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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 2,118 Documents

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Incidence and characteristics of antituberculosis drug-induced hepatotoxicity in children: a preliminary study Bina Akura; Hanifah Oswari; Bambang Supriyatno; Najib Advani
Paediatrica Indonesiana Vol 49 No 6 (2009): November 2009
Publisher : Indonesian Pediatric Society

Background Antituberculosis drugs show good efficacy but haveÂ adverse effects including hepatotoxicity.Objective To find the incidence and characteristics ofÂ antituberculosis hepatotoxicity in children during the first 2Â weeks of therapy.Methods A cohort study was performed in Cipto Mangunkusumo,Â Persahabatan, and Tangerang Hospitals from August 2008Â toMarch 2009. The diagnosis of tuberculosis (TB) based onÂ TB scoring system. Laboratory tests were performed includingÂ transaminase enzymes, bilirubin, y-GT, albumin, ureum, andÂ creatinine before and after 2 weeks of treatment. Patients wereÂ monitored during the first 2 weeks of therapy. Informed consentÂ obtained from the parents.Results Six of 81 subjects had hepatotoxicity reaction. Most ofÂ the patients were 1 to 5 years old (65%) and well nourished (50%). Extrapulmonary tuberculosis found in 67% of cases. Thirty-three percents of patients received four agents. Thirty-three percents of cases received 4 agents combined with other hepatotoxic drugs. Six subjects had hepatotoxicity (1 hepatitis, 2 mixed case, and 3 asymptomatic). Two of 50 children (4%) with pulmonary TB and 4 out of 31 ( 13%) children with extrapulmonary TB had hepatotoxicity reaction. Antituberculosis drug doses were similar between the hepatotoxicity group and control.Conclusions Incidence of antituberculosis hepatotoxicity in thefirst 2 weeks of therapy was 7%, consisted of hepatitis (1 cases),Â mixed (2 cases), and asymptomatic (3 cases). There was noÂ difference in sex as well as in nutritional state distribution found in cases with hepatotoxicity.

Correlation between cord blood bilirubin level and incidence of hyperbilirubinemia in term newborns Rudy Satrya; Sjarif Hidayat Effendi; Dida Akhmad Gumida
Paediatrica Indonesiana Vol 49 No 6 (2009): November 2009
Publisher : Indonesian Pediatric Society

Background Discharging healthy term newborns from thehospital after delivery at increasingly earlier postnatal ages hasrecently become a common practice due to medical, social, andeconomic reasons, however it contributes to readmission becauseof jaundice.Objective To investigate the correlation between level of cordblood bilirubin and development of hyperbilirubinemia amonghealthy term newborns.Methods Prospective observational study was performed on88 healthy term newborns. Cord blood was collected for thetotal bilirubin, conjugated bilirubin, unconjugated bilirubinlevel measurement and blood group test. Measurements of totalbilirubin, conjugated bilirubin, and unconjugated bilirubin wererepeated on the 5th day with serum sampling, or as soon as thenewborn appeared to be jaundice.Results Subjects were categorized into hyperbilirubinemia andnon-hyperbilirubinemia newborns. There was a correlationbetween cord blood and the 5th day bilirubin level. By ROCanalysis, cord blood bilirubin level of 2:2.54 md/dL was determined to have high sensitivity (90.5%), specificity of 85%, and accuracy of 86.4%.Conclusions There is a correlation between cord blood bilirubinlevel and hyperbilirubinemia in healthy term newborns. Cordblood bilirubin level at or greater than 2.54 mg/dL can predictthe development of hyperbilirubinemia.

Diagnostic accuracy of single-voided urine protein/ creatinine ratio for proteinuria assessment in children with nephrotic syndrome Devie Kristiani; Pungky Ardani Kusuma; Purnomo Suryantoro
Paediatrica Indonesiana Vol 49 No 6 (2009): November 2009
Publisher : Indonesian Pediatric Society

