Pub Date : 2023-03-16DOI: 10.14238/pi63.1sup.2023.35-48
S. Yuliarto, Kurniawan Taufiq Kadafi, Ika Maya Suryaningtias, I. Ratridewi, S. L. Winaputri
Background Early recognition of septic shock in terms of clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters is a fundamental challenge in the emergency room and intensive care unit for early identification, adequate management, prevention of disease progression, and reduction of mortality risk. Objective To evaluate for possible correlations between survival outcomes of post-resuscitation pediatric septic shock patients and parameters of clinical signs, macrocirculatory hemodynamics, as well as microcirculatory laboratory findings. Methods This prospective, study was conducted in the PICU at Saiful Anwar Hospital, Malang, East Java. Inclusion criteria were children diagnosed with septic shock according to the 2005 Surviving Sepsis Campaign (SSC) criteria, aged >30 days-18 years, who were followed up for 72h after resuscitation. The measured variables such as cardiac index (CI), systemic vascular resistance index (SVRI), stroke volume index (SVI) were obtained from ultrasonic cardiac output monitor (USCOM). Blood gas and lactate were obtained from laboratory findings. Heart rate, pulse strength, extremity temperature, mean arterial pressure (MAP), systolic blood pressure (SBP), capillary refill time (CRT), Glasgow coma scale (GCS), and diuretic used were obtained from hemodynamic monitoring tools. Survival outcomes of post-resuscitation pediatric septic shock patients were noted. Results There was a significant correlation between the outcomes of the pediatric septic shock patients 72h after fluid resuscitation and clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters. After the 6th hour of observation, strong pulse was predictive of survival, with 88.2% area under the curve (AUC). At the 12th hour of observation, MAP >50th percentile for age was predictive of survival, with 94% AUC. Conclusion For pediatric patients with septic shock, the treatment target in the first 6 hours is to improve strength of pulse, and that in the first 12 hours is to improve MAP >50th percentile for age to limit mortality.
{"title":"Use of hemodynamic and laboratory monitoring tools to reduce the risk of mortality from pediatric septic shock","authors":"S. Yuliarto, Kurniawan Taufiq Kadafi, Ika Maya Suryaningtias, I. Ratridewi, S. L. Winaputri","doi":"10.14238/pi63.1sup.2023.35-48","DOIUrl":"https://doi.org/10.14238/pi63.1sup.2023.35-48","url":null,"abstract":"Background Early recognition of septic shock in terms of clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters is a fundamental challenge in the emergency room and intensive care unit for early identification, adequate management, prevention of disease progression, and reduction of mortality risk. \u0000Objective To evaluate for possible correlations between survival outcomes of post-resuscitation pediatric septic shock patients and parameters of clinical signs, macrocirculatory hemodynamics, as well as microcirculatory laboratory findings. \u0000Methods This prospective, study was conducted in the PICU at Saiful Anwar Hospital, Malang, East Java. Inclusion criteria were children diagnosed with septic shock according to the 2005 Surviving Sepsis Campaign (SSC) criteria, aged >30 days-18 years, who were followed up for 72h after resuscitation. The measured variables such as cardiac index (CI), systemic vascular resistance index (SVRI), stroke volume index (SVI) were obtained from ultrasonic cardiac output monitor (USCOM). Blood gas and lactate were obtained from laboratory findings. Heart rate, pulse strength, extremity temperature, mean arterial pressure (MAP), systolic blood pressure (SBP), capillary refill time (CRT), Glasgow coma scale (GCS), and diuretic used were obtained from hemodynamic monitoring tools. Survival outcomes of post-resuscitation pediatric septic shock patients were noted. \u0000Results There was a significant correlation between the outcomes of the pediatric septic shock patients 72h after fluid resuscitation and clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters. After the 6th hour of observation, strong pulse was predictive of survival, with 88.2% area under the curve (AUC). At the 12th hour of observation, MAP >50th percentile for age was predictive of survival, with 94% AUC. \u0000Conclusion For pediatric patients with septic shock, the treatment target in the first 6 hours is to improve strength of pulse, and that in the first 12 hours is to improve MAP >50th percentile for age to limit mortality.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"7 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79725291","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.2023.29-34
I. Ratridewi, S. L. Winaputri, E. Sulistijono, B. I. Corebima, A. Yunus
Background Diagnosis of neonatal sepsis is still challenging. Several diagnostics test have been developed to help diagnose of neonatal sepsis, but sometimes it could not be done routinely in limited facilities. Procalcitonin (PCT) and red cell distribution width (RDW) have been reported to have correlations with the risk of developing sepsis. Objective To evaluate the diagnostic value of combined of PCT and RDW as markers for neonatal sepsis in preterm infants. Methods A cross sectional study was conducted in the neonatal ward, Syaiful Anwar hospital, Malang, East Java. The subjects were preterm infants with neonatal sepsis. Blood culture were taken as the gold standard and RDW and PCT levels were assessed as the comparison. All of the test were performed at the begining of the study. The incidence of sepsis was reported as the main outcome. The data obtained were processed and analyzed using the receiver operating characteristic (ROC) method to obtain the area under curve (AUC) value. Results Fifty-five preterm infants presenting neonatal sepsis were enrolled in this study. The combination of RDW and PCT showed AUC 0.814 (P=0.199) with sensitivity and specificity 78.9% and 80.6%, respectively in diagnosing neonatal sepsis compared to blood culture. Conclusion Combination of RDW and PCT as markers of sepsis in preterm infants have good sensitivity and specificity.
