Paediatrica Indonesiana <p>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.</p> <p>Paediatrica Indonesiana is accredited by Ministry of Research and Higher Education of the Republic of Indonesia no. 36a/E/KPT/2016 (2016-2021), and is indexed by Directory of Open Access Journals (DOAJ), Cross Ref, Google Scholar, PKP Index, Clarivate Analytics. </p> Indonesian Pediatric Society en-US Paediatrica Indonesiana 0030-9311 <p>Authors who publish with this journal agree to the following terms:</p> <p>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> <p>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</p> <p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons License"></a><br>This work is licensed under a <a href="" rel="license">Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License</a>.</p> Serum IGF-1 and short stature in adolescents with beta-thalassemia major <p><strong><em>Background</em></strong> The&nbsp; prevalence&nbsp; of&nbsp; short&nbsp; stature&nbsp; in&nbsp; thalassemia&nbsp; patients ranges from 39.3 to 65%.&nbsp; The&nbsp; cause&nbsp; of short stature is complex&nbsp; and&nbsp; still up for debate.&nbsp; In&nbsp; Indonesia, data on the&nbsp; prevalence&nbsp; and risk&nbsp; factors&nbsp; of&nbsp; short&nbsp; stature&nbsp; in&nbsp; adolescents&nbsp; with&nbsp; thalassemia&nbsp; have been limited.</p> <p><strong><em>Objective</em></strong> To assess for the prevalence and risk factors of short stature in adolescents with beta-thalassemia major.</p> <p><strong><em>Methods</em></strong> This cross-sectional study was done from February to March 2017 at the Thalassemia Clinic at Dr. Hasan Sadikin General Hospital, Bandung. The baseline characteristics data of 80 adolescents with thalassemia aged 10-14 years were recorded. Short stature was assessed by height-for-age, (Z-score &lt;-2SD) based on the 2007 WHO Reference Growth Chart. Mid-upper arm circumference was scored according to age and sex and serum IGF-1 was measured by ELISA method. Data analyses used were Chi-square, Fisher’s, and Mann-Whitney tests. Logistic regression model was used to further analyze for risk factors of short stature.</p> <p><strong><em>Results</em></strong> Subjects were 40 males and 40 females, 81.2% of whom had short stature. The mean serum IGF-1 level was 32.2 (SD 26.38) ng/mL. The IGF-1 cut-off point by ROC curve was £38.51 ng/mL, with sensitivity of 64.4% and specificity of 86.7%. The risk factors of short stature were IGF-1 level £38.51 ng/mL (PR 40.66; 95%CI 4.37 to 377.58; P&lt;0.001) and low family income (PR 19.76; 95%CI: 1.152 to 256.08; P=0.022).</p> <p><strong><em>Conclusion</em></strong> IGF-1 level may be useful as a predictor of short stature in adolescent beta-thalassemia major patients.</p> Monalisa Elizabeth Eddy Fadlyana Lelani Reniarti Faisal Faisal Hadyana Sukandar Kusnandi Rusmil ##submission.copyrightStatement## 2018-07-16 2018-07-16 58 4 Liver function in children with human immunodeficiency virus infection before and after 6 months of highly active antiretroviral therapy <p><strong><em>Background</em></strong> Highly active antiretroviral therapy (HAART) has resulted in dramatic decreases in morbidity and improved survival rate in human immunodeficiency virus (HIV)-infected patients. Although the risk of morbidity has decreased, it has been replaced by other long-term complications, such as hepatotoxicity. Hepatotoxicity is often reflected in biochemical abnormalities of liver function, such as elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and aspartate aminotransferase-to-platelet ratio index (APRI).</p> <p><strong><em>Objective</em></strong> To compare liver function spectrum (AST, ALT, and APRI) in HIV-infected children before and after at least 6 months of HAART.</p> <p><strong><em>Methods</em></strong> This observational study (before and after) was conducted in pediatric patients with HIV infection who received HAART for at least 6 months at Sanglah Hospital, Denpasar. Data were collected from medical records.