Background Measurement of protein excretion is not onlyused for diagnostic purpose but also to monitor disease severityand prognosis in children with nephrotic syndrome (NS).The common method to measure proteinuria is 24-hour urinecollection. However, 24-hour urine collection is cumbersome,time consuming, and tedious. An alternative simplified methodis the measurement of protein/creatinine ratio in single-voidedurine specimens.Objective The aim of this study was to determine whether urineprotein/creatinine ratio is accurate to predict pathologic (> 100mg/m2/day) and massive proteinuria (> 1 g/m2/day).Methods Seventy single voided and 24-hour urine specimenswere collected from children aged 3-18 years. The relationshipbetween urinary protein/creatinine ratio and total daily proteinexcretion was calculated using correlation and linear regressionanalysis. Diagnostic test was conducted to estimate the accuracyof protein/creatinine ratio for the diagnosis of pathologic andmassive proteinuria in NS.Results Correlation coefficient between quantity of protein in24-hour urine specimens and protein/creatinine ratio in singlevoided urine specimens was 0.96 (R2=0.93). Both sensitivity and specificity of urinary protein/creatinine ratio were 87% in diagnosing pathologic proteinuria, whereas the sensitivity and specificity of the ratio to predict massive proteinuria were 88% and 91%, respectively.Conclusion The urinary protein/creatinine ratio in single voidedurine specimen has a good accuracy to predict pathologic andmassive proteinuria in children with NS aged 3-18 years.

Febrile neutropenia in childhood leukemia: Manado experience 1997 - 2006 Stefanus Gunawan; Novie Homenta Rampengan; Max Frans Joseph Mantik; Tonny Homenta Rampengan
Paediatrica Indonesiana Vol 49 No 6 (2009): November 2009
Publisher : Indonesian Pediatric Society

Background Febrile neutropenia (FNP) is a common complicationof therapy among children with cancer. It is one of the causes ofsignificant morbidity and mortality in children and young adultstreated for cancer. With aggressive management of FNP, theoutcome of episodes in children has improved dramatically.Objective To determine factors associated with FNP, to assess how varied the current management, and to evaluate the outcome of FNP in childhood leukemia in Manado over the last 10 years.Methods Data from medical records was collected retrospectivelyfrom January 1997 to December 2006. Variables studied were: age, sex, nutritional status, sosio-economic status, type of leukemia, degree of fever, ANC at fever, phase of chemotherapy, antibiotic used, episodes ofFNP and the outcome of patients.Results Twenty of ninety one patients were studied. The mortality rate was crucial i.e., 11 of20, it was higher in boys than that in girls. Most children have severe to very severe neutropenia and more than half died (7 /13). Seven out of 12 malnourished patients died. Sixteen children are suffered from acute lymphoblastic leukemia (ALL). The outcome of high risk (HR) patients was worse than that of standard risk (SR). FNP occurred along the phase of chemotherapy. None of the factors studied showed significant difference. The choice of antibiotics is varied.Conclusion The outcome of FNP in our institution is grave.There is a need to evaluate application and compliance to thestandard guidelines.

The relationship between contact to cat and the development of asthma in children Made lndah Nastiti Utami Budha; Roni Naning; Ketut Dewi Kumara Wati
Paediatrica Indonesiana Vol 49 No 6 (2009): November 2009
Publisher : Indonesian Pediatric Society

Background Data suggesting history of direct or indirect contactto cats are either protective, has no effect or increase risk ofsensitization and asthma development.Objective To determine the relationship between childhoodcontact to cat and the development of asthma in children.Methods A case control study was conducted in Denpasar sinceDecember 2006 until Juli 2008. In this study, subjects withasthma (cases group) were selected for comparisons to a series of healthy subjects without asthma (controls group). Forty-sevensubjects (3-12 years) with asthma were recruited and matched(age and sex) with 4 7 healthy and non asthma controls. Data were collected using two kinds of questionnaires, i.e: ISAAC, ATS 78, and Robertson modification questionnaire from Medical School, University of Indonesia, which had been validated to determine asthma and asthma risk factors questionnaire. Data were analyzed as univariate by using chi-square or Fisher's exact test, and multivariate analysis by stepwise logistic regression model.Results Result of univariate analysis showed that there were seven significant risk factors of asthma. Using multivariate analysis, contact to cat was significant risk factor for asthma [OR: 4.5 (95% CI 1.3 to 16.0), P= 0.020]. Other significant risk factors were; contact to cockroach [OR: 11.7 (95% CI 2.6 to 51.6), P= 0.001], use of kapok mattress [OR: 6.4 (95% CI 1.4 to 29.0), P= 0.015], passive smoker [OR: 4.7 (95% CI 1.3 to 17.0), P= 0.018], and atopic history [OR: 9.2 (95% CI 2.3 to 36.7), P= 0.002].Conclusions There was a relationship between childhood contactto cat and the development of asthma in children. Risk factors that statistically significant were; contact to cockroach, use of kapok mattress, passive smoker, and history of allergy in study subject.

