Titis Prawitasari, Titis
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia Indonesian Hydration Working Group - FKUI

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MANIFESTASI KULIT SEBAGAI PETUNJUK DIAGNOSIS PADA KWASHIORKOR Angelina; Prawitasari, Titis
Majalah Kedokteran Indonesia Vol 68 No 6 (2018): Journal of the Indonesian Medical Association Majalah Kedokteran Indonesia Volum
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

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Abstract

Pendahuluan: Kwarshiorkor merupakan kondisi malnutrisi berat yang disebabkan asupan protein tidak adekuat. Kwashiorkor seringkali tidak terdiagnosis karena kecurigaan klinis masih rendah, adanya edema menutupi malnutrisi, kurangnya pengetahuan mengenai manifestasi klinis tipikal kwarshiorkor. Tujuan: Meningkatkan pengetahuan klinis terhadap kasus kwashiorkor, khususnya yang datang dengan manifestasi kulit, sehingga tidak terjadi keterlambatan diagnosis. Kasus: Anak lelaki 3,5 tahun dengan lesi kulit luas seluruh tubuh dirujuk dengan kecurigaan lupus eritematosa sistemik. Pasien terkesan cengeng, murah marah, tampak edema, dan alopesia yang jelas. Status dermatologikus secara umum didapatkan lesi kulit hipopigmentasi dan hiperpigmentasi dengan eritema, erosi multipel dan skuama putih kecoklatan. Status antropometri berdasarkan kurva WHO 2006 menunjukkan berat badan (BB) menurut umur 1 SD < Z score < 2 SD, tinggi badan (TB) menurut umur -1 SD < Z score < 0 SD, dan BB menurut TB > 3 SD. Terdapat riwayat penurunan BB 12 kilogram (kg) dalam 6 bulan terakhir. Pemeriksaan laboratorium terdapat hipoalbuminemia dan defisiensi seng. Selama perawatan pasien mendapat formula khusus gizi buruk F100 dan F135, suplementasi mikronutrien, dan vaselin album. Pada hari perawatan kelima eritema, erosi, dan deskuamasi kulit mulai menghilang. Berat badan menurun seiring dengan berkurangnya edema. Kesimpulan: Setiap tenaga kesehatan harus memikirkan kemungkinan kwarshiokor sebagai diagnosis banding pada pasien dengan edema dan menifestasi kulit luas, yang memiliki riwayat penurunan berat badan bermakna sebelumnya.
Skrining Sistematik terhadap Hiperkolesterolemia Familial pada Anak Berdasarkan Kriteria MedPed, Simon Brome Register Register dan Dutch Lipid Clinic Titis Prawitasari; Sudigdo Sastroasmoro; Damayanti R. Sjarif
Sari Pediatri Vol 13, No 2 (2011)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp13.2.2011.152-8

Abstract

Latar belakang. Hiperkolesterolemia familial (HF) merupakan kelainan genetik tersering penyebab terjadinya penyakit jantung koroner/aterosklerosis. Penyakit tersebut seringkali terlambat diketahui, padahal jika dapat diketahui sejak usia muda terjadinya penyakit jantung koroner dan kematian dapat dicegah. Terdapat berbagai macam kriteria untuk dapat mendeteksi dini HF pada orang dewasa, yaitu MedPed, Simon Broome RegisterdanDucth Lipid Clinic.Tujuan. Mendeteksi secara dini HF pada anak dengan riwayat orangtua mengalami penyakit jantung koroner dini dan hiperkolesterolemia berdasarkan kriteria MedPed, Simon Broome RegisterdanDucth Lipid Clinic.Metode. Studi potong lintang dari anak dengan riwayat orangtua mengalami PJK dini dan hiperkolesterolemia. Terhadap anak dan orangtua dilakukan pemeriksaan fisis dan laboratorium profil lipid (kolesterol total, LDL, HDL, trigliserida dan Apo B) kemudian digolongkan ke dalam 3 kriteria diagnosis berdasarkan MedPed, Simon Broome Registerdan Dutch Lipid Clinic. Dilakukan juga pemeriksaan untuk menyingkirkan kemungkinan peningkatan kolesterol akibat penyakit lainnya. Hasil. Terdapat 28 subyek dan 20 kasus indeks dari 20 keluarga. Rerata usia anak adalah 11,6±4,75 tahun, dengan rerata usia kasus indeks 47,8±5,50 tahun. Rerata usia saat kasus indeks mengalami serangan jantung pertama kali adalah 45,3±5,65 tahun. Berdasarkan data yang ada dilakukan penggolongan sesuai kriteria MedPed, Simon Broome Registerdan Dutch Lipid Clinic. Didapatkan 15% (3/20) anak yang mungkin menderita HF berdasarkan kriteria MedPed, jika menggunakan kriteria Simon Broome Register didapatkan sekitar 10% (2/20) sedangkan dengan kriteria Dutch Lipid Clinicdidapatkan 50% (10/20) anak yang sangat mungkin(probable)mengalami HF dan 30% (6/20) lainnya mungkin(possible)mengalami HF. Pada penelitian ini memang tidak dilakukan pemeriksaan genetik.Kesimpulan. Kriteria Dutch Lipid Clinicdapat lebih banyak mendeteksi kemungkinan anak yang mengalami HF berdasarkan riwayat orangtua mengalami penyakit jantung koroner dini dan hiperkolesterolemia dibandingkan kriteria lainnya.
Kandungan Zat Besi pada Produk Makanan Bayi Siap Saji Titis Prawitasari
Sari Pediatri Vol 14, No 4 (2012)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp14.4.2012.265-8

