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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 53 No 3 (2013): May 2013" : 11 Documents clear

Motherâ€™s health care-seeking behavior for children with acute respiratory infections in a post-earthquake setting Yulinar Wusanani; Djauhar Ismail; Rina Triasih
Paediatrica Indonesiana Vol 53 No 3 (2013): May 2013
Publisher : Indonesian Pediatric Society

Background Delayed health care-seeking behavior is a causeof high mortality in children due to acute respiratory infections(ARis). Factors that may affect health care-seeking behavior aresocioeconomic status, maternal age, maternal education, parents'perception of illness, child's age, number of children under fiveyears of age in the family, and occurrence of natural disasters. The2006 Central Java earthquake damaged homes and health carefacilities, and led to increased poverty among the residents.Objective To assess the relationship between socioeconomicstatus and mother's health care-seeking behavior for childrenunder five years of age with ARis in a post-earthquake setting.Methods This cross-sectional study used secondary data obtainedfrom the Child Health Need Assessment (CHNA) survey. Logisticregression test was used to analyze variables that may affectmother's health care-seeking behavior for children under fiveyears of age with ARis.Results Of the 665 infants surveyed, 442 infants (66.5%)had ARis. Health care-seeking behavior was good (81.7%)in the majority of mothers. We observed that socioeconomicstatus did not affect maternal health care-seeking behavior forchildren under five with ARis (OR 1.33; 95%CI 0.79 to 2.24;P= 0.26). Maternal age, maternal education, child's age andgender, number of children under five in the family, parents'perceptions of illness and severity of house damage caused by theearthquake also had no effect on maternal health care-seekingbehavior for children with ARis.Conclusion After the 2006 earthquake, we find that socioeconomicstatus, maternal age, maternal education, child age, child gender,number of children under five in the family, parents' perceptionsof illness, and severity of house damage have no effect on mother'shealth care-seeking behavior for their children with ARis.

Effect of vitamin A on severity of acute diarrhea in children Marlisye Marpaung; Supriatmo Supriatmo; Atan Baas Sinuhaji
Paediatrica Indonesiana Vol 53 No 3 (2013): May 2013
Publisher : Indonesian Pediatric Society

Background Vitamin A deficiency may increase the risk or bea cause of diarrhea. Many studies have been conducted on theefficacy of vitamin A in the management of acute diarrhea, butthe outcomes remain inconclusive.Objective To determine the effectiveness of vitamin A in reducingthe severity of acute diarrhea in children.Methods We performed a singleô€ˆblindô€ˆrandomized controlledtrial in the Secanggang District, Langkat Regency, North ofSumatera, from August 2009 to January 2010 in children aged6 months to 5 years, who had diarrheas. Subjects were dividedinto two groups. Group 1 received a single dose of vitamin A(100,000 IU for subjects aged 6 to 11 month old or with bodyweights :s 10 kg, or 200,000 IU for subjects aged 2: 12 month oldor with body weights> 10 kg). Group 2 received a single doseof placebo. The establishment of severity was based on changesin diarrheal frequency, stool consistency, volume and durationof diarrhea after treatment. We performed independent Tô€ˆtestand Chi square tests for statistical analyses. The study was anintentionô€ˆtoô€ˆtreat analysis.Results We enrolled 120 children who were randomized intotwo groups of 60 subjects each. Group 1, received vitamin Aand group 2 received a placebo. The results showed significantdifferences between the two groups in stool volume starting onthe first day (95%CI 192.30 to 3237.51; Pô€‰O.OOI), as well asdiarrheal frequency (P=O.OOl) and stool consistency (P=O.OOl)on the second day observation and duration of diarrhea followingtreatment (95%CI - 40.60 to - 25.79; Pô€‰O.OOI;).Conclusions Vitamin A supplementation is effective in reducingthe severity of acute diarrhea in children under five years of age.[Paediatr lndones. 2013;53:125-31.]