</p> <p><strong><em>Results </em></strong>Forty-nine patients were observed in this study. The mean AST, ALT, and APRI levels before HAART were higher than after at least 6 months of HAART. Anti-tuberculosis treatment and fluconazole therapy were not confounding factors for AST, ALT, and APRI.</p> <p><strong><em>Conclusion</em></strong> Liver function spectrum enzyme levels of AST, ALT, and APRI are improved after at least 6 months of HAART.</p> Eva Jacomina Jemima Sapulete I Gusti Ngurah Sanjaya Putra Ketut Dewi Kumara Wati Hendra Santoso I Putu Gede Karyana Komang Ayu Witarini Ni Nyoman Metriani Nesa ##submission.copyrightStatement## 2018-07-27 2018-07-27 58 4 Lung function test in children with left-to-right shunt congenital heart disease <p><strong><em>Background </em></strong>Increased pulmonary blood flow may lead to abnormal lung function in children with left-to-right (L to R) shunt congenital heart disease. This condition has been linked to considerable mortality and morbidity, including reduced lung function.</p> <p><strong><em>Objective</em></strong> To assess for lung function abnormality in children with L to R shunt congenital heart disease.</p> <p><strong><em>Methods </em></strong>We conducted a cross-sectional study involving children aged 5-18 years and diagnosed with L to R shunt congenital heart disease at Dr. Sardjito Hospital from March to May 2017. Subjects underwent spirometry tests to measure forced expiratory volume-1 (FEV-1), forced vital capacity (FVC), and forced expiratory volume-1 (FEV-1)/forced vital capacity (FVC).</p> <p><strong><em>Results </em></strong>Of 61 eligible subjects, 30 (49.2%) children had atrial septal defect (ASD), 25 (41%) children had ventricular septal defect (VSD), and 6 (9.8%) children had patent ductus arteriosus (PDA). Spirometry revealed lung function abnormalities in 37 (60.7%) children. Restrictive lung function was documented in 21/37 children, obstructive lung function in 11/37 children, and mixed pattern of lung function abnormality in 5/37 children. Pulmonary hypertension was found in 21 children. There was no significant difference in lung function among children with and without pulmonary hypertension (P=0.072).</p> <p><strong><em>Conclusion </em></strong>Abnormal lung function is prevalent in 60.7% of children with L to R shunt congenital heart disease, of which restrictive lung function is the most common. There was no significant difference in lung function among children with and without pulmonary hypertension.</p> Carolina Kurniawan Indah Kartika Murni Sasmito Nugroho Noormanto Noormanto Roni Naning ##submission.copyrightStatement## 2018-07-27 2018-07-27 58 4 Lung function in athletes and non-athletes aged 13-15 years <p><strong><em>Background</em></strong> Regular sports or physical training contributes in increasing the body’s pulmonary function. The increase of pulmonary function is determined by the strength of respiratory muscle, thoracic compliance, upper respiratory system resistance, and pulmonary elasticity.</p> <p><strong><em>Objective</em></strong> To compare pulmonary function between athletes and non-athletes aged 13-15 years.</p> <p><strong><em>Methods</em></strong> This is a cross-sectional analytical study conducted onnior high school students aged 13-15 years throughout June to August 2017. Participants are classified as athletes from particular sports and non-athletes. Assessment of pulmonary function was done using a spirometry test, in which each subject was asked to inhale and exhale in a particular method. Parameters assessed include vital capacity (VC), forced vital capacity (FVC), expiratory volume in 1 second (FEV1), forced expiratory flow (FEF) and FEV1/FVC. Differences in lung function between athletes and non-athletes were analyzed using independent T-test.