Cognitive development in babies with exclusive breastfeeding using Mullen Scale test I G. Maharditha; Soetjiningsih Soetjiningsih; I K. G. Suandi
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Breast milk is the best nutrition for babies' growthand development. There are many reasons for discontinuation ofexclusive breastfeeding (BF).Objective To evaluate the impact of exclusive breastfeeding onbabies' cognitive development.Methods A cohort study was conducted for full term newbornbabies. They were evaluated for cognitive development usingMullen scale test at of 6 and 9 months; t test was used to obtainmean difference of cognitive values. Logistic regression analysiswas performed to distinguish factors associated with the cognitivedevelopment.Results One hundred and forty babies were enrolled to this study(70 babies with exclusive BF and 70 babies with non-exclusiveBF). There were 34 boys (49%) in exclusive and 37 boys (53%) innon-exclusive BF group. Mean cognitive score at age six monthswas 1.41 points higher for exclusive BF group, mean rate 174.31(SO 4.89) and 172.90 (SO 4.19) for exclusive and non-exclusive BF,respectively. Mean cognitive score at nine months was 1.49 pointhigher in exclusive BF group with mean rate 175.28 (SO 4.39) and173.82 (SO 3.80) for exclusive and non-exclusive BF respectively.Logistic regression analysis showed that exclusively breastfed babieshad higher mean Mullen cognitive score of 4. 761 (95% CI 1.341;16.907) and 4.431 (95% CI 1.313; 14.949) times at sixth and ninthmonth respectively than non-exclusive BEConclusion Exclusively breastfed babies may have higher meanscore of Mullen cognitive score at sixth and ninth months whencompared with those who are non exclusively breastfed.

Reverse Transcription Polymerase Chain Reaction (RT-PCR) as an influenza diagnostic test among children in Yogyakarta Eva Musdalifah; M. Juffrie; Purnomo S; Amalia Amalia
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Influenza virus type A, especially H5Nl subtype oravian influenza, is a highly pathogenic agent that causes epidemicin the world with high mortality. Most cases are preschool andschool children. Anti-viral drug is effective when given at earlyphase. The gold standard for the diagnosis of influenza is viralculture, which takes 2 to 10 days. A rapid and accurate diagnostictest is needed to control further viral infection.Objective To determine the accuracy of RT-PCR as a diagnostictest for children with influenza compared with viral culture.Methods A cross-sectional study was conducted in primary healthcares of Jetis I, Godean I, II and Dr Sardjito Hospital Yogyakartabetween January 2005 and May 2007. The specimens, taken bytrained health personnel, were collected from both anterior naresand throat of children aged from birth to 14 years who met theeligibility criteria, then were stored in a frozen extraction tubeand sent to Jakarta for RT-PCR and viral culture as the goldstandard.Results There were 34 7 children enrolled in this study. Influenzainfection was confirmed in 63 children (18.2%). There were 24children with H3N2 subtype of influenza virus, 13 children withHINI subtype, and one child with H5Nl subtype. The sensitivity,specificity, positive and negative predictive value, positive andnegative likelihood ratio of RT-PCR test were 89%, 90%, 67%,97%, 9, 3, 0, and 12 respectively.Conclusions RT-PCR is accurate enough as influenza diagnostictest in children.

