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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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Comparison of gelatin and HES 130/0.4 solution for fluid resuscitation in children with dengue shock syndrome Merry Mawardi; Tony Rampengan; Jeanette Manoppo; Novie Homenta Rampengan
Paediatrica Indonesiana Vol 53 No 6 (2013): November 2013
Publisher : Indonesian Pediatric Society

Background Dengue shock syndrome (DSS) is characterizedby severe vascular leakage and hemostasis disorder, which causesdeath in 1-5% of cases. World Health Organization managementguidelines for fluid resuscitation in DSS remain empirical, ratherthan evidence-based.Objective To as sess the efficacy of ge latin compared tohydroxyethyl starch (HES) 130/0.4 solution for fluid resuscitationin children with DSS.Methods We performed a multi-centered, randomized study tocompare gelatin and HES 130/0.4 solution for resuscitation ofchildren with DSS. We randomly assigned 25 children with DSSto receive gelatin fluid and 25 children to receive HES 130/0.4.Statistical analyses were performed using Chi-square and MannWhitneytests.Results More rapid increase in pulse pressure was noted insubjects treated with HES 130/0.4 compared to those treatedwith gelatin at 8 hours and 28 hours of therapy (P=0.037 andP=0.048). The decrease in hematocrit in subjects treated withHES 130/0.4 was faster than that of gelatin at 4 hours of therapy(P=0.001). One patient died due to an unusual manifestation ofDSS. Respiratory rate decreased faster in subjects treated withHES 130/0.4 than those treated with gelatin at 4 hours and 8hours of therapy (P< 0.05). Body temperature remained higherin subjects treated with gelatin than HES 130/0.4 at 36 hours and48 hours of therapy (P< 0.05). However, the decrease in plateletcounts in subjects treated with HES 130/0.4 was more than thatof gelatin (P=0.018).Conclusion HES 130/0.4 solution may be better for volume replacementcompared to gelatin and is safe for fluid resuscitationin children with DSS.

Zinc therapy for different causes of diarrhea Hafaz Zakky Abdillah; Supriatmo Supriatmo; Melda Deliana; Selvi Nafianti; Atan Baas Sinuhaji
Paediatrica Indonesiana Vol 53 No 6 (2013): November 2013
Publisher : Indonesian Pediatric Society

Background The incidence of diarrhea in Indonesia has declinedin the past five years. In spite of the increasing number of studieson the treatment for acute diarrhea, especially the use of zinc,it is not known if bacterial vs. non-bacterial etiology makes adifference in the reduction of severity of acute diarrhea in childrenon zinc therapy.Objective To assess the effect of zinc therapy in reducing theseverity of acute bacterial and non-bacterial diarrhea.Methods We performed a cross-sectional study in the SecanggangDistrict, Lan gkat Regen cy of North Sumat era, from Augustto November 2009 in children aged 2 months to 14 years .Microscopic stool examination s were undertaken to separatesubjects into the acute bacterial or non-bacterial diarrhea groups.Both groups received 10 mg/day ofzinc sulphate for subjects aged<6 months or 20 mg/day for those aged 2:6 months for 10 days.Measurement of disease severity was based on the frequency ofdiarrhea (times/day) and the duration of diarrhea (hours) afterinitial drug consumption . We performed indepen dent T test forstatistical an alysis.Results Sixty-two children participated in this study, with 31children in the acute bacterial group, and the remainder in thenon-bacterial group. There were no significant differences betweenthe two gro ups in frequency of diarrhea (2 .61 vs 2.70 times/day,respectively, P=0.27) or in duration of diarrhea (63.39 vs 66.68hours, respectively, P= 0.06) .Conclusion Zinc is not more effective in reducing the severityof acute bacterial diarrhea compared to non-bacterial diarrhea inchildren.