</p> <p><strong><em>Results</em></strong> There were 60 athletes and 60 non-athletes included in this study. The mean age of athletes and non-athletes were 13.38 (SD 0.99) years old and 13.70 (SD 0.76) years old, respectively. The statistically significant differences in mean lung function parameters between athletes and non-athletes were as follows: VC: 85.03% <em>vs</em><em>.</em> 79.41%, respectively (P=0.035); FVC: 95.66% <em>vs</em><em>.</em> 88.43%, respectively (P=0.016); FEV1: 102.10% <em>vs</em><em>.</em> 94.28%, respectively (P=0.016); and FEV1/FVC: 105.95% <em>vs</em><em>.</em> 102.69%, respectively (P=0.011). However, there were no statistically significant differences in the means of FEF 25-75% between the two groups (P&gt;0.05).</p> <p><strong><em>Conclusions</em></strong> Parameters of lung function in athletes are in general significantly higher than in non-athletes.</p> Ni Komang Diah Saputri Ayu Setyorini Mestika Mayangsari Ida Bagus Subanada ##submission.copyrightStatement## 2018-07-27 2018-07-27 58 4 Valproate use and thyroid dysfunction in children with idiopathic epilepsy <p><strong><em>Background </em></strong>Long-term administration of valproic acid (VPA) has side effects, including thyroid dysfunction. Subclinical hypothyroidism (SCH) identified by elevated serum thyroid stimulating hormone (TSH) concentrations with normal thyroxine (T4) and triiodothyronine (T3), or normal free thyroxine (fT4) and free triiodothyronine (fT3) has been demonstrated in idiopathic epilepsy patients receiving VPA.</p> <p><strong><em>Objective </em></strong>To evaluate for associations between age at initiation of VPA treatment and duration of treatment with thyroid dysfunction.</p> <p><strong><em>Methods</em></strong> A cross-sectional study was conducted from October 2012 to May 2013 in Haji Adam Malik and Pirngadi Hospitals, Medan, North Sumatera. Subjects were children ranging from 0 and below 18 years who had been diagnosed with idiopathic epilepsy. Blood specimens were taken to evaluate serum T3, T4, and TSH levels in all subjects. Data were analyzed using bivariate and multivariate analyses.</p> <p><strong><em>Results </em></strong>A total of 49 subjects were included in the study. Age of ≤ 4 years at initiation of VPA was found to be a significant risk factor for SCH in the bivariate analysis (OR 6.67; 95%CI 1.215 to 36.594, P=0.036). Three factors had P values &lt;0.25 in the bivariate analysis and were subsequently analyzed by stepwise multivariate regression test: age at initiation of VPA, duration of treatment, and drug dosage. The VPA initiation at age <u>&lt;</u>4 years had 6.67 times the risk of SCH than the age of &gt;4 years (95%CI 1.215 to 36.594; P=0.029). Duration of treatment and VPA dosage were not significantly associated with SCH on multivariate analysis</p> <p><strong><em>Conclusion</em></strong> Age ≤ 4 years old at the initiation of VPA is associated with thyroid dysfunction. However, no significant association was found between duration of treatment as well as drug dosage with &nbsp;thyroid dysfunction. &nbsp;</p> Josephine Juliana Sibarani Melda Deliana Johannes H. Saing ##submission.copyrightStatement## 2018-08-30 2018-08-30 58 4 192 7 Hemostatic abnormalities in children with thalassemia major and liver iron overload <p><strong><em>Background</em></strong> Thalassemia major (TM) patients are susceptible to liver dysfunction due to iron deposition. Pediatric TM patients often present with bleeding. Blood loss necessitates transfusions, leading to increased iron absorption from the gut.</p> <p><strong><em>Objective </em></strong>To study hemostatic abnormalities in children with TM and iron deposition in the liver.</p> <p><strong><em>Methods </em></strong>This cross-sectional study involved 190 non-splenectomized children with TM. Liver iron deposition was evaluated using T2* MRI. Prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet counts were assessed from blood specimens.