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All Journal Sari Pediatri Paediatrica Indonesiana Narra J Archives of Pediatric Gastroenterology, Hepatology, and Nutrition
Yuliarti, Klara
Department Of Child Health, Faculty Of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Incidence and risk factors of nephritis in childhood Henoch-Schonlein purpura Yaulia Yanrismet; Eka Laksmi Hidayati; Zakiudin Munasir; Klara Yuliarti; Afifa Fahriyani
Paediatrica Indonesiana Vol 63 No 4 (2023): July 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.4.2023.304-14

Abstract

Background Henoch-Schönlein Purpura (HSP) is the most common systemic vasculitis disease in children. It is characterized by involvement of the skin, joints, gastrointestinal tract, and kidney. Kidney manifestations may progress to severe nephritis, even lead to end-stage kidney disease. Objective To identify the incidence and risk factors of nephritis in childhood HSP. Methods A retrospective cohort study was performed to evaluate clinical, demographic, laboratory, and therapeutic parameters of HSP patients aged 0-18 years between 2011-2019 at Dr. Cipto Mangunkusumo Hospital, Jakarta. Diagnoses of HSP were made according to the 2008 EULAR/PRES/PRINTO criteria. Wefollowed subjects’ medical records for at least 3 months after disease onset to observe incidence and risk factors of Henoch-Schönlein nephritis (HSN).Results There were 112 HSP patients (aged 2-17 years) included in this study. HSN was found in 40 out of 112 patients (35.7%). Nephritis developed within the first 4 weeks for a majority of cases. Multivariate analysis showed that persistent purpura (OR 3.306; 95%CI 1.315 to 8.315; P=0.011) and acute phase leukocytosis(OR 2.585; 95%CI 1.047 to 6.385; P=0.039) were significantly associated risk factors for HSN. We found that corticosteroid use did not reduce the risk of HSN. The accumulation of several risk factors was associated with the likelihood of developing HSN. Conclusion Persistent purpura and acute phase leukocytosis are independent risk factors for HSN. Therefore, blood tests are needed to estimate the risk of HSN. Early corticosteroid therapy do not reduce the risk of kidney impairment.
Pendampingan Asuhan Nutrisi Balita dengan Epilepsi di Era Pandemi COVID-19 Secara Daring: Uji Klinis Acak Terkontrol Klara Yuliarti; Achmad Rafli; Citra Raditha; Valensia Vivian The; Nadia Chairunnisa; Irawan Mangunatmadja
Sari Pediatri Vol 25, No 4 (2023)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp25.4.2023.221-30

Abstract

Latar belakang. Anak epilepsi berisiko mengalami malnutrisi, keterlambatan perkembangan, dan defisiensi vitamin D akibat obat anti-epilepsi. Pandemi COVID-19 membatasi kunjungan ke dokter sehingga menghambat pemantauan pertumbuhan anak epilepsi. Pemantauan jarak jauh dapat membantu asuhan nutrisi optimal selama pandemi..Tujuan. Mengevaluasi efektivitas pendampingan asuhan nutrisi pediatrik melalui WhatsApp pada balita epilepsi.Metode. Penelitian multisenter dimulai Maret 2021 pada pasien epilepsi (6 bulan - 5 tahun). Kelompok intervensi mendapat pendampingan asuhan nutrisi melalui WhatsApp selama 3 bulan, sementara kelompok kontrol tidak. Sebelum intervensi, subjek diberikan edukasi melalui webinar, pemeriksaan anemia defisiensi besi dan vitamin D 25-OH.Hasil. Sebanyak 73 subjek direkrut dan 69 subjek mengikuti penelitian sampai selesai. Defisiensi/insufisiensi vitamin D didapatkan pada 35,6% subjek. Oral nutrition supplement merupakan saran intervensi terbanyak (23,1%). Meski WhatsApp tidak signifikan untuk perbaikan status gizi, 84,2% orangtua melihat manfaatnya dalam meningkatkan pengetahuan dan mengatasi masalah nutrisi. Meskipun beberapa memerlukan nutrisi enteral dan kunjungan tatap muka, dampak positif WhatsApp terlihat dalam meningkatkan pemahaman orangtua. Kesimpulan. Asuhan nutrisi anak epilepsi dapat ditingkatkan melalui pendampingan WhatsApp di masa pandemi. Beberapa intervensi memerlukan konsultasi tatap muka, tetapi kombinasi supervisi daring dan kunjungan tatap muka dapat menjadi alternatif setelah pandemi, mengatasi kendala jarak dan mobilitas dalam memberikan asuhan nutrisi.
The role of early aggressive nutrition on growth of very preterm or very low birth weight infants Insani, Nadia Dwi; Rohsiswatmo, Rinawati; Sjarif, Damayanti Rusli; Marsubrin, Putri Maharani Tristanita; Yuliarti, Klara; Gultom, Lanny Christine
Paediatrica Indonesiana Vol. 64 No. 4 (2024): July 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.4.2024.318-24

Abstract

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.
Role of antioxidants in reducing oxidative stress and seizure frequency in drug-resistant epileptic patients Ismy, Jufitriani; Soebadi, Amanda; Mangunatmadja, Irawan; Monica, Merci; Sari, Teny T.; Yuliarti, Klara
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.790

