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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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Cri-du-chat syndrome Eka Agustia Rini; R. Trin Suciati
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Cri-du-chat syndrome (CDCS) is a rare chromosomal disorder, refers to a unique combination of physical and mental characteristics associated with a loss of genetic material on the distal short arm of the fifth chromosome.1 The incidence of CDCS is between 1:25,000 to 1:50,000 births. The prevalence among individuals with mental retardation is about 1.5 in 1000.2 A significant female predominance exists in affected newborns, with a male-to-female ratio of 0.72.2Subtle dysmorphism with neonatal complications and a high-pitched cry typically initiate diagnostic evaluation by cytogenetic studies. 2,3 Currently,there is no cure for cri-du-chat syndrome. The most successful approach in the management of children with CDCS requires a multidisciplinary team approach. 4 The case presented below will remind us how to reveal, suspect and diagnose Cri-Du-Chat syndrome, a rare case in pediatric.

Comparison of serial blood lactate level between dengue shock syndrome and dengue hemorrhagic fever (evaluation of prognostic value) M. Tatang Puspanjono; Abdul Latief; Alan R. Tumbelaka; Sudigdo Sastroasmoro; Hartono Gunardi
Paediatrica Indonesiana Vol 47 No 4 (2007): July 2007
Publisher : Indonesian Pediatric Society

Background Dengue shock syndrome (DSS) mortality is still high.Monitoring of blood lactate level is important to evaluate shock.Objectives The study were to review the difference between bloodlactate level of DSS and that of dengue hemorrhagic fever (DHF),to correlate blood lactate level with hypoxia state as shock riskfactors (PaO 2 , oxygen saturation, and anion gap) and to determinethe cut-off point of blood lactate level to predict shock.Methods The study was carried out at the Department of ChildHealth, Medical School, University of Indonesia, CiptoMangunkusumo Hospital, Jakarta, from January until July 2006.Three mL venous blood specimen was collected from all subjectsfor peripheral blood, blood gasses, serology, and blood lactateexaminations. This study consisted of a retrospective cohort anda cross sectional method. Data were analyzed with Chi-squaretest. Continous data tested using Mann-Whitney method. Toknow the correlation between blood lactate level and shock riskfactors we use logistic regression test.Results In DSS group, 73% shows hyperlactatemia (lactate =2mmol/L). Conversion of lactate means between two groups issignificantly different from day one to day two and three. Therewas a negative correlation between lactate level and pO 2 andoxygen saturation. Oxygen saturation is the only value that hasclinical correlation. Regressions analysis can be applied using Y= 7.05â€“0.05 X equation. The cut-off point of lactate level asmarker for shock by using ROC curve is 32.015 mmol/L with 70%sensitivity and 83.3% specificity.Conclusions Hyperlactatemia in DSS can be considered as a signfor unappropriate treatment of shock. Blood lactate level can beused as a biochemical marker for tissue hypoxia, to assess severityof the disease, as monitoring of treatment, and has prognosticvalue of DHF cases.

Safety and immunogenicity of the DTP/HB /Hib combination vaccine: phase I study Kusnandi Rusmil; Eddy Fadlyana; Novilia Sjafri Bachtiar; Hadyana Hadyana
Paediatrica Indonesiana Vol 53 No 6 (2013): November 2013
Publisher : Indonesian Pediatric Society

Background The World Health Organization (WHO) hasrecommended the introduction ofhepatitis B (HB) and Haemophilusinfluenza type b (Hib) vaccines into routine childhood vaccinationprograms. A new diptheria/tetanus/pertussis (DTP) /hepatitis B/Hibpentavalent combination vaccine has been developed.Objective To evaluate the safety and immunogenicity of a newcombination DTP/HB/Hib liquid vaccin e in infants.Met hods An open-label, uncontrolled, prospective interventionphase I study was con ducted on 30 healthy infants aged 6- 11weeks. Each subject received 3 doses of DTP/HB/Hib vaccine,formulated by Bio Fanna, 0.5 mL intramuscularly at the leftanterolateral thigh region using a 25-gauge n eedle of 25 mmlength . Subjects were followed for 1 month after administration ofeach vaccine dose to evaluate its safety, while serum anti-diphteria,tetanus, HB, Hib, and per tussis antibodies were measured priorto the l '' dose and 1 month after the Jtd dose.Results Among 30 vaccinated subjects, 18 infants had fever within24 hours after the first vaccination. Most cases of fever were mildin intensity and resolved within 24 hours. No other systemic orlocal reactions, or serious adverse events were observed in oursubjects during the study. The immunogenicity results after Jtdvaccine dose showed that the geometric mean titer of the antipolyribosylribitolphosphate (PRP) antibody levels increasedsignificantly from 0.0041Î¼,g/mL to 4.3 7 Î¼,g/mL after vaccination,and most infants h ad a fourfo ld or greater rise in antibody levelsover their pre-injection levels . All subjects who received DTP/HB/Hib liquid vaccine had seropro tective antibodies againsttetanus, diphtheria,a and hepatitis B, while 29/30 infants hadseroprotective antibodies against pertussis.Conclusion This new diphtheria/tetanus/pertusis/hepatitis B/Hibcombination vaccine has excellent safety profile and antibodyresponses in infants. These results encourage further clinicalevaluation in phase II.

