bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between early feeding of banana (Musa paradisiaca) and vomiting or abdominal distention in neonates
Authors: Wiryo Hananto , Hakimi M , Wahab A Samik , Soeparto Pitono
Published: March 2017

Objective To assess the relationship between banana given asearly solid food feeding and symptoms of intestinal obstruction (SIO)such as vomiting and abdominal distention among neonates.Methods A longitudinal cohort study was done in 1993 at a ruralcommunity of West Lombok District on Lombok Island, West NusaTenggara Province, Indonesia. There were 3420 neonates whowere followed up by interviewing their mothers until 28 days afterdelivery. The main outcome measure was the occurrence of SIO.Results Compared to infants who were not given solid food, therelative risk (RR) of SIO for infants given food other than bananaas early solid food feeding was 1.87 (95%CI 0.48;8.24), while forinfants given banana only as early solid food feeding, the RR was9.15 (95%CI 1.96;42.58). After the adjustments of birth weight, co-lostrum, and breast feeding, the odds ratio of SIO for infants givenbanana was 2.99 (95%CI 2.65;5.14).Conclusion Banana as early solid food for neonates feeding isan important risk factor for the occurrence of SIO
Antibiotic profile in pediatric wards, Department of Child Health, Cipto Mangunkusumo Hospital
Authors: Husni Amin , Abdoerrachman Hardjono , Akib Arwin
Published: March 2017

Introduction The medical profession has currently come to a con-clusion that the major problem in the future is failure of treatmentdue to antibiotic-resistant microorganisms.Objective The aim of this study was to determine the profile ofantibiotics used in the Pediatric Wards of Department of Child Health,Medical School, University of Indonesia, Cipto Mangunkusumo Hos-pital, Jakarta.Methods A descriptive retrospective study was conducted on all pa-tients hospitalized in the Pediatric Wards of Department of Child Health,Medical School, University of Indonesia, Cipto Mangunkusumo Hos-pital during June–July 2001. Data were obtained from the medicalrecords of the patients.Results Three hundreds and fifty-six hospitalized patients fulfilledthe inclusion criteria. The antibiotics were given to 48.7% of thepatients. The greatest user of antibiotics was the age group of 1-5year-old, 50% of patients had been given single antibiotic and therest given combined antibiotics. The ICU used antibiotics most fre-quently in contrast to the one-day care unit which used least. Thegreatest use of single antibiotic was in the class 1-2 wards whilecombined antibiotics were mostly used in the third class wards.Single antibiotics used were cefotaxime (49.4%), amoxicillin(20.7%), and ampicillin (11.55%). Combined antibiotics used wereampicillin + chloramphenicol (34.5%), cotrimoxazole (21.8%),cefotaxime + amikacin (5.7%), cefotaxime + cotrimoxazole (5.7%),and cefotaxime + isoniazid + rifampicin + pyrazinamide (5.7%).Conclusions The antibiotics most commonly used singly wascefotaxime. The combination of antibiotic mostly used was ampi-cillin + chloramphenicol
Free testosterone level in patients with homozygous beta thalassemia on regular transfusions regimen
Authors: Wirawan Riadi , Santosa Elly , Setiawan Lyana , Munthe Bulan Ginting , Astrawinata Dalima AW
Published: March 2017

Background Patients with homozygous beta thalassemia requireregular transfusions which will lead to iron deposition in tissuesincluding testicles.Objective This study aimed to evaluate testicular function in syn-thesizing testosterone by measuring free testosterone level. Thecorrelation between free testosterone level and transferrin satura-tion was evaluated.Methods This was a cross sectional study. Sampling was doneconsecutively. Free testosterone level was measured by radioim-munoassay in 20 homozygous beta thalassemic patients receiv-ing regular transfusions and compared to 20 healthy subjects.Results Fourteen out of 20 patients showed free testosterone levelbelow the reference range. Out of 20 thalassemic patients, onepatient’s serum was not enough for transferrin saturation determi-nation. Among the 19 patients, 18 had transferrin saturation above55%, 1 less than 55%, while all healthy subjects had normal trans-ferrin saturation. A significant difference was found between thetwo groups, both in the free testosterone level (p=0.001) and trans-ferrin saturation (p<0.001). A very weak correlation was found be-tween free testosterone level and transferrin saturation (r=-0.215).Conclusion We concluded that there might be a relationship be-tween iron overload and testicular endocrine function in patientswith homozygous beta thalassemia receiving regular transfusions
Rett syndrome in childhood: the clinical characteristics
Authors: Herini E S , Mangunatmadja Irawan , Solek Purboyo , Pusponegoro Hardiono D
Published: March 2017

The prevalence rate of RS in various coun-tries is from 1:10,000 to 1:23,000 female livebirths. RS is most often misdiagnosed as autism,cerebral palsy, or non-specific developmental de-lay. While many health professionals may not befamiliar with RS, it is a relatively frequent cause ofneurological dysfunction in females. There are nobiological markers for this disease, the diagno-sis is established by history taking and clinical find-ings. We reported two patients, both girls, with RS.
Hepatitis B serologic patterns in children of HBV carriers or infected mothers
Authors: Bisanto Julfina , Chair Imral , Istikowati Dyah
Published: March 2017

