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Paediatrica Indonesiana

paediatrica-indonesiana
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Published by Ikatan Dokter Anak Indonesia

ISSN : 00309311 EISSN : 2338476X DOI : -

Core Subject : Health,

Health Professions Medicine & Pharmacology

Paediatrica Indonesiana is a medical journal devoted to the health, in a broad sense, affecting fetuses, infants, children, and adolescents, belonged to the Indonesian Pediatric Society. Its publications are directed to pediatricians and other medical practitioners or researchers at all levels of health practice throughout the world.

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Articles 9 Documents

Search results for , issue "Vol 47 No 3 (2007): May 2007" : 9 Documents clear

Efficacy of dexamethasone for lung maturity in preterm delivery in association with lamellar bodies count Ni Made Sumiartini; Hendra Santoso; Wayan Retayasa; Made Kardana
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background Organ immaturities in preterm infants may result inperinatal death. One of the diseases is respiratory distress syndrome(RDS) which is caused by lung immaturity. Dexamethasone is oftenused to accelerate maturity of infant lungs.Objective To determine the efficacy of dexamethasone on lungmaturity measured by lamellar bodies count.Methods A quasi experimental study was done at PerinatologyDivision, Department of Child Health, Medical School, UdayanaUniversity, Sanglah Hospital, Denpasar. We recruited 72 subjects;36 subjects were given four times intramuscular dexamethasone5 mg every twelve hours before delivery. Thirty six subjects whodid not receive dexamethasone belonged to control group. Infantsâ€™lungs maturity assessment was performed using lamellar bodiescount taken from amniontic fluid.Results The gestational age ranged between 28 to 36 weeks, withthe mean gestational age in dexamethasone group was 32.2 (SD1.76) weeks and that in control group was 31.7 (SD 2.65) weeks.The efficacy of dexamethasone therapy on lung maturity wassignificant with Fisherâ€™s exact test P<0.0001, 95%CI 2.546;11.173. Using multivariate logistic regression analysis, there wassignificant correlation between dexamethasone and lung maturitymeasured by lamellar bodies count [OR=239.39; P<0.0001,95%CI 22.12;526.53].Conclusion Administration of dexamethasone in pregnantwomen during preterm delivery significantly improves lungmaturity measured by lamellar bodies count.

Clinical benefits of vitamin A supplementation in infants and children with severe pneumonia Prisca T.; J. S. Lisal; Azis Tanra; Dasril Daud
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background About 190 million preschool children living indeveloping countries are at risk of vitamin A deficiency. VitaminA deficiency and acute respiratory tract infection (ARI) are publichealth problems in developing countries. Children with vitaminA deficiency are more susceptible to measles, respiratory tractinfection, and other infections. Some studies show that vitaminA supplements may reduce the severity of respiratory tractinfection and other systemic complications of measles, anddiarrhea.Objective To evaluate the effect of vitamin A supplementation ininfants and children with severe pneumonia.Methods The study was a randomized trial on children with severepneumonia. Participants were randomly assigned to either receivevitamin A in addition to standard treatment (Group A), orstandard treatment alone (Group C). Time to achieve the normalrespiratory rate, time to achieve disappearance of subcostalretractions and fine rales were compared between the 2 groups.Result There was no significant difference in the achievement ofnormal respiratory rate between the vitamin group and the controlgroup (3.08 days vs 3.29 days). There was also no significantdifference in the disappearance of subcostal retractions amongthe two groups (2.30 days vs 2.48 days). However, there wassignificant difference in the disappearance of fine rales betweenthe two groups. The disappearance of fine rales in the vitamin Agroup occurred earlier (mean 3.72 days) than in the control group(mean 4.04 days) (P<0.01).Conclusions This study indicates that no significant difference inthe achievement of normal respiratory rate and disappearance ofsubcostal retractions between the vitamin A group as comparedto the control group, but there was a significant difference in thedisappearance of fine rales between two groups.

