bluuebunny/crossref_metadata_2025 huggingface dataset:
Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE II) as the predictor of neonatal mortality hospitalized in neonatal intensive care unit
Authors: Thimoty James , Hilmanto Dany , Yuniati Tetty
Published: March 2017

Background The assesment of severity of illness with scoringsystem has been used to predict neonatal mortality in neonatalintensive care unit (NICU). Score for Neonatal Acute PhysiologyPerinatal Extension II (SNAPPE II) is the best scoring systemalthough most of the studies were commonly conducted indeveloped countries.Objective To evaluate SNAPPE II as the predictor of neonatalmortality in NICU Hasan Sadikin General Hospital (HSGH)Ban dung.Methods This was a longitudinal observational study. All neonateshospitalized in NICU HSGH during the period of August toNovember 2008 were investigated according to SNAPPE IIrequirements. We excluded subjects admitted more than 48hours of age, who were discharged or moved to intermediatenewborn care ward less than 24 hours after admission. Predictionof mortality and determination of SNAPPE II cut-off point wereanalyzed using logistic regression. Discrimination was analyzedusing receiver operating characteristic (ROC) and calibration wasanalyzed using Hosmer-Lemeshow goodness-of-fit.Results Forty subjects fulfilled the inclusion criteria. There was agood relation between SNAPPE II and mortality prediction (P =0.007). The cut-off point for predicting mortality was 51. SNAPPEII showed good discrimination with AUC 0.933 (95% CI 0.843to 1.0) and good calibration 1.69 (P = 0.97).Conclusion SNAPPE II can be used to predict neonatal mortalityin NICU similar to that found in developed countries.
Academic achievement of elementary school-aged children with pre-anemic iron-deficiency
Authors: Pardede Paul Wiratama , Windiastuti Endang , Tridjaja Bambang
Published: March 2017

Background Relationship between iron deficiency andcognitive function has been investigated in many studies, butthey usually focused on iron deficiency anemia. Brain ironstorage might have already decreased before anemia exist.Objectives To investigate the prevalence of pre-anemic irondeficiencyin school-aged children and to determine whetherthis condition is a risk factor for low academic achievement.Methods A cross-sectional study was conducted on 87 subjectsof znd,6th grade in SDN 04 Petang, Kramat, Senen, Jakartaon August 2008. The subjects underwent peripheral bloodand ferritin serum concentration examinations. Twentyninesubjects who suffered from anemia were excluded. Theremaining 58 subjects were classified into normal body ironstatus group and preanemic iron-deficiency group.Results The prevalence of pre-anemic iron-deficiency in SDN04 Petang, Kramat was 6%. The prevalence ratio to determinewhether pre-anemic iron-deficiency was a risk factor for lowacademic achievement could not be calculated because theminimal sample number required was not reached. There wasno relationship between pre-anemic iron-deficiency and lowacademic achievement for mathematics, Indonesian language,science, and social science.Conclusions The prevalence of pre-anemic iron-deficiency inSDN 04 Petang, Kramat Senen Jakarta was 6%. This studyis not able to determine whether pre-anemic iron-deficiencyis a risk factor for low academic achievement in school-agedchildren; therefore further study with more efforts to detectthe presence of iron deficiency in children with inflammationis needed.
Controlling polio outbreak due to imported wild poliovirus in Indonesia: A success story
Authors: Soedarmo Sumarmo Poorwo , Utoro Sidik
Published: March 2017

Background As a WHO member state, Indonesia is committed toGlobal Polio Eradication. The last indigenous polio case was found in 1995. However, we faced a big challenge with the occurrence of polio outbreak, beginning with a polio case caused by imported wild poliovirus (WPV) type 1 in Sukabumi in 2005. The virus was originated from Sudan and imported to Indonesia through Saudi Arabia. The outbreak ended with totally 305 cases throughout the country. The last one occurred on 20 February 2006 in Aceh Tenggara District, Nanggroe Aceh Darussalam Province. In addition and separated from the WPV type 1 outbreak, in August 2005, four Acute Flaccid Paralysis (AFP) cases with type 1 Vaccine Derived Poliovirus (VDPV) in stool samples were identified in Madura, East Java Province. The first case was on 9 June 2005 and ended with 45 cases in Madura and another case in Probolinggo District, East Jawa.Objective To report a success of controlling outbreak of importedWPV in Indonesia.Methods Outbreak Response Immunization (ORI) and mopup immunization were conducted immediately. To completelystop the transmission, three rounds of National ImmunizationDays (NIDs) were conducted in 2005 (August, September, andNovember). Some more Supplementary Immunization Activities(SIAs) were conducted in 2006 (mop up in January, NIDs inFebruary and early April, mop ups in June and August 2006).For the VDPV outbreak, ORI of 18,880 children in 83 villagestook place during the first week of August, beside three roundsofNIDs in 2005.Results All activities resulted in satisfactorily coverage, whereeach round always exceeded 95%.Conclusions Those activities were conducted successfully andproven to be effective to stop the outbreak. Then again, Indonesia can be a polio free country in the coming years.
Growth velocity in elementary school children with iron deficiency anemia after iron therapy
Authors: Lyfia Dina , Deliana Melda , Hakimi Hakimi , Rosdiana Nelly , Lubis Bidasari
Published: March 2017