Familial congenital heart disease in Bandung, Indonesia Sri Endah Rahayuningsih
Paediatrica Indonesiana Vol 53 No 3 (2013): May 2013
Publisher : Indonesian Pediatric Society

Background Congenital heart disease (CHD) may occur inseveral members of a family. Studies have shown that familialgenetic factor play a role in CHD.Objective To identify familial recurrences of CHD in familieswith at least one member treated for CHD in Dr. Hasan SadikinHospital, Bandung Indonesia.Methods In this descriptive study, subjects were CHD patientshospitalized or treated from January 2005 to December 2011. Weconstructed family pedigrees for five families.Results During the study period, there were 1,779 patients withCHD. We found 5 families with 12 familial CHD cases, consistingof 8 boys and 4 girls. Defects observed in these 12 patients weretetralogy of Fallot, transposition of the great arteries, persistentductus arteriosus, ventricular septa! defect, tricuspid atresia,pulmonary stenos is, and dilated cardiomyopathy. Persistent ductusarteriosus was the most frequently observed defect (4 out of 12subjects) . None of the families had a history of consanguinity. Therecurrence risk of CHD among siblings was calculated to be 0.67%,and the recurrence risk ofCHD among cousins was 0.16%.Conclusion Familial CHD may indicate the need for geneticcounseling and further pedigree analysis.

Neutrophil, TLR2, and TLR4 expression in newborns at risk of sepsis Ari Yunanto; Agustina Tri Endharti; Aris Widodo
Paediatrica Indonesiana Vol 53 No 3 (2013): May 2013
Publisher : Indonesian Pediatric Society

Background There is increasing evidence that toll-like receptors (TLR) play a key role in the mediation of systemic responses to invading pathogens during sepsis. Saliva is an important body fluid for detecting physiological and pathological conditions of the human body. Neutrophils are participants in the acute response against pathogens in many tissues, and their influx into the oral cavity may occur at any time.Objective To compare mean neutrophils and the expression of TLR2 and TLR4 in saliva and blood of newborns at risk for sepsis to those of healthy newborns.Methods This cross-sectional study was conducted from July to December 2011 in the Division of Neonatology, Department of Child Health, Ulin General Hospital, Lambung Mangkurat University Medical School, Banjarmasin. Case subjects were newborns with sepsis risk factors (30 infants), while 30 healthy infants were in the control group. Saliva and blood specimen examinations were performed in the Biomedical Laboratory of Brawijaya University Medical School, Malang. We used T-test for statistical analyses.Results From saliva specimens, mean neutrophils were significantly higher in the case group than in the control group [14.43 (SD 12.21) % vs. 5.63 (SD 6.78) %, respectively, (P=0.021)]. In addition, mean TLR2 and mean TLR4 saliva levels were significantly higher in the case group than in the control group [TLR2: 64.97 (SD 26.42) % vs. 40.06 (SD 6.23) %, respectively, (P=0.011); TLR4: 1.5 (SD 1.61) % vs. 0.57 (SD 0.53) %, respectively, (P=0.044)]. From blood specimens, mean neutrophils were also significantly higher in the case group than in the control group [1.09 (SD 0.61)% vs. 0.21 (SD 0.09)%, respectively, (P=0.000)]. Similarly, mean blood TLR2 and TLR4 levels were significantly higher in the case group than in the control group [TLR2: 92.51 (SD 5.51) % vs. 81.74 (SD 11.79) %, respectively, (P=0.003); TLR4: 0.71 (SD 1.42) % vs. 0.12 (SD 0.06) %, respectively, (P=0.000)].Conclusion There are significant increases in neutrophils, asÂ well as neutrophil expression of TLR2 and TLR4 in the saliva and blood from newborns with sepsis risk factors compared to those of healthy newborns. [Paediatr Indones. 2013;53:132-7.]

