Pub Date : 2023-06-29DOI: 10.14238/pi63.3.2023.181-8
Tri Yanti Rahayuningsih, S. Putra, P. B. Yanuarso, Zulham Effendy
Background Children with Down syndrome (DS) differ from typical children because of many genetic-related aspects that may affect outcomes after congenital heart surgery. To date, there have been no studies on outcomes after congenital heart surgery on pediatric DS patients in Indonesia. Objective To determine outcomes and mortality in DS patients who underwent heart surgery at Dr. Cipto Mangunkusumo Hospital, Jakarta. Methods A prospective and retrospective cohort study was conducted in DS patients aged <15 years who underwent heart surgery from July 2007 to April 2015. The control group were patients in the same age range without DS who underwent heart surgery for various types of heart defects. Results There were 57 DS and 43 non-DS patients during study period. The types of heart defects found in DS patients were atrioventricular septal defect (AVSD) and ventricular septal defect (VSD) in 18/57 (31.6%) patients each, tetralogy of Fallot (12/57; 21%), atrial septal defect (ASD) (4/57; 7%), patent ductus arteriosus (PDA) (4/57; 7%) and transposition of the great arteries with VSD (TGA-VSD) (1/57; 1.8%). DS patients showed an increased incidence of preoperative PH (63.1%) compared to non-DS patients (25.6%). Median duration of surgery was longer in DS [2.9 (range 0.5-5.8) hours] than in non-DS [2.2 (range 0.7-4.7) hours]. DS patients have a longer mean cardiopulmonary bypass duration [79.5 (SD 33.9) minutes] compared to non-DS [59.9 (SD 23.6) minutes], longer mean aortic cross-clamp duration [45.3 (SD 23.7) minutes] compared to non-DS [34.8 (SD 15.7)]. There were significant differences in the incidence of preoperative pulmonary hypertension, surgical time, duration of cardiopulmonary bypass (CPB), and length of the aortic cross-clamp in DS patients compared to non-DS (P<0.05). Median length of ICU stay was 1.9 (range 0.6 to 34) days in DS and 1 (range 0.3 to 43) day in non-DS patients (P=0.373). Median duration of mechanical ventilation [19.9 (range 3-540) vs. 8 (range 3-600) hours (P=0.308)], rate of pulmonary complications [14/57 (24.6%) vs. 6/43 (14%) patients (P=0.216)], and incidence of sepsis [16/57 (28.1%) vs. 6/43 (14%) patients (P=0.143)] were not significantly different between DS and non-DS patients. However, complete atrioventricular (AV) block only occurred in DS patients [6/57 (10.5%)]. In the DS group, 5/57 (8.8%) patients died. There was no mortality in the non-DS group. Conclusion Morbidity and mortality after cardiac surgery in were higher in DS than in non-DS patients. DS patients may have problems related to preoperative PH, AV block, longer surgical time, duration of CPB, and aortic cross-clamp compared to non-DS.
{"title":"Short-term outcomes following congenital heart surgery in children with Down syndrome","authors":"Tri Yanti Rahayuningsih, S. Putra, P. B. Yanuarso, Zulham Effendy","doi":"10.14238/pi63.3.2023.181-8","DOIUrl":"https://doi.org/10.14238/pi63.3.2023.181-8","url":null,"abstract":"Background Children with Down syndrome (DS) differ from typical children because of many genetic-related aspects that may affect outcomes after congenital heart surgery. To date, there have been no studies on outcomes after congenital heart surgery on pediatric DS patients in Indonesia. \u0000Objective To determine outcomes and mortality in DS patients who underwent heart surgery at Dr. Cipto Mangunkusumo Hospital, Jakarta. \u0000Methods A prospective and retrospective cohort study was conducted in DS patients aged <15 years who underwent heart surgery from July 2007 to April 2015. The control group were patients in the same age range without DS who underwent heart surgery for various types of heart defects. \u0000Results There were 57 DS and 43 non-DS patients during study period. The types of heart defects found in DS patients were atrioventricular septal defect (AVSD) and ventricular septal defect (VSD) in 18/57 (31.6%) patients each, tetralogy of Fallot (12/57; 21%), atrial septal defect (ASD) (4/57; 7%), patent ductus arteriosus (PDA) (4/57; 7%) and transposition of the great arteries with VSD (TGA-VSD) (1/57; 1.8%). DS patients showed an increased incidence of preoperative PH (63.1%) compared to non-DS patients (25.6%). Median duration of surgery was longer in DS [2.9 (range 0.5-5.8) hours] than in non-DS [2.2 (range 0.7-4.7) hours]. DS patients have a longer mean cardiopulmonary bypass duration [79.5 (SD 33.9) minutes] compared to non-DS [59.9 (SD 23.6) minutes], longer mean aortic cross-clamp duration [45.3 (SD 23.7) minutes] compared to non-DS [34.8 (SD 15.7)]. There were significant differences in the incidence of preoperative pulmonary hypertension, surgical time, duration of cardiopulmonary bypass (CPB), and length of the aortic cross-clamp in DS patients compared to non-DS (P<0.05). Median length of ICU stay was 1.9 (range 0.6 to 34) days in DS and 1 (range 0.3 to 43) day in non-DS patients (P=0.373). Median duration of mechanical ventilation [19.9 (range 3-540) vs. 8 (range 3-600) hours (P=0.308)], rate of pulmonary complications [14/57 (24.6%) vs. 6/43 (14%) patients (P=0.216)], and incidence of sepsis [16/57 (28.1%) vs. 6/43 (14%) patients (P=0.143)] were not significantly different between DS and non-DS patients. However, complete atrioventricular (AV) block only occurred in DS patients [6/57 (10.5%)]. In the DS group, 5/57 (8.8%) patients died. There was no mortality in the non-DS group. \u0000Conclusion Morbidity and mortality after cardiac surgery in were higher in DS than in non-DS patients. DS patients may have problems related to preoperative PH, AV block, longer surgical time, duration of CPB, and aortic cross-clamp compared to non-DS.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90801253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.14238/pi63.3.2023.152-61
