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All Journal The Indonesian Biomedical Journal Sari Pediatri Paediatrica Indonesiana Indonesian Journal of Cardiology Narra J

Aryono Hendarto

Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia RS Dr. Cipto Mangunkusumo Jakarta

Author-ID : 3210249

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

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Vitamin D levels in epileptic children on long-term anticonvulsant therapy Fathy Pohan; Aryono Hendarto; Irawan Mangunatmadja; Hartono Gunardi
Paediatrica Indonesiana Vol 55 No 3 (2015): May 2015
Publisher : Indonesian Pediatric Society

Background Long-term anticonvulsant therapy, especially with enzyme inducers, has been associated with low 25-hydroxyvitamin D [25(OH)D] levels and high prevalence of vitamin D deficiency. However, there have been inconsistent results in studies on the effect of long-term, non-enzyme inducer anticonvulsant use on vitamin D levels.Objective To compare 25(OH)D levels in epileptic children on long-term anticonvulsant therapy and non-epileptic children. We also assessed for factors potentially associated with vitamin D deficiency/insufficiency in epileptic children.Methods This cross-sectional study was conducted at two pediatric neurology outpatient clinics in Jakarta, from March to June 2013. Subjects in the case group were epileptic children, aged 6-11 years who had used valproic acid, carbamazepine, phenobarbital, phenytoin, or oxcarbazepine, as a single or combination therapy, for at least 1 year. Control subjects were non-epileptic, had not consumed anticonvulsants, and were matched for age and gender to the case group. All subjectsâ€™ 25(OH)D levels were measured by enzyme immunoassay.Results There were 31 epileptic children and 31 non-epileptic control children. Their mean age was 9.1 (SD 1.8) years. Most subjects in the case group were treated with valproic acid (25/31), administered as a monotherapy (21/31). The mean duration of anticonvulsant consumption was 41.9 (SD 20) months. The mean 25(OH)D level of the epileptic group was 41.1 (SD 16) ng/mL, lower than the control group with a mean difference of 9.7 (95%CI 1.6 to 17.9) ng/mL. No vitamin D deficiency was found in this study. The prevalence of vitamin D insufficiency in the epileptic group was higher than in the control group (12/31 vs. 4/31; P=0.020). No identified risk factors were associated with low 25(OH)D levels in epileptic children.Conclusion Vitamin D levels in epileptic children with long-term anticonvulsant therapy are lower than that of non-epilepticÂ children, but none had vitamin D deficiency.

Iron profiles of preterm infants at two months of chronological age Henny Adriani Puspitasari; Endang Windiastuti; Aryono Hendarto
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Preterm infants are vulnerable to iron deficiency (ID) due to lack of maternal iron stores, repeated phlebotomy, and the bodyâ€™s increased demand for iron during growth. The risk of ID increases at 2 months of age, when hemoglobin (Hb) levels start to decrease. Adequacy of body iron level is assessed by ferritin, serum iron (SI), transferrin saturation (Tfsat), total iron-binding capacity (TIBC), and Hb measurements. Objective To describe iron profiles in preterm infants at 2 months of chronological age (CA). Methods This cross-sectional study was conducted in 2-month-old infants, born at 32-36 weeks of gestational age, and who visited the Growth and Development Clinics at Cipto Mangunkusumo, Fatmawati, or Budi Kemuliaan Hospitals. Parental interviews and medical record reviews were done during the clinic visits. Complete blood count, blood smear, SI, TIBC, Tfsat, and ferritin level tests were performed. Results Eighty-three subjects were enrolled in this study. Most subjects were male (51%) and born to mothers >20 years of age (93%). Subjectsâ€™ birth weights ranged from 1,180 g to 2,550 g. The prevalence of iron deficiency anemia (IDA) was 6% and that of ID was 10%. The lowest Hb level found in IDA infants was 6.8 g/dL, while the lowest ferritin level was 8.6 ng/mL. Median values for the other tests were as follows: SI 48 Âµg/dL, TIBC 329Âµg/dL, and Tfsat 17%. Subjects with IDA were all male (5/5), mostly achieved more than twice their birth weight (4/5), were non-iron supplemented (3/5), born to mothers with low educational background (3/5), and of low socioeconomic status (3/5). Conclusion The prevalence of IDA is 6% and that of ID is 10%. Most subjects with ID and IDA have low SI, high TIBC, low Tfsat, and low ferritin level. Most of the all-male IDA subjects weigh more than twice their birth weight, are non-iron supplemented, and born to mothers with low educational background and low socioeconomic status.

