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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 51 No 5 (2011): September 2011" : 11 Documents clear

Effectiveness of phototherapy with reflecting curtains on neonatal jaundice Ari Kurniasih; Guslihan Dasa Tjipta; Muhammad Ali; Emil Azlin; Pertin Sianturi
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Background Although phototherapy has been used in clinical practice for 40 years, there is still much debate on how to provide the most efficacious phototherapy. Phototherapy with white reflecting curtains may increase the average spectral irradiance provided, as well as decrease serum bilirubin concentrations at a faster rate in neonates with jaundice.Objective To determine if adding low cost, white, reflecting curtains to a standard phototherapy unit can increase the effectiveness of phototherapy for neonatal jaundice.Methods A randomized, controlled, open trial was conducted at H. Adam Malik and Pirngadi Hospitals, Medan, from May to December 2009. The criteria for inclusion in the study were full term newborns with neonatal jaundice presenting in their first week of life. Single phototherapy with white curtains hanging from the sides of the phototherapy unit (study group, n=30) was compared to single phototherapy without curtains (control group, n=30). The primary outcomes measured were the mean difference in total serum bilirubin levels and average spectral irradiation levels measured at baseline, and after 12 hours and 24 hours of phototherapy.Results The sum of average spectral irradiance in the curtained phototherapy unit was significantly higher than that of the standard phototherapy unit without curtains (P < 0.05). The decrease of total serum bilirubin levels after 12 and 24 hours of phototherapy was significantly greater in the study group (3.71 and 9.7 mg/dl, respectively) than in the control group (0.1 and 3.8 mg/dl, respectively), both P <0.05.Conclusion White, reflecting curtains in phototherapy units was significantly more effective than phototherapy without curtains for treatment of neonatal jaundice. [Paediatr Indones. 2011;51:256-61].

Glycemic control in diabetic children and adolescents after attending diabetic camp Erwin P. Soenggono; Rara Purbasari; Aman B. Pulungan; Bambang Tridjaja
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Background Type 1 diabetes mellitus (T1DM) is an emerging disease worldwide. Glycemic control in pediatric T1DM patients is a challenge in diabetes management. Attending diabetic camp has been associated with improved glycemic control in diabetic children and adolescents.Objective To determine the effect of diabetic camp attendance on glycemic control in children and adolescents with T1DMMethods A cross-sectional, non-experimental study was done in December 2010 at a diabetic camp held in Bogor, Indonesia. The two-day camp educated diabetics about T1DM, including insulin use, meal planning, exercise, monitoring and complications. The diabetic camp was attended by 28 children and adolescents, consisting of 5 boys and 23 girls, aged 7 â€“ 18 years. Eighteen participants completed the requested data for our study. Glycosylated hemoglobin (HbA1c) was measured before and 3 months after subjects attended the camp. Participants also filled the Pediatric quality of life (PedsQL) questionnaire. We compared HbA1c levels before camp and 3 months after, by Stata 19.Results Before camp, the mean HbA1c was 9.18% (SD 2.48) and 3 months after camp it was 8.67% (SD 1.62), a statistically significant improvement (P=0.004). The PedsQL revealed that none of the subjects had poor quality of life.Conclusion Glycemic control in T1DM children and adolescents was significantly improved 3 months after attending diabetic camp compared to that before attending camp. According to subjectsâ€™ self-assessment by PedsQL questionnaire, no subjects indicated a poor quality of life for the duration of their illness. [Paediatr Indones. 2011;51:294-7].

NPHS2 gene mutation, atopy, and gender as risk factors for steroid-resistant nephrotic syndrome in Indonesians Dedi Rachmadi; Danny Hilmanto; Ponpon Ijradinata; Abdurahman Sukadi
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Background Steroid-resistant nephrotic syndrome (SRNS) often develops into end stage renal disease. Previous studies have reported that NPHS2 gene mutation, gender, and atopic history are risk factors associated with SRNS. Interethnic, sociocultural, and environmental differences have also been suggested to affect these mutations.Objective To analyze possible risk factors for SRNS, including NPHS2 gene mutations (412Câ†’T and 419delG), gender and atopic history, in Indonesian subjects with SRNS.Methods A case-control study with 153 subjects, consisting of 88 SRNS patients and 65 control subjects, was undertaken in 10 Indonesian teaching centre hospitals from September 2006 to December 2007. Analysis of the NPHS2 gene mutation in 412 Câ†’T was performed by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR), while that for the NPHS2 gene mutation in 419delG was performed by restriction fragment length polymorphism (RFLP). Data was analyzed by multiple logistic regression.Results In our Indonesian subjects, the significant risk factors for SRNS were male gender (OR=2.21; CI 95%:1.07-4.56, P=0.036), NPHS2 412Câ†’T gene mutation (OR=18.07; CI 95%:6.76-48.31, P<0.001), and NPHS2 419delG gene mutation (OR=4.55; CI 95%:1.66-12.47, P=0.003). However, atopic history was not a significant risk factor for SRNS (OR=1.807; CI 95%:0.642-5.086, P=0.262).Conclusion NPHS2 412Câ†’T and 419delG gene mutations, as well as male gender are risk factors for SRNS in Indonesian subjects. Atopic history was not significantly associated with SRNS in our subjects. [Paediatr Indones. 2011;51:272-6].