{"title":"Combination of red cell distribution width and procalcitonin as diagnostic biomarkers of neonatal sepsis in preterm infants","authors":"I. Ratridewi, S. L. Winaputri, E. Sulistijono, B. I. Corebima, A. Yunus","doi":"10.14238/pi63.1sup.2023.29-34","DOIUrl":"https://doi.org/10.14238/pi63.1sup.2023.29-34","url":null,"abstract":"Background Diagnosis of neonatal sepsis is still challenging. Several diagnostics test have been developed to help diagnose of neonatal sepsis, but sometimes it could not be done routinely in limited facilities. Procalcitonin (PCT) and red cell distribution width (RDW) have been reported to have correlations with the risk of developing sepsis. \u0000Objective To evaluate the diagnostic value of combined of PCT and RDW as markers for neonatal sepsis in preterm infants. \u0000Methods A cross sectional study was conducted in the neonatal ward, Syaiful Anwar hospital, Malang, East Java. The subjects were preterm infants with neonatal sepsis. Blood culture were taken as the gold standard and RDW and PCT levels were assessed as the comparison. All of the test were performed at the begining of the study. The incidence of sepsis was reported as the main outcome. The data obtained were processed and analyzed using the receiver operating characteristic (ROC) method to obtain the area under curve (AUC) value. \u0000Results Fifty-five preterm infants presenting neonatal sepsis were enrolled in this study. The combination of RDW and PCT showed AUC 0.814 (P=0.199) with sensitivity and specificity 78.9% and 80.6%, respectively in diagnosing neonatal sepsis compared to blood culture. \u0000Conclusion Combination of RDW and PCT as markers of sepsis in preterm infants have good sensitivity and specificity.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"92 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79984219","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 Early-onset bacterial neonatal sepsis (bacterial EONS) is one of the most common causes of death and illness in newborns. Assessment of risk factors is important to identify infants who are more susceptible to bacterial EONS. A scoring model based on maternal and infant risk factors would be useful for predicting bacterial EONS. Objective To develop a scoring model to predict bacterial EONS by examining maternal and neonatal risk factors. Methods This diagnostic test study was conducted at Mohammad Hoesin Hospital, Palembang between January-September 2021 using various maternal and infant risk factors. Subjects were newborns suspected of having early-onset bacterial sepsis with birth weight >1000 grams. The potential risk factors evaluated consisted of premature rupture of membranes >18 hours, greenish-thick-and-foul-smelling amniotic fluid, maternal body temperature >38°C, maternal leukocytosis >15.000/?L, gestational of <37 weeks, birth weight of <2500 grams, and APGAR score of <7 at 1 minute. One hundred sixty-two subjects were selected consecutively. Analyses included odds ratio, logistic regression test, and ROC curve to assess sensitivity and specificity of each risk factor. Results Premature rupture of membranes >18 hours, greenish-thick-and-foul-smelling amniotic fluid, male sex, and gestation of <37 weeks were risk factors for bacterial EONS. In the multivariate analysis, premature rupture of membranes >18 hours had an OR of 5.94 (95%CI 1.69 to 20.86, P=0.005), greenish-thick-and-foul-smelling amniotic fluid had an OR of 3.74(95%CI 1.16 to 12.02, P=0,027), male sex had an OR of 4.28 (95%CI 1.14 to 16.02, P=0.031), and gestation of <37 weeks had an OR of 3.1 (95%CI 0.82 to 11.72, P=0.094). In the scoring model, each of these four risk factors were assigned a score of 2 (for maternal risk factors) and 1 (for neonatal risk factors). Using a cut-off score of 2.5 to predict bacterial EONS, the scoring system had a sensitivity of 80% and specificity of 47%. Conclusion Our scoring model of maternal and infant risk factors can be used to screen for possible bacterial EONS at an earlier stage of illness, although with limited specificity.
