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Comparison of serial blood lactate level between dengue shock syndrome and dengue hemorrhagic fever (evaluation of prognostic value) M. Tatang Puspanjono; Abdul Latief; Alan R. Tumbelaka; Sudigdo Sastroasmoro; Hartono Gunardi
Paediatrica Indonesiana Vol 47 No 4 (2007): July 2007
Publisher : Indonesian Pediatric Society

Background Dengue shock syndrome (DSS) mortality is still high.Monitoring of blood lactate level is important to evaluate shock.Objectives The study were to review the difference between bloodlactate level of DSS and that of dengue hemorrhagic fever (DHF),to correlate blood lactate level with hypoxia state as shock riskfactors (PaO 2 , oxygen saturation, and anion gap) and to determinethe cut-off point of blood lactate level to predict shock.Methods The study was carried out at the Department of ChildHealth, Medical School, University of Indonesia, CiptoMangunkusumo Hospital, Jakarta, from January until July 2006.Three mL venous blood specimen was collected from all subjectsfor peripheral blood, blood gasses, serology, and blood lactateexaminations. This study consisted of a retrospective cohort anda cross sectional method. Data were analyzed with Chi-squaretest. Continous data tested using Mann-Whitney method. Toknow the correlation between blood lactate level and shock riskfactors we use logistic regression test.Results In DSS group, 73% shows hyperlactatemia (lactate =2mmol/L). Conversion of lactate means between two groups issignificantly different from day one to day two and three. Therewas a negative correlation between lactate level and pO 2 andoxygen saturation. Oxygen saturation is the only value that hasclinical correlation. Regressions analysis can be applied using Y= 7.05â€“0.05 X equation. The cut-off point of lactate level asmarker for shock by using ROC curve is 32.015 mmol/L with 70%sensitivity and 83.3% specificity.Conclusions Hyperlactatemia in DSS can be considered as a signfor unappropriate treatment of shock. Blood lactate level can beused as a biochemical marker for tissue hypoxia, to assess severityof the disease, as monitoring of treatment, and has prognosticvalue of DHF cases.

Relationship between lipid profiles with carotid intima--media thickness in children with type I diabetes mellitus Rubiana Sukardi; Bambang Madiyono; Sudigdo Sastroasmoro; Jose RL Batubara
Paediatrica Indonesiana Vol 48 No 3 (2008): May 2008
Publisher : Indonesian Pediatric Society

Background The major cause of morbidity and mortality inpatients with type I diabetes mellitus is premature and extensiveartherosclerosis. Carotid intima-media thickness (IMT) isassociated with cardivascular risk factors and has been used as amarker of early artherosclerosis process.Objective To determine IMT of carotid artery and its relationshipwith duration of diabetes, lipid profiles, and mean HbA 1 level.Methods A cross-sectional study was conducted on patientswith type 1 DM at the Department of Child Health CiptoMangunkusumo Hospital. Ultrasound B-mode imaging wasperformed to measure the IMT. Age-matched non-diabteticsubjects served as controls. Statistical significant was assumedat P<O.S.Results The mean IMT values of type I DM patients aged < 12years, 12-18 years, 18+ years were 0.44 (SD 0.03) mm; 0.46(SD 0.01) mm; 0.51 (SD 0.01) mm, respectively, which weresignificantly greater than those of age-matched non-diabeticsubjects which were 0.39 (SD 0.01), 0.41 (SD 0.01) mm, 0.46(SD 0.01) mm, respectively. Patients with type I DM had ahigher apolipoprotein-Band HDL cholesterol levels than in non-diabetic subjects. Multiple regression analysis showed that therewas no relationship between total cholesterol, cholesterol LDL,chronic hyperglycemia (HbA 1) and IMT. However, IMT in typeI diabetes was linearly related with duration of diabetes .Conclusion Type I DM patients have greater IMT and highermean apolipoprotein B. There is a strong correlation betweenIMT and duration of diabetes.

Comparison of minimal inhibitory and bactericidal capacity of oral penicillin V with benzathine penicillin G to Streptococcus beta--hemolyticus group A in children with rheumatic heart disease Burhanuddin Iskandar; Bambang Madiyono; Sudigdo Sastroasmoro; Sukman T. Putra; Mulyadi M. Djer; Anis Karuniawati
Paediatrica Indonesiana Vol 48 No 3 (2008): May 2008
Publisher : Indonesian Pediatric Society

