bluuebunny/crossref_metadata_2025 huggingface dataset:
Autoimmune hemolytic anemia warm-antibody type (Warm AIHA) in an 8-year-old Balinese girl
Authors: Yasa Putu Tri , Mudita Ida Bagus , Santoso Hendra , Suraatmadja Sudaryat
Published: March 2017

A case of autoimmune hemolytic anemia warm antibody type A (warm AIHA) in an 8-year-old Balinese girl was reported. The diagnosis was established based on clinical features, laboratory findings including positive Coombs'  test positive. The etiology was probably primary or Idiopathic. The child was transfused with packed red cells and treated with oral prednisone. The response of the treatment was good and she experienced complete remission. The prognosis in patients with idiopathic warm AIHA are unpredictable. The girl underwent further follow-up in the child hematologic division every two weeks.
The association of neonatal jaundice and breast-feeding
Authors: Suradi Rulina , Situmeang Esther H. , Tambunan Taralan
Published: March 2017

To examine the prevalence of jaundice in neonates and its association with breast-feeding, we studied 100healthy breast-fed baby boys during the first 3 - 5 days after birth, delivered in Dr. Cipto Mangunkusumo Hospital. This wasan analytical, cross-sectional study performed prospectively. The study was conducted from April, 1, 1999 to October 15,1999. Jaundice was detected in 94 out of 100 infants (94%). Breast-feeding jaundice was encountered in 26 infants (28%)namely infants whose bilirubin levels was >12 mg/dL by day 3 (CI 95% : 19;37%). Most infants showed bilirubin levels on daytwo, three and five of 6 – 10 mg/dL (62%), 6 – 10 mg/dL (35%) and 12 – 15 mg/dL (34%), respectively. Several factors foundto be contributing to the occurrence of breast-feeding jaundice included : a. breast-feeding frequency (r :- 0.83, p < 0.01), b.mean breast-feeding duration : infants breast-fed for more than 30 minutes have consequences its breast-feeding frequencywas less in compared with those breast-fed in less than 30 minutes. c. time of meconium passage (p< 0.05), meconiumpassage in the first hours after birth played an important part in reducing enterohepatic circulation, d. fecal weight (r =-0.87,p < 0.01), feces retained in the intestine its bilirubin would be deconjugated and reabsorbed subsequently . e. weight loss (p< 0.05). In 11 infants who received blue light therapy there were no abnormalities both in physical and laboratory examinations.
Peak expiratory flow rate of primary school children in high and low air pollution level areas
Authors: Hasibuan Ismart Edy , Supriatmo M Nur , Faisal A , Panggabean Gabriel , Daulay Ridwan M , Siregar Zakaria , Lubis Helmi M
Published: March 2017

Background Chronic inhalation of air pollutants may causebronchoconstriction, bronchiolitis, and edema of airway, thus alterlung volume. To measure the lung volume, a simple lung functiontest, the peak expiratory flow rate (PEFR), can provide a feature oflung volume in liters/minute.Objective The purpose of this study was to measure PEFR val-ues of primary school children in a high air pollution level area(Medan) and compare the results with the PEFR values of those ina low air pollution level area (Tebing Tinggi).Methods A cross sectional study was conducted on primary schoolchildren (10-12 years of age) during May-July 2000 in Medan andTebing Tinggi. Data were obtained by questionnaires. Physical ex-amination included age, sex, height, weight, and PEFR value. PEFRvalues were measured by Mini Wright peak expiratory flow meter(MPFM) from three blows. The highest volume was taken as thePEFR value. Statistical analysis was done by t-test and p<0.05was considered significant.Results There were 212 primary school children eligible for thisstudy; 107 came from the high air pollution level area and 105from the low air pollution level area. The PEFR values did not dif-fer significantly between the two groups (p>0.05)Conclusion PEFR values in a high air population level area werenot statistically different compared with those in low air pollutionlevel area
Study of blood pressure in elementary school children at hill and seashore areas
Authors: Ariani Ani , Lisma T Erna , Lubis Iskandar Z , Ramayati Rafita , Rusdidjas Rusdidjas
Published: March 2017

Background Measurement of blood pressure is the most impor-tant tool for early detection of hypertension. There is an assump-tion that salt consumption of the population living at the seashoreis higher than that of those living on the hill area, and it would leadto higher blood pressure.Objective To find out whether there is any difference of bloodpressure between school-age children (6-13 years) living on thehill area (Brastagi subdistrict) and those living at the seashore area(Pantai Cermin sub district), North Sumatra.Methods A cross sectional study was conducted in Brastagi andPantai Cermin from September to October 1995. The subjects weretaken by a simple random sampling method. The blood pressurewas measured based on recommendation of The Second TaskForce on Blood Pressure Control in Children 1987.Results The means systolic pressure in boys of 6 years of age aswell as in girls of 6,8,12 and 13 years, and the means of diastolicpressure in girls of 6,7,8,11 years were higher in Pantai Cermin(p<0.05). Blood pressure had significant positive correlations(p<0.001) with age, weight and height in both areas. Overall, hy-pertension was found in 117 (11%) out of 1065 children, 11.6%among girls and 10.6% among boys. On the hill and at seashorearea, hypertension was found in 10.2% and 11.8% of children re-spectively, which was not statistically different (p>0.05).Conclusion In children, there was no significant difference be-tween the prevalence of hypertension on hill and seashore area
Lactose malabsorption in junior high school children
Authors: Budiarso Aswitha D. , Sofia Deny , Hadinegoro Sri Rezeki S , Hegar Badriul
Published: March 2017

