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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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Shigellosis in children less than five years in urban slum area: a study at primary health care in Jakarta Junita Elvira; Agus Firmansyah; Arwin A. P. Akib
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background Shigellosis has a global distribution especially incountries with poor hygiene and sanitation. The most commonmanifestation of shigellosis in children is diarrhea with broadspectrum manifestations from watery diarrhea to classicaldysentery. Appropriate antibiotic management is important toeradicate Shigella spp.Objective To find out shigellosis prevalence and manifestationsand also Shigella spp. resistance pattern in children less than 5years with acute diarrhea in certain district urban slum areas inJakarta.Methods This cross sectional study involved 475 outpatients ofless than 5 years old with acute diarrhea who visited primary healthcares in Jakarta from Julyâ€“ October 2005. Stool for culture andantibiotic resistance test was taken with single rectal swab.Results Shigella spp. was found only in 3 (0.6%) patients. Thesubjects were between 6 to 24 months. Watery diarrhea was foundin 1 subject and so was the classical dysentery manifestation offever and bloody diarrhea. Two strains were found, 2 cases of S.sonnei and 1 case of S. flexneri. They were resistance tocotrimoxazole, tetracycline, and colistine.Conclusion Shigella spp. was not the main cause of acute diarrheain children less than 5 years old. Due to the small number ofcases, we could not find the most common manifestation andresistance pattern of shigellosis in these children.

Effect of enalapril in children with steroid resistant primary nephrotic syndrome L. P. Primi Atmikasari; M. P. Damanik; Tonny Sadjimin
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background A significant proportion of children with nephrotic syndrome become steroid dependent or steroid resistant who need further medication with cytostatic or other immunosuppressive drugs such as cyclophosphamide or chlorambucil. Unfortunately studies show that the drugs give no good results and cause adverse effects.Objective To establish the effect of enalapril in decreasing proteinuria in children with steroid resistant nephrotic syndrome.Methods We conducted a clinical trial in Nephrology Division, Pediatrics Department, Dr. Sardjito General Hospital from January 2004 to October 2005. Subjects were randomized to either receive prednisone and enalapril (Enalapril Group) or prednisone and cyclophosphamide (CPA Group). The main parameter was proteinuria level, which was examined at the beginning of the study and then every two weeks for eight weeks.Results Remission rate in enalapril group was 96% whereas in CPA group was 82% (P=0.09). Proteinuria level reduction in Enalapril Group from the beginning until the end was 606.92 mg/dl (99%) whereas in CPA Group the reduction was 712.97 mg/dl (91%). Statistically, there was no significant difference in the average decrease of proteinuria level between both groups (P=0.30). Odds ratio for overall adverse events in combined prednisone and enalapril therapy group compared to combined prednisone and cyclophosphamide therapy group was 0.29 (CI 95% 0.17;0.41).Conclusion Combined prednisone and enalapril has similar effect tocombined prednisone and cyclophosphamide in children with steroidresistant nephrotic syndrome. Overall adverse events in combinedprednisone and enalapril group was lower than that in combinedprednisone and cyclophosphamide group.

Association of HLA class II and history of atopy and frequent relapse of childhood steroid-sensitive nephrotic syndrome Dany Hilmanto
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background The association between HLA class II and frequentrelapse of nephrotic syndrome (FRNS) has been reported.Objective To identify the association between HLA class II,history of atopy, and upper respiratory tract infection (URTI)with FRNS.Methods This was a case control study conducted at theDepartment of Child Health, Hasan Sadikin Hospital Bandungand Cipto Mangunkusumo Hospital Jakarta from November 2002to October 2003 on children aged 1-14 years with FRNS. Thesubjects consisted of 40 FRNS and 84 healthy children. HLAclass II was typed by polymerase chain reaction-sequence specificoligonucleotide (PCR-SSO) in Leiden, the Netherlands. Theassociation between HLA class II and FRNS was expressed byodds ratio (OR). The association between such factors and FRNSwas analyzed by logistic regression.Results Atopy was higher in patients than that in controls(P=0.013). URTI did not differ in both groups (P=0.173). HLA-DRB1*03 and DRB1*04 (OR=4.43, P=0.03), DQB1*02(OR=3.43, P=0.00), and DQB1*04 (OR=12.06, P=0.01) weresignificantly higher among patients than those in controls whereasHLA-DRB1*12 (OR=0.34, P=0.02) and DQB1*0301p(OR=0.35, P=0.02) were significantly lower among patients thanthose in controls. Using logistic regression analysis, only HLA-DRB1*12, DQB1*02 and atopy took part in FRNS.Conclusion HLA-DRB1*12, DQB1*02, and atopy all togetherhave association with FRNS.

