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> Risk factors of stunting in children aged 24-59 months <p><strong>Abstract</strong></p> <p><strong><em>Background</em></strong> Childhood stunting (low height-for-age) still remains a global health problem because it increases the risk of disturbances in growth and development as well as mortality. The prevalence of stunting in Bali is 32.5%, with the highest in Gianyar District at 41%. However, little is known about the risk factors of stunting children in Gianyar.</p> <p><strong><em>Objective</em></strong> <strong>&nbsp;</strong>To investigate the risk factors of stunting in children aged 24-59 months in Gianyar.</p> <p><strong><em>Methods</em></strong> <strong>&nbsp;</strong>This cross-sectional study involved 166 children, collected consecutively, aged 24-59 months, who visited the integrated health posts in 13 community health centers in Gianyar District, Bali from September to November 2016. Stunting is defined as -2SD below the WHO height-for-age z-score (HAZ), according to sex. Statistical analyses were done with Chi-square and multivariate logistic regression tests.</p> <p><strong><em>Results</em></strong> Of 166 subjects, 37 (22.3%) children were stunted. Multivariate analysis revealed that low paternal education (AOR 2.88; 95%CI 1.10 to 7.55; P=0.031), maternal height less than 150 cm (AOR 7.64; 95%CI 2.03 to 28.74; P=0.003), high risk maternal age (AOR 4.24; 95%CI 1.56 to 11.49; P= 0.005), low birth weight (AOR 5.09; 95%CI 1.03 to 25.31; P=0.047), and low birth length (AOR 9.92; 95%CI 1.84 to 53.51; P=0.008) were strongly associated with stunting.</p> <p><strong><em>Conclusion</em></strong> <strong>&nbsp;</strong>Risk factors for stunting in children are low paternal education, maternal height less than 150 cm, high risk maternal age, low birth weight, and low birth length.</p> Arya Krisna Manggala Komang Wiswa Mitra Kenwa Made Me Lina Kenwa Anak Agung Gede Dwinaldo Putra Jaya Sakti Anak Agung Sagung Sawitri, MD, MPH ##submission.copyrightStatement## 2018-08-07 2018-08-07 58 5 205 12 Forced expiratory volume in 1-second and blood gas analysis in children during asthma attacks <p><strong><em>Background</em></strong> Asthma is the most common chronic disease in the world, with a high incidence in children. Blood gas analysis and pulmonary function test using spirometry are recommended to evaluate the degree of asthma in children. Spirometry test is non-invasive and easier to implement compared to blood gas analysis.</p> <p><strong><em>Objective</em></strong> To evaluate for a possible correlation between forced expiratory volume in 1 second (FEV1) measured by spirometry test and blood gas analysis (pO2 and pCO2 levels) in children during an asthma attack.</p> <p><strong><em>Methods</em></strong> This cross-sectional study was done in children with asthma attacks who were admitted to Sanglah Hospital, Denpasar, Bali, between November 2016 and April 2017. Subjects underwent spirometry tests and blood gas analyses. Potential correlations between FEV1 and pO2 and pCO2 levels were analyzed by Spearman’s correlation test.</p> <p><strong><em>Results</em></strong> A total of 50 subjects, consisting of children aged 6 to 12 years, were diagnosed with asthma attacks during the study period. Subjects’ mean FEV1 level was 43.6%, mean pCO2 was 38.36 mmHg, and mean pO2 was 121.92 mmHg. There were no significant correlations between FEV1 and pCO2 level (r=0.206; P=0.152) or FEV1 and pO2 (r=0.157; P=0.277) found in this study.</p> <p><strong><em>Conclusion</em></strong> FEV1 does not correlate with pCO2 and pO2 level in children during asthma attacks.</p> Dewa Ayu Dini Primashanti Putu Siadi Purniti I Gusti Ayu Trisna Windiani ##submission.copyrightStatement## 2018-10-04 2018-10-04 58 5 221 6 NT-proBNP level and left ventricle diameters before and after transcatheter closure of PDA and VSD <p><strong><em>Background</em></strong> Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels before and after transcatheter closure may correlate with changes in left ventricular internal diameter end diastole (LVIDd) and end systole (LVIDs). Patent ductus arteriosus (PDA) and ventricular septal defect (VSD) are structural abnormalities which effects cardiac hypertrophy. Cardiac muscle stretching decreases after closure, followed by reduced left ventricle diameters and decreased NT-proBNP levels.</p> <p><strong><em>Objective</em></strong> To analyze for possible correlations between NT-proBNP levels and left ventricle diameters before and after transcatheter closure.