Quality of life in adolescents with primary headaches Naomi Riahta; Muhammad Ali; Bistok Saing; Yazid Dimyati; Johannes Saing
Paediatrica Indonesiana Vol 53 No 6 (2013): November 2013
Publisher : Indonesian Pediatric Society

Background Headaches are common problems in adults,adolescents, and children. Headaches impact a child's life, theirfamily life, and even society. An assessment of quality of life inadolescents with primary headaches may help to determine actionsnecessary to improve the quality of life of these patients.Objective To assess the quality oflife of adolescents with primaryheadach es compared to healthy adolescents.Methods We conducted a cross-sectional study in December2009 on adolescents aged 13 to 18 years. The headache groupconsisted of children with primary headaches according to theInternational Classification of Headache Disarders and the controlgroup consisted of healthy adolescents. Subjects were selected byconsecutive sampling, with 75 subjects in each group. Subjectsfilled the Pediatric Quality of Life Inventary version 4.0 (PedsQL4.0) questionnaire.Results The mean PedsQL total score was significantly lowerin the headache group than in the contra 1 group [ l 7 5. 7 vs.392.2, respectively, (95%CI of differences -28.l to -219.3, P =0.001)]. However, out of23 items in the questionnaire, 9 werenot significantly different between the headache and controlgroups.Conclusions Primary headaches in adolescents is associatedwith lower quality of life. Most quality of life domains scoresare significantly lower in adolescents with primary headachescompared to those without primary headaches.

Variables associated with malondialdehyde level in thalassemia major patients Arum Gunarsih; Pustika Amalia; Imam Boediman
Paediatrica Indonesiana Vol 52 No 3 (2012): May 2012
Publisher : Indonesian Pediatric Society

BackgmundThalassemia is the most cormnon hereditary haemolyticanaemia in the world, including in Indonesia. The main treatmentfor thalassemia is regular transfusions, but these are knO\vn to causeiron overload. Moreover, iron overload in jJô€®thalassemia patientsgenerates oxygen free radicals and peroxidative lipid injury. Ferritinserum concentration is used as indirect measurement of iron overload.Malondialdehyde (MDA), a terminal compound oflipid peroxidation,is used as an index of oxidative stress status.Objective To assess the correlation between iron overload (serumferritin level) and MDA as a marker of oxidative stress in thalassemiamajor patients.Methods This c rossô€®sectional study was conducted at CiptoMangunkusumo Hospital, Jakarta, from Mayô€®June 2009. Subjectswere thalassemia major patients (homozygous jJô€®thalassemia orjJô€®thalassemia;HbE) who received regular blood transfusions, ironô€®chelation, and vitamin E as an antioxidant. Data was collected by hisô€®toryô€®taking, physical examination, medical records, and questionnaires.Blocd specimens were dra\Vll from the thalassemia major subjects beforetransfusion and examined for serum ferritin and MDA levels.Results Fiftyô€®five subjects Mth thalassemia major (34 homozygousjJô€®thalassemia and 21 jJô€®thalassemia;HbE) were included in ourstudy. Mean serum ferritin level was 3693.2 (SD 21423),ug/L andme811 MDA level was 0.641 (SD 0.283) nmolimL. No cor relationwas found between serum ferritin and MDA levels in thalassemiamajor subjects (r=0.147, P=0.285). As additional results, this studyalso showed no correlation between MDA to reguler vitamin Econsumption (r=0.277, P=0.028) as well as MDA and nutritionalstatus (F0371, Pô€¯0.()J4).Conclusion There was no cor relation between serum ferritin leveland plasma MDA level in thalassemia major subjects, no cor relationsbetween MDA and regular vitamin E consumption, as well as MDAand nutritional status. [paediatr Indones. 2012;52:125,31].