{"title":"Scoring model to predict early-onset bacterial sepsis at Dr. Mohammad Hoesin Hospital, Palembang","authors":"Lilik Fitriana, Afifa Ramadanti, Indrayady Indrayady","doi":"10.14238/pi63.1.2023.29-36","DOIUrl":"https://doi.org/10.14238/pi63.1.2023.29-36","url":null,"abstract":"Background Early-onset bacterial neonatal sepsis (bacterial EONS) is one of the most common causes of death and illness in newborns. Assessment of risk factors is important to identify infants who are more susceptible to bacterial EONS. A scoring model based on maternal and infant risk factors would be useful for predicting bacterial EONS. \u0000Objective To develop a scoring model to predict bacterial EONS by examining maternal and neonatal risk factors. \u0000Methods This diagnostic test study was conducted at Mohammad Hoesin Hospital, Palembang between January-September 2021 using various maternal and infant risk factors. Subjects were newborns suspected of having early-onset bacterial sepsis with birth weight >1000 grams. The potential risk factors evaluated consisted of premature rupture of membranes >18 hours, greenish-thick-and-foul-smelling amniotic fluid, maternal body temperature >38°C, maternal leukocytosis >15.000/?L, gestational of <37 weeks, birth weight of <2500 grams, and APGAR score of <7 at 1 minute. One hundred sixty-two subjects were selected consecutively. Analyses included odds ratio, logistic regression test, and ROC curve to assess sensitivity and specificity of each risk factor. \u0000Results Premature rupture of membranes >18 hours, greenish-thick-and-foul-smelling amniotic fluid, male sex, and gestation of <37 weeks were risk factors for bacterial EONS. In the multivariate analysis, premature rupture of membranes >18 hours had an OR of 5.94 (95%CI 1.69 to 20.86, P=0.005), greenish-thick-and-foul-smelling amniotic fluid had an OR of 3.74(95%CI 1.16 to 12.02, P=0,027), male sex had an OR of 4.28 (95%CI 1.14 to 16.02, P=0.031), and gestation of <37 weeks had an OR of 3.1 (95%CI 0.82 to 11.72, P=0.094). In the scoring model, each of these four risk factors were assigned a score of 2 (for maternal risk factors) and 1 (for neonatal risk factors). Using a cut-off score of 2.5 to predict bacterial EONS, the scoring system had a sensitivity of 80% and specificity of 47%. \u0000Conclusion Our scoring model of maternal and infant risk factors can be used to screen for possible bacterial EONS at an earlier stage of illness, although with limited specificity.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"61 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90804168","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 : 2023-03-06DOI: 10.14238/pi63.1.2023.37-44
I. Yuniar, M. Karyanti, N. Kurniati, Desti Handayani
Background Sepsis is a leading cause of pediatric morbidity and mortality. The prevalence of sepsis mortality in Indonesia varies between 22.5 to 52%. Objective To identify the clinical criteria for predicting sepsis mortality and evaluate the performance of the PELOD-2 score. Methods This retrospective cohort study included pediatric patients admitted to the emergency department or pediatric intensive care unit (PICU) of Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2015 to May 2020. Demographic characteristics (age and sex), clinical manifestations [nutritional status, presence of shock, need for intubation, source of infection, inotrope use, mean arterial pressure, pulse rate, respiratory rate, and Glasgow Coma Scale (GCS) score], laboratory [leukocyte, platelet, neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte count ratio (NLCR), procalcitonin, C-reactive protein (CRP), and lactate profile], PELOD-2 score, and mortality data were recorded as outcomes. Results We analyzed data from 241 sepsis subjects. The overall mortality rate was 65%. Shock [OR 3.2 (95%CI 1.80 to -5.55, P<0.001)], GCS <9 [OR 2.4 (95%CI 1.30 to 4.23, P=0.005)], inotrope use [OR 3.1 (95%CI 1.74 to 5.5, P<0.001)], CRP >33.5 mg/L [OR 2.5 (95%CI 1.14 to 5.35, P=0.02)], and lactate level >2.85 [OR 2.1 (95%CI 1.02 to 4.56, P=0.04)] were considered significant predictors of mortality. A PELOD-2 cut-off score of >8 had optimal sensitivity (81.2%) and specificity (72.9%) to predict mortality, with an OR of 11.6 (95%CI 5.72 to 23.5, P<0.001). Conclusion Shock, GCS score, inotrope use, CRP, and lactate level can serve as clinical biomarkers to predict mortality in pediatric sepsis. A PELOD-2 score of >8 can predict mortality with reasonably good sensitivity and specificity.