Diagnostic tests of microscopic and urine dipstick examination in children with urinary tract infection Nurul Hidayah; Pungky Ardani Kusum; Noormanto Noormanto
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

BackgroundÂ Urinary tract infection (UTI) is common inÂ childrenand, if incorrectly handled, may cause long-term complications,suchÂ as renal failure. The best test to diagnose UTIs is urineculture. However, urine culture is time-consuming, taking 3 - 5days.Â Therefore, there is a need for faster, alternative methods.Urinalysis is a common diagnostic test toÂ establishÂ the diagnosisof UTI.ObjectiveÂ To determine the sensitivity andspecificity of urine leukocytes, nitrite and leukocyteÂ esterase forUTIs diagnosis.Methods We performed diagnostic tests at Dr. Sardjito Hospital,Yogyakarta. We examined the presence of leukocytes in urine by microscopy,urinary nitrite and leukocyte esterase by dipstick test, while comparing to urine culture as the gold standard.ResultsÂ Two hundred childrenÂ were included in our study. Byparallel test analysis, we found the sensitivity, specificity, positivepredictive value and negative predictive value of using all 3 testsin combination were 95%, 59%, 74% and 89%, respectivelyConclusion Test for urine leukocytes,Â nitrite and leukocyteesterase have high sensitivity but low specificity for diagnosingUTIs. Therefore, negative results in these 3 tests do not ruleout the possibility of UTI in children. [Paediatr Indones.2011 ;51;252-5].

Good outcomes in operative management of acquired prothrombin complex deficiency: a serial case report Lola Purnama Dewi; Eka Nurfitri; Evodia Evodia; M. Tiya Romli
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Background Acquired prothrombin complex deficiency (APCD) is a serious bleeding disorder in infants caused by idiopathic vitamin K deficiency. This disorder has a high mortality rate and sequelae are often seen in those that survive. The principal treatments are giving vitamin K and evacuating hemorrhages.Objective To report the outcome of surgical and non-surgical management in several cases of APCD.Method Eighteen infants diagnosed with APCD had similar histories: all were less than 4 months of age as well as exclusively breastfed, and none received vitamin K injections after birth. The diagnosis of APCD was made based on prolonged prothrombin times and proven intracranial hemorrhage on brain CT-scan. All subjects were treated with vitamin K injections for 5 days and offered craniotomy procedures.Results Out of 18 subjects, 10 underwent craniotomies, 9 within 48 hours of diagnosis and 1 on the fifth day of hospitalization. Two patients with small subdural hematomas were treated conservatively. Four subjects refused hospitalization. Two refused the craniotomy and died. All patients treated (12 cases), with both surgical and conservative treatment, were survived. Survivors were followed for 6 months and 10 of whom returned to the hospital for follow-up (9 patients who had operative procedures and 1 who did not). One patient who with craniotomy on the fifth day hospitalization had hydrocephalus as a sequela.Conclusion Operative procedure was needed for treatment of APCD in some cases with moderate until severe intracranial bleeding, while vitamin K injection only stop the progress of intracranial bleeding not as currable treatment of massive intracranial bleeding. [Paediatr Indones. 2011;51:298-302].

