Paediatrica Indonesiana

Challenges and opportunities to improve tuberculosis care for Indonesian children

Mon, 24 Feb 2025 09:11:03 +0700

No abstract for editorial

Mental health problems in children with chronic disease at the pediatric inpatient ward of Dr. Cipto Mangunkusumo Hospital

Thu, 27 Feb 2025 14:40:06 +0700

Background Since the survival of a patient with chronic physical illness has improved, major concerns arise about their quality of life and functioning. Childhood and adolescence are critical periods for promoting mental health because more than half of mental health problems begin at this stage, and many of those mental health problems will persist into adult life.

Objective To analyze the risk of mental health problems among children hospitalized with chronic disease.

Method An analytic observational study with a cross-sectional design was conducted using secondary data of 754 children aged 4-18 years admitted to the pediatric inpatient ward of Cipto Mangunkusumo Hospital, Jakarta between June 2021 and August 2022. We collected the results of subjects’ mental health screening conducted by the Growth, Development, and Social Pediatrics Division, Department of Child Health, Cipto Mangunkusumo Hospital during the subjects’ admission. Mental health problems evaluated in this study included psychosocial dysfunction screened using the Pediatric Symptom Checklist 17 (PSC-17) and depression screened using the Children’s Depression Inventory (CDI).

Results Of the 754 subjects included, 520 (69.0%) were classified as having a chronic disease. The prevalence of psychosocial dysfunction and depression in children with chronic diseases was 19.6% and 6.3%, respectively. Gender, nutritional status, and height had no significant association with psychosocial dysfunction and depression in children. Children with chronic disease were more likely to develop psychosocial dysfunction (OR 2.13; 95%CI 1.31 to 3.59; P<0.001) and depression (OR 2.57; 95%CI 1.04 to 7.62; P<0.03) compared with those who did not have chronic disease.

Conclusion Children with chronic disease were more likely to develop psychosocial dysfunction and depression compared to those without a chronic disease. These results highlight the importance of mental health support in pediatric patients with chronic disease.

Urinary neutrophil gelatinase-associated lipocalin to predict acute kidney injury in children with critical illness

Fri, 28 Feb 2025 10:03:23 +0700

Background Acute kidney injury (AKI) can increase mortality in children with critical illness. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker for early prediction of AKI in children.

Objective To determine the diagnostic value of uNGAL as a predictor of AKI in children with critical illness.

Methods This observational cross-sectional study was conducted in the Emergency Room, Pediatric Intensive Care Unit, and Pediatric Ward of Zainoel Abidin Public Hospital, Banda Aceh, Indonesia, between August and December 2023. Subjects were 40 children aged 1 month to 18 years with critical illness. uNGAL levels were measured on the first day of admission. Blood urea and creatinine levels were measured on the first and third days of admission. We calculated the diagnostic sensitivity and specificity of uNGAL to predict AKI. The optimal uNGAL cut-off point for this purpose was determined using receiver operating characteristic (ROC) curve analysis.

Result In the majority of patients (29/40; 72.5%) critical illness occurred at the ages of 5 to 18 years. The most common primary diseases were central nervous system disorders in 14/40 (35%) patients, gastrointestinal infection in 6/40 (15%) patients, and malignancy in 5/40 (12.5) patients. Median uNGAL levels were significantly elevated in subjects with renal impairment [17.37 (range 6.13-29.70) ng/mL] compared to those with normal renal function [4.87 (range 0.32-29.49) ng/mL] (P=0.0001). The optimal uNGAL cut-off point was >9.99 ng/mL, with an AUC of 0.842, 81% sensitivity, and 78.9% specificity to predict AKI. The OR of AKI in children with uNGAL levels >9.99 ng/mL was 10.66 (95%CI 2.30 to 49.30; P=0.003).

Conclusion Urinary neutrophil gelatinase-associated lipocalin (uNGAL) can be used as a predictor of acute kidney injury in children with critical illness.

Community prevalence and distribution of dengue virus serotype based on antibody neutralization assay in Jakarta, Indonesia

Tue, 18 Feb 2025 08:42:10 +0700

Background Dengue infection is still rising globally despite the implementation of preventive efforts in many endemic countries. Monitoring the circulation of dengue virus (DENV) serotypes is not performed routinely in the Indonesian national surveillance program, primarily due to high cost and effort.

Objective To evaluate the distribution of DENV serotypes based on serological profile and neutralizing antibody level against all four DENV serotypes in Jakarta, Indonesia.

Methods This cross-sectional study was performed as part of a dengue vaccine effectiveness study, 10 years after a dengue vaccination program was initiated. It was conducted in five community public health centers in Jakarta in subjects aged 12 years and above who had not received the dengue vaccine. We collected serum samples and DENV neutralizing antibody titers were measured using a plaque reduction neutralization test (PRNT).

Results Eighty healthy subjects with a median age of 15 (range 12-27) years were enrolled. The highest median antibody titer was that to DENV-2 [898 (range 29-91558) 1/dil], followed by that to DENV-3 [297.5 (range 10-36091); 1/dil], DENV-1 [288 (range 0-68237) 1/dil], and DENV-4 [164 (range 0-35812) 1/dil]. Neutralizing antibodies against the four DENV serotypes were found in all the 5 districts studied in Jakarta. A multitypic neutralizing antibody profile was observed in the majority (74/80 subjects; 92.5%). Three subjects were naïve.