Factors associated with intelligence in young children with Down syndrome Frieda Handayani Kawanto; Soedjatmiko Soedjatmiko; Aryono Hendarto
Paediatrica Indonesiana Vol 52 No 4 (2012): July 2012
Publisher : Indonesian Pediatric Society

Introduction Despite the considerable number of children withDo\Vll syndrome in Indonesia, there is little data available on thesuccess of intervention programs. This study was performed todefine factors affecting the intelligence of young children withDo\Vll syndrome.Objective To determine factors associated Mth lower intelligencein children with Down syndrome, including growth parametersand participation in intervention programs.Methods This crossô€ƒsectional study was undertaken fromDecember 2010 to March 2011. Subjects were 60 childrenwith Down syndrome aged 2ô€ƒ6 years who were enrolled inan intervention program at both the Medical RehabilitationDepartment, Cipto Mangunkusumo Hospital, and the Growthand Development Clinic, Harapan Kita Women's and Children'sHospital. Parents' data was obtained through self historyô€ƒtakingand perusal of medical records. Subjects' anthropometricdata (body weight, body height, and head circumference) wasobtained through measurements using calibrated instruments.A psychologist administered IQ tests on the subjects. Results ofthe anthropometric and IQ tests were given to parents one weekfollowing the examinations.Results From the 111 children with Down syndromeregistered in the intervention programs, 60 children (36boys and 24 girls) met the inclusion criteria. The mean ageof subjects was 4 years 6 months. Most subjects were wellô€ƒnourished. Fiftyô€ƒfive subjects had microcephaly. Eightyô€ƒtwopercent of subjects participated in the program regularly and70% of subjects had started in the program at less than 1 yearof age. Subjects' mean IQ was 52.8. Analysis showed thatgirls, subjects who were overweight and obese, subjects withmicrocephaly, those with irregular attendance in the program,and those living under the poverty line were at highest riskfor severe mental retardation.Conclusion Factors associated v.ith the intelligence in childrenwith Down syndrome were female gender, overweight/obesity,Â severe microcephaly, belowô€ƒpoverty line economic status, andirregular participation in the program. [Paediatr Indones.2012;52:194-9].

Plasma lipid profile and leptin concentration in super-obese children Aryono Hendarto; Sri Sudaryati Nasar; Damayanti Rusli Sjarif
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Background Leptin induced weight loss is completely specificfor adipose tissue loss, whereas food restriction result in both lossof adipose tissue and lean body mass in mammals. Most obeseperson has high endogenous leptin levels, indicating leptinresistance. There has been lack of data regarding plasma leptinlevel in Indonesian obese children.Objective This study was aimed to investigate the plasma leptinlevel and lipid profile in super-obese children.Methods This was a cross sectional study performed in PediatricOut Patient Clinic Mangunkusumo Hospital and Private Women& Children Hospital in Eastern part of Jakarta. Super-obese isdefined as children with BMI above 97 centiles CDC 2000 chart.Blood sample was obtained from all subjects, consisted ofperipheral blood picture, lipid profiles and leptin level.Results Seventy nine super-obese children were eligible with ageranged between 12 months and 180 months and mean of age was84.9 months (SD 36.8). More than 60% subjects had high LDLcholesterol, while 19% had low HDL level. The lowest leptinblood level was 2.877 Î¼ g/dL, while the highest was 70.430 Î¼ g/dL(mean 23.990; SD 12.726). Forty five subjects, all boys, hadincreased plasma leptin level.Conclusions In super-obese children, most of the subjectexperienced hyperlipidemia (LDL cholesterol) followed byhypertriglyceridemia. There was small number of low HDLcholesterol found. Super-obese girls had normal serum leptin level,in contrast, more than 60% super-obese boys had elevated serumleptin level.

Obesity in children with frequent relapse and steroid dependent nephrotic syndrome Jeanne Vidianty; Sudung O. Pardede; Aryono Hendarto; Arwin A. P. Akib
Paediatrica Indonesiana Vol 50 No 3 (2010): May 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi50.3.2010.139-43

Background Children \\lith frequent relapse and steroid dependentÂ nephrotic syndrome (FRNS/SDNS) will experience frequentÂ relapse v.ith many complications due to the disease and toxicity ofÂ steroid therapy. One of the most common complications is obesityÂ which is associated \\lith significant health problems in childhoodÂ and important risk factor of adult morbidity and mortality.Â Objective To find out the prevalence of obesity in children 'WithÂ FRNS/SDNS.Methods A cross sectional study was conducted from NovemberÂ 2008 until March 2009. Data were collected from the medicalÂ records of children 'With FRNS/SDNS treated during the period ofÂ 2000-2008. Body weight, height and body fat mass measurementÂ was performed on the subjects. The diagnosis of obesity was basedÂ on body mass index (BMI) and body fat mass measurement.Results Obesity was diagnosed in 10 of 43 children (23%). MostÂ of them were 5ô€€¼9 years old (58%) 'With maleô€€¼predominance.Â Most patients (70%) had age of onset younger than 5 years. TheÂ median of total relapse was 7 (range 2ô€€¼24) and cumulative doseÂ of prednisone was 12,240 (range 3,490 to 44,330) mg. Time sinceÂ the last dose of prednisone until the study in majority was 0 to 6Â months (53%). The prevalence of obesity based on BMI was 7%while based on body fat mass was 23 (el 95% 10 to 36) %.Â Conclusion The prevalence of obesity based on body fat massÂ was 23%. The median BMI of obese subjects is in the 90-95thÂ percentile.Â

