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All Journal Sari Pediatri Paediatrica Indonesiana Jurnal Respirologi Indonesia Oto Rhino Laryngologica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Narra J Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Junior Medical Journal

Irawan Mangunatmadja

Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia Jakarta

Author-ID : 3211165

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

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Prevalence and risk factors for epilepsy in children with spastic cerebral palsy Dedy Rahmat; Irawan Mangunatmadja; Bambang Tridjaja; Taralan Tambunan; Rulina Suradi
Paediatrica Indonesiana Vol 50 No 1 (2010): January 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (308.099 KB)

Background Epilepsy in cerebral palsy (CP) is usually difficult to treat and can lead to poor prognosis due to increased risk for motor and cognitive disorders. The prevalence and risk factors of epilepsy in children with CP vary among studies.Objective To determine the prevalence and risk factors for epilepsy in spastic CP.Methods We performed a retrospective study using medical records of patients with spastic CP at the Departement of Child Health, Cipto Mangunkusumo Hospital from January 2003 until December 2008. Prevalence ratio was calculated by comparing the prevalence of epilepsy in subjects with and without risk factors. We excluded patients with metabolic disorder, genetic syndrome, and onset of CP after 3 years of age.Results Two hundred thirty six out of 238 spastic CP patients were analyzed. The mean age at diagnosis of spastic CP was 28.8 months. Male to female ratio was 1.4:1. The prevalence of epilepsy in spastic CP was 39%. The risk factors for epilepsy in spastic CP were central nervous system infection, the ocurrence of seizure in the first year of life, and abnormality of EE G.Conclusions The prevalence of epilepsy in spastic CP is 39%. The risk factors for epilepsy in spastic CP are post central nervous system infection, and ocurrence of seizure in the first year of life. [Paediatr Indones. 2010;50:11-7].

Gross motor dysfunction as a risk factor for aspiration pneumonia in children with cerebral palsy Cut Nurul Hafifah; Darmawan Budi Setyanto; Sukman Tulus Putra; Irawan Mangunatmadja; Teny Tjitra Sari; Haryanti Fauziah Wulandari
Paediatrica Indonesiana Vol 57 No 5 (2017): September 2017
Publisher : Indonesian Pediatric Society

Background Respiratory problems, such as aspiration pneumonia, are major causes of morbidity and mortality in children with cerebral palsy (CP) and greatly affect the quality of life of these children. Nevertheless, there is limited data on the incidence and risk factors of aspiration pneumonia in children with CP in Indonesia. Objective To determine the incidence and risk factors of aspiration pneumonia in children with cerebral palsy.Methods In children with CP aged 1-18 years, incidence of pneumonia was studied prospectively for 6 months and the prevalence of the risk factors was studied cross-sectionally. At baseline, we evaluated subjectsâ€™ by history-taking, physical examination, risk factors, and chest X-ray to assess the incidence of silent aspiration. Subjects were followed-up for six months to determine the incidence of overt or silent aspiration pneumonia.Results Eight out of 36 subjects had one or more episodes of aspiration, consisting of silent aspiration (2/36) and clinically diagnosed aspiration pneumonia (7/36). Subjects with more severe gross motor dysfunction experienced more episodes aspiration pneumonia, although it was not statistically significant (p = 0.06), while dysphagia (P=0.2) and nutritional status (P=0.11) were not associated with pneumonia or silent aspiration.Conclusion Twenty-five percent of children with CP experienced aspiration pneumonia during the 6-month study period, with gross motor dysfunction as a possible risk factor.

