Paediatrica Indonesiana

Prevalence and risk factors of depression in juvenile systemic lupus erythematosus

Tue, 27 Aug 2024 09:14:24 +0700

Background Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organ systems, including the central nervous system. Depression is one of the neuropsychiatric manifestations of juvenile SLE .

Objective To estimate the prevalence of depressive disorders in juvenile SLE and identify its potential risk factors.

Methods This cross-sectional study was conducted in juvenile SLE patients at Dr. Mohammad Hoesin General Hospital, Palembang. Sociodemographic data and medications were recorded. Disease activity of SLE was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Physical activity was measured using the Physical Activity Questionnaire for Children (PAQ-C) and the Physical Activity Questionnaire for Adolescents (PAQ-A). All subjects were screened for depression using the Childhood Depression Inventory (CDI) questionnaire. Multiple linear regression analyses were used to determine risk factors for depressive disorders.

Results We included 72 patients, of whom 67 (93.1%) were female. Mean age of the patients was 12 years 4 months (SD 2 years 6 months); most (67; 93.1%) were 10-18 years of age. Depression was found in 24 patients (33.3%). SLEDAI scores of ?3 (flare) were found in 54 patients (75%) and low physical activity was found in 62 (86.1%) patients. The prevalence of depression based on the Children's Depression Inventory was 33.3%. A SLEDAI score of ?3 and low physical activity were significantly associated with depression (P=0.009 and P=0.025, respectively). On multiple linear regression analysis, only SLEDAI score of ?3 remained significantly associated with depression (P= 0.017; OR 12.6; 95%CI 1.6–101.7). Gender, age, family economic status, father's education, mother's education, family history of depression, and duration of illness were not associated with depression.

Conclusion A SLEDAI score indicating flare (?3) and low physical activity are significantly associated with an increased risk of depression. A SLEDAI score is an independent risk factor for depression when all other significant risk factors are considered.

Effectiveness of a short, intensive, art-based group intervention on attention level in children with autism spectrum disorders: a pre-post experimental study

Deldar Morad Abdulah, Bayar Mohammed Omar Abdulla, Pranee Liamputtong — Mon, 02 Sep 2024 10:02:00 +0700

Background The rate of autism spectrum disorder (ASD) is dramatically rising globally, especially in the Middle East and North Africa. There has been little research on the effects of art-based interventions on attention impairments among children with ASD.

Objective To examine the effectiveness of a short, intensive, art-based intervention on attention switching and attention to detail in children with moderate-severe ASD.

Methods In this pre- and post-experimental study, children previously diagnosed with levels 2 and 3 ASD were invited to join a one-month, art-based course. The art-based intervention was held 3 days/week for 2 hours per day.

Results The mean age of subjects was 8.33 (range 5 to 11) years; there were 10 (83.33%) males and 2 (16.67%) females. The total Autism Spectrum Quotient (AQ-Child) scores from baseline to one week after completion of the art-based course were not significantly different. In addition, mean social skills scores of attention switching and attention to detail, as well as communication scores were not significantly changed from baseline to after course completion. However, the children had significantly worse median imagination scores after the course compared to baseline scores (18.0 vs. 16.0, respectively) (P=0.0020).

Conclusion After a one-month, art-based, group intervention, AQ-Child scores did not change significantly in total score, social skills, attention switching, attention to detail, or communication. The median imagination score worsened after, compared to before, the intervention. However, these results need to be interpreted with caution due to the very small sample size.

Fecal short-chain fatty acids level and pediatric relapsing nephrotic syndrome

Jeanette Irene Christiene Manoppo, Natharina Yolanda, Adrian Umboh — Mon, 02 Sep 2024 09:38:19 +0700

Background The gut microbiota has a potential role in the development of nephrotic syndrome. Fecal short-chain fatty acid (SCFA) levels are representative of gut microbiota activity.

Objective To assess for potential associations of fecal short-chain fatty acid levels in pediatric relapsing nephrotic syndrome.