Nanda Andini, Lili Rohmawati, E. Fikri, Bugis Mardina
Background Sepsis is one of the main causes of neonatal mortality. The morbidity and mortality rates due to neonatal sepsis are as high as 9-20%. Premature rupture of membranes (PROM) and preterm gestational age are among the risk factors of neonatal sepsis. Objective To evaluate for potential associations between PROM as well as preterm gestational age to neonatal sepsis by meta-analysis and systematic review. Methods A meta-analysis and systematic review were performed using literature sourced from PubMed, Cochrane, and Google Scholar according to PRISMA guidelines. We calculated the incidence of sepsis in neonates with and without PROM and premature gestational age. Journal quality was assessed according to the Newcastle-Ottawa Scale (NOS) criteria. Results From the literature search for PROM, 21 case-control studies met the inclusion criteria. Neonatal sepsis was more common in neonates who had a maternal history of PROM than in those without [OR 2.69 (95%CI 1.56 to 4.65); P<0.00001]. From the literature search for gestational age, we found 17 case-control studies that met the inclusion criteria. Neonatal sepsis was more common in preterm than term neonates [OR 2.55 (95%CI 1.61 to 4.04); P<0.00001]. Conclusion Neonates with a maternal history of PROM and/or preterm gestational age are at high risk of developing neonatal sepsis.
{"title":"The association between premature rupture of membranes (PROM) and preterm gestational age with neonatal sepsis: a systematic review and meta-analysis","authors":"Nanda Andini, Lili Rohmawati, E. Fikri, Bugis Mardina","doi":"10.14238/pi63.3.2023.152-61","DOIUrl":"https://doi.org/10.14238/pi63.3.2023.152-61","url":null,"abstract":"Background Sepsis is one of the main causes of neonatal mortality. The morbidity and mortality rates due to neonatal sepsis are as high as 9-20%. Premature rupture of membranes (PROM) and preterm gestational age are among the risk factors of neonatal sepsis. \u0000Objective To evaluate for potential associations between PROM as well as preterm gestational age to neonatal sepsis by meta-analysis and systematic review. \u0000Methods A meta-analysis and systematic review were performed using literature sourced from PubMed, Cochrane, and Google Scholar according to PRISMA guidelines. We calculated the incidence of sepsis in neonates with and without PROM and premature gestational age. Journal quality was assessed according to the Newcastle-Ottawa Scale (NOS) criteria. \u0000Results From the literature search for PROM, 21 case-control studies met the inclusion criteria. Neonatal sepsis was more common in neonates who had a maternal history of PROM than in those without [OR 2.69 (95%CI 1.56 to 4.65); P<0.00001]. From the literature search for gestational age, we found 17 case-control studies that met the inclusion criteria. Neonatal sepsis was more common in preterm than term neonates [OR 2.55 (95%CI 1.61 to 4.04); P<0.00001]. \u0000Conclusion Neonates with a maternal history of PROM and/or preterm gestational age are at high risk of developing neonatal sepsis.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"88 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84168635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background There has been a resurgence of measles infection in countries with high vaccination rates, including Malaysia. Understanding the geographical variation in measles resurgence and associated factors is important for measles prevention and control programs, especially where local information is scarce. Objective To determine the incidence of laboratory-confirmed measles infection and associated factors in the state of Melaka, in the southern region of Malaysia. Methods We obtained measles surveillance data for 4 years (January 2015 to December 2018) from the e-Measles national database. A comparative cross-sectional study was carried out on these data involving children who had been selected through convenience sampling. Results A total of 130 laboratory-confirmed measles cases and 213 non-measles cases were included in the study. Among the laboratory-confirmed cases, 56 (43.1%) had not been vaccinated against measles virus. Thirty-eight cases (51.4%) had received at least one dose of measles vaccine, while 36 cases (48.6%) had completed two doses of measles vaccination. There was a higher risk of contracting laboratory-confirmed measles among unvaccinated children (OR 19.39, 95%CI 8.82 to 42.6, P<0.001) and children aged 8–18 years (OR 0.40, 95% CI 0.21 to 0.76, P=0.005) Conclusion Unvaccinated children and children aged 8–18 years have a higher risk of contracting laboratory-confirmed measles. The policy on routine immunization should be strengthened, the vaccine should be accessible to all children, and all children and adolescents should be given booster vaccinations.
