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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 2,127 Documents

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Correlation between C--reactive protein and serum iron levels in children with pneumonia I Gd. Oki Novi Purnawan; Ida Bagus Subanada; Sri Mulatsih
Paediatrica Indonesiana Vol 52 No 1 (2012): January 2012
Publisher : Indonesian Pediatric Society

Background Pneumonia is an infectious disease often occuringin children under five years of age. At the time of infection,pro-inflammatory cytokines are released. It is thought that thesepro-inflammatory cytokines cause changes to iron homeostasisin the body.Objective To determine a correlation between CRP and serumiron levels in children with pneumonia.Methods An analytical, cross-sectional study was performedin children aged 6 months-5 years with severe pneumonia atSanglah Hospital, Denpasar, Bali from April-November 2010.Laboratory examinations included CRP and serum iron levels.The correlation between CRP and serum iron levels was analyzedby Pearson's correlation.Results From 69 children with severe pneumonia, 23 childrenfulfilled the inclusion criteria. Subjects' median CRP level was9.22 mg/Land median serum iron level was 25.55 ug/dL. Thecoefficient correlation between CRP and serum iron levels was-0.580 (P=0.004). The determination coefficient value was0.316.Conclusion In children with severe pneumonia, CRP levelcorrelates negatively with serum iron levels. [Paediatr lndones.2012;52:38-42).

Supporting factors and barriers in implementing kangaroo mother care in Indonesia Hadi Pratomo; Uut Uhudiyah; Ieda Poernomo Sigit Sidi; Yeni Rustina; Rulina Suradi; Anne-Marie Bergh; Quail Rogers-Bloch; Reginald Gipson
Paediatrica Indonesiana Vol 52 No 1 (2012): January 2012
Publisher : Indonesian Pediatric Society

Background Kangaroo mother care (KMC) was introduced toIndonesia in the 1990s. Since then, KMC has not been widelyimplemented and has not received national policy support.Objective The objectives of this case study were to implementKMC by an intervention that would ultimately benefit tenhospitals in Java, Indonesia, as well as identify supporting factorsand barriers to KMC implementation.Methods An intervention with four phases was conducted inten hospitals. Two teaching hospitals were supported to serve astraining centers, six hospitals were supported to implement KMCand two other hospitals were supported to strengthen existingKMC practices. The four phases were comprised of a baselineassessment, a five-day training workshop, two supervisory visitsto each hospital, and an end-line assessment.Results A total of 344 low birth weight infants received KMCduring the intervention period. Good progress with regards toimplementation was observed in most hospitals between the firstand second supervisory visits. Supporting factors for KMC were thefollowing: support received from hospital management, positiveattitudes ofhealthcare providers, patients, families and communities,as well as the availability of resources. The most common challengeswere record keeping and data collection, human resources and staffissues, infrastructure and budgets, discharge and follow-up, as wellas family issues. Challenges related to the family were the inabilityof the mother or family to visit the infant frequently to provideKMC, and the affordability of hospital user fees for the infant tostay in the hospital for a sufficient period of rime.Conclusion KM C appeared to be well accepted in most hospitals.For an intervention to have maximum impact, it is importantto integrate services and maintain a complex network ofcommunication systems. [Paediatr lndones. 2012;52:43-50).

