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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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Clinical characteristics and electroencephalography features of intractable childhood epilepsy - A case series Irawan Mangunatmadja; Eva Devita Harmoniati
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/pi50.3.2010.133-8

Background The majority of epilepsy patients have good prognosis,Â but lOAO% will develop intractable epilepsy. Early identificationÂ of patients v.ith risks of developing intractable epilepsy allowsÂ more intensive therapy to be performed.Objective To study clinical characteristics and electroencephalography (EEG) features of intractable childhood epilepsy.Methods We reviewed children \\lith intractable epilepsy attendingÂ the Pediatric Neurology and Growth and Development Clinic inÂ Child Health Department, Cipto Mangunkusumo Hospital fromÂ 2005ô€2008. EEG examination was perfonned in epilepsy patientsÂ who had consumed two or more antiepileptic drugs for at leastÂ 18 months but still experienced seizure at least once per month.Â Data of clinical characteristics were collected from the medicalÂ records and information provided by the parents.Results There were 41 subjects. Age of onset between oô€ 1 yearÂ old was found in 50% subjects, neurological impainnent in 80%,Â microcephaly in 50%, and abnonnalÂ neuroimaging in 14 of 24Â subjects. Seizure manifestations were mostly generalized tonicÂ clonic, tonic, my oclonic, and complex partial seizures. AbnonnalEEG features were found in 88% subjects and the majorityÂ showed generalized sloMng of the background activity. FocalÂ and multifocal epileptifonn activity was found in 31 % and 28%Â subjects, respectively. Epileptifonn activity was located mostly inÂ the frontal and temporal lobe.Conclusions Most patients Mth intractable epilepsy haveageÂ of onset before the age of 1 year. A substantialpoportionofÂ them have neurological impairment, microcephaly,abnonnalÂ neuroimaging, and abnormal EEG features. Seizure manifestationÂ ismostlygeneralized seizure. Epileptiform activity in intractableÂ childhood epilepsy is often found in the frontal and temporal lobe.Â

Brainstem evoked response auditory in healthy term neonates with hyperbilirubinemia Isman Jafar; Irawan Mangunatmadja; Rinawati Rohsiswatmo; Sudjatmiko Sudjatmiko; Ronny Suwento; Safarina G. Malik
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/pi50.3.2010.144-8

Background Bilirubin in healthy term neonates, especially freeÂ bilirubin (Bf), could enter brain cell and cause damage perceivedÂ by brainstem evoked response auditory (BERA). Studies identifyÂ that Bf is more associated to abnonnal BERA than total bilirubinÂ is. Currently, phototherapy is perfonned in neonates with totalÂ bilirubin > 15 mg/dL. However, in developing countries whereÂ observation could not be done optimally, neonates \\lith totalbilirubin> 12 mg/dL will be subject for phototherapy.Objectives To determine the association between total bilirubinÂ > 12 mg/dL and BERA abnonnalities in healthy tenn neonates,Â and the value of total bilirubin and free bilirubin that initiateÂ abnonnal BERA.Methods This cross sectional study was carried out between MarchÂ 31ô€…August 8, 2008, in healthy term neonates at roomingô€…in ward,Â Department of Obstetric & Gy necology, Cipto MangunkusumoÂ Hospital (CMH). All eligible subjects were examined for Bf andÂ BERA using standard methods.Â Results The prevalence of abnormal BERA was 15.4%. ThereÂ was no significant relation between hy perbilirubinemia (> 12 mg/Â dL) and abnonnal BERA in healthy tenn neonates. Lowest totalÂ bilirubin and Bf level related to abnonnal BERA were 12.4 mg/dLÂ (mean 12.8 mg/dL) and O.oS)Lg/dL (mean l.3)Lg/dL), respectively.Â All BERA abnonnalities were unilateral.Conclusions There is no association between abnormal BERAÂ and hyperbilirubinemia (total bilirubin> 12 mg/dL) in jaundicedÂ infants who undergo phototherapy.

