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Pattern and influencing factors of breastfeeding of working mothers in several areas in Jakarta Rifan Fauzie; Rulina Suradi; Sri Rezeki S. Hadinegoro
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background Breast milk contains many essential nutrition factorsbest for babies. The 1997 Indonesian Health Demography foundthat the proportion of exclusive breastfeeding was still low (52%)and increased to 55.1% in 2002. Due to increasing number ofworking mothers, promoting breast feeding among them should beperformed properly. There are no data on exclusive breastfeedingrate and pattern among working mothers in Indonesia.Objective To describe exclusive breastfeeding rate and patternamong working mothers in several areas in Jakarta and the influ-encing factors.Methods A descriptive study using a questionnaire was conductedfrom October 2005 to February 2006. Subjects were workingmothers who had 6 to 12 month old baby and breastfed and thebaby had no congenital or chronic disease.Results Among 290 mothers interviewed, 40% worked at banksor insurance business, 34% were private employees, 25% medicalstaffs, and 2% were teachers. Almost 80% have exclusivelybreastfed for less than 4 months, 17% for 4 months, and only 4%for 6 months. Maternal leave, family support, mothersâ€™ knowl-edge, facilities at workplace, media influences, and working hoursseemed to have no relations to breastfeeding rate. There were122 (42%) mothers who had good knowledge about physiologyof lactation, 155 of them (53%) had fair knowledge, and only45% of them had poor knowledge.Conclusions The proportion of working mothers in several areasin Jakarta who have exclusively breastfed for 4 months is 17%, andonly 4% of subjects do exclusive breastfeeding for 6 months. Mostsubjects have a good to fair knowledge about the physiology oflactation but it does not seem to influence the decision to exclu-sively breastfed their babies.

Factors associated with the intention to exclusively breastfeed at Siloam Lippo Cikarang Hospital Naomi Dewanto; Sudigdo Sastroasmoro; Rulina Suradi; Theresia Santi
Paediatrica Indonesiana Vol 48 No 3 (2008): May 2008
Publisher : Indonesian Pediatric Society

Background World Health Organization (WHO) recommendsbreastfeeding as the appropriate method of infant feeding.Predelivery intentions about breastfeeding are strong predictorsof both initiating and continuing exclusively breastfeedingthrough the post delivery period.Objective To determine the association of age, education,occupation, parity, and information got by pregnant women withthe intention to give exclusive breastfeeding at Siloam LippoCikarang Hospital.Methods Pregnant women were chosen by consecutive samplingfilled in questionnaires contained identity, knowledge, obstacles ofbreastfeeding and intentions to exclusively breastfeed. Pregnantwomen visiting Obstetrics and Gynecologic Department SiloamLippo Cikarang Hospital who were able to read and write inIndonesian were eligible for this study.Result: Most of the 200 respondents were between 20-30 years ofage (69.5%), college graduated (55.5%), working women (50.5%),multiparous (58.5%) and have already got the informationabout breastfeeding (64.5%). The commonly cited source isprinted device (40%). Knowledge about breastfeeding in generalwere good (78%), but respondents who intended to exclusivelybreastfeed were only 58.5%. Multivariate analysis showed thatthe factors significant associated with the intention to exclusivelybreastfeed were age, with OR 0.9 (95%CI 0.84;0.98, P<0.05) andinformation, with OR 0.28 (95%CI 0.143;0.56, P<O.OOl)Conclusions The significant influencing factors to the intentionsto give exclusively breastfeed are age and information.

Acute renal failure in children: outcome and prognostic factors Partini P Trihono; Ommy A Soesilo; Rulina Suradi
Paediatrica Indonesiana Vol 43 No 6 (2003): November 2003
Publisher : Indonesian Pediatric Society

Background Acute renal failure (ARF) is an emergency conditionwith a high mortality rate despite the long-known dialysis and ad-vanced supportive care. Only few studies on prognostic factors ofARF in children are available in the literature, which are difficult tocompare to each other due to the different definitions of the ARFoutcome used.Objective To find out the clinical and laboratory characteristics ofchildren with acute renal failure and the prognostic factors affect-ing the outcome.Methods This observational prospective study was conducted onchildren with acute renal failure hospitalized in the Department ofChild Health, Cipto Mangunkusumo Hospital, between July andDecember 2001. Patients with acute on chronic renal failure wereexcluded. Clinical and laboratory data were taken at the time ofdiagnosis and the outcomes were noted after 2 weeks of observa-tion. We classified the outcome as cured, uncured, and dead. Ana-lytical study was done to find out the relationships among variousprognostic factors.Results Fifty-six children with ARF were recruited in this study.Male to female ratio was 1.3:1; the mean age was 4.4 year-old.The most frequent presenting symptom was dyspnea (34%), fol-lowed by oliguria (29%). The most frequent primary disease wasmalignancy (20%). Most of the patients had renal-type of ARF(73%). The outcomes were cure (71%), no cure (16%), and death(13%). Bivariate analysis and logistic regression revealed thatyounger age (OR=13.6; 95%CI 1.01;183.60) and the need for di-alysis (OR=10; 95%CI 1.53;65.97) had significant relationships withmortality or no cure.Conclusion We should be aware when finding ARF patientsless than 5 year-old and have the indications for dialysis, due tothe poor prognosis they might have

