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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.

Arjuna Subject : -

Articles 2,127 Documents

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Efficacy comparison of cetirizine and loratadine for allergic rhinitis in children Juliana Juliana; Rita Evalina; Lily Irsa; M. Sjabaroeddin Loebis
Paediatrica Indonesiana Vol 52 No 2 (2012): March 2012
Publisher : Indonesian Pediatric Society

Background Allergic rhinitis represents a global health problemaffecting 10% to more than 40% of the population worldwide.Several studies in recent years have described the efficacy ofsecond-generation antihistamines in younger children. It isnot well established whether cetirizine is more effective thanloratadine in reducing symptoms of allergic rhinitis.Objective The objective of this study was to compare the efficacyof loratadine with cetirizine for treatment of allergic rhinitis.Methods We conducted a randomized, double-blind, controlledtrial of 100 children, aged 13 to 16 years, from October toNovember 2009 at two junior high schools in Medan. GroupI received 10 mg of cetirizine and group II received 10 mg ofloratadine, each once daily in the morning for 14 days. Drugefficacy was assessed by changes from baseline symptom scoresand evaluation of therapeutic responses after 3 days, 7 days and14 days of treatment.Results The efficacy of cetirizine compared to that of loratadinewas not statistically significant in diminishing nasal symptomsafter 3 days, 7 days and 14 days of treatment (P=0.40, P=0.07,and P=0.057, respectively). Evaluation of side effects, however,revealed significantly fewer headaches in the cetirizine group after3 days and 7 days of treatment (P=0.01 and P=0.03, respectively)than in the loratidine group. In addition, the loratadine grouphad significantly more instances of palpitations after 7 days oftreatment (P=0.04) compared to the cetirizine group.Conclusion There was no significant difference in cetirizine andloratadine treatment effectiveness on allergic rhinitis. However,loratadine was found to cause more headaches and palpitationsthan cetirizine. [Paediatr lndones. 2012;52:61-6].

IgE-mediated soy protein sensitization in children with cowâ€™s milk allergy Agustina Santi; Mohammad Juffrie; Sumadiono Sumadiono
Paediatrica Indonesiana Vol 52 No 2 (2012): March 2012
Publisher : Indonesian Pediatric Society

Background Soy-based formula as an alternative to cow's milkformula is preferable to extensively hydrolyzed protein formulabecause of the lower cost and more acceptable taste. However,cow's milk allergy patients can subsequently develop a sensitivityto soy protein.Objective To compare soy protein sensitization in children withand without an allergy to cow's milk.Methods This study was conducted in Yogyakarta from September2007 until March 2008. Subjects were children aged below 4years with an atopic history. Subjects were divided into 2 groups:those with a positive skin prick test to cow's milk and thosewith a negative skin prick test to cow's milk (control group).Both groups were given soy formula and tested at 6 weeks forsensitization to soy.Results There were 45 children in each group. Age, sex, andatopic history were similar in both groups. We found no soyprotein sensitization (negative skin prick results) in all subjectsfrom both groups.Conclusion Risk of immunoglobulin E-mediated sensitizationto soy protein was not proven in children with cow's milk allergy.[Paediatr lndones. 2012;52:67-71).

Diagnostic accuracy of the 2004 Indonesian Pediatric Society medical standard of care for neonatal sepsis Oki Fitriani; Purnomo Suryantoro; Setya Wandita; Tunjung Wibowo; Ekawaty L. Haksari; Madarina Julia
Paediatrica Indonesiana Vol 52 No 2 (2012): March 2012
Publisher : Indonesian Pediatric Society

Background Neonatal sepsis is a leading cause of neonatal morbidityand mortality. There are no pathognomonic signs or symptomsto diagnose neonatal sepsis. Blood culture is the standard tool forsepsis diagnosis, but it is not available in most district hospitals. In2004, the Indonesian Pediatric Society (IPS) developed a medicalstandard of care to diagnose neonatal sepsis, but its accuracy hasnot been adequately verified.Objective To evaluate the diagnostic accuracy of the IPS medicalstandard of care 2004 to diagnose neonatal sepsis.Methods We conducted diagnostic testing at the PerinatalWard, Dr. Sardjito Hospital, Yogyakarta, from June to November2010. Inclusion criteria were neonates with signs and symptomsof infection. We excluded neonates with congenital anomalies,blood disorders, or whose mothers received peripartum antibiotictreatment. All neonates were assessed by the 2004 IPS medicalstandard of care for neonatal sepsis and by blood cultureexaminations.Results A total of 193 neonates with signs and symptoms ofinfection were evaluated. The IPS medical standard had asensitivity of 88% (95% CI 81 to 94), specificity of 17% (95%CI 2 to 25), positive predictive value of 53% (95% CI 45 to 60),negative predictive value of 57% (95% CI 39 to 75), positivelikelihood ratio of 1.06 (95% CI 0.94 to 1.19), and negativelikelihood ratio of0.71 (95% CI 0.36 to 1.42).Conclusion The 2004 IPS medical standard of care showedadequate sensitivity for diagnosing neonatal sepsis, but its lowspecificity limits its use as a diagnostic tool. [Paediatr lndones.2012;52:86-90].