Riboflavin as migraine prophylaxis in adolescents Athaillah Athaillah; Yazid Dimyati; Johannes H. Saing; Bistok Saing; Hakimi Hakimi; Aznan Lelo
Paediatrica Indonesiana Vol 52 No 3 (2012): May 2012
Publisher : Indonesian Pediatric Society

Background Migraine is a cause of recurrent headaches inchildren. Riboflavin has been sho\Vll to be efficacious in preventingmigraine in adults. However, there has been little research on itsuse in children and adolescents.Objective To assess the effectiveness of riboflavin for migraineprevention in adolescents.Methods We conducted a randomized, doubleô€…blind, controlledtrial in the Islamic Centre of the Musthafav.iyah Mandailing NatalDistrict, North Sumatera, from May to July 2010. Adolescents\\lith migraines, as defined criteria, were included. Subjects were divided into two groups,receiving either 400 mg of riboflavin or placebo for 3 months.Headache frequency was measured in headache days per month,headache duration was measured in hours, and functionaldisability was measured using the Pediatric Migraine DisabilityAssessment Scale (PedMIDAS). Migraines were assessed before,during and after intervention. Student's tô€…test was used forstatistical analysis.Results A total of 98 patients, ranging from 12 to 19 years inage (mean age 14.0 years) were enrolled. We found a significantreduction in headache frequency in the second and third months.Headache duration also differed significantly third months (P=0.012 and P=O.OOl, respectively). Riboflavindecreased disability, as indicated by lower PedMIDAS scores inthe riboflavin group compared to the placebo group (26.1 and34.3, respectively, P= 0.001).Conclusion Riboflavin effectively decreased migraine frequency,duration and disability in adolescents. [Paediatr Indones.2012;52:132-7].

Head circumference and anterior fontanel measurements in newborns Rizal Agus Tiansyah; Irawan Mangunatmadja; Aman Pulungan
Paediatrica Indonesiana Vol 52 No 3 (2012): May 2012
Publisher : Indonesian Pediatric Society

Background Head growth and anterior fontanel (AP) closureare passive processes in response to brain growth. The growthof the brain and skull starts in the third week of intrauterinegestation. roth processes run simultaneously as a part of integralgrowth, along 'With increasing gestational age, until postô€€¿birth.Measurement of head circumference (He) and AF in newbornsis done to determine if the brain and skull grew normally duringthe intrauterine period.Objectives To investigate the differences in He and AF sizebetween preterm and fullô€€¿term infants, and the relationshipbetween gestational age (GA) and birth weight (BW) to Heand AF size.Methods This was a descriptive analytic study on preterm andfullô€€¿term newborns. Measurement of HC and AF was conductedin three phases: just after birth, 1x24 and 2x24 hours of age.Analysis of HC and AF size differences between preterm and fullterm subjects was performed, as well as analysis of the correlationbetween GA and BW to HC and AF size.Results Two hundred fifty newborns completed the study. Therewere 180 fullô€€¿term and 70 preterm subjects. Median HC in fullô€€¿term and preterm male subjects were 34 cm (range 31ô€€¿37 cm)and 31 cm (27ô€€¿34 cm), respectively. Median HC in fullô€€¿termand preterm female subjects were 33 cm (31ô€€¿36 cm) and 32 cm(27ô€€¿3S.S cm), respectively. Median AF in fullô€€¿term and pretermmale subjects were 2.17 cm (1.0SA.6 cm) and 2.22 cm (1.3SA.Scm), respectively, and in fullô€€¿term and preterm female subjectswere 2.02 cm (lA.1S cm) and 2.22 cm (0.7SA cm), respectively.The HC of preterms were significantly lower than the fullterms(P<O.OOl), however the AF size was not different between these2 groups of newborns (P =0 .28). Correlation test between GA andBW to HC size revealed a positive correlation (r=0.620, P<O.OO 1and r=0.801, P<O.OOl, respectively), but not to AF size (r=ô€€¿ 0.06,pô€€ 0.279 and F- 0.049, Pô€€0.44, respectively).Concl usions We found that the HC size of pre terms wassignificantly lower than thefullterms, but no significant differencesÂ in AF size between the two groups. GA and BW were associatedwith HC size, but not associated to AF size. [paediatr lndones.2012;52:145-51].

