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 Clarivate Analytics (Emerging Source Citation Index/ESCI), Directory of Open Access Journals (DOAJ), Cross Ref, Google Scholar, PKP Index, and ICI Journals Master List.</p> en-US <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> (Anna Dewiyana) (Fransisca Hanum) Tue, 16 Apr 2019 08:06:26 +0700 OJS 60 Prognostic factor of heart failure in children with left-to-right shunt acyanotic congenital heart disease <p><strong><em>Background</em></strong> Anemia is highly prevalent and affects morbidity and mortality in adults with acquired heart disease. However, its role in children with acyanotic congenital heart disease (CHD) is unclear.</p> <p><strong><em>Objective</em></strong> To assess anemia and other potential prognostic factors of congestive failure in children with left-to-right shunt acyanotic CHD.</p> <p><strong><em>Methods</em></strong> We conducted a case-control study in the Pediatric Cardiology Clinic, Dr. Sardjito Hospital from January to December 2017 in children with left-to-right shunt acyanotic CHD. The case and control groups consisted of subjects with and without heart failure, respectively. Anemia was defined as hemoglobin concentration &lt;11 g/dL. Measured outcome was the prevalence of congestive heart failure, as determined by the Ross criteria. Anemia, defect type, defect size, age at diagnosis, and gender were analyzed by logistic regression analysis as potential predictive factors of heart failure.</p> <p><strong><em>Results</em></strong> Of 100 children with left-to-right shunt acyanotic CHD, 50 had heart failure (the case group) and 50 did not (the control group). The prevalence of anemia was 45%. Multivariable logistic regression revealed that defect size was the most significant factor for predicting heart failure, with adjusted OR 7.6 (95%CI 2.5 to 22.8) for moderate shunts and 21.1 (95%CI 6.8 to 65.4) for large shunts. Anemia, type of defect, age of diagnosis, and gender were not statistically significant factors for predicting outcomes.</p> <p><strong><em>Conclusion</em></strong> Anemia is not a significant, prognostic factor for heart failure in children with left-to-right shunt acyanotic CHD. However, moderate and large shunts in children with left-to-right shunt acyanotic CHD are predictive of the occurrence of congestive heart failure.</p> Weny Inrianto, Indah K. Murni, Sri Mulatsih, Sasmito Nugroho ##submission.copyrightStatement## Wed, 13 Mar 2019 10:35:02 +0700 Diagnostic value of electrocardiography for ventricular septal defect <p><strong><em>Background </em></strong>Congenital heart disease (CHD) in children requires attention from medical practitioners, because CHDs that are diagnosed early and treated promptly have good prognoses. Ventricular septal defect (VSD) is the most common type of congenital heart disease.</p> <p><strong><em>Objective </em></strong>To compare the accuracy of electrocardiography (ECG) to echocardiography in diagnosing VSD.</p> <p><strong><em>Methods</em></strong> This diagnostic study was conducted from November 2013 until July 2015. It involved patients with acyanotic CHDs who were suspected to have VSD at Dr. Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi.</p> <p><strong><em>Results</em></strong> Of 114 children screened, 97 were included and analyzed. The frequency of positive VSD was 69.1% based on ECG, and 99% based on echocardiography. There was a significant difference between ECG and echocardiography (P=0.000). However, when small VSDs were excluded, there was no significant difference between the two diagnostic tools [(P=1.000), Kappa value was 0.66, sensitivity was 98.5%, specificity was 100%, positive predictive value (PPV) was 100%, and negative predictive value (NPV) was 50%].</p> <p><strong><em>Conclusion</em></strong> There were significant differences between the ECG and echocardiography, for diagnosing VSD. However, if small VSDs were not included in the analysis, there was no difference between the two examinations, suggesting that ECG might be useful for diagnosing VSD in limited facilities hospitals.</p> Besse Sarmila, Burhanuddin Iskandar, Dasril Daud ##submission.copyrightStatement## Fri, 29 Mar 2019 07:58:56 +0700 Corticosteroids for pediatric septic shock patients <p><strong><em>Background</em></strong> Septic shock remains a major cause of mortality and admission to the pediatric intensive care unit (PICU) in children. Management includes adequate fluid resuscitation, followed by catecholamine infusion, if needed. Corticosteroid therapy is advised for catecholamine-refractory shock, although this practice is controversial, as it was not beneficial in other studies.