bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of peak expiratory flow measurement by Mini-Wright peak flow meter and electronic spirometer in healthy elementary school children
Authors: Said Mardjanis , Sastroasmoro Sudigdo , Supriyatno Bambang , Ananta Yovita
Published: March 2017

Objective This study aims to compare peak expiratory flow mea-surement by peak flow meter and electronic spirometer in healthyelementary school children.Methods This was a cross-sectional study performed in an el-ementary school near Cipto Mangunkusumo hospital (SDNPegangsaan 01). The study group consisted of healthy childrenaged 6-12 year old. Data regarding identity and history of illnesswas taken in each subject. Routine physical examination was per-formed and recorded. Each subject performed lung function testsby means of electronic spirometer AS-7 as well as by Mini-Wrightpeak flow meter. The subject should perform a minimum of threemaneuvers for each method where only the best result was re-corded. Method comparison test to assess agreement betweentwo methods was employed in this study.Results There were 10 males and 15 females enrolled in this study.None of the subjects currently have any respiratory symptoms andsigns. This study found that the mean peak expiratory flow (PEF) byspirometer was 226.8±73.13 L/min while by peak flow meter was223.0±45.05. Mean difference between spirometer and peak flowmeter measurements is 6.2 with standard deviation of 60.82. Thesevalues resulted in limits of agreement of -115.44 to +127.84 L/min.Conclusions This study finds disagreement between electronicspirometer and Mini-Wright peak flow meter in measuring peakexpiratory flow, therefore these two devices cannot be usedinterchangeably. Mini-Wright peak flow meter still has a role inhome monitoring, but the physician should interpret the resultscarefully.
Serum immunoglobulin E levels in children with idiopathic nephrotic syndrome
Authors: Asmaningsih Ninik , Poernomo Windhu , Noer M Sjaifullah
Published: March 2017

Background Children with idiopathic nephrotic syndrome (INS)have been known to have T-cell dysfunction and an impairment ofthe cytokine network that may alter glomerular permeability andthe glomerular filtration barrier. This disorder may contribute to thepresence of urinary protein loss in children with INS. The elevationof serum IgE levels has been noted in some cases, but its associa-tion with steroid-responsive nephrotic syndrome has not been fullyelucidated.Objective This study was done to investigate the association be-tween serum IgE levels prior to prednisone treatment in childrenwith INS and the outcome of treatment.Methods A prospective observational study has been conductedon 22 children with INS. Prednisone therapy was given with a doseof 60 mg/m 2 body surface area (BSA) for four weeks followed by asingle dose of 40 mg/m 2 BSA every other day for another fourweeks. This protocol was applied for steroid-responsive INS chil-dren. Children with steroid resistance were given oral cyclophos-phamide 2 mg/kg for eight weeks. IgE level measurements wereperformed prior to prednisone therapy and at remission. Data wereanalyzed using one-way ANOVA and multiple regression.Results Twenty-two children were enrolled in this study. High lev-els of serum IgE were found in 95.5% of children, with a mean of2002.5 (SD 2172.1) IU/ml. The serum IgE levels of INS childrenwith history of allergy were significantly higher than those of neph-rotic children without history of allergy (P<0.05). However, therewas no significant correlation between the serum IgE levels andthe outcome of treatment in children with INS.Conclusion The high serum IgE levels in children with INS seemto be associated with humoral immune disorder and did not haveany association with the outcome of therapy. Even though the se-rum IgE levels were significantly higher in INS children with historyof allergy, other factors that may influence serum IgE levels mustbe considered
The benefit of using plastic-covered mattresses and pillows on the frequency of asthma attacks in children with house dust mite allergy
Authors: Ratih Luh Putu Winansari , Santosa Hendra
Published: March 2017

Background House dust mite (HDM) is abundant in tropical ar-eas with an environmental temperature of 25-30 0 C and humidityof more than 50%. Minimizing exposure to HDM allergens will de-crease the frequency of asthma attacks in children with HDM hy-perreactivity.Objective To investigate the benefit of using plastic covered mat-tresses and pillows in decreasing the frequency of asthma attacksin children allergic to HDM.Methods This is a longitudinal analytical study on children aged3–12 years who showed positive HDM skin prick test (SPT). Thesubjects received communication, information, and education (CIE)for the first 3 months and CIE and plastic-covered mattresses andpillows for the second 3 months. The frequency of asthma attackswas observed for the two periods.Results Twenty-six children with asthma were included in this study,16 were boys and 10 were girls. SPT results were +2 in 17 chil-dren, +3 in 8 children, and +4 in 1 child, respectively. During theCIE as well as the CIE + plastic intervention periods, asthma at-tack frequency was decreased significantly in the 1 st , 2 nd , and 3 rdmonths. Among several variables (age, sex, SPT, atopic history infirst-degree relative, and other atopic history), age was the onlyone significantly related to asthma attack frequency.Conclusion Covering mattresses and pillows with plastic de-creased the frequency of asthma attacks in children with positiveSPT to HDM
Efficacy of fructooligosaccharide versus placebo for treatment of acute diarrhea in children: A double-blind randomized clinical trial
Authors: Suryanty Reni , Supriatmo Supriatmo , Hasibuan Berlian , Sinuhaji Atan Baas
Published: March 2017