Background Vertical transmission is usually the cause of increas-ing carrier rates for hepatitis B infection, especially in highly en-demic areas.Objective To determine the serologic patterns of hepatitis B inchildren of HBV carrier/infected mothers.Methods This was a cross sectional study on children of HBVcarrier/infected mothers. Subjects were recruited consecutively andexamined at the Department of Child Health, Cipto MangunkusumoHospital during January–July 2003. Children were included if theywere generally healthy and their parents gave permission. Chil-dren with chronic illness, previous blood transfusions, or drug abusewere excluded.Results Fifty-nine children of 32 HBV carrier/infected mothers wererecruited. HBsAg was positive in 8 children, anti-HBs in 37, andanti-HBc in 4 children. Seventy-three percent of children had beenvaccinated against HBV but only 81% had positive anti-HBs. Ofeighteen children who received hepatitis B vaccine and HBIg atbirth, none was infected. Six out of 25 children who received onlyhepatitis B vaccine were infected.Conclusion HBsAg, anti-HBs, and anti-HBc were positive in 14%,36%, and 7% of children of HBV carrier/infected mothers, respec-tively
Prevalence and associated factors of airway hyper- responsiveness in children with recurrent chronic cough
Authors: Adnyana I Gusti Agung Ngurah Sugitha , Suwendra Putu , Santoso Hendra
Published: March 2017

Background Airway hyper-responsiveness (AH) is a common char-acteristic of asthma. Patient who has recurrent chronic cough withAH is commonly referred as “cough variant asthma”. Histamineprovocation test should be performed to determine whether a pa-tient has “cough variant asthma” or recurrent viral bronchitis.Objective To determine AH prevalence in children with recurrentchronic cough and factors associated with it.Methods A cross sectional study was conducted on 6-12 year-oldchildren with recurrent chronic cough at the Pediatrics OutpatientClinic, Sanglah Hospital Denpasar from September 2002 until June2003Results Twenty one out of 64 (33%) subjects suffering from recur-rent chronic cough without wheezing had AH. Associated factorssignificantly associated with AH were age, allergic rhinitis, pater-nal and maternal history of atopy, passive smoking, use of mos-quito-coil, positive skin prick test, and eosinophilia. Spearman cor-relation analysis between associated factors and AH showed thatpositive skin prick test and passive smoking were moderately cor-related with AH (r=0.56, p<0.0001; r=0.57, p<0.0001, respectively),whereas multivariate regression logistic analysis on associatedfactors found true associated factors, such as positive skin pricktest (p=0.01; OR=14.82), history of atopy in father (p=0.02;OR=22.75), and passive smoking (p=0.03; OR=11.97).Conclusions The prevalence of airway hyper-responsiveness inchildren with recurrent chronic cough without history of wheezingwas 33%. Independent associated factors of AH in recurrent chroniccough children are positive skin prick test, history of atopy in fa-ther, and passive smoking
Comparison of absolute neutrophil count between premature and term infants
Authors: Faisal Ahmad , Tjipta Guslihan D , Lubis Bidasari , Aldy Dachrul
Published: March 2017

Background Neutrophils are very important in the body defenseagainst bacterial infection. Absolute neutrophil count (ANC) couldbe used for the recognition of early-onset bacterial sepsis inneonates.Objective The aim of this study was to compare the value of ANCbetween premature and term infants, to assess the prevalence ofearly-onset neutropenia in premature infants and its relationshipwith prematurity, and to find out the correlation between gesta-tional age and ANC.Methods A cross-sectional study was conducted during Februaryto May 2003. Subjects were newborn infants with gestational ageof less than 37 weeks who were born in Adam Malik and PirngadiHospitals, Medan. Newborn infants with severe asphyxia (5-minuteApgar score of less than 4), fever, seizure, and maternalhypertension were excluded. Complete blood count was done bymeans of automatic cell counter (Micros (R) , Germany). Term healthyinfants were used as control subjects.Results ANC differed significantly between both groups (p=0.0001).The prevalence of early-onset neutropenia in premature infantswas 9% (95%CI 0.065;0.21). Prematurity was related with theincidence of neutropenia with a prevalence ratio of 1.1. Therewas a weak positive correlation between gestational age andANC with an r-value of 0.49 (p=0.0001).Conclusions ANC in premature infants differs from that in terminfants. The prevalence of early-onset neutropenia in prematureinfants was 9% (95%CI 0.065;0.21). Prematurity is related with theincidence of early-onset neutropenia in newborn infants. There isa correlation between gestational age and ANC
Adverse events following immunization of combined diphtheria, whole-cell pertussis, tetanus, and hepatitis B (DPwT/HB) vaccine
Authors: Jong Diana Mettadewi , Tumbelaka Alan R , Latief Abdul
Published: March 2017

Background Combined vaccine of diphtheria, whole-cell pertussis,tetanus, and hepatitis B (DPwT/HB) will reduce the number ofinjections to children and simplify the delivery logistics. The adverseevents following immunization (AEFI) of this vaccine have to beconcerned since the events may increase or decrease.Objectives To evaluate AEFI of DPwT/HB vaccine in healthy in-fants.Methods A descriptive prospective study of AEFI of three dosesof DPwT/HB vaccine was performed on 74 healthy infants agedtwo to six months at the Department of Child Health, CiptoMangunkusumo Hospital, from July 2000 to March 2001.Results Out of 74 infants, 68 received two doses and 67 completedthe study with a total of 209 doses. Of 209 doses, adverse eventswere reported following 126 doses (60.3%), consisted of systemic(60.3%) and local reactions (9.5%). The three most frequent AEFIiwere mild fever (44.5%), high fever (15.7%), irritability (31.5%).Most AEFI were coincidental (51.1%), occurred after more than72 hours (31.4%) and lasted less than 24 hours (17.7%). Sys-temic reactions were mostly found in 4-month-old infants (33.3%),while local reactions in 2-, 3-, and 5-month-old infants (25%),respectively.Conclusion Most AEFI were coincidental and resolved withoutany complication
Cyclophosphamide in frequent-relapsing or steroid-dependent nephrotic syndrome: Review of 38 patients
Authors: Iriani Yulia , Tambunan Taralan , Sastroasmoro Sudigdo
Published: March 2017