Background Iron supplementation in children with iron deficiencyanemia could decrease the incidence of stunting.Objective To study the effect of iron therapy on growth velocityin children with iron deficiency anemia.Methods A randomized clinical trial study was conducted atLabuhan Batu on November 2006 to May 2007. Iron deficiencyanemia was diagnosed if there were anemia, with mean corpuscular hemoglobin concentration <31 %, red cell distribution width index > 220, and Mentzer index> 13. Elementary school children (6-12 year old) with iron deficiency anemia were randomly assigned either to iron therapy group (children were given 6 mg iron/kg/day) or to placebo group for 3 months.Results Among 300 children recruited, there were 125 children,who suffered from iron deficiency anemia. After one month ofiron therapy, means of hemoglobin concentration were 12.4 g/dl in iron group and 11.7 g/dl in placebo group. There was a significant increase of height in iron group (129.9 (SD 7.58) em vs. 132.2 (SD 7.23) em) and in placebo (130.8 (SD 8.78) em vs. 128.7 (SD 8. 79) em), However, no significant difference was found in the mean of growth velocity between placebo and iron groups (2.1 (SD 0.01) em vs. 2.0 (SD 0.9) em.Conclusion There is a significant increase in height, but nosignificant difference between both groups in growth velocity.
Effect of dengue hemorrhagic fever on thrombomodulin level
Authors: Widjaja Hendra , Mantik Max F. J.
Published: March 2017

Background Thrombocyte and endothelial cells play animportant role in dengue hemorrhagic fever pathogenesis.Thrombomodulin is a part of glycoprotein membrane inendothelial cells. Therefore, thrombomodulin level willincrease if endothelial cells disruption occurs.Objective To acknowledge the correlation between thedegree of dengue hemorrhagic fever and thrombomodulinlevel.Methods This was a cross-sectional study. Subjects werehospitalized pediatric patients with age ranging from oneto 13 year old in pediatric ward at Pro£ Dr. R.D. KandouHospital, Manado, who had fever. Three milliliters of bloodwere taken from vein, and were divided for two tests whichwere routine blood analysis and thrombomodulin analysis.Different data resulted from the dengue hemorrhagic fevergroup were processed, and analyzed statistically using F Testand LSD (least significant difference) test. The relationbetween dengue hemorrhagic fever and thrombomodulinwas analyzed with Spearman correlation coefficient.Results There was a significant result in the difference ofthrombomodulin level on four dengue hemorrhagic fevergroups which were classified according to the severity ofdengue hemorrhagic fever. There was a very significantpositive correlation between the severity of denguehemorrhagic fever and thrombomodulin level in detectingendothelial cells impairment.Conclusion Thrombomodulin level can be used as amarker to detect endothelial cells impairment in denguehemorrhagic fever. Higher grade of dengue hemorrhagicfever will have higher thrombomodulin level.
Behavior of elementary schoolchildren with iron deficiency anemia after iron therapy
Authors: Saragih Rina A.C. , Zulaicha T. Mirda , Sofyani Sri , Lubis Bidasari , Lubis Iskandar Z.
Published: March 2017

Background Some studies had been performed to determine theassociation between iron status and children's behavior yet it isstill controversial.Objective To investigate whether iron therapy has an effect onthe behavior of children with iron deficiency anemia (IDA).Method A randomized placebo-controlled clinical trial wasconducted in Labuhan Batu on November 2006-April2007. IDAwas defined as Hb < 12 g/dl, MCHC< 31%, ROW index > 220and Mentzer index> 13. Elementary school children (6-12 yearsold) with IDA were randomly assigned to the treatment groupwith a daily therapy of 6 mg iron/kg/day or placebo group for three months. The subjects' behavior was evaluated with child behavior check list (CBCL) before and six months after intervention.Results After six months, 110 subjects completed the therapy.Scores of CBCL in iron group after intervention were internalizing42.64 (SO 9.95), externalizing 37.13 (SO 9.04) & total score 38.24 (SO 10.20). There was significant decreased on externalizing and total problems score in the treatment group after intervention (P< 0.05). However, there was no significant difference on scores between groups.Conclusion Iron therapy had significantly decrease CBCL scoreon externalizing and total problems in the treatment group,however there was no significant difference on scores if comparedwith placebo group.
Effectiveness of cyproheptadine in the prevention of childhood migraine
Authors: Zulkarnain Zulkarnain , Saing Johannes , Dimyati Yazid , Saing Bistok
Published: March 2017

Background Migraine is one of the causes of recurrent headachein childhood. Cyproheptadine is well known as an antihistamine,but there are few studies revealing the drug's effect in pediatricmigraine.Objective To determine the effectiveness of cyproheptadine in the prophylactic treatment of childhood migraine.Methods A randomized placebo-controlled clinical trial studywas performed at Medan. One hundred children with migraineaccording to the International Headache Society criteria wereincluded in the study. Subjects were divided into two groups, andeach group was given either 4 mg cyproheptadine or placebo for 12 weeks. Headache frequency was measured in headache days per month, duration was measured in hours and functional disability was measured by Pediatric Migraine Disability Assessment (PedMID AS). The efficacy was measured before intervention; also 1, 2, and 3 months after intervention.Results A total of 100 patients, with age ranging from 11 to 18 years old (with mean, 15.5 years), were treated with cyproheptadine or placebo for headache. Compared to baseline, there was a significant difference on PedMIDAS grading of migraines in both groups (P<0.05). Headache frequency and duration per month were significantly different after treatment with cyproheptadine (P=0.009, 95% CI 0.001 to 0.030 and P= 0.029, 95% CI 0.690 to 27.510, RR=4.36), compared to placebo group (P> 0.05), but there were side effects of cyproheptadine up to 73%.Conclusion Cyproheptadine appears to be effective as analternative prophylactic treatment of childhood migraine.However, pediatricians should consider the significant side effectsof this drug.
Effectiveness of lactose-free formula in management of acute rotavirus diarrhea
Authors: Hartawan I. Nyoman Budi , Soenarto S. Yati , Suandi I. K. G.
Published: March 2017

