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All Journal Sari Pediatri Paediatrica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia World Nutrition Journal Narra J Archives of Pediatric Gastroenterology, Hepatology, and Nutrition The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy

Muzal Kadim

Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta

Author-ID : 294531

Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Articles

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Epidemiology of Rotavirus diarrhea in children under five: A hospital-based surveillance in Jakarta Muzal Kadim; Yati Soenarto; Badriul Hegar; Agus Firmansyah
Paediatrica Indonesiana Vol 51 No 3 (2011): May 2011
Publisher : Indonesian Pediatric Society

Background Rotavirus is still a major cause of acute diarrheaÂ in children around the world, both in developed and developingcountries. WHO Surveillance from 2001 to 2008 showed that inÂ children under five years of age treated for acute diarrhea, on averageÂ 40% of cases were caused by rotavirus. A previous study in IndonesiaÂ showed that the incidence of rotavirus diarrhea in children rangedÂ from 20%ô€‘60% of diarrhea cases. However, there have been fewÂ studies identifying the genotypes of rotavirus strains in Indonesia.Â This infonnation is indispensable for manufacturing vaccines.Objective To examine the epidemiology of rotavirus diarrhea,Â including genotypes and clinical characteristics, in children underÂ five years who were hospitalized in Jakarta.Methods This study was a prospective surveillance conductedÂ at Cipto Mangunkusumo Hospital, Jakarta from January toÂ December 2007 investigating hospitalized children under fiveÂ years of age who suffered from acute diarrhea.Results Ninetyô€‘nine patients joined the study. The incidence ofÂ rotavirus infection in this study was 67%. The youngest was 2months of age and the oldest 54 months of age, Mth an average ageÂ of 13.6 months. As much as 92% of rota virus diarrhea was foundÂ in subjects aged 3ô€‘23 months, Mth a peak age of 12ô€‘23 months.Â Nutritional status, degree of dehydration, bloating, fever, bloodÂ in stool, and mucus in the feces were not significantly differentÂ between rotavirus and nonô€‘rotavirus diarrhea. Vomiting tended toÂ be more frequently experienced by children Mth rotavirus diarrheaÂ than those with nonô€‘rotavirus (88% vs. 67%). There was no clear,Â seasonal pattern for rotavirus diarrhea. Most G genotypes in thisÂ study were G1 (35%), G9 (12.5%), G2 (7.5%) and the majority ofÂ P genotypes were P6 (52.5%), P8 (17.5%) and P4 (10%).Conclusions The incidence of rotavirus diarrhea in hospitalizedÂ children under five years of age in Jakarta was 67%, with apredominance ofG1, G9 and G2 genotypes.Â

Behavior and emotional problems in children with mental retardation Soedjatmiko Soedjatmiko; Muzal Kadim; Bambang Madiyono; Mardjanis Said
Paediatrica Indonesiana Vol 44 No 3 (2004): May 2004
Publisher : Indonesian Pediatric Society

Background Behavior and emotional problems in a mentally re-tarded child can inhibit the educational process of the child.Objectives The aims of this study were to find out the prevalenceof behavior and emotional problems in children with mental retar-dation as reported by parents and to assess associated risk fac-tors consisting of motherâ€™s psychopathology, marital discord, malesex, childâ€™s age, socioeconomic status, and family size.Methods This cross sectional study was carried out on 63 chil-dren with mental retardation in a school for retarded children, SLBC Asih Budi I, from January until March 2003. Parents were inter-viewed at school and home using special questionnaires, the ChildBehavior Checklist (CBCL) and Symptom Checklist-90 (SCL-90).Results The prevalence of behavior and emotional problems inthis study was 52%. The majority of behavior and emotional prob-lems were anxious/depressed (18%) and withdrawn (16%). Malesex and age group of 12-18 year-old were not risk factors of be-havior and emotional problems (OR=0.49, p=0.190 and OR=1.14,p=0.94, respectively) while socioeconomic status, family size, andmotherâ€™s psychopathology were risk factors (OR= 4.08, p=0.008;OR=4.17, p=0.014; OR=9.28, p=0.018; respectively). There wasa correlation between behavior and emotional problems of chil-dren and marital discord.Conclusion The prevalence of behavior and emotional problemswas 52% in which the majority was internalizing disorder. Risk fac-tors for behavior and emotional problems were motherâ€™s psycho-pathology, four or more children in the family, low socioeconomicstatus, and marital discord