Objective To compare the efficacy of fructooligosaccharide (FOS)versus placebo in pediatric patients with acute diarrhea with re-gard to duration and frequency of diarrhea and the volume andconsistency of the stools.Methods This double-blind randomized clinical trial was carriedout from July to November 2003 in the pediatric intensive careunit, outpatient clinic, and pediatric ward of Adam Malik Hospitaland Pirngadi Hospital, Medan. Subjects were children and infantsaged 4 to 24 months suffering from acute diarrhea without dehy-dration or with mild to moderate dehydration whose parents gaveconsent. Children included in this trial received tablets of either600 mg FOS or 761 mg fructulin as placebo. Patients with mild tomoderate dehydration were initially rehydrated according to theWHO protocol. Afterwards, 10 tablets of FOS or placebo were givento each subject to be taken twice daily. In subjects without dehy-dration, the tablets were given by their parents. Daily follow-upwas performed, in which body weight, temperature, duration andfrequency of diarrhea, and the volume and consistency of stoolswere recorded. For outpatients, home visits were made.Results Out of 142 children who met inclusion criteria, 135 com-pleted the study. These consisted of 68 children in the FOS groupand 67 in the placebo group. Subjects were mostly <12 months ofage (57.0%), male (57.8%), and moderately malnourished (34.1%).There was no statistically significant difference between both groupsin the duration and frequency of diarrhea and the volume and con-sistency of stools (P>0.05).Conclusion There is no effect of the administration of FOS assupplemental therapy on the duration and frequency of diarrheaand on the volume and consistency of stools in children with acutediarrhea
Clinical manifestations of rotavirus diarrhea in the outpatient clinic of Cipto Mangunkusumo Hospital, Jakarta
Authors: Tjitrasari Teny , Firmansyah Agus , Chair Imral
Published: March 2017

Background Rotavirus is one of the most common cause of acutediarrhea among hospitalized and pediatric outpatients, especiallythose aged 6-24 months. Data of hospitalized children showed thatrotavirus causes severe diarrhea, but data of outpatient children inIndonesia, especially at Cipto Mangunkusumo Hospital Jakarta, islimited.Objective To characterize the clinical manifestations of rotavirusdiarrhea in the pediatric outpatient clinic at Cipto MangunkusumoHospital Jakarta.Methods This was a cross-sectional study, done in July 2003 –March 2004. Stool specimens were collected from patients aged6-24 months with diarrhea and tested for rotavirus by ELISA.Result Of the 98 children enrolled, 35 (35.7%) children excretedrotavirus. Rotavirus diarrhea was seen in 43.8% of children aged6-11 months, of whom 37.0% of them were undernourished. Maleswere affected 1.4 times as much as females. The clinical manifes-tations were passage of diarrheic stools more than 10 times a day(58.3%), mild-moderate dehydration (55.8%), cough (51.9%),rhinorhea (46.0%), vomiting (44.8%), fever (41.1%), yellow stools(38.9%), and mucus in the stool (20.0%). The highest prevalenceof rotavirus diarrhea was identified in the combination of diarrhea,fever, vomiting and cough/rhinorrhea (55.3%). Stool analysis re-vealed that the prevalence of rotavirus diarrhea among childrenwith fat malabsorption, lactose malabsorption, and stool leukocyteof +2 were 50.0%, 46.7% and 33.9%, respectively.Conclusion The prevalence of rotavirus diarrhea in the pediatricoutpatient clinic of Cipto Mangunkusumo Hospital, Jakarta was35.7%. The highest prevalence of rotavirus diarrhea was identifiedin the combination of diarrhea, fever, vomiting and cough/rhinorhea(55.3%)
Evaluation of WHO criteria to determine degree of dehydration in children with acute diarrhea
Authors: Sari Suprawita , Supriatmo Supriatmo , Margaretha S L , Nafianti S , Hasibuan B , Sinuhaji A B
Published: March 2017

Objective To evaluate the diagnostic accuracy and agreementbetween the 1980 and 1990 WHO criteria for determining the de-gree of dehydration in children with acute diarrhea.Methods This prospective study was conducted in two hospitalsfrom October 2002 to February 2003. Clinical signs of dehydrationall patients were recorded. The degree of dehydration based onthe 1980 and 1990 WHO criteria was determined and comparedwith fluid deficit measured by the difference of body weight on ad-mission and on discharge. Chi-square test and kappa value analy-ses were performed. Sensitivity, specificity, predictive values, andaccuracy of each WHO criteria were assessed. The prevalence ofdehydration was also determined.Results Sixty-five patients, comprising 40 boys and 25 girls, werestudied. There was a significant difference between the two WHOcriteria in differentiating between dehydration and non-dehydra-tion (P<0.05). Based on the 1980 WHO criteria the prevalence ofdehydration was 62.2%. Its sensitivity, specificity, and accuracy indiagnosing dehydration were 100.0%, 55.5%, and 86.2%, respec-tively. Based on the 1990 WHO criteria, the prevalence of dehy-dration was 60.0%. Its sensitivity, specificity, and accuracy in diag-nosing dehydration were 94.9%, 46.1%, and 75.4%, respectively.There was also a significant difference between both criteria indetermining severe dehydration (P<0.05). Based on the 1980 cri-teria, the prevalence of severe dehydration was 15.4%. Its sensi-tivity, specificity, and accuracy in diagnosing severe dehydrationwere 30.0%, 94.5%, and 84.6%, respectively. Based on the 1990criteria, these results were 40.0%, 94.5%, and 86.2%, respectively.The prevalence was 15.4%. Kappa value comparing the two WHOcriteria was 0.852 in diagnosing dehydration and 0.915 in diag-nosing severe dehydration. There was no significant differencebetween the two criteria in their sensitivity and specificity (P>0.05).Conclusion Both WHO criteria can be applied to determine de-hydration in patients with acute diarrhea, although we feel that the1990 criteria is simpler
The effect of Ringer’s acetate versus Ringer’s lactate on aminotransferase changes in dengue hemorrhagic fever
Authors: Karyanti Mulya Rahma , Satari Hindra Irawan , Sjarif Damayanti Rusli
Published: March 2017