Background Steroid-sensitive nephrotic syndrome (SSNS) in chil-dren is characterized by relapsing courses in a substantial propor-tion of affected individuals. Children with frequent-relapsing neph-rotic syndrome (FRNS) or steroid-dependent nephrotic syndrome(SDNS) are at risk of severe steroid toxicity and need individual-ized treatment. Previous studies have elucidated that cyclophos-phamide (CPA) reduced the risk of relapses and increased thelength of subsequent remissions in children with relapsing SSNS.Methods This retrospective study evaluated 38 patients (26 FRNSand 12 SDNS) after cyclophosphamide therapy to elucidate theefficacy of CPA in FRNS or SDNS in the Department of Child Health,Cipto Mangunkusumo Hospital. All patients were treated with CPA(2 mg/kg per day) for 8 weeks, in combination with prednisone.Results The median (range) duration of follow up was 45 months(24-140 months) for FRNS and 29 months (24-63 months) forSDNS. The mean relapse rate one year prior to CPA therapy inFRNS and SDNS were 3.8 relapses/year (95%CI 3.4; 4.2) and 4.0relapses/year (95%CI 3.3; 4.7), which were reduced to 1.6 relapses/year (95% CI 1.1; 2.1) and 2.3 relapses/year (95%CI 1.5;3.2), re-spectively. The overall rate of cumulative sustained good response(complete remission or infrequent relapses) was 65% after 36months. Frequent relapsing versus steroid-dependent status wassignificantly correlated with rate of sustained good response after36 months (85% versus 15%) with OR=23 (95%CI 3.1;225.2).Conclusion The efficacy of cyclophosphamide therapy in themanagement of FRNS is better than in SDNS
The growth of foot arches and influencing factors
Authors: Idris Ferial Hadipoetro
Published: March 2017

Background Foot arches are important components for body sup-port. Foot arch deformity caused by growth abnormalities causeserious limitations in daily activities.Objectives To determine the patterns of foot arch growth, factorsinfluencing foot arch growth, and the timing for intervention in er-rant growth patterns.Methods A cross-sectional study evaluated the foot arches of chil-dren aged 0-18 years according to age and sex. Subjects includedhad no evidence of physical abnormality other than flat foot, knock-knee, or bow leg. Subjects were grouped per year of age. Data onfoot arch class, age, sex, weight, height, medial intercondylar dis-tance, and medial intermalleolar distance were recorded. Chi-square test, correlation, binary and linear regressions, general lin-ear model, and contrast matrix were performed.Results In 8376 children aged 0-18 years, flat foot grade 3 hadstable proportions in all age groups. Flat foot grade 2 and 1 hadsmaller proportions in older age groups than in younger ones. Theproportions of normal foot was greater in older age groups. Boysat the age of 7 and girls at 9 have a small percentage of pes cavus.The mean foot arch measurements were consistent with flat footgrade 2 at age 0-3 years, flat foot grade 1 at 4 years, and normalfoot at age 18. Median foot arch measurement of children 0-10years old was consistent with flat foot grade 1, while that of chil-dren 11 years old was consistent with normal foot. Age and heightgave positive influence. Based on these measurements we inferthat the optimal time for intervention is 0-7 years for boys and 0-3years for girls.Conclusion The proportion of flat foot grade 3 is stable through-out age groups, that of flat foot grade 2 and 1 are smaller in olderage groups, and that of normal foot is greater in older age groups.Overgrowth happens in very small percentages after age of 7 inboys and 9 in girls. Age, sex, height, weight, and growth of theknees are influencing factors
The efficacy of single-dose albendazole for the treatment of ascariasis
Authors: Putra Deddy S , Dalimunthe W , Lubis M , Pasaribu S , Lubis Chairuddin
Published: March 2017

Objective This study aims to assess the efficacy of single-dosealbendazole in treating mild, moderate, and severe ascariasis.Methods Stool specimens were collected from randomly selectedelementary school children in Suka village, Sumatera Utara, fromMarch to April 2002. Based on the number of eggs per gram feces(NEPG), samples were categorized as mild (NEPG < 7000), mod-erate (NEPG 7000-35,000), or severe (NEPG > 35,000) ascari-asis. All subjects then received 400 mg albendazole orally. NEPGcount was repeated on the 7 th , 14 th , 21 st and 28 th day after treat-ment. The chi-square test was used to compare cure rates be-tween subjects with mild, moderate, and severe ascariasis. TheANOVA and Kruskal-Wallis tests were employed to analyze quan-titative data.Results From the 134 specimens collected, we found mild ascari-asis in 57 (42.5%), moderate ascariasis in 57 (42.5%), and severeascariasis in 20 (15%). There was no significant difference be-tween the three groups in NEPG after treatment (P>0.05). Thecure rate and egg reduction rate on day 28 after treatment was 100%.Conclusion A single dose of 400 mg albendazole is effective forthe treatment of mild, moderate, and severe ascariasis.
Sonographic measurement of splenic length in children at Cipto Mangunkusumo Hospital
Authors: Wulandari H F , Firman Kemas
Published: March 2017