</p> <p><strong><em>Methods</em></strong> Subjects were PDA and VSD patients who underwent transcatheter closure in the Pediatrics Department of dr. Moh Hoesin Hospital, Palembang, South Sumatera, from May 2016 to March 2017. Measurement of NT-proBNP levels and echocardiography were performed before closure, as well as one and three months after closure.</p> <p><strong><em>Results</em></strong> There were 34 subjects (15 girls) with median age of 91.5 months. Median NT-proBNP levels were significantly reduced after closure: before closure 111.7pg/mL, one month after closure 62pg/mL, and three months after closure 39 pg/mL (P&lt;0.05). Median LVIDd and LVIDs were also significantly reduced after closure [LVIDd: 39.5mm before, 34.5mm one mo after, and 32.5mm 3 mo after (P&lt;0.05); LVIDs: 23.9mm before, 20.5mm 1 mo after, and 20.0mm 3 mo after (P&lt;0.05)]. At one month after closure, there was a moderate positive correlation between NT-proBNP levels and LVIDd (r=0.432; P=0.011), but no correlation with LVIDs (r=0.287; P=0.100). At three months after closure, there was a significant moderate positive correlation between changes of NT-proBNP levels and changes of LVIDd (r=0.459; P=0.006), as well as LVIDs (r=0.563; P=0.001).</p> <p><strong><em>Conclusion</em></strong> In pediatric PDA and VSD patients, NT-proBNP levels have a significant positive correlation with diastolic and systolic left ventricle diameters at three months after closure. Decreased NT-proBNP levels may be considered as a marker of closure effectiveness.</p> Devy Kusmira Ria Nova Achirul Bakri ##submission.copyrightStatement## 2018-10-04 2018-10-04 58 5 213 20 Risk factors for relapse in pediatric nephrotic syndrome <p><strong><em>Background</em></strong> Nephrotic syndrome (NS) is the most common kidney disease in children and is characterized by edema, massive proteinuria, hypoalbuminemia, and hyperlipidemia. High relapse rate remains a major problem in the management of this syndrome.</p> <p><strong><em>Objective</em></strong> To identify risk factors for relapse in pediatric nephrotic syndrome.</p> <p><strong><em>M</em></strong><strong><em>e</em></strong><strong><em>thods</em></strong> This study was carried out in the Wahidin Sudirohusodo Teaching Hospital in Makassar, South Sulawesi, Indonesia, from January to August 2017 using complete medical records of children diagnosed with NS. Subjects were divided into 2 groups: 1) relapsed NS or 2) non-relapsed NS.&nbsp; The following potential risk factors for relapse were analyzed using Chi-square test: age, sex, nutritional status, hypertension, serum creatinine level, and infection at the time of established diagnosis of NS.</p> <p><strong><em>Results</em></strong> A total of 142 children with NS who fulfilled the inclusion criteria aged 1.4 to 17.5 years were included in the study. Subjects were mostly boys (66.2%), with a male: female ratio of 1.95:1. The relapsed NS group had 80 cases (56.3%) and the non-relapsed NS group had 62 cases (43.7%). Statistical analysis revealed that nutritional status was a significant risk factor for relapse in pediatric nephrotic syndrome (P&lt;0.05).</p> <p><strong><em>Conclusion</em></strong> Nutritional status is an independent risk factor for relapse in pediatric nephrotic syndrome.&nbsp;</p> Husein Albar Fadel Bilondatu Dasril Daud ##submission.copyrightStatement## 2018-10-04 2018-10-04 58 5 238 41 Low peripheral oxygen saturation as a risk factor for brain abscess in children with cyanotic congenital heart disease <p><strong><em>Background</em></strong> Brain abscess is a severe infection of brain parenchyma, which occurs in 25-46% of cases of uncorrected cyanotic congenital heart disease. Low arterial oxygen saturation is the main risk factor for brain abscess in children with cyanotic congenital heart disease, however, the arterial oxygen saturation test is invasive and not routinely done in our setting.</p> <p><strong><em>Objectiv</em></strong><strong><em>e</em></strong> To evaluate low peripheral oxygen saturation as a risk factor for brain abscess in children with cyanotic congenital heart disease.</p> <p><strong><em>Methods</em></strong> We conducted a matched, case-control study at Sardjito Hospital, Yogyakarta for children aged less than 18 years with cyanotic congenital heart disease, from 2010-2016. Case subjects were children with brain abscess complications. The control group had only cyanotic congenital heart disease, and were matched for age and sex to the case group. During hospitalization due to the brain abscess complication in the case group, data regarding peripheral oxygen saturation, polycythemia, pneumonia, sepsis, dental caries and restricted pulmonary blood flow were collected and compared between both groups.