Predictors for the recurrent febrile seizures after the first complex febrile seizures Conny Tanjung; Irawan Mangunatmadja; Sudigdo Sastroasmoro; I. Budiman
Paediatrica Indonesiana Vol 46 No 5 (2006): September 2006
Publisher : Indonesian Pediatric Society

Background Complex febrile seizures (CFS) have been shownto be related to recurrence and epilepsy. Many studies were doneto determine the predictors of recurrence in both simple and com-plex febrile seizures. To our knowledge until now there is no pub-lished data that specially looks for predictors of recurrence after afirst CFS.Objective To find out clinical and demographical characteristicsof a first CFS and to define the predictors for the recurrent febrileseizures.Methods Prospective survival analysis study was done in chil-dren with first CFS who visited Cipto Mangunkusumo Hospital,Jakarta, over 14 months periods. The predictors for developmentof recurrence were analyzed by SPSS for Windows 11.5 usingKaplan-Meier test and Cox regression model with a level of signifi-cance <0.05.Results There were 62 subjects completed this study. Male-to-female ratio was 1.4:1. The mean age at onset was 18.2 months.Recurrence occurred in 9 subjects (14.5%). Body temperaturebetween 38-38.5Â°C (7 of 26 subjects, P=0.02), upper motor neu-ron type of delayed development (3 of 7 subjects, P=0.03), andepileptic history in the family (2 of 2 subjects, P<0.05) were asso-ciated with recurrence in bivariate analysis. In multivariate analy-sis only body temperature between 38-38.5Â°C (HR 1.6, 95% CI1.0;23.9) and epileptic history in the family (HR 16.9, 95% CI2.8;101.4) were identified as predictors.Conclusion Low body temperature at the first seizures and epi-leptic history in the family were independent predictors for the re-currence after a first CFS

The role of hearing capability test as a screening test for the possibility of hearing disorder in children with speech delay Fatmawaty Fatmawaty; Hartono Gunardi; Ronny Suwento; Abdul Latief; Rulina Suradi; Irawan Mangunatmadja
Paediatrica Indonesiana Vol 46 No 6 (2006): November 2006
Publisher : Indonesian Pediatric Society

Background Hearing disorder may cause speech delay so thatevery child with speech delay should undergo hearing test. Thegold standard for audiometric test is otoacustic emission (OAE)and brainstem evoked response audiometry (BERA). They havehigh sensitivity and specificity, but the availability is limited andexpensive. Hence, both tests are not available at the primary healthcare centers. In 1997, the Department of Health, Republic of Indo-nesia, established a simple subjective test instrument, i.e. the hear-ing capability test (HCT).Objective To asses the accuracy of HCT compared to the goldstandard hearing tests (OAE and/or BERA).Methods This study was a cross sectional study on 89 childrenaged less than 5 years who had speech delay and came to theGrowth and Development Outpatient Clinic or the General Outpa-tient Clinic, Pediatric Neurology Clinic of the Department of ChildHealth, Cipto Mangunkusumo (CM) Hospital; and Center for EarCare and Communicative Disorders (CECCD), Department of ENT,CM Hospital, during March to August 2005.Results HCT sensitivity and specificity were 92.9% and 27.7%,respectively. Positive predictive value (PPV), negative predictivevalue (NPV), positive likelihood ratio (PLR), and negative likehoodratio (NLR) were 84%, 50%, 1.9, and 0.7, respectively.Conclusion The sensitivity and specificity of HCT as a screeningtest of hearing disorder in children with speech delay were 93%and 28%, respectively. Based on this result, HCT should only beused as screening test and not as a diagnostic test

Neonatal seizures: clinical manifestations and etiology Daisy Widiastuti; Irawan Mangunatmadja; Taralan Tambunan; Rulina Suradi
Paediatrica Indonesiana Vol 46 No 6 (2006): November 2006
Publisher : Indonesian Pediatric Society

Background Neonatal seizures or fits are signs of central ner-vous system (CNS) diseases, metabolic disorders, or other dis-eases disrupting the CNS. Neonatal seizures are poorly classi-fied, under-recognized and often difficult to treat. It is important torecognize the type of neonatal seizures that might be the only signof a CNS disorder.Objective To recognize the type and etiology of neonatal sei-zures in several hospitals in Jakarta.Methods This was an observational case series study on full-termand preterm infants who had seizures during hospitalization in CiptoMangunkusumo, Harapan Kita, and Fatmawati Hospitals betweenJanuary-June 2005. Neonatal seizures were defined as seizuresoccurring in the first 28 days of life of a term infant or 44 completedweeks of the infantâ€™s conception age of preterm infant.Results There were 40 neonates who born within the study periodand had seizures. Girls were outnumbered boys. Most neonateswere full-term with birth weight of more than 2500 grams. Analy-ses were done on 38 neonates with epileptic and non-epilepticseizures, while the other two who had mixed clinical manifestationwere not included. Most seizures occurred in the first 3 days of life(23/38). The most common type was focal clonic (12/14) followedby general tonic (11/24) and motor automatism or subtle (10/24).The most common etiology was hypoxic ischemic encephalopa-thy (HIE) (19/38) followed by metabolic disturbances, mainly hy-pocalcaemia (11/38).Conclusion Common types of seizures in neonates were focalclonic, general tonic, and motor automatism (subtle). The mostcommon etiology was HIE followed by metabolic disturbances,mainly hypocalcaemia