Effect of subdural hemorrhage on term infants development - a prospective study Ketut Ariawati; Soetjiningsih Soetjiningsih; I. K. Kari
Paediatrica Indonesiana Vol 47 No 4 (2007): July 2007
Publisher : Indonesian Pediatric Society

Background Subdural haemorrhage (SDH) is a common problemin infants under 6 months of age and it has a risk to develop intodevelopmental delay.Objective To evaluate adverse effects of SDH on the developmentof term infants.Methods It was a prospective cohort study carried out on infantsbelow six months of age admitted to Sanglah Hospital due toSDH. Control was healthy term infants born in Sanglah Hospital.Mullen Scales test was performed at the age of 6 and 12 months.Multivariate analysis was conducted to examine the relationshipbetween several independent variabels and developmentaloutcome.Results Sixty six infants were enrolled in this study (33 infantswith SDH and 33 infants without SDH), 52 (79%) were maleand 14 (21%) were female. Mean age was 1.53 (SD 0.75) monthsvs 1.70 (SD 0.73) months. The result of Mullen Scales test at theage of 6 and 12 months showed that very low category was higherin infants with the history of SDH than that in control group.Multivariate logistic regression analysis showed that only SDHcorrelated with Gross Motor and Cognitive Scale delay at theage of 6 months and 12 months (Gross motor 6 months: P=0.01;OR 13.07; 95%CI 2.04;83.84; Gross motor 12 months: P=0.00;OR 23.58; 95%CI 2.87;193.84); (Cognitive 6 months: P=0.00;OR 12.11; 95%CI 2.44;59.90; Cognitive 12 months: P=0.00; OR26.67; 95%CI 3.25;218.86).Conclusion Term infants with history of subdural haemorrhageare associated with increased Gross Motor and Cognitive Scaledelay at the age of 6 and 12 months.

Parental knowledge, attitude and practice on malaria in Mandailing Natal district Syafruddin Haris; Sri Sofyani; Bidasari Lubis; Munar Lubis; Syahril Pasaribu; Iskandar Z. Lubis
Paediatrica Indonesiana Vol 47 No 4 (2007): July 2007
Publisher : Indonesian Pediatric Society

Background Malaria is still considered to be an important healthproblem in Indonesia. Malaria has been found in islands withdifferent degree of endemicity. Behavior of the community isone of the factors affecting the incidence of malaria in MandailingNatal district.Objective To know the parental knowledge, attitude, and practiceamong parents whose children suffered from malaria or not.Methods A cross sectional study was conducted in six primaryschools and one health centre in October 2004. Subjects wereparents whose children were malaria positive and malaria negativebased on laboratory examination. Sample size was 85 parents foreach group. Selected respondents were interviewed usingstructured questionnaire. Degree of knowledge, attitude, andpractice on malaria were established using scoring system withinthree categories: good, less, and poor. Data were collected andpresented using chi-square and P<0.05 was considered as a levelof significant.Results The mean age of 85 parents whose children were positivemalaria, was 38.47 years (SD 6.67) and the mean age of thosewhose children were negative malaria was 40.41 years (SD 8.05).Parentâ€™s education level was 62.9% primary school and 90% oftheir children were school-aged. There were significant differenceson parental knowledge, attitude and practice in each group(P<0.05). There was also a significant correlation betweenoccupation and knowledge, but not between parental educationlevel and parental age. Parental knowledge and attitude on theincidence of malaria in Mandailing Natal district were good,though their practice were poor.Conclusion There are significant differences on parentalknowledge, attitude and practice, between parents whose childrenwere positive and negative for malaria.

