Pub Date : 2023-04-11DOI: 10.14238/pi63.2.2023.57-64
Rizal Marubob Silalahi, W. Dalimunthe, Rita Evalina, J. Harahap, B. Lubis, I. Lubis
Background The most common COVID-19 infection clinical features in pediatric patients are similar to those of other pulmonary diseases, i.e., fever, cough, and shortness of breath. Information about the characteristics of coinfection and superinfection in COVID-19 cases can reduce misdiagnosis and differentiate COVID-19 from other pulmonary infections. Objective To observe the characteristics of pneumonia in children with suspected/confirmed COVID-19. Methods This descriptive study used medical record data of children hospitalized from 1 January 2020 – 31 January 2021 to describe the characteristics of pneumonia in suspected and confirmed COVID-19 cases in Haji Adam Malik Hospital, Medan, North Sumatra. Pneumonia-related findings, such as clinical symptoms, chest X-ray, and blood test results,were collected. Results There were 27 confirmed and 34 suspected COVID-19 children. Most of them were aged 6 to 8 years. Pneumonia was significantly associated with COVID-19. In confirmed COVID-19 cases, fever persisted after 3 days, with cough and shortness of breath. Patients did not have flu symptoms, but had below normal SpO2 (81-90%). The occurrence of lung rhonchi was significant in confirmed COVID-19 group. Chest X-ray results showed lung opacity in all confirmed COVID-19 patients. Mean white blood cell (WBC) count was significantly lower in COVID-19 confirmed (3.49x103/µL) vs. suspected group (17.9 x103/µL) (P=0.011). Mean CRP was significantly higher in COVID-19 confirmed (26.5 mg/L) vs. suspected group (4 mg/L). Conclusion Pneumonia with confirmed COVID-19 cases present with longer fever and lower SpO2. Patients are presented with lung ronchi, had lower WBCcount, and higher CRP. Chest X-ray shows opacity and consolidation.
{"title":"Characteristics of pneumonia in children with suspected/confirmed COVID-19","authors":"Rizal Marubob Silalahi, W. Dalimunthe, Rita Evalina, J. Harahap, B. Lubis, I. Lubis","doi":"10.14238/pi63.2.2023.57-64","DOIUrl":"https://doi.org/10.14238/pi63.2.2023.57-64","url":null,"abstract":"Background The most common COVID-19 infection clinical features in pediatric patients are similar to those of other pulmonary diseases, i.e., fever, cough, and shortness of breath. Information about the characteristics of coinfection and superinfection in COVID-19 cases can reduce misdiagnosis and differentiate COVID-19 from other pulmonary infections. \u0000Objective To observe the characteristics of pneumonia in children with suspected/confirmed COVID-19. \u0000Methods This descriptive study used medical record data of children hospitalized from 1 January 2020 – 31 January 2021 to describe the characteristics of pneumonia in suspected and \u0000confirmed COVID-19 cases in Haji Adam Malik Hospital, Medan, North Sumatra. Pneumonia-related findings, such as clinical symptoms, chest X-ray, and blood test results,were collected. \u0000Results There were 27 confirmed and 34 suspected COVID-19 children. Most of them were aged 6 to 8 years. Pneumonia was significantly associated with COVID-19. In confirmed COVID-19 cases, fever persisted after 3 days, with cough and shortness of breath. Patients did not have flu symptoms, but had below normal SpO2 (81-90%). The occurrence of lung rhonchi was significant in confirmed COVID-19 group. Chest X-ray results showed lung opacity in all confirmed COVID-19 patients. Mean white blood cell (WBC) count was significantly lower in COVID-19 confirmed (3.49x103/µL) vs. suspected group (17.9 x103/µL) (P=0.011). Mean CRP was significantly higher in COVID-19 confirmed (26.5 mg/L) vs. suspected group (4 mg/L). \u0000Conclusion Pneumonia with confirmed COVID-19 cases present with longer fever and lower SpO2. Patients are presented with lung ronchi, had lower WBCcount, and higher CRP. Chest X-ray shows opacity and consolidation.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"18 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78233380","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/pi63.2.2023.88-95
Wita Rostania, A. Alam, D. Hilmanto
Background The ease of access to antiretroviral therapy (ART) has improved both survival rate and comorbidities in patients with human immunodeficiency virus (HIV) infection. Impaired kidney function is one of the most common comorbidities of HIV. CD4 and viral load can be used to monitor HIV progression and to determine the effectiveness of ART. The most commonly used estimated-glomerular filtration rate (e-GFR) technique is to use serum creatinine but often causes late detection of kidney dysfunction while serum cystatin increases at the beginning of the GFR decrease. This supports cystatin C serum as an early diagnostic tool to detect kidney function or biomarker early kidney disorders. Objective To evaluate a possible association between serum cystatin C as a marker of kidney function and HIV progression through CD4 levels and viral load. Methods This cross-sectional study was conducted through evaluation of secondary data from medical and laboratory records of pediatric patients who had routine visits to the HIV Clinic at Dr. Hasan Sadikin General Hospital, Bandung, West Java, in January-February 2020. Results Sixty subjects were reviewed in the study. Median cystatin C-based eGFR was 28.1mL/minute/1.73m2. Subjects were categorized by viral load result into <40 and ?40 copies/mL. The median serum cystatin C was significantly higher [3.7 (range 2.61–6.55) mg/L] in the >40 copies/mL viral load group than the <40 copies/mL group [2.4 (range 0.26–13.61) mg/L]. The median absolute CD4 count, CD4 percentage, and cystatin C were 776 (range 7–1644) cells/mm3, 27.5 (range 1.6–57.4) %, and 3 (range 0.26–13.61) mg/L, respectively. There were no significant correlations (r=-0.2; P=0.1) between CD4 and serum cystatin C Conclusion Higher viral load associates with higher cystatin C level, while CD4 shows no correlation to cystatin C. However, patients with low CD4 tend to have increased cystatin C level.
