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All Journal Sari Pediatri Paediatrica Indonesiana Journal of General-Procedural Dermatology & Venereology Indonesia
Hikari Ambara Sjakti, Hikari Ambara
Departemen Ilmu Keseahatan Anak Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta
Health Professions Medicine & Pharmacology

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Journal : Paediatrica Indonesiana

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Feeding difficulties in children with cerebral palsy Hikari Ambara Sjakti; Damayanti Rusli Syarif; Luh Karunia Wahyuni; lmral Chair
Paediatrica Indonesiana Vol 48 No 4 (2008): July 2008
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi48.4.2008.224-9

Abstract

Background Children with cerebral palsy (CP) often have feedingdifficulties due to their disability. This results in inadequate calorieintake which finally leads to malnutrition. Several studies foundthat 30-90% of children with CP have feeding difficulties associ-ated with malnutrition. There has been no sufficient publisheddata about this problem in Indonesia.Objective To determine the prevalence of feeding difficulties andmalnutrition in children with CP.Methods A cross-sectional study was done from January toSeptember 2005 in the pediatric outpatient clinic of Dr. CiptoMangunkusumo Hospital (CMH). Children with CP underwentnutritional and feeding difficulties assessment. Nutritional sta-tus was determined by the ratio of body weight to body heightstandardized to CDC-NCHS 2000 growth curve and wereclassified based on Waterlow. Calorie intake was evaluated bydietary analysis and defined as adequate if it reached 13.9 kcal/em BH ± 10%. Feeding difficulties assessment included historytaking, physical examination and observation of feeding skill inthe outpatient clinic.Results Fifty-five children with CP were included in this study,most of them were spastic type, mainly spastic diplegic and spasticquadriplegic cerebral palsy (SQCP). Malnutrition was found in76% subjects, most were SQCP. Feeding difficulties were found in76% subjects, half of them were SQCP, 38% with spastic diplegic.Thirty- eight percents of the parents whose children had feedingdifficulties was not aware of these problems in their children.Parallel with data above, 78% subjects received inadequatecalorie intake.Conclusions The prevalence of undernourished and severemalnutrition in children with CP is 66% and 11% respectively.Malnutrition in CP patients tends to be related with inad-equate calorie intake due to feeding difficulties that is found in78% subjects especially those with SQCP
Gut wall integrity in exclusively breastfed vs. formula-fed infants Nur Hayati; Muzal Kadim; Irawan Mangunatmadja; Soepardi Soedibyo; Evita Bermansyah Ifran; Hikari Ambara Sjakti
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (323.171 KB) | DOI: 10.14238/pi56.4.2016.199-204

Abstract

Background Breast milk has bioactive substances that modulate gastrointestinal maturation and maintain mucosal integrity of the gut in infants. Markers that are both non-invasive and reliable, such as fecal alpha-1 antitrypsin (AAT), calprotectin, and secretory immunoglobulin A (sIgA) have been used to assess gut integrity in adults. Higher AAT levels may imply greater enteric protein loss due to increase intestinal permeability of immaturity gut.Objective To assess and compare gut integrity of exclusively breastfed (BF) and exclusively formula fed (FF) infants aged 4-6 months.Methods Subjects were 80 healthy infants (BF=40; FF=40), aged 4-6 months who visited the Pediatric Polyclinic at St. Carolus Hospital, and lived in Pasar Minggu or Cempaka Putih Districts, Jakarta. The fecal AAT was analyzed by an ELISA method. Mann-Whitney and unpaired T-test were used to analyze possible correlations between feeding type and gut integrity.Results The BF group had significantly higher mean fecal AAT than the FF group (P=0.02). Median sIgA levels were not significantly different between groups (P=0.104). The FF group had a higher mean fecal calprotectin level but this difference was also not significant (P=0.443). There was a significant correlation between breastfeeding and mean fecal AAT level (P=0.02), but no significant correlation with calprotectin (P=0.65) or sIgA (P=0.26).Conclusion The breastfed group shows better mucosal integrity compared to the formula fed group. Higher mean fecal AAT level in the BF group is related to the AAT content of breast milk. Therefore AAT content of BF group is actually lower than formula fed group which shows greater mucosal integrity in BF group.
Age at menarche and body fat in adolescent girls Aman Bhakti Pulungan; Resyana Putri Nugraheni; Najib Advani; Arwin AP Akib; Yoga Devaera; Hikari Ambara Sjakti; Attika Adrianti Andarie
Paediatrica Indonesiana Vol 60 No 5 (2020): September 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.5.2020.269-76

