Scientific Journal of Pediatrics

Impact of Surfactant Therapy on Preterm Neonates: A Meta-Analysis Evaluating Respiratory and Hemodynamic Outcomes

Ni Luh Ayudimartini — 2024-09-19

Introduction: Surfactant deficiency is a major contributor to neonatal respiratory distress syndrome (RDS) in preterm infants. Surfactant replacement therapy has become a cornerstone in managing RDS, but its impact on broader respiratory and hemodynamic outcomes remains an area of active investigation. This meta-analysis aimed to comprehensively evaluate the effects of surfactant therapy on preterm neonates, encompassing both respiratory and hemodynamic parameters.

Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library) was conducted to identify randomized controlled trials (RCTs) and observational studies evaluating surfactant therapy in preterm neonates. Studies reporting on respiratory outcomes (need for mechanical ventilation, duration of ventilation, oxygen requirement) and hemodynamic outcomes (patent ductus arteriosus (PDA) incidence, blood pressure, cerebral blood flow) were included. Data extraction and quality assessment were performed independently by two reviewers. Meta-analyses were conducted using random-effects models.

Results: A total of 35 studies (22 RCTs, 13 observational studies) involving 4,875 preterm neonates were included. Surfactant therapy was associated with a significant reduction in the need for mechanical ventilation (RR 0.72, 95% CI 0.65-0.80, p<0.001), duration of mechanical ventilation (MD -1.8 days, 95% CI -2.5 to -1.1, p<0.001), and oxygen requirement (MD -5%, 95% CI -7 to -3, p<0.001). A trend towards reduced incidence of PDA was observed (RR 0.85, 95% CI 0.71-1.02, p=0.08). Surfactant therapy also led to improvements in blood pressure parameters and cerebral blood flow.

Conclusion: Surfactant therapy in preterm neonates confers significant benefits in respiratory outcomes, including reduced need for and duration of mechanical ventilation, and decreased oxygen requirement. A potential beneficial effect on PDA incidence warrants further investigation. These findings underscore the critical role of surfactant therapy in improving the respiratory and hemodynamic status of preterm neonates.

The Influence of Personal Hygiene on the Prevalence of Soil-Transmitted Helminths (STH) in Children: A Case Series in a Remote Indigenous Community in Indonesia

Nur Laela Alydrus — 2025-01-09

Introduction: Soil-transmitted helminths (STHs) are a major public health concern, especially in remote indigenous communities with limited access to clean water and sanitation. This study aimed to investigate the influence of personal hygiene practices on the prevalence of STH infections in children in the Ammatoa Kajang community of Bulukumba Regency, Indonesia.

Methods: An observational case series was conducted among children aged 3-13 years in the Ammatoa Kajang community. Data on personal hygiene practices were collected through questionnaires and interviews, while stool samples were examined for STH infections using the Kato-Katz method. Data were analyzed using correlation tests to determine the relationship between personal hygiene and STH prevalence.

Results: The prevalence of STH infection was 45%, with Ascaris lumbricoides being the most common (30%), followed by Trichuris trichiura (10%) and hookworm (5%). Poor personal hygiene practices, such as infrequent handwashing, not using soap after defecation, and not wearing footwear, were significantly associated with an increased risk of STH infection.

Conclusion: Personal hygiene plays a crucial role in the prevalence of STH infections among children in the Ammatoa Kajang community. Health promotion programs focused on improving personal hygiene practices, along with improved sanitation facilities, are essential for reducing the burden of STH infections in this remote indigenous community.

Non-Invasive Neuromodulation for Drug-Resistant Epilepsy in Children: A Randomized Controlled Trial of Transcranial Magnetic Stimulation (TMS) versus Vagus Nerve Stimulation (VNS) in Jakarta, Indonesia

Febria Suryani — 2024-10-31

Introduction: Drug-resistant epilepsy (DRE) significantly impacts the quality of life in children. While vagus nerve stimulation (VNS) is an established treatment, repetitive transcranial magnetic stimulation (rTMS) offers a non-invasive alternative. This study aimed to compare the efficacy and safety of rTMS versus VNS in a pediatric DRE population in Jakarta, Indonesia.

Methods: This was a single-center, randomized, controlled, open-label trial conducted at Private Hospital, Jakarta. Children aged 5-18 years with DRE, defined as failure to achieve seizure freedom despite adequate trials of two appropriate antiepileptic drugs (AEDs), were randomly assigned (1:1) to receive either rTMS or VNS. The primary outcome was the percentage reduction in seizure frequency at 6 months post-intervention compared to baseline. Secondary outcomes included responder rate (≥50% seizure reduction), quality of life (QoL) using the PedsQL, cognitive function (using standardized neuropsychological tests), and adverse events.

Results: A total of 60 children were randomized (30 rTMS, 30 VNS). At 6 months, the mean percentage reduction in seizure frequency was significantly greater in the rTMS group (48.5%, SD 15.2%) compared to the VNS group (35.2%, SD 12.8%) (p = 0.001). Responder rates were 63.3% for rTMS and 46.7% for VNS (p = 0.17). PedsQL scores showed a significant improvement in the rTMS group compared to baseline in the psychosocial health summary score (p = 0.005), but not the VNS group (p=0.1). No significant differences were observed in cognitive function between the groups. Adverse events were generally mild and transient in both groups, though VNS was associated with more voice alteration and coughing.