{"title":"Association of CD4 cell counts and viral load with cystatin C level in children with human immunodeficiency virus (HIV) infection","authors":"Wita Rostania, A. Alam, D. Hilmanto","doi":"10.14238/pi63.2.2023.88-95","DOIUrl":"https://doi.org/10.14238/pi63.2.2023.88-95","url":null,"abstract":"Background The ease of access to antiretroviral therapy (ART) has improved both survival rate and comorbidities in patients with human immunodeficiency virus (HIV) infection. Impaired kidney function is one of the most common comorbidities of HIV. CD4 and viral load can be used to monitor HIV progression and to determine the effectiveness of ART. The most commonly used estimated-glomerular filtration rate (e-GFR) technique is to use serum creatinine but often causes late detection of kidney dysfunction while serum cystatin increases at the beginning of the GFR decrease. This supports cystatin C serum as an early diagnostic tool to detect kidney function or biomarker early kidney disorders. \u0000Objective To evaluate a possible association between serum cystatin C as a marker of kidney function and HIV progression through CD4 levels and viral load. \u0000Methods This cross-sectional study was conducted through evaluation of secondary data from medical and laboratory records of pediatric patients who had routine visits to the HIV Clinic at Dr. Hasan Sadikin General Hospital, Bandung, West Java, in January-February 2020. \u0000Results Sixty subjects were reviewed in the study. Median cystatin C-based eGFR was 28.1mL/minute/1.73m2. Subjects were categorized by viral load result into <40 and ?40 copies/mL. The median serum cystatin C was significantly higher [3.7 (range 2.61–6.55) mg/L] in the >40 copies/mL viral load group than the <40 copies/mL group [2.4 (range 0.26–13.61) mg/L]. The median absolute CD4 count, CD4 percentage, and cystatin C were 776 (range 7–1644) cells/mm3, 27.5 (range 1.6–57.4) %, and 3 (range 0.26–13.61) mg/L, respectively. There were no significant correlations (r=-0.2; P=0.1) between CD4 and serum cystatin C \u0000 Conclusion Higher viral load associates with higher cystatin C level, while CD4 shows no correlation to cystatin C. However, patients with low CD4 tend to have increased cystatin C level. \u0000 ","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"57 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85793367","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/pi63.2.2023.102-18
I. Sandinirwan, Bani Muslim, H. Leo, H. Hasanah, P. P. Karina
Background The ability to predict the progression to severe dengue is crucial in managing patients with dengue fever. Severe dengue is defined by one or more of the following signs: severe plasma leakage, severe bleeding, or severe organ involvement as it can be a life-threatening condition if left untreated. Objective To identify clinical manifestations and laboratory parameters associated with dengue hemorrhagic fever disease progression in children by systematic review and meta-analysis. Methods We searched six medical databases for studies published from Jan 1, 2000, to Dec 31, 2020. The meta-analysis used random-effects or fixed-effects models to estimate pooled effect sizes. We assessed heterogeneity using Cochrane Q and I2 statistics, publication bias by Egger’s test and LFK index (Doi plot), and categorized subgroup analysis by country. This study was registered with PROSPERO, CRD42021224439. Results We included 49 papers in the systematic review, and we encased the final selected 39 papers comprising 23 potential predictors in the meta-analyses. The other 10 papers were not included because the raw data could not be calculated for the effect measure in the meta-analysis. Among 23 factors studied, seven clinical manifestations demonstrated association with disease progression in children, including neurological signs, gastrointestinal bleeding, clinical fluid accumulation, hepatomegaly, vomiting, abdominal pain, and petechiae. Six laboratory parameters were associated during the early days of illness, including elevated hematocrit, aspartate aminotransferase [AST], and alanine aminotransferase [ALT], low platelet count, low albumin levels, and elevated activated partial thromboplastin time. Dengue virus serotype 2 (DENV-2) and secondary infections were also associated with severe disease progression. Conclusion This review supports the use of the warning signs described in the 2009 WHO guidelines. In addition, monitoring serum albumin, AST/ALT levels, identifying infecting dengue serotypes, and immunological status can improve the prediction of further risk of disease progression.