Correlation between brain injury biomarkers and Glasgow coma scale in pediatric sepsis Nahari Arifin; Irawan Mangunatmadja; Antonius Pudjiadi; Sudung O. Pardede
Paediatrica Indonesiana Vol 52 No 2 (2012): March 2012
Publisher : Indonesian Pediatric Society

Background Sepsis in children, with or without multiple organfailure, causes increased susceptibility to brain injury due tosystemic insults. Brain injury in sepsis is difficult to recognizeclinically. Neuron-specific enolase (NSE) and S-lOOB have beenextensively studied in brain injuries and appear to be promisingalternative biomarkers.Objectives To determine if there is a correlation between theGlasgow coma scale (GCS) and NSE as well as S-lOOB levels, inchildren with sepsis.Methods We performed an analytical study on septic childrenaged > 2 years. GCS scores were assessed on the first and thirddays of admission. Blood specimens to test for NSE and S-lOOBwere drawn on the first day of admission and stored at -70QC forfurther analysis at the end of the study.Results Out of 35 patients, 30 met the inclusion criteria. Postanalysis,one subject with NSE above the maximum level wasexcluded. Negative correlations were found between GCS scoreand NSE, as well as between GCS and S-lOOB levels. Analysisrevealed a significant ROC for NSE, but not for S-lOOB. NSEconcentration of 8.1 /.lg/L was the cut-off point for GCS scoresbelow 12.Conclusions There were negative correlations between GCSand NSE levels, as well as between GCS and S- lOOB levels. Thepredictive value ofNSE level was a cut-off point of 8.1 /.lg/L forGCS scores below 12. [Paediatr lndones. 2012;52:111-17]

Head circumference and anterior fontanel measurements in newborns Rizal Agus Tiansyah; Irawan Mangunatmadja; Aman Pulungan
Paediatrica Indonesiana Vol 52 No 3 (2012): May 2012
Publisher : Indonesian Pediatric Society

Background Head growth and anterior fontanel (AP) closureare passive processes in response to brain growth. The growthof the brain and skull starts in the third week of intrauterinegestation. roth processes run simultaneously as a part of integralgrowth, along 'With increasing gestational age, until postô€€¿birth.Measurement of head circumference (He) and AF in newbornsis done to determine if the brain and skull grew normally duringthe intrauterine period.Objectives To investigate the differences in He and AF sizebetween preterm and fullô€€¿term infants, and the relationshipbetween gestational age (GA) and birth weight (BW) to Heand AF size.Methods This was a descriptive analytic study on preterm andfullô€€¿term newborns. Measurement of HC and AF was conductedin three phases: just after birth, 1x24 and 2x24 hours of age.Analysis of HC and AF size differences between preterm and fullterm subjects was performed, as well as analysis of the correlationbetween GA and BW to HC and AF size.Results Two hundred fifty newborns completed the study. Therewere 180 fullô€€¿term and 70 preterm subjects. Median HC in fullô€€¿term and preterm male subjects were 34 cm (range 31ô€€¿37 cm)and 31 cm (27ô€€¿34 cm), respectively. Median HC in fullô€€¿termand preterm female subjects were 33 cm (31ô€€¿36 cm) and 32 cm(27ô€€¿3S.S cm), respectively. Median AF in fullô€€¿term and pretermmale subjects were 2.17 cm (1.0SA.6 cm) and 2.22 cm (1.3SA.Scm), respectively, and in fullô€€¿term and preterm female subjectswere 2.02 cm (lA.1S cm) and 2.22 cm (0.7SA cm), respectively.The HC of preterms were significantly lower than the fullterms(P<O.OOl), however the AF size was not different between these2 groups of newborns (P =0 .28). Correlation test between GA andBW to HC size revealed a positive correlation (r=0.620, P<O.OO 1and r=0.801, P<O.OOl, respectively), but not to AF size (r=ô€€¿ 0.06,pô€€ 0.279 and F- 0.049, Pô€€0.44, respectively).Concl usions We found that the HC size of pre terms wassignificantly lower than thefullterms, but no significant differencesÂ in AF size between the two groups. GA and BW were associatedwith HC size, but not associated to AF size. [paediatr lndones.2012;52:145-51].