</p> <p><strong><em>Objective</em></strong> To assess corticosteroid use in pediatric septic shock patients in Cipto Mangunkusumo Hospital.</p> <p><strong><em>Methods</em></strong> This cross-sectional study included all patients aged 1 month-18 years with a diagnosis of septic shock during the study period of January 2014 to July 2018 admitted in PICU Dr. Cipto Mangunkuskumo Hospital, Jakarta. Data obtained from medical records were, age, sex, immunology status, <em>port d’entrée </em>of sepsis, inotropic and vasopressor usage, mechanical ventilation, corticosteroid type, hospital length of stay (LOS), and mortality outcome.</p> <p><strong><em>Results</em></strong> Of 217 children with septic shock, 12 patients (5.5%) received corticosteroid therapy. The most common corticosteroid given was hydrocortisone (80%), with a 2 mg/kg BW loading dose, followed by a continuous infusion dose of 2-50 mg/kg BW/day. Almost all patients (11/12) received corticosteroid therapy until they died. Median duration of corticosteroid use was 2 (range 1-7) days, median number of inotropes and vasopressors used was 3 (range 2-4) agents, median LOS was 3 (range 1-9) days, and mortality rate was 100%.</p> <p><strong><em>Conclusion</em></strong> A small proportion of pediatric septic shock patients received corticosteroid therapy. Their mortality rate was 100%. Further clinical study is needed to evaluate the benefit of corticosteroid therapy in pediatric septic shock patients.</p> Irene Yuniar, Vembricha Nindya Manusita, Sonya Leonardy Low ##submission.copyrightStatement## Mon, 25 Feb 2019 08:21:54 +0700 Predictors of mortality in children with acute kidney injury in intensive care unit <p><strong><em>Background</em></strong> Acute kidney injury (AKI) can increase the morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Previous published studies have mostly been conducted in high-income countries. Evaluations of possible predictors of mortality in children with AKI in low- and middle-income countries have been limited, particularly in Indonesia.</p> <p><strong><em>Objective</em></strong> To assess possible predictors of mortality in children with AKI in the PICU.</p> <p><strong><em>Methods</em></strong> We conducted a retrospective cohort study at Dr. Sardjito Hospital, Yogyakarta, Indonesia. All children with AKI admitted to PICU for more than 24 hours from 2010 to 2016 were eligible and consecutively recruited into the study. Logistic regression analysis was used to identify independent predictors.</p> <p><strong><em>Results</em></strong> Of the 152 children with AKI recruited, 119 died. In order to get a P value of &lt;0.25, multivariate analysis is run to degree AKI, ventilator utilization, primary infection disease, MOF and age.Multivariate analysis showed that ventilator use, severe AKI, and infection were independently associated with mortality in children with AKI, with odds ratios (OR) of 19.2 (95%CI 6.2 to 59.7; P&lt;0.001), 8.6 (95%CI 2.7 to 27.6; P&lt;0.001), and 0.2 (95%CI 0.1 to 0.8; P=0.02), respectively.</p> <p><strong><em>Conclusion</em></strong> The use of mechanical ventilation and the presence of severe AKI are associated with mortality in children with AKI admitted to the PICU. Interestingly, the presence of infection might be a protective factor from mortality in such patients.&nbsp;</p> Umi Rakhmawati, Indah K. Murni, Desy Rusmawatiningtyas ##submission.copyrightStatement## Thu, 11 Apr 2019 10:10:22 +0700 Factors associated with insulin-like growth factor-1 in children with thalassemia major <p><strong><em>Background</em></strong> Insulin-like growth factor-1 (IGF-1) deficiency is the major cause of growth disorders and delayed puberty in children with thalassemia. Hence, identifying factors contributing to IGF-1 deficiency in thalassemia is of importance.</p> <p><strong><em>Objectives</em></strong> To evaluate the correlation between IGF-1 level and nutritional status, ferritin level, pre-transfusion hemoglobin, thyroid, as well as alanine transaminase level.</p> <p><strong><em>Methods</em></strong> We conducted a study in children aged 2 to 18 years with thalassemia major who visited outpatient clinics at two hospitals in Indonesia, Dr. Sardjito Hospital, Yogyakarta and Dr. Moewardi Hospital, Surakarta, Central Java, from July to December 2015. Clinical, laboratory, and demographic data were reviewed from medical records. IGF-1 levels were measured using an immunochemiluminiscent method.</p> <p><strong><em>Results</em></strong> A total of 48 children were recruited into the study. Subjects mean IGF-1 level was 109.28 ng/mL (SD 90.26) ng/mL. Seventy-five percent of the children had IGF-1 level &lt; -2SD. Subjects mean ferritin, pre-transfusion hemoglobin and ALT &nbsp;levels were 3.568 (SD 2131.31) ng/mL; 7.97 (SD 0.85) g/dL and 49.7 (SD 43.1), respectively. Most of the children (91.7%) was eutyroid, with a mean of TSH and FT4 level was 2.7 (SD 1.5) nmol/L and 12.3 (SD 7.1) μIU/ml, respectively.