Serum ferritin to detect iron deficiency in children below five years of age Windy Saufia Apriyanti; Sutaryo Sutaryo; Sri Mulatsih
Paediatrica Indonesiana Vol 53 No 3 (2013): May 2013
Publisher : Indonesian Pediatric Society

Background Iron deficiency (ID) anemia impacts thecognitive and motor development of children until the age of10 years, despite receiving iron therapy. Early det ection of IDis recommended and serum ferritin has been proposed as analternative indicator for ID det ection.Objective To assess th e diagnostic accuracy of serum ferritin fordetecting ID in children below five years of age.Methods T his cross-sectional, diagnostic study was conducted inprimary health care centers in Yogyakarta and Bantu!. Hemoglobin(Hb), serum ferritin and soluble transferrin receptor (sTfR) levelswere performed on children aged 6- 59 months.A sTfR level of 2:8.2 mg/L was used to define iron deficiency. T he best cutoff pointfor serum ferritin level use as a diagnostic tool was determined byreceiver operator curve.Results T he prevalence ofID was32%. Mean h emoglobin levelsin iron deficient and healthy children were 11.7 (SD 0.5) g/dL and12.2 (SD 0.7) g/dL, respectively. T he sensitivity, specificity, andpositive predictive value (PPV) of serum ferritin ( < 12 ug/L) were17%, 93%, and 56%, respectively. Using a cut off of <32.4 ug/L,serum ferritin had sensitivity of 62. l % and specificity of 50.8%.Conclusions The diagnostic value of serum fe rritin levels ismodestly capable of detecting ID. Therefore, serum ferritin shouldnot be used as an alternative indicator for detecting ID in childrenbelow five years of age.

Anthropometric measurements for detecting low birth weight Kusharisupeni Kusharisupeni; Wahyu Kumia Y. Putra; Engkus Kusdinar Achmad
Paediatrica Indonesiana Vol 53 No 3 (2013): May 2013
Publisher : Indonesian Pediatric Society

Background In several provinces of Eastern Indonesia, themajority of births take place at home (60%) and are assisted bytraditional birth attendants. Most of these newborns do not havetheir birth weight recorded, due to lack of available weighing scalesor lack of skill to perform the measurement, especially in ruralareas. As such, an early iden tification oflow birth weight cases isneeded to prevent infan t morbidity and mortality.Objective To assess anthropometric measurements including calf,chest, and h ead circumferences as a method of choice for detectinglow birth weight, as substitute for actual weighing.Methods This cross-sectional study was performed at BanjarBarn, South Kalimantan, Indonesia, from January to March 2012.Subjects were full term, singleton, and live-born infants duringthe study period, and obtained from private clinics by a purposivesampling procedure. Calf, chest, and h ead circumferences weremeasured to identify the most suitable substitute for birth weightusing Pearson's correlation, ROC, sensitivity, and specificity.Results In this study, a correlation was shown between birthweight and all anthropometric measurements. Optimal calf,chest, and head circumference cutoff points to identify low birthweight infants were 10.3 cm, 30. 7 cm, and 3 1.2 cm, respectively.The area under the curves (AUC) showed good accuracy for allmeasuremen t types. Calf circumference had the closest estimatedtrue prevalence to the true prevalence (8.52% and 8.6%, respectively)compared to the other measurement types.Conclusion Calf circumference is the most suitable measurementas a substitute for birth weight, due to its estimated trueprevalence.

Ibuprofen vs. indomethacin for persistent ductus arteriosus closure in preterm infants Deny Salverra Yosy; Ria Nova; Julniar M. Tasli; Theodorus Theodorus
Paediatrica Indonesiana Vol 53 No 3 (2013): May 2013
Publisher : Indonesian Pediatric Society