</p> <p><strong><em>Results</em></strong> During the study period, 18 children with cyanotic congenital heart disease had brain abscesses. This group was compared to the control group of 36 children. Bivariate analysis revealed that the lowest level of peripheral oxygen saturation (OR 0.92; 95%CI 0.85 to 0.98; P=0.02) and dental caries (OR 3.3; 95%CI 1.01 to 11.18; P=0.04) were significant risk factors for brain abscess. However, in the multivariate analysis, the only statistically significant risk factor associated with brain abscess was the lowest level of peripheral oxygen saturation (OR 0.92; 95%CI 0.86 to 0.99; P=0.04).</p> <p><strong><em>Conclusion</em></strong> Low peripheral oxygen saturation is a significant risk factor for brain abscess development in children with cyanotic congenital heart disease.&nbsp; A decrease of 1% peripheral oxygen saturation may increase the risk of brain abscess by 8%.</p> Nadia Qoriah Firdausy Indah Kartika Murni Agung Triono Noormanto Noormanto Sasmito Nugroho ##submission.copyrightStatement## 2018-10-17 2018-10-17 58 5 252 6 10.14238/pi58.5.2018.252-6 Predictors for coronary artery dilatation in Kawasaki disease <p><strong><em>Background </em></strong>Kawasaki disease (KD) is an acute, self-limited, febrile illness of unknown cause that predominantly affects children below 5 years of age. It has a high incidence of coronary complications such as aneurysms. The current treatment of choice is intravenous immunoglobulin, which is costly, with aspirin. Identifying the predictive factors for coronary artery dilatation or aneurysm is important in order to establish the indications for giving immunoglobulin, especially when resources are limited.</p> <p><strong><em>Objective</em></strong></p> <p>To identify the predictors for the development of coronary artery dilatation in patients with Kawasaki disease</p> <p><strong><em>Methods </em></strong>This cross-sectional study was done between January 2003 and July 2013. Inclusion criteria were patients who fulfilled the American Heart Association criteria for acute Kawasaki disease, and had complete clinical, echocardiogram, and laboratory data [hemoglobin, leukocyte, platelet, albumin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR)]. All of them received immunoglobulin and aspirin.</p> <p><strong><em>Results </em></strong>Of 667 KD patients, 275 met the inclusion criteria. There were 185 (67%) males. Subjects’ ages varied between 1 to 157 months. The frequency of coronary artery dilatation at the acute phase was 33.3%. Multivariate analysis showed that &gt;7-day duration of fever and hypoalbuminemia were significant predictive factors for coronary artery dilatation.</p> <p><strong><em>Conclusion </em></strong>Predictive factors for coronary artery dilatation are duration of fever over 7 days and hypoalbuminemia, while age, gender, hemoglobin level, leukocyte count, and platelet count are not. Frequency of coronary artery dilatation at the acute phase is 33.3%.</p> Najib Advani Anisa Rahmadhany Sarah Rafika ##submission.copyrightStatement## 2018-10-17 2018-10-17 58 5 257 62 10.14238/pi58.5.2018.257-62 Liver iron overload and hepatic function in children with thalassemia major <p><strong><em>Background</em></strong> Routine blood transfusions and increased intestinal iron absorption lead to iron accumulation in various organs, especially the liver. To date, T2-star magnetic resonance imaging (T2*MRI) is a valuable tool to evaluate iron level in organs.</p> <p><strong><em>Objective</em></strong> To assess the degree of liver iron overload among children with thalassemia major (TM) and its possible correlations with hepatic function laboratory values.</p> <p><strong><em>Methods </em></strong>This cross-sectional study was conducted in Cipto Mangunkusumo Hospital. The degree of liver iron overload was evaluated by T2*MRI. Assessments of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, and bilirubin levels were done to evaluate liver function.</p> <p><strong><em>Results </em></strong>A total of 291 TM children were included in this study. The mean age of subjects was 12 years. Most of the subjects were diagnosed as β-thalassemia homozygote (54.6%) and β-thalassemia/HbE (41.2%). Deferiprone (DFP) was the most commonly used iron chelator. Less than 10% of the subjects had normal liver iron deposition. The AST and ALT values increased proportionally with the severity of liver iron overload, with significant, moderately negative correlation coefficients (r=-0.388 and -0.434, respectively). However, albumin level decreased proportionally with the severity of liver iron overload, with a significant, moderately positive correlation coefficient (r=0.323). Liver T2* MRI had no significant correlations with direct, indirect, and ratio of direct/total bilirubin levels.