Topiramate as an adjunctive therapy in children with intractable epilepsy Hardiono D. Pusponegoro; Tri Lestari Handayani; Irawan Mangunatmadja; Dwi Putro Widodo; Rulina Suradi
Paediatrica Indonesiana Vol 42 No 11-12 (2002): November 2002
Publisher : Indonesian Pediatric Society

Background Epilepsy is a chronic disease that requires antiepileptic drugs (AEDs). Only 60-70% of new patients could be controlled effectively by standard AEDs and this stimulates the search for new, more effective and well-tolerated AEDs.Objective To asses the efficacy and safety of topiramate, as an adjunctive therapy to standard AEDs for children with intractable epilepsy.Methods This was an open label, parallel group study. Forty children with at least 4 seizures during a 4-week baseline period were randomly assigned to topiramate (n=20) or control group (n=20). In the topiramate group, the drug was given in adjunct to AEDs forÂ 2-week titration dosage continued with a 12-week stabilization period, while the control group received only AEDs adjusted to their clinical responses.Results Mean reduction from baseline in monthly seizures frequency was significantly greater in the topiramate group (88.6% vs. 25%; P=0.030). Other variable of efficacy was significantly different (e"50% reduction in seizures: 14/20 vs. 6 /20; P=0.049). Adverse effects of topiramate, such as decreased weight, paresthesia, somnolence, diarrhea, fever, aggressive reaction and flushing, were temporary and mild.Conclusion Results of this trial strongly suggested that topiramate is effective and well tolerated in reducing seizures of intractable epilepsy.

Electrodiagnosis in Clinical Neurology - The Challenge for Pediatric Neurology in Indonesia Irawan Mangunatmadja; A. C. Van Huffelen; R. H. J. M Gooskens
Paediatrica Indonesiana Vol 36 No 11-12 (1996): November - December 1996
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi36.11-12.1996.228-38

IntroductionIn most cases the diagnosis in neurology is based upon clinical manifestations, anatomical abnormalities, physiological disturbances and biochemical investigations. Clinical manifestations can be investigated by history of illness and neurological examinations. Neurophysiological examination (electrodiagnosis) can provide information on physiological abnormalities of the central nervous system (CNS). In recent years computer tomography (CT) and magnetic resonance imaging (MRI) have made it possiÂ¬ble to visualize the morphologic anatomy of the CNS in detail and to diagnose the lesion.1IntroductionIn most cases the diagnosis in neurology is based upon clinical manifestations, anaÂtomical abnormalities, physiological disturbances and biochemical investigations. Clinical manifestations can be investigated by history of illness and neurological exÂaminations. Neurophysiological examination (electrodiagnosis) can provide information on physiological abnormalities of the central nervous system (CNS). In recent years computer tomography (CT) and magnetic resonance imaging (MRI) have made it possiÂble to visualize the morphologic anatomy of the CNS in detail and to diagnose the lesion.1

Side effects of long-term antiepileptic drugs on renal tubules of Indonesian children Partini Pudjiastuti Trihono; Deasy Grafianti; Irawan Mangunatmadja; Mulya Rahma Karyanti
Paediatrica Indonesiana Vol 58 No 2 (2018): March 2018
Publisher : Indonesian Pediatric Society

Background Long-term treatment with antiepileptic drugs such as valproic acid (VPA) and carbamazepine (CBZ) may disrupt renal tubular function. Urinary N-acetyl-beta-D-glucosaminidase (NAG) may reflect tubular function and may be useful in detecting early-stage tubular injury. To date, no study has investigated the toxic effect of VPA and CBZ on renal tubules using urinary NAG in Indonesian children. Objectives To determine the toxicity of long-term VPA and/or CBZ treatment on renal tubules in children with epilepsy by measuring urinary NAG index (iNAG). Methods This cross-sectional study was conducted from January to March 2015 at Cipto Mangunkusumo Hospital and Anakku Clinic Pondok Pinang, Jakarta. We included children aged 3 to 16 years with epilepsy on VPA (n=36), CBZ (n=14), or VPA-CBZ combination (n=14) therapy. We measured urinary levels of creatinine and NAG. The urinary NAG reference value was obtained from age-matched healthy controls (n=30). To eliminate diurnal variations in NAG, iNAG was calculated by dividing urinary NAG by urinary creatinine. A urinary iNAG of more than two standard deviations above the mean for healthy children was considered elevated. Results Mean urinary iNAG values for the control, VPA, CBZ, and combination groups were 3.01, 5.9, 4.07, and 6.9 U/g, respectively. All treated groups had higher mean urinary iNAG values compared to the control group. Urinary iNAG was increased in 11/36 children on VPA, 2/14 children on CBZ, and 9/14 children on combination therapy. Conclusion Long-term VPA use may impair renal tubular function, as shown by the increased urinary iNAG. Combination therapy increases damage in the renal tubules.