{"title":"Evaluating the importance of clinical manifestations and laboratory parameters associated with progression to severe dengue in children","authors":"I. Sandinirwan, Bani Muslim, H. Leo, H. Hasanah, P. P. Karina","doi":"10.14238/pi63.2.2023.102-18","DOIUrl":"https://doi.org/10.14238/pi63.2.2023.102-18","url":null,"abstract":"Background The ability to predict the progression to severe dengue is crucial in managing patients with dengue fever. Severe dengue is defined by one or more of the following signs: severe plasma leakage, severe bleeding, or severe organ involvement as it can be a life-threatening condition if left untreated. \u0000Objective To identify clinical manifestations and laboratory parameters associated with dengue hemorrhagic fever disease progression in children by systematic review and meta-analysis. \u0000Methods We searched six medical databases for studies published from Jan 1, 2000, to Dec 31, 2020. The meta-analysis used random-effects or fixed-effects models to estimate pooled effect sizes. We assessed heterogeneity using Cochrane Q and I2 statistics, publication bias by Egger’s test and LFK index (Doi plot), and categorized subgroup analysis by country. This study was registered with PROSPERO, CRD42021224439. \u0000Results We included 49 papers in the systematic review, and we encased the final selected 39 papers comprising 23 potential predictors in the meta-analyses. The other 10 papers were not included because the raw data could not be calculated for the effect measure in the meta-analysis. Among 23 factors studied, seven clinical manifestations demonstrated association with disease progression in children, including neurological signs, gastrointestinal bleeding, clinical fluid accumulation, hepatomegaly, vomiting, abdominal pain, and petechiae. Six laboratory parameters were associated during the early days of illness, including elevated hematocrit, aspartate aminotransferase [AST], and alanine aminotransferase [ALT], low platelet count, low albumin levels, and elevated activated partial thromboplastin time. Dengue virus serotype 2 (DENV-2) and secondary infections were also associated with severe disease progression. \u0000 Conclusion This review supports the use of the warning signs described in the 2009 WHO guidelines. In addition, monitoring serum albumin, AST/ALT levels, identifying infecting dengue serotypes, and immunological status can improve the prediction of further risk of disease progression.","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":"89960600","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/pi63.2.2023.73-9
Rusida Harjayanti Sanindya Arum, Kristia Hermawan, P. Widjajanto, S. Sutaryo
Background Neuroblastoma is an extracranial solid tumor originating from neural crest cells which failed to properly migrate. Neuroblastoma is commonly found in children under 12 months of age. The survival rate of these patients is still relatively low, both in developed countries and Indonesia. Objective To determine whether age, sex, primary tumor location, degree of cell differentiation, and patient compliance are associated with the survival of children with neuroblastoma at Dr.Sardjito Hospital. Methods This retrospective cohort study included pediatric neuroblastoma patients at Dr. Sardjito Hospital, Yogyakarta, Central Java, between January 2012 to September 2020, however there has been no evaluation about survival of neuroblastoma. We collected secondary data from medical records and registration data of pediatric cancer patients in the Pediatric Hematology Oncology Department of Dr. Sardjito Hospital, we matched te data based on medicals records and manual data in the ward and olyclinic, which included age at diagnosis, sex, primary tumor location, degree of cell differentiation, and patient adherence to therapy. To confirm weather the information about survived or death, apart from medical record we do tracking by telephone to the parent. Results we do the observation and calculating based on our retrospective data , Of 54 pediatric neuroblastoma patients, 54% were female. The median length of observation was 13.25 months, with an incidence rate of 62/100 person-years and a median survival of 13 months from the time of diagnosis. The 5-year survival rate in our study was 21.3%. Multivariate analysis revealed that stage IV patients had higher risk of death (HR 10.9; 95%CI 1.47 to 81.01; P=0.02) compared to other stages. Sub-group follow-up analysis revealed no significant difference in stage IV male patients compared to female patients (HR 1.62; 95%CI 0.81 to 3.22; P=0.172). The survivial in group with primary tumor location outside the adrenal medulla and stage IV was not significantly different from patients whose tumor location was unknown (HR 2.45; 95%CI 0.71 to 8.43; P=0.155). The group whose primary tumor location was in the adrenal medulla did not have a significant difference in survival compared to patients whose primary tumor location was unknown (HR 2.09; 95%CI 0.84 to 5.22; P=0.114). Conclusion The predictor factors studied are not significantly associated with mortality in children with neuroblastoma.
