Paediatrica Indonesiana
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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Identification of risk factors for recurrent febrile convulsion
Nadirah Rasyid Ridha;
P. Nara;
Hadia Angriani;
Dasril Daud
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi49.2.2009.87-9
Background Febrile convulsion (FC) occurs in about 2 to 4percent of all children, approximately one third of whom willthen develop recurrent febrile convulsion (RFC). Risk factorsfor RFC are family history of convulsions, an age of less than 18months, a relatively lower temperature and shorter duration offever preceeding the first FC.Objective The aim of the study was to determine the risk factorsfor RFC.Methods One hundred children aged 6 months to 5 years withFC or RFC were included in this case-controlled study, which wascarried out from July 2006 to June 2007. Data on the children'sfirst FC were collected from medical records and the family historywas taken directly from the parents.Results Fifty children with RFC and 50 children withoutrecurrence were included in this study. An age of less than 18months (P< 0.0001, COR= 71.37), a family history of FC(P< 0.0001, COR= 6.00), and a fever duration ofless than 12hours preceding the first FC (P< 0.0001, COR = 4.96) wereassociated with a risk of recurrence. A relatively lower degree oftemperature at first febrile convulsion did not increase the riskfor RFC (P = 1.21). Multivariate logistic regression showed thatyounger age and shorter duration of fever preceding the first FCwere associated with RFC.Conclusion Younger age and shorter duration of fever precedingthe first FC are associated with an increased risk ofRFC.
Characteristics of HIV-infected children born to HIV-positive mothers in Cipto Mangunkusumo Hospital between 2002 and 2007
Fransisca Mayer;
Arwin Akib;
Imam Boediman
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi49.2.2009.112-8
Background In 2003, the Joint United Nation Program onHIV/AIDS and the World Health Organisation estimatedthat there will be 36.2 million people living with HIV /AIDSthrougout the world by the end of2003, and that 2.1 millionof them will be children less than 15 years old. The profileof children with HIV in the Department of Child Health,Cipto Mangunkusumo Hospital has not been studied.Objective To identify the characteristics of HIV-infectedchildren born to HIV-positive mothers, and to evaluate thePrevention Programme for Mother-to-Child Transmissionat Cipto Mangunkusumo Hospital.Methods This was a cross-sectional study conductedbetween March and May 2008 based on medical records.The study population consisted of all mother-child pairswho were admitted between January 2002 and December2007.Results Between 2002 and 2007,342 children were born toHIV-infected mother, with 201 (58.5%) children contractingHIV The median age of children was 20 months. Therewere 121 (35.4%) cases involved in prevention of motherto-child transmission. Triple-drug antiretroviral therapywas prescribed to 78.1 o/o children. The most frequentmorbidities were chronic diarrhea, wasting syndrome, andoropharyngeal candidiasis. Thirty-six children died; mostlydue to sepsis (30.5%)Conclusion The majority of cases of HIV were between 1and 5 years old. The most frequent morbidities were chronicdiarrhea, wasting syndrome, and oropharyngeal candidiasis.Thirty-six children died mostly due to sepsis. The preven-tion program for mother-to-child transmission should beencouraged among pregnant women who are known to beHIV-positive.