Intrinsic risk factors for gross motor delay in children aged 6-24 months Joanna Erin Hanrahan; Irawan Mangunatmadja
Paediatrica Indonesiana Vol 59 No 1 (2019): January 2019
Publisher : Indonesian Pediatric Society

Background. Gross motor is one of the skill domain with the highest parental concern as mastering it determines the autonomy of a child. Several internal risk factors including perinatal asphyxia, prematurity, low birth weight, wide fontanelle, and microcephaly have been studied in predicting gross motor delay with varied results. This study is made to arrange a strategic intervention on the prevention of delayed development. Objective. To evaluate perinatal asphyxia, gestation age <37 weeks, birth weight <2500 grams, microcephaly, and wide fontanelle as predictors of gross motor delay in children aged 6-24 months. Methods. A case control study design was used. Data collection was conducted by direct assessment of gross motor skill and parentsâ€™ interview in Cipto Mangunkusumo National Hospital and Anakku Clinic, South Jakarta. Children with gross motor delay were included in the case group and children with normal gross motor were included in the control group. Data was analyzed using bivariate and multivariate analysis with a statistical significance value of P<0.05 and 95% confidence intervals. Results. One hundred and twenty-six subjects were studied, with 63 children in the case group and 63 children in the control group. Baseline characteristics of subjects were similar between the two groups. Microcephaly and gestation age <37 weeks were predictors of gross motor delay [(aOR 4.613 (95% CI 95 2.023 to 10.521, P<0.001) and (aOR 3.668 (95% CI 1.153 to 11.673, P=0.028), respectively]. Conclusion. Microcephaly and gestation age <37 weeks are significant predictors of gross motor delay in children aged 6-24 months.

Non-nutritive sucking milestones of preterm infants in Indonesia: a descriptive study Luh Karunia Wahyuni; Irawan Mangunatmadja; Risma Kerina Kaban; Elvie Zulka Kautzia Rachmawati; Melinda Harini; Budiati Laksmitasari; Agatha Geraldyne; Inez Ayuwibowo Sangwidjojo; Dini Prima Utami; Victor Prasetyo Poernomo; Adrian Prasetya Sudjono
Paediatrica Indonesiana Vol 62 No 5 (2022): September 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.5.2022.311-7

Background Non-nutritive sucking (NNS) maturity has been used as one of the markers of oral feeding readiness in infants. Prematurity may hinder the attainment of NNS milestones. Depending on gestational age (GA) at birth, preterm infants may display various degrees of immaturity, potentially affecting the strength, coordination, and efficiency of skills required for NNS. Objective To identify the progression of NNS patterns across gestational age groups of preterm infants in Indonesia by comparing NNS parameters between moderate-to-late preterm and very preterm infants. Methods NNS evaluation was conducted in 120 preterm infants born at 28-34 weeks gestational age in five tertiary hospitals in Jakarta, Indonesia. Three aspects of NNS (suction pressure, number of suctions per burst, and time between bursts) were documented and arranged to present a descriptive overview. A suction pressure measurement device was used to record, identify, and analyze NNS parameters. We hypothesize that maturity, as determined by GA, positively affected the attainment of NNS milestones. Results Moderate-to-late preterm infants (GA 32 to <37 weeks), compared to very preterm infants (GA 28 to <32 weeks), had higher mean NNS pressure (-79.8 vs. -72.7 mmHg, respectively, P=0.041) and shorter mean time between bursts (6.63 vs. 7.36 s, respectively, P=0.030). Mean number of suctions per burst were also significantly different between the two GA groups (8.90 vs. 8.99 sucks/burst, respectively, P=0.048). Conclusion Maturity, as reflected by GA, had a positive effect on the attainment of NNS milestones in preterm infants in Indonesia. Significant differences in the three NNS parameters: number of suctions per burst, time between bursts, and suction pressure were found between moderate-to-late preterm and very preterm infants.

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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