{"title":"Resurgence of measles infection among children: findings from a surveillance-based population study","authors":"Na’eemah Zaini, Idayu Badilla Idris, Intan Azura Mhd. Din, Norfazilah Ahmad","doi":"10.14238/pi63.3.2023.162-8","DOIUrl":"https://doi.org/10.14238/pi63.3.2023.162-8","url":null,"abstract":"Background There has been a resurgence of measles infection in countries with high vaccination rates, including Malaysia. Understanding the geographical variation in measles resurgence and associated factors is important for measles prevention and control programs, especially where local information is scarce. \u0000Objective To determine the incidence of laboratory-confirmed measles infection and associated factors in the state of Melaka, in the southern region of Malaysia. \u0000Methods We obtained measles surveillance data for 4 years (January 2015 to December 2018) from the e-Measles national database. A comparative cross-sectional study was carried out on these data involving children who had been selected through convenience sampling. \u0000Results A total of 130 laboratory-confirmed measles cases and 213 non-measles cases were included in the study. Among the laboratory-confirmed cases, 56 (43.1%) had not been vaccinated against measles virus. Thirty-eight cases (51.4%) had received at least one dose of measles vaccine, while 36 cases (48.6%) had completed two doses of measles vaccination. There was a higher risk of contracting laboratory-confirmed measles among unvaccinated children (OR 19.39, 95%CI 8.82 to 42.6, P<0.001) and children aged 8–18 years (OR 0.40, 95% CI 0.21 to 0.76, P=0.005) \u0000Conclusion Unvaccinated children and children aged 8–18 years have a higher risk of contracting laboratory-confirmed measles. The policy on routine immunization should be strengthened, the vaccine should be accessible to all children, and all children and adolescents should be given booster vaccinations.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"5 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81587881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.14238/pi63.3.2023.173-80
Adhi Teguh Perma Iskandar, Ahmad Kautsar, A. Rahmadhany, Risma K Kaban, B. Supriyatno, J. Prihartono, D. I. Santoso, Tetty Yuniarti, N. Advani, M. M. Djer, Fiolita I. Sutjipto
Background Lung recruitment maneuvers (LRMs) are a strategy to gradually increase mean positive airway pressure (MAP) to expand the alveoli, leading to decreased pulmonary vascular resistance and increased cardiac output (CO). However, the hemodynamic impact of LRM using assist control volume guarantee (AC-VG) ventilator mode done in preterm infants born at 24 to 32 weeks’ gestation, especially in the first 72 hours of life, remains unknown. Objective To determine the effect of LRM on right- and left cardiac ventricular output (RVO and LVO), ductus arteriosus (DA) diameter and its pulmonary hypertension (PH) flow pattern, as well as superior mesenteric artery (SMA) flow. Method This randomized, controlled, single-blinded clinical trial was performed in 24-32-week preterm neonates with birth weights of >600 grams. Subjects were allocated by block randomization to the LRM and control groups, each containing 55 subjects. We measured RVO, LVO, DA diameter, PH flow pattern, and SMA resistive index (RI) at 1 and 72 hours after mechanical ventilation was applied. We analyzed for hemodynamic differences between the two groups. Results During the initial 72 hours of mechanical ventilation, there were no significant differences between the control vs. LRM groups in mean changes of LVO [41.40 (SD 91.21) vs. 15.65 (SD 82.39) mL/kg/min, respectively; (P=0.138)] or mean changes of RVO [65.56 (SD 151.20) vs. 70.59 (SD 133.95) mL/kg/min, respectively; (P=0.859)]. Median DA diameter reduction was -0.08 [interquartile range (IQR) -0.55; 0.14] mm in the control group and -0.10 (IQR -0.17 to -0.01) mm in the LRM group (P=0.481). Median SMA resistive index was 0.02 (IQR -0.16 to 0.24) vs. 0.01(IQR -0.20 to 0.10) in the control vs. LRM group, respectively. There was no difference in proportion of pulmonary hypertension flow pattern at 72 hours (25.4% vs. 20% in the control vs. LRM group, respectively) (P=0.495). Conclusion When preterm infants of 24-32 weeks gestational age are placed on mechanical ventilation, LRM gives neither additional hemodynamic benefit nor harm compared to standard ventilator settings.