Background Injection ofbenzatine penicillin G (BPG) every 28days is still the drug of choice for secondary prevention of rheu-matic heart disease (RHD). BPG sometimes poses problems dueto pain at the injection site, possible anaphylaxis, and is not alwaysavailable. Some centers choose oral penicillin over BPG.Objectives To compare minimal inhibitory capacity (MIC) andminimal bactericidal capacity (MBC) of oral penicillin V serumwith those of BPG among SGA infected RHD.Methods This was a clinical trial with crossover design study tocompare MIC of penicillin V and BPG. Outcome measures wereMIC and MBC. Statistical analysis was performed using pairedt-test and wilcoxon test.Result There were 32 subjects consisted of 17 males and 15females. The mean value of MIC and MBC serum of penicillinV were 0.031 and 0.125. The mean value of MIC and MBCserum of BPG3 were 0.094 and 0.031. Respectively the MICof penicillin V was similar to that of BPGy The mean value ofMIC and MBC of BPG4 were 0.125 and 0.250. Respectively theMIC of penicillin V was significantly higher than that of BPG 4.The MBC of penicillin V was significantly higher than that ofBPG 4. The MIC ofBPG 3 was similar to that ofBPG 4â€¢ The MBCof BPG 3 was similar to that of BPG 4.Conclusions The MIC of penicillin V was similar to that ofBPG 3,the MBC of oral penicillin V was higher than that ofBPG 3â€¢ TheMIC and MBC of penicillin V was higher than those of BPG 4.

Factors associated with the intention to exclusively breastfeed at Siloam Lippo Cikarang Hospital Naomi Dewanto; Sudigdo Sastroasmoro; Rulina Suradi; Theresia Santi
Paediatrica Indonesiana Vol 48 No 3 (2008): May 2008
Publisher : Indonesian Pediatric Society

Background World Health Organization (WHO) recommendsbreastfeeding as the appropriate method of infant feeding.Predelivery intentions about breastfeeding are strong predictorsof both initiating and continuing exclusively breastfeedingthrough the post delivery period.Objective To determine the association of age, education,occupation, parity, and information got by pregnant women withthe intention to give exclusive breastfeeding at Siloam LippoCikarang Hospital.Methods Pregnant women were chosen by consecutive samplingfilled in questionnaires contained identity, knowledge, obstacles ofbreastfeeding and intentions to exclusively breastfeed. Pregnantwomen visiting Obstetrics and Gynecologic Department SiloamLippo Cikarang Hospital who were able to read and write inIndonesian were eligible for this study.Result: Most of the 200 respondents were between 20-30 years ofage (69.5%), college graduated (55.5%), working women (50.5%),multiparous (58.5%) and have already got the informationabout breastfeeding (64.5%). The commonly cited source isprinted device (40%). Knowledge about breastfeeding in generalwere good (78%), but respondents who intended to exclusivelybreastfeed were only 58.5%. Multivariate analysis showed thatthe factors significant associated with the intention to exclusivelybreastfeed were age, with OR 0.9 (95%CI 0.84;0.98, P<0.05) andinformation, with OR 0.28 (95%CI 0.143;0.56, P<O.OOl)Conclusions The significant influencing factors to the intentionsto give exclusively breastfeed are age and information.

Effect of inhaled procaterol and budesonide on right ventricular diastolic function in children with asthma Alit Utamayasa; Najib Advani; Imam Boediman; Sudigdo Sastroasmoro; Bambang Madiyono
Paediatrica Indonesiana Vol 49 No 3 (2009): May 2009
Publisher : Indonesian Pediatric Society

Objectives To study changes in parameters of right ventricular(RV) diastolic function after procaterol and budesonide inhalationin children with asthma.Methods This was a one-group pretest-posttest design to determinechanges in right ventricular diastolic function followingfour weeks of inhaled procaterol and budesonide administration.Subjects were children aged 8 to 18 years with frequent episodicasthma recruited consecutively at the Department of ChildHealth, Cipto Mangunkusumo Hospital. M-mode and 2-Dechocardiography examinations were performed to determine RVisovolumetric relaxation time (IVRT), acceleration time (AT),deceleration time (DT), E wave, A wave, E/ A ratio, and tricuspidannular plane systolic excursion (TAPSE). Means of the RVfunction parameters before and after treatment were comparedusing the paired t-test or Wilcoxon test.Results There were 29 patients comprising 16 boys and 13 girls. Themeans or medians of theE wave, A wave, E/A ratio, accelerationtime (AT), deceleration time (DT), and isovolumetric relaxationtime (IVRT) before and after treatment were 0.55 and 0.55 em/sec(P=0.709), 0.45 and 0.35 em/sec (P<O.OOOl), 1.17 and 1.58 em/sec(P<0.0001), 52.73 and 55.03 m/sec (P=0.04), 55.39 and 58.10 m/sec (P=0.03), and 46.50 and 70.0 m/sec (P<0.0001), respectively.The median pre- and post-inhalation TAPSE were 1.63 and 1.84em, respectively (P<0.001).Conclusions In children with frequent episodic asthma, thereare changes in RV diastolic functions IVRT, AT, DT, E/A ratioand A wave following procaterol and budesonide inhalation.There was no increase in E wave following inhalation. TAPSEwas increased following procaterol and budesonide inhalation.

