient substances. Objective To assess for a potential association between serum zinc level and prognosis of infants with early-onset neonatal sepsis (EONS). Methods This prospective cohort study was done in neonates with clinical EONS from September 2017 until December 2018. Serum zinc level was measured on the first day of diagnosis and prognosis was assessed on the fourth day. The association between serum zinc levels and prognosis of EONS was analyzed by Chi-square test and logistic regression with adjustment for confounding variables. Results A total of 70 subjects were divided into two groups based on their serum zinc levels. A cut-off point of 75 ug/dL was used based on area under the curve (sensitivity 91.2% and specificity 93.7%), with accuracy 97.8% (95%CI 0.943 to 1.000; P=0.0001). Subjects with lowzinc level had a 16.8 times greater risk compared to subjects with high serum zinc (RR=16.81; 95% CI 4.35 to 65.02; P <0.0001). Multivariate analysis revealed that subjects with low serum zinc levels had 203.7 times greater risk of worsening than subjects who had a higher serum zinc level (RR 203.72; 95% CI 26.79 to 1549.17; P <0.0001). Covariates such as male sex, low gestational age (<37 weeks), low birth weight (<2,500 grams), asphyxia, Caesarean section delivery, and the presence of comorbidities did not have significant associations with outcomes of EONS (P >0.05). Conclusion Serum zinc level is associated with prognosis of early onset neonatal sepsis, with a cut-off of 75 ?g/dL. The high level of serum zinc associates with a better prognosis.
FULL OUTLINE OF UNRESPONSIVENESS SCORE AS A PREDICTOR OF OUTCOMES IN CRITICALLY ILL PEDIATRIC PATIENTS Assa, Novita Purnamasari; Wati, Dyah Kanya; Subanada, Ida Bagus; Soetjiningsih, Soetjiningsih; Kardana, Made; Sukmawati, Made
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Mortality predictions are very important for improving service quality in the pediatric intensive care unit (PICU). The full outline of unresponsiveness (FOUR) is a new coma scale and is considered capable of predicting mortality and outcome. Objective To assess the ability of FOUR scores to predict outcomes of critically ill patients in the PICU. Methods This prospective cohort study included children aged 1 months - 18 years who were admitted to the PICU. Subjects were assessed by FOUR, grouped into score < 9 or score >9, and followed until outcomes were obtained. Bivariate analysis to assess the risk of death was made by cross-tabulation and the strength of the association in the form of risk ratio by Chi-square test. Multivariate analysis was done by logistic regression test. Results Of 94 subjects, 47 had FOUR scores ?9 and 47 subjects had FOUR >9. Bivariate analysis revealed that PICU patients with FOUR score ?9 had a higher risk of death than those with FOUR score >9 (RR 12.5; 95%CI 3.1 to 49.8; P<0.0001). Multivariate analysis revealed that FOUR score, length of stay ?7 days, and non-surgical disease significantly increased the risk of mortality in PICU patients (by 42.8 times, 8.9 times, and 5.9 times, respectively). Conclusion The FOUR scores have good ability to predict the outcomes of critically ill pediatric patients. A FOUR score ?9 at the beginning of treatment is significantly associated with the outcome of mortality during treatment in the PICU.
FECAL CALPROTECTIN AND ITS ASSOCIATION WITH FUNCTIONAL DYSPEPSIA IN CHILDREN Manoppo, Jeanette; Somali, Rizal; ASPR, PITIKA
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Calprotectin is a calcium-binding protein found normally in small amounts within the digestive tract. Fecal calprotectin measurement is used as a biomarker to identify digestive tract inflammation. Functional dyspepsia is one of the most common health issues in children, occurring in 3-27%, and accounts for considerable quality of life impairment and health care expenses. Objective To determine fecal calprotectin concentration in generally healthy children as well as to assess for a possible association between fecal calprotectin and functional dyspepsia. Methods This cross-sectional study was conducted from February to April 2019 in primary school-aged children in Manado, North Sulawesi. Subjects consisted of 38 children aged 6?12 years. Fecal calprotectin was measured in subjects? stool specimens, and considered to be normal if fecal calprotectin concentration of < 50 ?g/g. Diagnosis of functional dyspepsia was defined using the parent-filled Rome IV questionnaire form. Data were analyzed with Chi-square and Phi-coefficient correlation tests. Results Thirty-eight subjects, 22 boys and 16 girls, were grouped according to fecal calprotectin concentration (normal vs. elevated) and functional dyspepsia diagnosis. Mean fecal calprotectin concentration was 312.45 ?g/g in the functional dyspepsia group and 20.89 ?g/g in the healthy group. Elevated fecal calprotectin was found in 55.6% of the functional dyspepsia group and 10.3% of the healthy group. There was a positive correlation between fecal calprotectin elevation and functional dyspepsia (r=0.471; P=0.004). Conclusion Current fecal calprotectin physiological cut-off level of 50 ?g/g seems valid for children aged 6?12 years. Elevated fecal calprotectin is associated with functional dyspepsia in children.