Plasma homocysteine and blood pressure in small for gestational age children Irene Melinda Louis; Adrian Umboh
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Homocysteine is associated with endothelial damage and hypertension. Increased plasma homocysteine levels are often accompanied by cardiovascular impairment, including hypertension. Small for gestational age children have been found to have morbidity and mortality in cardiovascular diseases.Objective To assess for a possible association between homocysteine level and blood pressure in small for gestational age children.Methods This observational study was undertaken from December 2011 to April 2012 in Prof. Dr. R. D. Kandou Hospital, Manado, North Sulawesi, on children who were born small for gestational age in year 2004-2005. Data was analyzed by T-test to compare homocysteine levels in small for gestational age and normal birth weight children. Regression analysis and simple coefficient test were used to assess for an association between homocysteine levels and blood pressure in children who were small for gestational age at birth.Results The mean homocysteine level in small for gestational age children was significantly higher than that of normal birth weight children (P<0.001). We observed no correlation between homocysteine level and systolic blood pressure in the small for gestational age group (r=0.151, P=0.189). However, there was a weak correlation between homocysteine level and diastolic blood pressure in the small for gestational age group (r=0.237, P=0.049).Conclusion Children who were small for gestational age at birth have significantly higher mean homocysteine level than that of normal birth weight children. Higher homocysteine levels are associated with higher diastolic blood pressure in children who were small for gestational age at birth.

McIsaac criteria for diagnosis of acute group-A Î²-hemolytic streptococcal pharyngitis Imanuel Y. Malino; Dwi Lingga Utama; Yati Soenarto
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background The early use of antibiotics for acute upper respiratory infections is controversial because most of these infections are caused by viruses. A strategy is needed to correctly identify the causitive agents of acute pharyngitis, so that antibiotics can be prescribed appropriately.Objective To assess McIsaac criteria for diagnosing acute group-A Î²-hemolytic streptococcal (GABHS) pharyngitis in children.Methods This diagnostic study was conducted from August 2011 to February 2012, to compare clinical criteria of McIsaac to throat swab culture results as the gold standard for diagnosis. Subjects were children aged 3-14 years who visited the pediatric outpatient clinic or emergency ward at Sanglah Hospital and the pediatric outpatient clinic at Wangaya Hospital.Results There were 550 cases of acute pharyngitis during the study period, with 313 patients aged 3-14 years and 199 patients excluded due to a history of taking antibiotics in the two weeks prior to the hospital visit. Hence, 114 subjects were eligible for the study. GABHS prevalence in this study was 7.9%. McIsaacâ€™s area under the curve (AUC) from receiver operating characteristic (ROC) curve was 78.1%(95%CI 60.3 to 96%, P= 0.005). A McIsaac score â‰¥4 had a 66.7% (95%CI 49 to 97%) sensitivity, 87.6% (95% CI 81 to 94%) specificity, 31.6% (95 %CI 11 to 52%) positive predictive value (PPV), 96.8% (95%CI 93 to 100%) negative predictive value (NPV), 86.0% accuracy, 5.4 (95% CI 2.7 to 10.7) positive likelihood ratio (LR+) and 0.4 (95% CI 0.2 to 0.9) negative likelihood ratio (LR-).Conclusion A McIsaac criteria total score of <4 is favorable for excluding a diagnosis of GABHS pharyngitis. A McIsaac total criteria score of â‰¥4 requires further examination to confirm a diagnosis of GABHS pharyngitis.

The use of topical zinc in tuberculin test Anisa Rahmadhany; Darmawan Budi Setyanto; Partini Pudjiastuti Trihono
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

with under-diagnosis or over-diagnosis commonly occurring. The tuberculin test as a supporting examination for tuberculosis infection has a false negative value rate of 10-25%. Also, a majority of children with tuberculosis have lower plasma zinc levels than healthy children. Zinc deficiency may impair the immune response, leading to more false negative skin-test results.Objective To evaluate the effectiveness of topical zinc for augmenting the diameter of tuberculin induration in children with tuberculosis.Methods This unblinded, clinical trial was performed from October to December 2012 in subjects matched with themselves. Subjects were children with tuberculosis aged 2-18 years at the Department of Child Health at Cipto Mangunkusumo Hospital and Persahabatan Hospital. Every subject was injected tuberculin in volar region of left and right arm. Test sites then were covered with topical zinc cream on the right arm and placebo cream on the left arm. Indurations were measured after 72 hours. The difference of tuberculin diameter of 3 mm was considered as clinically significant. Data analysis was performed with Wilcoxon signed rank test.Results There were 47 subjects in this study. The majority of subjects were well-nourished (53%). Subjectsâ€™ median treatment duration was < 6 months, median age was 72 months and 47% of subjects were under the age of five years. Sixteen subjects had a median 1 mm difference in tuberculin induration diameter between the zinc arm and placebo arm (P<0.001), but this was clinically insignificant. Twenty-two subjects (43%) had Koch reaction after zinc cream application, but the placebo cream did not cause Koch reaction.Conclusion Application of topical zinc does not increase tuberculin induration compared to placebo.