Gut wall integrity in exclusively breastfed vs. formula-fed infants Nur Hayati; Muzal Kadim; Irawan Mangunatmadja; Soepardi Soedibyo; Evita Bermansyah Ifran; Hikari Ambara Sjakti
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Background Breast milk has bioactive substances that modulate gastrointestinal maturation and maintain mucosal integrity of the gut in infants. Markers that are both non-invasive and reliable, such as fecal alpha-1 antitrypsin (AAT), calprotectin, and secretory immunoglobulin A (sIgA) have been used to assess gut integrity in adults. Higher AAT levels may imply greater enteric protein loss due to increase intestinal permeability of immaturity gut.Objective To assess and compare gut integrity of exclusively breastfed (BF) and exclusively formula fed (FF) infants aged 4-6 months.Methods Subjects were 80 healthy infants (BF=40; FF=40), aged 4-6 months who visited the Pediatric Polyclinic at St. Carolus Hospital, and lived in Pasar Minggu or Cempaka Putih Districts, Jakarta. The fecal AAT was analyzed by an ELISA method. Mann-Whitney and unpaired T-test were used to analyze possible correlations between feeding type and gut integrity.Results The BF group had significantly higher mean fecal AAT than the FF group (P=0.02). Median sIgA levels were not significantly different between groups (P=0.104). The FF group had a higher mean fecal calprotectin level but this difference was also not significant (P=0.443). There was a significant correlation between breastfeeding and mean fecal AAT level (P=0.02), but no significant correlation with calprotectin (P=0.65) or sIgA (P=0.26).Conclusion The breastfed group shows better mucosal integrity compared to the formula fed group. Higher mean fecal AAT level in the BF group is related to the AAT content of breast milk. Therefore AAT content of BF group is actually lower than formula fed group which shows greater mucosal integrity in BF group.

The relationship between thrombocytopenia and intraventricular hemorrhage in neonates with gestational age Idha Yulandari; Lily Rundjan; Muzal Kadim; Pustika Amalia; Haryanti F. Wulandari; Setyo Handryastuti
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Background The prevalence of thrombocytopenia in neonates ranges from 22 to 35%, and one of the most feared complicaÂtions is intraventricular hemorrhage (IVH). Previous research in Cipto Mangunkusumo Hospital (CMH), Jakarta reported a high incidence of IVH (43.47%) in infants with a gestational age of <35 weeks. Intraventricular hemorrhage causes disturbances in neurological development and can be fatal. In Indonesia, reÂsearch on the relationship between thrombocytopenia and IVH has been limited.Objective To study the relationship between thrombocytopenia and IVH in neonates with gestational age <35 weeks and assess for a correlation between the severity of thrombocytopenia and the severity of IVH.Methods This cross-sectional study was performed by reviewing medical records in the Neonatology Division of the Child Health Department, University of Indonesia, CMH. Subjects were neonates hospitalized from January 2012 to December 2014 with IVH. Subjects were categorized into either mild to moderate IVH (grade â‰¤2) or severe IVH (grade >2). Thrombocyte counts were recorded on the same day as the diagnosis of IVH.Results The risk of severe IVH was 28.2% in neonates with thrombocyte counts <100,000/uL, and 10.4% in neonates without thrombocytopenia (P=0.014). Multivariate analysis revealed that gestational age <32 weeks and the use of respiraÂtory support (ventilator and high frequency oscillatory ventilaÂtion) had significant associations with severe IVH. However, multivariate analysis did not show a significant relationship between thrombocytopenia and severe IVH (correlation coefÂficient = 0.21).Conclusion Thrombocytopenia is not significantly associated with the incidence of severe IVH based on multivariate analysis. Also, the severity of thrombocytopenia has no correlation with the severity of IVH.