UCP3 gene polymorphism and insulin resistance in obese female adolescents Dian Eurike; Harry Freitag Luglio Muhammad; Rina Susilowati; Madarina Julia
Paediatrica Indonesiana Vol 52 No 3 (2012): May 2012
Publisher : Indonesian Pediatric Society

Background A previous study on obese female adolescents inYogyakarta done in the year 2007 suggests that genetic factorsmight influence insulin resistance. One genetic factor that hasbeen associated \\lith insulin resistance in other populations isthe ô€55C;T polymorphism in the uncoupling protein 3 (UCP3)gene.Objective To investigate an association between the ô€55C;Tpolymorphism in the UCP3 gene and insulin resistance in obesefemale adolescents in Yogyakarta.Methods A total of79 obese female adolescents were enrolled inthis crossô€sectional study. Genotyping of the ô€ 5 SC/T polymorphismin the UCP3 gene was performed by polymerase chain reactionô€restriction fragment length polymorphism (PCRô€RFLP).Results The TiT homozygous individuals had a higher risk ofinsulin resistance (OR 2.3; 95% CI 0.4 to 14.1), as well as higherfasting insulin concentration and homeostatic model assessmentfor insulin resistance (HOMAô€IR) compared to individuals v.ithother genotypes. The T allele carriers also had a higher risk ofinsulin resistance (OR 1.3; 95% CI 0.7 to 2.5), as well as higherfasting insulin concentration and HOMAô€ IR compared to Callele carriers. However, none of these results were statisticallysignificant (P > 0.05).Conclusion The TiT genotype and T allele of the UCP3 geneô€55CiT polymorphism was not significantly associated increasedrisk of insulin resistance in obese female adolescents in Yogyakarta.[Paediatr lndanes. 2012;52:152-6].

Comparison of 25-hydroxyvitamin D levels in exclusively and non-exclusively breastfed infants Analysa Margaretha Bogar; Helena Anneke Tangkilisan; Hesti Lestari
Paediatrica Indonesiana Vol 52 No 3 (2012): May 2012
Publisher : Indonesian Pediatric Society

Background Vitamin D is an essential nutrient for theprevention of rickets. Human milk typically contains a vitaminD concentration of 25 lUlL or less. Breastfed infants are at riskof vitamin D deficiency. Previous studies conducted in countrieswith four seasons have reported that risk factors associated withvitamin D deficiency influence the vitamin D status in exclusivelybreastfed infants.Objective To compare the levels of 25-hydroxyvitamin D(25 (OH)D) in exclusively and non-exclusively breastfed in-fants.Methods This cross-sectional study was conducted in SingkilDistrict, Manado from February to May 2011. Of 48 Posyandu(Integrated Health Center), 4 were chosen to be the sourcesof subjects for this study. Subjects were collected consecutivelyamong infants aged 6-7 months. The resulting exclusively andnon-exclusively breastfed groups had 36 infants each.Results The mean 25 (OH)D level in the exclusively breastfedgroup was 61.75 nmoliL (95% CI 58.02 to 65.48) and in the nonexclusivelybreastfed group was 85.09 nmollL (95% CI 79.49 to90.68). The difference in 25 (OH)D levels in the two groups wasstatistically significant. However, 25 (OH)D levels of both groupswere Mthin the normal range.Conclusion The 25 (OH)D level was significantly lower in ex-clusively breastfed infants compared to that in non-exclusivelybreastfed infants, but both levels were still in the normal range.[Paediatr rndones. 2012;52:157-60].