Background The prevalence of lactose malabsorption varieswidely throughout the world. Only people of Caucasian geneticbackground continue to produce high amount of lactase throughoutadulthood. Previous studies in Indonesia revealed that theprevalence of lactose malabsorption was 21-58% in children aged3-11 years.Objective To determine the prevalence of lactose malabsorptionin the older age group and whether a change in milk drinking habitcan affect it.Methods A cross sectional descriptive study was conducted on98 children aged between 12 and 14 years (junior high school) inJakarta. Lactose malabsorption was evaluated with LactometerBreath Hydrogen Test (Hoek Loes, Amsterdam). Milk drinking habitwas recorded, and drinking at least 1 glass of milk everyday since6 months or more before the study was considered as regular milkdrinking.Results This study showed 73% of the children had lactose malabsorption.Regular milk drinking habit was found in 32 (33%) childrenand lactose malabsorption occurred in 26. From 66 childrenwho were irregular milk drinkers, lactose malabsorption was foundin 46 (70%). Lactose intolerance was about the same in both groups.Conclusion There was an increasing prevalence of lactose malabsorptionin older children. Milk drinking habit is a major concernto review the practical implications of lactose malabsorption.
Intracranial hemorrhage in hemorrhagic disease of the newborn
Authors: Mangunatmadja Irawan , Sundariningrum Rina W , Pusponegoro Hardiono D , Windiastuti Endang
Published: March 2017

Background Hemorrhagic disease of the newborn (HDN) repre-sents a special case of vitamin K deficiency because the four vita-min K-coagulation factors (factors II,VII,IX,X) are already at physi-ologically low levels in the newborn. It responds to vitamin Ktherapy.Objective The aim of this study was to review the incidence, clini-cal manifestation, and outcome of HDN.Methods This was a retrospective cross sectional study on 22patients hospitalized for HDN in the Department of Child Health,Cipto Mangunkusumo Hospital from January 1997 until Decem-ber 2001. Data were obtained from medical records.Results The commonest age group (17 out of 22) was 1–3 month-old. Normal delivery was found in 19 patients and only 3 patientsreceived prophylaxis vitamin K. Almost all of them (20 out of 22)were exclusively breastfed. Seizure, pallor, decreased conscious-ness, and bulging of the anterior fontanel were significant clinicalmanifestations found in 21, 21, 13, and 9 patients respectively.Based on brain USG and/or CT scan, intracranial hemorrhage wasfound in 19 patients. Six out of 22 patients died and 7 patientssurvived with handicapConclusion Intracranial hemorrhage due to vitamin K mostly oc-curred at the age of 1 to 3 month-old. The commonest clinical mani-festations were seizure, pallor, decreased consciousness, andbulging of the anterior fontanel. Prevention by giving vitamin K rou-tinely to all newborn babies is recommended
The first 24-hour bilirubin level as a predictor of hyperbilirubinemia in healthy term newborns
Authors: Triasih Rina , Haksari Ekawaty L , Surjono Achmad
Published: March 2017

Background Early discharging healthy term newborns results ina difficulty to recognize hyperbilirubinemia.Objective The aim of this study was to determine the value of thefirst 24-hour total and unbound bilirubin levels in predicting hyper-bilirubinemia in healthy term newborns.Methods The first 24-hour and the 5 th day total and unboundbilirubin levels were measured in 84 healthy term newborns. Thetotal bilirubin level was measured spectrophotometrically, whereasunbound bilirubin level was determined by peroxidase-oxidationmethod. Hyperbilirubinemia was defined as serum total bilirubin of>12.9 mg/dL or serum unbound bilirubin of >0.5 mg/dL after 24hours of life.Results A correlation between the first 24-hour and the 5 th daytotal bilirubin levels was found (r= 0.53) with a regression equa-tion: Y (total bilirubin on day 5) = 4.69 + 1.15X (total bilirubin in thefirst 24 hours). In unbound bilirubin (r=0.31), the regression equa-tion was Y (unbound bilirubin on day 5) = 0.13 + 0.95X (unboundbilirubin in the first 24-hours). The relative risk for developing hy-perbilirubinemia in newborns whose TB 1 was >4.5 mg/dL was 12(95% CI 2.9;48.4), whereas newborns whose UB 1 was >0.09 mg/dL was 9.5 (95% CI 1.2;77.4).Conclusion Total bilirubin level of >4.5 mg/dL in the first 24 hourscan predict the development of hyperbilirubinemia in term new-borns in the first week of life. Newborns with such level of totalbilirubin need a longer stay or should visit the hospital on day 5-7
Neonatal birth trauma: incidence and predisposing factors
Authors: Aminullah Asril , Budiwardhana Novik , Firmansyah Agus
Published: March 2017

Background The incidence of birth trauma and its predisposingfactors at a major teaching hospital in Indonesia had not been reported.Objective To find the incidence of birth trauma, calculate a riskassessment of predisposing factors, to study whether cesareansection lowers birth trauma, and to identify the variety of morbidityand mortality due to birth trauma.Methods The incidence was studied retrospectively from 4843medical records from January 2000 through June 2001 using theICD-10 classification. Birth trauma cases were then included in acase-control study for a risk assessment profile of predisposingfactors with logistic regression analysis.Results Three hundreds and thirty five out of 4843 neonates wereidentified to have birth trauma. Analysis revealed that forcepsextraction (OR=48.29; p<0.01), vacuum extraction (OR=25.37;p<0.01), breech vaginal delivery (OR=3.94; p=0.03), and cesareansection (OR=3.44; p<0.01) were significant risk factors.Macrosomic infant (OR=3.86; p=0.04) was also significant. Birthinjury to face (ICD-10 code P15.4) was the most common finding,followed by cephalhematoma and bruising of the scalp.There was no mortality due to birth trauma.Conclusions The incidence of birth trauma was still high. Cesareansection was found to be one of the risk factors, butcompared to forceps and vacuum extraction, the risk of traumais considered to be more acceptable.
Fava bean–induced hemolytic crisis in glucose-6-phosphate dehydrogenase deficiency
Authors: Karyana IPG , Mudita IB
Published: March 2017