Assessment of the quality of general movements in newborn infants: a tool to predict developmental disorders at an early age Ahmad Suryawan; Bambang Permono; Komang Ayu Witarini; Risa Etika; Fatimah lndarso; Moersintowarti B. Narendra
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Nowadays, quality assessment of general movements(GMs) in infants can be used as a tool to predict developmentaloutcome. Until now, there is no published study in this field inIndonesia.Objectives The aim of this study was to evaluate the quality ofGMs of newborn infants.Methods A prospective study was done at neonatal ward, Dr.Soetomo Hospital in Surabaya, between December 2006 andJanuary 2007. A single supine position video recording of newbornsat GMs preterm and writhing age was made using Precthl's method.Infants were chosen consecutively among singletons above 28week gestational age. The quality of GMs was assessed by meansof Gestalt perception by one of the authors, who had been trainedand certified in GMs. GMs were classified into: normal-optimal,normal-suboptimal, mildly-abnormal, and definitely-abnormal.Correlation tests were used to assess the relationship betweenperinatal conditions and the quality of GMs.Results 106 videos were recorded, and 100 were assessedcompletely. Abnormal GMs were found in both 35 pretermage (normal-optimal 2.9%; normal-suboptimal 28.6%; mildly-abnormal45. 7o/o; definitely-abnormal22.9o/o) and 65 writhing age(3.1 o/o; 41.5%; 41.5%; 13.8%, respectively) (P=0.285). There wasa weak negative correlation between birth weight and the qualityofGMs (r=-0.20, P=0.044).Conclusions The quality ofGMs in Indonesian newborn infants inour study was predominantly abnormal, which puts these infantsat high risk for later developmental disorders. The lower theinfants'birth weight, the more likely for abnormal GMs.

Diagnostic accuracy of septic markers for neonatal sepsis Thermiany AS; W Retayasa; M Kardana; IN Lila
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Neonatal sepsis is a major cause of morbidity andmortality. A positive blood culture is the gold standard fordiagnosis of neonatal sepsis. The signs and symptoms suggestingneonatal sepsis are non-specific. There is no rapid and reliablelaboratory test findings for confirmation of etiologic diagnosis.Clinical signs, symptoms, and laboratory examinations are notperceived as sensitive or specific for diagnosis of sepsis.Objective The purpose of this study was to evaluate the accuracyof the septic markers for diagnosis of neonatal sepsis.Methods Blood culture was used as gold standard to compareseptic markers to diagnose neonatal sepsis. Sensitivity, specificity,positive predictive value (PPV), negative predictive value (NPV),positive and negative likelihood ratio (LR), and accuracy werecalculated.Results We identified 130 cases suspected of neonatal sepsis duringSeptember 2005 until March 2006. Four patients were excludedbecause of major congenital anomalies. The mean age was 2.2 daysand 51.6% were boys. We found fifty six (44.4%) neonates havepositive blood culture. All of septic markers had sensitivity morethan 80%. Immature to Total Neutrophil ratio (Iff) ratio had thehighest sensitivity (96.4%) and C-Reactive Protein (CRP) had thelowest sensitivity (80.4o/o). Combination among leukocyte count,thrombocyte, and Iff ratio had the highest sensitivity (sensitivitywas 85. 7%, specificity was 97.1 o/o, positive predictive value was95.9%, negative predictive value was 89.5%, accuracy was 94.4%,and positive likelihood ratio was 30.0).Conclusion Septic markers can be used in the diagnosticevaluation of neonates with suspected sepsis.

Early neonatal mortality rate and the risk factors in Wangaya hospital Made lndah Nastiti Utami Budha; Wayan Retayasa; Made Kardana
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background The first week of life of a neonate is a critical period.In Asia, early neonatal mortality rate remains high.Objective To investigate early neonatal mortality rate and the riskfactors in Wangaya Hospital.Methods A cross sectional study was carried out retrospectivelyon neonates registered at Perinatology Unit, Wangaya HospitalDenpasar, Bali since January 2006. The study was done fromOctober to November 2007. Data was obtained from medicalrecord, analyzed as univariate using chi-square test or Fisher'sexact test and multivariate logistic regression analysis model.Results Early neonatal mortality rate in Wangaya Hospital was 38.7per 1000 livebirths. Univariate analyses showed that there werefive significant risk factors of early neonatal death, i.e., respiratorydistress, asphyxia, birth weight less than 2500 grams, sepsis, andgestational age less than 3 7 weeks. Multivariate analysis showedthat those five variables were significant as risk factors of earlyneonatal death i.e., OR (95% confidence interval) for respiratorydistress: 16.8 (3.7 to 76.6)], asphyxia: 13.5 (6.1 to 29.9)], birthweight <2500 grams: 8.1 (3.3 to 19.9)], sepsis: 7.3 (3.1 to 17.1),and gestational age <37 weeks: 3.5 (1.6 to 7.8)].Conclusions Early neonatal mortality rate in Wangaya Hospitalremains high. Respiratory distress, asphyxia, birth weight <2500gram, sepsis, and gestational age <37 weeks were independent riskfactors of early neonatal death.

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