</p> <p>&nbsp;Ferritin level had no significant correlation with IGF-1 level <br>(<em>r</em>=-0.794; P=0.431). However, a strong, positive correlation was documented between pre-transfusion hemoglobin level and IGF-1 level (<em>r</em>=2.380; P=0.022). Multivariate linear regression analysis revealed that factors with significant correlations to IGF-1 level were pre-transfusion hemoglobin level &lt;8 g/dL (β=-0.090; 95%CI -0.002 to 0.182; P=0.056) and undernutrition (β=0.077; 95%CI 0.045 to 0.109; P&lt;0.001).</p> <p><strong><em>Conclusion</em></strong> Low pre-transfusion hemoglobin level and undernutrition are significantly correlated to low IGF-1 level in children with thalassemia major.</p> Muhammad Riza, Sri Mulatsih, Rina Triasih ##submission.copyrightStatement## Thu, 11 Apr 2019 09:59:03 +0700 Waist circumference, body mass index, and skinfold thickness as potential risk factors for high blood pressure in adolescents <p><strong><em>Background</em></strong> The prevalence of hypertension in children and adolescents has increased with the rising obesity epidemic. Recent studies have found that prevalence of hypertension was higher in obese children or adolescents than in the normal weight ones. Anthropometric measurements such as body mass index (BMI), waist circumference, and skinfold thickness have been used as criteria to determine obesity in children and adolescents. Increased waist circumference has been most closely related to increased blood pressure.</p> <p><strong><em>Objective</em></strong> To compare waist circumference, BMI, and skinfold thickness as potential risk factors for hypertension in adolescents.</p> <p><strong><em>Methods</em></strong> This cross-sectional study was conducted in May 2014 in three senior high schools in Medan, North Sumatera, and included 253 students with normal urinalysis test. All subjects underwent blood pressure, waist circumference, tricep- and subscapular-skinfold thickness (TST and SST), body weight, and body height measurements. The study population was categorized into underweight, normoweight, overweight, and obese, according to four different criteria: waist circumference, BMI, TST, and SST; all variables were analyzed for possible correlations with systolic and diastolic blood pressure.</p> <p><strong><em>Results</em></strong> There were significant positive correlations between systolic blood pressure and waist circumference (OR 7.933; 95%CI 2.20 to 28.65; P=0.011) as well as BMI (OR 4.137; 95%CI 1.16 to 14.75; P=0.041). There were also significant correlations between diastolic blood pressure and waist circumference (OR 3.17; 95%CI 1.83 to 5.51; P=0.002), BMI (P=0.0001; OR=3.69), TST (OR 4.73; 95%CI 2.31 to 9.69; P=0.0001), and SST (OR 3.74; 95%CI 2.35 to 5.94; P=0.0001). Multivariate analysis showed that waist circumference was a predictive factor for systolic blood pressure (OR 9.667), but not for diastolic blood pressure.</p> <p><strong><em>Conclusion</em> </strong>Waist circumference is the strongest, significant, predictive factor for elevated systolic blood pressure; meanwhile BMI, SST, and TST could be predictive factors for elevated diastolic blood pressure.&nbsp;</p> Roslina Dewi, rafita ramayati, Nelly Rosdiana, Oke Rina Ramayani, Rosmayanti Siregar, Beatrix Siregar ##submission.copyrightStatement## Fri, 22 Mar 2019 10:14:21 +0700 Relationship between serum zinc and homocysteine in children with nephrotic syndrome <p><strong><em>Background</em></strong> In children, most idiopathic nephrotic syndrome (NS) is a minimal lesion, which responds well to steroids. Hyperhomocysteinemia is pathologic and worsens NS by causing chronic inflammation, leading to glomerular sclerosis. Zinc metalloenzymes are involved in homocysteine metabolism.</p> <p><strong><em>Objective</em></strong> To assess for a possible relationship between serum zinc and homocysteine in children with NS.</p> <p><strong><em>Methods</em></strong> A cross-sectional study was conducted in children with NS aged 1-18 years, who were admitted to Hasan Sadikin Hospital from November 2017 - January 2018. Subjects were selected consecutively. Serum zinc and homocysteine were measured in all subjects. Statistical analysis was done with Pearson’s correlation test. If the distribution was not linear, the analysis was continued with non-linear regression.