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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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Search results for , issue "Vol 49 No 4 (2009): July 2009" : 11 Documents clear

Confusions and dilemma around hepatic dysfunction associated falciparum malaria: A case report and brief review of the literature Eka Sianti; Jose Meky Mandei
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Malaria remains a big burden in East Indonesia. Severe malaria assaults children in endemic area and leads toenormous morbidities and mortalities.According to the World Health Organization's criteria,recognition of one or more of the following clinicalfeatures should raise the suspicion of severe malariai.e, cerebral malaria (unrousable coma), severe anemia(hemoglobin <5 g/dl), renal failure (creatinine serum> 3 mg/dl), pulmonary edema or adult respiratory distresssyndrome (ARDS), hypoglycemia (glucose < 40 mg/dl),circulatory collapse or shock, disseminated intravascularcoagulation (DIC), repeated generalized convulsions,acidosis (pH < 7 .25), macroscopic hemoglobinuria,hyperparasitaemia ( > 5% of the erythrocytes infested byparasites), or jaundice (bilirubin> 3 mg/dl).l-3Jaundice in malaria due to hepatic dysfunction isa classical case, nevertheless, there are some confusionsand dilemmas in managing it.1 We report a case withjaundice due to hepatic dysfunction and hemolysisassociated falciparum malaria that we treated inGeneral Hospital of Fakfak, West Papua, and providea brief literature review on the matter.

Serological profile and hemolytic disease in term neonates with ABO incompatibility Desiana Dharmayani; Djajadiman Gatot; Rinawati Rohsiswatmo; Bambang Tridjaja
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Background Hemolytic disease of the newborn (HDN) due toABO blood type incompatibility is one of the most commoncause of neonatal hyperbilirubunemia that potentially leads tobilirubin encephalopathy. Data on ABO-hemolytic disease of thenewborn (ABO-HDN), especially regarding umbilical cord bloodserological profile, are limited.Objective To identify the serological profile and hemolytic disease in term neonates with ABO incompatibility.Methods This was a cross-sectional descriptive study, conductedat RSIA Budi Kemuliaan Jakarta.Results We found 68 healthy term neonates with ABOincompatibility, nine of them had positive direct antiglobulintest (OAT) result, and 38 subjects had a positive result onOAT with elution method. The highest titer of IgG was 1:8.Hyperbilirubinemia was found in 30 ( 44%) subjects, andABO-HDN was diagnosed in 28 (41 %) subjects. Within thepositive OAT group, eight out of nine subjects had sufferedfrom hyperbilirubinemia and ABO-HDN. Meanwhile, withinthe positive OAT with elution method group; 24 subjects hadsuffered from hyperbilirubinemia with 23 of them having ABOHDN. Based on the chi-square analysis; those with positive OAT with elution method had 3.2 times higher risk of suffering from ABO-HDN. Furthermore, there was a 3.6 times higher risk ofsufferring from hyperbilirubinemia.Conclusion In healthy term neonates with ABO incompatibility,the incidence of ABO-HDN is 41%. OAT serological examinationwith elution method is better than OAT in assessing riskfor hyperbilirubinemia and ABO-HDN.

Role of early education in reading ability of deaf students Bambang Udji Djoko Rianto
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Background Reading is a very complex process which includescognitive process. Reading is initialized by visual analysis and lettertransformation into vocabulary form, word identification by lettersound mapping, words correlation, and interpretation. Deafnesscauses difficulties in acquiring language information via hearingprocess thus inhibits a successful conversation process.Objective To determine the role of early education in deaf students to reading ability.Methods A cross sectional design was performed from Septemberuntil December 2007. This study compared deaf students,younger than 6 years old, who received early education in specialeducation schools B (group I), with deaf children aged 6 years old and older who received education in special education schools B/conventional educational method (group II).Results There were 22 deaf children in group I and 24 in group II. The measured variables included age, age of school enrollment, duration of studies, degree of deafness, sex, and parental educational level. Logistic regression analysis showed that the variables which significantly contributed to reading skills were the early education and duration of study. In early education group, the children had significantly better reading ability (P=0.02; OR= 19.95; 95% CI 1.939 to 53.62), besides duration of study (P=O.Ol; OR=70.754; 95% CI 6.267 to 798.75), compared to conventional education.Conclussion Compared to those who receive education in specialeducation school B with a conventional educational method, deafstudents who receive early education in special education schoolsB have better reading ability significantly. Duration of studyalso contribute significantly to reading skill.