Adverse events following immunization (AEFI) reports of extended program immunization (EPI) in Indonesia during 1998-2002 Nastiti Kaswandani; Sri Rezeki Hadinegoro; Rulina Suradi
Paediatrica Indonesiana Vol 44 No 4 (2004): July 2004
Publisher : Indonesian Pediatric Society

Background The incidence of adverse events following immuni-zation (AEFI) increased in correlation with the number of vaccinedoses. Meanwhile AEFI reports should be managed properly tomaintain the compliance and immunization coverage.Objectives The aims of this study were to investigate the inci-dence and profile of AEFI, its onset, severity, classification, andoutcome.Methods This study was a passive surveillance of AEFI reportsreceived by the National Committee on AEFI, Ministry of Health ofIndonesia, during 1998 to 2002.Results Two hundreds and four AEFI cases were reported; 4 casesas zero reports, 182 cases as individual reports, and 18 clusterreports. The AEFI incidence was 0.44 per 1 million doses of vac-cines. Vaccine reaction rate was 1 per 2.3 million vaccine doses.The most common vaccines reported as the causes of AEFI wereDTP, Polio, and TT. Among 182 reported cases, local or mild AEFIreactions were observed in 45, moderate in 49, and severe in 88.Based on WHO field classification, this study reported that 84 casesbelonged to coincidence, 72 to vaccine reactions, 13 to program-matic errors, 7 to injection reactions, and 6 to unclassified reac-tions. Forty-seven patients died, 12 had some sequelae, and 123completely recovered. Meanwhile, among the death cases, 70%occurred coincidently, 17% due to vaccine reactions, and 6 wereunclassified.Conclusions The incidence of AEFI in the extended program im-munization (EPI) in Indonesia during the period of 1998-2002 were182 cases, thus vaccine reaction rate was 1 per 2.3 million vac-cine doses. The most common vaccine which caused AEFI wasDTP. Most AEFI with severe symptoms happened in 4-24 hoursafter immunization.

Prevalence of patent ductus arteriosus in premature infants at the Neonatal Ward, Cipto Mangunkusumo Hospital, Jakarta Benita Deselina; Sukman Tulus Putra; Rulina Suradi
Paediatrica Indonesiana Vol 44 No 6 (2004): November 2004
Publisher : Indonesian Pediatric Society

Background Patent ductus arterious (PDA) is one of the mostcommon congenital heart diseases encountered in preterm infants.The lower the birth weight and gestational age are, the higher theincidence of PDA is.Objectives To investigate the incidence of PDA in premature infantshospitalized in the neonatal wards of Cipto Mangunkusumo Hospitalusing echocardiography.Methods Preterm infants born between August and October 2003were included in this study. Clinical features were retrieved from medicalcharts. The first echocardiography was conducted on all of the preterminfants at the chronological age of 3 days. If PDA was detected,echocardiography was repeated at the chronological age of 6 days.Results During the 3-month period, sixty-five preterm infantsparticipated in this study and underwent echocardiography. In thefirst echocardiogram, the incidence rate of PDA was 32%. Atgestational age of less than 28 weeks, 1 of 2 infants had PDA. Of 3infants with birth weight of more than 1000 grams, 2 had PDA. Onthe second echocardiography, the incidence rate of PDA was 14%and mostly found in infants at gestational age of less than 28 weeks(8/9) and in those with birth weight of less than 1000 grams (7/9).All infants with RDS whose PDA was identified in the firstechocardiography proved to maintain their PDA in the secondechocardiography.Conclusion The incidence rate of PDA in preterm infants was14%. The lower the birth weight, the higher the incidence rate ofPDA. The presence of RDS is related to the delay in the closing ofthe arterial duct

Blood glucose levels in healthy, term, appropriate for gestational age, exclusively breastfed infants Lineus Hewis; Rulina Suradi; Taralan Tambunan
Paediatrica Indonesiana Vol 45 No 1 (2005): January 2005
Publisher : Indonesian Pediatric Society