Repeat urine cultures in children with urinary tract infection Risky Vitria Prasetyo; Ninik Asmaningsih Soemyarso; Mohammad Sjaifullah Noer
Paediatrica Indonesiana Vol 52 No 3 (2012): May 2012
Publisher : Indonesian Pediatric Society

Background Urinary tract infections (UTIs) are the secondleading cause of infection in children, following respiratorytract infections. Repeat urine cultures after antibiotic treatmentare routinely obtained in clinical practice to verify proof ofbacteriologic cure. The American Academy of Pediatrics doesnot recommended repeat cultures, due to increased cost anddiscomfort to patients.Objective To determine the frequency of positive repeat urinecultures after 3 days of antibiotics in children 'With UTIs.Methods We conducted a retrospective study on childrenwith UTIs who visited the Division of Pediatric Nephrology,Department of Child Health at Dr. Soetomo Hospital, Surabayafrom January 2006 to December 2011. Results of repeat urinecultures were obtained after 3 days of antibiotic treatment.Descriptive statistics were used to analyze the data.Results Of the 779 pediatric UTI cases, repeat urine cultureswere performed in 264 (33.9%) cases. Of the 264 patients whocomprised our study, there were similar numbers of girls and boys(50.4% vs. 49.6%, respectively). The mean age of patients was43.9 (SD 1.59) months and 35.5% of subjects were aged under 1year. In the initial urine cultures of our subjects, Escherichia coliwas the most common organism found, v,ith 92 cases (34.8%),compared to 58 cases (21.9%) of Klebsiella pneumoniae and 29cases (10.9%) of Pseudom.onas aeruginosa. Repeat urine culturesshowed no bacterial growth in 168 cases (63.6%).Conclusion Mostly negative repeat urine cultures v,ill probablyobviate the need of this test in daily routine practice. [PaediatrIndanes.2012,52:170Â·4].

Peripheral blood examination to assess bleeding risk in children with dengue infections Irene Huwae; Kurniawan Kadafi
Paediatrica Indonesiana Vol 52 No 3 (2012): May 2012
Publisher : Indonesian Pediatric Society

Background Dengue viral infection may cause mild to severeclinical manifestations, with or without bleeding. A number offactors may cause bleeding in patients with dengue. However,health providers may be unable to perform the examinationsrequired to sufficiently predict the risk of bleeding.Objective To find risk factors for bleeding using peripheral bloodexaminations in children with dengue infection.Methods This crossô€sectional study was conducted at thePediatric Ward of the Dr. Saiful Anwar General Hospital,Malang, from January 2010 to December 2011. We includedchildren aged 1 to 18 years with dengue viral infection, asconfirmed by the 1997 WHO criteria and serology. Peripheralblood examinations were made daily, depending on the patient'scondition. We classified the bleeding status into nonô€bleeding,petechial bleeding (mild hemorrhage), and mucosal bleeding(severe hemorrhage). We recorded subjects' bleeding status atthe time of their highest packed cell volume (PCV), and recordedtheir leukocyte and platelet counts at that time. We computedthe parameters' medians and compared them to bleeding statusby Chiô€square test. For significant (P<0.05) associations wecalculated the OR (odds ratio) \\lith a 95% confidence interval.All patients were treated according to the 1997 WHO dengueguidelines.Results There were all 294 subjects with dengue and 282subjects had complete data, 202 \\lith bleeding (120 petechial,82 mucosal bleeding) and 80 without bleeding. The medianPCV was 36.8%, while median platelet count was 51,000/,uLand median leukocyte count was 3,400/,uL. The OR of PCV> 36.8% for bleeding was 2.31 (95%CI 1.35 to 3.95). The ORof platelet count <51,000/ ,uL for bleeding was 2.34 (95%CI1.37 to 3.99) compared to platelet count> 51,000/ ,uL. TheOR of platelet count < 51,000/ ,uL for mucosal bleeding was3.39 (95%CI 1.78 to 6.48). Chiô€square analysis for leukocytecount showed it was not associated with bleeding in dengue(Pô€‘ 0.186).Conclusion The PCV level > 36.8% increased the risk forbleeding by 2.31 times, for both petechial and mucosal bleeding.Platelet count < 51,000/ ,uL increased the risk for bleeding 2.34times and for mucosal bleeding by 3.4 times. Leukocytes countwas not associated with bleeding. Basic laboratory examinationsof PCV and platelet count may, therefore, be used as a predictorof bleeding in children with dengue infection. [paediatr lndones.2012;52:175-80].

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