{"title":"The clinical and biomarker approach to predict sepsis mortality in pediatric patients","authors":"I. Yuniar, M. Karyanti, N. Kurniati, Desti Handayani","doi":"10.14238/pi63.1.2023.37-44","DOIUrl":"https://doi.org/10.14238/pi63.1.2023.37-44","url":null,"abstract":"Background Sepsis is a leading cause of pediatric morbidity and mortality. The prevalence of sepsis mortality in Indonesia varies between 22.5 to 52%. \u0000Objective To identify the clinical criteria for predicting sepsis mortality and evaluate the performance of the PELOD-2 score. \u0000Methods This retrospective cohort study included pediatric patients admitted to the emergency department or pediatric intensive care unit (PICU) of Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2015 to May 2020. Demographic characteristics (age and sex), clinical manifestations [nutritional status, presence of shock, need for intubation, source of infection, inotrope use, mean arterial pressure, pulse rate, respiratory rate, and Glasgow Coma Scale (GCS) score], laboratory [leukocyte, platelet, neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte count ratio (NLCR), procalcitonin, C-reactive protein (CRP), and lactate profile], PELOD-2 score, and mortality data were recorded as outcomes. \u0000Results We analyzed data from 241 sepsis subjects. The overall mortality rate was 65%. Shock [OR 3.2 (95%CI 1.80 to -5.55, P<0.001)], GCS <9 [OR 2.4 (95%CI 1.30 to 4.23, P=0.005)], inotrope use [OR 3.1 (95%CI 1.74 to 5.5, P<0.001)], CRP >33.5 mg/L [OR 2.5 (95%CI 1.14 to 5.35, P=0.02)], and lactate level >2.85 [OR 2.1 (95%CI 1.02 to 4.56, P=0.04)] were considered significant predictors of mortality. A PELOD-2 cut-off score of >8 had optimal sensitivity (81.2%) and specificity (72.9%) to predict mortality, with an OR of 11.6 (95%CI 5.72 to 23.5, P<0.001). \u0000Conclusion Shock, GCS score, inotrope use, CRP, and lactate level can serve as clinical biomarkers to predict mortality in pediatric sepsis. A PELOD-2 score of >8 can predict mortality with reasonably good sensitivity and specificity.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"48 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87775837","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}
Sirenomelia, also known as mermaid syndrome, is a very rare lethal congenital disorder with multisystem malformations, characterized by fusion of the lower limbs. Here we report a preterm neonate with fusion of the lower limbs. The baby was born by cesarean section to a 27-year-old primigravida mother at 35 weeks and 3 days’ gestation. There was no maternal history of hypertension, heart disease, asthma, or diabetes mellitus. At birth, the infant did not cry, had weak tone, a heart rate (HR) of <60 beats per minute (BPM), an Apgar score of 1/2, and a birth weight of 2,300 grams. The infant had an imperforate anus and no urogenital openings or external genitalia. There was a small penis-like protrusion without an aperture, such as in cases of ambiguous genitalia. The two lower limbs were fused, with five toes on each foot. Despite neonatal resuscitation, the infant died within 75 minutes of birth. The child was diagnosed with sirenomelia. This case report aims to emphasize the importance of early prenatal diagnosis and education of the patient’s family.
{"title":"Sirenomelia or “mermaid syndrome”: an extremely rare case in Indonesiasia","authors":"Q. Santosa, Setya Dian Kartika, Irwan Nuryadin, Alfi Muntafiah","doi":"10.14238/pi63.1.2023.45-50","DOIUrl":"https://doi.org/10.14238/pi63.1.2023.45-50","url":null,"abstract":"Sirenomelia, also known as mermaid syndrome, is a very rare lethal congenital disorder with multisystem malformations, characterized by fusion of the lower limbs. Here we report a preterm neonate with fusion of the lower limbs. The baby was born by cesarean section to a 27-year-old primigravida mother at 35 weeks and 3 days’ gestation. There was no maternal history of hypertension, heart disease, asthma, or diabetes mellitus. At birth, the infant did not cry, had weak tone, a heart rate (HR) of <60 beats per minute (BPM), an Apgar score of 1/2, and a birth weight of 2,300 grams. The infant had an imperforate anus and no urogenital openings or external genitalia. There was a small penis-like protrusion without an aperture, such as in cases of ambiguous genitalia. The two lower limbs were fused, with five toes on each foot. Despite neonatal resuscitation, the infant died within 75 minutes of birth. The child was diagnosed with sirenomelia. This case report aims to emphasize the importance of early prenatal diagnosis and education of the patient’s family.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"46 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87557912","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 : 2023-03-02DOI: 10.14238/pi63.1.2023.22-8
A. Moelyo, Ardi Findyartini, B. Tridjaja, A. Hendarto
Background The uncertain and somewhat chaotic clinical learning environment during the COVID-19 pandemic may potentially trigger burnout in pediatric residents. Objective To investigate the prevalence of burnout in pediatric residents in Indonesia during the COVID-19 pandemic and to identify potential risk factors associated with burnout. Methods This analytic observational study was conducted between April and June 2020. A questionnaire-based survey using an Indonesian translation of the Maslach Burnout Inventory-Human Services Survey was conducted online across 15 pediatric training institutions treating COVID-19 patients in Indonesia. Results were interpreted in accordance with the inventory guidelines. The chi-square test was used to analyze for possible associations between each subscale and gender, marital status, training stage, as well as institution of origin. One-way ANOVA of each subscale was performed on pediatric training institutions located in different regions. Results Of 983 respondents (82% average response rate), the prevalences of high emotional exhaustion and high depersonalization were 28.0% and 15.8%, respectively, while more than half of respondents (50.2%) had a low sense of personal accomplishment. Most respondents felt more exhausted than depersonalized. The location of pediatric training institution (Java or outside Java) was the only significant factor associated with burnout (P=0.003). Conclusion In the early stages of the pandemic, more than half of pediatric residents in Indonesia had a low sense of personal accomplishment. The only significant factor associated with burnout among was the location of training institution (Java or outside Java), suggesting a potential role of differences in hospital situation and clinical learning environment during the pandemic between Java and outside Java.