Background Indomethacin and ibuprofen are anti-prostaglandinE2 agents administered for persistent ductus arteriosus (PDA)closure. Ibuprofen has weaker cyclooxygenase-1 inhibitor affinitythan that of indomethacin, causes decreased gastrointestinalcirculation, as well as brain and kidney side effects.Objective To compare the efficacy of oral ibuprofen andindomethacin for PDA closure in preterm infants.Methods A randomized double-blind controlled trial on preterminfants with PDA was performed in Moehammad HoesinHospital, Palembang, from October to December 2011. Persistentductus arteriosus was diagnosed by echocardiography. Subjectswere divided into two groups, and received either ibuprofen orindomethacin. Ibuprofen was given at a dose of 10 mg/kgBW /don day 1 and 5 mg/kgBW /d on days 2 and 3. Indomethacin wasgiven in three doses over 24 hour-intervals; the first dose was 0.2mg/kg, and the second and third doses were 0.1 mg/kg each.Results Sixty infants were enrolled in this study, 36 boys (60%)and 24 girls ( 40%). Fifty-two subjects completed the study protocol.Ductus arteriosus (DA) closure after treatment was observed in 22out of 26 subjects in the ibuprofen group and 19 out of 26 subjectsin the indomethacin group (P= 0.04). The mean DA diameterreductions after administration of ibuprofen or indomethacin were0.40 (SD 0.16) mm and 0.30 (SD 0.21) mm, respectively (95%CIof differences0.05 to0.17; P= 0.04). Serum creatinine was elevatedin the indomethacin group following treatment compared to theibuprofen group [P = 0.002, 95% CI of differences 0.06 to 0.27].Ductus arteriosus reopening occurred in 4 out of 19 subjects in theindomethacin group, while n one in the ibuprofen group .Conclusions Ibuprofen is better than indomethacin, in terms ofhigher PDA closure rate and mean DA diameter reduction aftertreatment. In additional, indomethacin has significantly greaterincrease in mean serum creatinine level after treatment thanibuprofen.

Azithromycin vs. chloramphenicol for uncomplicated typhoid fever in children Yulia Antolis; Tony Rampengan; Rocky Wilar; Novie Homenta Rampengan
Paediatrica Indonesiana Vol 53 No 3 (2013): May 2013
Publisher : Indonesian Pediatric Society

Background The emergence of multiple-drug-resistantSalmonella typhi strains has made it necessary to evaluate newagents for the treatment of typhoid fever. Azithromycin has in vitroactivity against many enteric pathogens, including Salmonella spp.However, there is not enough evidence to compare azithromycinwith first-line antibiotics currently used.Objective To analyze the efficacy of azithromycin comparedto that of chloramphenicol as a first-line drug in the therapy ofuncomplicated typhoid fever in children.Methods We conducted a randomized open trial from November2011 to March 2012 on 60 children aged 2-13 years withuncomplicated typhoid fever. Subjects were randomly assignedto receive either azithromycin (10 mg/kgBW /day orally oncedaily) or chloramphenicol (100 mg/kgBW/day orally in fourdivided doses) for 7 days. Efficacy was measured by recordingclinical cures and fever clearance times. Data was analyzed withChi-square and T-tests.Results All of 30 patients in the azithromycin group and 28out of the 30 patients in the chloramphenicol group were cured(P= 0.246). Fever clearance time was shorter in the azithromycingroup (mean 37.9 (SD 32.75) hours, 95%CI 25.67 to 50.13)than in the chloramphenicol group (mean 49 (SD 45.83) hours,95%CI 3 1.89 to 66.11).Conclusions The efficacy of azithromycin is similar to that ofchoramphenicol in the treatment of uncomplicated typhoid feverin children. Azithromycin has shorter fever clearance time andhigher cure rate compared to those of chloramphenicol, althoughthese results are n ot statistically significant.