Background Dengue hemorrhagic fever (DHF) infection causeshepatocelullar impairment. In management of DHF, World HealthOrganization (WHO) recommends the crystalloids Ringer’s acetate(RA) or Ringer’s lactate (RL), which are similar in composition toplasma. Acetate in RA is not metabolized in the liver, hence notburdening the liver, whereas lactate in RL is metabolized mostly inthe liver, thus placing a burden on the liver.Objective To compare aminotransferase changes as markers ofhepatocellular impairment subsequent to the use of RA and RL inthe management of DHF with and without shock.Methods This study was a double-blind randomized controlledtrial on DHF patients aged 1-18 years in Cipto MangunkusumoHospital who had not received prior treatment with crystalloids orcolloids. Subjects were randomly assigned to receive either RA orRL intravenously. Aminotransferase levels were examined on thefirst, second and third weeks from the onset of fever.Results Ninety-two patients who fulfilled inclusion criteria wereenrolled in this study, consisting of those without and with shock.Mean transaminase levels of patients without shock in the RA andRL groups did not differ significantly. Mean transaminase levels ofpatients with shock in the RA group were lower than those in theRL group, but this difference was not significant statistically. Meanalteration of transaminase levels in patients with and without shockwere not significantly different.Conclusion In DHF without shock, there is no significant differ-ence between aminotransferase level changes of patients receiv-ing RA and RL solutions. In DHF with shock, aminotransferaselevels of patients receiving RA tend to be lower than those receiv-ing RL, but this difference is insignificant
The risk for delayed development in low birth weight, appropriate for gestational age preterm infants
Authors: Peryoga Stanza Uga , Sukadi Abdurachman , Wiradisuria Sambas
Published: March 2017

Background Preterm infants, particularly those who have hadsevere asphyxia, hyperbilirubinemia, and sepsis, tend to be at riskfor neurodevelopmental impairment.Objective The purpose of this study was to assess the risk for de-layed development in low birth weight (LBW), appropriate for gesta-tional age (AGA) preterm infants compared to that in term, non-LBWinfants, and to investigate the roles of severe asphyxia, sepsis, andhyperbilirubinemia as potential risk factors for delayed development.Methods This was a hospital-based retrospective cohort studyinvolving preterm, LBW and term, non-LBW infants conducted inHasan Sadikin Hospital, Bandung. The Bayley InfantNeurodevelopmental Screener (BINS) test was performed to as-sess the risk of delayed development at 3 months of corrected agefor the preterm infants and at 3 months of chronological age for theterm infants. Bivariate analysis using the chi-square test and mul-tivariate analysis using logistic regression were performed.Results One hundred and twelve infants fulfilled eligibility criteria,consisting of 52 preterm, LBW and 60 term, non-LBW infants. Basedon the BINS test, of the preterm, LBW infants, 32 (61%) were atlow risk, 11 (21%) at moderate risk, and 9 (17%) at high risk fordelayed development. Of the control infants, 49 (82%) were at lowrisk, 10 (17%) at moderate risk, and 1 (1.7%) at high risk for de-layed development. Logistic regression analysis showed signifi-cant association between accompanying diseases such as sepsis(OR=25.60; P=0.001) and hyperbilirubinemia (OR=16.07; P=0.001)with delayed development. Despite more than twofold odds fordelayed development in infants with severe asphyxia (OR=2.51)and LBW-prematurity (OR=2.47), the association was statisticallyinsignificant (P=0.20 and P=0.15, respectively).Conclusions In preterm infants appropriate for gestational age,prematurity and low birth weight alone may or may not predisposeto delayed development at 3 months of age. However, the risk fordelayed development in such infants is increased when sepsis orhyperbilirubinemia is present
Nutritional status changes in children with malignant solid tumor before and after chemotherapy
Authors: Januar Boris , Nasar Sri S , Suradi Rulina , Abdulsalam Maria
Published: March 2017

Background Although aggressive multimodal treatment programsin childhood cancer have significantly increased survival rates, themorbidity caused by protein energy malnutrition related to therapyis still high.Objective To describe nutritional status changes in children withmalignant solid tumors after 21 days of chemotherapy.Methods A descriptive prospective study with pre- and post-testdesign in children with malignant solid tumors was conducted inthe Department of Child Health, Medical School University of In-donesia/Cipto Mangunkusumo Hospital, Jakarta between Janu-ary and July 2004. Anthropometrics (body weight, BW and mid-upper-arm circumference, MUAC) and serum albumin measure-ments were performed before and after 21 days of chemotherapy.Results Twenty-two children were enrolled in this study. After 21days of chemotherapy, 8 children had decreased BW and 6 chil-dren had decreased MUAC, but 3 children gained weight and hadincreased MUAC. Based on MUAC-for-age, 7 children had de-creased nutritional status. Fifteen children had reduced serum al-bumin levels based on a 10% cut-off point. The number of childrenwho had reduced serum albumin was larger than those who hadreduced BW and MUAC. In the evaluation of average oral foodconsumption during 21 days, 7 out of 16 children could acceptmore than 2/3 portion of served food. All of the children who re-ceived enteral feeding could accept more than 2/3 portion of servedfood.Conclusion There was a decrease of nutritional status, BW,MUAC, and serum albumin in most of the subjects after chemo-therapy. Serum albumin level measurement was the more sensi-tive parameter in determining nutritional status changes. Enteralfeeding seems more appropriate to fulfill nutritional needs than oralfeeding
The impact of obesity on left ventricular mass and left ventricular systolic function in children
Authors: Nova Ria , Madiyono Bambang , Sastroasmoro Sudigdo , Sjarif Damayanti R
Published: March 2017