{"title":"Pediatric residents’ burnout in Indonesia: a national survey during the pandemic","authors":"A. Moelyo, Ardi Findyartini, B. Tridjaja, A. Hendarto","doi":"10.14238/pi63.1.2023.22-8","DOIUrl":"https://doi.org/10.14238/pi63.1.2023.22-8","url":null,"abstract":"Background The uncertain and somewhat chaotic clinical learning environment during the COVID-19 pandemic may potentially trigger burnout in pediatric residents. \u0000Objective To investigate the prevalence of burnout in pediatric residents in Indonesia during the COVID-19 pandemic and to identify potential risk factors associated with burnout. \u0000Methods This analytic observational study was conducted between April and June 2020. A questionnaire-based survey using an Indonesian translation of the Maslach Burnout Inventory-Human Services Survey was conducted online across 15 pediatric training institutions treating COVID-19 patients in Indonesia. Results were interpreted in accordance with the inventory guidelines. The chi-square test was used to analyze for possible associations between each subscale and gender, marital status, training stage, as well as institution of origin. One-way ANOVA of each subscale was performed on pediatric training institutions located in different regions. \u0000Results Of 983 respondents (82% average response rate), the prevalences of high emotional exhaustion and high depersonalization were 28.0% and 15.8%, respectively, while more than half of respondents (50.2%) had a low sense of personal accomplishment. Most respondents felt more exhausted than depersonalized. The location of pediatric training institution (Java or outside Java) was the only significant factor associated with burnout (P=0.003). \u0000Conclusion In the early stages of the pandemic, more than half of pediatric residents in Indonesia had a low sense of personal accomplishment. The only significant factor associated with burnout among was the location of training institution (Java or outside Java), suggesting a potential role of differences in hospital situation and clinical learning environment during the pandemic between Java and outside Java.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83096949","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 : 2023-03-02DOI: 10.14238/pi63.1.2023.13-21
Sri Mulyani, Suprihati Winarto, H. W. Karyadini
Background Secretory IgA (sIgA) content of breastmilk in the first postpartum month is a reflection of the pregnant woman's immune response to environmental antigen exposure. The role of secretory IgA in breastmilk is to protect and support the development of the neonatal immune response in early life. Objective To examine possible factors associated with sIgA levels in breastmilk and colostrum, including environmental exposure, food consumed, maternal history of atopy, and the appearance of allergic symptoms in infants. As a secondary objective, we determined the association between infant factors (IgE, exposure to cigarette smoke) and maternal factors (sIgA, maternal allergies) with infant allergies. Methods This prospective cohort study of 80 postpartum mothers and their infants was conducted at Sultan Agung Islamic Hospital, Semarang. We collected maternal colostrum on the second or third postpartum day and mature milk between the 22nd to 25th postpartum day. Exposure factors to mothers and infants in the final trimester of pregnancy up to one month postpartum was recorded through a questionnaire and home visits. The infant’s IgE level was measured at 4 months of age. Results Mean colostrum sIgA was 108.9 (SD 16.5) mg/dL (95%CI 97.9 to 121.1 mg/dL) and mean mature milk sIgA was 94.1 (SD 23.9) mg/dL (95%CI 89.1 to 99.2 mg/dL). Mean colostrum sIgA levels were higher in mothers exposed to cigarette smoke [119.1 (SD 1.7) vs. 92.9 (SD 1.5) mg/dL; P=0.026] and frequent infections [128.2 (SD 1.7) vs. 95.9 (SD 1.6) mg/dL; P=0.007] compared to that in unexposed mothers. Mean colostrum sIgA was also higher in mothers with atopic allergy than in those without (136.8 mg/dL vs. 99.3 mg/dL; p=0.017) and in mothers of infants with IgE levels >29 IU/ml than in mothers of infants with IgE levels <29 IU/mL (136.8 vs. 101.2 mg/mg/dL; P=0.045). Elevated colostrum sIgA (>136.8 mg/dL) was not associated with allergies in the infants (P=0.269). Conclusions Maternal atopic allergy and frequent infections are associated with increased colostrum sIgA levels. Breastmilk sIgA levels are not associated with allergies in the infant. Maternal exposure to antigens may stimulate the production of specific breastmilk sIgA.