Phototherapy for neonatal jaundice at distances of 20 cm vs 40 cm Winra Pratita; Supriatmo Supriatmo; Guslihan Dasa Tjipta
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Neonatal jaundice is one of the most common problems in newborns. Phototherapy is the most widespread treatment for lowering bilirubin concentration in neonates. Phototherapy may be more effective if the light source is placed closer to the neonate.Objective To compare the effectiveness of phototherapy with a 20 cm distance between the light source and the neonate vs a 40 cm distance for decreasing serum bilirubin concentrationMethods An open, randomized, controlled trial was conducted at H. Adam Malik and Pirngadi Hospitals in Medan from August 2009 to March 2010. Subjects were divided into two groups. One group (n=30) received phototherapy at a distance of 20 cm between the light source and the neonate, while the other group (n=30) received phototherapy at a distance of 40 cm. The inclusion criteria in the study were newborns presenting with neonatal jaundice in their first week of life. Serum bilirubin levels were measured at baseline, as well as after 12 hours and 24 hours of phototherapy.Results The mean total bilirubin levels of the 20 cm and 40 cm groups at baseline were 18.8 (SD 1.73) mg/dL and 17.7 (SD 1.46) mg/dL, respectively, not significantly different. After 24 hours of phototherapy, the mean decreases in total serum bilirubin levels of the 20 cm and 40 cm groups were significantly different with 7.6 (SD 1.01) mg/dL and 2.0 (SD 0.83) mg/dL, respectively, (P<0.05).Conclusion Phototherapy with a 20 cm distance between the light source and the neonate is more effective than a 40 cm distance for decreasing bilirubin levels at 24 hours in newborns with hyperbilirubinemia.

Obesity and secondary sexual maturity in boys Modella Rahmani Femina; Madarina Julia; Soeroyo Machfudz
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Obesity induces earlier secondary sexual maturity in girls. However, results of studies in boys have been inconclusive.Objective To assess for an association between obesity and sexual maturity in boys.Methods This was a prospective cohort study on 133 obese and 133 matched-for-age, non-obese, prepubertal boys, aged 9 to 10 years. They were observed every 4 months for a two year period. Obesity was defined as the BMI â‰¥the 95th percentile, according to the Centers for Disease Control 2000 growth charts. Secondary sexual maturity was defined as testicular volume of â‰¥4 mL and Tanner staging of pubic hair of â‰¥P2. Two trained nurses and a pediatric resident collected the data.Results By the end of the study period, 106 (79.7%) obese boys had attained a testicular volume of 4 mL or more, vs. 85 (63.9%) non-obese boys (RR 1.78; 95%CI 1.19 to 2.67; P=0.004). Furthermore, 81 (60.9%) obese boys attained pubic hair states of Tanner stage P2 vs. 37 (27.8%) non-obese boys (RR 1.85 95%CI 1.46 to 2.34; P<0.001). The mean durations for achieving testicular volume of â‰¥4 mL were 21.25 (95%CI 20.75 to 21.74) months in obese boys and 22.26 (95%CI 21.80 to 22.72) months in non-obese boys (P=0.007). The mean durations for achieving Tanner stage P2 were 17.04 (95%CI 16.44 to 17.63) months in obese boys and 20.87 (95%CI 20.05 to 21.68) months in non-obese boys.Conclusion Obesity is associated with earlier onset of sexual maturity in boys.