Abstract

Latar belakang. Setelah ASI eksklusif 6 bulan, bayi harus telah mendapatkan MPASI karena cadangan zatbesi dalam tubuh yang makin menipis dan asupan yang diperoleh dari ASI sudah tidak memadai lagi.Tujuan. Melakukan evaluasi kandungan zat besi yang tercantum dalam label produk MPASI siap saji yangada di pasaran.Metode. Dilakukan survei terhadap produk MPASI yang terdapat di swalayan di Jakarta Barat dan Timurselama bulan Mei 2011.Hasil. Dievaluasi 15 produk dari 5 produsen, berupa bubur, tim dan biskuit untuk golongan usia 6 bulan keatas, 8 bulan ke atas, dan 9 bulan ke atas. Semua mencantumkan petunjuk penggunaan dan saran penyajian.Takaran saji berbagai produk tersebut berbeda, antara 40-50 g (5-6) sendok makan per saji untuk bubur dantim serta 19-21 g per saji (2-3) keping untuk biskuit. Jumlah kalori per saji MPASI bubur dan tim antara160-210 kalori, sedangkan jumlah kalori per saji MPASI biskuit antara 80-90 kalori. MPASI yang terdapatdi pasaran mempunyai kandungan zat besi berkisar antara 0,48-4,8 mg (6-60)% dari AKG. Setelah 6 bulan,kekurangan asupan zat besi dapat tercukupi dengan minimal pemberian 1-2 kali MPASI siap saji per hari,di samping pemberian ASI atau susu formula sesuai kebutuhan berdasarkan usia.Kesimpulan. Produk MPASI/makanan bayi siap saji yang ada di pasaran mengandung antara 0,48-4,8 mgzat besi per takaran sajinya. Produk MPASI biskuit mempunyai kandungan zat besi yang paling rendah diantara bentuk lainnya.
Profil Asupan Minum pada Anak Prasekolah di Daerah Urban dan Rural di Indonesia dan Faktor-faktor yang Memengaruhinya Titis Prawitasari; Bernie Endyarni Medise; Diana Sunardi; Dewi Friska; Erfi Prafiantini; Rizki Yusrini Pohan; Budi Wiweko
Sari Pediatri Vol 22, No 4 (2020)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp22.4.2020.236-42