Factors affecting mortality of neonatal sepsis in Moewardi Hospital, Surakarta Yulidar Hafidh; Dwi Hidayah; Sunyataningkamto Sunyataningkamto
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background Mortality of neonatal sepsis is still a significantproblem. It might be affected by many factors.Objective The purpose of this study was to determine factorswhich affect mortality of neonatal sepsis at neonatal ward ofMoewardi Hospital, Surakarta.Methods Data of neonatal sepsis was obtained from medicalrecords at the neonatal ward of Moewardi Hospital from December2004 to November 2005. We recorded data from 97 neonatalsepsis consisted of 46 male and 52 female babies. Statisticalanalysis had been performed using univariate Chi-square andmultivariate multiple logistic regression analysis.Results Overall neonatal sepsis mortality was about 40%. Therewere no significant difference in factors associated with mortalityof neonatal sepsis such as gender (OR=0.44; 95% CI 0.19;1.014),referral patients (OR=1.61; 95% CI 0.195;.014), and bacterialgrowth culture (OR=1.96; 95% CI 0.856;4.44), except for birthweight which affected mortality (OR=6.29; 95% CI 2.57;15.42).Conclusion Birth weight affects mortality of neonatal sepsis inMoewardi Hospital. Patients with positive bacterial growth culturehas two times higher risk of death, however, it is not statisticallysignificant.

Soy protein sensitization in cowâ€™s milk allergy patients Dina Muktiarti; Zakiudin Munasir; Alan R. Tumbelaka
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background The management of cowâ€™s milk allergy (CMA) isavoidance of cowâ€™s milk as strictly as possible. Extensive hydrolyzedprotein and amino acid based formulas are recommended dietaryproducts for treatment of CMA. However, they have somedisadvantages, such as bitter taste and high cost. Alternativeprotein sources from vegetable proteins, such as soy, can be usedas milk-substitute. Previous studies showed the prevalence of soyallergy in CMA patients in Western countries ranged between 0to 63%, but the prevalence in Asia was not greater than 20% andno data about this prevalence in Indonesia.Objectives To determine the proportion of soy proteinsensitization in CMA patients and characteristics of CMA patientswho were sensitized to soy protein.Methods Fifty seven CMA patients who consumed soy proteinwere taken their blood sample to examine the soy-specific IgE.Results From 57 CMA patients, we found only 18% of patientswho were sensitized to soy protein. Seven out of ten CMA patientswho were sensitized to soy protein were under 12 months old.Atopic dermatitis was the most frequent clinical manifestation(8/10) and all of them had family history of atopic diseases. Soysensitization in IgE-mediated and non-IgE mediated CMA were6/10 and 4/10, respectively.Conclusions Proportion of soy sensitization in CMA patients inthis study was 18%. Soy protein can be used as an alternative forcowâ€™s milk substitute in CMA patients.