Abstract

Drug-resistant epilepsy presents significant challenges in treating epileptic patients, leading to recurrent seizures and necessitating the use of polypharmacy with anti-epileptic drugs. Both of these conditions contribute to increased oxidative stress, which is detrimental to the brain. The aim of this study was to determine the role of vitamins C and E in reducing oxidative stress and seizure frequency in drug-resistant epileptic patients. This was a double-blinded, randomized clinical trial with a placebo, parallel design, and block randomization. The subjects were drug-resistant epileptic patients aged 1–18 years who received routine treatment. Randomization was performed on 100 patients who were divided into the treatment or placebo groups. The patients received a combination of vitamin C (100 mg/day) and vitamin E (200 IU/day for those <5 years or 400 IU/day for those ≥5 years) or a placebo for eight weeks. Malondialdehyde (MDA) levels and seizure frequency were measured prior to and after the intervention. A total of 42 and 46 patients were followed till the end of the study in the intervention and placebo groups, respectively. Our data indicated that the MDA levels prior to treatment were not significantly different between the treatment and placebo groups (0.901 vs 0.890 mmol/mL, p=0.920) and were significantly reduced after the treatment in both the treatment group (p<0.001) and placebo group (p=0.028). The changes in MDA levels (between post- and pre-treatment) were also not significantly different between the two groups (p=0.181). Our per-protocol analysis indicated that the reduction in seizure frequency was significantly higher in the treatment group compared to the placebo group (95% vs 35%, p<0.001), with 92% and 60% relative and absolute risk reduction, respectively. The intention-to-treat analysis also indicated that the reduction in seizure frequency was significantly higher in the intervention group than in the control group (80% vs 32%, p<0.001), with relative and absolute risk reduction of 70% and 48%, respectively. There was no significant relationship between changes in MDA levels and seizure frequency in either group. In conclusion, vitamins C and E could reduce seizure frequency and, therefore, could be considered as adjuvant therapy in drug-resistant epileptic patients.
Performance of WHO mid-upper arm circumference cut-off to diagnose severe acute malnutrition in under-fives Neldy, Fahreza Aditya; Yuliarti, Klara; Andriastuti, Murti
Paediatrica Indonesiana Vol. 64 No. 5 (2024): September 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.5.2024.439-46

Abstract

Background Many studies indicate that the current WHO recommendation of cut-off value mid-upper arm circumference (MUAC) is not sensitive to detect severe acute malnutrition (SAM) in under-fives cases. Various new cut-off values have been proposed with better diagnostic values but have a wide interval, 12.1 cm—14.5 cm, which may be due to different races or habitus. Objective To evaluate the diagnostic value of MUAC in diagnosing SAM compared to the weight for height Z score (WFZ) index, to evaluate sensitivity, specificity, positive and negative predictive value of MUAC with 11.5 cm as standard cut-off, and to find an alternative cut-off value that may offer better diagnostic performance. Methods We collected 421 subjects consecutively in January-February 2020 in Cipto Mangunkusumo Hospital and Puskesmas Cengkareng. We performed brief conversations for demographic data and did the measurement of physical examination and anthropometric measurement by trained researchers and research assistants. Results Mid-upper arm circumference has excellent diagnostic value to assess SAM in under-fives with area under curve 0,939 (CI95% 0,903-0,974). Diagnostic values MUAC using cut off 11.5 cm were 21% sensitivity (Se) 21%, 99.7% spesificity (Sp)and Youden Index (YI) of 0.20. By using 13.3 cm as a new cut-off value, MUAC has Se 89%, Sp 87%, and YI of 0.76. Conclusion We conclude that WHO MUAC cut-off using 11.5 cm has lower performance to detect SAM cases than the proposed new cut-off value of 13.3 cm. New MUAC cut-off should be considered to detect more SAM cases among under-fives.
Refeeding Syndrome in Malnutrition – Diagnosis and Management Aini, Mei Tsarah; Yuliarti, Klara
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 3 No. 4 (2024): APGHN Vol. 3 No. 4 November 2024
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.3.4.2024.43-59

Abstract

Background: Refeeding Syndrome (RS) is a one of the potentially life-threatening complications in malnourished children. The diagnosis of RS is often challenging due to its diverse clinical manifestations. A comprehensive understanding of the risk factors, sign, symptoms and the management of RS is important to reduce morbidity and mortality. Discussion: The management of malnutrition consists of a ten-step process divided into three phases. Adherence to this protocol is important to mitigate the risk of RS. RS is a metabolic complication that occurs when malnourished children rapidly reintroduced to nutrition. This condition is characterized by a shift of electrolytes from the extracellular to the intracellular, leading to hypophosphatemia, hypokalemia, hypomagnesemia, and thiamine deficiency. Children with RS require aggressive electrolyte and vitamin supplementation, followed by a cautious nutritional re-initiation. A gradual approach to nutritional reintroduction and electrolyte supplementation, are a critical preventive measure of RS. Conclusion: All malnourished children are at risk of RS. Recognizing its risk factors and watchful monitoring are essential for early detection and prevention of RS.
Co-Authors Achmad Rafli Afifa Fahriyani Aini, Mei Tsarah Citra Raditha Damayanti Rusli Sjarif Eka Laksmi Hidayati, Eka Laksmi Gultom, Lanny Christine Insani, Nadia Dwi Irawan Mangunatmadja Irawan Mangunatmadja Iskandar, William Jayadi Ismy, Jufitriani Marsubrin, Putri Maharani Tristanita Merci Monica br Pasaribu Murti Andriastuti, Murti Nadia Chairunnisa Neldy, Fahreza Aditya Rinawati Rohsiswatmo Sari, Teny T. Soebadi, Amanda Valensia Vivian The Yaulia Yanrismet Zakiudin Munasir