Paediatrica Indonesiana

Modified Ross score and echocardiographic score in children with heart failure: a subgroup analysis

Tue, 28 May 2024 11:25:51 +0700

Background Over the past two decades, heart failure in children has increased in terms of symptom recognition and prevalence. The initial clinical manifestations of heart failure in children are non-specific. Therefore, diagnosis requires the support of echocardiography. The symptomatic severity of heart failure in children can be classified through a simple scoring system such as Ross score. The duration of heart disease, duration of therapy, and cardiac remodeling status may have clinical and anatomical effects on the disease.

Objective To analyze for a possible correlation between modified Ross score and echocardiographic score by subgroup analysis consisting of duration of heart disease, duration of therapy, and cardiac remodeling.

Methods This cross-sectional study included children aged 1 month - 18 years with heart failure who sought treatment at Prof.Dr. I.G.N.G Ngoerah Hospital, Denpasar from June 2019 to February 2020. Cardiac remodeling was defined as >20% increase in left ventricle internal end diastolic dimension (LVIDd) compared to normal values, ??based on body surface area. Spearman’s correlation test was used for statistical analysis.

Results A total of 30 subjects were analyzed in this study. The median modified Ross score and echocardiography score were 3 points (range 2-11) and 4 (range 2-6), respectively. The median durations of heart disease and preventive heart failure therapy were 2 years (range 7 days-15 years) and 1 year (range 7 days-15 years), respectively. The mean LVIDd was 4.3 (SD 1.4) cm. Twenty-one out of 30 subjects experienced a ? 20% increase of LVIDd from baseline. The modified Ross score and echocardiographic score had no significant correlation (r=0.18; P=0.33). However, the modified Ross score had significant correlations with duration of heart disease (r=-0.632; P<0.001) as well as duration of therapy (r=-0.584; P=0.001). In addition, no correlation was found between echocardiographic score with heart disease and therapy duration (P>0.05). Echocardiography score and remodelling process was significantly correlated (r=0.64; P<0.001).

Conclusion There is no correlation between modified Ross score and echocardiographic score. Duration of heart disease and duration of therapy are significantly negatively correlated with modified Ross scores. The remodelling process is positively correlated with echocardiographic score. Further research on acute symptomatic and validated echocardiographic scores are needed.

Hair zinc level and autism spectrum disorder in children

Tue, 28 May 2024 11:48:44 +0700

Background Autism spectrum disorder (ASD) is one of the most common neurodevelopmental disorders. In children with ASD, the neurodevelopmental and behavioral disorders are characterized by impaired quality of interaction, communication, and social imagination, with limited interest and repetitive behavior. Various studies have found that the mean zinc level is lower in children with ASD than in children without ASD, especially in the low functioning autism.

Objective To compare hair zinc level in children with and without ASD.

Methods This case-control study included children with ASD and controls without ASD. Subjects were children under 5 years old who came to Prof I.G.N.G. Ngoerah Hospital and Masadini Clinic in Denpasar. Hair zinc cut-off level was determined by the area under curve (AUC) based on the receiver operating characteristic (ROC) curve.

Results A total of 128 subjects consisted of 64 cases and 64 controls, with a mean age of 4 (SD 0.8) years. Most subjects were male (76%); 82.3% were well-nourished. The mean maternal age at delivery was 28.82 (SD 3.2) years. Subjects’ mean hair zinc level was 87.9 (SD 231.1) ?g/g. Bivariate analysis with Chi-square test revealed that children with hair zinc concentration of <33.88 ?g/g were 22.19 times more likely to have ASD than those with higher zinc levels (OR 22.19; 95%CI 8.02 to 42.09; P<0.001).

Conclusion Low hair zinc level is more likely to occur in children with ASD than in children without ASD.

Potential risk factors of pediatric acute respiratory distress syndrome in sepsis

Tue, 28 May 2024 11:22:08 +0700

Background Sepsis in children is characterized by a dysregulated host response to infection and life-threatening organ dysfunction. Pediatric acute respiratory distress syndrome (PARDS) is a severe complication of sepsis. Several known risk factors of PARDS are immunodeficiency, obesity, source of infection, and genetic factors.