{"title":"Predictors of mortality in children with neuroblastoma","authors":"Rusida Harjayanti Sanindya Arum, Kristia Hermawan, P. Widjajanto, S. Sutaryo","doi":"10.14238/pi63.2.2023.73-9","DOIUrl":"https://doi.org/10.14238/pi63.2.2023.73-9","url":null,"abstract":"Background Neuroblastoma is an extracranial solid tumor originating from neural crest cells which failed to properly migrate. Neuroblastoma is commonly found in children under 12 months of age. The survival rate of these patients is still relatively low, both in developed countries and Indonesia. \u0000Objective To determine whether age, sex, primary tumor location, degree of cell differentiation, and patient compliance are associated with the survival of children with neuroblastoma at Dr.Sardjito Hospital. \u0000Methods This retrospective cohort study included pediatric neuroblastoma patients at Dr. Sardjito Hospital, Yogyakarta, Central Java, between January 2012 to September 2020, however there has been no evaluation about survival of neuroblastoma. We collected secondary data from medical records and registration data of pediatric cancer patients in the Pediatric Hematology Oncology Department of Dr. Sardjito Hospital, we matched te data based on medicals records and manual data in the ward and olyclinic, which included age at diagnosis, sex, primary tumor location, degree of cell differentiation, and patient adherence to therapy. To confirm weather the information about survived or death, apart from medical record we do tracking by telephone to the parent. \u0000Results we do the observation and calculating based on our retrospective data , Of 54 pediatric neuroblastoma patients, 54% were female. The median length of observation was 13.25 months, with an incidence rate of 62/100 person-years and a median survival of 13 months from the time of diagnosis. The 5-year survival rate in our study was 21.3%. Multivariate analysis revealed that stage IV patients had higher risk of death (HR 10.9; 95%CI 1.47 to 81.01; P=0.02) compared to other stages. Sub-group follow-up analysis revealed no significant difference in stage IV male patients compared to female patients (HR 1.62; 95%CI 0.81 to 3.22; P=0.172). The survivial in group with primary tumor location outside the adrenal medulla and stage IV was not significantly different from patients whose tumor location was unknown (HR 2.45; 95%CI 0.71 to 8.43; P=0.155). The group whose primary tumor location was in the adrenal medulla did not have a significant difference in survival compared to patients whose primary tumor location was unknown (HR 2.09; 95%CI 0.84 to 5.22; P=0.114). \u0000Conclusion The predictor factors studied are not significantly associated with mortality in children with neuroblastoma.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"55 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76608161","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/pi63.2.2023.96-101
Dea Puspitarini, E. S. Herini, C. D. Satria, Kristia Hermawan
Background Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause of chronic kidney disease (CKD) in children. Delayed diagnosis of CAKUT due to lack of universal screening (such as prenatal ultrasound screening or postnatal ultrasound screening in neonates with risk of CAKUT) has led to more cases of advanced CKD in children. CKD has high morbidity and mortality, and early detection is required to prevent the progression of CKD. Objective To determine the factors that predict the development of advanced CKD in children with CAKUT. Methods This retrospective cohort study included children with CAKUT at Dr. Sardjito Hospital, Yogyakarta, Indonesia from January 2016 to February 2021. Patients who were diagnosed with CAKUT were followed up to 5 years or until the onset of advanced CKD. Advanced CKD was defined as a decreased estimated glomerular filtration rate (eGFR) of less than 30mL/min/1.73m2 based on the revised Schwartz formula. CKD progression-free survival was determined with Kaplan-Meier and Cox regression analyses. Results Among 62 subjects with CAKUT, 7 (11.3%) subjects progressed to advanced CKD. The mean time of advanced CKD progression was 52.2 (95%CI 46.9 to 57.5) months. The overall incidence rate was 22 per 1,000 person-years. Based on Kaplan-Meier analysis, children with eGFR <60 mL/min/1.73m2 at the time of diagnosis had more rapid progression to advanced CKD than patients with eGFR ?60 mL/min/1.73m2 [40.2 (95%CI 33.4 to 46.6) months vs. 58.2 95%CI 46.9 to 57.5) months; P=0.02, respectively]. Conclusion Reduced eGFR at the time of diagnosis showed rapid progression to advanced CKD.
{"title":"Predictive factors of advanced chronic kidney disease in children with congenital anomalies of kidney and urinary tract","authors":"Dea Puspitarini, E. S. Herini, C. D. Satria, Kristia Hermawan","doi":"10.14238/pi63.2.2023.96-101","DOIUrl":"https://doi.org/10.14238/pi63.2.2023.96-101","url":null,"abstract":"Background Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause of chronic kidney disease (CKD) in children. Delayed diagnosis of CAKUT due to lack of universal screening (such as prenatal ultrasound screening or postnatal ultrasound screening in neonates with risk of CAKUT) has led to more cases of advanced CKD in children. CKD has high morbidity and mortality, and early detection is required to prevent the progression of CKD. \u0000Objective To determine the factors that predict the development of advanced CKD in children with CAKUT. \u0000Methods This retrospective cohort study included children with CAKUT at Dr. Sardjito Hospital, Yogyakarta, Indonesia from January 2016 to February 2021. Patients who were diagnosed with CAKUT were followed up to 5 years or until the onset of advanced CKD. Advanced CKD was defined as a decreased estimated glomerular filtration rate (eGFR) of less than 30mL/min/1.73m2 based on the revised Schwartz formula. CKD progression-free survival was determined with Kaplan-Meier and Cox regression analyses. \u0000Results Among 62 subjects with CAKUT, 7 (11.3%) subjects progressed to advanced CKD. The mean time of advanced CKD progression was 52.2 (95%CI 46.9 to 57.5) months. The overall incidence rate was 22 per 1,000 person-years. Based on Kaplan-Meier analysis, children with eGFR <60 mL/min/1.73m2 at the time of diagnosis had more rapid progression to advanced CKD than patients with eGFR ?60 mL/min/1.73m2 [40.2 (95%CI 33.4 to 46.6) months vs. 58.2 95%CI 46.9 to 57.5) months; P=0.02, respectively]. \u0000Conclusion Reduced eGFR at the time of diagnosis showed rapid progression to advanced CKD.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"52 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77241620","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 : 2023-04-10DOI: 10.14238/pi63.2.2023.129-33
Celine Celine, N. Utami
Hyperthyroidism is considered to be an emergency in children. Death can occur in 10-20% of cases. This condition is found more often in adolescents and girls. Cholestasis may be caused by the hyperthyroidism or side effects of anti-thyroid drugs. Increased hepatic blood flow without adequate oxygen supply as a result of a hypermetabolic state affects the transport of bilirubin, leading to cholestasis.