This paper reports a case of hemolytic crisis dueto fava beans in a child with G6PD deficiency.
5-alpha-reductase deficiency: a case report
Authors: Jong Diana Mettadewi , Pulungan Aman B , AAP Bambang Tridjaja , Batubara Jose RL
Published: March 2017

The condition of 5-alpha-reductase type 2deficiency (5-ARD) is an inherited disorderresulting in the inability to converttestosterone to dihydrotestosterone(DHT).This disorder was previously termed asfamilial incomplete male pseudohermaphroditism type2, pseudovaginal perineoscrotal hypospadias.Clinical manifestation of 5-ARD is limited to malegenetic. The affected males are usually identifiedas female in childhood but undergo striking virilizationat puberty.While overall incidence for various countries arenot established, increased incidence is reported in theDominican Republic, some highland tribes in NewGuinea, Lebanon and Turkey. This was the firstdocumented case in Cipto Mangunkusumo (CM)Hospital.
The role of indoor air pollution and other factors in the incidence of pneumonia in under-five children
Authors: Sunyataningkamto Sunyataningkamto , Z Iskandar , T Alan R , I Budiman , Surjono Ahmad , Wibowo Tunjung , Lestari Endang Dewi , Wastoro Dwi
Published: March 2017

Background The World Health Organization has asked for a spe-cial attention to the relation between pneumonia and indoor airpollution, i.e., household biomass fuel smoke, cigarette smoke,and mosquito coil smoke, especially in developing countries.Objective To analyze the role of indoor air pollution and otherfactors as risk factors for pneumonia in under-five-year children.Methods This case-control study was carried out from August un-til December 2000 at Public Health Centers in Banjarnegara,Kebumen, Jepara, and Pekalongan districts. All children qualify-ing pneumonia classification as recommended by WHO in IMCI(Integrated Management of Childhood Illness) were defined ascases and without pneumonia as controls. Severe pneumonia andno pneumonia (as classified in IMCI) were excluded. Statisticalanalysis was done using bivariate and logistic regression.Results There were three hundreds and five children with pneu-monia and 289 children without pneumonia. By bivariate analysis,biomass fuel smoke (OR=3.25; 95%CI 1.50;7.07) and cigarettesmoke exposure from other family members (OR=1.63; 95%CI1.11;2.38) were risk factors for pneumonia, while mosquito coilsmoke (OR=1.13; 95%CI 0.79;1.69) was not. History of wheezing(OR=2.60; 95%CI 2.7;8.55), malnutrition (OR=2.60; 95%CI1.33;5.07), and male sex (OR=1.47; 95%CI 1.06;2.04) were otherrisk factors.Conclusions Household biomass fuel smoke and cigarette smokewere risk factors for pneumonia. Other variables as risk factorswere history of wheezing, male sex, and malnutrition
Stent implantation into ductus arteriosus: a new alternative of palliative treatment of duct-dependent pulmonary circulation
Authors: Djer Mulyadi M , Madiyono Bambang , Sastroasmoro Sudigdo , Putra Sukman T , Oesman Ismet N , Advani Najib , Alwi Mazeni
Published: March 2017

Background The technical aspects of ductal stenting have beenreported, but little is known about the fate of the duct after stentimplantation.Objectives To determine the effects of PDA stenting on the degreeof cyanosis, blood oxygen saturation, long-term patency of PDA,and the growth of pulmonary artery and its branches, in patientswith duct-dependent pulmonary circulation.Methods This was a case series study conducted at the Depart-ment of Pediatric Cardiology, Institut Jantung Negara (National HeartInstitute), Kuala Lumpur, Malaysia from November 1996 to Septem-ber 2001 on patients with duct-dependent pulmonary circulation whounderwent stent implantation. All patients were followed-up until oc-clusion or block occurred or until the end of follow-up time. The evalu-ation consisted of clinical manifestations, electrocardiography, chestx-ray, echocardiography, and cardiac catheterization.Results Stent was successfully implanted in 60 patients (84%),failed in 7 patients (10%) and contra indicated in 4 patients (6%).There was significant improvement on the degree of cyanosis afterstent implantation (p<0.0001). The blood oxygen saturation signifi-cantly increased from 74% (ranged 42-93; SD 12) before proce-dure, to 90% (ranged 62-100; SD 8) afterward (p<0.0001). The meanduration of follow-up time was 14.2 months (ranged 2.5-50.8; SD13) and the minimal patency of PDA was 11.2 months (ranged 1.1-47.7; SD 10.7) after implantation. At the end of follow-up, the stentswere widely patent in 33 patients (55%), stenotic in 15 patients (25%)and spontaneously occluded in 12 patients (20%). There was in-creased growth of pulmonary artery as measured by McGoon ratiofrom 1.23 (ranged 0.4-2.3; SD 0.4) to 1.81 (ranged 0.7-0.9; SD 0.57),and no distortion of pulmonary artery and its branches found.Conclusion Stent implantation into ductus arteriosus decreasedthe degree of cyanosis, increased blood oxygen saturation, main-tained long-term patency of ductus arteriosus, and promoted theincreased growth of pulmonary artery without distortion of pulmo-nary artery and its branches
Knowledge, attitude, and practice of working and non-working mothers concerning immunization of underfive children
Authors: Ali Muhammad , Saputra Ifan Eka , Adillida Adillida , Sofyani Sri , Lubis Iskandar Z
Published: March 2017