The risk factors for febrile neutropenia during chemotherapy in children with malignancy Rini Sulviani; Ponpon Idjradinata; Harry Raspati
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background Febrile neutropenia is the most common side effectof myelosuppressive chemotherapy. It is important to identify itsrisk factors to decrease the morbidity and mortality of febrileneutropenia.Objective To identify whether age, type of malignancy, phase anddose of chemotherapy, nutritional status, and absolute neutrophylcount are risk factors for febrile neutropenia.Methods A hospital-based case control study was conducted atHasan Sadikin Hospital from June 2000 to July 2005. Data wascollected from medical records. The case group consisted ofchildren with malignancy who received chemotherapy andsuffered from febrile neutropenia, while the control groupconsisted of children without febrile neutropenia. Chi square andlogistic regression analysis were performed to analyze data usingSPSS for Windows version 13.0.Results Eighty-seven cases and 94 controls were evaluated.Analysis showed that malignancy type i.e, hematologicmalignancy, chemotherapy phase, and absolute neutrophyl countmight be the risk factors for febrile neutropenia (OR=4.6, 95%CI 1.3;16.7, P=0.019; OR=8.1, 95% CI 2.2;30.5, P=0.002; andOR=1.0, 95% CI 1.003;1.007, P <0.001, respectively), while age,chemotherapy dose, and nutritional status might not be the riskfactors (median 60, range 6-144, P=0.342; OR=1.9, 95% CI0.8;4.8, P=0.129; and P=0.798, respectively).Conclusion Hematologic malignancy, induction phase ofchemotherapy, and absolute neutrophyl count =250/mm 3 are therisk factors for febrile neutropenia in children with malignancywho received chemotherapy.

Trombocytosis in childhood relapsing nephrotic syndrome Ade Hafni; Danny Hilmanto; Dedi Rachmadi; Nanan Sekarwana
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background Thrombosis is a serious complication of nephroticsyndrome (NS). Long-term steroid treatment may inducethrombocytosis in relapsing NS that may predispose to thrombosis.Most children with idiopathic NS respond to steroids; however, asubstantial number of patients will relapse frequently and requirerepeated high dose steroid therapy, thus increase the risk ofthrombocytosis.Objective To compare the occurrence of thrombocytosis betweenchildren with frequent relapses of NS (FRNS) and those withinfrequent relapses (IFRNS).Methods We reviewed the medical records of children aged 1-14years diagnosed as FRNS and IFRNS at the Department of ChildHealth, Hasan Sadikin General Hospital Bandung from 2000-2005. We excluded children with iron deficiency anemia,hemolytic anemia, acute haemorrhage, malignancy, and those whoreceived cyclophosphamide.Results There were 33 children (26 males, 7 females) with FRNSand 33 children (27 males, 6 females) with IFRNS. The meanplatelet level of children with FRNS (517,909+165,670/ml) washigher than that of children with IFRNS (416,272+145,763/ml)(P=0.005). The occurrence of thrombocytosis in children withFRNS (18) was higher than that of children with IFRNS (7)(P=0.005).Conclusion This study shows that thrombocytosis is morecommon in FRNS than IFRNS, therefore we should take moreprecaution to the occurrence of thrombosis in FRNS.

Effect of oral vitamin K prophylaxis on prothrombine time and activated partial thromboplastin time: a randomized controlled comparison with an intramuscular vitamin K in infants V. Lily Limantara; Sudaryat S.; I. B. Mudita; W. Retayasa; M. Kardana
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background Low plasma concentration of vitamin K in thenewborn accounts for serious bleeding in the neonatal period andearly infancy. The aim of prophylactic vitamin K is to preventbleeding. Oral prophylaxis is preferable to intramuscular (IM)administration because oral administration is less expensive andless traumatic.Objective To compare oral vs. intramuscular vitamin K onprothrombine time (PT) and activated partial thromboplastin time(APTT) during the first 60 days of life.Methods We randomized newborn infants to either receive oralvitamin K 2 mg at birth and repeated at 7 and 30 days of life orthe 1 mg intramuscular vitamin K. PT and APTT were monitoredat 0, 15, and 45 days of age. Independent t-test, repeatedmeasurement, and regression analysis were used for statisticalanalyses and comparison of the results.Results Fifty infants were assigned into the oral group and 50 tothe IM group. All participants completed 60 days of study. BothPT and APTT decreased after administration of oral or IM vitaminK, and the values did not differ significantly at any time pointand through the period of investigation. Using regression analysisit was shown that only vitamin K administration was correlatedwith PT and APTT with P value were 0.044 and 0.036,respectively. During 60 days of study, there was no hemorrhagicdiathesis in both groups.Conclusions Through the first 60 days of life, 3 doses of oralvitamin K maintain hemostasis by decreasing PT and APTT ininfants at values equal to those achieved by the intramuscularpreparation. Diathesis hemorrhagic event did not occur in bothgroups.