Background Acute rota virus diarrhea causes mucosal destruction, blunted villi, villus shortening, and death of cells. The process also decreases lactose secretion which responsible in lactose absorption. Non-absorbed lactose then causes the progression of osmotic and secretory diarrhea causing delayed recovery. Lactose-free formula may decrease lactose, thus shortened the duration of diarrhea episode.Objective To compare the cure rate and duration of acute rota virus diarrhea in children treated with lactose-free formula and lactose containing formula.Methods A randomized, double-blind controlled trial was performed to infants and children aged 2: 6 to 59 months old with acute rotavirus diarrhea accompanied with mild or moderate dehydration that were admitted to pediatric gastroenterology division. Latex agglutination test was used to detect rota virus. After an appropriate rehydration therapy had been done, they were fed with either lactose-free formula (n = 29) or lactose-containing formula (n = 31). Comparisons between duration of diarrhea, weight gain, and defecation frequency were made. Statistical analysis for comparing the two groups were independent t-test and multivariate analysis (Cox regression). Statistical significant was defined ifF< 0.05 with 95% confidence interval.Results The mean duration of diarrhea in lactose-free formulagroup was 57.59 hours (SD 9.40) and lactose-containing formulawas 85.97 hours (SD 13.94), mean difference was 28.38 hours(SE 3.09) [P = 0.001; (95% CI 22.19 to 34.56)]. Decrease instool frequency was found significantly in the lactose-free formula group. Multivariate analysis (Cox regression) revealed that the intervention was affected significantly.Conclusion Lactose-free formula may shorten the duration of acute rotavirus diarrhea.
Muscular ventricular septal defect closure with Gianturco coil at Soetomo hospital (a case report)
Authors: Utamayasa Alit , Ontoseno Teddy , Rahman Mahrus A , Yoanna Vinny , Herdyanto Rio
Published: March 2017

Ventricular septal defect (VSD) is the mostcommon congenital heart disease (CHD)in children.1'2 It occurs in 1.5 to 3.5 of1,000 live births and constitutes 20% ofcongenital cardiac defects.1 The VSD may be small,medium or large and is classified based on its locationin the interventricular septum. There are four types ofVSD, i.e., perimembranous (80% ofVSDs), musculartype (5% to 20%) inlet or AV canal type (8%), andfinally, subpulmonary (5% to 7%).1-4 When multiplemuscular defects are seen, it is often referred to as"Swiss-cheese" type of VSD. 1•2The management strategies, which consist ofmedical, surgical and intervention techniques, depend toa large degree on the size of the VSD.1-4 Approximately40% of VSDs spontaneously and completely closed,with closure rates approaching 80-90% by age 2 years.2Indication ofVSD closure are symptoms of heart failure,left heart chambers overload and history of endocarditis.The surgical approach is considered gold standard butit is associated with morbidity and mortality, high cost,patient discomfort, sternostomy and skin scar.3 Since1988, percutaneous techniques have been conductedin order to reduce those drawbacks of surgery. Morerecently, percutaneous techniques and devices havebeen developed specifically for closure of muscularVSD (m VSD) and perimembranous VSD (pm VSD)using either the Rashkind double umbrella, the BardClamshell, the Button device, theAmplatzer septal, duct118 • Paediatr lrulones, Vol. 50, No. 2, March 2010or muscular VSD occluder, or the Gianturco coils.3AGianturco coils have been widely used to closeunwanted vascular communications and small- tomoderate- sized patent ductus arteriosus, withexcellent closure rates. In 1999, Latiff et al successfullyused this coil to close multiple muscular VSDs in a10-month old boy. Thus, percutaneuos closure ofVSDs using Gianturco coils is a feasible, reasonablealternative to surgery.5'6 We report a case of fouryear-old girl with muscular VSD who underwentcardiac catheterization and transcatheter closure withGianturo coil in Dr. Soetomo Hospital, Surabaya.
Risk factors for non-optimal breastfeeding practices in low birth weight infants
Authors: Haksari Ekawaty L , Wandita Setya , Yustivani Yustivani
Published: March 2017

Background Low birth weight infants are ongoing problems sincethey are likely to have high risks of morbidity, mortality andfeeding problems. American Academy of Pediatrics recommendsbreastfeeding practice for infants with low birth weight, yet someproblems have occured.Objective To determine risk factors for non-optimal breastfeedingpractices in low birth weight infants.Methods In this historical cohort study we included mothers with6-month-old infants, single birth with weight of2000-2499 gramsand the pregnancy period of 2:: 34 weeks, and excluded motherswith infants who had a major congenital disorder, labioschizis,labiognatopalatoschizis, or history of admission in NICU. Datawere collected using standard longitudinal surveillance form forbreastfeeding mothers. Analyses were performed using chi-squaretest and logistic regression.Results The percentage of low birth weight infants breastfedoptimally were 42.7%. Working mothers presented the highestrisk for non-optimal breastfeeding. The onset of lactation formore than 6 hours was the second factor (81.8%). The resultsof multivariate logistic regression analysis showed that motherswho worked (RR 2.79; 95% CI 1.84 to 4.23) and onset lactationof more than 6 hours (RR 2.34; 95% CI 1.57 to 3.50) were therisk factors for non-optimal breastfeeding practices in low birthweight infants.Conclusion Mother's working status and onset of lactationfor more than 6 hours were the risk factors for non-optimalbreastfeeding in low birth weight infants.
Obesity in children with frequent relapse and steroid dependent nephrotic syndrome
Authors: Vidianty Jeanne , Pardede Sudung O. , Hendarto Aryono , Akib Arwin A. P.
Published: March 2017