Quality assurance for increasing growth monitoring and promotion (GMP) performance Oktora Wahyu; Endy Paryanto; Tonny Sadjimin
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background Measuring body weight of under-five children is oneof the Family Nutritional Improvement Program or UsahaPerbaikan Gizi Keluarga (UPGK) activities which was integratedin Integrated Health Post (Posyandu) activities. Growthmonitoring and promotion (GMP) has been used as the maincomponent of the health and nutritional program in severaldeveloping countries. Unfortunately, this activity did not run asexpected. This study aimed to understand how quality assurance/total quality management (QA/TQM) influence the performanceof the GMP.Methods This 6 month operational research included 76 Posyandusin four subdistricts of Jogyakarta Province. The results of thePosyandusâ€™s GMP score performance were used as a basis toimprove the performance for the next consecutive months withQA system. Data were transformed as a score index. Studentâ€™s t-test was used to analyze the data.Results The quality assurance could increase the performance ofGMP, which was done in Posyandus intervention group for 3consecutive months. The baseline scores for both groups were0.47Â±0.12 vs 0.42Â±0.17 (P=0.302), at the second monthmonitoring: 0.58Â±0.07 vs 0.42Â±0.16, for the intervention group(P<0.001). The mothersâ€™ index (percentage of the children underfive attendance and mothers who brought KMS at weighingsession), however, did not significantly change.Conclusion Total quality management increased the generalperformance of Posyandus, but the program could not influencethe mothersâ€™ index.

The benefit of co-trimoxazole treatment in the management of acute watery diarrhea caused by invasive bacterial infection Bobby Setiadi Dharmawan; Agus Firmansyah; Imral Chair
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background World Health Organization (WHO) states thatantimicrobials are reliably helpful only for children with bloodydiarrhea (probable shigellosis), suspected cholera with severedehydration, and symptomatic infection caused by Giardia lamblia.The benefit of antimicrobial treatment in management of acutewatery diarrhea caused by invasive bacterial infection is still debated.Objective To prove the benefit of co-trimoxazole treatment inthe management of acute watery diarrhea caused by invasivebacterial infection in patients age 2â€“24 months.Methods This was a randomized, double blind clinical trialinvolving infants and children aged 2â€“24 months with acutewatery diarrhea caused by invasive bacterial infection withoutco-morbidity or complications. Invasive bacterial infection wasdefined by fecal leukocytes greater than ten cells (+2) per highpower field on stool. Subjects were assigned to receive either co-trimoxazole or placebo. The duration and frequency of diarrheabetween two groups were compared.Result Of 70 patients (co-trimoxazole, n=35; placebo, n=35),42 (60%) were children aged 12â€“24 months, of whom 61% wereundernourished. Males were affected 1.2 times as much as females.The clinical manifestations were mild-moderate dehydration(64%), mucus in the stool (100%), fever (24%), vomiting (10%),fever with vomiting (56%) and lactose malabsorption (53%).Duration of diarrhea in placebo group (mean 117.0 [SD 28.1]hours) was not significantly different (P=0.43) compared to thatin co-trimoxazole group (mean 122.5 [SD 30.1] hours). Frequencyof diarrhea per day in placebo group (mean 5.23 [SD 1.48] times)was not significantly different either (P=0.37) compared to thatin co-trimoxazole group (mean 5.64 [SD 2.20] times).Conclusion It is concluded that co-trimoxazole therapy providesno benefit to patients with acute watery diarrhea caused byinvasive bacterial infection. This disorder seems to be self-limited.