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Latar belakang. Asupan minum yang kurang akan berdampak terhadap performa fisik dan kognitif serta dapat menimbulkan manifestasi klinis, seperti pusing, lesu, dan gangguan konsentrasi. Anak memiliki proporsi cairan tubuh yang lebih tinggi dibandingkan dewasa. Hingga saat ini belum ada data mengenai kecukupan asupan minum anak prasekolah di Indonesia.Tujuan. Mengetahui kecukupan asupan minum anak prasekolah di daerah urban dan rural di Indonesia.Metode. Penelitian dengan desain potong lintang dilakukan pada bulan Januari-Maret 2016 di Jakarta dan Maluku pada anak usia 36-72 bulan. Perhitungan jumlah cairan dilakukan dengan mencatat jumlah yang diminum dalam 7 Day-Fluid Diary Record. Asupan minum total ditentukan berdasarkan jumlah yang dikonsumsi dari semua kategori dan sesuai dengan angka kecukupan gizi (AKG) 2019.Hasil. Sebanyak 585 anak mengikuti penelitian ini dengan median asupan minum adalah 1133,1 (85-2991,4) mL/hari dan jenis asupan paling tinggi adalah air putih. Subjek yang tinggal di daerah urban mempunyai faktor risiko lebih rendah untuk mengalami asupan minum yang kurang (RR=0,580; 95%IK: 0,418-0,807; p=0,001). Demikian pula semakin muda usia subjek, maka semakin kecil kemungkinan untuk mengalami kejadian asupan minum yang kurang (RR =0,497; 95%IK: 0,356-0,694; p=0,000).Kesimpulan. Rerata asupan minum anak usia prasekolah di Indonesia sedikit lebih rendah dari anjuran AKG. Anak prasekolah berusia ≥54 bulan dan anak yang tinggal di area rural lebih berisiko mengalami kekurangan asupan minum.
Gambaran Fungsi Kognitif HIV Anak yang Telah Memperoleh Terapi Antiretrovirus Herlina Herlina; Nia Kurniati; Titis Prawitasari; Soedjatmiko Soedjatmiko; Sri Rezeki Hadinegoro; Irawan Mangunatmadja; Darmawan B. Setyanto
Sari Pediatri Vol 18, No 2 (2016)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp18.2.2016.100-5

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Latar belakang. Pasien HIV anak berisiko tinggi mengalami gangguan neurokognitif akibat keterlibatan sistem saraf pusat (SSP). Pemberian antiretrovirus (ARV menurunkan viral load di SSP sehingga mencegah penurunan fungsi kognitif.Tujuan. Memberikan gambaran fungsi kognitif pasien HIV anak dalam terapi ARV.Metode. Studi potong lintang dilakukan terhadap pasien HIV anak berusia 5-15 tahun. Penilaian kognitif dilakukan dengan instrumen Wechsler intelligence scale for children IV (WISC IV) dilanjutkan dengan pemeriksaan elektroensefalografi untuk membuktikan kerusakan akibat keterlibatan SSP pada infeksi HIV.Hasil. Sembilan puluh pasien HIV anak (median usia 9 tahun) telah memperoleh ARV selama  1-124 bulan dengan median 69 bulan. Hasil rerata verbal, performance, dan full-scale IQ (FSIQ) berturut-turut adalah 88,66 (SB 15,69), 85,30 (SB 15,35), dan 85,73 (SB 15,61). Dua puluh tiga (25,6%) subjek memiliki verbal IQ abnormal, 34 (37,8%) performance scale abnormal, dan 32 (35,6%) FSIQ abnormal. Hasil EEG abnormal didapatkan pada 22 subjek (22,4%) dan tidak memiliki hubungan dengan stadium klinis, usia dan lama pemberian ARV, serta viral load. Stadium HIV menunjukkan hubungan bermakna dengan komponen verbal scale IQ dan FSIQ (p=0,042 dan p=0,044). Hasil IQ tidak memiliki hubungan dengan usia pemberian ARV, lama pemberian ARV, dan viral load.Kesimpulan. Pasien HIV anak yang telah mendapat terapi ARV selama 1-124 bulan memiliki rerata IQ abnormal pada verbal, performance, dan FSIQ meskipun jika dinyatakan dalam bentuk kategori, lebih dari 50% subjek memiliki IQ normal pada ketiga skala WISC. 
Adolescent rape: Characteristics and short-term impact Titis Prawitasari; Hartono Gunardi; Bambang Madiyono; Rosdiana S Tarigan
Paediatrica Indonesiana Vol 45 No 6 (2005): November 2005
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi45.6.2005.246-50