{"title":"Effects of lung recruitment maneuvers using mechanical ventilator on preterm hemodynamics","authors":"Adhi Teguh Perma Iskandar, Ahmad Kautsar, A. Rahmadhany, Risma K Kaban, B. Supriyatno, J. Prihartono, D. I. Santoso, Tetty Yuniarti, N. Advani, M. M. Djer, Fiolita I. Sutjipto","doi":"10.14238/pi63.3.2023.173-80","DOIUrl":"https://doi.org/10.14238/pi63.3.2023.173-80","url":null,"abstract":"Background Lung recruitment maneuvers (LRMs) are a strategy to gradually increase mean positive airway pressure (MAP) to expand the alveoli, leading to decreased pulmonary vascular resistance and increased cardiac output (CO). However, the hemodynamic impact of LRM using assist control volume guarantee (AC-VG) ventilator mode done in preterm infants born at 24 to 32 weeks’ gestation, especially in the first 72 hours of life, remains unknown. \u0000Objective To determine the effect of LRM on right- and left cardiac ventricular output (RVO and LVO), ductus arteriosus (DA) diameter and its pulmonary hypertension (PH) flow pattern, as well as superior mesenteric artery (SMA) flow. \u0000Method This randomized, controlled, single-blinded clinical trial was performed in 24-32-week preterm neonates with birth weights of >600 grams. Subjects were allocated by block randomization to the LRM and control groups, each containing 55 subjects. We measured RVO, LVO, DA diameter, PH flow pattern, and SMA resistive index (RI) at 1 and 72 hours after mechanical ventilation was applied. We analyzed for hemodynamic differences between the two groups. \u0000Results During the initial 72 hours of mechanical ventilation, there were no significant differences between the control vs. LRM groups in mean changes of LVO [41.40 (SD 91.21) vs. 15.65 (SD 82.39) mL/kg/min, respectively; (P=0.138)] or mean changes of RVO [65.56 (SD 151.20) vs. 70.59 (SD 133.95) mL/kg/min, respectively; (P=0.859)]. Median DA diameter reduction was -0.08 [interquartile range (IQR) -0.55; 0.14] mm in the control group and -0.10 (IQR -0.17 to -0.01) mm in the LRM group (P=0.481). Median SMA resistive index was 0.02 (IQR -0.16 to 0.24) vs. 0.01(IQR -0.20 to 0.10) in the control vs. LRM group, respectively. There was no difference in proportion of pulmonary hypertension flow pattern at 72 hours (25.4% vs. 20% in the control vs. LRM group, respectively) (P=0.495). \u0000Conclusion When preterm infants of 24-32 weeks gestational age are placed on mechanical ventilation, LRM gives neither additional hemodynamic benefit nor harm compared to standard ventilator settings.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"11 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74882546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.14238/pi63.3.2023.169-72
Paediatrica Indonesiana, M. F. Huzein, Nadirah Rasyid, D. Daud, M. F. Huzein
Background Transforming growth factor-? (TGF-?) expression contributes to the growth of retinoblastoma. TGF-? is produced or released by infiltrating cells such as lymphocytes and monocytes/macrophages. TGF-? levels are a potential marker of disease severity. Objective To assess the difference in serum TGF-? levels before chemotherapy in patients with retinoblastoma grades III and IV. Methods This cross-sectional observational study was done at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia from January to November 2019. Subjects were pediatric patients with grade III and IV retinoblastoma who had not undergone chemotherapy. Patients who met the inclusion criteria provided blood specimens for TGF-? testing. We analyzed the difference in serum TGF-? level between grade III and grade IV patients. Results We obtained 38 subjects, consisting of 13 grade III and 25 grade IV retinoblastoma patients. Mean TGF-? levels were in 1,061 ng/L in grade III and 988 ng/L in grade IV patients. The Mann-Whitney U test revealed no significant difference between the levels of TGF-?, retinoblastoma grade III and IV (P=0.655). However, TGF-? levels in both groups were markedly above the normal value (100 ng/L). Conclusion TGF-? levels are markedly increased in grade III and IV retinoblastoma patients. There was no significant difference in TGF-? level between grade III and IV patients. Our findings suggest that TGF-? plays an important role in tumor cell development. Further research on differences in TGF-? levels between late stages (grades III and IV) and early stages (grades I and II) of retinoblastoma to elucidate the role of TGF-? as a marker of retinoblastoma severity.