Association between C-reactive protein levels and physical fitness in 7 to 9 year old children at poor elementary schools in Surakarta, Indonesia
Lilisianawati Lilisianawati;
Endang Dewi Lestari;
Diana Mayasari Hadianto;
Maria Galuh Kamenyangan Sari;
Leilani Lestarina;
Harsono Salimo
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi49.2.2009.75-81
Background Data regarding inflammatory factors in children arenot so well developed as in adults. Higher levels of physical fitnessmay be helpful in modifying the low-grade inflammatory state thatis indexed by C-reactive protein (CRP) levels.Objective To evaluate the association of physical fitness with CRPlevels in children and to identify the possible related factors.Methods This cross-sectional study was conducted at poorelementary schools in Surakarta, Indonesia using a group of 217underweight children aged from 7 to 9 years old. Physical fitnesswas assessed using a modified Harvard Step Test. CRP levels weremeasured using a high-sensitivity assay. The association betweenphysical fitness and CRP level was assessed using linear regressionanalysis. Multivariate analyses were used to adjust covariates,and statistical analyses were performed using SPSS for Windowssoftware version 15.0.Results Subjects were 48% female and 52% male, and elevenchildren (5%) had a CRP level > 5 mg/L. Mean fitness level andCRP level did not differ by age and gender. Fitness level was notinversely correlated with CRP (r=0.10, P=0.14). Physical fitnesswas significantly correlated with BMI (r=0.14; P=0.04), physicalactivity [0R=3.3 (95% CI 1.7 to 6.4)], and fat intake [0R=0.5(95% CI 0.2 to 0.9) ].Conclusion These findings indicate that physical fitness is notinversely correlated to CRP levels in children. However, ourstudy reveased an association between high fat intake and lowphysical fitness as well as a significant association betweenhigh physical activiry and physical fitness.
Comparison of the efficacy of artesunate-amodiaquine with quinine-clindamycin for treatment of uncomplicated falciparum malaria in children
Purnama Fitri;
Armila Armila;
Munar Lubis;
Syahril Pasaribu;
Chairuddin P. Lubis
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi49.2.2009.91-6
Background Drug-resistant Plasmodium falciparum malaria is amajor contributor to increasing malaria-related morbidity andmortality. Artesunate-amodiaquine is a potential combinationtherapy that shows improved treatment efficacy. Clindamycin incombination with quinine is also a safe and effective treatmentfor multidrug-resistant P. falciparum malaria.Objectives To compare the efficacy of artesunate-amodiaquine andquinine-clindamycin combination therapies for the treatment ofuncomplicated falciparum malaria.Methods This randomized open label trial in 23 2 children agedbetween one month and 18 years old took place in MandailingNatal, North Sumatra, from August to September 2006. The AAgroup received a 3-day oral course of artesunate (4 mg/kg BWonce a day) plus amodiaquine (10 mg/kg BW once a day). TheQC group received a 3-day course of clindamycin (5 mg of base/kgBW twice a day) plus a 7-day course of quinine (10 mg of salt/kgBW orally for the first four days, then 5 mg of quinine salt/kg BWfor the next three days). We performed thin and thick peripheralblood smears on days 0, 2, 7, and 28.Results A total of 232 eligible children were enrolled but only22 7 completed the study (114 in group AA, 113 in group QC).The cure rates were lOOo/o in both groups by the second day, andthere was no recrudescence in either group. We found more sideeffects in AA group compared with in QC group, i.e., headacheand vomiting.Conclusion Artesunate-amodiaquine and quinine-clindamycincombinations showed similar efficacy for the treatment of uncomplicatedP. falciparum.
Systemic juvenile rheumatoid arthritis in an 11 year old boy: a case report
I Wayan Gustawan;
Ketut Dewi Kumara Wati;
Hendra Santosa
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi49.2.2009.119-123
Juvenile rheumatoid arthritis (JRA) is the mostcommon rheumatic condition in childrenand a major cause of chronic disability. 1 JRAis defined as persistent arthritis in one oro e joints for at least six weeks, when certainexclusionary conditions have been eliminated.2·3The three major subtypes of JRA are based onthe symptoms at disease onset and are designatedas systemic onset, pauciarticular onset, andpolyarticular onset.2 Systemic onset juvenilerheumatoid arthritis (SoJRA) represents about10-20% of all forms of JRA.4The incidence of ]RA is approximately 13.9/100,000 per year among children 15 years old oryounger.1 In Finland, the incidence was 19.5/100,000of the population under 16 years of age. The incidencewas significantly higher than in earlier years (1980,1985, and 1990) in the same district.5 Different racialand ethnic groups appear to have varying frequenciesof the subtype of JRA.1The treatment of JRA is achieved usingcombinations of anti-inflammatory and immunomodulatorymedications in combination withphysical and occupational therapy, occasionalsurgery, nutritional support, and psychosocial andeducational partnerships with patients and parents.3,6It is widely thought that a comprehensive teamapproach is associated with a superior outcome. 7This paper reports a case of systemic JRA in an 11-year old boy.