Objective To compare the knowledge and attitude of working moth-ers (WM) and non-working mothers (NWM) concerning immuniza-tion in children.Methods A cross sectional study was conducted on February, 18-23, 2002 at PT. Olagafood Industri, a noodle manufacture in TanjungMorawa, Medan. Subjects were female workers and non-workingwives of male workers who had under-five-year children. Motherswere interviewed using a questionnaire. Sample size for each groupwas 38. Degree of knowledge, attitude, and practice concerningimmunization were classified into good, insufficient, and bad.Results Mothers’ age, educational level, and children’s age werecomparable between the two groups. Ten WM and 8 NWM hadgood knowledge concerning immunization, which did not differ sig-nificantly (p>0.05). Good attitude toward immunization was foundin 25 WM and 12 NWM; it was a statistically significant difference(p<0.05). The practice of immunization showed similar result asthe attitude. The age of mothers had a significant relationship withthe degree of knowledge and practice, but not with attitude.Conclusion Degree of knowledge about immunization betweenWM and NWM are comparable, but differences exist in their atti-tude and performance
Behavior and emotional problems in children with mental retardation
Authors: Soedjatmiko Soedjatmiko , Kadim Muzal , Madiyono Bambang , Said Mardjanis
Published: March 2017

Background Behavior and emotional problems in a mentally re-tarded child can inhibit the educational process of the child.Objectives The aims of this study were to find out the prevalenceof behavior and emotional problems in children with mental retar-dation as reported by parents and to assess associated risk fac-tors consisting of mother’s psychopathology, marital discord, malesex, child’s age, socioeconomic status, and family size.Methods This cross sectional study was carried out on 63 chil-dren with mental retardation in a school for retarded children, SLBC Asih Budi I, from January until March 2003. Parents were inter-viewed at school and home using special questionnaires, the ChildBehavior Checklist (CBCL) and Symptom Checklist-90 (SCL-90).Results The prevalence of behavior and emotional problems inthis study was 52%. The majority of behavior and emotional prob-lems were anxious/depressed (18%) and withdrawn (16%). Malesex and age group of 12-18 year-old were not risk factors of be-havior and emotional problems (OR=0.49, p=0.190 and OR=1.14,p=0.94, respectively) while socioeconomic status, family size, andmother’s psychopathology were risk factors (OR= 4.08, p=0.008;OR=4.17, p=0.014; OR=9.28, p=0.018; respectively). There wasa correlation between behavior and emotional problems of chil-dren and marital discord.Conclusion The prevalence of behavior and emotional problemswas 52% in which the majority was internalizing disorder. Risk fac-tors for behavior and emotional problems were mother’s psycho-pathology, four or more children in the family, low socioeconomicstatus, and marital discord
Hemolytic anemia in falciparum and vivax malarial patients based on serum bilirubin examination
Authors: Yusroh Yoyoh , Lubis Bidasari , Pasaribu Syahril , Lubis Munar , Sembiring Tiangsa , Adillida Adillida
Published: March 2017

Objective To examine hemolysis in falciparum and vivax malarialpatients based on serum bilirubin examination.Methods A cross sectional study was conducted on childrenyounger than 15 years of age who visited public health center inthe district of Mandailing Natal with complaints of fever, shivering,pale, jaundice, diarrhea, or headache between April 9 th and April19 th 2001. Variables recorded were age, gender, body weight, bodyheight, symptoms and signs, anti malarial drugs, and laboratorytest results. Thin and thick blood smears were done as diagnostictools of malaria. Thin blood smear was also performed to deter-mine the level of malaria parasites in blood (parasitemia) and toexamine the morphology of red blood cells. Hemolysis was deter-mined by bilirubin examination.Results In P. falciparum malaria, there was a moderate correlation(r=0.68, p<0.0001) between parasitemia and indirect bilirubin con-centration. While in P. vivax malaria, there was only a weak corre-lation (r=0.46, p=0.007) between parasitemia and indirect bilirubinconcentration. It was also found that in falciparum malaria, para-sitemia, total and indirect bilirubin concentrations were significantlyhigher than that in vivax malaria, with p values of 0.009, 0.015 and0.003, respectively.Conclusion Hemolysis in falciparum malaria is more severe thanthat in P. vivax malaria, with marked elevation of indirect bilirubin.The elevation of serum bilirubin correlated with parasitemia
Bowel habits of exclusively breastfed 0-4 month-old babies
Authors: Tehuteru Edi S , Firmansyah Agus , Madiyono Bambang
Published: March 2017

Background Exclusively breastfed newborns have frequent bowelmovements and sometimes watery stool, which parents or doctorsmight think as diarrhea.Objective The aim of this study was to observe the bowel habitsof exclusively breastfed infants.Methods A longitudinal study was done on 100 babies born be-tween November and December 2002 in Cinta Kasih MaternityHospital. The inclusion criteria were fullterm baby, exclusivelybreastfed for 4 months, and informed consent from parents. Ba-bies with problems in organ or nerve that influenced the gastrointes-tinal tract were excluded. Stool frequency, consistency, and colorwere observed.Results The mean stool frequency per day were 3 times in the 1 stweek (95%CI 2.6;3.4), 2 times in the 2 nd week (95%CI 1.7;2.3),1.8 times in the 3 rd week (95%CI 1.5;2.1), and 1.5 times in the 4 thweek (95%CI 1.3;1.7). In the second and third month, it was 1.4times a day and the fourth month, 1.2 times a day. The consis-tency of meconium was soft in the first four days. After that, 18% ofbabies had watery stool, which increased to 30% on day 15-113.In the last week of the fourth month, all babies had soft stool. Meco-nium was black and lasted for 1-3 days. On the fourth day, thestool became yellow. On day 5-14, 6% of babies had green stool,which increased to 12% on day 15-120.Conclusion The first week of the first month was the week whenthe stool frequency was highest compared to the weeks or monthsafter. The consistency of meconium was soft. After it disappeared,most babies had soft stool. Eighteen up to 30% percent of babieshad watery stool. Regarding the color, meconium was black andstayed for 1-3 days. After that, most babies had yellow stool and 6-12% had green stool
Delayed puberty in thalassemia major patients
Authors: Batubara Jose RL , Akib Arwin , Pramita Diah
Published: March 2017