Effect of adding tyndallized probiotics to the World Health Organization standard therapy for acute diarrhea in children Kesatrianita Mawarni Fanny; Wahyu Damayanti; Mohammad Juffrie
Paediatrica Indonesiana Vol 52 No 2 (2012): March 2012
Publisher : Indonesian Pediatric Society

Background Diarrhea is the major cause of morbidity and mortalityin children. Probiotics can decrease the frequency and durationof diarrhea. There are two types of probiotics, live and tyndallized.Tyndallized probiotics have been stetilized, so they are unable to produceactive metabolites, but may have an effect on human immunity.Objective To evaluate the effectiveness of supplementing WHOstandard therapy with tyndallized probiotics in children withacute, watery diarrhea.Methods We performed a randomized, single-blind, controlledtrial in children aged 3-60 months who were diagnosed with acute,watery diarrhea at Gunungsitoh General Hospital, Nias, NorthSumatera. Subjects were collected by consecutive sampling byway of parent interviews.Results One hundred subjects with acute, watery diarrhea weredivided into 2 groups of 50. One group was treated with onlyWHO standard therapy for acute, watery diarrhea. The othergroup was treated by WHO standard therapy with the additionof tyndallized probiotics. There were no significant differences inbasic characteristics between the two groups. Diarrheal durationfor the group receiving WHO standard therapy only was 3.95 Â±1.3 days, while that of the group receiving both WHO standardtherapy and tyndallized probiotics was 4.6 Â± 2.3 days (P > 0.05).Diarrheal frequency on the fifth day in the WHO standard therapygroup was 1.90 Â± 0.99 times per day, while that of the tyndalhzedprobiotic group was 1.56 Â± 0.67 times per day (P > 0.05).Conclusion There were no significant differences between WHOstandard therapy alone and WHO standard therapy with the additionof tyndallized probiotics for decreasing the duration and frequency ofdiarrhea in children. [Paediatr lndones. 2012;52:91-4].

Comparison of maternal anxiety scores in pediatric intensive care unit and general ward parents Lie Affendi Kartikahadi; Soetjiningsih Soetjiningsih; I Gusti Ayu Endah Ardjana; I Gusti Ayu Trisna Windiani
Paediatrica Indonesiana Vol 52 No 2 (2012): March 2012
Publisher : Indonesian Pediatric Society

Background Hospitalization of a child is known to be a dreadfuland stressful situation for parents. One study reported thatadmitting a child to a general ward caused mild anxiety to mothers,while admitting a child to the pediatric intensive care unit (PICU)caused moderate anxiety to mothers.Objective To compare Hamilton anxiety scores of mothers whosechildren were admitted to the PICU to those of mothers whosechildren were admitted to the general ward.Methods A cross-sectional study was done on mothers ofchildren aged 1 month-12 years. Children were admitted toeither the intensive care unit or the general ward from October2010-January 2011. All subjects were assessed by Hamiltonanxiety scores and questioned for risk factors and other causesof maternal anxiety. Consecutive sampling was used to allocatethe subjects. Differences were considered statistically significantfor P < 0.05.Results Of the 72 subjects, the median Hamilton anxiety score inmothers of children admitted to the PICU was 20.5 (interquartilerange 14-29.75), higher than that of mothers of children admittedto the general ward (14, interquartile range 9-16.75). MannWhitneyU test revealed a statistically significant difference inscores between the two groups (P = 0.DO1). Ancova multivariateanalysis showed the admission location to be the only significantrelationship to Hamilton anxiety score (P = 0.0001).Conclusion Hamilton anxiety scores were higher for mothersof children admitted to the PICU than that of mothers withchildren admitted to the general ward. [Paediatr lndones.2012;52:95-8].