Background Obesity causes cardiovascular disturbances. Theincidence of cardiovascular disease is higher even in mildly obesepatients than in lean subjects.Objectives The purpose of this study was to compare left ven-tricular (LV) mass, LV internal dimensions, and LV systolic func-tion between obese and normal children; and to determine the as-sociation of the degree of obesity with LV mass and LV systolicfunction.Methods This cross-sectional study was conducted on elemen-tary school students in Jakarta from February to April 2003. Wemeasured the subjects’ body weight and height, and performedlipid profile and echocardiography examinations. Measurementsof LV mass, LV internal dimensions with regard to septum thick-ness, LV internal diameter, and LV posterior wall thickness; andLV systolic function as indicated by shortening fraction and ejec-tion fraction, were performed echocardiographically. The differ-ences in measurements between obese and normal children aswell as between obese children with and without lipid abnormalitywere analyzed. The correlation between the degree of obesity withLV size and systolic function was determined.Results Twenty-eight normal children and 62 obese children wereenrolled in the study. Mean LV mass was 35.7 (SD 5.16) g/cm 3 inobese children versus 24.0 (SD 3.80) g/cm 3 in normal children(P<0.0001). Mean septum thickness was 0.8 (SD 0.14) mm inobese children versus 0.6 (SD 7.90) mm in normal children (P<0.0001). Mean posterior wall thickness was 0.9 (SD 0.14) mm inobese children versus 0.6 (SD 9.97) mm in normal children(P<0.0001). Mean LV internal diameter was 4.0 (SD 0.34) mm inobese children versus 3.9 (SD 0.29) mm in normal children(P=0.300). There was strong correlation between the degree ofobesity and LV mass (r=0.838, P<0.0001). LV systolic function(shortening fraction) was 37.1 (SD 4.20) percent in obese childrenversus 35.8 (SD 4.99) percent in normal children (P=0.19). Ejec-tion fraction was 67.4 (SD 5.32) percent in obese children versus65.5 (SD 6.29) percent in normal children (P=0.13). There wasweak correlation between LV systolic function and the degree ofobesity (shortening fraction r=0.219, P=0.038; ejection fractionr=0.239, P=0.023).Conclusions Obese children had significantly greater LV mass,septum thickness, and posterior wall thickness than normal chil-Backgrounddren. Such significant difference was absent for LV internal diam-eter and measures of LV systolic function. There was no signifi-cant difference in LV mass and LV systolic function between obesechildren with or without abnormality of lipid profile. A strong corre-lation exists between the degree of obesity and LV mass, but thecorrelation between degree of obesity and LV systolic function wasweak
Child immune response and the role of nutrition
Authors: Harsono Ariyanto
Published: March 2017

The immune function is designed to defendthe body in a safe and efficient way againsta variety of dangerous materials includingtoxins and infectious organisms. Mechanical andbiological barriers prevent the penetration ofexogenous material into the body. Only after thesebarriers have been breached and cells have beendirectly attacked does the immune system come intoplay. By a variety of mechanisms, certain immunecells can directly phagocytose and destroy manypathogens. They require the close cooperation ofsomatic cells, which both alert the immune systemthrough alarm signals and later participate in theeffector phase. This first alarm signal can be groupedtogether as “stress signals”, known as the innateimmune response.
Adolescent rape: Characteristics and short-term impact
Authors: Prawitasari Titis , Gunardi Hartono , Madiyono Bambang , Tarigan Rosdiana S
Published: March 2017

Background Data in Indonesia show that adolescents still havethe highest rate for rape and other sexual assaults among agegroup. There are gender differences in adolescent rape and sexualassault, with female victims exceeding males with a ratio of 3:1.Sexual assault and rape can affect numerous children and oftenlead to short-term and long-term consequences.Objectives To determine the characteristics and short-term im-pacts of adolescent rape.Methods A cross-sectional study was conducted on 31 adoles-cents who had been raped 1-9 months previously. Subjects andparents were assessed using Child Behavior Checklist, Draw aPerson, House Tree Person, and Raven’s Progressive Matrices todetermine psychological problems. History and physical examina-tion findings at the time of rape were reviewed.Results Thirty out of 31 female adolescents were 13-18 years old.Almost half of them came from low income families and large fam-ilies, two-thirds of all subjects were living with their parents. Nine-teen of 31 perpetrators were friends or acquaintances, only 4 wererelatives. Tears of hymen were found in 21 subjects and only 8 ofthem had non-genital injuries. Nine of 31 subjects had a high aver-age range in non-verbal processing. Most subjects had a greattendency to feel insecure, anxiety, depression, and had interper-sonal relationship problems. Regression and aggressiveness werefound in almost half of the subjects. All subjects felt that theirmothers were protective and half of them had dominant fathers.Conclusion Almost half of the adolescent victims come from low-economic status and large families, most of the assailants werefriends or acquaintances. Adolescent rape victims have ongoingbehaviour problems. The most common problems are anxiety,depression, and relationship problems
Birth weight and blood pressure in first-grade elementary school students: A preliminary study
Authors: Umboh Adrian , Gunawan Stefanus
Published: March 2017