Methods This cross-sectional study was done on patients at the Pediatric Nephrology Subdivision of Prof. Dr. R.D. Kandou General Hospital, a referral hospital in Manado, Indonesia. Subjects were 25 patients aged less than 18 years with nephrotic syndrome (NS). We compared the levels of fecal acetic acid, propionic acid, butyric acid percentage, absolute butyric acid, and total short-chain fatty acid between children with relapsing and non-relapsing NS. A receiver operating characteristic (ROC) curve analysis was conducted to determine the significant SCFA cut-off level to diagnose NS.

Results Comparison of fecal SCFAs between relapsing and non-relapsing NS groups showed significantly lower butyric acid percentages, absolute butyric acid level, and total SCFAs levels in the relapsing NS group, but not in acetic acid or propionic acid levels. Further multivariate analysis did not show a significant difference in total SCFA levels between relapsing and non-relapsing NS. Absolute butyric acid level had the strongest association with relapsing NS, with the highest predictive score. The absolute butyric acid cut-off value of 0.85 mg/mL had a high sensitivity (90%) and high specificity (93.3%) for predicting relapsing nephrotic syndrome.

Conclusion Fecal acetic acid, propionic acid, and total short-chain fatty acid in stool are not associated with relapsing NS in children. However, fecal butyric acid measurements are inversely associated with relapsing NS.

Clinical characteristics, management, and survival of retinoblastoma patients: a five-year study at an Indonesian tertiary eye hospital

Aliya Numasari Putri, Maya Sari Wahyu Kuntorini, Primawita Oktarima Amiruddin — Fri, 30 Aug 2024 09:57:05 +0700

Background Studies on the clinical characteristics of retinoblastoma in Indonesia have been limited, even though retinoblastoma is the most common pediatric ocular malignancy worldwide and the second-most common pediatric malignancy in Indonesia. The estimated patient survival rate in lower-middle-income countries is 77%, and survival is highly dependent on early diagnosis and therapy.

Objective To identify the clinical characteristics of retinoblastoma in patients at the Cicendo National Eye Hospital, as an Indonesian tertiary eye hospital.

Methods This retrospective, observational study included pediatric patients <18 years of age diagnosed with retinoblastoma at the Cicendo National Eye Hospital, Bandung, West Java, between January 2018 and December 2022. We collected patients’ medical record data on age, gender, laterality, chief complaints, stage of disease, grouping, histopathologic features, therapy, and survival.

Results Of 247 retinoblastoma patients (328 eyes) enrolled, 53.85% presented at 1-2 years of age and 50.61% were males. Patients mostly presented with unilateral (67.21%) retinoblastoma, leukocoria (51.82%) as the chief complaint, and classified as International Retinoblastoma Staging System (IRSS) stage III (33.20%). Tumors were mostly intraocular (58.84%), particularly group E (39.02%). Most tumors showed undifferentiated (45.43%) and high-risk features (54.27%). Most eyes were treated with combination therapy (74.09%), particularly local and systemic therapy (59.45%). Survival was noted at 18.62% of patients, but 62.75% of patients were lost to follow-up.

Conclusion Most patients present with advanced retinoblastoma. Most histopathological results shows undifferentiated and high-risk features of the tumor. Delays in diagnosis and therapy may occur due to a lack of awareness and knowledge regarding clinical manifestations of retinoblastoma, which leads to worse prognosis.

Clot waveform analysis to differentiate mild, moderate, and severe hemophilia A

Ina Susianti Timan, Novie Amelia Chozie, Novianti Santoso — Mon, 02 Sep 2024 08:46:12 +0700

Background Clot waveform analysis can be used to evaluate clot formation profiles. This waveform can be obtained from activated partial thromboplastin time (APTT) assays without additional reagents and shows different patterns in hemophilia patients with coagulation factor VIII (F VIII) deficiency or abnormality.

Objective To determine the clot wave pattern and its process in clot formation phases (pre-coagulation, coagulation, and post-coagulation) in normal and hemophilia A subjects, analyze for possible correlations between clot wave parameters and F VIII activity, and obtain the pattern of coagulation curves in hemophilia subjects as a step to assess clot waveform analysis as a possible screening tool for hemophilia.