Objective To describe the potential risk factors of PARDS in septic children at Haji Adam Malik General Hospital, Medan, North Sumatera.

Methods This descriptive study using eligible medical record data from sepsis patients aged 1 month – 18 years was conducted at Haji Adam Malik General Hospital in 2020–2022. A total sampling method was used for subject selection. Patients’ demographic and clinical characteristics, mechanical ventilation modes and parameters, laboratory results, and outcomes were collected from medical records. Patients were classified as having sepsis with PARDS if Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria of ARDS was met.

Results Of 112 pediatric sepsis patients, 33.9% developed PARDS. The mortality rates for PARDS was 73.7%. Of the patients with PARDS, 57.9% had immunodeficiency, 60.5% patients had an intrapulmonary infection, 39.5% had an extrapulmonary infection, and 23.7% of patients had a suspected genetic disorder. In addition, 39.5% had good nutritional status, followed by 21.1% with obese.

Conclusion The majority of patients with PARDS have intrapulmonary infection and immunodeficiency. Some of patients with PARDS have suspected genetic disorders and well nourished.

Evaluation of performance of Indonesian Sepsis National Guidelines (PNPK) 2021 in diagnosing pediatric bacterial sepsis

Tue, 04 Jun 2024 09:35:47 +0700

Background Sepsis remains one of the causes of child morbidity and mortality worldwide. The reference standard diagnosis of sepsis is blood culture, but its false negative is relatively high. Therefore, a validated triage tool is needed for rapid

diagnosis. In Indonesia, diagnosis and management of pediatric sepsis are based on Indonesian Sepsis National Guidelines 2021.

Objective To evaluate the performance of Indonesian Sepsis National Guidelines 2021 in diagnosing pediatric bacterial sepsis in PICU.

Methods This cross-sectional study was conducted in the PICU unit of Dr. Sardjito Hospital, Yogyakarta, using subject’s the medical records. All patients with suspected bacterial infection who were admitted to the PICU, had complete evaluation of PELOD-2 score, and the blood culture results were included in this study. Sepsis was assessed with Indonesian Sepsis National Guidelines 2021. Performance analysis of the guidelines was conducted with SPSS version 25, by assessing sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and likelihood ratio.

Results Two hundred subjects were enrolled in this study, of whom 52.5% were males.

Most subjects aged under one year (40.5%), and the most common infection was respiratory system (49%). A total of 63.5% were referral cases, with the length of stay in the previous hospital more than 48 hours (69.7%). There were 77% of subjects had antibiotics treatment at the previous hospital. As for outcomes, 63.5% survived and 36.5% died. The positivity rate of blood culture in this study was 19%. Performance evaluation of Sepsis Indonesian Sepsis National Guidelines 2021 revealed sensitivity 28.95%, specificity 87.65%, accuracy 76.5%, positive predictive value 35.48%, negative predictive value 84.02%, positive likelihood ratio 2.34 (95%CI 1.28 to 4.32) and negative likelihood ratio 0.81 (95%CI 0.7 to 0.94).

Conclusion Indonesian Sepsis National Guidelines 2021 (PNPK Sepsis 2021) has low sensitivity and high specificity in diagnosing bacterial sepsis.

Efficacy of lactose-free formula in acute diarrheal management for children under 5 years: a systematic review and meta-analysis

Thu, 30 May 2024 13:58:27 +0700

Background Acute diarrhea is the most common gastrointestinal disease in children under five years of age with high morbidity and mortality risk. The use of lactose-free formula in the management of children with acute diarrhea was said to accelerate the diarrheal resolution time.

Objective To determine the efficacy of lactose-free formula in managing acute diarrhea in pediatric patients by systematic review and meta-analysis.

Methods A comprehensive literature search was conducted on PubMed, Proquest, Web of Science, and CINAHL Plus Database from November 1971 to July 11^th, 2021. The study selection process was carried out under PRISMA 2020 guidelines based on several eligibility criteria. The quality of the included studies were further assessed using Modified Jadad Scores.