Abstract

Background Menarcheal age is important in adolescent girls due to its associations with health outcomes at adulthood. Modifiable factors that may influence menarcheal age include body fat mass and fat distribution. Objective: To investigate possible correlations between body fat mass and fat distribution with age at menarche in adolescent girls. Methods This study was a cross-sectional study on 32 girls aged 10-15 years in Central Jakarta, who experienced menarche within the time period of July to September 2019. Data on menarcheal age was collected by recall. Body fat mass and distribution were calculated using anthropometric measurements and bioelectrical impedance analyzer (BIA) results. Results The mean age of study subjects was 12.06 (SD 0.82) years and the mean age at menarche was 11.91 (SD 0.83) years. Correlation tests revealed a moderate negative correlation between body mass index-for-age and menarcheal age (r= -0.45; P=0.01) and weak negative correlation between waist-height ratio and menarcheal age (r= -0.37; P=0.03). Conclusion Menarcheal age is correlated with body mass index-for-age and waist-height ratio. However, no significant correlations between menarcheal age and body fat mass or distribution are found.
Microbiological profiles and prognostic factors of infection mortality in febrile neutropenic children with malignancy Yuni Astria; Hindra Irawan Satari; Hartono Gunardi; Hikari Ambara Sjakti
Paediatrica Indonesiana Vol 61 No 5 (2021): September 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.5.2021.283-90

Abstract

Background Post-chemotherapy febrile neutropenia results in high morbidity and mortality in children with malignancy. Many prognostic factors, such as microorganism patterns, as well as the use of antibiotics and antifungals can affect the outcomes. However, limited study is available in Indonesia. Objective To determine the microbial profiles, antibiotic sensitivity, and other factors that influence mortality from febrile neutropenia in pediatric malignancies with infections. Methods This retrospective cohort and descriptive study of 180 children with 252 episodes of neutropenic fever was done in Cipto Mangunkusumo Hospital, Jakarta, between 2015 and 2017. Medical history of possible predictive prognostic factors, including microorganism patterns and antibiotic sensitivity, were recorded. Prognostic factors were analyzed using multivariate logistic regression tests. Results The most common bacteria was Gram-negative (54.5%), while Candida sp. was the most common fungal infection (82.5%). Klebsiella sp. was mainly sensitive to amikacin (85.71%), while Pseudomonas aeruginosa was sensitive to ceftazidime (75%), as well as amikacin and gentamicin (100% sensitivity in combination). Staphylococcus sp. was mainly sensitive to amoxi-clav and ampi-sulbactam (76.9%). Almost all fungal groups were susceptible to fluconazole, ketoconazole, voriconazole (80-100%). Prognostic factors that increased mortality risk were central venous cannulation (RR 1.947; 95%CI 1.114 to 3.402), wasting (RR 1.176; 95%CI 1.044 to 1.325), severe wasting (RR 1.241; 95%CI 0.975 to 1.579), and hematologic malignancies (RR 0.87; 95%CI 0.788 to 0.976). Conclusion Central venous cannulation and wasting are significant prognostic factors of increased mortality in children with febrile neutropenia. Gram negative bacteria along with Candida sp. is the most common pathogen in such condition.
Survival rate of pediatric osteosarcoma in Indonesia: a single center study Hikari Ambara Sjakti; Isyanaditta Agung Putri; Endang Windiastuti
Paediatrica Indonesiana Vol 62 No 1 (2022): January 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.1.2022.27-31