Objectives The aim of this study was to determine the 10 th and90 th percentiles and medians of normal splenic lengths of Indone-sian children at Cipto Mangunkusumo Hospital by ultrasonogra-phy using a method introduced by Rosenberg et al .Methods The maximum splenic length was obtained in longitudi-nal coronal plane with the splenic hilum visualized. The age of thepatients were recorded. The medians and 10 th and 90 th percen-tiles for each age group were determined.Results Sixty-nine boys and 46 girls were examined at our institu-tion. The youngest subject was one month old and the oldest was15 years old. The 10 th percentile, median, and 90 th percentilesplenic length in the 1-3 months age group were 3.421 cm, 3.795cm, and 4.343 cm, respectively. In the 3-6 month age group thesemeasurements were 3.689 cm, 4.29 cm, and 5.094 cm, respec-tively; in the 6-12 month age group 4.016 cm, 4.72 cm, and 5.366cm, respectively; in the 1-2 years age group 4.558 cm, 5.04 cm,and 5.502 cm, respectively; in the 2-4 year age group 5.151 cm,6.225 cm, and 6.816 cm, respectively; in the 4-6 year age group5.774 cm, 6.415 cm, and 7.82 cm, respectively; in the 6-8 year agegroup 6.077 cm, 7.505 cm, and 8.228 cm, respectively; in the 8-10years age group 6.354 cm, 7.77 cm, and 8.602 cm, respectively;in the 10-12 years age group 6.354 cm, 7.77 cm, and 8.602 cm,respectively; and in the 12-15 year age group 7.934 cm, 9 cm, and9.919 cm, respectively. In all age groups, the 10 th percentiles,medians, and 90 th percentiles were smaller than those of Ameri-can children as reported by Rosenberg et al.Conclusion The normal splenic lengths of Indonesian childrenare smaller than those of American children as reported byRosenberg et al.
Oral-dental hygiene and oral microorganisms in children with and without congenital heart disease
Authors: Panggabean Erniwaty P , Irsa Lily , Anwar Rosihan , Lubis Munar , Rusdidjas Rusdidjas , Pasaribu Syahril
Published: March 2017

Objective This study was done to compare the dental and oralhygiene status of children with and without congenital heart dis-ease (CHD) by investigating oral microorganisms and dental andoral hygiene indices.Methods A cross-sectional study was done on children aged 2 to15 years from April 2002 to December 2003 at the Department ofChild Health, Haji Adam Malik Hospital, Medan. There were twosubject groups, the first consisting of children with CHD and thesecond of those without. The dental and oral hygiene status wasdetermined by determining caries index and oral hygiene index.Swabs from the subjects’ upper first molars were taken and cul-tured to determine the types of microorganisms present. Data wereanalyzed using the chi-square test, Fisher’s exact test, and t-test.Results There was a significant difference in mean oral hygieneindex between children with (mean 2.75; SD 1.85) and without(mean 1.45; SD 0.78) CHD (P<0.001). Positive bacterial cultureswere more frequent in children with CHD than in those without.The proportion of normal anaerobes was significantly higher in chil-dren with CHD (P=0.038). Such a significant difference was notfound for normal aerobes, pathogenic aerobes, and pathogenicanaerobes. In children with CHD, there was no significant asso-ciation between mean caries index and oral hygiene index withculture results. In those without CHD, a significant association wasfound between the caries index components of decayed tooth in-dex (P=0.003) and DMF-T (P=0.022) with culture results.Conclusions Oral-dental hygiene in children with CHD is poorrelative to that in children without CHD. Microorganism growth ap-pears more likely in children with CHD than in those without
The use of 4.5% hypertonic saline challenge test in diagnosing asthma in children with chronic recurrent cough
Authors: Supriyatno Bambang , Medina Dina , Tumbelaka Alan R , Rahajoe Nastiti N
Published: March 2017

Background The 4.5% hypertonic saline (HS) challenge test hasseveral benefits compared to histamine challenge test as gold stan-dard. Saline is an inexpensive non-pharmacological substancewhich is relatively safe. Its mechanism in inducing bronchospasmresembles that of asthma. Moreover, it can easily be made in amodest medical laboratory.Objective To determine the ability of 4.5% HS challenge test com-pared to histamine challenge test in diagnosing asthma in childrenwith chronic recurrent cough (CRC).Methods This study was a diagnostic test on children with CRCaged 6 to 14 years, conducted in outpatient clinic of Department ofChild Health, Cipto Mangunkusumo Hospital, Jakarta. All subjectsunderwent lung function tests. Subjects whose FEV 1 was <80% werediagnosed as asthmatic and underwent the 4.5% HS challenge testonly. Those whose FEV 1 was 80% underwent the histamine chal-lenge test followed by the 4.5% HS challenge test one or two weekslater. Test results were expressed as positive or negative. Based onthe results, we calculated the sensitivity, specificity, predictive val-ues, and likelihood ratios of the 4.5% HS challenge test.Results Forty-five subjects, consisting of 22 boys and 23 girls,were enrolled. The average age of subjects was 9 years old. Atopichistory in the family or in subjects themselves was found in 80% ofsubjects. Eight subjects had FEV 1 of <80%. Forty-four subjectswere diagnosed with asthma based on a baseline FEV 1 of <80%or a positive histamine provocation test. Thirty-seven subjects hada positive 4.5% HS challenge test; all had asthma. Sensitivity andspecificity of the 4.5% HS challenge test were 84.1% and 100.0%,respectively; the positive and negative predictive values were100.0% and 12.5%, respectively. The positive likelihood ratio wasinfinite and negative likelihood ratio was 0.16.Conclusion The 4.5% hypertonic saline challenge test can be usedas an alternative bronchial provocation test in diagnosing asthma inchildren with CRC. Further study with larger sample size is neededfor widespread usage.
The prevalence of factor VIII inhibitor in patients with severe hemophilia-A and its clinical characteristics
Authors: Harijadi Harijadi , Gatot Djajadiman , Akib Arwin AP
Published: March 2017