Background Children \\lith frequent relapse and steroid dependent nephrotic syndrome (FRNS/SDNS) will experience frequent relapse v.ith many complications due to the disease and toxicity of steroid therapy. One of the most common complications is obesity which is associated \\lith significant health problems in childhood and important risk factor of adult morbidity and mortality. Objective To find out the prevalence of obesity in children 'With FRNS/SDNS.Methods A cross sectional study was conducted from November 2008 until March 2009. Data were collected from the medical records of children 'With FRNS/SDNS treated during the period of 2000-2008. Body weight, height and body fat mass measurement was performed on the subjects. The diagnosis of obesity was based on body mass index (BMI) and body fat mass measurement.Results Obesity was diagnosed in 10 of 43 children (23%). Most of them were 5􀀼9 years old (58%) 'With male􀀼predominance. Most patients (70%) had age of onset younger than 5 years. The median of total relapse was 7 (range 2􀀼24) and cumulative dose of prednisone was 12,240 (range 3,490 to 44,330) mg. Time since the last dose of prednisone until the study in majority was 0 to 6 months (53%). The prevalence of obesity based on BMI was 7%while based on body fat mass was 23 (el 95% 10 to 36) %. Conclusion The prevalence of obesity based on body fat mass was 23%. The median BMI of obese subjects is in the 90-95th percentile.
Relationship between obesity and leptin serum among low socioeconomic primary school children aged 5-7 years
Authors: Soenarto Soenarto , Sendow-Tangkilisan Helena Anneke
Published: March 2017

Background Obesity has become a major health problem globally, indicates as an epidemic problem by World Health Organization (WHO). Adiposity rebound period may represent critical period for the development of adiposity. Recent data suggest that, in industrialized countries, people of low socioeconomic group are more likely to be obese than their high socioeconomic counterparts. Level of serum leptin was reported to be higher in obese subjects. There has been lack of data regarding leptin serum level in Indonesian obese children.Objective This study aimed to investigate leptin serum level in low socioeconomic obese children. Methods This was a cross sectional study perfonned in Tuminting District, Manado. Obesity was defined based on body mass index for Asia􀁇Pacific condition, i.e., grade I obesity (BMI 25/29.9 kg/ mL), grade II (BM] 30-40 kg/ml), and grade III (BM] > 40 kg/m2 Low socioeconomic status was detennined based on Government's program Cash Direct Aid Program. loBod sample was obtained from inclusion subjects, consisted of leptin serum.Results Fifty􀁇two low socioeconomic obese children were eligible \\lith age ranged between 5 to 7 years. They were divided into grade ] obesity (43 or 82.7%), and grade II (9 or 17.3%). The lowest leptin blood level was 10,291 pg/mL, while the highest was 41,500 pg/dL. All girls had nonnal serum leptin level; in contrast all boys had increased serum leptin level. Conclusions Leprin level increased in those subjects whose BMI increased.
Sleep patterns in 1 to 36 month-old children
Authors: Sambo Catharina , Sekartini Rini , Trihono Partini
Published: March 2017

Background Better understanding about sleep patterns inIndonesian children can contribute to basic knowledge foreducating parents and health providers about good sleephygiene.Objectives To find out sleep patterns in 1􀁊36 month􀁊oldchildren.Method A descriptive, cross􀁊sectional study was held in EastJakarta on May 2009. Subjects were 1 to 36 months old childrenwho came \\lith their parents or primary caregivers. Data collectionwas performed using modified Brief Infant Sleep Questionnaire(BISQ), consisted of subjects' characteristics, sleep patterns, sleepproblems, and associating factors.Results Among 147 children, sleep problems were identified in33.3% of them. Bedtime was mostly at 8 p.m., wake up time was5 a.m. Median time needed to fall asleep was 20 minutes. Averagefrequency of night waking was twice during one night. Mediannight waking duration was 15 minutes. Median sleep duration atnight was 9 hours 20 minutes, and median nap duration was 2hours 20 minutes. Median total sleep time was 12 hours. Pronesleeping position was significantly associated \\lith sleep problems(p􀁋0.036, RR􀁋1.67, 95%CI􀁋1.66-2.64).Conclusions Prevalence of sleep problem is 33.3%, \\lith awakeningat night was being the most occurring problem. Prone sleepingposition is associated \\lith sleep problems. [Paediatr Indones.2010;50:170-5].
Pediatric Logistic Organ Dysfunction (PELOD) Score as prognosis of multiple organ failure in sepsis
Authors: Hendra Hendra , Runtunuwu Ari Lukas , Manoppo Jeanette Irene Chistie
Published: March 2017

Background Sepsis is an emergency event that often found inpediatric intensive care unit. If this condition is not early detectedand promptly treated, severe complications including septic shockand multiple organ failure may result that can end up as death.Objective To discover alternative measurement as a prognosis ofmultiple organ failure in sepsis.Methods This cross sectional study was conducted in 37 patientsdiagnosed as sepsis. The age of the patients were 1 month until 13years and the patients were hospitalized in child health departmentof R. D. Kandou Hospital during June 2009 – September 2009.Result Bronchopneumonia (18) was the most commoninfection source, followed by gastroenteritis (11), encephalitis(6) and meningitis (2). The bacteria which is found was Proteusmirabilis (5), Citrobacter difersus (5), Staphylococcus aureus (3),Escherichia coli (2) and Acinetobacter baumannii (1). There wasno significant difference in gender distribution, nutrition statusand blood culture between both groups. Laboratory findings andclinical manifestations which included white blood cell (WBC)> 10.000/μL (34), platelet count > 150.000 (27) and bodytemperature 38oC – 39oC (20). There was a correlation betweenPELOD score and multiple organ failure (P=0.02). A higherPELOD score will increase opportunity to get multiple organfailure. In patient with organ failure more than two, PELODscore 0-10 (9 patients), score 11-20 (7 patients), score 21-30 (8patients), and score 31-40 (1 patient).Conclusion There was a correlation between PELOD score andmultiple organ failure in patient with sepsis. A higher PELODscore will increase opportunity to get multiple organ failure.
The management of vesicoureteral reflux in children
Authors: Akbar Nurul , Rodjani Arry
Published: March 2017