Background Delayed puberty is the most common endocrine com-plication in thalassemia major. The main cause of delayed pu-berty in thalassemia major is the failure of the hypothalamic-pitu-itary axis due to iron accumulation in the pituitary.Objectives The purpose of this study was to determine the preva-lence of delayed puberty in β-thalassemia major patients in theDepartment of Child Health, Cipto Mangunkusumo Hospital,Jakarta. This study also evaluated the adequacy of chelationtherapy and determined serum gonadotropin and sex hormonelevels in these patients.Methods Seventy-two patients with β-thalassemia major aged 13-18 years old who visited the Thalassemia Outpatient Clinic of CiptoMangunkusumo Hospital during February-July 2003 were includedin the study. Each subject underwent examinations to determinethe body weight and height, pubertal status, serum iron level, totaliron binding capacity, and the levels of serum LH, FSH, estradiol(in girls) or testosterone (in boys).Results Delayed puberty occurred in 40 of 72 patients (56%). Themajority of patients with delayed puberty showed low levels of se-rum LH, estradiol, and testosterone whereas low levels of serumFSH only occurred in 6 of 21 boys and 11 of 19 girls. Most of thepatients without delayed puberty had normal levels of serum LH,FSH, and estradiol, but 8 of 16 boys showed decreased serumtestosterone levels. Only 3 patients used chelation therapy ad-equately, all of them showed normal puberty.Conclusions The prevalence of delayed puberty in β-thalassemiamajor patients in this study was still high (56%). Periodic examina-tion and recording of pubertal stage need to be done in girls whohave reached 8 years old and boys who have reached 9 years oldso that early detection and management of delayed puberty canbe done.
Adverse events following immunization (AEFI) reports of extended program immunization (EPI) in Indonesia during 1998-2002
Authors: Kaswandani Nastiti , Hadinegoro Sri Rezeki , Suradi Rulina
Published: March 2017

Background The incidence of adverse events following immuni-zation (AEFI) increased in correlation with the number of vaccinedoses. Meanwhile AEFI reports should be managed properly tomaintain the compliance and immunization coverage.Objectives The aims of this study were to investigate the inci-dence and profile of AEFI, its onset, severity, classification, andoutcome.Methods This study was a passive surveillance of AEFI reportsreceived by the National Committee on AEFI, Ministry of Health ofIndonesia, during 1998 to 2002.Results Two hundreds and four AEFI cases were reported; 4 casesas zero reports, 182 cases as individual reports, and 18 clusterreports. The AEFI incidence was 0.44 per 1 million doses of vac-cines. Vaccine reaction rate was 1 per 2.3 million vaccine doses.The most common vaccines reported as the causes of AEFI wereDTP, Polio, and TT. Among 182 reported cases, local or mild AEFIreactions were observed in 45, moderate in 49, and severe in 88.Based on WHO field classification, this study reported that 84 casesbelonged to coincidence, 72 to vaccine reactions, 13 to program-matic errors, 7 to injection reactions, and 6 to unclassified reac-tions. Forty-seven patients died, 12 had some sequelae, and 123completely recovered. Meanwhile, among the death cases, 70%occurred coincidently, 17% due to vaccine reactions, and 6 wereunclassified.Conclusions The incidence of AEFI in the extended program im-munization (EPI) in Indonesia during the period of 1998-2002 were182 cases, thus vaccine reaction rate was 1 per 2.3 million vac-cine doses. The most common vaccine which caused AEFI wasDTP. Most AEFI with severe symptoms happened in 4-24 hoursafter immunization.
Recurrent cerebral abscess in tetralogy of Fallot
Authors: Sahli Wanty , Pelupessy J M Ch
Published: March 2017

Tetralogy of Fallot (TF) classically consistsof the combination of right ventricularoutflow obstruction (pulmonary stenosis),ventricular septal defect (VSD), overridingaorta, and right ventricular hypertrophy. Thedegree of pulmonary stenosis and VSD determine thevariety of clinical manifestations.This type of congenital heart disease accountsfor about 10% of all congenital cardiac deformitiesand is the most common cyanotic lesion after thefirst year of life. Cerebral abscess is a serious com-plication in TF and is usually seen after the age of 2years.
Low-dose sublingual immunotherapy compared to subcutaneous immunotherapy and conventional therapy in childhood asthma
Authors: Harsono Ariyanto
Published: March 2017

Background Evidence begin to accumulate that high-dose sub-lingual immunotherapy (SLIT) is as effective as subcutaneousimmunotherapy (SIT) in the treatment of childhood asthma.Since the capacity of sublingual area is similar whether the doseis high or low, the efficacy of low dose may be important to bestudied.Objective To investigate the efficacy of low-dose sublingual im-munotherapy in the treatment of childhood asthma.Methods Parents signed informed consent prior to enrollment,after having received information about the study. Patients weremoderate asthma aged 6-14 years with disease onset of lessthan 2 years before the commencement of the study and peakexpiratory flow rate (PEFR) variability of more than 15%. Pa-tients were randomly allocated into group A, B, and C whoreceived subcutaneous immunotherapy, low-dose sublingualimmunotherapy, and conventional asthma therapy, respectively.Randomization was stratified into two strata according to agei.e., 6-11 years or 11-14 years. Patients of each stratum wererandomized in block of three for each group. At the end of threemonths, lung function tests were repeated. The primary outcomewas PEFR variability at the end of the study. The study wasapproved by the Ethics Committee of Soetomo HospitalSurabaya.Results Distribution of variants as represented by sex, age,eosinophil count, and total IgE concentration were normal inthe three groups. PEFR variability decreased significantly from16.97+0.81 to 8.50+5.08 and 17.0+0.87 to 8.40+4.72 in groupreceiving SIT and SLIT, respectively (p<0.05), but decreasednot significantly from 17.00+0.83 to 10.82+0.5.41 in control group(p>0.05).Conclusion Low-dose SLIT is as efficacious as SIT in the treat-ment of moderate asthma in children
Recurrent idiopathic chylothorax
Authors: Nataprawira Heda Melinda D , Rosmayudi Oma , Effendy Syaiful
Published: March 2017