{"title":"Serum transforming growth factor-beta levels and severity of retinoblastoma in children","authors":"Paediatrica Indonesiana, M. F. Huzein, Nadirah Rasyid, D. Daud, M. F. Huzein","doi":"10.14238/pi63.3.2023.169-72","DOIUrl":"https://doi.org/10.14238/pi63.3.2023.169-72","url":null,"abstract":"Background Transforming growth factor-? (TGF-?) expression contributes to the growth of retinoblastoma. TGF-? is produced or released by infiltrating cells such as lymphocytes and monocytes/macrophages. TGF-? levels are a potential marker of disease severity. \u0000Objective To assess the difference in serum TGF-? levels before chemotherapy in patients with retinoblastoma grades III and IV. \u0000Methods This cross-sectional observational study was done at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia from January to November 2019. Subjects were pediatric patients with grade III and IV retinoblastoma who had not undergone chemotherapy. Patients who met the inclusion criteria provided blood specimens for TGF-? testing. We analyzed the difference in serum TGF-? level between grade III and grade IV patients. \u0000Results We obtained 38 subjects, consisting of 13 grade III and 25 grade IV retinoblastoma patients. Mean TGF-? levels were in 1,061 ng/L in grade III and 988 ng/L in grade IV patients. The Mann-Whitney U test revealed no significant difference between the levels of TGF-?, retinoblastoma grade III and IV (P=0.655). However, TGF-? levels in both groups were markedly above the normal value (100 ng/L). \u0000Conclusion TGF-? levels are markedly increased in grade III and IV retinoblastoma patients. There was no significant difference in TGF-? level between grade III and IV patients. Our findings suggest that TGF-? plays an important role in tumor cell development. Further research on differences in TGF-? levels between late stages (grades III and IV) and early stages (grades I and II) of retinoblastoma to elucidate the role of TGF-? as a marker of retinoblastoma severity.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"14 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81816542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-27DOI: 10.14238/pi63.3.2023.146-51
Meilani Puspasari Simarmata, Nelly Rosdiana, A. Wahyuni
Background Leukemia is the most common malignancy in childhood. Malnutrition is the main nutritional disorder occurring in children with cancer. Nutritional supportive care is a medical modality that has been associated with improved tolerance to chemotherapy, survival, and quality of life, as well as decreased risk of infection in children undergoing cancer therapy. Objective To examine differences in induction phase outcomes in well-nourished and malnourished pediatric acute lymphoblastic leukemia (ALL) patients. Methods This prospective study was conducted in newly-diagnosed ALL patients aged 1 to 18 years who underwent induction phase chemotherapy at Haji Adam Malik General Hospital, Medan, North Sumatera. Mid-upper arm circumference (MUAC) was used to determine nutritional status. Patient characteristics such as complete blood count (CBC) at the time of diagnosis, occurrence of febrile neutropenia, duration of induction, length of hospital stay, and remission status were collected. We analyzed differences in CBC, frequency of febrile neutropenia, as well as duration of induction and hospital stay between well-nourished and malnourished patients. We also assessed the difference in remission attainment between the two groups. Results There were 21 subjects in each group. Compared to well-nourished subjects, malnourished ones had a higher median incidence of febrile neutropenia [1 (range 0 to 30) vs. 3 (range 0 to 4); P=0.04], longer mean induction duration [64.2 (SD 11.5) vs. 71.2 (SD 10.6) days; P=0.046], and longer median hospital stay [30 (range 19 to 56) vs. 36 (range 22 to 49) days; P=0.001] compared to well-nourished subjects. There was no significant difference in CBC parameters and remission status after induction between the two groups. Conclusion Malnourished pediatric ALL patients had a significantly higher incidence of febrile neutropenia, duration of induction phase, and duration of hospital stay compared to well-nourished ALL patients.
{"title":"Differences in induction phase outcomes of acute lymphoblastic leukemia between well-nourished and malnourished pediatric patients","authors":"Meilani Puspasari Simarmata, Nelly Rosdiana, A. Wahyuni","doi":"10.14238/pi63.3.2023.146-51","DOIUrl":"https://doi.org/10.14238/pi63.3.2023.146-51","url":null,"abstract":"Background Leukemia is the most common malignancy in childhood. Malnutrition is the main nutritional disorder occurring in children with cancer. Nutritional supportive care is a medical modality that has been associated with improved tolerance to chemotherapy, survival, and quality of life, as well as decreased risk of infection in children undergoing cancer therapy. \u0000Objective To examine differences in induction phase outcomes in well-nourished and malnourished pediatric acute lymphoblastic leukemia (ALL) patients. \u0000Methods This prospective study was conducted in newly-diagnosed ALL patients aged 1 to 18 years who underwent induction phase chemotherapy at Haji Adam Malik General Hospital, Medan, North Sumatera. Mid-upper arm circumference (MUAC) was used to determine nutritional status. Patient characteristics such as complete blood count (CBC) at the time of diagnosis, occurrence of febrile neutropenia, duration of induction, length of hospital stay, and remission status were collected. We analyzed differences in CBC, frequency of febrile neutropenia, as well as duration of induction and hospital stay between well-nourished and malnourished patients. We also assessed the difference in remission attainment between the two groups. \u0000Results There were 21 subjects in each group. Compared to well-nourished subjects, malnourished ones had a higher median incidence of febrile neutropenia [1 (range 0 to 30) vs. 3 (range 0 to 4); P=0.04], longer mean induction duration [64.2 (SD 11.5) vs. 71.2 (SD 10.6) days; P=0.046], and longer median hospital stay [30 (range 19 to 56) vs. 36 (range 22 to 49) days; P=0.001] compared to well-nourished subjects. There was no significant difference in CBC parameters and remission status after induction between the two groups. \u0000Conclusion Malnourished pediatric ALL patients had a significantly higher incidence of febrile neutropenia, duration of induction phase, and duration of hospital stay compared to well-nourished ALL patients.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"72 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73599006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-27DOI: 10.14238/pi63.3.2023.208-12
Pierluigi Morreale, Veronica Notarbartolo, Giancarlo Allegro, Mario Giuseppe Vallone, Francesca Finazzo, Vincenzo Antona, Maria Fiorella Sanfilippo, Calogero Comparato
Pulmonary arteriovenous malformations (PAVMs) in children are rare lesions characterized by abnormal low resistance vascular structures connecting a pulmonary artery to a pulmonary vein, resulting in an intrapulmonary right-to-left shunt. The insidious onset and variable signs and symptoms make diagnosis difficult, especially in children. PAVMs can be single or multiple, congenital or acquired, and up to 47-80% of cases are associated with hereditary hemorrhagic telangiectasia (HHT).