Conclusion: rTMS demonstrated superior efficacy in reducing seizure frequency compared to VNS in this Indonesian pediatric DRE population. While VNS is an established method, rTMS may present a non-invasive and potentially more effective therapeutic alternative. Further, larger, multicenter studies are warranted to confirm these findings and explore long-term outcomes.

Predictive Value of Drug-Induced Sleep Endoscopy (DISE) in Pediatric Obstructive Sleep Apnea: A Multicenter Cohort Study in Indonesia

Sarah Istiqomah — 2024-10-31

Introduction: Obstructive sleep apnea (OSA) is a significant pediatric health concern in Indonesia, but diagnostic and treatment pathways are often resource-constrained. Drug-induced sleep endoscopy (DISE) offers a dynamic assessment of upper airway obstruction, but its predictive value for treatment outcomes in Indonesian children remains unclear. This study aimed to evaluate the predictive value of DISE findings for polysomnography (PSG)-determined OSA severity and surgical outcomes in a multicenter cohort of Indonesian children.

Methods: A prospective, multicenter cohort study was conducted at three tertiary hospitals in Indonesia. Children aged 2-18 years with suspected OSA underwent DISE and overnight PSG. DISE findings were classified using the VOTE (Velum, Oropharynx, Tongue base, Epiglottis) classification system. The primary outcome was the correlation between DISE findings and the apnea-hypopnea index (AHI) on PSG. Secondary outcomes included the prediction of surgical success (defined as a postoperative AHI < 5 and >50% reduction from baseline) after adenotonsillectomy (T&A). Statistical analyses included Spearman's rank correlation, receiver operating characteristic (ROC) curve analysis, and logistic regression.

Results: 250 children (mean age 8.2 ± 3.5 years, 60% male) were included. A significant positive correlation was found between the total VOTE score and AHI (ρ = 0.62, p < 0.001). Tongue base obstruction (VOTE-T) showed the strongest correlation with AHI (ρ = 0.58, p < 0.001). The area under the ROC curve (AUC) for the total VOTE score predicting severe OSA (AHI ≥ 10) was 0.85 (95% CI, 0.79-0.91). In the subgroup of 180 children who underwent T&A, a higher total VOTE score (particularly VOTE-T and VOTE-E scores) was significantly associated with a lower likelihood of surgical success (OR 0.45, 95% CI 0.28-0.72, p = 0.001).

Conclusion: DISE, using the VOTE classification, demonstrates good predictive value for OSA severity and surgical outcomes in Indonesian children. Tongue base and epiglottic obstruction are particularly important predictors. DISE can be a valuable tool for guiding treatment decisions in resource-limited settings.

Early Childhood Feeding Practices and the Development of Severe Early Childhood Caries (S-ECC): A Prospective Cohort Study in Medan, Indonesia

Andhika Kurnianta Kusuma — 2024-10-31

Introduction: Severe early childhood caries (S-ECC) is a significant public health problem, particularly in developing countries like Indonesia. Early childhood feeding practices are recognized as major risk factors, but prospective data from specific regions like Medan, Indonesia, are limited. This study aimed to investigate the association between various feeding practices and the development of S-ECC in a cohort of children in Medan.

Methods: A prospective cohort study was conducted involving 450 mother-child dyads recruited from Posyandu (integrated health posts) in Medan, Indonesia. Baseline data on maternal demographics, socioeconomic status, oral health knowledge, and infant feeding practices were collected via questionnaires and interviews. Children were followed up at 6-month intervals for 36 months. Dental examinations were performed by calibrated dentists using the dmft index (decayed, missing, filled teeth) to diagnose S-ECC. Cox proportional hazards regression was used to analyze the association between feeding practices and S-ECC development, adjusting for potential confounders.

Results: The incidence of S-ECC at 36 months was 38.2% (n=172). Prolonged bottle feeding (beyond 12 months) (Hazard Ratio [HR] = 2.15; 95% Confidence Interval [CI]: 1.55-2.98; p<0.001), nocturnal bottle feeding with sweetened liquids (HR = 2.85; 95% CI: 2.01-4.03; p<0.001), and frequent consumption of sugary snacks/drinks (≥3 times/day) (HR = 1.92; 95% CI: 1.38-2.67; p<0.001) were significantly associated with an increased risk of S-ECC. Exclusive breastfeeding for the first 6 months showed a protective effect (HR = 0.62; 95% CI: 0.45-0.86; p=0.004), even after adjusting for socioeconomic status and maternal oral health knowledge.

Conclusion: This study confirms the significant impact of early childhood feeding practices on S-ECC development in Medan, Indonesia. Prolonged and nocturnal bottle feeding, particularly with sweetened liquids, and frequent consumption of sugary snacks/drinks were key risk factors. Promoting exclusive breastfeeding for the first six months and educating mothers about appropriate feeding practices are crucial for S-ECC prevention in this population.