Risk factors influencing the outcomes in infants with epilepsy Setyo Handryastuti; Irawan Mangunatmadja
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Background Epilepsy in young children should always beconsidered as a symptom of an underlying brain disease. Parentsand caregivers often asked whether the seizures can be controlledand whether the epilepsy will affect the child development.Objective To find out risk factors influencing the outcomes ininfants with epilepsy.Methods This was a retrospective study on infants aged 1 monthuntil 12 months with recurrent epileptic seizures. We looked forthe risk factors as sex, types of medication, age at onset of seizure,epilepsy syndrome, etiology of epilepsy, history of neonatal seizure,first EEG features, and type of seizure for the last 6 month-period.The outcomes evaluated were controlled seizure and developmentalstatus.Results Hundred forty infants with epilepsy were reviewed,consisted of 84 (60%) infants with symptomatic epilepsy, and 56(40%) infants categorized as idiopathic. Forty-six (33%) infantshad controlled seizure, while 94 (67%) infants had uncontrolledseizure. Abnormal developmental status was found in 75 infants(54%). Abnormal developmental status was more found in infantswith polytherapy, age at onset of 1-4 months, symptomaticepilepsy, positive remote symptomatic, history of neonatal seizure,abnormality of first EEG, and uncontrolled seizure. Uncontrolledseizure of epilepsy was more found in infants with polytherapy,early age at onset (1-4 month old), symptomatic epilepsy, positiveremote symptomatic, history of neonatal seizure, and abnormalityof first EEG.Conclusion Our data indicate that classifying syndrome of epilepsythrough diagnostic screening and age of onset are important todetermine the outcomes.

Brainstem auditory evoked potentials in children with microcephaly Irawan Mangunatmadja; Dwi Putro Widodo; Hardiono D Pusponegoro
Paediatrica Indonesiana Vol 43 No 1 (2003): January 2003
Publisher : Indonesian Pediatric Society

Background Hearing loss (HL) is commonly found in childrenwith microcephaly. The aim of this study was to reveal hearing lossand auditory brainstem pathways disorders in children with micro-cephaly and other handicaps.Methods There were 194 children who were referred for hearingevaluation. Subjects with history of congenital perinatal infection(TORCH) were excluded. Data were collected from the results ofBrainstem Auditory Evoked Potentials (BAEP) recordings, includ-ing sex, age, clinical manifestations, latency and interlatency be-tween waves I, III, V, and the hearing levels of each ear.Results Moderate to profound HL were found in fourteen ears(58%) of patients with microcephaly. Moderate to profound HL (28%)and endocochlear damage (15%) were found in the ears of pa-tients with microcephaly and delayed speech. Moderate to pro-found HL (39%) and endocochlear damage (11%) were detectedin the ears of patients with microcephaly and delayed develop-ment. Moderate to profound HL (21%) and endocochlear damage(16%) were found in the ears of microcephalic patients with bothdelayed speech and delayed development. Moderate to profoundHL (26%) and endocochlear damage (32%) were detected in theears of patients with microcephaly and cerebral palsy.Conclusion This study revealed the importance of early HL de-tection in microcephalic patients especially those with other handi-caps such as delayed speech, delayed development, and cere-bral palsy

Intracranial hemorrhage in hemorrhagic disease of the newborn Irawan Mangunatmadja; Rina W Sundariningrum; Hardiono D Pusponegoro; Endang Windiastuti
Paediatrica Indonesiana Vol 43 No 3 (2003): May 2003
Publisher : Indonesian Pediatric Society