A comparison of axillary and tympanic membrane to rectal temperatures in children Tania Paramita; Mulya Rahma Karyanti; Soedjatmiko Soedjatmiko; Aryono Hendarto; Dadi Suyoko; Abdul Latief
Paediatrica Indonesiana Vol 57 No 1 (2017): January 2017
Publisher : Indonesian Pediatric Society

Background Core body temperature measurement is not commonly done in pediatric populations because it is invasive and difficult to perform. Therefore, axillary and tympanic membrane temperature measurements are preferable, but their accuracy is still debatable.Objective To compare the accuracy of axillary and tympanic temperatures to rectal temperature in children with fever, and to measure the cut-off point for fever based on each temperature measurement method.Methods A diagnostic study was conducted among feverish children aged 6 months to 5 years who were consecutively selected from the Pediatric Outpatient Clinic, Pediatric Emergency Unit, and the inpatient ward in the Department of Child Health, Cipto Mangunkusumo Hospital (CMH), from December 2014 to January 2015. Subjects underwent three measurements within a two minute span, namely, the axillary, tympanic membrane, and rectal temperature measurements. The values obtained from the examination were analyzed with appropriate statistical tests.Results The cut-off for fever on axilla was 37.4oC and on tympanic membrane wasÂ 37.4oC, with sensitivity 96% (95%CI 0.88 to 0.98) and 93% (95%CI 0.84 to 0.97), respectively; specificity 50% (95%CI 0.47 to 0.84) and 50% (95%CI 0.31 to 0.69), respectively; positive predictive value/PPV 90% (95%CI 0.81 to 0.95) and 85% (95%CI 0.75 to 0.91), respectively; and negative predictive value/NPV 83% (95%CI 0.61 to 0.94) and 69% (95%CI 0.44 to 0.86), respectively. The optimal cut-off of tympanic membrane and axilla temperature was 37.8oC (AUC 0.903 and 0.903, respectively).Conclusion Axillary temperature measurement is as good as tympanic membrane temperature measurement and can be used in daily clinical practice or at home. By increasing the optimum fever cut-off point for axillary and tympanic membrane temperature to 37.8oC, we find sensitivity 81% and 88%, specificity 86% and 73%, PPV 95% and 91%, and NPV 95% and 91%, respectively.Â

Association between low-grade chronic inflammation with adipocytokines and body fat mass in superobese male children Aryono Hendarto; Sudigdo Sastroasmoro; Damayanti Rusli Sjarif
Paediatrica Indonesiana Vol 59 No 1 (2019): January 2019
Publisher : Indonesian Pediatric Society

Background Obesity causes adipocytokines dysregulation and enhances the pro-inflammatory response. Low-grade chronic inflammation is related to cardiometabolic diseases. Objective To evaluate the status of low-grade chronic inflammation in pre-pubertal, obese boys and its potential correlation to adipocytokines and body fat mass. Methods This cross-sectional study included pre-pubertal, male, superobese children as the subjects. We determined obesity status using the CDC 2000 BMI-for-age chart. Body fat percentage was measured using bioelectric impedance analysis (BIA). Fasting blood specimens were collected to evaluate hsCRP, leptin, adiponectin, and TNF-Î± levels. Results Eighty subjects were recruited into this study, with a mean age of 6.9 years. Ten subjects (12.5%) had low-grade chronic inflammation (hsCRP level â‰¥ 1 mg/L). The levels of hsCRP was not correlated with leptin, adiponectin, and TNF-Î± levels. A weak, but significant correlation was observed between hsCRP level and body fat mass (r= +0.383; P<0.0001). The hsCRP level increased with increasing body fat mass, until it reached its peak at body fat mass of 28 kg. Beyond that point, hsCRP level was stable. Conclusion Low-grade chronic inflammation begins at a young age in obese children. The hsCRP level has a weak correlation with body fat mass, but no correlation with adipocytokine levels. Prevention and treatment of childhood obesity should be prioritized to prevent further cardiovascular and metabolic diseases.

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.