Results Fifteen randomized controlled trials (RCTs) were included, involving a total of 1,390 children with acute diarrhea. Shorter recovery time (MD -0.21; 95%CI -0.50 to 0.08; P=0.16) was observed in patients receiving lactose-free formula than the control group. However, this finding was not statistically significant. The subgroup analysis showed that lactose-free formula significantly shortened the recovery time compared to oral rehydration solution (ORS) group (MD -0.70; 95%CI -0.98 to -0.41; P=0.00001). Furthermore, lactose-free formula also significantly reduced the amount of stool output (MD -0.61; 95%CI -0.86 to -0.36; P=0.00001) and the incidence of persistent diarrhea more than seven days (OR 0.22; 95%CI 0.10 to 0.51; P=0.0004) compared to the control group.

Conclusion Lactose-free formula as dietary management for acute diarrhea in children can reduce stool output and the incidence of persistent diarrhea for more than seven days. It also may shorten the recovery time compared to the administration of ORS alone.

Gastroschisis survival improvement and early intervention: experience in a developing country

Mon, 10 Jun 2024 11:16:06 +0700

Background Gastroschisis is the most common abdominal congenital defect worldwide. While the mortality rate is 5–10% in developed countries, the rate escalates in developing countries due to less access to surgical care, and studies on the condition are scarce. Gastroschisis mortality and morbidity rates in Indonesia are unknown or unclear; little is also known about influencing factors that reveal epidemiological characteristics.

Objective To identify the rate and factors associated with gastroschisis mortality in Indonesia.

Methods A retrospective cohort study was conducted at Dr. Cipto Mangunkusumo Hospital, which included neonates with gastroschisis who underwent defect closure surgery from January 2015 to September 2020. We explored possible influencing risk factors, including gestational age, birth weight, number of surgeries, age at closure, and presence of gastroschisis complications. Bivariate analysis was done using Chi-square or Fisher’s test.

Results Of 49 neonates with gastroschisis, 42 were included in the study. Seven neonates were excluded due to incomplete medical records. The mortality rate of gastroschisis based on our data was 69%. The age at closure (<1 day) was significantly associated with lower mortality rate (P=0.005). In contrast, other factors, including gestational age, birth weight, number of surgeries, and the presence of complicated gastroschisis were not the risk factors of gastroschisis mortality.

Conclusion The mortality rate of gastroschisis is high in Indonesia, specifically at Dr. Cipto Mangunkusumo Hospital. Immediate closure is significantly associated with a decreased likelihood of death. Awareness, diagnosis, and efficient referral of gastroschisis from remote areas to a tertiary facility must be encouraged to reduce the high mortality rate.

Circumcision in subject with hemophilia: the Yogyakarta Method

Thu, 30 May 2024 15:39:55 +0700

Background Circumcision is one of the most common surgical procedures in boys in Indonesia. In cases patient with hemophilia (PWH), doctors tend to avoid this procedure due to increased bleeding tendency. In 2007, we developed a protocol for clotting factor concentrate (CFC) administration for circumcision in SWH, namely, the “Yogyakarta Method.”

Objective To evaluate the outcomes of the Yogyakarta Method for circumcising PWH.

Methods This descriptive study was based on medical records of PWH who underwent circumcision at Dr. Sardjito Hospital (DSH), Yogyakarta and 3 surrounding hospitals under DSH supervision from 2008-2017 and 2018-2022. Diagnoses of hemophilia were based on clinical findings and factor assays. Subjects with hemophilia A received factor VIII (25 IU/kg/dose) and those with hemophilia B received factor IX (50 IU/kg/dose) before, during and after the procedure. In addition, patients received tranexamic acid (15 mg/kg/dose). Circumcision was performed by a pediatric surgeon or urologist.

Results From 2008-2017, 28 PWH underwent circumcision, 14/28 of whom were in DSH. Twenty-six patients had hemophilia A and 2 had hemophilia B. Their severities were mild (12 subjects), moderate (10), and severe (6). Subjects’ median age was 10.5 (5-19) years and their median CFC use was 8 (range 7-10) doses in hemophilia A and 4 (range 4-5) doses in hemophilia B patients. Three of 28 PWH had bleeding episodes after the procedure. Following the encouraging results from the initial 2008-2017 study period, most of PWH circumcised in 2018-2022 underwent the procedure in the same 3 district hospitals rather than at DSH (21/28 subjects), and had similar CFC consumption. Only 1 bleeding episode occurred after the procedure during the second study period.