Background Hemorrhagic disease of the newborn (HDN) repre-sents a special case of vitamin K deficiency because the four vita-min K-coagulation factors (factors II,VII,IX,X) are already at physi-ologically low levels in the newborn. It responds to vitamin Ktherapy.Objective The aim of this study was to review the incidence, clini-cal manifestation, and outcome of HDN.Methods This was a retrospective cross sectional study on 22patients hospitalized for HDN in the Department of Child Health,Cipto Mangunkusumo Hospital from January 1997 until Decem-ber 2001. Data were obtained from medical records.Results The commonest age group (17 out of 22) was 1â€“3 month-old. Normal delivery was found in 19 patients and only 3 patientsreceived prophylaxis vitamin K. Almost all of them (20 out of 22)were exclusively breastfed. Seizure, pallor, decreased conscious-ness, and bulging of the anterior fontanel were significant clinicalmanifestations found in 21, 21, 13, and 9 patients respectively.Based on brain USG and/or CT scan, intracranial hemorrhage wasfound in 19 patients. Six out of 22 patients died and 7 patientssurvived with handicapConclusion Intracranial hemorrhage due to vitamin K mostly oc-curred at the age of 1 to 3 month-old. The commonest clinical mani-festations were seizure, pallor, decreased consciousness, andbulging of the anterior fontanel. Prevention by giving vitamin K rou-tinely to all newborn babies is recommended

Outcomes of tuberculous meningitis in children: a case review study Yazid Dimyati; Anna Tjandradjani; Irawan Mangunatmadja; Dwi Putro Widodo; Hardiono D. Pusponegoro
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.5.2011.288-93

Background Tuberculous meningitis is a severe extrapulmonary complication of tuberculosis, with high morbidity and mortality rates.Objective To assess the relationship between presenting clinical characteristics and outcomes of pediatric tuberculous meningitis.Methods We present a case review study of all children diagnosed with tuberculous meningitis in Cipto Mangunkusumo Hospital, Jakarta between January 1998 and December 2004. We compared demographic, clinical, and diagnostic characteristics to clinical outcomes.Results We included 43 patients. Common characteristics on admission were young age (mean 3.2 years), stage II and III tuberculous meningitis (91%), and neurological symptoms existing for more than 1 week, including convulsions (52%), unconsciousness (23%), meningeal irritation (56%), and cranial nerve palsy (67%). A common feature of tuberculous meningitis on computed tomography scan of the brain was hydrocephalus in 19/24 cases. Clinical outcomes were neurological sequelae (88%) and death (12%). Factors associated with poor outcome in univariate analyses were young age, as well as stage II and III tuberculous meningitis.Conclusions Tuberculous meningitis starts with nonspecific symptoms and is often only diagnosed when brain damage has already occurred. Outcome is directly associated with age and the stage of tuberculous meningitis. Earlier diagnosis may significantly improve outcomes. [Paediatr Indones. 2011;51:288-93].

Rett syndrome in childhood: the clinical characteristics E S Herini; Irawan Mangunatmadja; Purboyo Solek; Hardiono D Pusponegoro
Paediatrica Indonesiana Vol 44 No 4 (2004): July 2004
Publisher : Indonesian Pediatric Society

The prevalence rate of RS in various coun-tries is from 1:10,000 to 1:23,000 female livebirths. RS is most often misdiagnosed as autism,cerebral palsy, or non-specific developmental de-lay. While many health professionals may not befamiliar with RS, it is a relatively frequent cause ofneurological dysfunction in females. There are nobiological markers for this disease, the diagno-sis is established by history taking and clinical find-ings. We reported two patients, both girls, with RS.

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.