{"title":"Factors associated with secretory IgA levels in colostrum and breastmilk","authors":"Sri Mulyani, Suprihati Winarto, H. W. Karyadini","doi":"10.14238/pi63.1.2023.13-21","DOIUrl":"https://doi.org/10.14238/pi63.1.2023.13-21","url":null,"abstract":"Background Secretory IgA (sIgA) content of breastmilk in the first postpartum month is a reflection of the pregnant woman's immune response to environmental antigen exposure. The role of secretory IgA in breastmilk is to protect and support the development of the neonatal immune response in early life. \u0000Objective To examine possible factors associated with sIgA levels in breastmilk and colostrum, including environmental exposure, food consumed, maternal history of atopy, and the appearance of allergic symptoms in infants. As a secondary objective, we determined the association between infant factors (IgE, exposure to cigarette smoke) and maternal factors (sIgA, maternal allergies) with infant allergies. \u0000Methods This prospective cohort study of 80 postpartum mothers and their infants was conducted at Sultan Agung Islamic Hospital, Semarang. We collected maternal colostrum on the second or third postpartum day and mature milk between the 22nd to 25th postpartum day. Exposure factors to mothers and infants in the final trimester of pregnancy up to one month postpartum was recorded through a questionnaire and home visits. The infant’s IgE level was measured at 4 months of age. \u0000Results Mean colostrum sIgA was 108.9 (SD 16.5) mg/dL (95%CI 97.9 to 121.1 mg/dL) and mean mature milk sIgA was 94.1 (SD 23.9) mg/dL (95%CI 89.1 to 99.2 mg/dL). Mean colostrum sIgA levels were higher in mothers exposed to cigarette smoke [119.1 (SD 1.7) vs. 92.9 (SD 1.5) mg/dL; P=0.026] and frequent infections [128.2 (SD 1.7) vs. 95.9 (SD 1.6) mg/dL; P=0.007] compared to that in unexposed mothers. Mean colostrum sIgA was also higher in mothers with atopic allergy than in those without (136.8 mg/dL vs. 99.3 mg/dL; p=0.017) and in mothers of infants with IgE levels >29 IU/ml than in mothers of infants with IgE levels <29 IU/mL (136.8 vs. 101.2 mg/mg/dL; P=0.045). Elevated colostrum sIgA (>136.8 mg/dL) was not associated with allergies in the infants (P=0.269). \u0000Conclusions Maternal atopic allergy and frequent infections are associated with increased colostrum sIgA levels. Breastmilk sIgA levels are not associated with allergies in the infant. Maternal exposure to antigens may stimulate the production of specific breastmilk sIgA.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"229 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75692100","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 : 2023-02-28DOI: 10.14238/pi63.1.2023.7-12
Partini Pudjiastuti Trihono, Jeanne Laurensie Sihombing, R. Dewi
Background Pediatric hypertension is an emerging health issue due to its increasing prevalence. Age-, gender-, and height-specific blood pressure percentiles have been widely used as a primary tool for detection of hypertension in the pediatric population. However, this method is too complicated to be used in general pediatric practice. The blood pressure to height ratio has been proposed as a practical tool to detect hypertension in children. Objective To evaluate the accuracy of blood pressure to height ratio to be used as a tool for screening high blood pressure in Indonesian adolescents. Methods This diagnostic test study using data from the 2013 Indonesia Basic Health Research (Riset Kesehatan Dasar/RISKESDAS) report included 39,057 adolescents aged 15-18 years with complete data on age, gender, weight, height, and blood pressure. Blood pressure values were classified using the 2017 American Academy of Pediatrics (AAP) hypertension clinical guidelines. Blood pressure to height ratio was calculated as mmHg/cm body height. A receiver-operator characteristics (ROC) curve analysis was performed to assess the accuracy of systolic blood pressure to height ratio (SBPHR) and diastolic blood pressure to height ratio (DBPHR) for screening high blood pressure in adolescents. The optimal cut-off points, sensitivity, and specificity of SBPHR and DBPHR were calculated. Results The optimal cut-off points for defining elevated blood pressure in male adolescents aged 13-18 years were SBPHR 0.69 for male adolescents (sensitivity 96%, specificity 80%) and DBPHR 0.46 (sensitivity 97%, specificity 84%). In female adolescents, the optimal cut-offs were SBPHR 0.72 (sensitivity 97%, specificity 82%) and DBPHR 0.48 (sensitivity 98% and specificity 79%). Conclusion Blood pressure to height ratio is a practical method with high sensitivity and specificity for detecting elevated blood pressure in Indonesian adolescents aged 15 to 18 years.