Conclusion The Yogyakarta method is safe and sufficient to control bleeding in circumcision of PWH. This method is also suitable in a district hospital setting.

Family functioning, parental cancer-related emotions, and quality of life in childhood cancer patients

Tue, 04 Jun 2024 08:48:19 +0700

Background Childhood cancer and its treatment affects not only children’s health, but also children’s and families’ psychosocial function, relationship, emotion, and quality of life. Several studies in developed countries have been conducted to address this issue using the Family Adaptation and Cohesion Scales (FACES) III and the Situation-Specific Emotional Reaction Questionnaire (SSERQ). Screening psychosocial problems is crucial as part of cancer comprehensive care.

Objective To investigate the dynamics of family functioning, parental cancer-related emotions, and to evaluate possible associations with the child's quality of life.

Methods This cross-sectional study was done in child with cancer aged 0-18 years. Parents completed the validated Indonesian versions of three sets of questionnaires regarding subjects’ quality of life (PedsQL), family function (FACES III), and family cancer-related emotions (SSERQ). Validity and reliability tests were done to assess the Indonesian versions of the questionnaires.

Results A total of 269 subjects were recruited. Parental proxy of PedsQL evaluations revealed that the 8-12-year-old age group had significantly lower score than the other groups (P=0.014). Solid tumor subjects had significantly lower PedsQL score compared to subjects with hematological malignancy (P=0.001). The FACES III questionnaire results showed that connected families tended to have better PedsQL score based on children’s evaluation compared to disengaged families (P=0.049). No significant difference was found between adaptability of family function and PedsQL score. The SSERQ revealed significant associations between negative emotions and lower PedsQL scores in the children (all P=0.000).

Conclusions Parental proxy of PedsQL scores were significantly lower in older children (8 to 12 years). Children with connected families have significantly higher PedsQL scores than disengaged families, for the PedsQL children’s evaluation. Parents’ emotions (loneliness, helplessness, and uncertainty) experienced by a family member of a child with cancer are also correlated with lower PedsQL scores by both evaluations.

Risk factors associated with sepsis in children with acute lymphoblastic leukemia and febrile neutropenia

An nieza Dea Versary, Susi Susanah, Anggraini Alam — Fri, 14 Jun 2024 09:18:56 +0700

Background Children with acute lymphoblastic leukemia (ALL), especially those with febrile neutropenia, are susceptible to sepsis. Several factors have been associated with the occurrence of sepsis in children with leukemia.

Objective To identify potential risk factors associated with sepsis in children with ALL and febrile neutropenia.

Methods This cross-sectional study was done in children with ALL who sought treatment at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from January 2019 to March 2022. We recorded patients’ gender, age, nutritional status, absolute neutrophil count (ANC), co-infection, prophylactic antibiotic use, and phase of chemotherapy.

Results Of 131 subjects, 57.3% were male and 42.8% were wasted. Subjects had a median age of six years old and median ANC of 230 cells/mm³. Furthermore, 48.9% of subjects had co-infections, 87.8% had not received prophylactic antibiotics, and 48.9% were in the induction phase of chemotherapy. Multiple logistic regression analysis revealed that older age [OR 1.16 (95%CI 1.04 to 1.29); ?=0.149; P=0.008] and co-infection [OR 12.9 (95%CI 5.01 to 33.21); ?=2.551; P<0.001] were significantly associated with sepsis in children with ALL and febrile neutropenia. Bronchopneumonia was the most common co-infection (72.5%).

Conclusion Older age and co-infection are significantly associated with sepsis in children with ALL and febrile neutropenia.