Vesicoureteral reflux (VUR) is defined as retrograde flow of urine from the bladder to the ureter.  It is usually asymptomatic but commonly found in children with urinary tract infection (UTI). The prevalence is about 1-2% in general pediatric population.1 However, the prevalence in children with UTI is much higher, reaching 30-57%.1,2 Similar prevalence (45.8%) is also reported in CiptoMangunkusumo Hospital. 3
Predicting hypertension using waist circumference in obese Indonesian adolescents
Authors: Alamanda Elvietha , Prawirohartono Endy Paryanto , Mulyani Nenny Sri
Published: March 2017

Background Increasing prevalence of pediatric obesity and hypertension demonstrate the urgent need for early intervention. Waist circumference (WC) provides a measurement of central obesity, which has been specifically associated with cardiovascular risk factor including hypertension.Objectives To identify the optimal cut􀀹off point of we in predicting hypertension in obese adolescents.Methods We randomly recruited 115 adolescents aged 12-17 years from schools in Yogyakarta, Central Java, Indonesia. We measured height, weight, WC, and blood pressure in 109 subjects. Optimum WC cut-offs to predict hypertension were determined using receiver-operating characteristic (ROC).Results The optimum WC cut off point to predict any hypertension in adolescents was at the 88.95 cm with 97.8% sensitivity and 47.3% specificity. Age􀀹specific cut􀀹off points for subjects < 15 year old was 90.1 cm with 91.7% sensitivity and 58%specificity, and for subjects 2: 15 year old was 103.5 cm with 75% sensitivity and 88% specificity.Conclusions Waist circumference can be used to predict hypertension in obese adolescents with fair sensitivity and specificity. Waist circumference values associated with hypertension in adolescents vary with age and ethnicity.
Accuracy of modified simple pediatric nutritional risk score to detect in-hospital malnutrition
Authors: Nesal Ni Nyoman Metriani , Sidiartha Gusti Lanang , Prawirohartono Endy Paryanto , Suandi Kompiang Gede
Published: March 2017

Background In-hospital malnutrition is malnutrition that occurs during hospitalization. Approximately 70% patients with in-hospital malnutrition are not identified. Only few nutritional screening tools are widely used among children , one of those is the modified risk score.Objective To determine cutoff point and accuracy of risk scores using the modified simple nutritional risk score to detect in-hospital malnutrition.Methods A diagnostic study on 1 month-12 year old children hospitalized at Sanglah Hospital Denpasar was conducted between September-December 2008. The subjects were collected using consecutive sampling method and were assessed using the modified simple pediatric nutritional risk score. In􀀿hospital malnutrition was defined days), 5% (length of stay 8-30 days), or 10% (length of stay >30 days). The statistical analyses done were sensitivity, specificity, positive/negative predictive value (PPV /NPV), positive/negative likelihood ratio (PLR/NLR), and post-test probability.Results This study recruited 310 children. Based on ROC curve, the cutoff point \\lith combination of the highest sensitivity and spesificity the sensitivity was 79%, spesificity was 92%, positive likelihood ratios was 2.71, negative likelihood ratio was 0.29 , and post test probality was 47%.Conclusion The modified simple pediatric nutritional risk score can be used as a screening tool to detect in􀀿hospital malnutrition.
Procalcitonin levels in children aged 3-36 months with suspected serious bacterial infection
Authors: Herawaty Tuty , Tumbelaka Alan R. , Widodo Dwi Putro , Trihono Partini Pudjiastuti , Setyanto Darmawan B. , Yanuarso Piprim B.
Published: March 2017

Background Fever in children aged 3-36 months is usually caused by viral infection, however, 11-20% of cases may progress into serious bacterial infection (SBI). A good diagnostic tool is required to detect SBI to reduce mortality and avoid unnecessary use of antibiotics.Objectives To determine procaldtonin (peT) levels, and etiology of bacteremia in febrile children aged 3-36 months old with suspected SBI.Methods A cross-sectional descriptive study was conducted in Cipto Mangunkusumo and Tangerang General Hospital during April-May 2010. Complete blood cells count and acute illness observation score (AIOS) were perfonned on febrile children aged 3-36 months. Subjects meeting the inclusion criteria underwent blood culturing and testing of procalcitonin levels.Results There were 39 children met the criteria. Boys and girls ratio was 1.6 Mth median age of 10 months. Mean of AlOS was 20.5 (4.5 SD) and mean of hemoglobin was 10.2 (SD 2.1) g/dL. Median of leukocyte and absolute neutrophyl count were 18,600/uL and 12,300/uL, respectively. Median of procaldtonin 1.8 (range 0.04-71.60) ng/mL, mean of procalc itonin in bacteremia subgroup 22.60 (SD 27.6) ng/mL and 6.38 in non-bacteremia subgroup (11.0 SB) ng/mL. In children with severely ill appearance, the likelihood of procaldtonin levels ≥2 ng/mL was 8.67 times higher (95%CI 1.66 to 50.56) than in moderately or mildly ill-appearing children. In subjects Mth procalcitonin level of ≥2 ng/mL, the risk of bacteremia was 8.1 times (95% CI 2.9 to 1051.6) higher and the risk of sepsis was 55.47 times higher than in subjects Mth procalcitonin <2 ng/mL (95% CI 1.22 to 68.02). We observed bacteriemia in 11 of 39 subjects (28.2%). The pathogens isolated from these 11 subjects were Klebsiella pneumonia, Staphylococcus aureus, Eschericia coli, Serratia marcesens, Staphylococrus saprophyticus, and Serratia liqueafaciens.Conclusion The proportion of bacteremia in children aged 3-36 months old with suspected serious bacterial infection was 28.2% with no predominant microorganism. Elevated procaldtonin level of ≥ 2 ng/mL was assodated with severe illness apppearance, bacteremia, and sepsis.
Influence of Hepatitis B immunization to prevent vertical transmission of Hep-B virus in infants bam from Hep-B positive mother
Authors: Fitria Liza , Gunardi Hartono , Akib Arwin A. P.
Published: March 2017