</p> <p><strong><em>Results </em></strong>There were 23 children who met the inclusion criteria. Mean serum homocysteine and zinc levels were 10.37 (SD 4.11) µmol/L and 51.13 (SD 29.69) µg/dL, respectively. Pearson’s correlation analysis showed no linear correlation between them (r coefficient -0.173; P=0.430). However, after adjusting for age and serum albumin level, multiple regression analysis suggested a cubical relationship between serum homocysteine and zinc, using the equation: homocysteine = -4.572 + 0.735 x zinc - 0.0012 x zinc<sup>2 </sup>+ 0.00005 x zinc<sup>3 x </sup>age (months) (R<sup>2 </sup>multiple=53.2%; P=0.012). This equation indicates that 53.2% of homocysteine variation was influenced by serum zinc concentration.</p> <p><strong><em>Conclusion </em></strong>In childhood NS, homocysteine is not correlated linearly with zinc, but related with cubical model.</p> Welli Hamik, Dany Hilmanto, Sri Endah Rahayuningsih ##submission.copyrightStatement## Mon, 15 Apr 2019 07:28:11 +0700 Risk factors for delayed speech in children aged 1-2 years <p><strong><em>Background</em></strong> Speech delay is one of the most common developmental delays in children. To minimize the negative outcomes of speech delay, risk factors should be explored to help in early patient diagnosis.</p> <p><strong><em>Objectives</em></strong> To assess for associations between delayed speech in children aged 1 to 2 years and possible risk factors including gender, gestational age, birth weight, asphyxia during birth, head circumference, anterior fontanelle closure, gross motor development, duration of breastfeeding, caregiver identity, number of siblings, exposure to gadgets and television, and social interaction.</p> <p><strong><em>Methods</em></strong> Parents of children aged 1 to 2 years who were treated at Dr. Cipto Mangunkusumo Hospital, and <em>Klinik Anakku</em>, Pondok Pinang in Jakarta from January 2018 to March 2018 were interviewed. Data were processed with <em>SPSS Statistics for Mac </em>and analyzed by Chi-square test and logistic regression method.</p> <p><strong><em>Results</em></strong> Of 126 subjects, 63 children had speech delay and 63 children had normal speech development. Multivariate analysis revealed that the significant risk factors for delayed speech were delayed gross motor development (OR 9.607; 95%CI 3.403 to 27.122; P&lt;0.001), exclusive breastfeeding for less than 6 months (OR 3.278; 95%CI 1.244 to 8.637; P=0.016), and exposure to gadgets and television for more than 2 hours daily (OR 8.286; 95%CI 2.555 to 26.871; P&lt;0.001).</p> <p><strong><em>Conclusion</em></strong> Delayed gross motor development, exclusive breastfeeding for less than 6 months, media exposure for more than 2 hours daily, and poor social interaction are risk factors for delayed speech development in children.</p> Sabrina Tan, Irawan Mangunatmadja, Tjhin Wiguna ##submission.copyrightStatement## Fri, 08 Feb 2019 00:00:00 +0700 Motor clinical progression in a series of pediatric Duchenne and Becker muscular dystrophy cases <p>Muscular dystrophy is a neuromuscular disorder that begins with muscle weakness and impaired motor function. Duchenne muscular dystrophy (DMD) is more severe and destructive than Becker muscular dystrophy (BMD), and both are progressive in nature. These 2 types of muscular dystrophy are caused by mutations in related to X-chromosome genes.<sup>1</sup> The mutations that occur in DMD are nonsense mutations. Deletion is present in 60% of DMD cases, while duplication occurs in 10% of DMD cases, resulting in loss of dystrophin protein. Mutations in BMD are missense mutations, so dystrophin is still formed, but in decreased amounts and quality.<sup>2,3</sup></p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The prevalence of DMD was reported to be three times greater than that of BMD, with a prevalence of 1.02 per 10,000 male births <em>vs</em>. 0.36 per 10,000 male infants, respectiveley.<sup>4</sup> Anatomical pathology examination revealed loss of dystrophin in the examination of muscle biopsy without the presence of evidence leading to other neuromuscular diseases. Clinical DMD symptoms begin to appear at the age of 2-4 years. The child is observed to fall often and has difficulty climbing stairs. Muscle weakness worsens, especially in the upper limbs, continuing with heart and respiratory problems. The main causes of death in DMD are respiratory failure and heart failure.<sup>5</sup> The BMD has varied clinical symptoms, beginning with the appearance of myalgia, muscle cramps, and arm weakness progressing towards myopathy. Some patients are asymptomatic until the age of 15, but 50% of patients show symptoms at age 10, and almost all by age 20.<sup>6</sup></p> Zakiah Nur Istianah, Sunartini Sunartini, Sasmito Nugroho ##submission.copyrightStatement## Wed, 13 Mar 2019 10:34:09 +0700