Risk factors of mortality in septicemic extramural neonates: an experience from resource limited setting of central India

Rajkumar Motiram Meshram, Kalyani S Kadu — Thu, 04 Apr 2024 08:54:30 +0700

Background: Sepsis is responsible for 30-40% neonatal deaths which can be attributed to various maternal, neonatal and sociocultural risk factors. Objective: To recognize the clinical and laboratory risk factors of mortality in extramural neonatal sepsis. Material and methods: Prospective observational study was conducted for duration of one year on extramural neonates with suspected sepsis. Maternal, neonatal and sociocultural factors were analyzed. Results: Average duration of hospital stay was shorter in non-survival compared to survival neonates (p=0.01). On univariate analysis preterm (p<0.001), weight<2500gms (p=0.01), home delivery (p=0.004) by Traditional Birth Attendant (p=0.003) , unbooked mother (p=0.03), peripartum febrile illness (p=0.02) and Premature rupture of membrane > 18 hours were the significant risk factors of mortality. Those neonates admitted with lethargy (p=0.04), hypothermia (p=0.01), respiratory distress (p<0.001), convulsion (p<0.0001), Jaundice (p=0.006), Apgar score <5at 1minute (p=0.01) , prolonged CFT (P<0.001), previously hospitalized (p<0.001) ,required mechanical ventilation (p=0.01),had thrombocytopenia (p=0.02), positive CRP (P<0.001), hypoglycemia (p=0.04), oxygen saturation ?90% (p=0.04), abnormal CSF/chest radiograph finding (p=0.002) had significantly higher mortality. Delivery conducted by traditional birth attendant, neonates travelled more than 80km, prematurity, bottle feed, h/o previous hospitalization, h/o lethargy, hypothermia, convulsions, prolonged CFT and isolation of micro-organisim were the independent risk factors of mortality in extramural neonates with sepsis Conclusion: Delivery conducted by traditional birth attendant, neonates travelled more than 80km, prematurity, bottle feed, h/o previous hospitalization, h/o lethargy, hypothermia, convulsions, prolonged CFT and isolation of micro-organisim were the independent risk factors of mortality in extramural neonates with sepsis.

Gardening-cooking based intervention for improving healthy eating habits in preschool children

Tue, 28 May 2024 11:43:38 +0700

Background Preschool children generally have inadequate fruit and vegetable intake, but a high intake of calories. Nutrition education taught from an early age might instill good eating habits and behavior, especially regarding fruit and vegetable consumption.

Objectives To compare preschoolers’ fruit and vegetable preferences, fiber intake, and consumption of high-calorie food before and after a gardening-cooking intervention.

Methods This study had a quasi-experimental, pre- and post-test design, as well as intervention and control groups. Subjects were preschool children aged 4-6, selected by purposive sampling, with 33 subjects in each group. The intervention group engaged in nutrition education, gardening, and cooking programs. While the control group was not given the programs, only given nutrition education at the end of data collection. Data were analyzed using independent T-test, paired T-Test, Wilcoxon, and Mann-Whitney tests.

Results There were significant increases in attitude score, fruit and vegetable preference, and fiber intake, as well as decreased intake of high calorie foods (P<0.05 for all) before and after treatment in the intervention group. In contrast, there were no significant changes in the control group pre- and post-test.

Conclusion Gardening-cooking based intervention for 9 sessions is effective in improving attitudes, fruit and vegetable preferences, and fiber intake, as well as reducing high-calorie food consumption in preschool children.

Case report of pseudomembranous colitis in a 3-year-old resulting from Clostridium difficile infection not associated with prior antibiotic therapy

Tue, 28 May 2024 11:55:37 +0700

Pseudomembranous colitis (PMC) is a serious condition caused by Clostridium difficile, frequently arising after antimicrobial therapy. In recent years, Clostridium difficile infection rates have been rising and more younger patients have been affected than adult. This case report is about a 3-year-oldboy with clinical, laboratory, and endoscopic findings typical of pseudomembranous colitis, without a history of previous antibiotic therapy.

Comparison between COVID-19 and DHF co-disease with COVID-19 alone in two pediatric sibling patients

Suryadi Nicolaas Napoleon Tatura — Tue, 28 May 2024 12:57:34 +0700

We report herein the difference between Corona virus disease-19 (COVID-19) and dengue hemorrhagic fever (DHF) co-infection compared with COVID-19 alone in two pediatric sibling patients. This case report highlights a 10-year-old boy with both COVID-19 and DHF who had less severe coagulation disorder than his sister with COVID-19 alone. In a patient with a dual infection, the presence of dengue antibodies may induce immunological protection against COVID-19. We found reports of milder symptoms in patients who had dengue prior to SARS- CoV-2 infection; however, the opposite occured when SARS-CoV-2 infection precedes dengue.