Trombocytosis in childhood relapsing nephrotic syndrome Ade Hafni; Danny Hilmanto; Dedi Rachmadi; Nanan Sekarwana
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background Thrombosis is a serious complication of nephroticsyndrome (NS). Long-term steroid treatment may inducethrombocytosis in relapsing NS that may predispose to thrombosis.Most children with idiopathic NS respond to steroids; however, asubstantial number of patients will relapse frequently and requirerepeated high dose steroid therapy, thus increase the risk ofthrombocytosis.Objective To compare the occurrence of thrombocytosis betweenchildren with frequent relapses of NS (FRNS) and those withinfrequent relapses (IFRNS).Methods We reviewed the medical records of children aged 1-14years diagnosed as FRNS and IFRNS at the Department of ChildHealth, Hasan Sadikin General Hospital Bandung from 2000-2005. We excluded children with iron deficiency anemia,hemolytic anemia, acute haemorrhage, malignancy, and those whoreceived cyclophosphamide.Results There were 33 children (26 males, 7 females) with FRNSand 33 children (27 males, 6 females) with IFRNS. The meanplatelet level of children with FRNS (517,909+165,670/ml) washigher than that of children with IFRNS (416,272+145,763/ml)(P=0.005). The occurrence of thrombocytosis in children withFRNS (18) was higher than that of children with IFRNS (7)(P=0.005).Conclusion This study shows that thrombocytosis is morecommon in FRNS than IFRNS, therefore we should take moreprecaution to the occurrence of thrombosis in FRNS.

Effect of oral vitamin K prophylaxis on prothrombine time and activated partial thromboplastin time: a randomized controlled comparison with an intramuscular vitamin K in infants V. Lily Limantara; Sudaryat S.; I. B. Mudita; W. Retayasa; M. Kardana
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background Low plasma concentration of vitamin K in thenewborn accounts for serious bleeding in the neonatal period andearly infancy. The aim of prophylactic vitamin K is to preventbleeding. Oral prophylaxis is preferable to intramuscular (IM)administration because oral administration is less expensive andless traumatic.Objective To compare oral vs. intramuscular vitamin K onprothrombine time (PT) and activated partial thromboplastin time(APTT) during the first 60 days of life.Methods We randomized newborn infants to either receive oralvitamin K 2 mg at birth and repeated at 7 and 30 days of life orthe 1 mg intramuscular vitamin K. PT and APTT were monitoredat 0, 15, and 45 days of age. Independent t-test, repeatedmeasurement, and regression analysis were used for statisticalanalyses and comparison of the results.Results Fifty infants were assigned into the oral group and 50 tothe IM group. All participants completed 60 days of study. BothPT and APTT decreased after administration of oral or IM vitaminK, and the values did not differ significantly at any time pointand through the period of investigation. Using regression analysisit was shown that only vitamin K administration was correlatedwith PT and APTT with P value were 0.044 and 0.036,respectively. During 60 days of study, there was no hemorrhagicdiathesis in both groups.Conclusions Through the first 60 days of life, 3 doses of oralvitamin K maintain hemostasis by decreasing PT and APTT ininfants at values equal to those achieved by the intramuscularpreparation. Diathesis hemorrhagic event did not occur in bothgroups.