</p> <p><strong><em>Results </em></strong>Most subjects were diagnosed with β-thalassemia and β-thalassemia/HbE. The majority of subjects were on deferiprone (DFP) treatment. Approximately 89.5% of subjects had liver iron overload. Prolongation of PT and aPTT, as well as thrombocytopenia were observed in 60%, 27.9%, and 19.5% of subjects, respectively. Prolonged aPTT and thrombocytopenia were observed three times more frequently in subjects with moderate - severe liver iron overload than in subjects with normal - mild liver iron overload (P=0.04 and 0.001, respectively).</p> <p><strong><em>Conclusion </em></strong>Most TM subjects have liver iron overload ranging from mild to severe. Prothrombin time and prolongation, as well as aPTT prolongation, and thrombocytopenia are easily found in TM children. There were significantly more moderate - severe liver iron deposition patients with aPTT prolongation and thrombocytopenia than normal – mild patients with these conditions. Hence, we suggest that pediatric TM patients undergo liver iron deposition evaluations and use iron chelators in an optimal manner, in order to limit the risk of bleeding.</p> Pustika Amalia Wahidiyat Stephen Diah Iskandar Novie Amelia Chozie Damayanti Sekarsari ##submission.copyrightStatement## 2018-08-13 2018-08-13 58 4 The outcomes of childhood acute lymphoblastic leukemia with hyperleukocytosis <p><strong><em>Background</em></strong> Hyperleukocytosis in childhood acute lymphoblastic leukemia (ALL) is an&nbsp; emergency in oncology. This condition showed high mortality and relapse rates, as well as low survival rate. The outcomes of this group of patients are not yet well studied.</p> <p><strong><em>Objective</em></strong> To evaluate the characteristics and outcomes of childhood acute lymphoblastic leukemia (ALL) with hyperleukocytosis.</p> <p><strong><em>Methods</em></strong> This was a retrospective cohort study.&nbsp; The patients were children less than 18 year of age who were diagnosed as ALL in Dr. Sardjito Hospital, Yogyakarta, from January 1<sup>st</sup> 2010 to November, 30<sup>th</sup> 2016. Event-free survival rate and overall survival rate were estimated for group of patients with the white blood cell (WBC) groups 50-200x10<sup>9</sup>/L and &gt;200x10<sup>9</sup>/L using the Kaplan-Meier method.</p> <p><strong><em>Result</em></strong><strong><em>s</em></strong> There were 705 children diagnosed as ALL during the study period, 129 (18%) with hyperleukocytosis and 111 of them met the inclusion criteria, consisted of 76 children in a group of WBC 50-200 x 10<sup>9</sup>/L and 35 children in a group of WBC &gt;200 x 10<sup>9</sup>/L. Presentation at diagnosis: median age were 7 years (range 1 month-18 years), male was 1.5 higher than female, 92% of cases with lymphoid infiltration, 5% with CNS involvement, 40% had bleeding tendency, and 10% had clinical tumor lysis syndrome (TLS). Median WBC was 122 (range 53.4-876) x 10<sup>9</sup>/L; mean Hb was 8 (SD 3) g/dL; median platelet count was 30 (range 1-221) x 10<sup>9</sup>/L. Immunophenotyping was done in 23 patients, 5/23 (8%) was T cell. The patients in lower WBC group showed lower death (26% <em>vs.</em> 34%,&nbsp; P=0,389), higher two-year event-free survival (EFS) 68% <em>vs.</em> 45%, P=0.003, and overall survival (77% <em>vs.</em> 68%, P= 0.16), compared to patients in higher WBC group. Univariate and multivariate Cox regression analyses revealed that none of the variables was a significant prognostic factor for 2 years EFS or overall survival.</p> <p class="ListParagraph1CxSpLast"><strong><em>Conclusion</em> </strong>The group of children with ALL and hyperleukocytosis with lower WBC at diagnoses showed better outcomes than the higher WBC.</p> Din Alfina Pudjo Hagung Widjajanto Suryono Yudha Patria ##submission.copyrightStatement## 2018-08-15 2018-08-15 58 4 Age and HIV stage at initiation of highly active antiretroviral therapy determine non-reversal of stunting at 3 years of treatment <p><strong><em>Background</em></strong> Highly active antiretroviral therapy (HAART) has been reported to improve growth, especially in the first 2 years of treatment. It is not clear whether catch up growth is maintained after 2 years of HAART.