Metabolic syndrome and visceral fat thickness in obese adolescents Lanny C. Gultom; Damayanti R. Sjarif; Evita K. B. Ifran; Partini P. Trihono; Jose R. L. Batubara
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background Metabolic syndrome (MS) is one of the long-termconsequences of obesity which can be found in adolescents. MS iscaused by excessive visceral fat accumulation. The visceral fatthickness (VFT) itself can be measured by using waist circumference(WC) measurement and abdominal ultrasonography. Until now,there are no WC and VFT cut-off points to predict MS in childrenand adolescents. This study used MS criteria based on NationalCholesterol Education Program â€“ Adult Treatment Panel III(NCEP-ATP III) which specifically modified.Objective The objectives of this study are (a) to determine the MSocurrence based on modified NCEP-ATP III in obese adolescents;(b) to measure the VFT by using abdominal ultrasonography in obeseadolescent with MS and obese adolescent without MS.Methods We conducted a cross-sectional study from March toMay 2006. Fifty obese adolescents were recruited from severaljunior and senior high schools in Jakarta.Results Of those 50 obese adolescents, there were 34 subjects withWC>P 80Â and 16 subjects with WC <P 80 . Of those 34 subjectswith WC>P 80 , 17 subjects had MS and the others had no MS. Allthe 16 subjects with WC <P 80 did not have MS. The VFT in 17subjects with WC>P 80Â who had MS was 5.19 cm (SD 2.07 cm).The VFT in 17 subjects with WC>P 80 who had no MS was 3.94cm (SD 1.62 cm). The VFT in all 16 subjects with WC <P 80 whodid not have MS was 3.54 cm (SD 0.92 cm). All obese adolescentswith MS had WC>P 80Â and they also had visceral fat which wasthicker than obese adolescents without MS.Conclusions All obese adolescents with MS have WC>P 80Â andthicker visceral fat than obese adolescents without MS; the VFTof obese adolescents without MS, who had WC>P 80 was 3.94cm (SD 1.62 cm), and the VFT of obese adolescents without MS,who had WC <P 80 was 3.54 cm (SD 0.92 cm).

Intracranial hemorrhage in infants after massaged by a traditional birth attendant Elisabeth S. Herini; Sunartini Hapsara; S. Yudha Patria
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background The overall incidence of birth related injuries declineswith the improvement in obstetrics. However, the incidence ofhead trauma in infants after massaged by a traditional birthattendant (TBA) is still unknown.Objective To study the characteristics of intracranial hemorrhagein infants after massaged by a TBA.Methods A retrospective study was conducted in Sardjito Hospital,Yogyakarta, Indonesia between October 2001 and May 2005.Infants with intracranial hemorrhage after massaged by a TBAwere included. Data on patientsâ€™ demography, history of massagingby TBA, clinical presentation, and injury characteristics such asanemia, clotting time (CT), bleeding time (BT), prothrombin time(PT) and activated partial thromboplastin time (APTT) werenoted. Computed cranial tomography (CT) scans were performed.Results A total of seven infants were diagnosed with intracranialhemorrhage after massaged by a TBA. There were four malesand three females (mean age 46 days; range 27-60 days). Allinfants were referred to Sardjito Hospital, Yogyakarta, Indonesiawith bad condition and anemia; mean hemoglobin level was 5.5g/dl (range 3.7-8.3 g/dl). All infants presented with seizures.Coagulation screening showed normal results in five patients. Theremaining patients had a prolonged CT and PT. CT scan showedsubdural hemorrhage in four patients, intracerebral hemorrhagein four, epidural hemorrhage in two, and subarachnoid hemorrhagein one. Two patients had chronic hemorrhage, while the rest hadacute hemorrhage. Four of them underwent craniotomy, twopatients were under an observation only, and one patient was nottreated due to parental refusal. Six patients survived and the onewho refused to be treated died.Conclusions The parents, midwives, and doctors have to be awareof head massaging since it may harm infants.

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