Toxoplasma gondii immunoglobulin G in paired infant-and-mother sera
Ayling Sanjaya;
Nurhayati Masloman;
Rocky Wilar;
Josef Tuda
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi49.2.2009.65-8
Background Toxoplasmosis is a worldwide zoonotic diseasecaused by Toxoplasma gondii. Congenital toxoplasmosis (CT)is the result of vertical transmission during pregnancy thatmay cause pathologic effects on the newborn such as classicaltriad of congenital toxoplasmosis. Newborn humans are notimmunologically competent and the infant must be protected by passive lgG antibodies that are selectively transported across the placenta during development. We studied the transfer of passive lgG from the mother to developing infant using blood specimen taken from the infant within one month of birth.Objective To determine the seropositivity of lgG to T. gondii in paired sera of infants and mothers.Methods A cross sectional study was carried out on 50 pairedsera of infants of less than one month of age and their mothers. The study was carried out between November 2007 and January 2008 at Prof. R. D. Kandou Hospital in Manado. T. gondii lgG was detected using the Latex Agglutination method. The seropositivity ofT. gondii lgG was analyzed descriptively.Results A total of 28 mothers from 50 infant-mother pairs wereseropositive for T. gondii IgG. Of the 28 seropositive mothers, 22 of their paired infants were seropositive. The remaining six seropositive mothers had infants that were not seropositive for T. gondii.Conclusions The identification of seropositive lgG for T. gondii in infants less than one months age indicates that the lgGs in infants are mostly derived from their mothers. CT must be considered and further examinations are needed.
Plasma prothrombin time and activated partial thromboplastin time as predictors of bleeding manifestations during dengue hemorrhagic fever
I. N. Budastra;
B. N. P. Arhana;
IB. Mudita
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi49.2.2009.69-74
Background Massive bleeding and shock are complications ofdengue hemorrhagic fever (DHF) that are associated withhigh mortality. Impaired hemostasis, especially coagulopathy,contributes to bleeding manifestations in DHF. Parameters suchas activated partial thromboplastin time (APTT) and plasmaprothrombin time (PPT) indicate the impact of coagulationsystem.Objective To determine the relationship between APTT and PPTlevels with bleeding manifestations in DHF patients.Methods A prospective cohort study was applied to subjectsdiagnosed with DHF at the Infection and Tropical DiseasesDivision, Department of Child Health, Medical School, UdayanaUniversity, Sanglah Hospital, Denpasar, Indonesia. Laboratorytests to determine APTT and PPT were carried out on thethird, fourth, and fifth day after the onset of fever. Bleedingmanifestations were examined in patients during their hospitalstay. Univariate and Cox regression analyses were performedto examine relationship between APTT and PPT values withbleeding manifestations in DHF patients.Results Forty-three children were enrolled in this study. Therewas a significant relationship between increases in APTT valuewith bleeding manifestations in DHF patients [RR 2.79 (95%CI1.68 to 4.69), P <0.01]. Cox regression analysis showed that onlyincreased APTT values correlated with bleeding manifestations[RR 2.05 (95%CI 1.92 to 3.90), P = 0.02].Conclusion APTT values may be used as a predictor for bleedingmanifestations in DHF.