{"title":"Pulmonary arteriovenous malformation as a cause of exercise intolerance in children: a case report","authors":"Pierluigi Morreale, Veronica Notarbartolo, Giancarlo Allegro, Mario Giuseppe Vallone, Francesca Finazzo, Vincenzo Antona, Maria Fiorella Sanfilippo, Calogero Comparato","doi":"10.14238/pi63.3.2023.208-12","DOIUrl":"https://doi.org/10.14238/pi63.3.2023.208-12","url":null,"abstract":"Pulmonary arteriovenous malformations (PAVMs) in children are rare lesions characterized by abnormal low resistance vascular structures connecting a pulmonary artery to a pulmonary vein, resulting in an intrapulmonary right-to-left shunt. The insidious onset and variable signs and symptoms make diagnosis difficult, especially in children. PAVMs can be single or multiple, congenital or acquired, and up to 47-80% of cases are associated with hereditary hemorrhagic telangiectasia (HHT).","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"269 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135503203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-26DOI: 10.14238/pi63.3.2023.136-45
G. Ilmana, Z. Munasir, N. Chozie, B. Medise
Background Quality of life is an important outcome in the management of children with chronic conditions such as rheumatic diseases. The Pediatric Quality of Life Inventory Rheumatology Module (PedsQL-RM) questionnaire has been proven valid and reliable, but a validated Indonesian version of the questionnaire is not yet available. Objective To translate the PedsQL-RM into the Indonesian language, perform a transcultural adaptation, and assess its validity. Methods A cross-sectional study was performed in patients aged 2 to 18 years with systemic lupus erythematosus (SLE) or juvenile idiopathic arthritis (JIA) in Dr. Cipto Mangunkusumo Hospital, Jakarta. The initial phase of the study consisted of forward translation from the original English version into Indonesian, synthesis by experts, backward translation, and cognitive debriefing, resulting in the final version of the questionnaire. The second phase was testing the final questionnaire on patients in each age group and their parents. Tests were carried out in two sessions with an interval of 2 to 4 weeks. The questionnaire consisted of a child report and a parent report, each measuring five dimensions: pain and hurt, activities, treatment, worry, and communication. We subsequently assessed validity and reliability of each dimension in the child and parent reports for the child and teen age groups. Validity was expressed as correlation coefficient (r) between dimension scores with the total score. Results The finalized Indonesian questionnaire was completed by 53 children aged 2-18 years with SLE or JIA and their parents. Due to small numbers of subjects in the younger age ranges, analysis was only performed in the 8-to-18-year age group. Validity varied from good to very good (r = 0.437 to 0.910) for the child report and from poor to good (r = 0.153 to 0.808) for the parent report. The questionnaire was deemed reliable, with a Cronbach’s alpha of 0.755 to 0.785. Conclusion The Indonesian version of the PedsQL-RM is valid and reliable for assessing quality of life in children aged 8 to 18 years with rheumatologic disease. Further study is needed to assess the validity and reliability of the tool for children aged 2 to 7 years.