Background Hemophilia is a hereditary blood-clotting disorderdue to factor VIII deficiency. Up to this date, the administration offactor VIII in preventing and managing bleeding has been the maintreatment. One of the complications, which may occur due to re-peated administrations of factor VIII, is the formation of factor VIIIantibody (factor VIII inhibitor).Objective To find out the prevalence of severe hemophilia-A withfactor VIII inhibitor and its clinical characteristics.Methods A cross-sectional descriptive study was performed onchildren with severe hemophilia-A at the National Hemophilia CareCentre, Cipto Mangunkusumo Hospital, Jakarta, Indonesia, in June-August 2004.Results Out of 45 children studied, 16 had factor VIII inhibitor withaverage inhibitor titre of 1.15 Bethesda units (BU) (range 0.15-15BU). Most of them (12 patients) had inhibitor titre <5 BU. Chronicarthropathy was found in 17 out of 45 (37%) children with severehemophilia-A, consisting of nine patients from positive inhibitorgroup and 8 patients from negative inhibitor group. Thirty-ninepatients (86%) used an on-demand treatment pattern, among whom15 had positive inhibitor. Among patients receiving prophylactictreatment pattern, only one had positive inhibitor. There were 39patients (86%) treated using cryoprecipitate, among whom factorVIII inhibitor was found in 12, while among those treated with fac-tor VIII concentrate, the inhibitor was positive in 4/6. The averageamount of factor VIII transfused in positive and negative factor VIIIinhibitor groups was similar.Conclusion The prevalence of factor VIII inhibitor in severe he-mophilia-A patients was 35%. Chronic arthropathy occurred moreoften in patients with positive factor VIII inhibitor. Factor VIII inhibi-tor was found more frequently in patients with an on-demand treat-ment pattern and in those using factor VIII concentrate
Macronutrient malabsorption in acute diarrhea: Prevalence and affecting factors
Authors: Hendrawati Lilis D. , Firmansyah Agus , Darwis Darlan
Published: March 2017

Introduction Diarrhea remains a major problem for communityhealth in Indonesia. More than 25% of children with severe diar-rhea suffer from malabsorption syndrome.Objectives This study aimed to determine the age range of chil-dren with acute diarrhea, the prevalence of macronutrient malab-sorption, and the relationship between age and bacterial infec-tion in macronutrient malabsorption.Methods This was a cross-sectional study, subjects were chil-dren aged 0-59 months with acute diarrhea whose stools wereobtained and examined in the laboratory of GastrohepatologyDivision, Department of Child Health, Cipto Mangunkusumo Hospi-tal, Jakarta from January 2002 to December 2003.Results Children with acute diarrhea were mostly in the agerange of 0-11 months (61%). The prevalence of lactose malab-sorption was 11%, carbohydrate malabsorption was 19%, andfat malabsorption was 51%. Moreover, the age group of 0-11months had a 1.5 times greater possibility of lactose and fatmalabsorption compared to that of 12-59 months. The 12-59 monthsage group had a greater possibility of suffering carbohydratemaldigestion (70%). The group of children who did not sufferfrom bacterial infection had a higher prevalence of lactose mal-absorption (54%), carbohydrate maldigestion (65%), and fatmalabsorption (58%).Conclusions Acute diarrhea occurred more frequently in theage of 0-11 months. There was a significant correlation betweenthe age groups of 0-11 months and 12-59 months in experiencingmacronutrient malabsorption. Lactose malabsorption, carbohy-drate maldigestion, and fat malabsorption were encountered morefrequently in the group that did not have bacterial infection
The efficacy of suppository versus oral ibuprofen for reducing fever in children
Authors: Handayani Suhesti , Hadinegoro Sri Rezeki , Sastroasmoro Sudigdo
Published: March 2017

Background Ibuprofen suppository is used to reduce fever inchildren who are unable to receive it orally. The effectiveness ofibuprofen suppository compared to that of oral ibuprofen has notbeen documented in Indonesian children.Objective The aim of this study was to compare the efficacy ofibuprofen suppository with that of oral ibuprofen for reducingfever in children.Methods This study was a randomized clinical trial without blind-ing on children aged 2-5 years with body weight of 12.5 to 16 kgwho had fever. Subjects received ibuprofen in either oral (7.5mg/kg) or suppository (125 mg) form. The temperature was mea-sured prior to ibuprofen administration, 30 minutes afterwards,and every subsequent half hour until the end of the sixth hour.Any observed adverse effects were recorded.Results Mean time needed for fever reduction was 2.72 (SD 1.1)hours in the suppository group, compared to 3.43 (SD 0.9) hoursin the oral group (P=0.004). The mean rate of fever reduction inthe suppository group was 0.90 (SD 0.4) °C/hour, while in theoral group it was 0.61 (SD 0.3) °C/hour. However, mean maxi-mum temperature lowering ability did not differ significantly [2.11(SD 0.7) °C for the suppository group and 1.99 (SD 0.7) °C, forthe oral group (P=0.489)]. There was no significant difference inmean duration of effect [220.8 (SD 83.0) hours for the supposi-tory group and 196.6 (SD 92.7) hours for the oral group (p=0.231)].Conclusions There was no significant difference between bothpreparations in maximum temperature lowering ability and dura-tion of effect. Temperature reduction was significantly fasterwith the administration of ibuprofen suppository
The effect of soybean formula and formula 100 supplementation on the growth of preschool children
Authors: Mexitalia M , Nugroho Yohanes Tri , Susanto J C
Published: March 2017