Short-term impact of acute uncomplicated malaria on the cognitive performance of school children living in an endemic area
Masyitah Masyitah;
Lily Rahmawati;
Sri Sofyani;
Munar Lubis;
Iskandar Z. Lubis
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi49.2.2009.82-6
Background In Indonesia, malaria remains a public healthproblem. In North Sumatra between 2000 and 2004, an estimated50,670 clinical cases occurred every year, leading to the deathsof 9-10 people per year.Objectives To determine the short-term impact of acute uncompli-cated malaria on the cognitive performance of school children.Methods A prospective study was conducted on students at fourelementary schools in Madina, North Sumatra, Indonesia, fromAugust 15 to September 3, 2006. Subjects were classified intomalaria and non-malaria groups based on microscopically confirmedblood smears; they were selected by means of random sampling.Cognitive performance was measured with two examination paperson mathematics and Indonesian language before and two weeksafter artesunate and amodiaquin treatment for three days in themalaria group. Independent or paired t-tests were used to analyzedifferences in mean scores of cognitive performance.Results From 925 children examined, 384 suffered from malaria.One-hundred and thirty three children were recruited from themalaria group and 132 children were recruited from the non-malaria group. There was no difference in the distribution ofgeneral characteristics of the subjects. There was a significantdifference in cognitive performance between the malaria andnon-malaria groups (P<0.0001) before and after treatments. Inthe malaria group, there was a significant difference in cognitiveperformance before (mean 38.9; SD 15.19) and after treatment(mean 72.9; SD 10.41) with P
Comparison of the efficacy and safety of hydroxyethyl starch 130/0.4 and Ringer's lactate in children with grade III dengue hemorrhagic fever
Risky Vitria Prasetyo;
Abdul Latief Azis;
Soegeng Soegijanto
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi49.2.2009.97-103
Background Theoretically hydroxyethyl starch (HES) will givemore rapid recovery from shock, including in dengue shocksyndrome (DSS) and currently gained popularity for its lessdeleterious effects on renal function and blood coagulation.Objectives To compare the efficacy and safety ofHES 130/0.4 andRinger's lactate (RL) for shock recovery in children with DSS.Methods A randomized controlled study was performed on 39children admitted with DSS at Dr. Soetomo Hospital, Surabaya,between March and May 2007. Children were grouped intograde III (n=25) and grade IV (n=14) dengue hemorrhagicfever (DHF) according to the WHO criteria. Within eachgroup, subjects were randomly assigned to receive initial fluidresuscitation with either HES 130/0.4 (n=9 in the DHF grade IIIgroup, 10 in the DHF grade IV) or RL (n= 16 in the DHF gradeIII group, 4 in the DHF grade IV). Clinical and laboratory datawere collected to determine improvements in shock recovery andadverse reactions.Results In both the grades III and IV DHF, HES 130/0.4significantly decreased hemoglobin and hematocrit levels. Clinicalimprovements in pulse pressure and pulse rate were seen aftertreatment with HES 130/0.4 although these were statisticallyinsignificant if compared to the RL group. No differences in fluidrequirement and recurrent shock episodes were noted betweenthe RL and HES groups. No adverse reactions were found duringthe study.Conclusion HES 130/0.4 administration is effective and safe inchildren with DSS.
Comparison of once a day and three times a day iron treatment in 9-12 year old elementary school children with iron deficiency anemia
Dedy Gunadi;
Nelly Rosdiana;
Bidasari Lubis
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society
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DOI: 10.14238/pi49.2.2009.104-7
Background The compliance of iron deficiency anemia treatmentthat is administered three times daily in children is low. Thecompliance will be better if therapy is administered once daily.Objective To compare the iron therapy response of once per dayvs. three times a day administration in 9-12 year old children withiron deficiency anemia.Methods Children with iron deficiency anemia were randomlyallocated into a ferrous sulfate once-daily group or a ferrous sulfatethree times-daily group with the same dose of 5 mg/kg /day ofelemental iron for 30 days. Iron deficiency anemia was definedas Hb < 12 g/dL (World Health Organization criteria), MCV< 70 fl, RDW > 16 %, Mentzer index > 13 and RDW index >220. Iron treatment response was characterized by the increase inHb level 30 days after treatment. Peripheral blood samples werecollected at the start and end of the study.Results Ninety seven children were enrolled. There weresignificant increases in Hb levels in both groups after 30 days ofiron therapy, but there was no significant difference in Hb levelbetween the two groups (P=0.55).Conclusion The administration of a once daily dose of ferroussulfate did not show a significant difference in the increase ofHblevels compared to a three times daily dose.