{"title":"Translation, cultural adaptation, and validation of the Indonesian version of Pediatric Quality of Life Inventory Rheumatology Module (PedsQL-RM) questionnaire for children with rheumatic diseases","authors":"G. Ilmana, Z. Munasir, N. Chozie, B. Medise","doi":"10.14238/pi63.3.2023.136-45","DOIUrl":"https://doi.org/10.14238/pi63.3.2023.136-45","url":null,"abstract":"Background Quality of life is an important outcome in the management of children with chronic conditions such as rheumatic diseases. The Pediatric Quality of Life Inventory Rheumatology Module (PedsQL-RM) questionnaire has been proven valid and reliable, but a validated Indonesian version of the questionnaire is not yet available. \u0000Objective To translate the PedsQL-RM into the Indonesian language, perform a transcultural adaptation, and assess its validity. \u0000Methods A cross-sectional study was performed in patients aged 2 to 18 years with systemic lupus erythematosus (SLE) or juvenile idiopathic arthritis (JIA) in Dr. Cipto Mangunkusumo Hospital, Jakarta. The initial phase of the study consisted of forward translation from the original English version into Indonesian, synthesis by experts, backward translation, and cognitive debriefing, resulting in the final version of the questionnaire. The second phase was testing the final questionnaire on patients in each age group and their parents. Tests were carried out in two sessions with an interval of 2 to 4 weeks. The questionnaire consisted of a child report and a parent report, each measuring five dimensions: pain and hurt, activities, treatment, worry, and communication. We subsequently assessed validity and reliability of each dimension in the child and parent reports for the child and teen age groups. Validity was expressed as correlation coefficient (r) between dimension scores with the total score. \u0000Results The finalized Indonesian questionnaire was completed by 53 children aged 2-18 years with SLE or JIA and their parents. Due to small numbers of subjects in the younger age ranges, analysis was only performed in the 8-to-18-year age group. Validity varied from good to very good (r = 0.437 to 0.910) for the child report and from poor to good (r = 0.153 to 0.808) for the parent report. The questionnaire was deemed reliable, with a Cronbach’s alpha of 0.755 to 0.785. \u0000Conclusion The Indonesian version of the PedsQL-RM is valid and reliable for assessing quality of life in children aged 8 to 18 years with rheumatologic disease. Further study is needed to assess the validity and reliability of the tool for children aged 2 to 7 years.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"7 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77105190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-17DOI: 10.14238/pi63.2.2023.119-28
Amanda Soebadi, Rivaldo Suhito, S. Handryastuti
Background Although febrile seizures are generally benign, judicious management is needed to prevent inadequate or excessive management. In 2016, the Indonesian Pediatric Society (IPS) issued Recommendations for the Management of Febrile Seizures, but it is unclear whether pediatricians follow these recommendations in their clinical practice. Objectives To evaluate adherence to the 2016 IPS Recommendations for the Management of Febrile Seizures amongst pediatricians in Indonesia, as well as factors influencing adherence. Methods An anonymous online questionnaire was distributed by e-mail to IPS member pediatricians. We collected data on age, year of completion of pediatric residency or subspecialty training, practice region, type of practice, number of febrile seizure patients managed per month, and history of attending teaching sessions on the recommendations. We scored participants’ adherence to the recommendations in terms of pharmacologic treatment, ancillary testing, and prognosis. We also analyzed the difference in scores according to participant characteristics. Results Of 308 participants, 247 (80%) obtained a total adherence score of 50% or more of the highest possible score. Median total adherence score was 63.2% (range 20.6% to 100%) of the highest possible score. Median adherence scores were significantly higher in pediatricians who were 31 to 60-years-old vs. >60-years-old (64.7% vs. 52.9%, P=0.004), completed their residency training within the past <10 years vs. >10 years (64.7% vs. 61.8%, P=0.034), practiced in hospitals vs. clinics or private practices (61.8% vs. 50.0%, P=0.006), were aware vs. unaware of the recommendations (64.7% vs. 52.9%, P=0.02), and had vs. had not read the recommendations (62.7% vs. 50.0%, P=0.01). Most participants (93.5%) reported the recommendations to be feasible in their settings. Obstacles to implementation included lack of medication availability (8/20), lack of time to read the recommendations (8/20), lack of awareness of the recommendations (2/20), and limited infrastructure (2/20). Conclusions Most pediatricians in Indonesia have moderately good adherence to the 2016 IPS Recommendations for the Management of Febrile Seizures. Awareness of the recommendations needs to be raised further and limitations in medication distribution and infrastructure need to be overcome for better adherence.