Background Fetal programming theory reveals that low birthweight is associated with higher risks of hypertension and cardio-vascular diseases in the adulthood.Objective To study the difference in blood pressure among first-grade students of different birth weight groups.Methods A cross-sectional study was performed. Blood pressureof 214 healthy first-grade elementary school students (102 malesand 112 females) in Bunaken Subdistrict, Manado, Indonesia, wasmeasured using a standard sphygmomanometer with appropriatecuff for arm size. Two readings were taken. Parents were asked tocomplete a questionnaire concerning the information on birth weightand length and confirmed by retrieving the record on a growthchart and/or a maternal-child health book. The subjects were di-vided into 6 groups according to their birth weight. The differencesin blood pressure values between birth weight groups were exam-ined by ANOVA.Results Systolic blood pressures were significantly higher in the<2500 g birth weight group (100.73+9.99 mmHg vs. 93.70+8.29mmHg) and in the 2500-<3000 g birth weight group compared tothose of the 3500-<4000 g one (99.56+9.14 mmHg vs. 93.70+8.29mmHg) with a P of 0.048 and 0.014, respectively. There was nodifference between diastolic blood pressure and birth weight.Conclusion Our study showed that the lower birth weight grouptends to have a higher systolic blood pressure than that of childrenwith normal birth weight
Retinopathy of prematurity: Prevalence and risk factors
Authors: Rohsiswatmo Rinawati
Published: March 2017

Background Retinopathy of prematurity (ROP) is one of the ma-jor causes of infant blindness. There are several factors known asrisk factors for ROP. Recent studies show ROP as a disease ofmultifactorial origin.Objective To report the prevalence of ROP in Cipto MangunkusumoHospital, Jakarta and its relation to several risk factors.Methods A cross-sectional descriptive study was conducted fromDecember 2003-May 2005. All infants with birth weight 2500 gramsor less, or gestational age 37 weeks or less, were enrolled con-secutively and underwent the screening of ROP at 4 to 6 weeks ofchronological age or 31 to 33 weeks of postconceptional age.Result Of 73 infant who met the inclusion criteria, 26% (19 out of73 infant) had ROP in various degrees. About 36.8% (7 out of 19infants) were in stage III or more/threshold ROP. No ROP wasnoted in infants born >35 weeks of gestational age, and birth weight>2100 grams. No severe ROP was found in gestational age >34weeks and birth weight >1600 grams. None of full-term, small forgestational age infants experienced ROP. Birth weight, sepsis,apneu, asphyxia, multiple blood transfusions, and oxygen therapyfor more than 7 days were statistically significant with the develop-ment of ROP. However, using multivariate analysis, only asphyxia,multiple blood transfusions, and oxygen therapy for more than 7days were statistically significant with the development of ROP.Conclusion Screening of ROP should be performed in infantsborn 34 weeks of gestational age and/or birth weight <1600 grams.Infants with birth weight from 1600-<2100 grams need to bescreened only if supplemental oxygen is necessary or with clini-cally severe illness
Nasopharyngeal carcinoma in childhood
Authors: Lubis Bidasari , Rosdiana Nelly , Margaretha Saur L
Published: March 2017

Nasopharyngeal carcinoma (NPC) is a raretumor which originates from thenasopharyngeal epithelium. It accountsfor <1% of childhood malignancy cases,whereas almost all adult nasopharyngeal cancers arecarcinomas. In children, nasopharyngealmalignancies are mostly rhabdomyosarcomas andonly 20-30% are carcinomas or lymphomas.Approximately one third of the undifferentiated typeNPC is diagnosed in adolescents or young adults.
Situational analysis of pediatric residency training program in Indonesia
Authors: Soenarto Srisuparyati , Emilia Ova
Published: March 2017

Background Over the last twenty years, higher education, par-ticularly pediatric residency training, has changed dramatically. Aquestion arises whether the pediatric residency training conductedin Indonesia today has been set up to meet the changing as wellas the community needs.Objective To evaluate whether the pediatric residency trainingprogram in Indonesia today has met the changing as well as thecommunity needs.Methods Twelve centers with pediatric training program in Indone-sia were involved in this study. Each institution had various numberof respondents, with a total of 42 respondents. A structured ques-tionnaire with open responses was selected to ensure the varietyand flexibility of responses.The questionnaires included statementswhich encompassed areas such as curriculum, training and educa-tional system, and alumni achievement of educational objectives.Continuous content analysis of the responses was made.Results Coverage was considered adequate by 80% of respon-dents and was suggested to be continuously updated to be in linewith existing national problems but not yet considered internationalstandard. Additional knowledge and competence proposed by therespondents are mollecular biology, genetics, generic skills, com-munication skills, and introduction to sophisticated instruments. Thelength of the existing program was appropriate. Graduate knowl-edge was sufficient and fulfilled pediatric standards. Current pro-gram was different from that of the past. The objectives are compre-hensible. The placement of trainees enabled them to follow eachdivision in a spiral fashion (at least three times during the training).Conclusion The curriculum content of the training process wascontinuously updated to be inline with existing national problems.Additional knowledge, and competence, and the present lengthof study was considered appropriate. Graduate knowledge issufficient and fulfills pediatric standards. Furthermore, the objec-tives of the current program are clearer and placement of train-ees enables them to follow each division at least three times
Etiological patterns of bacterial meningitis in neonatal sepsis
Authors: Setiawan Andy , Amir Idham , Tumbelaka Alan R.
Published: March 2017