Methods In this cross-sectional study, we performed clot wave analysis in 145 adult and pediatric subjects with hemophilia to obtain the clot wave pattern in this condition. Clot wave analysis was also done in 160 subjects with normal hemostasis to obtain reference clot wave parameters.

Results In this study, the starting point of coagulation phase in normal subjects was between 30-40 seconds, with a shorter pre-coagulation phase and steeper slope. Hemophilia patients had a longer pre-coagulation phase and flatter slope, especially in severe hemophilia A patients, who had longer and more variable coagulation starting points (P<0.001). The absolute values of maximum coagulation velocity (Min1), maximum coagulation acceleration (Min2), and maximum coagulation deceleration (Max2) of hemophilia A patients were also lower than those of normal hemostasis patients, with lower absolute value seen in severe than in mild-moderate hemophilia A patients. A moderate correlation was found between Min1, Min2, and Max2 with F VIII activity (P<0.001).

Conclusion Clot wave analysis may be considered as a method for screening hemophilia patients to distinguish mild-moderate and severe hemophilia A patients in health facilities that lack the ability to perform F VIII assays.

Profiles of diphtheria cases in children in Hasan Sadikin Hospital, West Java

Fri, 30 Aug 2024 09:56:45 +0700

Background Diphtheria cases continue to be reported in Indonesia, which has long been one of the countries with the highest number of diphtheria cases worldwide. One of Indonesia's province with the highest annual diphtheria cases is West Java. Dr. Hasan Sadikin General Hospital (RSHS) is one of the tertiary referral hospitals in Bandung, West Java, that treats several diphtheria cases annually. No study focused on the clinical characteristics of diphtheria cases in children admitted to RSHS between 2017 and 2021 yet. Therefore, this study sought to analyze that.

Objective To find out the profiles of children < 18-year-old with diphtheria admitted in RSHS between 2017-2021.

Methods This descriptive, cross-sectional study reviewed the medical records of diphtheria patients 0 to 18-year-old who were admitted to RSHS between year 2017 and 2021.

Results Out of 45 subjects, 76% were males. The median of age was eight years old, ranging from 2 to 17 years. Most patients lived in urban areas and had normal anthropometry status, although some showed abnormal findings. The data showed that 44% had more than 3 days of onset until admission to the hospital, and the median length of stay was 9 days. The clinical characteristics showed that 91% of patients had pseudomembrane, also present with cough, common cold, hoarseness, stridor, and bull’s neck. As many as 44% of patients did not have complete basic immunization status. Complications found were airway obstructions, myocarditis, and sepsis, and 2 deaths were reported.

Conclusion Pseudomembrane was found in the majority of patients. Most patients were over five years of age, and almost half number of the patients did not have complete basic immunization status, indicating the need for improved immunization and booster coverage.

The role of early aggressive nutrition on growth of very preterm or very low birth weight infants

Fri, 30 Aug 2024 10:04:11 +0700

Background Very preterm infants (<32 weeks gestational age) are at high risk of poor neurodevelopmental outcomes. Early aggressive parenteral nutrition (protein ³ 2g/kg/day) can reduce the incidence of malnutrition in very preterm infants. At present, Fatmawati General Hospital does not have a standard nutritional protocol for preterm infant.

Objective To determine the difference in growth (days to regain birth weight and growth velocity) of very preterm (<32 weeks gestational age) or very low birth weight (VLBW) (<1500g) infants who were born and hospitalized in the Neonatal Unit of Fatmawati General Hospital, Jakarta, before and after applying early aggressive parenteral nutrition using a nutrition protocol from Cipto Mangunkusumo Hospital, Jakarta.

Methods A quasi-experimental study was conducted on 23 very preterm or VLBW infants in the Neonatal Unit of Fatmawati General Hospital, from July to November 2019. Control group data were taken from medical records of very preterm or VLBW babies discharged from our unit from January 2018 – to June 2019 and compared to those of the intervention group.