{"title":"Hyperthyroid crisis with cholestasis in a 12-year-old girl: a case report","authors":"Celine Celine, N. Utami","doi":"10.14238/pi63.2.2023.129-33","DOIUrl":"https://doi.org/10.14238/pi63.2.2023.129-33","url":null,"abstract":"Hyperthyroidism is considered to be an emergency in children. Death can occur in 10-20% of cases. This condition is found more often in adolescents and girls. Cholestasis may be caused by the hyperthyroidism or side effects of anti-thyroid drugs. Increased hepatic blood flow without adequate oxygen supply as a result of a hypermetabolic state affects the transport of bilirubin, leading to cholestasis.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85337028","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 : 2023-04-06DOI: 10.14238/pi63.2.2023.80-7
Evita B. Ifran, Wresti Indriatmi, Tetty Yuniarti, Nadjib Advani, S. Sungkar, Dewi Irawati Soeria Santoso, R. Rohsiswatmo, Y. Vandenplas, B. Hegar
Abstract Background Significant hemodynamic changes in preterm infants during early life could have consequences, especially on the intestinal blood flow. Alteration of superior mesenteric artery (SMA) blood flow may lead to impairment in gut function and feeding intolerance. Objectives To assess SMA blood flow velocity in very preterm and/or very low birth weight (VLBW) infants in early life and to elucidate the factors influencing them. Methods This is a cross-sectional study conducted in NICU at Cipto Mangunkusumo Hospital, Jakarta. Superior mesenteric artery (SMA) blood flow was evaluated by peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) measurement using Color Doppler US at < 48 hours after birth. Maternal and neonatal data that could be potentially associated with SMA blood flow were obtained. Bivariate analyses were conducted with a P value of < 0.05 considered significant. Results We examined 156 infants eligible for the study. PSV, EDV, and RI of SMA blood flow were not related to both gestational age and birth weight. Infant with small for gestational age (SGA) showed significantly lower EDV median [15.5 (range 0.0-32.8) vs 19.4 (range 0.0-113.0)] and higher RI [0.80 (range 0.58-1.00) vs 0.78 (range 0.50-1.00)] compared to appropriate for gestational age (AGA). Infants born from mother with preeclampsia showed lower PSV median [(78.2 (range 32.0-163.0) vs 89.7 (range 29.2-357.0)]) and EDV [16.2 (range 0.0-48.5) vs 19.4 (range 0.0-113.0)] compared to without PE, while absent/reverse end-diastolic velocity (AREDV) revealed a lower EDV median [16.9 (range 0.0 – 32.4) vs 19.4 (range 0.0 – 113.0)] compared to no AREDV. Furthermore, infants with hs-PDA showed lower EDV median [16.2 (range 0.0-113.0) vs 19.4 (range 0.0-71.1)] but higher RI median [0.80 (range 0.50-1.00) vs 0.78 (range 0.55-1.00)] compared to non hs-PDA. No difference in SMA blood flow across other factors was observed.
