Paediatrica Indonesiana最新文献

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}