{"title":"Blood pressure to height ratio for screening hypertension among Indonesian adolescents","authors":"Partini Pudjiastuti Trihono, Jeanne Laurensie Sihombing, R. Dewi","doi":"10.14238/pi63.1.2023.7-12","DOIUrl":"https://doi.org/10.14238/pi63.1.2023.7-12","url":null,"abstract":"Background Pediatric hypertension is an emerging health issue due to its increasing prevalence. Age-, gender-, and height-specific blood pressure percentiles have been widely used as a primary tool for detection of hypertension in the pediatric population. However, this method is too complicated to be used in general pediatric practice. The blood pressure to height ratio has been proposed as a practical tool to detect hypertension in children. \u0000Objective To evaluate the accuracy of blood pressure to height ratio to be used as a tool for screening high blood pressure in Indonesian adolescents. \u0000Methods This diagnostic test study using data from the 2013 Indonesia Basic Health Research (Riset Kesehatan Dasar/RISKESDAS) report included 39,057 adolescents aged 15-18 years with complete data on age, gender, weight, height, and blood pressure. Blood pressure values were classified using the 2017 American Academy of Pediatrics (AAP) hypertension clinical guidelines. Blood pressure to height ratio was calculated as mmHg/cm body height. A receiver-operator characteristics (ROC) curve analysis was performed to assess the accuracy of systolic blood pressure to height ratio (SBPHR) and diastolic blood pressure to height ratio (DBPHR) for screening high blood pressure in adolescents. The optimal cut-off points, sensitivity, and specificity of SBPHR and DBPHR were calculated. \u0000Results The optimal cut-off points for defining elevated blood pressure in male adolescents aged 13-18 years were SBPHR 0.69 for male adolescents (sensitivity 96%, specificity 80%) and DBPHR 0.46 (sensitivity 97%, specificity 84%). In female adolescents, the optimal cut-offs were SBPHR 0.72 (sensitivity 97%, specificity 82%) and DBPHR 0.48 (sensitivity 98% and specificity 79%). \u0000Conclusion Blood pressure to height ratio is a practical method with high sensitivity and specificity for detecting elevated blood pressure in Indonesian adolescents aged 15 to 18 years.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"590 ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72432479","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 : 2023-02-28DOI: 10.14238/pi63.1.2023.51-6
Marlinna Marlinna, M. Julia, Noormanto Noormanto
Prader-Willi Syndrome (PWS) is a disorder resulting from a loss of genetic information on chromosome 15q11.2-q13 inherited from the father. It can be caused by paternal deletions (65-75%) or uniparental maternal disomy (20-30%). The prevalence of PWS is estimated to be 1/10,000 - 1/20,000 births.1 Although its incidence is relatively rare, PWS can cause major health problems for patients and decreased quality of life for their families. The course of PWS is characterized by severe hypotonia in the neonatal period, severe feeding problems resulting in growth failure, as well as small hands and feet. Hypogonadism manifests as genital hypoplasia, delayed puberty, and infertility. Children with PWS have delayed motor and language development. Most patients have some degree of intellectual disability. Hyperphagia and obesity occur in early childhood. The patient’s excessive eating behavior affects the patient’s and family’s quality of life, and is often responsible for high morbidity and mortality.