{"title":"Superior mesenteric artery blood flow in infants of very preterm and very low birthweight and its related factors","authors":"Evita B. Ifran, Wresti Indriatmi, Tetty Yuniarti, Nadjib Advani, S. Sungkar, Dewi Irawati Soeria Santoso, R. Rohsiswatmo, Y. Vandenplas, B. Hegar","doi":"10.14238/pi63.2.2023.80-7","DOIUrl":"https://doi.org/10.14238/pi63.2.2023.80-7","url":null,"abstract":"\u0000Abstract \u0000 \u0000Background Significant hemodynamic changes in preterm infants during early life could have consequences, especially on the intestinal blood flow. Alteration of superior mesenteric artery (SMA) blood flow may lead to impairment in gut function and feeding intolerance. \u0000Objectives To assess SMA blood flow velocity in very preterm and/or very low birth weight (VLBW) infants in early life and to elucidate the factors influencing them. \u0000Methods This is a cross-sectional study conducted in NICU at Cipto Mangunkusumo Hospital, Jakarta. Superior mesenteric artery (SMA) blood flow was evaluated by peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) measurement using Color Doppler US at < 48 hours after birth. Maternal and neonatal data that could be potentially associated with SMA blood flow were obtained. Bivariate analyses were conducted with a P value of < 0.05 considered significant. \u0000Results We examined 156 infants eligible for the study. PSV, EDV, and RI of SMA blood flow were not related to both gestational age and birth weight. Infant with small for gestational age (SGA) showed significantly lower EDV median [15.5 (range 0.0-32.8) vs 19.4 (range 0.0-113.0)] and higher RI [0.80 (range 0.58-1.00) vs 0.78 (range 0.50-1.00)] compared to appropriate for gestational age (AGA). Infants born from mother with preeclampsia showed lower PSV median [(78.2 (range 32.0-163.0) vs 89.7 (range 29.2-357.0)]) and EDV [16.2 (range 0.0-48.5) vs 19.4 (range 0.0-113.0)] compared to without PE, while absent/reverse end-diastolic velocity (AREDV) revealed a lower EDV median [16.9 (range 0.0 – 32.4) vs 19.4 (range 0.0 – 113.0)] compared to no AREDV. Furthermore, infants with hs-PDA showed lower EDV median [16.2 (range 0.0-113.0) vs 19.4 (range 0.0-71.1)] but higher RI median [0.80 (range 0.50-1.00) vs 0.78 (range 0.55-1.00)] compared to non hs-PDA. No difference in SMA blood flow across other factors was observed.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"267 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75151295","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 : 2023-04-06DOI: 10.14238/pi63.2.2023.65-72
N. Utami, R. Sekartini, R. Kolopaking, B. Besral, H. Khusun
Background Many children in low and middle-income countries (LMIC) have reduced cognitive abilities, but few studies have explored the influencing factors. Objective To determine the determinants of children's low cognitive development at 4 to 6-year-old. Methods This is a retrospective cohort study in year 2021. The data was obtained from Bogor Longitudinal Study of Child Growth and Development (BLSCGD) that started from year 2012. For this analysis, we considered 165 of children aged 4-6 years. The dependent variable in this analysis was cognitive development as measured by the Indonesian Wechsler Preschool and Primary Scale of Intelligence (WPPSI) with the indicators of full-scale IQ (FSIQ), verbal IQ (VIQ) and performance IQ (PIQ). The independent variables were determinants of children’s cognitive development at 4-6 years, consisted of socio-demographic factors, determinants from early life (0-23 months), as well as determinants from current conditions. Multivariate analysis done with the logistic regression test. Results Bivariate analysis revealed that paternal education level was significantly associated with FSIQ and inadequate calorie intake in infancy and poor child stimulation were significantly associated with VIQ. In the final model of multivariate analysis, low paternal education level retained a significant association with FSIQ. Psychosocial stimulation was significantly associated with VIQ and inadequate calorie intake during infancy was significantly associated with PIQ. Conclusion Low paternal education level and inadequate psychosocial stimulation are risk factors for reduced child cognitive development in 4-6-year-olds. Inadequate calorie intake in infancy even though not statistically significant it has high OR values for low VIQ and PIQ, thus the results showed the importance of calory intake in infancy.
{"title":"Cognitive performance of 4-6-year-old children: a longitudinal study","authors":"N. Utami, R. Sekartini, R. Kolopaking, B. Besral, H. Khusun","doi":"10.14238/pi63.2.2023.65-72","DOIUrl":"https://doi.org/10.14238/pi63.2.2023.65-72","url":null,"abstract":"Background Many children in low and middle-income countries (LMIC) have reduced cognitive abilities, but few studies have explored the influencing factors. \u0000Objective To determine the determinants of children's low cognitive development at 4 to 6-year-old. \u0000Methods This is a retrospective cohort study in year 2021. The data was obtained from Bogor Longitudinal Study of Child Growth and Development (BLSCGD) that started from year 2012. For this analysis, we considered 165 of children aged 4-6 years. The dependent variable in this analysis was cognitive development as measured by the Indonesian Wechsler Preschool and Primary Scale of Intelligence (WPPSI) with the indicators of full-scale IQ (FSIQ), verbal IQ (VIQ) and performance IQ (PIQ). The independent variables were determinants of children’s cognitive development at 4-6 years, consisted of socio-demographic