Metabolic syndrome and visceral fat thickness in obese adolescents Lanny C. Gultom; Damayanti R. Sjarif; Evita K. B. Ifran; Partini P. Trihono; Jose R. L. Batubara
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background Metabolic syndrome (MS) is one of the long-termconsequences of obesity which can be found in adolescents. MS iscaused by excessive visceral fat accumulation. The visceral fatthickness (VFT) itself can be measured by using waist circumference(WC) measurement and abdominal ultrasonography. Until now,there are no WC and VFT cut-off points to predict MS in childrenand adolescents. This study used MS criteria based on NationalCholesterol Education Program â€“ Adult Treatment Panel III(NCEP-ATP III) which specifically modified.Objective The objectives of this study are (a) to determine the MSocurrence based on modified NCEP-ATP III in obese adolescents;(b) to measure the VFT by using abdominal ultrasonography in obeseadolescent with MS and obese adolescent without MS.Methods We conducted a cross-sectional study from March toMay 2006. Fifty obese adolescents were recruited from severaljunior and senior high schools in Jakarta.Results Of those 50 obese adolescents, there were 34 subjects withWC>P 80Â and 16 subjects with WC <P 80 . Of those 34 subjectswith WC>P 80 , 17 subjects had MS and the others had no MS. Allthe 16 subjects with WC <P 80 did not have MS. The VFT in 17subjects with WC>P 80Â who had MS was 5.19 cm (SD 2.07 cm).The VFT in 17 subjects with WC>P 80 who had no MS was 3.94cm (SD 1.62 cm). The VFT in all 16 subjects with WC <P 80 whodid not have MS was 3.54 cm (SD 0.92 cm). All obese adolescentswith MS had WC>P 80Â and they also had visceral fat which wasthicker than obese adolescents without MS.Conclusions All obese adolescents with MS have WC>P 80Â andthicker visceral fat than obese adolescents without MS; the VFTof obese adolescents without MS, who had WC>P 80 was 3.94cm (SD 1.62 cm), and the VFT of obese adolescents without MS,who had WC <P 80 was 3.54 cm (SD 0.92 cm).

Intracranial hemorrhage in infants after massaged by a traditional birth attendant Elisabeth S. Herini; Sunartini Hapsara; S. Yudha Patria
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background The overall incidence of birth related injuries declineswith the improvement in obstetrics. However, the incidence ofhead trauma in infants after massaged by a traditional birthattendant (TBA) is still unknown.Objective To study the characteristics of intracranial hemorrhagein infants after massaged by a TBA.Methods A retrospective study was conducted in Sardjito Hospital,Yogyakarta, Indonesia between October 2001 and May 2005.Infants with intracranial hemorrhage after massaged by a TBAwere included. Data on patientsâ€™ demography, history of massagingby TBA, clinical presentation, and injury characteristics such asanemia, clotting time (CT), bleeding time (BT), prothrombin time(PT) and activated partial thromboplastin time (APTT) werenoted. Computed cranial tomography (CT) scans were performed.Results A total of seven infants were diagnosed with intracranialhemorrhage after massaged by a TBA. There were four malesand three females (mean age 46 days; range 27-60 days). Allinfants were referred to Sardjito Hospital, Yogyakarta, Indonesiawith bad condition and anemia; mean hemoglobin level was 5.5g/dl (range 3.7-8.3 g/dl). All infants presented with seizures.Coagulation screening showed normal results in five patients. Theremaining patients had a prolonged CT and PT. CT scan showedsubdural hemorrhage in four patients, intracerebral hemorrhagein four, epidural hemorrhage in two, and subarachnoid hemorrhagein one. Two patients had chronic hemorrhage, while the rest hadacute hemorrhage. Four of them underwent craniotomy, twopatients were under an observation only, and one patient was nottreated due to parental refusal. Six patients survived and the onewho refused to be treated died.Conclusions The parents, midwives, and doctors have to be awareof head massaging since it may harm infants.

Cri-du-chat syndrome Eka Agustia Rini; R. Trin Suciati
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Cri-du-chat syndrome (CDCS) is a rare chromosomal disorder, refers to a unique combination of physical and mental characteristics associated with a loss of genetic material on the distal short arm of the fifth chromosome.1 The incidence of CDCS is between 1:25,000 to 1:50,000 births. The prevalence among individuals with mental retardation is about 1.5 in 1000.2 A significant female predominance exists in affected newborns, with a male-to-female ratio of 0.72.2Subtle dysmorphism with neonatal complications and a high-pitched cry typically initiate diagnostic evaluation by cytogenetic studies. 2,3 Currently,there is no cure for cri-du-chat syndrome. The most successful approach in the management of children with CDCS requires a multidisciplinary team approach. 4 The case presented below will remind us how to reveal, suspect and diagnose Cri-Du-Chat syndrome, a rare case in pediatric.

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