Correlation of tobacco smoke exposure to intelligence quotient in preschool children Nina Natalia; Nurhayati Masloman; Jeanette C. Manoppo
Paediatrica Indonesiana Vol 52 No 2 (2012): March 2012
Publisher : Indonesian Pediatric Society

Background Exposure to tobacco smoke at home happens in 29-69% of children globally and 43% oflndonesian children. Smokeexposure during the developmental stage may affect cognitiveabilities, as measured by intelligence quotient (IQ). There havebeen few studies conducted on the correlation of tobacco smokeexposure to IQ. This is the first study of this type in Indonesia.Objectives To assess the correlation between tobacco smokeexposure and IQ in preschool children and to assess the correlationbetween serum cotinine levels and IQ in preschool childrenexposed to tobacco smoke.Methods A cross-sectional study was conducted in the Tumintingdistrict, Manado in January - May 2011. Subjects were collected byrandom sampling of 3-5 year-old children. In our study, 35 childrenwere deemed to have been exposed to tobacco smoke by serumcotinine ~ 0.05 ng/ml and 25 children were deemed to not havebeen exposed to tobacco smoke (cotinine < 0.05 ng/ml). Resultswere analyzed by t-test and simple correlation analysis using SPSSversion 17 software with a significance level of P < 0.05.Results There was a statistically significant difference in IQbetween the two groups, with mean IQ of 106.54 in the groupexposed to tobacco smoke and mean IQ of 109.36 in the group notexposed to tobacco smoke (P=0.01). The mean serum cotininelevel in the group with tobacco smoke exposure was 1. 77 ng/mL.There was no correlation between the mean level of cotinine andmean IQ in this group (r = -0.19 and P=0.14).Conclusions The mean IQ in the group with tobacco smokeexposure was lower than that of the group not exposed to tobaccosmoke. There was no correlation between mean serum cotininelevel and mean IQ. [Paediatr lndones. 2012;52: 106-10].

Correlation between brain injury biomarkers and Glasgow coma scale in pediatric sepsis Nahari Arifin; Irawan Mangunatmadja; Antonius Pudjiadi; Sudung O. Pardede
Paediatrica Indonesiana Vol 52 No 2 (2012): March 2012
Publisher : Indonesian Pediatric Society

Background Sepsis in children, with or without multiple organfailure, causes increased susceptibility to brain injury due tosystemic insults. Brain injury in sepsis is difficult to recognizeclinically. Neuron-specific enolase (NSE) and S-lOOB have beenextensively studied in brain injuries and appear to be promisingalternative biomarkers.Objectives To determine if there is a correlation between theGlasgow coma scale (GCS) and NSE as well as S-lOOB levels, inchildren with sepsis.Methods We performed an analytical study on septic childrenaged > 2 years. GCS scores were assessed on the first and thirddays of admission. Blood specimens to test for NSE and S-lOOBwere drawn on the first day of admission and stored at -70QC forfurther analysis at the end of the study.Results Out of 35 patients, 30 met the inclusion criteria. Postanalysis,one subject with NSE above the maximum level wasexcluded. Negative correlations were found between GCS scoreand NSE, as well as between GCS and S-lOOB levels. Analysisrevealed a significant ROC for NSE, but not for S-lOOB. NSEconcentration of 8.1 /.lg/L was the cut-off point for GCS scoresbelow 12.Conclusions There were negative correlations between GCSand NSE levels, as well as between GCS and S- lOOB levels. Thepredictive value ofNSE level was a cut-off point of 8.1 /.lg/L forGCS scores below 12. [Paediatr lndones. 2012;52:111-17]

Reduced serum zinc levels while improving growth of underweight school children in trial of zinc-fortified milk in Indonesia Endang Dewi Lestari; Lilisianawati Lilisianawati; Saptawati Bardosono; Leilani Lestarina; Harsono Salimo
Paediatrica Indonesiana Vol 52 No 2 (2012): March 2012
Publisher : Indonesian Pediatric Society

Background Most children in low-income countries haveinadequate dietary zinc. The study was aimed to demonstrate theeffect of iron-zinc fortified milk in improving zinc status amongunderweight school children in Indonesia.Objective To evaluate the effects of milk fortification with zinc onserum zinc levels in underweight Indonesian school children.Methods A double-blind, randomized, controlled, communitybasedstudy was conducted on 426 underweight children aged 7to 9 years in several low economic income level elementary schoolsin Jakarta and Solo. Subjects were randomly allocated to receiveeither zinc-fortified milk (n= 217) or standard milk (n=209) for6 months. The fortified milk provided an 2.38 mg zinc per dayand the standard milk provided 0.88 mg zinc per day.Results Among underweight children, the prevalence of stuntingwith a height-for-age z-score < - 2.0 SD was 39.7%. Almost allsubjects (98%) had zinc intake ofless than 60% of the Indonesianrecommended daily allowance (RDA) for that particular agegroup. After receiving the milk intervention, mean serum zincconcentration declined significantly in both groups (from 13 .50Â±3.05 Î¼mol/Lat baseline to 10.59Â±1.93 Î¼mol/L, P< 0.05), butgrowth parameters (weight and height) improved.Conclusion Reduced mean serum zinc levels were observed inchildren who received standard milk, as well as those who receivedzinc-fortified milk. These reduction in serum zinc levels may be apart of homeostatic control mechanim for improving the negativezinc balance in zinc pools, as a negative effect on linear growthwas not observed. Larger clinical trials of adequate sample sizeneed to be conducted in order to provide better understandingon zinc regulation among underweight school children. [Paediatrlndones. 2012;52:118-24).