Background Hepatitis B is one of the most common infectious diseases worldv.ide. Indonesia has moderate-high endemicity for hepatitis B infection. Perinatal transmission increases the risk for chronic hepatitis B. Infants from HBsAg-positive mothers should receive hepatitis B immunoglobulin (HBIG) and vaccination within 12 hours of birth, but this practice is not routinely done in Indonesia due to financial constraints.Objectives To detennine the influence of Hep-B immunization on preventing Hepatitis B vertical transmission. Methods A descriptive cohort study was conducted from May 2009 - January 2010. Subjects were term infants born from HBsAg-positive mothers v.ith no history of HBIG administration. They had received complete hepatitis B immunization and 1 month after the last dose were evaluated for HBsAg and anti-HBs. Cord blood was also taken during labor to measure HBsAg.Results There were 22 infants born from HBsAg-positive mother who met the inclusion criteria. HBsAgwas positive in 6 of22 cord blood specimens. There were 15 infants who completed this study. One of 15 infants had positive HBsAg after completed hepatitis B immunization and 12 of 15 infants had protective level of anti-HBs. Effectiveness of hepatitis B immunization to prevent vertical transmission in this study was 70-90%.Conclusion Hepatitis B immunization can prevent vertical transmission of hepatitis B in infants born to mothers who are HBsAg-positive even without administration of HBIG.
Knowledge of pediatrician on gastroesophageal reflux/gastroesophageal reflux disease in children: a preliminary study
Authors: Surjono Edward , Firmansyah Agus , Batubara Jose R. L.
Published: March 2017

Background Gastroesophageal reflux (OER) is involuntary movement of gastric content into esophagus due to transient lower esophageal sphincter relaxation. This condition usually ignored by physician. Many GER cases have severe complication before properly managed. Ten years after incorporating GER into Indonesia pediatric training curriculum, the knowledge of GER among pediatrician need to be measured.Objectives To measure pediatrician's knowledge of GER/GERD in children.Methods This was a cross sectional study using questionnaire and interview.Result There were 387 respondents who filled the questionnaire and being interviewed. The majority of respondents were between 25-45 years old (33.6%). Respondents who graduated before the year 2000 were 48.3%, and after 2000 were 51.7%. Majority of respondents were general pediatrician (90.2%) and 41.3% working in teaching hospitals Among pediatricians graduated after year 2000,6 6%,5 0.5% and 57.5% could gave more than 80% correct answer to questions about general knowledge, diagnosis and management of GERD as compared to 49.2%, 42.2% and 47% subjects graduated before year 2000. More pediatricians graduated before year 2000 answered the questions on general knowledge, diagnosis and management < 60% correctly compared to those graduated after year 2000 (42.2%, 25.2% and 28.3% vs. 14%,11.5% and 12%, respectively). Fifty five of 160 (34.4%) respondents who working in teaching hospital gave more than 80% correct answer to questions about GERD. Compared to those working in non-teaching hospitals, only 17.6% were able to correctly answer more than 80% of questions.Conclusions Better knowledge about GER/GERD are found among pediatricians graduated after the topics has been introduced to the curriculum and among those practicing in teaching hospitals.
Gastroesophageal reflux disease with Thal fundoplication
Authors: Effendi Irwan , Jurnalis Yusri Dianne , Sayoeti Yorva , Yusuf Yusirwan
Published: March 2017

Gastroesophageal reflux (GER) is a common phenomenon among heathy infants, with approximately 50% of infants aged 0 to 3 months and 67% of infants aged 4 months experiencing at least one episode of vomiting per day. GER defined as regurgitation of gastric contents into the esophagus or mouth. GER typically improves through the first postnatal year, with only 5% of healthy 12 month old infants experiencing vomiting.1,2 Complicated GER or gastroesophageal reflux disease (GERD) has been reported to affect up to 8% of infants and children with GER.l,3 Antireflux procedures (ARPs) are increasingly offered to control GERD symptoms. We report a case of a baby with GERD and treated with ThaI fundoplication procedures. Fundoplication procedure is rarely performed in management of GERD, and this is the first fundoplication procedure in children with GERD at M. Djamil Hospital.
Comparison of zinc-probiotic combination therapy to zinc therapy alone in reducing the severity of acute diarrhea
Authors: Hatta Muhammad , Supriatmo Supriatmo , Ali Muhammad , Sinuhaji Atan Baas , Hasibuan Berlian , Nasution Fera Luna
Published: March 2017