Background Sepsis and meningitis are major causes of mortalityand morbidity in neonates. The prevalence of sepsis is around 1-4out of every 1000 live births, and one-fourth is accompanied bymeningitis. These numbers are higher in prematures.Objective To find out the prevalence and etiological patterns ofbacterial meningitis in neonatal sepsis, and the pattern of antibi-otic susceptibility for organisms causing bacterial meningitis.Methods This was a cross sectional study, conducted in the neo-natal ward and emergency room at Cipto Mangunkusumo Hospi-tal from October 2003 to October 2004.Results Seventy two neonates fulfilled the inclusion criteria andwere examined for blood and cerebrospinal fluid (CSF) cultures.Sixty out of 72 neonates were proven for sepsis. Bacterial menin-gitis was found in 18 neonates, and all cases were accompaniedby sepsis. Positive CSF cultures were found in 12 neonates. Theother six were diagnosed based on CSF cell count >32/μl.Acinetobacter calcoaceticus was the major causative organismsin this study. The organisms were highly resistant to first line anti-biotics, except for chloramphenicol. They were also sensitive toceftazidime (second line), meropenem, and imipenem.Conclusions The prevalence of bacterial meningitis in neonatalsepsis at Cipto Mangunkusumo Hospital was 18/60 in 2003-2004.The major causative organism was Acinetobacter calcoaceticus.Antibiotic resistance was very high and only chloramphenicol,ceftazidime, meropenem, and imipenem remain effective
Effects of zinc supplementation on nutritional status and cognition in children
Authors: S Retno Asih , Warsiki Endang , Hidajat Boerhan
Published: March 2017

Background Zinc deficiency is common in children in develop-ing countries and data suggests the effects are detrimental towardschildren’s growth and neuropsychologic performance. Results ofmultiple studies which assess these effects have been inconsis-tent.Objective To evaluate the effects of zinc supplementation onnutritional status and cognition in children with zinc deficiency.Methods Forty-six stunted children aged 50-80 months with lowhair zinc levels were randomly assigned to receive either 7.5 mgelemental Zn or placebo twice a week for 3 months. Anthropom-etry and cognition were assessed at the beginning and the end ofthe supplementation period. Differences among both groups foranthropometry and cognition before and after supplementation wereanalyzed with paired t-test. A comparison of different anthropom-etry and cognition among the two groups were analyzed using theindependent t-test.Results There were no significant differences among baselinecharacteristics except on sex distribution.There was a significantdifference in weight for age between the zinc group and placebo[0.28 (SB 0.18) vs 0.09 (SB 0.14); P=0.0001]. Height incrementswere also greater in the zinc group [0.34 (SB 0.15) vs 0.02 (SB0.12); P=0.0001). There was no significant difference betweenweight for height. Intelligence quotient (IQ) measured by theStanford-Binnet test was slightly higher in the zinc group [2.26 (SB3.11) vs 2.00 (SB 2.81], but the difference was not significant ac-cording to sex.Conclusion Zinc supplementation produced highly positive re-sponses in weight for age and height for age increments in chil-dren with zinc deficiency compared with placebo. There was noeffect of zinc supplementation on weight for height index and noneon cognition measured by intelligence quotient (IQ)
Juvenile rheumatoid arthritis associated with uveitis in a 4-year-old girl
Authors: Sukmawati Made , Santoso Hendra , Susila Niti
Published: March 2017

The variability of the disease may explain mis-conceptions that JRA is usually a benign disease. Acohort study in which 506 subjects during the periodof 1970-1999 found that approximately one-third ofJRA patients achieve disease remission. The visualcomplications are also important in determining theoutcome. Functional disability is common and can belong-lasting. Recognizing JRA symptoms earlier areimportant to prevent mortality, disability, and long-term complications. Although JRA is the most com-mon rheumatic disease in children, many doctors arenot familiar with this disease. The purpose of thispaper is to report a case of juvenile rheumatoid ar-thritis associated with uveitis in a 4-year, 8-month-old girl.
Childhood renal cell carcinoma
Authors: Shahab Nouval , Rodjani Arry , Umbas Rainy
Published: March 2017

Renal cell carcinoma (RCC) in children isseldom found. The incidence of thistumor in childhood is estimated to be 0.1-0.3% out of all neoplasms and 2-7% out ofall malignant renal tumors. The Third NationalCancer Survey reported an incidence of only four casesof RCC per year compared to 117 per year of Wilms’tumor.The incidence of RCC has not been reported inIndonesia. This is the first case of childhood RCCfound in our institution. To the best of our knowl-edge, this is the first report of childhood RCC in In-donesia.
Clinical gestational age assessment in newborns using the new Ballard score
Authors: Erman Erman , Retayasa Wayan , Soetjiningsih Soetjiningsih
Published: March 2017

Background The new Ballard score (NBS) is presently consid-ered to be the most reliable method for estimating clinical gesta-tional age (GA) in newborn infants.Objective The aim of this study was to compare the NBS andDubowitz/Finnstrom score against ultrasonography assessment ofgestational age.Methods A cross sectional randomized study involving neonatesborn in Sanglah Hospital, Bali, June to August 2004 was carriedout. Gestational age was estimated within the first 24 hour by ei-ther Dubowitz/Finnstrom score or NBS confirmed by USG (C-GLMP) as the gold standard.Results One hundred and fifty-five newborns were enrolled in thisstudy. Subjects were randomly divided into two groups, theDubowitz/Finnstrom score group (76 newborns) and NBS group(79 newborns). The mean age of mothers was 28.4 years old; meanbirth weight was 3151.3 g (SD 596.3 g). The proportion of small forGA, appropriate for GA, and large for GA were 6%, 77% and 17%,respectively. Pearson correlation ( r ) between C-GLMP andDubowitz/Finnstrom score was 0.71 (P<0.005); and with NBS was0.79 (P<0.005) .Conclusion The strength of correlation between either NBS orDubowitz/Finnstrom score and USG assessment of gestational ageare similar
Fibrinogen status in relapse and remission of childhood nephrotic syndrome
Authors: Limantara Veronica Lily , Mudita Ida Bagus , Suarta I Ketut
Published: March 2017