The chylous drainage may lead to highmorbidity and may even compromise survival becauseof the large amount of loss, that is, deficits inlymphocytes, protein, and immunoglobulin. Thetreatment of chylothorax is still debatable withdifferent therapeutic approaches i.e., purelyconservative with elemental diet or total parenteralnutrition, or surgical (early or late) with ligation ofthe thoracic duct, pleurodesis, or placement ofpleuroperitoneal shunts. The purpose of this reportis to describe a case of chylothorax in a 2-year-oldgirl which was recurrent and difficult to manage.
Blood glucose levels in healthy, term, appropriate for gestational age, exclusively breastfed infants
Authors: Hewis Lineus , Suradi Rulina , Tambunan Taralan
Published: March 2017

Objective This study aimed to determine blood glucose levels ofhealthy, term, appropriate for gestational age (AGA), exclusivelybreastfed infants at the age of 6, 12, 24, 48, and 72 hours of life,and to investigate the incidence of hypoglycemia in those infants.Methods All healthy, term, AGA infants born in CiptoMangunkusumo General Hospital, Jakarta, who were exclusivelybreastfed during the recruitment period of December 2003 untilFebruary 2004, were included in this study. These infants weresubjected to blood glucose level determination at the age of 6, 12,24, 48, or 72 hours of life, and the clinical signs of hypoglycemiawere monitored.Results Two hundred and fifteen blood samples taken from 137newborns were studied. There was no incidence of hypoglycemiaobserved, whether symptomatic or asymptomatic. The range ofblood glucose levels was between 41 mg/dl and 115 mg/dl. Themeans and the standard deviations (SD) of the blood glucose lev-els of the 6-, 12-, 24-, 48- and 72-hour old infants were 59.7 (11.98)mg/dl, 64.1 (13.51) mg/dl, 65.9 (14.42) mg/dl, 67.0 (14.95) mg/dl,and 78.6 (16.51) mg/dl, respectively.Conclusions The current concern for hypoglycemia in the popu-lation of healthy, term, AGA, exclusively breastfed infants duringthe first few days of life was not proven to exist. Therefore, there isno reason to resort to prelacteal feeding in such infants
The risk of early-onset neonatal sepsis in preterm infants with maternal histologic chorioamnionitis
Authors: Adnyana IGK Winata , Soetjiningsih Soetjiningsih
Published: March 2017

Background Chorioamnionitis, usually a subclinical condition, maycause preterm delivery and long-term morbidity.Objective The objective of this study was to determine the risk ofearly-onset neonatal sepsis in preterm infants with maternal histo-logic chorioamnionitis (HCA).Methods This was a prospective cohort study of preterm infantsborn at Sanglah Hospital, Denpasar from September 2002 to Feb-ruary 2004. Histopathological examinations of the subjects’ placen-tas were done and the infants were monitored for 72 hours for clini-cal signs of early-onset neonatal sepsis. Maternal and neonatal riskfactors were analyzed using multivariate statistical analysis.Results Eighty-two preterm infants were included, of which 41 werepositive for maternal HCA. Twenty-five (61%) of the infants posi-tive for maternal HCA developed early-onset neonatal sepsis, com-pared to 5 (12%) of those negative for maternal HCA (RR=5, 95%CI2.12;11.78). Nine infants died from early onset neonatal sepsis.Eight of them had positive HCA, and only one had negative HCA.The average length of hospital stay between infants with and with-out maternal HCA did not differ significantly [12.0 (SD 5.08) vs.12.6 (SD 1.34); P=0.80]. Logistic regression model analysis iden-tified only HCA as a significant risk factor for early-onset neonatalsepsis (OR=6.9, 95%CI 2.0;23). Gestational age (OR=1.3, 95%CI0.8;2.0), birth weight (OR=1.0, 95%CI 0.9;1.0), and neonatal as-phyxia (OR=1.0, 95%CI 0.1;4.4) were not found to be significantrisk factors.Conclusion Preterm infants with maternal histologicchorioamnionitis are at a higher risk for developing early-onsetneonatal sepsis
Use of surfactant in neonatal intensive care units
Authors: Kosim M Sholeh
Published: March 2017

Surfactant is currently an important therapyfor newborns in neonatal intensive care units(NICUs) with respiratory problems,specifically respiratory distress syndrome(RDS). Surfactant was initially used in 1959, after itwas recognized for maintaining lung inflation at lowtranspulmonary pressures. Avery and Mead in Jobereported that saline extracts from the lungs ofpreterm infants with RDS lacked the low surfacetension characteristics of pulmonary surfactant.Subsequently, in 1980, clinical potential of surfactanttherapy for RDS was demonstrated by Fujiwara et al,reported in Jobe, in the use of surfactant preparedfrom an organic solvent extracted from bovine lung(Surfactant TA). Small randomized controlled trials(RCTs) in 1985, which tested surfactants preparedfrom bovine alveolar-lavage or human amniotic fluid,demonstrated significant decrease in pneumothoraxand death rates. Subsequent multi-center trialsdemonstrated decreased death rates andcomplications of RDS; although still investigational,its use begun in 1989. A synthetic surfactant wasapproved for the treatment of the syndrome in theUnited States in 1990, and an animal surfactant wasapproved in 1991. These surfactants represent a newclass of drug developed specifically for preterminfants.
Intestinal permeability of autistic and healthy children as measured by D-xylose test
Authors: Pusponegoro Hardiono D , Rahayu Tuty , Firmansyah Agus
Published: March 2017