Background Although the incidence of diarrhea in Indonesia has declined in the last five years, the mortality rate in children under five years old is still high. Therefore, appropriate and comprehensive management of diarrhea is essential. There have been many studies on the role of zinc therapy and probiotic therapy in reducing the severity of acute diarrhea, but not many studies have compared the use of a combination of the two therapies tozinc therapy alone.Objective To compare the efficacy of zinc-probiotic combination therapy to zinc alone in reducing the severity of acute diarrhea.Methods We conducted a randomized, open-label, controlled trial from July 2009 to January 2010 in Adam Malik Hospital and Pirngadi Hospital, Medan. Children aged between 1 month and 5 years who met the criteria were divided into two groups. Group I received zinc sulphate (aged <6 months: 10 mg/day; aged 2:6 months: 20 mg/day) combined with heat-killed Lactobacillus acidophilus (3x101O CFU/day) for 10 days. Group II received only zinc sulphate at the same dosage as group I. Measurement of disease severity was based on the frequency of diarrhea (times/day) and the duration of diarrhea (hours) after initial drug consumption.Results Eighty subjects were enrolled, randomised, and divided equally into two groups. 40 children received zinc-probiotic in combination (group I) and the remainder (group II) received zinc alone. We observed significant differences in frequency of diarrhea (2.1 vs 3.1 times/day, P=0.001, 95%CI -1.62 to -0.49), and duration of diarrhea (52.1 vs. 72.6 hours, P=0.00l, 95%CI -30.91 to -10.18) in the two groups.Conclusion Combination of zinc-probiotic therapy was more effective in reducing the severity of acute diarrhea than zinc therapy alone in children under five years of age.
The correlation between leptin and highly sensitive C-reactive protein levels in obese children aged 9-15 years
Authors: Warouw Sarah M. , As'ad Suryani , Satriono Satriono
Published: March 2017

Background Obesity is a low level and chronic inflammatory condition predominantly affecting white adipose tissue, where macrophage infiltration is found. Leptin is one of many molecules relating obesity to cardiovascular disease. Leptin can increase cytokine production in macrophages and monocytes, and increase oxidative stress on endothelial cells. Pro-inflammatory cytokines, in turn, may trigger the release of C-reactive protein.Objective To examine the correlation between leptin and hsCRP in obese children aged 9-15 years.Methods This cross-sectional study was done in Manado from May to December 2009, on elementary and junior high school children. Subjects were obese children aged 9-15 years, with nutritional status detennined by Body Mass Index and converted into z-score. Physical examination, blood pressure, and blood examinations for  fasting blood sugar (FBS), lipid profile, leptin, and hsCRP were perfonned. Data were analyzed with appropriate statistical methods.Results The mean leptin level in obese children was 34,009.2 pgiL (SD 18,224.79), higher than that of the control, 7,760.9 pgiL (SD 8,859.55) (P<0.0001). The mean hsCRP level in obese children was 3.6 mgiL (SD 3.60), higher than that of the control, 0.7 mgiL (SD 1.32) (<0.0001). There was a significant positive correlation between leptin and hsCRP levels in obese children (r 􀀁 0.355; P<0.0001).Conclusions There is significant positive correlation between leptin and hsCRP levels in obese children aged 9-15 years. Increased leptin and hsCRP levels indicate a low degree of chronic inflammation. Thus, intervention is needed to decrease the body weight of obese children.
Signet ring cell carcinoma of the colon in a 10 year-old boy
Authors: Irene Irene , Ariawati Ketut
Published: March 2017

Signet ring cell carcinoma (SRCC), a variant of adenocarcinoma, is defined by the presence of more than 50% of tumor cells with prominent intracytoplasmic mucin.1 Primary gastrointestinal malignancies constitute only 1% of pediatric neoplasms and 0.34% take the form of colon carcinoma. It is a very rare disease in persons under 17 years of age, 94% of which is found in children> 9 years of age. [.4 In contrast to adults, approximately50% of colon carcinoma cases in children are the highly malignant mucin'producing adenocarcinoma type.4 The typical signet-ring cell has a large mucin vacuole that fills the cytoplasm and pushes the nuclei to the side, thereby giving the cells their signature histologic appearance.S,6 Carcinoma of the colon during childhood has been associated with familialpolyposis and ulcerative colitis. However, carcinoma arising de novo is the most common type.2,3 Risk factors include a high caloric diet rich in animal fat, sedentary lifestyle, smoking, alcohol consumption, low vegetable fibre consumption, chronic inflammatory bowel disease, ulcerative colitis, Crohn's disease, and polymorphism in key enzymes of injurious compounds.s
Some aspects of thyroid dysfunction in thalassemia major patients with severe iron overload
Authors: Rindang Cynthia , Batubara Jose R. L. , Amalia Pustika , Satari Hindra
Published: March 2017