Comparison of alcohol, povidone-iodine and octenidine dihydrochloride as skin disinfectants to reduce bacterial count prior to peripheral venous catheter insertions in newborn infants Lily Rundjan; Rinawati Rohsiswatmo; Sarah Rafika; Enty Enty; Lucky H. Moehario
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

AbstractBackground Vascular access may increase the risk of bloodstream infections, especially in newborn infants with weak immune systems and requiring invasive supportive care. Skin disinfection prior to peripheral venous catheter insertion lowers the risk of infection. However, antiseptics chosen for this task should be effective and safe for newborn infants.Objective To compare the effectiveness of 70% alcohol (BD alcohol swabs Â®), 10% povidone-iodine (Pharma-RSUPNCM), and octenidine (Octenisept Â®) as antiseptics for reducing skin bacteria for pre-invasive procedures in neonates.Methods Infants aged less than 28 days, regardless of gestational age, at the Neonatal Unit of Cipto Mangunkusumo Hospital (RSUPNCM) were included in our study. Infants were divided into three groups, each tested with different skin antiseptics (alcohol, povidone-iodine or octenidine). Skin swabs were performed before and after application of skin antiseptic, followed by inoculation onto blood agar plates. Colony-forming units were counted after 18 hours of incubation at 37ÂºC.Results Ninety subjects were divided into 3 groups of 30, each group using either 70% alcohol swabs, 10% povidone-iodine, or octenidine as skin antiseptic. Skin swabs were taken before and after antiseptic application and drying, as well as 5 minutes after application. The mean reductions in CFU/cm2 (%) after antiseptic application (and fully dried) were 97.54% for povidone-iodine, 97.52% for octenidine, and 89.07% for alcohol. There were no significant differences in mean CFU reductions among the three antiseptics groups (P=0.299). Furthermore, 5 minutes after application, there were still no significant differences in the three antiseptic groups (P=0.289).Conclusions Although octenidine showed a significant bacterial count reduction after application, it was not significantly different from those of alcohol or povidone-iodine. [Paediatr Indones. 2011;51:277-81].

Assessing the quality of life of asthmatic children using the PedQLâ„¢ Yulia Wigoeno; Rini Sekartini; Darmawan Budi Setyanto; Sri Rezeki Hadinegoro
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Background Asthma is the most common chronic respiratory illness in childhood. Its prevalence in Indonesia is 6.7 - 10%. Asthma influences growth, development and quality of life in affected children. Studies abroad have shown that children with asthma have a decreased quality of life (QoL), yet such data is limited in Indonesia.Objective To assess quality of life of asthmatic children in Indonesia, the influence of sociodemographic and medical characteristics on QoL, and to compare child self-reporting to their parentsâ€™ proxy-reporting.Methods This descriptive analysis, cross-sectional study was conducted from May to July 2010. We assessed the quality of life of asthmatic children aged 2-18 years using the PedsQLTM 4.0 generic scale.Results A total of 100 asthmatic children and their parents were included, with 43% of the subjects aged 8-12 years and a male to female ratio of 1.7:1. We observed that 26.8% of children who self-reported had impaired QoL, while 35% of children who reported by proxy had impaired QoL. In a multivariate analysis, we found the following characteristics to independently influence QoL: male gender (P 0.018 OR 0.26 95% CI 0.08 to 0.9) based on child self-report, and having partly controlled/uncontrolled asthma based on self-report and proxy-report (P 0.013 OR 6.24 95% CI 1.48 to 26.37 and P 0.018 OR 3.43 95% CI 1.24 to 10.05, respectively). There was good correlation between the self-report and the proxy-report on emotional and social functioning (r > 0.5), yet we found physical and school functioning to be weakly correlated (r < 0.5).Conclusions We observed a relatively high (26.8-35%) impaired QoL in asthmatic patients. Parental assessment of their childâ€™s QoL was generally lower than the childâ€™s self-assessment. Male gender is a protective factor against impaired QoL, but having partly controlled/uncontrolled asthma is a risk factor for lower QoL. [Paediatr Indones. 2011;51:245-51].

Hemoglobin level and cardiothoracic ratio in children with chronic severe anemia Fera Wahyuni; Muhammad Ali; Bidasari Lubis; Netty D. Lubuis; Tina Christina Tobing
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.5.2011.262-5