Background Preschool children are vulnerable in growth. Soy-bean formula (SF) and formula-100 (F100) are supplementary foodswhich contain of high energy and are available at low price; how-ever, they are not widely used for preschool children.Objectives To investigate the effect of SF compared to F100 onthe growth of preschool children.Methods A cross-over trial was conducted on 96 preschool chil-dren aged 4-7 years. Subjects were randomly divided into 2 groupswhich received 200 ml soybean formula (n=49) or F100 (n=47) for1 month and crossed-over after a six-week wash-out period. Bodyweight was measured weekly. Body height and food analysis by 3-day food recall were measured at the beginning and the end of thestudy. The criteria of the acceptability of the formula was eithergood or poor.Results Supplementation with SF as well as F100 induced catchup growth as shown by the increase of Δz-score. There were nosignificant difference of Δ weight for age z-score, Δ height for agez-score, and Δ weight for height z score between groups duringthe first and second phases of the trial. The acceptability of F100was significantly better than that of SF at the beginning; neverthe-less, the difference was not significant at the second phase trial.Conclusions Soybean formula and F100 given for a one monthperiod can induce catch-up growth in preschool children. Soybeanformula as an alternative health food can be accepted by preschoolchildren
Erythrocyturia and proteinuria conversion in post-streptococcal acute glomerulonephritis
Authors: Suarta I Ketut
Published: March 2017

Background Acute glomerulonephritis (AGN) is a sudden onsetof macroscopic hematuria and edema. The chronic post-strepto-coccal acute glomerulonephritis (PSAGN) can be predicted if mi-croscopic hematuria, proteinuria, and low serum complement C3level are present for a period exceeding six months after initial onsetof illness. It is prudent to follow the course of PSAGN until proteinurianormalizes and microhematuria disappears in urinalysis.Objective To acquire the time of erythrocyturia and proteinuriaconversion in post-streptococcal acute glomerulonephritis (PSAGN)among children.Methods A retrospective cohort study on children with PSAGNwas conducted in the Pediatric Outpatient Clinic and Ward atSanglah Hospital, Denpasar, Bali from January 2001-December2003. All subjects were recorded for clinical and laboratory signs,including initial symptoms, history of previous streptococcal infec-tions, blood pressure, complete blood count, serum albumin, ASTOtiter, complement C3 level, BUN, and serum creatinin. Erythrocyt-uria and proteinuria follow-ups were done by recording urinalysisfindings for a six-month period after initial onset.Results Thirty subjects 21 boys and 9 girls, mean age 8.7 (SD 2.5)years] with PSAGN were enrolled in the study, 16 had hematuria withedema. Twenty-one subjects had the history of upper respiratory tractinfections and 9 with skin infections. Mean systolic blood pressure was141.3 (SD 21.8) mmHg, mean diastolic blood pressure was 90.8 (SD16.3) mmHg, mean ASTO titer was 1103.3 (SD 686.1) IU/ml, and meancomplement C3 level was 42.2 (SD 15.5) mg/dl. Urinalysis monitoringshowed 2/30, 9/30, 12/30, 22/30, 27/30 subjects had conversion he-maturia at the first, second, third, fourth, and fifth month, respectively.Median duration of erythrocyturia conversion was 4.0 months (95% CI:3.53-4.47). There were 11/30, 18/30, 21/30, 23/30, 25/30, 26/30 sub-jects with proteinuria conversion at the first, second, third, fourth, fifth,and sixth month, respectively. Median duration of proteinuria conver-sion was 2.0 months (95% CI: 1.25-2.75).Conclusion Three out of 30 children remained with persistenthematuria and 4 of 30 remained with persistent proteinuria
The role of bovine colostrum on recovery time and length of hospital stay of acute diarrhea in infants and children: a double-blind randomized controlled trial
Authors: Suwarba IGN , S Sudaryat , S Hendra , Suandi IKG , Widiana Raka
Published: March 2017

Background WHO standard treatment for acute diarrhea remainsunsatisfying to the parents of acute diarrhea patients, particularlythe need of medical treatment. Bovine colostrum contains immuneand growth factors that is thought able to neutralize some agentscausing acute diarrhea in infants and children.Objective To evaluate the efficacy of bovine colostrum as adju-vant therapy on recovery time and length of hospital stay for acutediarrhea in infants and children.Methods A double-blind randomized controlled trial was conductedon infants and children with acute diarrhea admitted to SanglahHospital. Treatment group received standard therapy with bovinecolostrums and control group received standard therapy plus pla-cebo. The primary outcomes were achievement of recovery timeand length of hospital stay. Recovery time was determined by thenumber of days needed to achieve defecation frequency <3 times/day and needed to achieve normal stool consistency.Results Seventy infants and children were enrolled. The treatmentgroup significantly achieved recovery time earlier than the control groupin regard to the time of achieving defecation frequency to <3 times/day [2.31 (0.76) vs 3.34 (1.45); mean difference of -1.03; P= 0.001; CI95% -1.58;-0.48] and normal stool consistency [2.40 (0.77) vs 3.43(1.48); mean difference of -1.03; P = 0.001; CI 95% -1.59;-0.46]. Lengthof hospital stay was shorter in the treatment group than the controlgroup [2.89 (0.78) vs 3.94 (1.53); mean difference of -1.05; P= 0.001;CI 95% (-1.3;-0.7)]. No significant difference was found in mean ofbody weight recovery in two groups [0.47 (0.16) vs 0.49 (0.20); meandifference of -0.03; P=0.556; CI 95%: -0.11;0.06]. Age, nutritionalstatus, breastfeeding, and diarrhea before admission did not influ-ence the study outcome.Conclusion Bovine colostrums as an adjuvant in standard therapyfor acute diarrhea in infants and children is effective in regard toachieve earlier recovery time and shorter length of hospital stay
Clinical features of dengue hemorrhagic fever and risk factors of shock event
Authors: Dewi Rismala , Tumbelaka Alan Roland , Sjarif Damayanti Rusli
Published: March 2017