Mothers' response on Kangaroo Mother Care intervention for preterm infants Bernie Endyami; Rosalina D. Roeslani; Rinawati Rohsiswatmo; Soedjatmiko Soedjatmiko
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Background The low birth weight still remains the main causeof neonatal deaths. Kangaroo Mother Care (KMC) program canprovide a better care for low birth weight newborn infants throughskin-to-skin contact.Objective The aim of this study was to assess factors andresponses from mothers that would influence the re-introductionand re-implementation of KMC at neonatology ward, CiptoMangunkusumo Hospital, Jakarta.Methods This was a prospective preliminary study usingquestionnaires, to mothers oflow birth weight infants who wouldundergo KMC in neonatal ward.Results Most mothers felt sad, guilty, worried, afraid and notconfident when they first saw their babies, thus, they were initiallydoubtful and afraid in the beginning of KMC. But, after KMCwas implemented, most of the mothers found positive effectson mother-infant bonding, maternal affection in love or touch,breastfeeding and mother's confidence in newborn care.Conclusions KMC provides benefits for mothers. Most mothersyield positive response when implementing KMC program to theirinfants.

Impact of iron therapy on Mentzer index and red cell distribution width index in primary school children with iron deficiency anemia Budi Andri Ferdian; Nelly Rosdiana; Bidasari Lubis
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Background Iron deficiency anemia (IDA) remains a commonnutritional problem, especially in school-age children. Due tothe many examinations that are needed to be performed and the invasive gold standard procedure, an easy and simple alternative examination to diagnose IDA is needed.Objective To determine the impact of iron therapy on Mentzerand red cell distribution width (RDW) indexes of children withIDA.Methods A randomized open clinical trial was conducted inprimary school aged children in North Aek Nabara, betweenNovember 2006 and November 2007. IDA was determined basedon WHO criteria. Subjects with severe anemia were excluded.Subjects were randomly assigned to groups that received eitheriron therapy or a placebo.Results Three-hundred subjects from aged 9 to 12 years oldwere recruited and 104 subjects completed the study. The meanRDW index of the iron and placebo groups after three monthsobservation were 239.96 (SD 39.25) and 235.17 (SD 31.77),respectively. The mean Mentzer index mean for the iron therapyand placebo groups after three months observation were 16.08(SD 1.98) and 16.20 (SD 2.27), respectively.Conclusion After therapy, there are no significant differences ineither the Mentzer or RDW indexes between the therapy andplacebo groups.

Magnesium intake and insulin resistance in obese adolescent girls Harry Freitag Luglio Muhammad; Emy Huriyati; Rina Susilowati; Madarina Julia
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Background The worldwide increase in the prevalence ofcardiovascular diseases in adulthood is related to obesity inchildren and adolescents. Insulin resistance and hyperinsulinemia observed in obese individuals are the precursors of cardiovascular diseases and type 2 diabetes mellitus. Magnesium, through its action on insulin receptors, is proposed to be an important factor in preventing insulin resistance.Objective The aim of this study was to assess the associationbetween magnesium intake and insulin resistance in obeseadolescent girls.Methods This was a cross-sectional study on obese adolescentgirls in Yogyakarta, Indonesia. Insulin resistance was defined as a HOMA-IR index of3.16 or more. HOMA-IR was calculated usingfasting insulin and plasma glucose levels. Magnesium intake andenergy adjusted magnesium intake were measured using a 24-hour food recall method on 6 non-consecutive days.Results Of 7 8 obese adolescent girls included in our study, 56% of them were found to be insulin resistant. Magnesium intake was only 61 o/o of the recommended daily requirement for adolescent girls. There were no significant associations between magnesium intake and either HOMA-IR or hyperinsulinemia.Conclusion Our study does not find an association betweeninsulin resistance and magnesium intake in obese adolescent girls.

Diagnostic value of urine Gram staining for urinary tract infection in children I Nyoman Sartika; Ketut Suarta; Pungky Ardhani
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Background Urine culture is the standard procedure for diagnosisof urinary tract infection (UTI). To reduce the cost and timespent in examining cultures, several rapid methods have beendeveloped including microscopic examination, chemical tests,and automated systems.Objective To determine the value of microscopic examination of a Gram stained uncentrifuged drop of urine for diagnosis of UTI.Methods We carried out a diagnostic test in Sanglah Hospital,Denpasar, from January 2007 to December 2007. Midstream urine specimens were Gram stained and then examined using a high power oil immersion lens. Twenty fields of view were examined and finding of two or more microorganisms was taken as positive result. Urine was also cultured and a yield of more than 105 CFU/ml was taken as positive result. The sensitivity, specificity, and predictive values of Gram stained urine were determined using urine culture as gold standard.Results From 43 subjects in our study, 12 subjects (28%) hadpositive urine culture. The prevalence was higher in males (58%)than females. UTI was most commonly caused by Klebsiellapneumoniae (33%). The sensitivity, specificity, positive predictivevalue, and negative predictive valuey, of the urine Gram stainwere 67% (95%CI 40 to 93), 9.7% (95%CI 91 to 100), 89%,88%, respectively. The accuracy, positive likelihood ratio, negative likelihood ratio, and post-test probability of the urine Gram stain were 88, 21, 0.3, and 89%, respectively.Conclusion Microscopic examination of Gram stained uncentrifuged drop of urine is specific and accurate, but not sensitive for the diagnosis of UTI.