Results The intervention group regained their birth weight significantly faster than the control group [mean 7.43 (SD 3.5) vs. 16.73 (SD 5.1) days, respectively; (P=0.00)]. Mean growth velocity was also significantly higher in the intervention group than in the control group [14.6 (SD 6.0) vs. 8.9 (SD 6.9) gram/kg/day, respectively; (P=0.002)].

Conclusion Provision of early aggressive parenteral nutrition reduces the time to regain birth weight and leads to higher growth velocity in very preterm/VLBW infants.

Comparison of oral caffeine and oral theophylline for apnea of prematurity: A randomized clinical trial

Nensy Anggrainy, Gatot Irawan Sarosa, Adhie Nur Radityo Suswihardhyono — Mon, 02 Sep 2024 10:14:31 +0700

Background Caffeine and theophylline are methylxanthine compounds that have been widely used in the treatment of apnea of prematurity (AOP). Previous studies comparing the two agents have shown inconsistent results and have mostly used intravenous preparations.

Objective To assess the effectiveness of oral administration of caffeine compared to oral theophylline as therapy for apnea of prematurity.

Methods Fifty consecutively recruited premature neonates (gestational age 28-34 weeks, birth weight <2,500 g) with AOP who were able to tolerate at least 10 mL/kg of enteral feeding were randomized to receive either oral caffeine or oral theophylline for seven days. The main outcome was the daily frequency of apnea after treatment. Secondary outcomes were duration of oxygen or CPAP administration, duration of oxygen fraction (FiO2) taper to reach 21%, time to achievement of full feeding tolerance, length of hospital stay, and side effects.

Results We randomized 25 subjects into each group. The distribution of baseline characteristics (gender, gestational age, mode of delivery, birth weight and length, age at onset of AOP, and initial frequency of AOP) was similar between both groups. The mean daily number of apnea episodes after treatment was significantly higher in the caffeine group compared to the theophylline group [3.16 (SD 1.31) vs. 2.28 (SD 1.40); P=0.031]. The caffeine group, compared to the theophylline group, also had a longer mean duration of oxygen or CPAP use [12.56 (SD 7.67) days vs. 8.40 (SD 6.41) days; P=0.030] and duration of FiO₂ taper [5.76 (SD 2.68) vs. 4.08 (SD 2.54); P=0.035]. There were no significant differences in mean time to full feeding and mean length of hospital stay. There was no significant difference in the occurrence of side effects between the two groups.

Conclusion In premature neonates with AOP, oral theophylline is slightly more effective than oral caffeine in reducing the frequency of apnea and is associated with a shorter duration of oxygen or CPAP use and duration to reach 21% FiO₂.

Mid-upper arm circumference as an indicator of nutritional status improvement in children aged 6-59 months with severe acute malnutrition

Tue, 27 Aug 2024 15:50:01 +0700

Background The prevalence of severe acute malnutrition (SAM) in Indonesia remains high, especially in children with pre-existing chronic disease. These children often present with conditions that could interfere with weight measurements, such as edema or organomegaly. Mid-upper arm circumference (MUAC) is a potential indicator of nutritional status improvement.

Objective To analyze the correlation between MUAC and body weight as parameters for nutritional improvement in children with SAM.

Methods We performed registry analysis of patients admitted to the Pediatric Ward, Cipto Mangunkusumo Hospital, Jakarta, Indonesia from November 2016 to December 2020. We included children aged 6-59 months who were severely wasted (z-score <-3 on the WHO weight-for-height growth chart), had no conditions that could alter weight measurement, and had a 7-day minimum hospital stay. Patients with missing body weight and/or MUAC data were excluded. MUAC and weight increment between admission and discharge were analyzed using bivariate correlation and linear regression analyses.

