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Bilirubin-albumin binding capacity in term and preterm infants M. Basalamah; Achmad Surjono
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background The risk of kernicterus remains a problem injaundiced newborn especially in low birth weight infants.Kernicterus can develop at low bilirubin levels. Bilirubin-albuminbinding plays an important role in its pathogenesis. Bilirubinalbumin binding concentration can also be used as the cut-offpoint in the administration of phototeraphy.Objective To determine the pattern of albumin bindingconcentration in serum model in vitro and in serum of prematureand term newborn infants from cord blood sample.Methods This study was conducted in Installation of Maternal-Perinatal Dr. Sardjito Hospital from August-September 2004.Blood cord samples from 20 term and 17 preterm infants wereanalysed. Total bilirubin was measured spectrophotometrically andunbound bilirubin concentration was determined by horseradishperoxidase oxidation using UB-analyzer apparatus micromethod.Student t test and linear regression analysis were performed.Results Bilirubin-albumin binding capacity of term infants showeda statistically significant difference compared to that of prematureinfants (18.9Â±2.1 mg/dl vs 10.2Â±3.6 mg/dl, P<0.001). This cut-off level approximately reflected a value of unbound bilirubin of1 mg/dl in term and 0.5 mg/dl in premature infants.Conclusions There is a different pattern of bilirubin-albuminbinding capacity between term and preterm infants which is higherin term infants. Bilirubin level of 19 mg/dl and 10 mg/dl in termand preterm newborn, respectively, can be used as cut-off pointto perform more aggressive intervention, such as phototeraphy,and to lower the risk of kernicterus.

The influence of socioeconomic status and birth weight on blood pressure of Indonesian pre-pubertal children Madarina Julia; M M van Weissenburch; HA Delemarrevan de Waal; Achmad Surjono
Paediatrica Indonesiana Vol 47 No 6 (2007): November 2007
Publisher : Indonesian Pediatric Society

Background It has been shown that elevated blood pressure (BP)in childhood contributes to the development of coronary arterydisease, cerebrovascular accidents, heart failure, and renal failurein adults. There is also evidence of some correlations betweenchildhood BP and BP in adulthood. Obesity as well as low birthweight are a risk factors for elevated BP, both in children and inadults. Most epidemiological studies have also shown arelationship between high BP and socioeconomic status (SES).Objective To assess the influence of socioeconomic status andbirth weight on blood pressure of school-aged prepubertal childrenliving in Indonesia.Methods A cross-sectional survey on 2922 school-agedprepubertal children from the rural, poorurban and nonpoor urbancommunities was performed. Data on age, sex, stature, BMI, birthweight, systolic and diastolic BP were collected from all children.Results Overall and within every socioeconomic status group,blood pressures were positively associated with stature and bodymass index (BMI). Children from poor-socioeconomic families,i.e. rural and poor urban, had significantly lower height and BMI,and hence, in the unadjusted analyses, poor socioeconomic statuswas associated with lower systolic and diastolic BP. However, afteradjustment for age, sex, stature and BMI, rural children were foundto have significantly higher systolic BP compared to nonpoor urbanchildren, with regression coefficient (95% CI) of 1.19(0.42 to1.96). Birth weight was not associated with blood pressure inchildhood.Conclusion This study indicated that for a given stature and BMI,poor children had a higher systolic BP

Feeding pattern and nutritional status of infants in Belu District, East Nusa Tenggara Dwikisworo Setyowireni; Achmad Surjono
Paediatrica Indonesiana Vol 47 No 6 (2007): November 2007
Publisher : Indonesian Pediatric Society

Background The reduction of high rates of malnutrition willrequire greater attention to specific aspects of child feeding.Although much attention has been devoted recently to promotingappropriate breastfeeding practices, little effort has been directedto enhance complementary feeding.Objectives To assess feeding pattern among infants in Belu DistrictNusa Tenggara Timur, related to nutritional status of children.Methods Cross-sectional study was conducted in Belu District,East Nusa Tenggara using a two stage cluster sampling method toselect a sample of representative households. All infants wereassessed for current feeding practices and anthropometric.Results Among 87.8% infants are still breastfed, and 80.2% weregiven colostrum. The mother gave the baby plain water (27.4%),or sugar water (15.6%), or other liquid (31.7%) before giving thefirst breast milk. Timely first suckling was practiced 10.1% infants,timely first complementary feeding was achieved 90.3%, as wellas high rate of early introduction of semi-solid food in infants lessthan 4 months. Introduction of solid food was progressivelyincreased (3% in the newborn period to 72% in 3 months infant).Exclusive breastfeeding among infants < 4 months was decreasing(90% in newborn period to 28% in 3 months infants). Theproportion of infants fed solid foods was progressively increased(4% in infants <1 month to 72% in 3 months infant). The highprevalence of wasting reached 27.8% (CI 95%: 24,6-31,3). Theprevalence of children below -2 SD Z-scores was 10% (CI 95%:8-12.5), was classified as serious condition.Conclusions This study showed that high percentage of exclusivebreastfeeding rate otherwise rate of continued breastfeeding (oneyear) is low. A sufficient high rate on complementary feeding isestablished as well as early introduction of semi-solid foods. Theprevalence of underweight is high and classified as serious wasting.