Academic achievement of elementary school-aged children with pre-anemic iron-deficiency Paul Wiratama Pardede; Endang Windiastuti; Bambang Tridjaja
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Background Relationship between iron deficiency andcognitive function has been investigated in many studies, butthey usually focused on iron deficiency anemia. Brain ironstorage might have already decreased before anemia exist.Objectives To investigate the prevalence of pre-anemic irondeficiencyin school-aged children and to determine whetherthis condition is a risk factor for low academic achievement.Methods A cross-sectional study was conducted on 87 subjectsof znd,6th grade in SDN 04 Petang, Kramat, Senen, Jakartaon August 2008. The subjects underwent peripheral bloodand ferritin serum concentration examinations. Twentyninesubjects who suffered from anemia were excluded. Theremaining 58 subjects were classified into normal body ironstatus group and preanemic iron-deficiency group.Results The prevalence of pre-anemic iron-deficiency in SDN04 Petang, Kramat was 6%. The prevalence ratio to determinewhether pre-anemic iron-deficiency was a risk factor for lowacademic achievement could not be calculated because theminimal sample number required was not reached. There wasno relationship between pre-anemic iron-deficiency and lowacademic achievement for mathematics, Indonesian language,science, and social science.Conclusions The prevalence of pre-anemic iron-deficiency inSDN 04 Petang, Kramat Senen Jakarta was 6%. This studyis not able to determine whether pre-anemic iron-deficiencyis a risk factor for low academic achievement in school-agedchildren; therefore further study with more efforts to detectthe presence of iron deficiency in children with inflammationis needed.

Echocardiographic patterns in asphyxiated neonates Maswin Masyhur; Idham Amir; Sukman Tulus Putra; Alan Roland Tumbelaka
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Background Neonatal asphyxia is a disorder in neonates dueto decreased oxygenation (hypoxia) and decreased perfusion toorgans (ischemia). Duration of asphyxia and early managementinfluence the severity of organ dysfunction, including the heart.Objectives To obtain patterns of cardiac abnormality inneonatal asphyxia in Cipto Mangunkusumo Hospital withechocardiography. Design A cross-sectional study was performed on 22 asphyxiated neonates and 22 other non-asphyxiated neonates from March to October 2008. Inclusion criteria were term neonates, Apgar score :S 6 in the first minute for asphyxiated neonates and ?. 7 for normal/non-asphyxiated neonate. Echocardiographic examination was performed before the age of 48 hours.Results There were 7/22 asphyxiated neonates and 1/22 nonaxphyxiated neonate with heart disease (P <0.05). The mostcommon cardiac abnormality found in asphyxiated neonates waspatent ductus arteriosus, followed by atrial septal defect, tricuspid regurgitation, and pulmonary hypertension.Conclusion Cardiac abnormality is significantly found more oftenin asphyxiated than in non-asphyxiated neonates.

Number of blood pressure measurements needed for screening of hypertension in children and adolescents Madarina Julia
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Background Routine blood pressure assessment is recommended because childhood hypertension is significantly associated with increased risk of cardiovascular disease in adulthood. However, results of blood pressure measurements in children are highly variable, associated with the risk of under or over-diagnosing in hypertension.Objective To assess the optimal number of measurements to screen elevated blood pressures in children and adolescents.Methods This study used two sets of data, i.e. a dataset from 104 obese and non-obese, male and female primary school-children, and a dataset from 79 obese female adolescents. Blood pressure (BP) was measured using standard techniques described by the fourth report of the National High Blood Pressure Education Program (NHBPEP) Working Group on Children and Adolescents. Elevated BP was defined as systolic and diastolic BP at or above the 90th percentile for gender, age, and height.Results BP measurements taken on day-one were significantlyhigher than those taken on day-two and three. This led tohigher prevalence of elevated BP when only one measurementwas performed. Using the average of two measurements in twooccasions detected elevated blood pressure with specificity andpositive predictive value (PPV) ranged from 0. 74 to 1.0 and 0.58to 1.0, respectively.Conclusions It is necessary to measure blood pressure repeatedly to minimize the risk of over-diagnosing in hypertension in children and adolescents. Using the average of three measurements in three visits is recommended, but drawing conclusions based on two measurements in two occasions have yielded sufficiently high specificity.

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