SUBCLINICAL HYPOTHYROIDISM IN PEDIATRIC NEPHROTIC SYNDROME: THE CORRELATIONS WITH ALBUMIN, GLOBULIN, AND PROTEINURIA Nuraeni, Erni; Faisal, Faiisal; Widiasta, Ahmedz; Novina, Novina
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

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Background Nephrotic syndrome causes loss of medium-sized plasma proteins and binding proteins, resulting in thyroid hormone deficiency. Objective To assess for potential correlations between subclinical hypothyroidism in pediatric nephrotic syndrome with albumin, globulin, and proteinuria. Methods This cross-sectional study was conducted in the Department of Pediatrics, Hasan Sadikin General Hospital, Bandung, West Java. All types of nephrotic syndrome patients aged 1 month to < 18 years were included. Blood and urine specimens were collected from the patients for albumin, globulin, thyroid function (T3, fT4 and TSH), and proteinuria tests and analyzed with standard techniques. Results There were 26 subjects, 20 males and 6 females. Ten subjects developed subclinical hypothyroidism, with mean albumin and thyroid-stimulating hormone (TSH) levels of 0.92 g/dL and 6.9 mIU/L, respectively. There was a negative correlation between albumin level and subclinical hypothyroidism (rpb=-0.702; P<0.001) and a positive correlation between proteinuria and subclinical hypothyroidism (r=0.573; P=0.003). Univariate logistic regression analysis revealed that globulin had no impact on the presence of subclinical hypothyroidism, but albumin and proteinuria did have such an impact. The odds ratios of albumin and proteinuria with subclinical hypothyroidism were 27.00 (95%CI 1.69 to 17.7) and 19.80 (95%CI 1.94 to 201.63), respectively. Conclusion Subclinical hypothyroidism correlates with serum albumin level and proteinuria in nephrotic syndrome patients. Tha low serum albumin level has a high likelihood of subclinical hypothyroidism.  
EFFECTS OF PROBIOTIC ON GUT MICROBIOTA IN CHILDREN WITH ACUTE DIARRHEA: A PILOT STUDY Samsudin, Dion Darius; Firmansyah, Agus; Hidayati, Eka Laksmi; Yuniar, Irene; Karyanti, Mulya Rahma; Roeslani, Rosalina Dewi
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Acute diarrhea is a common health problem in Indonesia. During acute diarrhea, changes in gut microbiota are marked by decrease beneficial microbes Bifidobacterium and Lactobacillus, and increased pathogenic bacteria Enterobacter and Clostridium. Such microbial imbalances are known as dysbiosis. Treatment with probiotics may help repair dysbiosis, quicken healing time, and decrease complications. Objective To assess for dysbiosis during acute diarrhea, and determine if it can be normalized by probiotic treatment. Methods This placebo-controlled, unblinded clinical trial was performed in Budhi Asih District Hospital, Jakarta, from January to March 2018. Twenty-four children age 6-24 months with acute diarrhea and 12 healthy children were enrolled. First fecal specimen was collected for all subjects and analyzed using non-culture real time PCR to count the population of Lactobacillus, Bifidobacterium, Enterobacter, Clostridium, and all bacteria. Children with diarrhea were assigned to probiotic or placebo treatment for 5 days and the second fecal specimen was analyzed two weeks after the diarrhea subsided. Results Prior to treatment, significant higher amounts of Lactobacillus were observed in children with acute diarrhea than in healthy controls [median (interquartile range/IR): 1.52x103 (1.22x104) vs. 6.87x10 (2.41x102), respectively; proportion in percentage (from total bacteria population): 0.044% vs. 0.003%, respectively]. However, median (IR) Clostridium was significantly higher in healthy controls than in children with acute diarrhea [2.37x102 (4.64x103) vs. 4.67 (1.50x102), respectively (P<0.05), with proportion of 0.01% vs. 0.0001%, respectively]. Children who received probiotics had significantly higher count of Bifidobacterium compared to the placebo group [1.94x104 (4.97x104) vs. 1.74x103 (2.08x107), respectively, with proportion of 0.394% vs. 0.081%, respectively]. Conclusion This pilot study do not find evidence of dysbiosis in children with acute diarrhea. Group who received probiotic had higher Bifidobacterium count compared towards those who received placebo.