背景:虽然热性惊厥通常是良性的，但需要明智的管理，以防止管理不足或过度。2016年，印度尼西亚儿科学会(IPS)发布了《热性癫痫发作管理建议》，但目前尚不清楚儿科医生是否在临床实践中遵循这些建议。目的评估印度尼西亚儿科医生对2016年IPS热性癫痫发作管理建议的依从性，以及影响依从性的因素。方法通过电子邮件向IPS会员儿科医师发放匿名在线问卷。我们收集了年龄、完成儿科住院医师或亚专科培训的年份、执业区域、执业类型、每月管理的热性惊厥患者数量以及参加建议教学课程的历史等数据。我们根据药物治疗、辅助测试和预后对参与者的依从性进行评分。我们还根据参与者的特征分析了得分的差异。结果308名参与者中，247名(80%)获得了最高可能分数的50%或更高的总依从性得分。中位总依从性得分为最高可能得分的63.2%(范围20.6%至100%)。31 - 60岁的儿科医生与60岁的儿科医生(64.7% vs. 52.9%， P=0.004)、在过去10年内完成住院医师培训的儿科医生(64.7% vs. 61.8%， P=0.034)、在医院执业的儿科医生与在诊所或私人诊所执业的儿科医生(61.8% vs. 50.0%， P=0.006)、知道和不知道这些建议的儿科医生(64.7% vs. 52.9%， P=0.02)、读过和没有读过这些建议的儿科医生(62.7% vs. 50.0%， P=0.01)的依从性得分中位数显著高于60岁的儿科医生(64.7% vs. 50.0%， P=0.01)。大多数参与者(93.5%)报告这些建议在他们的环境中是可行的。实施的障碍包括缺乏药物可用性(8/20)，没有时间阅读建议(8/20)，缺乏对建议的认识(2/20)和有限的基础设施(2/20)。结论:印度尼西亚大多数儿科医生对2016年IPS热性癫痫发作管理建议的依从性较好。需要进一步提高对建议的认识，需要克服药物分配和基础设施方面的限制，以更好地遵守建议。
{"title":"The management of febrile seizures by pediatricians in Indonesia: adherence to 2016 Indonesian Pediatric Society recommendations and influencing factors","authors":"Amanda Soebadi, Rivaldo Suhito, S. Handryastuti","doi":"10.14238/pi63.2.2023.119-28","DOIUrl":"https://doi.org/10.14238/pi63.2.2023.119-28","url":null,"abstract":"Background Although febrile seizures are generally benign, judicious management is needed to prevent inadequate or excessive management. In 2016, the Indonesian Pediatric Society (IPS) issued Recommendations for the Management of Febrile Seizures, but it is unclear whether pediatricians follow these recommendations in their clinical practice. \u0000Objectives To evaluate adherence to the 2016 IPS Recommendations for the Management of Febrile Seizures amongst pediatricians in Indonesia, as well as factors influencing adherence. \u0000Methods An anonymous online questionnaire was distributed by e-mail to IPS member pediatricians. We collected data on age, year of completion of pediatric residency or subspecialty training, practice region, type of practice, number of febrile seizure patients managed per month, and history of attending teaching sessions on the recommendations. We scored participants’ adherence to the recommendations in terms of pharmacologic treatment, ancillary testing, and prognosis. We also analyzed the difference in scores according to participant characteristics. \u0000Results Of 308 participants, 247 (80%) obtained a total adherence score of 50% or more of the highest possible score. Median total adherence score was 63.2% (range 20.6% to 100%) of the highest possible score. Median adherence scores were significantly higher in pediatricians who were 31 to 60-years-old vs. >60-years-old (64.7% vs. 52.9%, P=0.004), completed their residency training within the past <10 years vs. >10 years (64.7% vs. 61.8%, P=0.034), practiced in hospitals vs. clinics or private practices (61.8% vs. 50.0%, P=0.006), were aware vs. unaware of the recommendations (64.7% vs. 52.9%, P=0.02), and had vs. had not read the recommendations (62.7% vs. 50.0%, P=0.01). Most participants (93.5%) reported the recommendations to be feasible in their settings. Obstacles to implementation included lack of medication availability (8/20), lack of time to read the recommendations (8/20), lack of awareness of the recommendations (2/20), and limited infrastructure (2/20). \u0000Conclusions Most pediatricians in Indonesia have moderately good adherence to the 2016 IPS Recommendations for the Management of Febrile Seizures. Awareness of the recommendations needs to be raised further and limitations in medication distribution and infrastructure need to be overcome for better adherence.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"94 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88547641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-11DOI: 10.14238/pi63.2.2023.134-8
Afrilia Intan Pratiwi, Sumadiono Sumadiono, M. Sitaresmi
Henoch-Schonlein Purpura (HSP) is an acute immunoglobulin A (IgA)–mediated disorder characterized by generalized vasculitis. HSP commonly occurs in children. The annual worldwide incidence is 13-20 per 100,000 children under 17 years of age.1–3 It is characterized by non-thrombocytopenic palpable purpura mostly located on the dependent parts like lower extremities and buttocks, arthralgia/arthritis, bowel angina, and hematuria/proteinuria. HSP pathophysiology is not yet completely understood. Genetic factors are thought to drive the fundamental susceptibility and clinical manifestations. Proposed triggering factors include upper respiratory tract infections, medications, vaccinations, and malignancies. Disease course is usually benign and self-limited. Even though the prognosis is generally good, recurrences or relapses are common within 1 year of initial presentation.4
{"title":"A case report of multiple relapses of Henoch-Schonlein purpura","authors":"Afrilia Intan Pratiwi, Sumadiono Sumadiono, M. Sitaresmi","doi":"10.14238/pi63.2.2023.134-8","DOIUrl":"https://doi.org/10.14238/pi63.2.2023.134-8","url":null,"abstract":"Henoch-Schonlein Purpura (HSP) is an acute immunoglobulin A (IgA)–mediated disorder characterized by generalized vasculitis. HSP commonly occurs in children. The annual worldwide incidence is 13-20 per 100,000 children under 17 years of age.1–3 It is characterized by non-thrombocytopenic palpable purpura mostly located on the dependent parts like lower extremities and buttocks, arthralgia/arthritis, bowel angina, and hematuria/proteinuria. HSP pathophysiology is not yet completely understood. Genetic factors are thought to drive the fundamental susceptibility and clinical manifestations. Proposed triggering factors include upper respiratory tract infections, medications, vaccinations, and malignancies. Disease course is usually benign and self-limited. Even though the prognosis is generally good, recurrences or relapses are common within 1 year of initial presentation.4","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"17 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78639896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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