The association between duration of breastfeeding and atopy in children with or without family history of atopic disease Riana Novy; Budi Setiabudiawan; Cissy B. Kartasasmita
Paediatrica Indonesiana Vol 47 No 4 (2007): July 2007
Publisher : Indonesian Pediatric Society

Background Atopic diseases (AD) are the most common chronicdiseases in childhood, and their incidence has a tendency to increaserecently. Tendency to have atopy could be triggered by many factorsoriginated in early life, including time of breastfeeding cessation.Objective To determine the association between exclusive andduration of breastfeeding and atopy in children with or withoutfamily history of atopic disease.Methods This was an observational clinical epidemiology studyperformed at Babakansari, Padasuka, Garuda Primary Health CareCenter in Bandung from January to March 2006. One hundredfifty of 749 children were randomized from group with and withoutfamily history of AD. They underwent skin prick tests and totalserum IgE level analysis. Atopy was defined as a positive skinprick test to any of the eight allergens tested. History of exclusiveand duration of breastfeeding was obtained from their parents.Significance tests for contingency tables were on the basis of x 2test for association odds ratio with 95% confidence interval.Results Atopy was found in 28.2% of children, of whom 32.4% withand 23.9% without family history of AD. Children exclusivelybreastfed exhibited a reduced risk of atopy (5.8% v 35.3%, OR=0.11,95%CI= 0.03;0.34, P<0.001). The difference of atopy was stronglysignificant between children who had exclusive breastfeeding andthose without exclusive breastfeeding whether or not the subjectshad family history of AD (P<0.001). There was a highly significantrisk reduction for atopy related to prolonged breastfeeding (=6months) (OR=0.37, 95%CI = 0.19 to 0.72, P=0.001). Thedifference of atopy was strongly significant between children whohad prolonged breastfeeding and short breastfeeding duration whetheror not the subjects had family history of AD (P<0.001)Conclusions Exclusive and prolonged breastfeeding decrease atopyin children with as well as without family history of AD.

Effect of oral glucose administration on pain in neonates undergoing peripheral blood collection Effa Triani; Munar Lubis; Chairoel Yoel
Paediatrica Indonesiana Vol 47 No 4 (2007): July 2007
Publisher : Indonesian Pediatric Society

Background Peripheral blood sampling with heel sticks in neonatescould represent minor invasive procedure which generates pain.The oral glucose administration can reduce the pain in neonatesduring this procedure.Objective To compare the pain sense after oral glucoseadministration or placebo during peripheral blood sampling withheel sticks in neonates.Methods A double blind randomized clinical trial study wasconducted from January to March 2004 in three teaching hospitalsin Medan. The population of this study was divided into twogroups (glucose and placebo) and each group consisted of 32neonates. The intervention group got 1 ml of 40% glucose andthe placebo group got 1 ml of sterile water. Blood sample wastaken with sterile hemolet with heel sticks from healthy atermneonates. The pain was measured using NIPS score and measuredin first 30 seconds after heel sticking. The heart and respiratoryrate measurement was done before and during the interventionand we also counted crying time. Data were analyzed with studenttâ€“test.Results The significant mean difference of NIPS score in glucosegroup was 2.22 (SD 0.83) vs 4.72 (SD 0.96) in placebo group(P<0.0001). There was significant mean difference of crying time,i.e. 0.16 (SD 0.37) in glucose group vs 2.05 (SD 0.77) in placebogroup (P<0.0001). There was significant differences of heart ratebefore and during heel sticking in both groups.Conclusion There were some differences of pain sense in neonateswho received 40% glucose compared to those who received sterilewater during peripheral blood sampling.