Objective To evaluate fibrinogen concentration of relapsing neph-rotic syndrome (NS) in children, and to investigate relationshipbetween fibrinogen with albumin and cholesterol.Methods A cross-sectional study among NS patients admitted topediatric outpatient clinic and pediatric ward at Sanglah Hospital,Denpasar, from November 1, 2003 to January 31, 2004. All pa-tients were evaluated for clinical and laboratory findings of relapseand remission, including edema, proteinuria, serum albumin, totalcholesterol, as well as total platelet count and fibrinogen concen-tration to evaluate coagulation parameters in nephrotic patients.Results There were 36 patients with the mean age of 7.4 (SD 2.3)years included in this study. Mean fibrinogen concentration in re-lapse state was 671.8 (SD 102.7) mg/dl, while in remission statewas 255.2 (SD 50.5 mg/dl); the mean difference was 416.6 mg/dl(95% CI 362.9;470.4; P<0.001). Fibrinogen was inversely andstrongly correlated with serum albumin concentrations (r=-0.91;P<0.001). Fibrinogen was positively and strongly correlated to to-tal cholesterol (r=0.80; P<0.001). Using multiple regression analy-sis, it was shown that only relapse/remission status was signifi-cantly associated with fibrinogen concentration (P<0.001).Conclusion Fibrinogen status is significantly correlated with re-lapse and remission status of NS in childhood patients.
Social maturity among obese children in Surakarta, Indonesia
Authors: Lestari Endang Dewi , Hidayah Dwi , Karini Suci Murti
Published: March 2017

Background Although it is clear that childhood obesity has asso-ciation with many aspects included social aspect, the social matu-rity aspect on childhood obesity is scarcely found.Objective To examine the prevalence of social maturity and thepossible associated factors among obese children.Methods A cross sectional study was conducted from January toFebruary 2005. Twenty percent of elementary schools in every sub-district were randomly selected. All obese children from selectedschools were recruited to the study after obtaining the informedconsent. Criteria of obesity in children was based on BMI e”95 thpercentile according to age and sex. Social maturity was measuredusing Vineland Social Maturity Scale, which consisted of 8 catego-ries, i.e., self-help general, self-help eating, self-help dressing, self-direction, occupation, communication, locomotion, and socializa-tion. Social maturity score was determined using age group. Thetotal score was divided into two categories i.e. immature and ma-ture. Possible associated factors with the social maturity such asgender, maternal education less than 9 years, being held back aclass, and parental guidance by step mother were analyzed usingSPSS 10.0 for Windows.Results There were 158 obese children recruited in the study. Theprevalence of social immaturity was 32.5%. The odds ratio (OR)for parental guidance by single parent or others was 2.32 (95%CI1.01;5.31); OR for intelligence was 3.93 (95%CI 1.42;10.89); ORfor male was 2.41 (95%CI 1.08;5.38) and OR for maternal educa-tion less than 9 years was 1.22 (95%CI 0.61;2.41). Multivariateregression, analysis showed significant association between gen-der (for male OR=2.44; 95%CI 1.06;5.58) and intelligence(OR=3.31; 95%CI 1.12;9.84) with social maturity.Conclusion The prevalence of social maturity in obese children ishigh. The factors associated with social maturity among obese chil-dren are the history of had ever been held back a class and male.Further investigation is needed to find out the understanding ofspecific influence of social maturity in the prevalence of obesity.
Predictors for the recurrent febrile seizures after the first complex febrile seizures
Authors: Tanjung Conny , Mangunatmadja Irawan , Sastroasmoro Sudigdo , Budiman I.
Published: March 2017

Background Complex febrile seizures (CFS) have been shownto be related to recurrence and epilepsy. Many studies were doneto determine the predictors of recurrence in both simple and com-plex febrile seizures. To our knowledge until now there is no pub-lished data that specially looks for predictors of recurrence after afirst CFS.Objective To find out clinical and demographical characteristicsof a first CFS and to define the predictors for the recurrent febrileseizures.Methods Prospective survival analysis study was done in chil-dren with first CFS who visited Cipto Mangunkusumo Hospital,Jakarta, over 14 months periods. The predictors for developmentof recurrence were analyzed by SPSS for Windows 11.5 usingKaplan-Meier test and Cox regression model with a level of signifi-cance <0.05.Results There were 62 subjects completed this study. Male-to-female ratio was 1.4:1. The mean age at onset was 18.2 months.Recurrence occurred in 9 subjects (14.5%). Body temperaturebetween 38-38.5°C (7 of 26 subjects, P=0.02), upper motor neu-ron type of delayed development (3 of 7 subjects, P=0.03), andepileptic history in the family (2 of 2 subjects, P<0.05) were asso-ciated with recurrence in bivariate analysis. In multivariate analy-sis only body temperature between 38-38.5°C (HR 1.6, 95% CI1.0;23.9) and epileptic history in the family (HR 16.9, 95% CI2.8;101.4) were identified as predictors.Conclusion Low body temperature at the first seizures and epi-leptic history in the family were independent predictors for the re-currence after a first CFS
Left ventricular functions and mass of the adolescents and young adults with thalassemia major: An echocardiography study
Authors: Ali Muhammad , Putra Sukman Tulus , Gatot Djajadiman , Sastroasmoro Sudigdo
Published: March 2017

