Muhammad Ali

Association between oxygen saturation and critical congenital heart disease in newborns

Background Critical congenital heart disease (CCHD) is relatively common, with a prevalence of 6-8 in every 1,000 live births. This congenital anomaly is a newborn condition that would be ideally suited for a screening program, if simple and reliable methods were available. Pulse oximetry (PO) has been proposed as a screening method to detect CCHD. Objective To assess for a possible association between decreased oxygen saturation and CCHD in newborns. Methods We conducted a cross-sectional study from March 2014 to February 2015 in several hospitals in North Sumatra. Healthy, full term and post-term newborns aged 2 to 72 hours underwent pulse oximetry measurements on the right hand and one of the lower extremities. If oxygen saturation (SpO2) was ≤ 95%, the measurement was repeated 2 more times. Subjects also underwent echocardiography. Results A total of 386 newborns underwent SpO2 measurements: 377 newborns had SpO2 > 95% and 9 newborns had SpO2 ≤ 95%. Of the infants with SpO2 > 95%, 297 were excluded because their parents refused echocardiography examination. Thus, 80 newborns with SpO2 > 95% and 9 newborns with SpO2 ≤ 95% underwent echocardiography. Echocardiography revealed that 5 of 9 newborns with SpO2 ≤ 95% suffered from Tetralogy of Fallot (ToF) (3 subjects) and transposition of the great arteries (TGA) (2 subjects). One infant with SpO2 > 95% had ventricular septal defect (VSD), as detected by echocardiography. Oxygen saturation ≤ 95% had significant association with CCHD (P<0.001). Conclusion Decreased oxygen saturation has a significant association with critical congenital heart disease in newborns. [Paediatr Indones. 2018;58:90-4; doi: http://dx.doi. org/10.14238/pi58.1.2018.90-4].

Comparison of ventilation parameters and blood gas analysis in mechanically-ventilated children who received chest physiotherapy and suctioning vs. suctioning alone

Background Chest physiotherapy and suctioning are routine methods for airway clearance in mechanically-ventilated children. However, chest physiotherapy has not been confirmed to affect ventilation parameters, such as tidal volume (TV), peak inflation pressure (PIP), peak inspiratory flow (PIF), and peak expiratory flow (PEF), as well as blood gas analysis (BGA) values in pediatric intensive care unit (PICU) patients. Objective To determine the efficacy of chest physiotherapy and suctioning vs. suctioning alone for improving the mechanical ventilation parameters and BGA. Methods This randomized, single-blind, clinical trial was conducted from November 2012 to June 2013 in the PICU at Haji Adam Malik Hospital, Medan. A total of 40 mechanically-ventilated pediatric patients were enrolled and divided into either the chest physiotherapy and suctioning group (24 subjects) or the suctioning alone group (16 subjects). Subjects underwent treatment, followed by monitoring of their ventilation parameters and blood gas analyses. Data were analyzed by independent t-test and Mann-Whitney test. Results Subjects comprised of 23 boys and 17 girls, with an age range of 1–204 months. After the respective treatments (chest physiotherapy and suctioning vs. suctioning alone), the ventilation parameters were as follows: median TV (60.0 vs. 56.5 mL, respectively; P=0.838), median PEF (10.4 vs. 10.8 I/s, respectively; P=0.838), median PIF (7.4 vs. 8.2 I/s, respectively; P=0.469), and mean PIP (17.3 vs . 15.6 cmH 2 O, respectively; P=0.23). The BGA values were: median pH (7.4 vs. 7.3, respectively; P=0.838), median pCO 2 (38.4 vs . 36.2 mmHg, respectively; P=1.000), mean pO 2 (136.6 vs. 139.2 mmHg, respectively; P=0.834), median HCO 3 (20.4 vs. 22.7 mmol/L, respectively; P=0.594), median TCO 2 (22.0 vs. 23.7 mmol/L, respectively; P=0.672), mean BE (-4.3 vs. -3.1 mmol/L, respectively; P=0.629), and median O 2 saturation (98.5 vs. 98.3 %, respectively; P=0.967). Conclusion In mechanically-ventilated children in the PICU, ventilation parameters and BGA values are not significantly different between subjects who received both chest physiotherapy and suctioning and those who received suctioning alone.

Quality of life in adolescents with primary headaches

Background Headaches are common problems in adults, adolescents, and children. Headaches impact a childs life, their family life, and even society. An assessment of quality of life in adolescents with primary headaches may help to determine actions necessary to improve the quality of life of these patients. Objective To assess the quality oflife of adolescents with primary headach es compared to healthy adolescents. Methods We conducted a cross-sectional study in December 2009 on adolescents aged 13 to 18 years. The headache group consisted of children with primary headaches according to the International Classification of Headache Disarders and the control group consisted of healthy adolescents. Subjects were selected by consecutive sampling, with 75 subjects in each group. Subjects filled the Pediatric Quality of Life Inventary version 4.0 (PedsQL 4.0) questionnaire. Results The mean PedsQL total score was significantly lower in the headache group than in the contra 1 group [ l 7 5. 7 vs. 392.2, respectively, (95%CI of differences -28.l to -219.3, P = 0.001)]. However, out of23 items in the questionnaire, 9 were not significantly different between the headache and control groups. Conclusions Primary headaches in adolescents is associated with lower quality of life. Most quality of life domains scores are significantly lower in adolescents with primary headaches compared to those without primary headaches.