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Background Data in Indonesia show that adolescents still havethe highest rate for rape and other sexual assaults among agegroup. There are gender differences in adolescent rape and sexualassault, with female victims exceeding males with a ratio of 3:1.Sexual assault and rape can affect numerous children and oftenlead to short-term and long-term consequences.Objectives To determine the characteristics and short-term im-pacts of adolescent rape.Methods A cross-sectional study was conducted on 31 adoles-cents who had been raped 1-9 months previously. Subjects andparents were assessed using Child Behavior Checklist, Draw aPerson, House Tree Person, and Raven’s Progressive Matrices todetermine psychological problems. History and physical examina-tion findings at the time of rape were reviewed.Results Thirty out of 31 female adolescents were 13-18 years old.Almost half of them came from low income families and large fam-ilies, two-thirds of all subjects were living with their parents. Nine-teen of 31 perpetrators were friends or acquaintances, only 4 wererelatives. Tears of hymen were found in 21 subjects and only 8 ofthem had non-genital injuries. Nine of 31 subjects had a high aver-age range in non-verbal processing. Most subjects had a greattendency to feel insecure, anxiety, depression, and had interper-sonal relationship problems. Regression and aggressiveness werefound in almost half of the subjects. All subjects felt that theirmothers were protective and half of them had dominant fathers.Conclusion Almost half of the adolescent victims come from low-economic status and large families, most of the assailants werefriends or acquaintances. Adolescent rape victims have ongoingbehaviour problems. The most common problems are anxiety,depression, and relationship problems
Malnutrisi rumah sakit dan asuhan nutrisi pediatrik di Rumah Sakit Hasan Sadikin Bandung Tisnasari Hafsah; Titis Prawitasari; Julistio Tryoga Budhiawan Djais
Jurnal Gizi Klinik Indonesia Vol 16, No 2 (2019): Oktober
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (702.225 KB) | DOI: 10.22146/ijcn.43090

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Hospital malnutrition and pediatric nutrition care in Hasan Sadikin Hospital BandungBackground: Malnutrition during hospitalization delays the recovery of children with acute or chronic illnesses. The Pediatric Nutrition Care (PNC) can improve nutritional support and reduce the prevalence of hospital malnutrition.Objectives: This study was done to find evidence of hospital malnutrition and to evaluate the nutrition care in the pediatric ward of Dr. Hasan Sadikin Hospital, Bandung. Methods: We evaluated malnutrition by comparing body weight change between the first day of admission and at hospital discharge to the length of hospitalization. Screening for malnutrition risk was done using modified Pediatric Yorkhill Malnutrition Screening (mPYMS). Score≥2 was determined as high risk. The PNC process was evaluated by a focused group discussion with PNC-associated pediatric ward personnel.Results: From February-March 2016, 760 patients were admitted to the pediatric ward, of which 111(14.6%) were included in the study. An mPYMS score of ≥2 was found in 69(62.2%) of the patients. During hospitalization, body weight decreased in 23(20.7%) patients, 10(9.0%) of whom were defined as hospital malnutrition. Among these, seven had an mPYMS score≥2. PNC was performed in patients with an mPYMS score≥2 by dietitians who also provided a standardized nutrition care process following American Dietetic Association recommendation. However, a dedicated multidisciplinary PNC team was absent and the nutrition and metabolic disease division was consulted only in a few cases. Performing consistent monitoring and evaluation of PNC was also found to be difficult. Conclusions: Hospital malnutrition may be prevalent among pediatric patients in Dr. Hasan Sadikin Hospital, Bandung. Improving PNC services may reduce this prevalence.
Zinc supplementation in preterm infants and growth indicators in a developing country Kaban, Risma Kerina; Azis, Henri; Prawitasari, Titis; Kautsar, Ahmad; Lusyati, Setya Dewi; Insani, Nadia Dwi
Paediatrica Indonesiana Vol. 63 No. 6 (2023): November 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.6.2023.443-9

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Background Zinc is one of the micronutrients that is found deficient in preterm infants. To date, no parenteral zinc supplements are available in Indonesia and there is no recommendation established for routine zinc supplementation in preterm infants. Objective To evaluate the impact of zinc supplementation on growth indicators and morbidity in preterm infants. Methods This double-blind, randomized controlled trial included preterm infants aged 28-32 weeks who were assigned to one of two groups: the first group received a 10 mg zinc supplementation, while the second (control) group received a placebo. At discharge or at a maximum of 40 weeks post-menstrual age (PMA, calculated from the first day of the mother's last menstrual period), the following were evaluated : growth indicators (weight, length, and head circumference), serum zinc level, zinc supplementation side effects, and morbidity rate (intraventricular hemorrhage/IVH, necrotizing enterocolitis/NEC, btonchopulmonary dysplasia/BPD). Data were analyzed with independent T-test using SPSS version 22 software. Results Seventy-eight subjects were assigned to the zinc supplementation group and 76 subjects were assigned to the placebo group. Serum zinc level and mean body weight increment were significantly higher in the zinc group compared to the placebo group (P=0.00 and P=0.02, respectively). There were no significant differences between groups in mean body length or head circumference increment, nor in morbidity rate. Conclusion Preterm infants who received zinc supplementation have higher serum zinc level and mean body weight increment compared to the placebo group. No side effects are observed to have been caused by zinc supplementation.
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

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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

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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.