factors, determinants from early life (0-23 months), as well as determinants from current conditions. Multivariate analysis done with the logistic regression test. \u0000Results Bivariate analysis revealed that paternal education level was significantly associated with FSIQ and inadequate calorie intake in infancy and poor child stimulation were significantly associated with VIQ. In the final model of multivariate analysis, low paternal education level retained a significant association with FSIQ. Psychosocial stimulation was significantly associated with VIQ and inadequate calorie intake during infancy was significantly associated with PIQ. \u0000Conclusion Low paternal education level and inadequate psychosocial stimulation are risk factors for reduced child cognitive development in 4-6-year-olds. Inadequate calorie intake in infancy even though not statistically significant it has high OR values for low VIQ and PIQ, thus the results showed the importance of calory intake in infancy.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"27 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90728677","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 : 2023-03-31DOI: 10.14238/pi63.1sup.2023.49-56
S. Yuliarto, Kurniawan Taufiq Kadafi, Nelly Pramita Septiani, I. Ratridewi, S. L. Winaputri
Background Sepsis is a major cause of morbidity and mortality in children. The American College of Critical Care Medicine (ACCM) protocol currently in use in the management of septic shock carries a risk of fluid overload. With the use of ultrasonographic monitoring, the Ultrasound-guided Fluid Resuscitation (USFR) protocol may reduce the incidence of fluid overload and mortality. Objective To assess the difference in outcomes of fluid resuscitation in pediatric septic shock using the USFR vs. ACCM protocols. Methods This randomized clinical trial involved 36 subjects randomized equally into the USFR and ACCM groups. After randomization, each subject was given fluid resuscitation starting at 20 mL/kg and repeated every 5-10 minutes as needed, according to the ACCM protocol. After fluid resuscitation was given, patients in the ACCM group were evaluated for clinical signs, liver span, and rhonchi, whereas those in the USFR group underwent USCOM examination for cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI). After 60 minutes, subjects in both groups were re-assessed for clinical signs, USCOM, pulmonary edema using lung ultrasound score (LUS), and liver span. Subjects were blinded as to the protocol they received. We compared 24-hour and 72-hour mortality rates, clinical improvement of shock at 60 minutes, cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI), as well as pulmonary edema and hepatomegaly, between the two groups. Results At 60 minutes after resuscitation, there were significant differences between the ACCM and USFR groups in the proportion of clinical improvement (0/18 vs. 5/18, P=0.016), pulmonary edema (15/18 vs. 4/18, P<0.001), and hepatomegaly (16/18 vs. 5/18, P<0.001). Mortality rates at 24 hours and 72 hours in the ACCM vs. USFR groups were 17% vs. 12% (P=0.199) and 78% vs. 39% (P=0.009), respectively. Conclusion The USFR protocol reduces the occurrence of fluid overload and leads to a lower mortality rate at 72 hours compared to the ACCM fluid resuscitation protocol.
脓毒症是儿童发病和死亡的主要原因。目前在脓毒性休克管理中使用的美国重症医学学院(ACCM)方案存在液体超载的风险。超声引导下的液体复苏(USFR)方案可以减少液体过载的发生率和死亡率。目的评价USFR与ACCM方案在小儿感染性休克液体复苏中的效果差异。方法36例患者随机分为USFR组和ACCM组。随机化后，根据ACCM方案，每名受试者给予20 mL/kg的液体复苏，并根据需要每5-10分钟重复一次。给予液体复苏后，评估ACCM组患者的临床体征、肝跨度和rhonchi，而USFR组患者则进行USCOM检查心脏指数(CI)、脑卒中容量指数(SVI)和全身血管阻力指数(SVRI)。60分钟后，重新评估两组受试者的临床症状、USCOM、肺水肿(肺超声评分(LUS))和肝跨度。受试者对他们收到的协议是不知情的。我们比较了两组之间24小时和72小时死亡率、60分钟休克的临床改善、心脏指数(CI)、脑卒中容量指数(SVI)和全身血管阻力指数(SVRI)，以及肺水肿和肝肿大。结果复苏后60分钟，ACCM组与USFR组患者的临床改善比例(0/18 vs 5/18, P=0.016)、肺水肿比例(15/18 vs 4/18, P<0.001)、肝肿大比例(16/18 vs 5/18, P<0.001)差异均有统计学意义。ACCM组和USFR组24小时和72小时死亡率分别为17%对12% (P=0.199)和78%对39% (P=0.009)。与ACCM液体复苏方案相比，USFR方案减少了液体过载的发生，导致72小时死亡率降低。
{"title":"Difference in outcomes of pediatric septic shock after fluid resuscitation according to the Ultrasound-guided Fluid Resuscitation (USFR) and American College of Critical Care Medicine (ACCM) protocols: A randomized clinical trial","authors":"S. Yuliarto, Kurniawan Taufiq Kadafi, Nelly Pramita Septiani, I. Ratridewi, S. L. Winaputri","doi":"10.14238/pi63.1sup.2023.49-56","DOIUrl":"https://doi.org/10.14238/pi63.1sup.2023.49-56","url":null,"abstract":"Background Sepsis is a major cause of morbidity and mortality in children. The American College of Critical Care Medicine (ACCM) protocol currently in use in the management of septic shock carries a risk of fluid overload. With the use of ultrasonographic monitoring, the Ultrasound-guided Fluid Resuscitation (USFR) protocol may reduce the incidence of fluid overload and mortality. Objective To assess the difference in outcomes of fluid resuscitation in pediatric septic shock using the USFR vs. ACCM protocols. Methods This randomized clinical trial involved 36 subjects randomized equally into the USFR and ACCM groups. After randomization, each subject was given fluid resuscitation starting at 20 mL/kg and repeated every 5-10 minutes as needed, according to the ACCM protocol. After fluid resuscitation was given, patients in the ACCM group were evaluated for clinical signs, liver span, and rhonchi, whereas those in the USFR group underwent USCOM examination for cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI). After 60 minutes, subjects in both groups were re-assessed for clinical signs, USCOM, pulmonary edema using lung ultrasound score (LUS), and