Background Dengue hemorrhagic fever (DHF) can lead to highmorbidity and mortality. Its clinical features vary from time to time.Many studies were performed to determine the risk factors of se-vere dengue infection.Objective To find out clinical features and risk factors for predict-ing the likelihood of shock in DHF.Methods A retrospective cohort study was conducted in all con-firmed DHF children who were hospitalized at the Department ofChild Health, Cipto Mangunkusumo Hospital within the period ofJanuary 1, 2003 until June 30, 2004. Risk factors for developmentof shock were analyzed using chi-square test and multiple logisticregressions with a level of significance of <0.05.Results A total of 101 patients, consisted of 47 males and 54females were enrolled in this study. Mean age was 6.5 (SD 3.6)years, ranged from 5 months to 15 years. About 31.7% patientshad grade III DHF, 30.7% grade II, and 26.7% grade IV (including1 patient with encephalopathy). Shock was more frequent amongpatients aged between 6-10 years, female, under-nourished, bodytemperature <38°C, hematocrit level 46-50 vol%, and platelet count<20 000/ml. During year 2003-2004, there was increased numberof patients who developed shock. Based on univariate analysis,hepatomegaly, high hematocrit value, and thrombocytopenia wereconsidered significantly different. Among those variables analyzedwith multiple logistic regression method, only hepatomegaly andthrombocytopenia were identified as predictors of shock.Conclusion There was an alteration on clinical features of DHFin our hospital in 2003-2004 period compared to the previous years.Hepatomegaly and platelet count <50 000/ml are independent riskfactors of shock among DHF patients
The prevalence of atopic dermatitis history in asthmatic children
Authors: Suryati Rifda , Akib Arwin AP , Boediman I , Latief Abdul
Published: March 2017

Background Atopic dermatitis (AD) is a risk factor of asthma. Thereis still limited information about its prevalence and characteristicsin asthmatic children.Objective To find out the prevalence of AD history in asthmaticchildren.Methods This was a cross-sectional study conducted at the De-partment of Child Health, Cipto Mangunkusumo Hospital, Jakarta,from July until December 2004. Patients with asthma who were ator less than 5 years of age were included in the study. The parentshad completed study questionnaire about asthma, AD, and someinformation about atopic family history, the food history in infantperiod and environment factors.Results Ninety children met the inclusion criteria. Male and femaleratio was 1.5:1. Most of subjects reported onset of asthma in 12-36 months of age. The history of AD was found in 26% of asth-matic children with quite similar number for both sexes. All sub-jects had atopic family history with asthma as the most commonmanifestation. The environment factors contributed to this eventwere mother’s diet containing allergen and smoking history in familyduring pregnancy and lactation period. More than half of subjectshad no breast-feeding. Solid food and formulated milk had beenearly-introduced.Conclusion History of AD is found in 26% asthmatic children.The percentage of characteristic distribution of factors which hadbeen assumed has a role in asthma and AD was similarly equalbetween subjects with and without history of AD
Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94
Authors: Gatot Djajadiman , Windiastuti Endang
Published: March 2017

Background Before 1990, the survival rates of childhood acutelymphoblastic leukemia (ALL) patients remained low. In 1994, theHematology Oncology Working Group of the Indonesian PediatricAssociation constructed a national protocol based on standard in-ternational protocol. As the outcome was still not promising, in 1998the protocol was modified by introducing low dose MTX infusion forCNS prophylaxis.Objective To analyze the survival of pediatric ALL patient treated withthe modified protocol in Cipto Mangunkusumo Hospital, Jakarta.Methods A prospective study was carried out to all newly diag-nosed and relapsed children with ALL from January 1998 throughDecember 2004. Patients were stratified into standard risk group(SRG) and high risk group (HRG). HRG met with one of thesecriteria: WBC >50 000/ìl, the presence of CNS involvement, medi-astinal mass, relapse, or L 3 morphology. After completing induc-tion therapy, all patients received low-dose MTX (LDMTX) infusion(500 mg/m 2 ), especially for those aged less than 3 years. If thepatient could not afford LDMTX, cranial irradiation (CRT) was given.Results There were 309 patients, consisted of 190 SRG and 119 HRGpatients. Male to female ratio was 1.8:1. Complete remission wasachieved in 86.3% SRG patients compared with 63.8% in HRG pa-tients (P<0.05). Event-free survival (EFS) rate in SRG and HRG were65.9% (95%CI 59.8; 71.9%) and 40.4% (95%CI 32.5; 48.4%), respec-tively. The overall survival (OS) rates in SRG was 81.2% (95%CI 76.3;86.2%) and in HRG was 56.0% (95%CI 47.8; 64.2%). The overall OSand EFS for both groups were 71.6% (95%CI 67.0; 76.2%) and 59.6%(95%CI 54.5; 64.7%), respectively. Failure of therapy was mostly dueto severe aplasia resulted in bleeding and severe infection. CNS re-lapse was rare in both groups, i.e. 3.1% in SRG and 0.8% in HRG.Conclusion Treatment of ALL using modified national protocol forSRG shows promising results. However, the outcome of HRG pa-tients is still inferior to those reported elsewhere. The use of low-dose MTX infusion can replace the role of cranial irradiation asCNS prophylaxis measure.
Genetic problems at present and their challenges in the future: Thalassemia as a model
Authors: Wahidiyat I , Wahidiyat P A
Published: March 2017

Compared to the infectious diseases, geneticdisorders are not so frequently encounteredin the clinic, so that there has been a trendthat they are neglected by people or evenby the authorities. Our government is still fightingagainst infectious diseases and nutritional disorders.The immunization programs of the government haveindeed reduced the occurence of many infectious dis-eases. Actually, the government has to begin to thinkhow to handle the emerging genetic disorders, afterhaving eradicating infectious diseases.
Incidence of HIV-infected infants born to HIV- infected mothers with prophylactic therapy: Preliminary report of hospital birth cohort study
Authors: Kurniati Nia , Nilamsari T , Akib Arwin AP
Published: March 2017