Background Severe iron overload due to recurrent transfusions for chronic anemia and inadequate iron chelation therapy in thalassemia major patients result in various complications, including hypothyroidism. Currently, there has been no data on the prevalence of hypothyroidism in thalassemia major patients at the Thalassemia Centers, Department of Child Health, CiptoMangunkusumo Hospital (DCH CMH).Objective To study the prevalence of primary hypothyroidism in thalassemia major patients in the Thalassemia Center, DCH MCH.Methods We performed a cross-sectional, descriptive study. All thalassemia major subjects aged O􀁬18 years with severe iron overload underwent thyroid functionexamination. Primary hypothyroidism was defined as either normal (compensated) or decreased (decompensated) free T4 (FT4) levels, along with elevated sensitive thyroid􀁬stimulatinghonnone (TSH)levels. Results 179 subjects enrolled this study Mth male: female ratio of 1: 1.6. The prevalence of primary hypothyroidism in thalassemia majorpatients Mth severe iron overloadws26.8% (48/179). Of those 48,45 had compensated hypothyroidism and 3 had decompensated hypothyroidism, 25.1% and 1.7% of the total subjects, respectively. Compensated hypothyroidism was observed in 17 subjects aged ≤1O years and in 28 subjects aged> 10 years. All 3 decompensated hypothyroidism cases were> 10 years of age. No relationship was found between the occurrence of primary hypothyroidism and mean pre-tr811sfusion Hb levels (P=0.481, OR 1.30; 95% CI 0.63 to 2.68), elevated serum ferritin levels (P=0.74, OR 0.89; 95% CI 0.46 to 1.75), and compliance to iron chelation therapy (P=0.570, OR 0.76; 95% CI 035 to 1.65). Based on multivariate analysis, only age of <10 year-old (P=O.029, OR 0.469; 95% CI 0.23 to 0.93) was significantly associated Mth primary hypJthyroidism. Further analysis using receiver operator curve (ROC) technique found that age of 8.5 year-old was the cutoff value to predict the risk of hypothyroidism. Conclusion The prevalence of primary hypothyroidism in our study is high. The occurrence of hypothyroidism is associated with age.
Properties of endotracheal tubes reprocessed by two procedures
Authors: Elisa Elisa , Purwanto S. H. , Aman A. T. , Pranoto Y. , Kusmono Kusmono
Published: March 2017

Background Reusing endotracheal tubes (EITs) has been performed in Indonesia with no evidence of its safety. Objective To evaluate sterility, as well as the mechanical, surface, and matrix properties of reused EITs following 2 different reprocessing procedures.Methods Reused EITs were cleaned and disinfected, then sterilized by ethylene oxide gas sterilization (group A) or dry heat sterilization (group B). New EITs were used as the standard for comparison. Microbes were identified and microbial counts were determined as colony forming units (CFUs). Evaluation of mechanical properties was perfonned by a Universal Testing machine. All samples underwent tensile and compression tests.Load defonnation curves were recorded from F max and strain at F max. Microstructure analysis was done using X􀁅ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX).Results Positive cultures of commensal bacteria were found in 2/12 samples in group A, and 5/17 samples in group B. T here was no statistically significant difference between them (P =0.07). Pseudomonas aeruginosa or other common pathogens were not found. Samples from both groups showed equal flaccidity, compared to the standard. Surface microstructure analysis of reused EITs 'With XPS and EDX showed degradation of the matrixcomponent. SEM analysis detected some large particles and fissures. EDX analysis on the large particles detected sodium and calcium signals. Altogether, signs of contamination and material damage were very strong.Conclusion Both reprocessing methods of reused EITs gave comparable results on sterility and mechanical behavior, but reprocessing may cause decreased surface and matrix quality.
Clinical manifestations in semilobar holoprosencephaly
Authors: Elisa Elisa , Putranti A. H. , Mulyono E.
Published: March 2017

Holoprosencephaly (HPE) is a brain malformation caused by a primary defect in induction and patterning of the rostral neurotube (basal forebrain) during the first 4 weeks of embryogenesis. T his defect results in incomplete separation of the cerebral hemispheres.Based on the degree of hemispheric nonseparation, HPE traditionally has been classified into three types: alobar, semilobar, and lobar.! In 1963, DeMyer et al. mentioned that defects in brain development may frequently coexist with abnormalities on the midfacial region. T he median facio-cerebral anomalies appear in various associated gradations and combinations.When combined in patterns, these facies always predict a severe, highly characteristic brain anomaly.2
Using iron profiles to identify anemia of chronic disease in anemic children with tuberculosis
Authors: Wigati Reni , Windiastuti Endang , Hegar Badriul
Published: March 2017

Background Anemia of chronic disease (ACD) is commonly found in patients with chronic inflammation or infection. By examining soluble transferrin receptor or bone marrow iron, ACD was found in 80% of anemic adult tuberculosis (TB) patients. Iron profile, another tool to differentiate ACD from iron deficiency anemia (IDA), is both less expensive and less invasive. Few studies have been reported on iron profiles of anemic children with TB in Indonesia.Objective We aimed to use iron profiles to determine the proportion of ACD in anemic children with tuberculosis.Methods A cross-sectional study on anemic children with TB who came to Cipto Mangunkusumo Hospital and Tebet Puskesmas (community health center) was performed in September-November 2010. Iron profiles included the measurements of serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TF), and serum ferritin (SF).Results Our study comprised of 66 subjects, with a median age of 3.8 years (6 months–18 years). Most subjects had normal SI (85%), normal TIBC (71%), low transferrin saturation (51%), and normal SF (71%). Only 10 children had iron homeostasis disorder and 6 of these were diagnosed as having ACD. Thus, iron profiles failed to prove that iron metabolism was disturbed. The profile of children with organ-specific TB was more consistent with ACD compared to the profile of childhood TB. [SI 29.1 (11-83) vs 44 (10-151) μg/dL; TIBC 239.3 (100.80) vs 299.0 (58.51) μg/dL; TF 18.3 (4-100) vs 15 (1-53) %; and SF 154 (34.9-655) vs 36.1 (2.5-213.4) μg/L].Conclusion The proportion of ACD (9%) diagnosed by using iron profiles was not as high as previously reported. Further research using newer techniques is needed to detect ACD in anemic children with TB. [