Background Thalassemia major (TM) is a transfusion-depen-dent disease. Multiple transfusions cause an accumulation of ironin the body. On the heart, iron can induce cardiomyopathy, theleading cause of death in TM.Objective To evaluate left ventricular functions and mass amongadolescents and young adults with TM.Methods A cross-sectional study was conducted on 58 patientswith TM in Cipto Mangunkusumo Hospital, Jakarta. Hematologicaldata was collected from medical record. Left ventricular systolic func-tions (EF, FS), diastolic functions (A, E, E/A ratio, IVRT), and mass(LVDDi, LVDSi, LVMi) were detected using an echocardiographySonos 4500. T test, linier regression, and multiple regression analy-sis were performed.Results Out of 32 TM patients, 30 were enrolled to study. Leftventricular systolic and diastolic functions of TM patients were lowerthan those of the control and statistically significant [EF 66.1% (SD4.9) and 71.6% (SD 5.6); P<0.0001, FS 36.0% (SD 3.7) and 39.8%(SD 5.5); P=0.003, E/A 2.14 (SD 0.4) and 1.83 (SD 0.3); P=0.002,respectively]. Left ventricular mass of TM patients was greater thanthat of control, and also statistically significant [LVMi 111.1 g/m 2(SD 30.8) and 75.4 g/m 2 (SD 14.5); P<0.0001, respectively]. Linierand multiple regression analysis showed significant and powerfulcorrelation between left ventricular diastolic functions (E/A ratio)and serum ferritin concentration (r=0.71; P<0.0001).Conclusion Left ventricular functions and mass of adolescentsand young adults with TM show abnormalities. The higher the con-centration of ferritin serum is, the more likely for TM patient to suf-fer from diastolic abnormality
The accuracy of clinical diagnosis for dehydration according to the integrated management of childhood illness
Authors: Marudut Siswanto , Soenarto Yati , Juffrie Mohammad
Published: March 2017

Background Acute diarrheal disease causes over 5 milion deathsworldwide in children under 5 years old, mostly because of failureto detect and treat dehydration properly and immediately.Objective To determine the validity of clinical diagnosis of dehy-dration according to Integrated Management of Childhood Illness(IMCI) as a diagnostic test for dehydration in children under fiveyears old.Methods A prospective observational study was done for clinicaldiagnosis in dehydration. Children aged 2 months-5 years old withdiarrhea and or vomiting who visited the primary health centers inYogyakarta were enrolled. Clinical diagnosis was made by atrained IMCI nurses. Dehydration was defined as the presence ofdecreasing consciousness, very sunken eyes, slow reaction whenoffered a drink, and decreased skin elasticity. Ninety-five per-cents confidence intervals (CI) were calculated, and the signifi-cance was assessed by X 2 .Results There were 148 children aged 2 months to 5 years oldenrolled this study. Clinical dehydration used according to IMCIproduced sensitivity of 91% (95% CI 83;98), specificity of 82%(95% CI 75;89), positive predictive value (PPV) of 70% (95% CI58;77), negative predictive value (NPV) of 94% (95% CI 90;98),positive likehood ratio of 5.17 (95% CI 3.37;7.94), and negativelikehood ratio of 0.11 (95% CI 0.04;0.27).Conclusion Clinical diagnosis for dehydration according to IMCIis sufficiently accurate as a diagnostic test for dehydration in chil-dren under 5 years old
Intracardiac rhabdomyoma in a newborn with tuberous sclerosis
Authors: Suarca I Kadek , Winaya Ida Bagus Agung , Kari I Komang
Published: March 2017

Primary congenital cardiac tumors, especiallyintracardiac tumors, are rare in children.Rhabdomyoma is the most common oneand usually diagnosed in the first few days oflife. Referral from pediatric cardiac centers found thatthe incidence of cardiac tumors was 0.08%-0.20%.Rhabdomyoma represents 36%-42% in autopsy seriesand 79% in clinical series.
Exhaled nitric oxide in acute exacerbation of pediatric asthma
Authors: Ratnawati Ratnawati , Nguyen V , Morton J , Henry R L , Thomas P S
Published: March 2017

Background Measurement of exhaled nitric oxide (eNO) is a non-invasive and easy method to monitor airway inflammation.Objectives To compare the levels of eNO during and after anexacerbation of asthma, to evaluate the effect of glucocor-ticosteroids (GCS) on the levels of eNO and to correlate eNOwith other markers of inflammation such as symptom scores, FEV 1and sputum eosinophils.Methods The observational study was performed over 24 monthsat a tertiary paediatric hospital. Subjects underwent eNOmeasurement, spirometry and sputum induction during an asthmaexacerbation and then two weeks later. A symptom score wasrecorded everyday for two weeks. All subjects were treated withß 2 -adrenergic agonists and an oral glucocorticosteroid (GCS).Results Fifteen subjects with acute asthma exacerbation aged 5and 16 years old participated in the study. The mean level ofeNO during the acute exacerbation was significantly higher thaneNO levels at the follow-up visit, 11.2 (95%CI 9.2;13.2) vs. 8.0(95%CI 5.0;11.1) ppb, P=0.03. In the acute exacerbation, eNOcorrelated with sputum eosinophils (P=0.04), but no correlationcould be found between eNO and the other markers ofinflammation during exacerbation or follow up.Conclusions eNO level increased during asthma exacerbation anddecreased after two weeks of glucocorticosteroid therapy.Measurement of eNO is a practical monitoring method inemergency management of asthmatic children.