Results Out of 4,746 pediatric inpatients, 1,996 presented with SAM. Of these, 124 were eligible for analysis. Subjects’ median age was 18 (IQR 11-32) months and median length of stay was 16 days (IQR 9-29 days). Weight increment (g/kg/day) and MUAC increment (mm/day) were independently and significantly correlated (P<0.001; Spearman’s rho=0.414). An adequate weight increment of 5-10 g/kg/day was equivalent to a MUAC increment of 0.319-0.439 mm/day (P<0.001; R=0.374).

Conclusion MUAC increment has a moderate positive correlated with weight increment. MUAC is a useful parameter of nutritional status improvement in SAM patients, especially in patients with conditions that could interfere with weight measurement.

Risk factors of tuberculosis in children with adult household tuberculosis contact

Fri, 02 Aug 2024 15:57:07 +0700

Background Since children are more likely than adults to become infected with Mycobacterium tuberculosis or suffer from tuberculosis (TB), it is important to identify the risk factors of TB in children with adult household TB contacts.

Objective To identify the risk factors of TB in children with adult household TB contacts. Methods This cross-sectional study was conducted at the Pediatric Respirology Inpatient Ward and Outpatient Clinic at Dr. Soetomo Hospital, Surabaya, Indonesia, using medical records of hospitalized patients from 2010 to 2018. Patients were children below 18 years of age who had a history of adult TB household contact(s). We analyzed age at TB diagnosis, nutritional status, BCG vaccination status, and HIV status as possible risk factors of TB.

Results A total of 367 children with adult household TB contacts were included in our study. Age of <5 years (OR 8.38; 95%CI 3.78 to 18.21; P<0.001), severe malnutrition (OR 8.88; 95%CI 1.19 to 66.27, P<0.05), absence of BCG scar (OR 2.96; 95%CI 1.32 to 6.62, P<0.05), and positive HIV status (OR 6.72; 95%CI 1.72-38.49, P<0.05) were risk factors for contracting active TB.

Conclusion Age of <5 years, severe malnutrition, absence of BCG scar, and positive HIV status are significant risk factors for active TB in children with adult household TB contacts.

Childhood borderline lepromatous leprosy

Fri, 30 Aug 2024 10:07:27 +0700

Leprosy (Morbus Hansen) is a chronic, severe infectious disease caused by the Mycobacterium leprae that mostly affects the skin, mucosa, eyes, and nerves. Despite the availability of effective treatment, leprosy has become a major public health problem in many developing countries.

H1N1pdm09 infection in children: A case report of reemerging disease in COVID-19 pandemic

Tue, 03 Sep 2024 11:32:43 +0700

An outbreak of H1N1 infection was first declared by the World Health Organization in 2009 and confirmed in the post-pandemic phase in 2010. Amid the COVID-19 pandemic, we found a confirmed case of H1N1pdm09 in Bunda Women and Children Hospital Jakarta. A 13-year-old boy was referred to our hospital after four days of hospitalization due to worsening tachypnea following a productive cough and fever. The patient had severe dyspnea with inspiratory effort and oxygen desaturation to 80%, therefore admitted to our pediatric intensive care unit. On physical examination, the patient had increased work of breathing, looked irritable, had a respiratory rate of about 40x/minute with non-rebreathing mask support, and crackles were heard in both lungs. Chest x-ray showed right bronchopneumonia. There was a history of a generalized seizure for less than 1 minute, which stopped spontaneously in previous hospital care. The patient was diagnosed with mucopolysaccharidosis at age six years old and has never received enzyme replacement therapy. Laboratory results revealed thrombocytopenia, leukopenia, neutrophilia, monocytosis, high c-reactive protein and procalcitonin, and elevated liver enzymes. The investigation of etiology was performed using the respiratory panel test and showed a positive real-time polymerase chain reaction for H1N1pdm09 and Influenza A. The patient was given oxygen therapy with a high-flow nasal cannula with an oxygen fraction of 40% and a flow of 20 liters per minute, fluid maintenance while fasting, antibiotics, inhaled beta-2 agonists, and a neuraminidase inhibitor (oseltamivir). The patient's clinical and laboratory markers improved on the third day of treatment, and he was discharged two days later.