Food and migraine in adolescents

Background Migraine headaches are a common problem worldwide, especially in adolescents. They are usually chronic, with frequent relapses. Therefore, any dietary risk factor for headaches has important implications on migraineurs. However, the association between migraine and diet needs to be examined further. Objective To investigate the association between diet and migraine in adolescents. Methods We conducted a cross-sectional study in August to September 2009 on 13 - 18 year old adolescents in a senior high school in Medan, North Sumatera. We included subjects diagnosed with migraine, according to the International Headache Society (IHS) criteria. Ninety participants completed the questionnaire. Foods we observed for a link to migraine included milk, chocolate, ice cream, cheese, bread, instant noodles, meatballs, chili sauce, sweetener, yoghurt, pizza, and other foods and beverages. Results Of the 90 participants with migraines, there were more females (61.1%) than males. There were statistically significant associations between migraine and triggering foods (P = 0.045, 95% CI 0.59 to 0.79) as well as between migraine and family history of migraine (P = 0.043, 95% CI 0.46 to 0.66). Stress (P = 0.164), menstruation (P = 0.369), and sound or light (P= 0.577) had no significant association with migraine. A wide variety of foods and beverages were implicated as migraine precipitants. The most common were chili sauce (75.8%), ice cream (71.0%), milk (67.7%), instant noodles (67.7%), chocolate (61.3%), peanuts (59.7%), cheese (54.8%) and meatballs (54.8%). Conclusion Food and family history have a significant association with the occurrence of migraine in adolescents.

Decreased peak expiratory flow in pediatric passive smokers

Background Indonesia ranks fifth among countries with the highest aggregate levels of tobacco consumption in the world. Infants and children exposed to environmental tobacco smoke have increased rates of asthma, respiratory and ear infections, as well as reduced lung function. The effects of tobacco smoke exposure on lung function in children have been reported to be dependent on the source of smoke and the length and dose of exposure. Lung function may also be affected by a child’s gender and asthma status. Objective To compare peak expiratory flow (PEF) in pediatric passive smokers to that of children not exposed to second hand smoke, and to define factors that may affect PEF in passive smokers. Methods In August 2009 we conducted a cross-sectional study at an elementary school in the Langkat district. Subjects were aged 6 to 12 years, and divided into two groups: passive smokers and those not exposed to secondhand smoke. Subjects’ PEFs were measured with a Mini-Wright peak flow meter. Measurements were performed in triplicate with the highest value recorded as the PEF. Demographic data including age, sex, weight, height, family income, parental education levels and occupations were obtained through questionnaires. Results Of the 170 participants, 100 were passive smokers and 70 were not exposed to secondhand smoke. Age distribution, weight and height were similar in both groups. We observed a significant difference in PEFs between the group of passive smokers and the group not exposed to secondhand smoke, 211.3 L/minute (SD 61.08) and 242.7 L/minute (SD 77.09), respectively (P < 0.005). The number of years of exposure to smoke (P = 0.079) and the number of cigarettes smoked daily in the household (P = 0.098) did not significantly influence PEF. Conclusion The PEF in pediatric passive smokers was significantly lower than that of children not exposed to secondhand smoke. PEF in passive smokers was not influenced by the number of years of smoke exposure or the number of cigarettes smoked daily in the household.

Comparison of skin prick allergy test in urban and rural children

Background Children who grow up in rural areas have a lower incidence of atopy and other allergic manifestations than children in urban areas. Several recent studies have suggested that agricultural exposure may protect children from developing asthma and atopy, but these findings are inconsistent. Objective To examine an association between living in rural or urban areas and skin prick allergy test results in children and to detennine associated risk factors for atopy. Methods We conducted a cross-sectional study in Karo district (rural) and Medan (urban) in October-December 2009. We enrolled primary school children who had a history of atopy in their families. Skin prick testing was done on the volar side of the forearm and included eight aero-allergens: house dust mites, house dust, cotton, chicken feathers, cat dander, cockroaches, mould, and pollen. We analyzed the folloMng risk factors for association Mth atopy: tobacco smoke, pets, livestock exposure, and having older sibling(s). Results We recruited 49 children from the Karo district and 52 children from the city of Medan. There were significant associations between living in an urban area and positive skin prick test results for house dust mites and house dust compared to living in a rural area (P=0.04, 95% CI: 1.11 to 5.91; P=0.04, 95% CI: 1.13 to 12.45, respectively). The reverse was true for cockroach allergens (P=0.02, 95% CI: 0.16 to 0.81). Tobacco smoke and livestock exposure were associated Mth negative skin prick test results in rural children (P=O.03, 95% CI: 0.03 to 0.81 and P=0.002, 95% CI: 0.02 to 0.42, respectively). Multivariate analysis revealed that lack of livestock exposure was the major risk factor associated Mth any positive skin prick test results in rural children (P=0.004; 95% CI ; 0.02 to 0.49). Conclusion There were differing associations between living in rural and urban areas to various skin prick test results in children. Lack of livestock exposure was the risk factor associated with positive skin prick test results in rural children.