Pediatric residentsâ€™ burnout in Indonesia: a national survey during the pandemic Annang Giri Moelyo; Ardi Findyartini; Bambang Tridjaja; Aryono Hendarto
Paediatrica Indonesiana Vol 63 No 1 (2023): January 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1.2023.22-8

Background The uncertain and somewhat chaotic clinical learning environment during the COVID-19 pandemic may potentially trigger burnout in pediatric residents. Objective 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. Methods 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. Results 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). Conclusion 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.

Predictors of pediatric Henoch-Schönlein purpura recurrence Santoso, Dara Ninggar; Kurniati, Nia; Hendarto, Aryono; Chozie, Novie Amelia; Prawira, Yogi; Marsubrin, Putri Maharani Tristanita
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.307-15

Background Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children and is usually self-limited with a favorable prognosis. However, recurrence in children is associated with a poorer prognosis, i.e., a higher risk of progressing to chronic kidney disease (CKD) as a long-term complication. In Indonesia, the recurrence rate of HSP and its predictors in children have not been well established . Objective To estimate the incidence of recurrent HSP and determine its predictors in children at Dr. Cipto Mangunkusumo National General Hospital (RSCM). Methods A retrospective cohort review of medical records followed children aged <18 years at RSCM for 6 months after HSP diagnosis based on the the European League Against Rheumatism (EULAR)/ Paediatric Rheumatology European Society (PRESS)/Paediatric Rheumatology International Trials Organization (PRINTO) criteria. Multivariate, Cox logistic regression, and Kaplan-Meier analyses were performed. Results This study included 116 children aged 2–17 years with HSP. Twenty-six (22.4%) of the subjects experienced recurrence, with an incidence of 3.56 per 100,000 person-years. The only statistically significant predictor for recurrence was the presence of infection after the first episode of HSP (HR 11.301; 95%CI 4.327 to 29.519; P<0.001). The cumulative survival of subjects with infection for recurrence over 6 months was 51%, with mean 5.3 months survival duration (95%CI 4.76 to 5.99; P< 0.0001). Chronic kidney disease, a long-term complication of HSP, was noted in 22 (19%) participants. Conclusion Recurrence of HSP was observed in 22.4% of our subjects within 6 months follow up. However, subjects with a history of infection after their first episode of HSP resolution should be notified about the possibility of recurrence. Chronic kidney disease occurred in 22 participants (19%), possibly becoming a long-term complication of HSP.

Co-Authors Abdul Latief Alan R Tumbelaka Ali Khomaini Alhadar Ali Khomaini Alhadar Aman B Pulungan Anggia Widyasari Anjar Setiani Annang Giri Moelyo Antonius H. Pudjiadi Ardi Findyartini, Ardi Aria Kekalih Arwin A. P. Akib Atut Vebriasa Bambang Tridjaja AAP, Bambang Tridjaja Cut Nurul Hafifah Dadi Suyoko Dahlan Ali Musa Dalima Ari Wahono Astrawinata Damayanti Rusli Sjarif Darmawan B Setyanto Dilawar, Ismail Djajadiman Gatot Endang Windiastuti Fathy Pohan Frieda Handayani Kawanto Hartono Gunardi Henny Adriani Puspitasari Heri Wibowo Herlina Dimiati I Dewa Gede Ariputra Irawan Mangunatmadja Irma Annisa Jeanne Vidianty Kemas Firman Lisnawati Rachmadi Ludi Dhyani Rahmartani Luh Karunia Wahyuni, Luh Karunia Marsubrin, Putri Maharani Tristanita Merry Angeline Halim Mulya Rahma Karyanti, Mulya Rahma Mulyadi M. Djer Murni, Indah K. Muzal Kadim Najib Advani Najib Advani Ni Ketut Prami Rukmini Nia Kurniati Nina Dwi Putri Novie Amelia Chozie Partini P Trihono Piprim B. Yanuarso, Piprim B. Pramita Gayatri Primo Parmato Reni Fahriani Rhyno Febriyanto Riki Alkamdani Rinawati Rohsiswatmo Risma K. Kaban RR Putri Zatalini Sabila Rubiana Sukardi, Rubiana Rumaisha Hasnah Ibrahim Santoso, Dara Ninggar Saptawati Bardosono Soedjatmiko Sondang Sidabutar Sri S Nasar Sri Sudaryati Nasar Stanislaus Djokomuljanto Stephen Diah Iskandar Sudigdo Sastroasmoro Sudigdo Sastroasmoro Sudung O. Pardede Sukman Tulus Putra Sukman Tulus Putra Supriatna, Novianti Susanti, Dhama S. Tania Paramita Teny Tjitra Sari Tety Nidiawati Velanie Frida Batubara Yessi Yuniarti Yogi Prawira, Yogi Zakiudin Munasir

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