Hepatitis B antibody titers in Indonesian adolescents who received the primary hepatitis B vaccine during infancy Hartono Gunardi; Adra Firmansyah; Sri Rezeki S Harun; Sudigdo Sastroasmoro
Paediatrica Indonesiana Vol 53 No 3 (2013): May 2013
Publisher : Indonesian Pediatric Society

Backgi-ound Hepatitis B (HB) has been classified as moderate-tohighlyendemic in Indonesia. HB vaccination, the most effectivemethod to prevent HB viral transmission, induces protectiveantibodies against HB surface antigen (anti-HBs). However, theseantibodies decline in titer over time. Studies on the duration ofprotection and the prevalence of n on-responders in Indonesianadolescents have been limited.Objectives To determine anti-HBs titers in 15-17-year oldIndonesian adolescents given primary HB vaccine during infancyand the prevalence of non-responders after a HB vaccine boosterdosage.Methods This cross-sectional study was performed from Februaryto September 2008 on adolescents aged 15-17 years in threesenior high schools in Jakarta who received complete primary HBvaccines during infancy, based on parents' recall. Investigationsincluded HB vaccination history, anthropometric measurements,and blood tests for anti-HBs before and 4-6 weeks after a boosterdose ofHB vaccine.Results Of 94 subjects, 35 had protective anti-HBs and 59 hadundetectable anti-HBs. A booster dose was administered to 5 8 of then on-protected subjects, of which 33 showed anamnestic responses.However, 25 subjects failed to generate protective anti-HBs. Takinginto consideration the adolescents with protective anti-HBs beforeand after the booster dose, serologic protection was demonstratedin 73%. Non-responder prevalence was 27%. The high prevalenceof non-responders may indicate bias of parents' recall.Conclusion Protective anti-HBs is detected in less than half ofIndonesian adolescents given primary HB vaccine during infancy.Following booster dosage, anamnestic responses are n oted in onethirdof subjects. The prevalence of non-responders is 27%, butconfirmation with further study is needed.

Prevalence of insulin resistance in obese adolescents Aman B. Pulungan; Ardita Puspitadewi; Rini Sekartini
Paediatrica Indonesiana Vol 53 No 3 (2013): May 2013
Publisher : Indonesian Pediatric Society

Background Childhood obesity is a global health problem, withthe prevalence is differed in each country and affected by manyfactors, such as lifestyle and physical activity. Insulin resistance(IR) as a basic mechanism of several metabolic diseases in obesity,is related with metabolic syndrome (MetS) along with its longterm complications, such as type 2 diabetes mellitus (T2DM).Several factors are known to be associated with IR, and thepresence of acanthosis nigricans (AN) has an important meaningin predicting IR.Objectives To assess the prevalence of IR, MetS in obeseadolescents and its potentially associated factors, such as gender,signs of AN, and family history of metabolic diseases.Methods A cross-sectional study was performed in obeseadolescents, aged 12-15 years, over a two-month period. Fastingblood glucose, insulin, and lipid profiles were measured. Obesitywas defined using body mass index (BMI). Insulin resistancewas quantified by the homeostasis model assessment for IR(HOMA-IR) . Metabolic syndrome was defined according to theInternational Diabetes Federation (IDF) 2007 criteria.Results Of92 obese adolescents, IR was found in 38% of subjects,with females predominating (57.2%). Signs of AN were seen in71. 4% of subj ects and a positive family history of metabolic diseaseswas found in 82.8% of subjects, including family history of obesity,type 2 diabetes mellitus (T2DM), and hypertension. Less than10% of subjects were considered to be in a prediabetic state, andnone had T2DM. No statistical significance was found betweengender, family history, or signs of AN and IR (P>0.05). Metabolicsyndromes was found in 19.6% of subjects, with the fo llowingprevalences for each component: 34.8% for hypertension, 78.3%for central obesity, 8.7% for impaired fasting glucose (IFG), 22.8%for low levels of HDL, and 2 1. 7% for high triglyceride levels. Astrong correlation was found between IR and IFG with OR= 5 .69(95%CI 1.079 ~ 29.993, P= D.04).Conclusion We find a high prevalence ofIRin obese adolescents,and IR increases the risk of prediabetes. Thus, prevention strategies are needed to overcome the long term impact of obesity on health.

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