Background The etiopathogenesis of autistic disorder is unknown.Some authors suggest that food peptides may reach the centralnervous system through a defect of intestinal permeability and pro-duce toxic effects resulting in behavior impairment.Objectives To investigate the prevalence of increased intestinalpermeability in children with autistic disorder using oral D-xylosetest.Method A cross-sectional study was conducted on 27 childrenwith autistic disorder and 54 healthy children (27 siblings and 27unrelated children matching with those of the autistic group). Thesubjects underwent oral D-xylose test. Subjects were free fromfever, drugs, and diarrhea. Student t-test and chi-square were usedfor statistical analysis.Results Prevalence of increased intestinal permeability in the au-tistic group was 63%, which proved to be significant (P=0.007,95%CI: -0.931; -0.987) compared to controls.Conclusion The intestinal permeability significantly increased inautistic children
The influence of intensive nutritional counseling in Posyandu towards the growth 4-18 month old children
Authors: Noviati Noviati , Susanto J C , Selina H , Mexitalia M
Published: March 2017

Introduction Under 5 years is a critical period for child growth,when growth faltering often occurs. Periodical growth monitoringand nutritional counseling can detect growth faltering earlier, de-termine the cause, and find alternatives to solve such problems.Objective To determine the benefit of nutritional counseling onknowledge, attitude, practice of mothers, and child growth.Methods A randomized controlled trial was conducted inSendangguwo, Semarang on 143 children of the treatment groupand 135 children of the control group. Nutritional counseling wasgiven to mothers in the treatment group by trained health volun-teers. Changes of weight for age Z-score (WAZ), height for age Z-score (HAZ), and weight for height Z-score (WHZ) were analyzedrepeatedly by using ANOVA. The differences of ΔWAZ, ΔHAZ, andΔWHZ between groups were compared by student t-test. GEE (gen-eralized estimating equation) analysis was used to analyze theeffect of confounding variables on the changes of WAZ.Results After 6 months of counseling, knowledge, attitude, andpractice of nutrition in the treatment group significantly increasedcompared to that of the control group (P<0.001). The WAZ, HAZ,and WHZ curves in the control group decreased. However, in thetreatment group, WHZ increased and there was stabilization ofWAZ. At the end of the study, treatment group had significantlyimproved their WAZ (P<0.001), HAZ (P=0.004), and WHZ(P<0.001) compared to that of the control group.Conclusion Nutritional counseling can improve knowledge, atti-tude, and practice of mothers, and has beneficial effects on childgrowth by WAZ, HAZ, and WHZ
Randomized controlled trial of Phyllanthus niruri Linn extract
Authors: Sarisetyaningtyas Patria Vittarina , Hadinegoro Sri Rezeki , Munasir Zakiudin
Published: March 2017

Background Clinical benefits of antiviral treatment in childrenexperience varicella without complications, remains controversial.Phyllanthus niruri Linn extract as a natural medicine is used toincrease cellular and humoral immunity.Objective To determine the efficacy and safety of Phyllanthusniruri Linn extract in the treatment of varicella in children comparedto placebo.Methods This was a double-blind randomized controlled trial onchildren ages 2-14 years who experienced varicella without com-plications. Subjects were randomly assigned to receive eitherPhyllanthus niruri Linn extract syrup (5 mg/5ml, 3 times daily) orplacebo. Efficacy was measured by calculating the number of pap-ules and crusts after taking the extract for 4 days of administration.A five-day monitoring sheet to record daily follow up and adverseeffects of the subjects were given to their parents.Results Efficacy of Phyllanthus niruri Linn measurement basedon no more new papules occurred at the five-day monitor was de-tected in 46 subject (51.1%) of the Phyllantus niruri Linn groupcompared to the placebo group (P=0.723). Meanwhile, the differ-ence of efficacy based on time of crusts disappear in Phyllanthusniruri Linn and placebo group were 22 subjects (43.1%) and 15subject (30.0%), respectively (P=0.053). This finding proved haveclinical benefit (NNT=7.6).Conclusion There was no significant difference between the ef-ficacy of Phyllanthus niruri Linn and placebo in terms of the pre-vention appearing new papules and crusts. However, clinicallyPhyllanthus niruri Linn accelerates appearing and aborting crustcompared to placebo
The value of IgG to IgM ratio in predicting secondary dengue infection
Authors: Karyana I Putu Gede , Santoso Hendra , Arhana Bagus Ngurah Putu
Published: March 2017

Background The determination of primary or secondary dengueinfection using hemagglutination inhibition (HI) test is time-con-suming. The IgG to IgM ratio which can be obtained earlier wasused by several studies to differentiate secondary from primaryinfection, but they still reported various cut-off points.Objective To find the diagnostic value and best cut off point ofIgG to IgM ratio for predicting secondary dengue infection.Methods This was a prospective study carried out between July2003 and June 2004. Children with suspected dengue hemor-rhagic fever (DHF) were tested for HI during acute and convales-cent phase. The IgG and IgM titer were examined during the acutephase using ELISA method.Results Sixty-two children were recruited, 48 with secondary in-fection and 14 with primary infection. The prevalence of second-ary infection was 77%. The best cut off point of the IgG to IgM ratioto predict secondary infection was >1.1 with sensitivity of 87.5%,specificity 92.9%, likelihood ratio 12.3, and post test probability97.7%.Conclusion The IgG to IgM ratio of >1.1 is a good predictor forsecondary infection
Growth diagrams of Indonesian children The nationwide survey of 2005
Authors: Batubara Jose , Alisjahbana Anna , JGMGerver-Jansen Angèle , Alisjahbana Bachti , Sadjimin Tony , Tasli Yulniar , Juhariah Juhariah , Tririni Angky , Padmosiwi Woro Indri , Listiaty Tya , Delemarre–van de Waal Henriette A , Gerver Willem J
Published: March 2017