Covert bacteriuria in schoolchildren Taralan Tambunan; Yuli Kumalawati; Partini P. Trihono; Astuti Giantiti; Muzal Kadim; Vera Irawani
Paediatrica Indonesiana Vol 41 No 1-2 (2001): January 2001
Publisher : Indonesian Pediatric Society

Covert bacteriuria is defined as significant bacteriuria detected during a screening program, This study was done as a pari of pilot program held by Medical School University of Indonesia namely Community Health Program. The screening was carried out at four Primary School al Cibubur Subdistrict Eastern Jakarta. The population target was focused on children at the third, four1h and fifth grade from each school. Screening urinalyses include examinatiOfl for the presence of glucose, protein, blood and bacteria. There were 460 children enrolled to this study, but only 449 cases were eligible for assessment comprising 217 males and 232 females aged ranged between 7.4-14.1 years. Covert bacteriuria were found in ten cases (2.22%), comprising five males and females consecutively. Antibiotics were not given. Repeated urine culture done two weeks later revealed that six cases cured spontaneously, four other cases still showing bacteriuria although all cases remain asymptomatic. We conclude that covert bacteriuria in schoolchildren is a benign condition, most of them are spontaneously cured without antibiotic treatment. This conclusion is in accordance with the opinion of most authors that screening for bacteriuria in healthy children does not have a place in any age group including schoolchildren.

Selenium level in steroid-resistant and steroid-sensitive nephrotic syndrome Sudung Oloan Pardede; Andini Striratnaputri; Muzal Kadim
Paediatrica Indonesiana Vol 60 No 6 (2020): November 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.6.2020.316-20

Background The mechanisms of pathogenesis of steroid-resistant nephrotic syndrome (SRNS) and steroid-sensitive nephrotic syndrome (SSNS) are not well understood. Antioxidants, such as glutathione peroxidase enzyme (GPx) and its cofactor, selenium, are thought to slow the progress of nephrotic syndrome (NS). Objective To compare selenium levels in SRNS and SSNS pediatric patients. Methods This cross-sectional study was conducted in 51 SRNS and 30 SSNS patients, aged 2 to 18 years, who visited the Pediatric Nephrology Outpatient Clinic at Cipto Mangunkusumo Hospital, Jakarta. Subjects were included by consecutive sampling. Selenium was measured on venous blood using GC tools MS â„¢ (Agilent technologies, inc.). Results Median selenium levels in SRNS patients were 92 (range 42-154) Î¼g/L and in SSNS patients were 93 (range 69-193) Î¼g/L. Conclusion Selenium levels in SRNS and SSNS patients were not significantly different.

Prevalence and risk factors of irritable bowel syndrome in adolescents Muzal Kadim; Aida Rosita Tantri; Muhammad Indera Ramadani
Paediatrica Indonesiana Vol 61 No 6 (2021): November 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.6.2021.299-305

Background Irritable bowel syndrome (IBS) is a common gastrointestinal disorder in children and adults. The IBS is diagnosed by symptoms that fulfill the Rome IV criteria. This condition can impact quality of life, especially in adolescents. Objectives To investigate the prevalence of IBS in high school students and analyze its risk factors. Methods This cross-sectional study was done with e-questionnaires from Rome IV Diagnostic Questionnaire on Pediatric Functional Gastrointestinal Disorders (R4PDQ). Students from high school and occupational schools age 14 to 18-years-old in Jakarta were included in this study. Possible risk factors for IBS were analyzed using Fisherâ€™s exact test for bivariate analysis and logistic regression for multivariate analysis. Results Of 210 subjects, 10 (4.8%) had IBS. The IBS-M and IBS-C subtypes were more common than IBS-D. Gastrointestinal infection history was significantly associated with IBS (OR 7.1; 95%CI 1.7 to 29.3; P=0.013). Other factors such as gender, corporal punishment, asthma, spicy and fatty food consumption, as well as socioeconomic status were not significantly associated with IBS (P>0.05). Conclusion The prevalence of IBS in adolescents is 4.8%. History of gastrointestinal infection is a risk factor for IBS.