Conclusion All four dengue serotypes are widely circulating in Jakarta based on neutralizing antibody detection in the community, with the highest neutralizing antibody titer being against DENV-2, followed by DENV-3, DENV-1 and DENV-4.

Risk factors of drug-resistant epilepsy in children under three-year-old

Suryawati Sukmono, Irawan Mangunatmadja, Sudung O. Pardede — Fri, 28 Feb 2025 09:15:04 +0700

Background Repeated seizures may result in chronic injury to the brain, triggering the neuroplasticity process that can cause or augment existing pathological processes. High neuroplasticity during first 3 year of life may influence the clinical course and outcome of children with epilepsy.

Objective To evaluate initial risk factors and evolution risk factors during treatment to predict drug-resistant epilepsy in children under 3 years old. Initial risk factors consist of initial seizure frequency, seizure type, imaging result, history of febrile convulsion, neurodevelopmental status and initial electroencephalography (EEG) result. Evolution risk factors evaluate changes in initial risk factors and seizure control after treatment. Evolution risk factors consist of early response to therapy (seizure control during the first 6 months of treatment), evolution of seizure type and frequency, changes in EEG (background rhythm and epileptiform discharges) during treatment and neurodevelopmental evolution.

Methods This retrospective cohort study used medical record data of pediatric patients 1 month to 3 years old with drug-resistant epilepsy seeking treatment at Cipto Mangunkusumo Hospital, Anakku Clinic Pondok Pinang, and National Brain Center Hospital, Jakarta, from 2015 to 2020.

Results Thirty-three subjects met drug-resistant epilepsy criteria. Abnormal EEG was the only initial risk factor significantly associated with drug-resistant epilepsy (OR 4.48; 95%CI 1.82 to 11.03; P=0.001). Increased seizure frequency (aOR 7.0; 95%CI 1.0 to 49.7; P=0.048) and seizure persistence during the first six months of treatment (aOR 10.92; 95%CI 2.6 to 45.87; P=0.01) were significantly related with drug-resistant epilepsy.

Conclusion Abnormal initial EEG result was the only initial risk factor associated with drug-resistant epilepsy. Evolution risk factors associated with drug-resistant epilepsy were increased seizure frequency and seizure persistence in the first six months of treatment.

Medical and non-medical factors associated with stunting in infants and toddlers aged 3-59 months in Palembang

Tue, 18 Feb 2025 09:53:18 +0700

Background Although the prevalence of stunting in South Sumatera is estimated to be relatively high, there have been few studies to date on stunting and the factors associated with it in the region.

Objective To determine the proportion of stunting in infants and toddlers aged 3-59 months at Mohammad Hoesin General Hospital (RSMH), Palembang, South Sumatera, and to identify medical and non-medical factors associated with stunting in these children.

Methods A cross-sectional study was conducted at RSMH from April to September 2023. Stunting was defined according to the WHO standard and combined with a growth pattern that reflects chronic malnutrition. We recorded the proportion of stunting as well as data on several potential medical and non-medical risk factors of stunting.

Results A total of 183 subjects met the inclusion criteria. The overall proportion of stunting was 65/183 (35.5%). The proportion of stunting was higher in boys (39.6%) and in children <2 years of age (38.2%). Medical risk factors significantly associated with stunting were infectious disease [OR 4.13 (95%CI 1.91 to 8.94); P=0.001] and chronic disease [OR 3.02 (95%CI 1.56 to 5.85); P=0.001]. The only non-medical factor significantly associated with stunting was low paternal education level [OR 2.45 (95%CI 1.17 to 5.15); P=0.016].

Conclusion During the study period, over a third of pediatric patients at RSMH experienced stunting. Infectious disease, chronic disease, and low paternal education level were significant risk factors that contributed to the occurrence of stunting.

The mTOR and total protein levels of stunted children

Ria Andreinie, Ninik Mudjihartini, Dian Novita Chandra, Rini Sekartini — Thu, 27 Feb 2025 14:39:35 +0700

Background Malnutrition is still a major health problem for children, with stunting being one of its manifestations. Human growth is in part controlled by the mammalian target of rapamycin (mTOR) pathway. Studies reviewing mTOR level and growth disorders in children are still limited and no research has described mTOR levels in stunted children in Indonesia.

Objective To assess for a relationship between mTOR and total protein levels in blood plasma in stunted children aged 6-24 months and compare these levels with those in non-stunted children.

Methods This case-control study was conducted in South Sumatra Province, Indonesia. Subjects were children aged 6-24 months. The inclusion criteria for the case group are children who have a length-for-age of <-2SD and the control group are children who have a body length according to age of more than or equal to -2 SD from the WHO growth standard chart. Anthropometric measurements were plotted on the WHO Growth Standards chart, while mTOR and total protein levels were measured using an ELISA method and spectrophotometry, respectively.

Results Of 142 subjects, 71 children were allocated into each case and control group. Child characteristics that were significantly different between the two groups were age (P=0.002), birth length (P=0.012), weight-for-age Z-score (WAZ) (P<0.001), and body mass index (BMI) (P=0.015).

WAZ status with the categories underweight and severely underweight had a higher risk of stunting. The mTOR and total protein levels between the two groups were not significantly different.

Conclusion Further research is needed to explain the mechanism of mTOR signal deviations in children's growth and development, as mTOR and protein levels are not significantly different in stunted and non-stunted children.