Abstract

Background Over the years, the survival rate of children with osteosarcoma has increased with improved management. However, survival tends to be lower in low-middle-income countries. Objective To report the survival rate of children with osteosarcoma in a single center in Indonesia and to evaluate the outcomes of treatment modalities currently used. Methods We performed a retrospective analysis of the medical records of pediatric osteosarcoma patients in Cipto Mangunkusumo Hospital from 2015 to 2019. Patients were categorized based on age group, sex, primary tumor location, treatment modalities, disease metastasis, and disease outcome. Results We included 83 children with osteosarcoma, with an age range of 4-17 years (median 13 years). Mean estimated overall survival and event-free survival were 28 (95%CI 24 to 32) months and 10 (95%CI 8 to 13) months, respectively. Overall survival duration between treatment modality groups was significantly different (P<0.05). The mean estimated overall duration of survival was 9 (95%CI 3 to 15) months for chemotherapy, 18 (95%CI 14 to 22) months for chemotherapy with surgery, and 21 (95%CI 14 to 27) months for chemotherapy with surgery and radiation. Conclusion The survival rate of childhood osteosarcoma in Indonesia remains low. The current treatment option currently used in our center may contribute to the low rate of survival.
Role of cytogenetic profiles as prognostic factors for complete remission after induction phase in acute myeloblastic leukemia Hikari Ambara Sjakti; Gatot Djajadiman; Pustika Amalia Wahidiyat; Agus Kosasih; Iswari Setianingsih
Paediatrica Indonesiana Vol 61 No 6 (2021): November 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.6.2021.343-9

Abstract

Background Risk stratification for acute myeloid leukemia (AML) in children is a must in treatment strategy. This stratification is based on cytogenetic profiles, which are needed to determine proper management to gain better outcomes and reduce side effects of treatment. There is no such risk stratification available in Indonesia until now. Objective To evaluate the association between cytogenetic profiles of t(8,21) and inv(16) mutations with the complete response to induction phase of chemotherapy in pediatric AML. Methods A prospective study was conducted between year 2018 and 2020, involving children with AML from 4 pediatric oncology centers in Jakarta. Subjects were evaluated for cytogenetic profiles, especially t(8,21) and inv(16), as the favorable predictors for AML. Bone marrow remission was evaluated after 2 cycles of induction phase. The results were evaluated for remission rate and survival analysis. Results Karyotype data of 18 subjects were obtained. Translocation t(8;21) detected in 1 subject, and inv(16) mutation in 4 subjects. These two variables had no significant correlation with complete remission after induction phase. Nevertheless, favorable group had more tendencies to achieved remission than unfavorable group. Complete remission achieved in 61% subjects, 90% of theme had a relapse period with an average time 43 weeks. The relapse period in favorable group was shoter than in unfavorable group (34 weeks and 44 weeks, respectively). Conclusions This study shows that cytogenetic profiles of t(8;21) and inv(16) mutation can not be used as prognostic factors for complete remission after induction phase of chemotherapy in pediatric AML.
Co-Authors Agus Kosasih Aman Bhakti Pulungan Arwin AP Akib Arwin AP Akib Attika Adrianti Andarie Aulia Fitri Swity Bernie Endyarni Medise Damayanti Rusli Syarif Dewi Anggraeni Dian Puspita Sari Djajadiman Gatot Eka Laksmi Hidayati, Eka Laksmi Endang Windiastuti Endang Windiastuti Evita Bermansyah Ifran Fatimah Saidah Gatot Djajadiman Githa Rahmayunita Hartono Gunardi Hindra Irawan Satari Irawan Mangunatmadja Iswari Setianingsih Isyanaditta Agung Putri Jacoeb, Tjut Nurul Alam Krisanti, Inge Ade Kristin Handojo lmral Chair Luh Karunia Wahyuni, Luh Karunia Lusiana Lusiana Muzal Kadim Najib Advani Nur Hayati Piprim B. Yanuarso Pustika Amalia Wahidiyat Resyana Putri Nugraheni Rosary Rosary Soepardi Soedibyo Teny Tjitra Sari Yoga Devaera Yuni Astria