Co-Authors A. C. Van Huffelen Abdul Latief Adrian Prasetya Sudjono Agatha Geraldyne Agung Putra Agung Triono Agus Firmansyah Agus Firmansyah Agus Firmansyah Alan Roland Tumbelaka Alifiani H. Putranti Aman Pulungan Amanda Seobadi Andreas, Yana Anna Tjandradjani Anton Dharma Saputra Antonius H. Pudjiadi Antonius Pudjiadi Aryono Hendarto Asep Aulia Rachman Ayuningtyas, Talitha Rahma Bambang Tridjadja, Bambang Bambang Tridjaja AAP, Bambang Tridjaja Budiati Laksmitasari Citra Raditha Conny Tanjung Cut Nurul Hafifah Daisy Widiastuti Danu, Nugroho Darlan, Dewi M. Darmawan B. Setyanto Daulay, Rini S. Deasy Grafianti Dedy Rahmat Dheeva Noorshintaningsih Dina Indah Mulyani, Dina Indah Dini Prima Utami Dwi P. Widodo Dwi Putro Widodo Dwi Putro Widodo Dwi Putro Widodo E S Herini Elisabeth Siti Herini Endang Windiastuti Eva Devita Harmoniati Evita Bermansyah Ifran Fathy Pohan Fatmawaty Fatmawaty Fijri Auliyanti H F Wulandari Hardiono D Pusponegoro Hardiono D. Pusponegoro Hardiono D. Pusponegoro Hardiono D. Pusponegoro, Hardiono D. Hartono Gunardi Hartono Gunardi Haryanti Fauziah Wulandari Herlina Herlina Hidra Irawan Satari Hikari Ambara Sjakti, Hikari Ambara I. Budiman Idham Amir, Imral Chair Inez Ayuwibowo Sangwidjojo Iqbal Taufiqqurrachman Irene Yuniar, Irene Irma Rochima Puspita Iskandar Japardi Isman Jafar Ismy, Jufitriani Jasin, Madeleine Ramdhani Joanna Erin Hanrahan KHOIRUL ANAM Kristian Kurniawan Lenny S. Budi Lily Rundjan Luh Karunia Wahyuni, Luh Karunia Mardjanis Said Mardjanis Said Marissa Tania Stephanie Pudjiadi Masayu Rita Dewi Melinda Harini Merci Monica br Pasaribu Mulya Rahma Karyanti, Mulya Rahma Mulyadi M. Djer Murti Andriastuti, Murti Muzal Kadim Nahari Arifin Najib Advani Nastiti Kaswandani Nia Kurniati Nur Hayati Pamungkas, Indra Parmaditya Partini Pudjiastuti Trihono Purboyo Solek Pustika Amalia Pustika Amalia Putri, Armitha Putri, Shally Adhina Adhina R. H. J. M Gooskens Rachmawati, Elvie Zulka Kautzia Rafli, Achmad Rina W Sundariningrum Rinawati Rohsiswatmo Rini Sekartini Risma Kerina Kaban Rismala Dewi Rizal Agus Tiansyah Ronny Suwento, Ronny Rosalina Roeslani Rosary Rosary Rulina Suradi Rulina Suradi Rulina Suradi Rusda, Muhammad Safarina G. Malik Santoso, Dara Ninggar Sari, Teny T. Setyanto, Darmawan Budi Setyo Handryastuti Setyo Handryastuti Setyo Handryastuti Setyo Handryastuti, Setyo Sisca Silvana, Sisca Soebadi, Amanda Soedjatmiko Soepardi Soedibyo Sri Rezeki Hadinegoro Sri Sofyani, Sri Sudigdo Sastroasmoro Sudjatmiko Sudjatmiko Sudung O Pardede, Sudung O Sudung O. Pardede Sudung O. Pardede, Sudung O. Sukman Tulus Putra Sukmono, Suryawati Susanti Himawan Tantri, Aida Rosita Taralan Tambunan Taralan Tambunan Taralan Tambunan Taralan Tambunan Tatang M. Puspandjono Teny Tjitra Sari Titis Prawitasari, Titis Tri Lestari Handayani Tuty Victor Prasetyo Poernomo Vimaladewi Lukito Wahyuni Indawati, Wahyuni Wicaksono, Yuda Satrio Winny N Wishwadewa Wulandari, Harjanti F Wulandari, Harjanti F Yazid Dimyati Yeti Ramli Yeti Ramli Yuliarti, Klara Zizlavsky, Semiramis

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