liver span. Subjects were blinded as to the protocol they received. We compared 24-hour and 72-hour mortality rates, clinical improvement of shock at 60 minutes, cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI), as well as pulmonary edema and hepatomegaly, between the two groups. Results At 60 minutes after resuscitation, there were significant differences between the ACCM and USFR groups in the proportion of clinical improvement (0/18 vs. 5/18, P=0.016), pulmonary edema (15/18 vs. 4/18, P<0.001), and hepatomegaly (16/18 vs. 5/18, P<0.001). Mortality rates at 24 hours and 72 hours in the ACCM vs. USFR groups were 17% vs. 12% (P=0.199) and 78% vs. 39% (P=0.009), respectively. Conclusion The USFR protocol reduces the occurrence of fluid overload and leads to a lower mortality rate at 72 hours compared to the ACCM fluid resuscitation protocol.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"25 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87924709","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 : 2023-03-16DOI: 10.14238/pi63.1sup.2023.21-28
I. Ratridewi, S. L. Winaputri, E. Sulistijono, F. Juniantika
Background High incidence of late-onset sepsis (LOS) in preterm infants contributes to neonatal morbidity. Therapeutic outcomes of LOS have deteriorated as a result of increased antibiotic resistance problems, mainly from ESBL isolates. Controlling risk factors is important in reducing morbidity and mortality as well as providing guidance for antibiotic selection. Objectives To determine the risk factors of LOS due to ESBL-producing bacteria in preterm infants. Methods This is a retrospective study. The inclusion criteria was neonates diagnosed with late-onset neonatal sepsis by clinical signs and a positive blood culture. The blood culture result and characteristics patients as secondary data were extracted from medical records within the hospital facilities and the institutional database of the Neonatology Department of Universitas Brawijaya (January 2019 to March 2021). Statistical analysis was done to compare characteristics of the patients in the ESBL positive group to those in the ESBL negative group to assess the potential risk factors. Results Among 124 preterm infants with LOS, 62 of them were ESBL-positive case subjects and the other 62 were non-ESBL-producing control subjects. Gram-negative bacteria were the most common pathogens identified, with 96% (n=59) of them being the ESBL-producing strain, predominated by Klebsiella pneumoniae (n=56). Factors significantly correlated with the occurrence of LOS-ESBL included prior history of invasive procedures (OR 3.13; 95%CI 1.45 to 6.73; P=0.00), central access insertion (OR 9.54; 95%CI 3.7 to 24.2; P=0.00), and parenteral nutrition (OR 6.03; 95%CI 2.77 to 13.16; P=0.00). Central access insertion had the strongest influence (Exp(B) 6.98; P= 0.00). Conclusion Prior invasive procedures, central access insertion, and parenteral nutrition had significant correlations with the occurrence of LOS-ESBL in preterm infants. Central access insertion is a predictive factor for LOS-ESBL.
{"title":"Risk factors of late onset sepsis caused by extended spectrum beta-lactamase (ESBL) - producing bacteria in preterm infants","authors":"I. Ratridewi, S. L. Winaputri, E. Sulistijono, F. Juniantika","doi":"10.14238/pi63.1sup.2023.21-28","DOIUrl":"https://doi.org/10.14238/pi63.1sup.2023.21-28","url":null,"abstract":"Background High incidence of late-onset sepsis (LOS) in preterm infants contributes to neonatal morbidity. Therapeutic outcomes of LOS have deteriorated as a result of increased antibiotic resistance problems, mainly from ESBL isolates. Controlling risk factors is important in reducing morbidity and mortality as well as providing guidance for antibiotic selection. \u0000Objectives To determine the risk factors of LOS due to ESBL-producing bacteria in preterm infants. \u0000Methods This is a retrospective study. The inclusion criteria was neonates diagnosed with late-onset neonatal sepsis by clinical signs and a positive blood culture. The blood culture result and characteristics patients as secondary data were extracted from medical records within the hospital facilities and the institutional database of the Neonatology Department of Universitas Brawijaya (January 2019 to March 2021). Statistical analysis was done to compare characteristics of the patients in the ESBL positive group to those in the ESBL negative group to assess the potential risk factors. \u0000Results Among 124 preterm infants with LOS, 62 of them were ESBL-positive case subjects and the other 62 were non-ESBL-producing control subjects. Gram-negative bacteria were the most common pathogens identified, with 96% (n=59) of them being the ESBL-producing strain, predominated by Klebsiella pneumoniae (n=56). Factors significantly correlated with the occurrence of LOS-ESBL included prior history of invasive procedures (OR 3.13; 95%CI 1.45 to 6.73; P=0.00), central access insertion (OR 9.54; 95%CI 3.7 to 24.2; P=0.00), and parenteral nutrition (OR 6.03; 95%CI 2.77 to 13.16; P=0.00). Central access insertion had the strongest influence (Exp(B) 6.98; P= 0.00). \u0000Conclusion Prior invasive procedures, central access insertion, and parenteral nutrition had significant correlations with the occurrence of LOS-ESBL in preterm infants. Central access insertion is a predictive factor for LOS-ESBL.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"4 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88561689","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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