{"title":"A 14-year-old patient with Prader-Willi syndrome: a case report","authors":"Marlinna Marlinna, M. Julia, Noormanto Noormanto","doi":"10.14238/pi63.1.2023.51-6","DOIUrl":"https://doi.org/10.14238/pi63.1.2023.51-6","url":null,"abstract":"Prader-Willi Syndrome (PWS) is a disorder resulting from a loss of genetic information on chromosome 15q11.2-q13 inherited from the father. It can be caused by paternal deletions (65-75%) or uniparental maternal disomy (20-30%). The prevalence of PWS is estimated to be 1/10,000 - 1/20,000 births.1 Although its incidence is relatively rare, PWS can cause major health problems for patients and decreased quality of life for their families. \u0000The course of PWS is characterized by severe hypotonia in the neonatal period, severe feeding problems resulting in growth failure, as well as small hands and feet. Hypogonadism manifests as genital hypoplasia, delayed puberty, and infertility. Children with PWS have delayed motor and language development. Most patients have some degree of intellectual disability. Hyperphagia and obesity occur in early childhood. The patient’s excessive eating behavior affects the patient’s and family’s quality of life, and is often responsible for high morbidity and mortality. ","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"11 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80559153","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 : 2023-02-28DOI: 10.14238/pi63.1.2023.1-6
T. Dantara, Deddy Christian Aritonang
Background Sikari is a remote district in Papua, Indonesia, which is malaria-endemic. Malaria infection during pregnancy has been linked to poor birth outcomes. Objective To evaluate for an association between malaria infection in pregnancy and birth outcome. Methods This cohort study compared the outcomes of newborns from mothers infected with malaria during pregnancy vs. uninfected controls. We included clinical data of 82 pregnant women from January to December 2020 at the Batavia Public Health Center, Sikari District, Mamberamo Raya, Papua. Malaria diagnosis was established based on the World Health Organization (WHO) criteria and positive rapid diagnostic tests. The maternal and infant characteristics analyzed were years of formal education, antenatal care (ANC) visits, gestational age, obstetric history, diagnosis of malaria, birth weight, APGAR score, and newborn mortality. Results Forty-six mothers (56.1%) were diagnosed with malaria during pregnancy, of whom 33 (71.7%) had tropical malaria, 7 (15.2%) had tertian malaria, and 6 (13.0%) had mixed malaria. Malaria infections of any type were associated with an increased risk of preterm birth (OR 5.34; 95%CI 1.10 to 25.91; P=0.04), low birth weight (LBW) (OR 49.00; 95%CI 28.62 to 838.89; P=0.00), newborn mortality (OR 13.86; 95%CI 0.76 to 251.37; P=0.04), and low 5-minute APGAR score (OR 23.65; 95%CI 1.34 to 416.61; P=0.03). Tropical malaria was associated with a higher risk of preterm birth (OR 5.44; 95%CI 1.06 to 27.86; P=0.04), LBW (OR 15.22; 95%CI 1.82 to 127.02; P=0.01), newborn mortality (OR 14.09; 95%CI 0.75 to 265.48; P=0.04), and low APGAR (OR 24.33; 95%CI 1.34 to 440.77; P=0.03). Mixed malaria was associated with a higher risk of LBW (OR 35.00; 95%CI 2.73 to 449.10; P=0.01) and low APGAR score (OR 40.56; 95%CI 1.67 to 985.39; P=0.02). Conclusion Malaria infections are associated with an increased risk of preterm birth, low birth weight, newborn mortality, and low 5-minute APGAR scores.
{"title":"The association between maternal malaria infection and poor birth outcomes in a remote community in Papua, Indonesia","authors":"T. Dantara, Deddy Christian Aritonang","doi":"10.14238/pi63.1.2023.1-6","DOIUrl":"https://doi.org/10.14238/pi63.1.2023.1-6","url":null,"abstract":"Background Sikari is a remote district in Papua, Indonesia, which is malaria-endemic. Malaria infection during pregnancy has been linked to poor birth outcomes. \u0000Objective To evaluate for an association between malaria infection in pregnancy and birth outcome. \u0000Methods This cohort study compared the outcomes of newborns from mothers infected with malaria during pregnancy vs. uninfected controls. We included clinical data of 82 pregnant women from January to December 2020 at the Batavia Public Health Center, Sikari District, Mamberamo Raya, Papua. Malaria diagnosis was established based on the World Health Organization (WHO) criteria and positive rapid diagnostic tests. The maternal and infant characteristics analyzed were years of formal education, antenatal care (ANC) visits, gestational age, obstetric history, diagnosis of malaria, birth weight, APGAR score, and newborn mortality. \u0000Results Forty-six mothers (56.1%) were diagnosed with malaria during pregnancy, of whom 33 (71.7%) had tropical malaria, 7 (15.2%) had tertian malaria, and 6 (13.0%) had mixed malaria. Malaria infections of any type were associated with an increased risk of preterm birth (OR 5.34; 95%CI 1.10 to 25.91; P=0.04), low birth weight (LBW) (OR 49.00; 95%CI 28.62 to 838.89; P=0.00), newborn mortality (OR 13.86; 95%CI 0.76 to 251.37; P=0.04), and low 5-minute APGAR score (OR 23.65; 95%CI 1.34 to 416.61; P=0.03). Tropical malaria was associated with a higher risk of preterm birth (OR 5.44; 95%CI 1.06 to 27.86; P=0.04), LBW (OR 15.22; 95%CI 1.82 to 127.02; P=0.01), newborn mortality (OR 14.09; 95%CI 0.75 to 265.48; P=0.04), and low APGAR (OR 24.33; 95%CI 1.34 to 440.77; P=0.03). Mixed malaria was associated with a higher risk of LBW (OR 35.00; 95%CI 2.73 to 449.10; P=0.01) and low APGAR score (OR 40.56; 95%CI 1.67 to 985.39; P=0.02). \u0000Conclusion Malaria infections are associated with an increased risk of preterm birth, low birth weight, newborn mortality, and low 5-minute APGAR scores.","PeriodicalId":19660,"journal":{"name":"Paediatrica Indonesiana","volume":"2 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89689193","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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