Percentage birth weight loss and hyperbilirubinemia during the first week of life in term newborns S. A. K. Indriyani; I Wayan Retayasa; Achmad Surjono; Purnomo Suryantoro
Paediatrica Indonesiana Vol 49 No 3 (2009): May 2009
Publisher : Indonesian Pediatric Society

Background Hyperbilirubinemia is the most common problem interm newborns during the first week of life. Hyperbilirubinemiain term newborns without other risk factors is usually causedby dehydration and reduced calorie intake that is marked byexcessive weight loss.Objective To determine the relationship between percentage birthweight loss and hyperbilirubinemia during the first week of lifein term newborns.Methods A cross sectional study was conducted at the Departmentof Child Health, Medical School, Udayana University, SanglahHospital, Denpasar, Indonesia. The weight of term newbornswas measured on the first, third, and seventh day after birth.In addition, a complete blood count, reticulocyte count, andperipheral blood smear, were carried out on the first day. Serumbilirubin level was measured on the first, third, and seventh day.Clinical signs, jaundice, type and frequency of intake, and timeof meconium transit were followed during the stay in hospital.Linear regression, correlation, and logistic regression analysis wereperformed to determine variables related to hyperbilirubinemia.Results 68 newborns were enrolled in this study, with 7 developedhyperbilirubinemia by the third day. There was a significant(P<0.001) but weak to moderate correlation (r = 0.39)between percentage birth weight loss and total serum bilirubinconcentration on the third day. Logistic regression analysisshowed that percentage birth weight loss on the third day wassignificantly related to hyperbilirubinemia [OR 38.18 (95% CI2.29 to 637.61), P=0.011].Conclusion Percentage birth weight loss is related to hyperbilirubinemiain term newborn during the first week of life.

Influence of socioeconomic status on the association between low weight at birth and stunted growth or overweight in rural and urban Indonesian prepubertal children Madarina Julia; M. M. van Weissenbruch; H. A. Delemarre-van de Waal; Achmad Surjono
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/pi48.4.2008.214-9

Background Low birth weight (LBW) has been associated with in-creased risk for both stunted growth andand overweight later in life.Objective To assess relative contribution of LBW on the preva-lence of stunted growth or overweight in rural and urban Indo-nesian children in Indonesia.Methods This is a cross-sectional survey of 2 833 (1125 rural and1708 urban) school-aged prepubertal children. Each child had dataon age, sex, stature, BMI (body mass index) and birth weight.Results Compared to the urban population, the prevalence ofstunted growth was significantly higher in the rural, i.e. 16.3 vs.32.7%, P<O.OOl. However, there was no significant difference iinn the prevalence of LBW in the two communities. While overall,stunted children were more likely to be born with LBW, OR 1.80(95%CI 1.31; 2.47), P<O.OOl. After stratifying data into rural andurban residences, the contribution of LBW on the risk of stuntedgrowth appeared to be only significant in the urban population, OR2.42 (95%CI 1.59; 3.68), P<O.OOl. In the rural, similar proportionsof LBW were found in stunted and not stunted children. Test of in-teraction showed that this difference in OR was significant, the ratioof OR 1.88 (95%CI 1.11; 3.17), P=0.02. We observed no associationbetween LBW and overweight.Conclusions In rural area, LBW is not an important contributorfor stunted growth, while in urbanarea LBW is an important riskfactor for stunted growth. As there is no significant difference inthe prevalence of LBW between the two communities, the dif-ference in the prevalence of stunted growth is more likely to beassociated with different pattern of post-natal growth

The first 24-hour bilirubin level as a predictor of hyperbilirubinemia in healthy term newborns Rina Triasih; Ekawaty L Haksari; Achmad Surjono
Paediatrica Indonesiana Vol 43 No 3 (2003): May 2003
Publisher : Indonesian Pediatric Society

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

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