Background Reference curves of growth have been developedin many countries based on cross-sectional data. The World HealthOrganization (WHO) has recommended an international referencewhich is based on the growth standards developed within the UnitedStates during the 1970s. In general these growth references areused in Indonesian pediatric clinics although it is known that thesereferences are not appropriate for this population with a differentethnic background. In order to evaluate reliably Indonesian chil-dren with growth disorders reference standards based on mea-surements in Indonesian children are necessary.Objective To make a standard growth chart for Indonesian chil-dren especially with regards to height, weight, and head circum-ference from a healthy Indonesian infants and children, age 0-18years. This standard charts were compared to CDC growth charts.Methods Weight and height and head circumference were takenfrom children with age ranging from birth up to 18 years. All sub-jects were recruited from 7 different parts of Indonesia. The agegrouping for children from 0-1 years old was based on 3-monthinterval, while for children older than 12 months was based on a 6-month interval. The study was cross sectional.Results There were 34 800 children (17 229 boys and 17 571girls) included in this study with age ranging from 0 up to 18 years.Graphs were presented for weight for age, supine length for age,head circumference for age in male and female infants, and weightfor height and height for age in boys and girls 1-18 years.Comparson of the results of this study with the CDC data werepresented as a graph.Conclusion The standard charts for Indonesian children basedon weight for height, supine length for height and head circumfer-ence for age were presented in graphs for children 0-1 year, weightfor height and height for age for boys and girls 1-18 years old. Allchildren were compared to CDC growth charts and there exists amean difference of -1.47 SDS for boys and -1.43 SDS forgirls.
Association between cord blood IgE levels in newborns and family history of atopic diseases
Authors: Hutapea Andhika T. , Setiabudiawan Budi , Soepriadi Myrna , Rustama Diet Sadiah
Published: March 2017

Background Cord blood-IgE (CB-IgE) levels have been usedwidely as a specific marker of atopic diseases. In some previousstudies, CB-IgE levels in subjects with and without a family historyof atopic diseases have been controversial.Objective To determine the CB-IgE level in newborns and to iden-tify the association between CB-IgE and family history of atopicdiseases.Methods A cross-sectional study was done to compare the CB-IgElevels in neonates with or without a family history of atopic diseasesin mother, father, or siblings. Subjects of this study were 124 new-borns who consecutively born in Puskesmas Kiaracondong,Bandung, during the period of March 2001 to July 2002. Subjectswere divided into 2 groups based on history of atopic diseases.Measurements of CB-IgE levels were done by sandwich ELISAmethods. Data were analyzed by c 2 statistics, t test, ANOVA, andDunkan’s test.Results The mean CB-IgE levels in the group with and without afamily history of atopic diseases were 3.2±2.5 IU/ml and 0.5±0.5IU/ml (P<0.001), respectively. The mean CB-IgE levels in maleand female infants with a family history of atopic diseases were3.3±2.7 IU/ml and 3.03±2.2 IU/ml (P>0.05), respectively. Basedon the cut-off point (1.3 IU/ml), CB-IgE levels had significant posi-tive association with a family history of atopic diseases (OR 156,95%CI 29.61;1104.24). CB-IgE levels in neonates with 1, 2, and 3atopic family members were 1.67±0.78 IU/ml, 3.76±2.11 IU/ml, and6.6±2.7 IU/ml, respectively (F=32.603; P<0.001).Conclusion Most newborns with a family history of atopic dis-eases showed high levels of CB-IgE, but there were no correlationwith gender. The probability of having atopic diseases increase inconcord with the number of family with atopic diseases
Morphology and disaccharidase activity of small intes- tinal mucosa in post-weaning-induced malnourished rats and after realimentation
Authors: Sosrosumihardjo Rustadi , Firmansyah Agus , Rasad Asri , Harjodisastro Daldiyono , Ridwan Endi , Wanandi Septilia Inawati , Retno Dwirini
Published: March 2017

Background The most common cause of failure to thrive in in-fants is malnutrition which causes histological and biochemicalchanges of small intestine. Studies on histology and enzyme ac-tivity of small intestinal mucosa were not much developed.Objective To study about histology and disaccharidases activity ofsmall intestinal mucosa in post-weaning-induced malnourished rats.Methods We used Sprague-Dawley white rats as the subjects ofthis study with post test-control group design. The study was per-formed at the CentER for Research of Food and Nutrition Devel-opment from April 2003 to December 2004.Results There were a decrease of body weight (hypotrophy nor-moblastic) and an increase of disaccharidase activity of small in-testinal mucosa in post-weaning-induced malnourished rats. Afterrealimentation, there were an increase of body weight, an improve-ment of the hypotrophy, and a decrease of the enzyme but theystill cannot reach normal condition.Conclusion In malnourished rats, there are decrease of bodyweight hypotrophy normoblastic and increase of disaccharidasesactivity of intestinal mucosa that are improved after realimentation
Male pseudohermaphroditism due to 5-alpha reductase type-2 deficiency in a 20-month old boy
Authors: Andhita Ida Bagus , Suryawan Wayan Bikin
Published: March 2017

5-alpha-reductase (5-ARD) type 2 deficiencyis an autosomal sex-linked disorder, resulting inthe inability to convert testosterone to the morephysiological active dihydrotestosterone (DHT).DHT is the most potent androgen, bound selec-tively to the androgen receptors in genital skin andfibroblasts, making its action necessary for the de-velopment of normal male genital anatomy. SinceDHT is required for normal masculinizaton of theexternal genitalia in utero, genetic males with 5-ARD are usually born with ambiguous genitalia(male pseudohermaphroditism). The hallmarkof 5-ARD is elevated ratio of serum testosteroneto DHT. In healthy prepubertal children, thebaseline testosterone-to-DHT ratio is 1:2. Thispaper reports a 20-month old patient with malepseudohermaphroditism due to 5-alpha reductasetype-2 deficiency.