Risk factors of recurrent abdominal pain in adolescents Muzal Kadim; Anjar Setiani; Aryono Hendarto
Paediatrica Indonesiana Vol 61 No 3 (2021): May 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.3.2021.141-8

Background Recurrent abdominal pain is 2-4% of all cases encountered by pediatricians. Risk factors vary among countries. There is no data on prevalence and risk factors of recurrent abdominal pain in adolescents in Indonesia. Objective To evaluate prevalence and risk factors of recurrent abdominal pain in junior high school students. Methods A cross-sectional study was performed among junior high school students in South Jakarta who experienced recurrent abdominal pain according to Roma III criteria. Students allowed by their parents to participate to this study were asked to complete a Roma III questionnaire. Data about sociodemographic and history of recurrent abdominal pain among the parents were also collected using a questionnaire. ResultsThree hundred ninety-six adolescents participated in this study, 17.2% among them experiencing recurrentabdominal pain. Irritable bowel syndrome (IBS) was the most common type (42.6%), followed by functional dyspepsia (30.9%), functional abdominal pain syndrome (11.8%), functional abdominal pain (10.3%), and abdominal migraine (4.4%). The risk factor most responsible was anxious personality (OR 3.86; 95%CI 2.05 to 7.29, P<0.001). Other risk factors that contribute were female, age > 13 years, and middle to lower family income. Conclusions Prevalence of recurrent abdominal pain in adolescents is 17.2%. Irritable bowel syndrome is the most common type. The risk factors are anxious personality, female, age > 13 years, and middle to lower family income.

Functional gastrointestinal disorders in adolescents during online learning Simanjuntak, Sumardi F.; Prawitasari, Titis; Kadim, Muzal; Sari, Teny Tjitra; Gunardi, Hartono; Vandenplas, Yvan; Hegar, Badriul
Paediatrica Indonesiana Vol. 63 No. 5 (2023): September 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.5.2023.353-60

Background The COVID-19 pandemic necessitated the use of online schooling in order to comply with national and local lockdown guidelines. Online learning required students and teachers to adapt to a new method of schooling. The inability of adolescents to adapt to their environment can interfere with their psychosocial condition and become a risk factor for functional gastrointestinal disorders (FGID). Objective To determine the prevalence of FGID in adolescents and evaluate possible risk factors that existed during online learning. Methods This cross-sectional study was done in children aged 12-18 years who participated in online learning during the COVID-19 pandemic. The diagnosis of FGID was based on Rome IV criteria. Psychosocial problems were assessed using the Pediatric Symptom Checklist Questionnaire–17 (PSC-17) which includes internalization, externalization, and attention subscales. Subjects with a PSC-17 mixed subscale total score of >15 were considered as having an increased likelihood of having a behavioral health disorder. Data were collected by online questionnaires via Google Forms. Results Of 1,413 participants, 23% experienced FGID; of these, 32.6% had >2 FGID diagnostic criteria. Upon multivariate analysis, internalization psychosocial problems were the most common risk factors for FGID, followed by mixed subscale psychosocial problems, unstable internet connection, and not understanding of the material. ConclusionThe prevalence of FGID in adolescents in this study is 23%. Environmental and psychosocial conditions are interrelated as risk factors for FGID in adolescents during online learning in the COVID-19 pandemic.

Early enteral nutrition administration and time to achieve resting energy expenditure in critically ill children Yulman, Annisa Rahmania; Pudjiadi, Antonius Hocky; Tridjaja, Bambang; Kadim, Muzal; Prawitasari, Titis
Paediatrica Indonesiana Vol. 65 No. 5 (2025): September 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.5.2025.390-8