</p> <p><strong><em>Conclusion </em></strong>Most of the children with TM have mild to severe liver iron overload. Liver T2* MRI had significant, moderate correlations with AST, ALT, and albumin values. Bilirubin level has no correlation with T2* MRI. Our findings suggest that monitoring of AST, ALT, and albumin levels is important because they may reflect the severity of liver iron overload. However, they should not be used as the only predictors of iron overload.</p> Pustika Amalia Wahidiyat Stephen Diah Iskandar Ludi Dhyani Rahmartani Damayanti Sekarsari ##submission.copyrightStatement## 2018-09-27 2018-09-27 58 5 233 7 Preterm infant physiological responses to music therapy: a systematic review <p><strong><em>Background</em></strong> Prematurity is still the leading cause of mortality and morbidity in neonates. The premature change of the environment causes stress, which leads to hemodynamic instability. Music therapy may have a positive impact on hemodynamic parameters of preterm infants in the NICU.</p> <p><strong><em>Objective</em></strong> To evaluate preterm infants’ physiological responses to music therapy in NICU setting.</p> <p><strong><em>Methods</em></strong> A systematic review was performed in 12 electronic databases from March 2000–April 2018. Our review included all English language publications on parallel or crossover RCTs of music therapy versus standard care or placebo in preterm infants. The outcomes were physiological indicators [heart rate (HR), respiratory rate (RR), and oxygen saturation (SaO<sub>2</sub>)]. Risk of bias was assessed using the Revised Cochrane risk of bias tool for randomized trials (RoB 2.0).</p> <p><strong><em>Results</em></strong> The search yielded 20 articles on 1,148 preterm infants of gestational age 28 and 37 weeks, who received recorded music, recorded maternal/male voice or lullaby, or live music interventions in the NICU with intensity of 30–76 dB. Recorded music improved all outcomes in 6, 6, and 4 of 16 studies for HR, RR, and SaO<sub>2</sub>, respectively. Seven studies used classical music as melodic elements. However, eight studies showed no significant results on all outcomes.</p> <p><strong><em>Conclusion</em></strong> Despite the finding that music interventions demonstrate promising results in some studies, the variation in quality of the studies, age groups, outcome measures, as well as type and timing of the interventions across the studies make it difficult to draw overall conclusions about the effects of music in preterm infants.</p> Ferry Liwang Dinarda Ulf Nadobudskaya Indah Lestari Toto Wisnu Hendrarto ##submission.copyrightStatement## 2018-10-15 2018-10-15 58 5 242 51 Factors associated with pericardial effusion in pediatric systemic lupus erythematosus <p><strong><em>Background</em></strong> Cardiovascular involvement in systemic lupus erythematosus (SLE) has been reported to range from 4-78%. Complications can affect all structures of the heart, including the endocardium, myocardium, pericardium, and valves. Pericarditis is the most common manifestation, with an incidence of 11-54% in SLE patients. Pericardial effusion is often observed in patients with pericarditis, and can be confirmed by echocardiography.</p> <p><strong><em>Objective</em></strong> To determine factors associated with pericardial effusion in children with SLE.</p> <p><strong><em>Methods</em></strong> We conducted a restrospective cross-sectional study by reviewing medical records of children with SLE aged less than 18 years who underwent echocardiography at the Dr. Sardjito Hospital. Yogyakarta, from January 2011 to March 2018. Patients with congenital heart disease or incomplete medical records were excluded. A multivariate logistic regression analysis was done to determine factors that independetly associated with pericardial effusion.</p> <p><strong><em>Results</em></strong> Among 165 children with SLE, 73 fulfilled the inclusion criteria. The prevalence of pericardial effusion was 54.8%. Median age was 13 (range 5-17) years and the female-to-male ratio was 8:1. Hemolytic anemia (OR=4.135; 95%CI 1.039 to 16.453; P=0.044) was significantly associated with pericardial effusion.</p> <p><strong><em>Conclusion</em></strong> Hemolytic anemia is significantly associated with pericardial effusion in children with SLE.</p> Pediana Rachmawati Indah K. Murni Sasmito Nugroho Noormanto Noormanto Sumadiono Sumadiono ##submission.copyrightStatement## 2018-10-04 2018-10-04 58 5 227 32