Proteinuria and malaria parasite counts in children Mahrani Lubis; Rusdidjas Rusdidjas; Rafita Ramayati; Oke Rina Ramayani; Rosmayanti S Siregar; Supriatmo Supriatmo
Paediatrica Indonesiana Vol 53 No 6 (2013): November 2013
Publisher : Indonesian Pediatric Society

Background Malaria-induced proteinuria has been observed insevere cases of malaria. Few studies have been done to assess foran association between proteinuria and malaria parasite countsbefore the disease becomes severe.Objective To investigate a possible association between proteinuriaand malaria parasite counts in children .Methods A cross-sectional study was conducted on school-agedchildren in Panyabungan, Mandailing Natal, between Septemberto November 2010. Malaria was diagnosed by microscopicexamination of peripheral blood smears. Children with malariaunderwent proteinuria t ests by urine dipstick method. Anassociation between proteinuria and malaria parasite counts wasanalyzed using linear regression test.Results Of 181 participants with Plasmodium fak:iparum malaria,53.6% were female and had a mean age of 7.8 years. Subjects'nutritional status were as follows: 50.8% normoweight, 28.2%mild malnutrition, 3 .3% moderate malnutrition, and 17. 7% severemalnutrition. Clinical manifestations showed 36.5% suffered fromsubfebrile temperatures and 29.8% had pallor. Proteinuria occurredin 45.9% participants and there was a weak association betweenproteinuria and malaria parasite counts (raa .261, Paa .0001).Conclusion There is a weak association between proteinuria andmalaria parasite counts in children.

Impact of wealth inequality on child nutrition in Bangladesh Mortuza Ahmmed
Paediatrica Indonesiana Vol 53 No 6 (2013): November 2013
Publisher : Indonesian Pediatric Society

Background The prevalence of malnutrition in Bangladesh isamong the highest in the world. Millions of women and childrensuffer from one or more forms of main utrition, including low birthweight, wasting, stunting, underweight, vitamin A deficiency,iodine deficiency disorders, and anemia. Today malnutritionnot only affects individuals, but its effects are passed from onegeneration to the next as malnourished mothers give birth toinfants wh o struggle to develop and thrive.Objective To assess the economic impact on child nutrition inBangladesh.Methods The 2011 Bangladesh Demographic Health Survey datawas used for this study. In this study, quintiles were calculatedbased on asset and wealth scores by use of principal componentanalysis. To understand the nutritional status and healthinequality, concentration index was also calculated.Results The negative concentration index showed a higher rateof malnutrition in the children less than five years of age from thepoorest class. Furthermore, the ratio of poorest to richest indicatedthat stunting and underweight conditions in rural children underfive years of age were almost two times higher than that of therichest children. This inequality in the health situation of childrenmay be explained in terms of income inequality. In Bangladesh,about 40% of the wealth is concentrated in 10% of the families.The results are discussed as possible input for public policy.Conclusion Bangladeshi children under the age of five yearsand in the poorest economic class are nearly twice as likely to beunderweight or stunted compared to children of similar age in therichest economic class

Inhaled iloprost as part of combination therapy for persistent pulmonary hypertension of the newborn Heru Samudro; Mulyadi M. Djer
Paediatrica Indonesiana Vol 52 No 1 (2012): January 2012
Publisher : Indonesian Pediatric Society

Persistent pulmonary hypertension of thenewborn (PPHN) is rare, but life-threatening.If not treated, PPHN may cause respiratoryfailure and death in neonates. l,2,3 PPHNoften occurs in term or post-term infants with a historyof difficult labor, infection or asphyxia during birth.These infants do not have adequate oxygen duringlabor.3 Based on etiology, PPHN can be categorizedinto primary PPHN, which occurs by itself withoutapparent cause; or secondary PPHN, which is causedby meconium aspiration, hyaline membrane disease,neonatal sepsis with pneumonia, congenital heartabnormality, or maternal drug use (non-steroidalanti-inflammatories, methamphetamine, or selectiveserotonin re uptake inhibitors) during the thirdtrimester of pregnancy.

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