Background Chronic severe anemia is known to increase cardiac output when the hemoglobin levels are < 7 g/dL for more than three months. Chronic severe anemia is also associated with a high incidence of cardiac enlargement and congestive heart failure.Objective To determine the relationship between hemoglobin level and cardiothoracic ratio in children with chronic severe anemia.Methods We conducted a cross-sectional study in Haji Adam Malik Hospital, Medan, Indonesia from October to December 2009. Subjects had chronic severe anemia and were aged 1 to 15 years. Hematological data was collected at the beginning of the study. The heart was considered enlarged if the cardiothoracic ratio (CTR) was greater than 50% (0.50) by chest roentgenogram. We used simple linear regression to analyze the relationship between hemoglobin and CTR values.Results Thirty subjects enrolled in our study. Their mean age was 115.7 months (SD 56.95). Hemoglobin levels ranged from 2.1 to 6.9 g/dL. The mean hemoglobin level and duration of anemia were 4.71 g/dL (SD 1.48) and 3.9 months (SD 0.70), respectively. Heart enlargement was observed in 23 patients (76.6%). The CTR ranged from 0.52 to 0.69, with a mean of 0.54 (SD 0.06). We found a significant correlation between CTR and hemoglobin levels with Pearsonâ€™s correlation coefficient, (r) = - 0.612 and P = 0.001.Conclusion Low hemoglobin levels significantly correlated with high CTR values in children with chronic severe anemia. [Paediatr Indones. 2011;51:262-5].

Comparison of oral and intravenous cyclophosphamide in children with steroid-resistant nephrotic syndrome Eka Laksmi Hidayati; Sudung O. Pardede; Partini P. Trihono
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.5.2011.266-71

Background There are variations in remission rates following treatment of steroid-resistant nephrotic syndrome (SRNS) with cyclophosphamide.Objective To compare the efficacy of oral versus intravenous cyclophosphamide (CPA) in the management of pediatric SRNS.Methods This was a prospective study of 41 children with SRNS treated with CPA. One group received oral CPA at a dose of 2 mg/kg body weight/day for 8-12 weeks, while the other group received intravenous CPA at a dose of 500mg/m2 body surface area (BSA) monthly for 6 months. All patients were concomitantly treated with prednisone on alternate days. The primary outcome was the number of patients attaining remission.Results The study was comprised of 20 children receiving oral CPA and 21 children receiving intravenous CPA. There were 29 boys and 12 girls. The mean age of children at the onset of nephrotic syndrome (NS) was 47 Â± 40 months old (range 12 months â€“ 13 years), and the mean duration of NS before initiation of CPA therapy was 15 Â± 28 months (range 1 â€“ 129 months). Remission was achieved in 29 (70.7%) patients, with no difference between oral and intravenous route of CPA administration. The mean time to achieve remission was 22.7 weeks (about 5 months). The oral route group required less time in achieving remission than the intravenous route group. No association was found between remission and other factors, such as onset of steroid resistance, route of CPA, hypertension and hematuria. Side-effects included infection, anemia, nausea/vomiting, and alopecia. None of the patients required discontinuation of the medication.Conclusion Oral CPA was as effective as intravenous CPA for children with steroid-resistant nephrotic syndrome. [Paediatr Indones. 2011;51:266-71].

Does 20 mg long-acting methylphenidate alter blood pressure and heart rate in children with ADHD? Tjhin Wiguna; Sasanto Wibisono; Sudigdo Sastroasmoro; Fransiscus D. Suyatna
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Objective To identify the cardiovascular effects of long-acting methylphenidate administered for twelve weeks in Indonesian children with ADHD.Methods This was an 18-week, time series study on children with ADHD who were given 20 mg of long-acting methylphenidate for twelve weeks. During the study period we made ten serial observations of the subjects, including before, during and 6 weeks following drug administration. We included drug naive children with ADHD between the ages of 7 â€“ 10 years. Children with mental retardation and chronic physical or mental disorders were excluded. Blood pressure was measured by sphygmomanometer with a childâ€™s cuff at the brachial artery. We also collected data on heart rate, side effects, complaints and other medications used during the study. Repeated analysis was performed on the data with a P level of 0.05.Results Twenty-one subjects were recruited for this study. Mean blood pressure fluctuated insignificantly during the research period, for both mean systolic and mean diastolic blood pressures (P=0.115 and P=0.059). Mean heart rate also fluctuated insignificantly (P=0.091). All fluctuations were within the normal ranges. During the study, there were complaints of dizziness, nausea, and gastrointestinal upset, but they were reportedly mild and disappeared before the second week of observation.Conclusion Administration of 20 mg long-acting methylphenidate for twelve weeks in children with ADHD altered mean blood pressures and heart rates, but within the normal range for children of their age. However, cardiovascular risk observation is still needed when administering methylphenidate to children with ADHD, especially for those using the medication long-term.[Paediatr Indones. 2011;51:282-7].

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