Phenotype and genotype characteristics of Indonesian 21-hydroxylase deficient patients Atiek Widya Oswari; Bambang Tridjaja; Iswari Setianingsih; Taralan Tambunan; Aman B. Pulungan; Jose R. L. Batubara
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Background Congenital adrenal hyperplasia (CAH) is the mostcommon cause of ambiguous genitalia in children and 90-95%cases show 21-hydroxylase deficiency. More than 100 mutationshave been described and of these, four mutations have beenfrequently reported in Asia. Those mutations are deletion/largegene conversion (LGC), intron2 splice mutation (I2 splice), pointmutations at codon 172 (I172N) and codon 356 (R356W).Genotyping is very valuable since close correlation observedbetween genotype and phenotype.Objective To identify phenotype and genotype characteristics ofCAH due to 21-hydroxylase deficiency (CAH-21OH) andcorrelation between them.Methods From June to November 2006 we analyzed 37 confirmedCAH-21OH patients treated at the Department of Child Health,Cipto Mangunkusumo Hospital during the period of 1990-2006.Polymerase chain reaction (PCR) followed by restriction fragmentlength polymorphism (RFLP) analysis or amplification-createdrestriction site (ACRS) were performed. We first identified deletion/LGC and I172N mutation that had been mostly reported in saltwasting (SW) and simple virilizing (SV) form patients respectively.Results There were 37 patients, consisted of 6 males and 31females with the ratio 1:5.2. Of those, 25, 10, 2 patients wereSW, SV and non-classic (NC) form, respectively. PCR-RFLP orACRS was performed to detect two mutations in 32 patients (64alleles). Deletion/LGC was found in 6 alleles while I172Nmutations in two. All deletion alleles showed SW phenotype butI172 mutated alleles showed SW and SV phenotype.Conclusion There is a consistent close association betweengenotype and phenotype in our CAH-21OH patients.

Benefits of domperidone in ambulatory acute diarrhea with severe vomiting Irene A. O.; Achirul Bakri; Erial Bahar; Rusdi Ismail
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Background Recently, most patients with diarrheal disease (DD)cases are hospitalized not due to severe dehydration, but due tosevere vomiting which interferes with fluid and food intake. Useof anti-vomiting medicines is not recommended because of itsâ€œcentralâ€ side effects. Domperidone has prokinetic and antiemeticeffects with only minimal extrapyramidal side effects.Objective To evaluate domperidone in preventing hospitalizationof DD patients in outpatient setting.Methods This randomized double blind, placebo-controlledclinical trial, was conducted from February to August 2005 atMohammad Hoesin Hospital, Palembang. We included patientsaged 6 to 59 months old with acute diarrhea who had vomited atleast 4 times in the last 24 hours, not in need of hospitalization,and agreed to participate. We excluded patients who had takenanti-vomiting drug, or those who had severe diseases, includingsevere malnutrition. The dose of domperidone was 1.25 mg per 5kg body weight.Results There were 183 subjects randomized, consisted of 91 whotook domperidone (treatment group) and 92 who took placebo(control group). The duration and decrease of vomiting frequencywere significantly different in favor of domperidone. Domperidoneprevented hospitalization significantly (P=0.001, OR=4.1, ARR= 20%, RRR=71%, NNT=5). No overt acute clinical side effectswere found.Conclusion Domperidone significantly shortened the duration anddecreased the frequency of vomiting in DD cases.

Natural course of gastroesophageal reflux disease during infancy - six-month follow-up Eka Laksmi Hidayati; Agus Firmansyah; Alan R. Tumbelaka
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Background Very few data have been published about the naturalcourse of gastro-esophageal reflux (GER) symptoms duringinfancy; further, no risk factors of GER disease (GERD) have beenidentified.Objectives To determine the prevalence and natural course ofregurgitation in infancy and factors of gastroesophageal refluxdisease.Methods A cohort of 223 healthy infants who attended IntegratedHealth Services run by local housewife (Posyandu) of Ciputat â€“suburb of Jakarta â€“ between March and November 2005.Information on subjectsâ€™ history of regurgitation and other reflux-related symptoms was obtained by interviewing mother and diaryrecord. Subjects were followed up to age of 1 year irrespective ofthe clinical status.Results At 6 months of age most infants (56.5%) had regurgitation1 to 3 days per week and only 2.7% infants regurgitated daily.Regurgitation 1 to 3 episodes per day was found in 92.8% ofsubjects. The proportion of infants regurgitation decreasedgradually with age; the proportion for the consecutive 6 to 11month was 100%, 65.5%, 33.6%, 14.3%, 3.6% and 1.3%,respectively. At the age of 1 year no infants was found to beregurgitated. Related symptoms included hiccup (58.3%),vomiting (23.3%) and back arching (2.2%). Feeding problemoccurred in 34.1% infants and occurred more likely in infantswho regurgitate daily compared to 4 â€“ 6 day per week (OR 3.5;95%CI 2.2;5.6) and 1 â€“ 3 day per week (OR 1.8; 95%CI 0.6;0.9).Conclusions Regurgitation in infancy disappears spontaneouslywith age. Reflux-related symptoms are hiccup, vomiting and backarching. Feeding problem occurs most likely in infants whoregurgitate daily.

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