</p> <p><strong><em>Objective</em></strong> To assess growth in stunted children with HIV after 3 years of HAART and analyze possible risk factors for non-reversal of stunting.</p> <p><strong><em>Methods</em></strong> This study was done from May 2016 to April 2017 to follow children with HIV who started HAART between January 2009 and April 2014, and continued for 3 years. Inclusion criteria were children with HIV, aged &lt; 18 years, compliance to the regimen, and stunting. Exclusion criteria were patients lost to follow up or who died prior to 3 years of HAART. Non-reversal of stunting was defined as HAZ ≤ -2SD after 3 years of HAART. Possible risk factors for non-reversal were analyzed using Chi-square test with P&lt;0.05, as well as risk ratio (RR) and 95% confidence intervals (CI).</p> <p><strong><em>Results</em></strong> Of 150 HIV-infected pediatric patients, 115 were on HAART and 55 (47.8%) were stunted at HAART initiation. Of the 55 stunted and HAART-treated children, 31 (56.4%) were male. Baseline median age was 3.6 years (interquartile range 0.37-8.48). Non-reversal occurred in 32 (58.2%) subjects. Multivariate Cox regression model analysis showed predictors of non-reversal after 3 years of HAART to be age &gt;2 years (RR 16.05; 95%CI 2.89 to 89.02; P=0.002) and HIV stage III-IV (RR 8.93; 95%CI 1.47 to 54.37; P=0.017).</p> <p><strong><em>Conclusion</em></strong> HAART initiation at age &gt;2 years and HIV clinical stage III-IV at diagnosis are risk factors for non-reversal of stunting after 3 years of HAART.</p> Putu Diah Vedaswari Ketut Dewi Kumara Wati I Gusti Lanang Sidiartha I Gusti Ayu Putu Eka Pratiwi Hendra Santoso Komang Ayu Witarini ##submission.copyrightStatement## 2018-08-30 2018-08-30 58 4 180 5 Long term follow-up of multidrug resistant tuberculosis in a pubertal child <p>Increasing awareness of the rising global rates of multidrug-resistant tuberculosis (MDR-TB) has led to a concerted international effort to confront this disease. Nonetheless, despite cure rates &gt;80% in some programs, MDR-TB patients tend to have chronic disease and require prolonged therapy.<sup>1-3 </sup>Little is known about the long-term results and follow-up of patients with MDR-TB, include the recurrence rate and chronic disability in patients who have recovered from TB.<sup>4</sup></p> <p>There are many side effects and adverse reactions to drugs can occur during MDR-TB treatment. These could be physical and or psychological, as well as reversible or irreversible. Treatment of MDR-TB requires a combination regimen, consists of second and third-line anti-tuberculosis drugs which more toxic than first-line drugs. Additionally, MDR-TB treatment requires a long duration of treatment (18-24 months) and causes discomfort in the patient.<sup>5 </sup>In a cohort of 60 patients treated for MDR-TB, the most common side effects included gastritis (100%), dermatological disorders (43%), and peripheral neuropathy (16.7).<sup>6</sup> While in a cohort of 75 patients, the incidence of depression, anxiety, and psychosis for MDR-TB treatments was 13.3%, 12.0%, and 12.0%, respectively.<sup>7</sup></p> <p>Aggressive and effective management are needed so the patient can tolerate the treatment and remain adhere the treatment.<sup>8</sup> Long-term follow-up is required for the rehabilitation of disorders due to psychosocial sequelae. &nbsp;As such, psychosocial support can be benefit pediatric MDR-TB patients. &nbsp;</p> <p>Here, we present a case report on a two-year follow-up of a pubertal child with MDR-TB, &nbsp;focusing on medical aspects and her development.</p> Andri Kurnia Wahyudhi Retno Asih Setyoningrum Ahmad Suryawan ##submission.copyrightStatement## 2018-08-30 2018-08-30 58 4 198 204