Background Human immunodeficiency virus (HIV) is expandingrapidly and was reported double in several places in Indonesia Toour knowledge, reports regarding HIV-infected infants are stillscarce.Objectives To investigate the incidence of HIV-infected infantsborn to HIV- mothers who had received prophylaxis therapy at birth.Methods A prospective hospital-based cohort study was held fromJanuary 2003 until December 2004 in Cipto Mangunkusumo Hos-pital, Jakarta. The inclusion criteria were mothers with positive HIVand their infants had been given anti retroviral (ARV) therapy. Thebabies were followed up monthly and the status of infection wasdetermined by PCR at the age of 4 weeks and 6 months. Outcomewas measured based on PCR assays or clinical signs of HIV in-fection.Results The mothers’ age ranged from 19 to 27 years. All of themwere carrying their first child and only 41% mothers took ARV pro-phylaxis. Almost all mothers underwent caesarean section and theinfants had formula feeding. HIV infection was diagnosed in 7 in-fants and 2 of them had RNA assays more than 5,000 copies/ml.Six infants were negatives whereas 3 infants were diagnosed asindeterminate HIV infection and needed further examination. Oneneeded no further investigation as the mother was seronegative.Conclusions Preventing HIV transmission from mother to infantcan be done by giving ARV during prenatal, intrapartum, and post-natal period to the newborn. In our hospital, transmission was con-firmed in 6 of 17 infants. Unison protocol must be used and popu-lation of HIV-pregnant mother must be registered in order to knowhow high the transmission rate among Indonesian HIV people
Relationships between plasma zinc and ferritin with nutritional status in thalassemic children
Authors: Arijanty Luszy , Nasar Sri Sudaryati , Madiyono Bambang , Gatot Djajadiman
Published: March 2017

Background Repeated blood transfusions in thalassemic chil-dren can lead to iron overload in the body. High ferritin level leadsto low plasma zinc status because of their competitive inhibition.Previous study found that there was a correlation between plasmazinc level and nutritional status.Objective To obtain plasma zinc level, to investigate the correla-tion between plasma zinc and ferritin, and the impact of plasmazinc on nutritional status in children with thallasemia.Methods A cross sectional study was conducted on 67 thalas-semic children. This study was performed at Thalassemia Center,Cipto Mangunkusumo Hospital, Jakarta, from 1 st until 31 st of March2005. The age of the patients ranged from 4 to 18 years, with fer-ritin levels more than 2000 ng/ml during the last 6 months or totaltransfusion more than 5 liters. The subjects were divided into 2groups, i.e. group 1 (4-10 years) and group 2 (>10-18 years). Di-etary intake was assessed by 3 day-dietary recall. The nutritionalstatus were judged by mid upper arm circumference (MUAC) forage and height for age (H/A). Venous blood was obtained to mea-sure plasma zinc and ferritin levels. Statistical analysis was doneby Student’s t-test (2-tailed) and linear regression analysis.Results We found that 42% subjects were well-nourished, 51%were undernourished, and 7% were severely malnourished. All sub-jects had low plasma zinc status 31.9 (SD 16.9) μg/dl. There was aweak negative correlation between plasma zinc and ferritin level (r= -0.282, P=0.021). Lower zinc intake was detected in 65 out of 67subjects.Conclusion All thalassemic children in our hospital had low plasmazinc level. There was a weak negative correlation between plasmazinc level and ferritin level. There was no significant correlationbetween plasma zinc status and nutritional status
Comparison of clinical efficacy and safety between salbutamol-ipratropium bromide nebulization and salbutamol alone in children with asthmatic attack
Authors: Kartininingsih Lusiana , Setiawati Landia , S Makmuri M
Published: March 2017

Background Indonesian guidelines for childhood asthma recom-mend giving ipratropium bromide when there are no improvementafter 2 times salbutamol nebulization. The efficacy and safety ofearly nebulization of ipratropium bromide combined with salbutamolas first line in moderate asthma exacerbation in children are stillunknown.Objective To compare efficacy and safety between nebulizedsalbutamol-ipratropium bromide and salbutamol alone in childrenwith moderate asthma exacerbation.Methods Fifty-two children (2-6 years) with acute asthma (clinicalscore 5-10) were enrolled into a randomized single blind controlledtrial comparing 2 groups of 2.5 mg nebulized salbutamol (group 1)and 2.5 mg salbutamol combined with 0.5 mg ipratropium bromide(group 2). Nebulization was given until clinical score decreased<5, maximum of 3 doses during 2 hours. Clinical measurementsincluded clinical score, oxygen saturation and side effects whichwere assessed every 20 minutes up to 120 minutes. Statisticaltest for homogeneity and comparison of clinical outcomes and sideeffects used independent t-test, Fisher’s exact test, and Mann-Whitney U test (P<0.05).Results The groups were similar in all baseline measures. Therewere significantly decreasing clinical score in groups 2 at 20, 40,60, 80, 100, and 120 minutes (P<0.05), and the means of oxygensaturation were significantly higher in group 2 at 20, 40, 60, 80,100, and 120 minutes (P<0.05). In group 1, 11.5% of patients werehospitalized after the study and none in groups 2 (P> 0.05). Therewere no toxic effects attributable to ipratropium bromide, and theside effects were not different between these two groups.Conclusion The combination of nebulized ipratropium bromideand salbutamol in a child with acute moderate asthma exacerba-tion was associated with higher reduction of clinical score and higheroxygen saturation, and may reduce hospitalization