COMPARISON OF GROWTH DIAGRAMS OF INDONESIAN CHILDREN TO 2006 WORLD HEALTH ORGANIZATION GROWTH STANDARDS IN DIAGNOSING STUNTING Wicaksono, Rizki Aryo; Arto, Karina Sugih; Saragih, Rina Amalia Karomina; Deliana, Melda; Lubis, Munar; Batubara, Jose Rizal Latief
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Stunting represents a linear growth disturbance due to chronic malnutrition, recurrent infection, and inadequate psychosocial stimulation. The 2006 World Health Organization (WHO) Growth Standards are utilized as a modality in monitoring children?s growth, but to date, there has been no recommendation on use of the Growth Diagrams of Indonesian Children to monitor the growth of Indonesian children. Objective To determine the proportion of stunting, the sensitivity and specificity of Growth Diagrams of Indonesian Children for diagnosing stunting. In addition, we aimed to compare proportions of stunting using the 2006 WHO Growth Standards and Growth Diagrams of Indonesian Children. Method A cross-sectional study was conducted in Lawe Alas District, Southeast Aceh, Indonesia, from December 2017 to May 2018. Subjects were children aged 1-59 months who fulfilled the inclusion criteria. Subjects were obtained using a consecutive sampling method. Weight and height measurements were plotted on the Growth Diagrams of Indonesian Children and on the 2006 WHO Growth Standards to determine the stature o subjects. Stunting was defined as the index Z-score for HAZ of less than -2 SD for the 2006 WHO Growth Standards, and an HAZ index of below the 10th percentile (p10th) for the Growth Diagrams of Indonesian Children. Results Of 141 subjects, 66 (46.8%) had stunting based on the 2006 WHO Growth Standards and 51 (34.8%) had stunting based on Growth Diagrams of Indonesian Children. The sensitivity and specificity of the Growth Diagrams of Indonesian Children were 75.5% and 98.66%, respectively. Significantly more children were considered to be stunted using the 2006 WHO Growth Standards than using the Growth Diagrams of Indonesian Children. Conclusion Stunting prevalence is high in Southeast Aceh. The Growth Diagrams of Indonesian Children is a spesific and sensitive tool to diagnosed stunting in accordance with Indonesian children?s growth patterns.
MULTILEVEL SURVIVAL ANALYSIS FOR UNDER-FIVES IN INDONESIA 2015 Ifada, Linta; Nurmalasari, Mieke; Pramana, Setia
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Marking the end of the Millennium Development Goals (MDGs) era, governments continue their plans via the Sustainable Development Goals (SDGs). One of the MDGs that has continued is the reduction in under-five mortality. Even though the trend of under-five mortality in Indonesia is decreasing, more efforts are needed to reduce the under-five mortality rate. Objective To determine the individual and contextual factors of the under-five survival rate and to assess for possible characteristics that may lead to variance among regencies in Indonesia. Methods Data from 2015 Intercensal Population Survey (Survei Penduduk Antar Sensus/SUPAS 2015) in Indonesia were analyzed using multilevel survival analysis. The Intercensal Population Survey covers all regions in Indonesia up to the regency level. Data were collected by direct interviews of selected household members, with regards to demographic and household characteristics, including births and deaths of under-fives. Our sample population was limited to all under-fives who were born and died during the 2010-2015 period. The number of subjects analyzed was 219,413 after exclusion of children with incomplete data. Results Individual factors associated with under-five survival rate were maternal education, maternal age at first birth, work status, sex, previous birth interval, type of birth, place of residence, and sanitation level. The contextual factor (health care facility ratio per 1000 under-fives per regency) was not associated with under-five survival rate. The 5.27% variance can be explained by the differing characteristics among regencies. Conclusion The individual factors affecting the survival of under-fives are maternal education, maternal age at first birth, maternal work status, sex, previous birth interval, type of birth, place of residence, and sanitation level.

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