Background Malnutrition in critically ill children remains a significant concern, as a standardized nutritional support protocol has yet to be developed. Resting energy expenditure (REE) is recommended as a parameter for determining the fulfillment of energy needs in critically ill children, which should ideally be achieved within 72 hours. To achieve these energy needs, enteral nutrition (EN) is believed to have a lower mortality rate and a shorter length of stay compared to parenteral nutrition (PN). Objective To evaluate the factors associated with delayed EN initiation and late achievement of REE. Methods Data consisting of age, sex, nutritional status, timing of EN initiation, time required to achieve REE targets, PELOD-2 score, use of ventilators, duration of ventilation, hemodynamic status, use of inotropes and inotropic score, use of sedation, gastrointestinal symptoms, procedures performed during treatment, and technical issues were collected retrospectively from medical records from 2017 – 2018 in the Pediatric Intensive Care Unit (PICU) at Dr. Cipto Mangunkusumo Hospital. The REE was calculated using Schofield formula based on age and sex. These data were used to compare the proportion of the subjects receiving early EN (<48 hours) and delayed EN (>48 hours) and those who achieved REE <72 hours and delayed REE (>72 hours). Multivariate analysis was performed to determine which factors affecting late EN initiation and delayed REE achievement using logistic regression analysis. Results Of 203 subjects, 63.1% received early EN and 67.5% achieved REE at ≤72 hours. Delayed EN was associated with post-abdominal surgery (OR 10.89; 95%CI 4.31 to 27.50; P<0.001), ventilator use (OR 4.60; 95%CI 1.78 to 11.90; P=0.004), inotrope use (OR 4.18; 95%CI 1.56 to 11.17; P=0.002), gastrointestinal symptoms (OR 3.41; 95%CI 1.59 to 7.29; P=0.002), and abnormal nutritional status (OR 2.49; 95%CI 1.09 to 5.72; P=0.031). The REE >72 hours was associated with late EN (OR 20.62; 95%CI 6.48 to 65.65; P<0.001), enteral intolerance after receiving EN (OR 14.77; 95%CI 4.40 to 49.6; P<0.001), and PELOD-2 score ≥7 (OR 3.98; 95%CI 1.01 to 15.66; P=0.048). Conclusion The prevalence of EN and REE within 72 hours in the PICU is quite encouraging. Factors contributing to delayed EN administration include post-abdominal surgery, ventilator use, inotrope use, gastrointestinal symptoms, and abnormal nutritional status. Delayed EN >48 hours, enteral intolerance after receiving EN, and PELOD-2 score >7 were the factors contributing to delayed REE achievement. However, these delays can be reduced by developing a comprehensive enteral feeding protocol. The factors influencing delayed EN and late REE achievement are an important basis for designing enteral feeding protocols to improve the clinical outcomes of critically ill children in the PICU.

Co-Authors Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Amrina Rasyada Andini Striratnaputri Anjar Setiani Aryono Hendarto Astuti Giantiti Astuti, Sri Kesuma Aswitha Boediarso Aswitha Boediharso Aswitha Boediharso Aswitha D Boediarso Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Bambang Madiyono Bambang Supriyatno Bambang Tridjaja AAP, Bambang Tridjaja Berlian Hasibuan Bernie Endyarni Medise Chozie, Novie A. Cindy Gisella Zahrany Deddy S Putra Deddy S Putra Evita Bermansyah Ifran Ezy Barnita Farahdina Shahnaz Fatima Safira Alatas, Fatima Safira Fatima Safra Alatas Handayani, Dyah Suci Hartono Gunardi Haryanti F. Wulandari Hasri Salwan Hikari Ambara Sjakti, Hikari Ambara I Gusti Ngurah Sanjaya Putra Idha Yulandari Idham Amir Irawan Mangunatmadja Jennie Dianita Sutantio Jeshika Febi Kusumawati Kholisah Nasution Laila, Dewi S. Lily Rundjan Lukito Ongko Mardjanis Said Mardjanis Said Masita, Bertri Maulidya Muhammad Indera Ramadani Mulyadi M. Djer Najib Advani Nina Dwi Putri Nur Hayati Partini P. Trihono Perdana, Andri Permatasari, Ruth K. Pramita G D Pramita GD Pudjiadi, Antonius Hocky Pustika Amalia Rahman, Himawan Aulia Ratno Juniarto Marulitua Sidauruk Setia Budi Setyo Handryastuti Simanjuntak, Sumardi F. Soedjatmiko Soedjatmiko Soepardi Soedibyo Sudung Oloan Pardede Sulaiman Yusuf Syafruddin Haris Tantri, Aida Rosita Taralan Tambunan Teny Tjitra Sari, Teny Tjitra Titi Sunarwati Sularyo Titis Prawitasari, Titis Vera Irawani Wahyu Ika Wardhani William Cheng Yati Soenarto Yuli Kumalawati Yulman, Annisa Rahmania Yvan Vandenplas

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