Urine dipstick test for diagnosing urinary tract infection Syarifah Julinawati; Oke Rina; Rosmayanti Rosmayanti; Rafita Ramayati; Rusdidjas Rusdidjas
Paediatrica Indonesiana Vol 53 No 6 (2013): November 2013
Publisher : Indonesian Pediatric Society

Background Urinary tract infection (UTI) is a common diseasein children. Approximately 3-5% of girls and 1 % of boys developa UTI. In children, prompt treatment is essential because UTImay be a risk factor for developing renal insufficiency or end stagerenal disease. Howevet; prompt treatment depends on having arapid diagnosis. Urine dipstick testis a useful and commonly usedbecause it is low cost and gives rapid results, compared to urinecultures for diagnosing UTis. However, the diagnostic accuracyof the urine dipstick test is debatable.Objective To compare urine dipstick test (leukocyte esterase,nitrite, and combined leukocyte es terase and nitrite) to urineculture for diagnosing UTis.Methods A diagnostic study was held in H. Adam Malik Hospitalfrom May to June 2010. There were 70 children aged 2 to 14years and recruited by consecutive sampling. Two midstreamurine specimens were collected from subjects after cleaning theexternal urethral orifice. The first specimen was used for urinedipstick testing for leukocyte esterase and nitrite. The secondurine specimen was cultured in the laboratory. Urinalysis forleukocyte esterase and nitrite studies were performed with freshand uncentrifuged urine. Leukocyte esteras e and nitrite causeda change in dipstick color apparent within 2 minutes. Urinalyseswere considered to be positive for UTI if either leukocyte esteraseor nitrite were positive. The results of urine culture were used asthe golden standard.Results The sensitivities of leukocyte esterase and nitratetests were 90 .5% and 73.8%, respectively. However, thesensitivity for combined leukocyte esterase and nitrite testwas 96.4%. Nitrite test was more specific (60.7%) than theleukocyte esterase test (39.3%). The specificity of both teststaken together was 64.3% . For leukocyte esterase alone, nitratealone, and the two combined the positive predictive values(PPV) were 69.1 %, 73.8%, and 64.3.%, respectively, and thenegative predictive values (NPV) were 73.3%, 60.7%, and96.4%, respectively.Conclusion Urine dipstick test for leukocyte esterase and nitritecombined may be a good alternative diagnostic test for UTis inchildren than leukocyte esterase or nitrite by themselves in areaswith limited resources.

Methisoprinol for children with early phase dengue infection: a pilot study Melissa G. Ompico
Paediatrica Indonesiana Vol 53 No 6 (2013): November 2013
Publisher : Indonesian Pediatric Society

Background Dengue fever is associated with many healthcomplications and medical costs. Furthermore, there is currentlyno approved dengue antiviral medication or vaccine. Empiricevidence has suggested that patients who received supplementalmethisoprinol therapy had faster recovery times and fewercomplications .Objective To detennine the effects of oral methisoprinol on theclinical course and laboratory findings of children with early phasedengue infection.Methods We conducted a randomized, double-blind study fromJune to September 2012 on 22 children aged 2.7-16.8 years withlaboratory-confirmed early dengue infection. Subjects had notpreviously received antithrombotic agents, nor did they havebleeding disorders or immunodeficiency. We randomized thesubjects to receive either oral methisoprinol (100 mg/kg BW/day,divided into four doses) or placebo for 72 hours, with 11 subjectsper group. The primary endpoint was fever clearance time (FCT),and secondary endpoints were platelet nadii; white blood cell(WBC) nadii; maximum hemoconcentration, length of hospitalstay, and development of complications .Results The mean decrease in WBC count was less withmethisoprinol than with placebo [1.14 (SD 0.84) vs 2.60 (SD 3.12)x [09 /L; P = 0.004]. In addition, the mean decrease in platelet countwas less in patients on methisoprinol [38.36 (SD 58.3) vs. 50.46 (SD73.42) x 109/L; P=0.046]. No significant differences between thetwo groups were found for FCT (P=0.158), length ofhospital stay(P=0.511), hemoconcentration, or dengue complications.Conclusion Methisoprinol initiated at an early phase in dengueinfection reduced the anticipated leukopenia by 56% andthrombocytopenia by 24%. Hence it can be used along withstandard approved fluid and antipyretic therapy.

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