Objective This study aimed to determine blood glucose levels ofhealthy, term, appropriate for gestational age (AGA), exclusivelybreastfed infants at the age of 6, 12, 24, 48, and 72 hours of life,and to investigate the incidence of hypoglycemia in those infants.Methods All healthy, term, AGA infants born in CiptoMangunkusumo General Hospital, Jakarta, who were exclusivelybreastfed during the recruitment period of December 2003 untilFebruary 2004, were included in this study. These infants weresubjected to blood glucose level determination at the age of 6, 12,24, 48, or 72 hours of life, and the clinical signs of hypoglycemiawere monitored.Results Two hundred and fifteen blood samples taken from 137newborns were studied. There was no incidence of hypoglycemiaobserved, whether symptomatic or asymptomatic. The range ofblood glucose levels was between 41 mg/dl and 115 mg/dl. Themeans and the standard deviations (SD) of the blood glucose lev-els of the 6-, 12-, 24-, 48- and 72-hour old infants were 59.7 (11.98)mg/dl, 64.1 (13.51) mg/dl, 65.9 (14.42) mg/dl, 67.0 (14.95) mg/dl,and 78.6 (16.51) mg/dl, respectively.Conclusions The current concern for hypoglycemia in the popu-lation of healthy, term, AGA, exclusively breastfed infants duringthe first few days of life was not proven to exist. Therefore, there isno reason to resort to prelacteal feeding in such infants

Nutritional status changes in children with malignant solid tumor before and after chemotherapy Boris Januar; Sri S Nasar; Rulina Suradi; Maria Abdulsalam
Paediatrica Indonesiana Vol 45 No 4 (2005): July 2005
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi45.4.2005.166-70

Background Although aggressive multimodal treatment programsin childhood cancer have significantly increased survival rates, themorbidity caused by protein energy malnutrition related to therapyis still high.Objective To describe nutritional status changes in children withmalignant solid tumors after 21 days of chemotherapy.Methods A descriptive prospective study with pre- and post-testdesign in children with malignant solid tumors was conducted inthe Department of Child Health, Medical School University of In-donesia/Cipto Mangunkusumo Hospital, Jakarta between Janu-ary and July 2004. Anthropometrics (body weight, BW and mid-upper-arm circumference, MUAC) and serum albumin measure-ments were performed before and after 21 days of chemotherapy.Results Twenty-two children were enrolled in this study. After 21days of chemotherapy, 8 children had decreased BW and 6 chil-dren had decreased MUAC, but 3 children gained weight and hadincreased MUAC. Based on MUAC-for-age, 7 children had de-creased nutritional status. Fifteen children had reduced serum al-bumin levels based on a 10% cut-off point. The number of childrenwho had reduced serum albumin was larger than those who hadreduced BW and MUAC. In the evaluation of average oral foodconsumption during 21 days, 7 out of 16 children could acceptmore than 2/3 portion of served food. All of the children who re-ceived enteral feeding could accept more than 2/3 portion of servedfood.Conclusion There was a decrease of nutritional status, BW,MUAC, and serum albumin in most of the subjects after chemo-therapy. Serum albumin level measurement was the more sensi-tive parameter in determining nutritional status changes. Enteralfeeding seems more appropriate to fulfill nutritional needs than oralfeeding

Coagulation abnormality as a complication of L-asparaginase therapy in childhood lymphoblastic leukemia Djajadiman Gatot; Keumala Pringgardini; Rulina Suradi
Paediatrica Indonesiana Vol 46 No 1 (2006): January 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.1.2006.46-50

Background Bleeding, one of the most common symptoms ofacute leukemia in untreated patients, is mostly due to thrombocy-topenia as a result of myeloinvasion by leukemic cells. Neverthe-less, a further contributory factor for the additional hemorrhagiccomplication during intensive chemotherapy is the myelosuppressiveeffect of most active drugs. L-asparaginase, one of the cytostaticsused during remission induction therapy for childhood of acutelymphoblastic leukemia (ALL), is widely reported to impair the he-mostatic system.Objective To determine the influence of shorter courses of L-as-paraginase (L-Ase) on some of the hemostatic parameters in thetreatment of childhood ALL.Methods A prospective analytical study was carried out in theDepartment of Child Health, Cipto Mangunkusumo Hospital Jakartafrom July 1, 1999 to June 30, 2001 on newly diagnosed ALL pa-tients with normal liver function tests treated according to our na-tional ALL protocol which one of its composition contained 6 in-stead of 9 injections of L-asparaginase.Results All of 30 children with ALL included in the study, experi-enced prolongation of prothrombin time (PT), activated partialthromboplastin time (aPTT), and decreased fibrinogen concentra-tion, markedly during the administration of L-asparaginase. How-ever, none of the patients had additional hemorrhage or evidenceof disseminated intravascular coagulation (DIC).Conclusion The use of shorter courses of L-asparaginase, 6 in-jections, in the remission induction chemotherapy of childhood ALLin our department may reduce the blood clotting factors withoutfurther hemorrhage complication or evidence of DIC

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

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