Risk factors of coronary heart disease in children and young adults with parental history of premature coronary heart disease Murti Andriastuti; Sudigdo Sastroasmoro; Agus Firmansyah
Paediatrica Indonesiana Vol 43 No 2 (2003): March 2003
Publisher : Indonesian Pediatric Society

Background Morbidity and mortality of coronary heart disease(CHD) are recently increasing. This is related to changes in lifestyle,such as lack of activity and high consumption of fatty diet. Themain cause of CHD is atherosclerosis. The development of ath-erosclerosis takes a long time, is asymptomatic, and might beginin childhood. The important risk factors that have roles in increas-ing the likelihood of atherosclerosis are family history of prematureCHD, hypertension, hyperlipidemia, obesity, smoking and irregu-lar activity.Objective The aim of this study was to find out the prevalence ofCHD risk factors in children and young adults who had parentalhistory of premature CHD.Methods This was a descriptive cross sectional study conductedon offspring of premature CHD patients who were admitted in theintensive cardiology care unit (ICCU) of Cipto MangunkusumoHospital between January 1999 to December 2001 and of prema-ture CHD patients who visited the Cardiology Clinic of the Depart-ment of Internal Medicine, Cipto Mangunkusumo Hospital duringMarch and April 2002. Subjects were aged 12 to 25 year-old.Results Among the subjects, 40% had hyperlipidemia, 8% hadhypertension, 11% were obese, 21% were active smokers, 41%were passive smokers, and 73% had irregular activity. Ninety-sevenpercents subjects had more than 1 risk factors.Conclusions The prevalence of hyperlipidemia, hypertension,obesity, passive smoker, active smoker and irregular activity inchildren and young adults with parental history of premature CHDin this study were higher than those in the normal population.Most had more than 1 risk factor, increasing the likelihood of CHD.A screening test should be performed on children with parentalhistory of premature CHD so that early preventive measures mightbe done to minimize the risk factors

Clinical manifestations of acute asthma in children at the Department of Child Health Cipto Mangunkusumo Hospital Kadek Ayu Lestari; Imam Budiman; Sudigdo Sastroasmoro
Paediatrica Indonesiana Vol 43 No 4 (2003): July 2003
Publisher : Indonesian Pediatric Society

Background Acute asthma is an asthma attack or worsening ofasthma manifestation and pulmonary function. Severe asthma at-tack might be prevented by early recognition of the attack and ap-propriate therapy. Clinical manifestations of asthma in children varywidely, so does the assessment of the attack that is often not accu-rately defined by doctors. This leads to delayed and inadequatetreatment of the attack.Objective This study aimed to know the clinical manifestationsof acute asthma in children at the Department of Child Health, Medi-cal School University of Indonesia/Cipto Mangunkusumo Hospi-tal.Methods This was a descriptive, cross sectional study, conductedat the emergency room (ER), the Pediatric Pulmonology Outpa-tient Clinic, and the Pediatric Outpatient Clinic. Subjects were asth-matics who were having attack and aged 2-18 year-old. Data ofage, sex, pulse rate, respiratory rate, duration of attack, expiratory,and inspiratory effort signs were obtained by history and physicalexamination followed by the assessment of attack severity.Results Subjects consisted of 92 children, mostly obtained fromthe ER (40%), with male to female ratio of 1.5:1 and average ageof 5.8 years old. Most of the subjects had mild attack (83%) andduration of attack of less than 24 hours (56%). Most subjects (70%)only had signs of increased expiratory effort, in which all of themhad mild attack. The rest of the subjects showed the combinationof inspiratory and expiratory efforts; 12 patients with mild attack,15 with moderate attack, and 1 with severe attack.Conclusion Patients who only showed expiratory effort usuallyhad mild attack. Patients showing expiratory and inspiratory ef-forts usually had mild or moderate attack. Treatment should betailored to the degree of attack

Inhibiting ability of benzathine penicillin G towards group A Streptococcus Î² -hemolyticus in 21 and 28 days after a single intramuscular injection Bambang Madiyono; Mulyadi M Djer; Sudigdo Sastroasmoro; Amin Subandrio; Erni Erfan
Paediatrica Indonesiana Vol 43 No 4 (2003): July 2003
Publisher : Indonesian Pediatric Society

Background The effectiveness of a single intramuscularbenzathine penicillin G as a secondary prevention of acute rheu-matic fever after 28 days is still controversial. The latest studyshowed that serum penicillin concentration was below protectivelevel in 4 weeks after a single intramuscular injection.Objective This study was a preliminary study to compare the in-hibiting ability of benzathine penicillin G towards group A Strepto-coccus Î² -hemolyticus in 21 and 28 days after a single IM injectionby using Mueller-Hinton broth method.Methods The inhibiting ability was measured by the serum in-hibitory concentration and serum bactericidal concentration aftera single intramuscular injection of benzathine penicillin G 1.2 mil-lion units.Results The subjects were 28 patients, with mean age of 15.5years (SD 3.4). The numbers of male and female were equal. Meanserum inhibitory concentration in 21 days after a single injectionwas 926.4 (SD 3080.1) and after 28 days was 1540.9 (SD 4275.1),which was not significantly different (p=0.0662). Mean serum bac-tericidal concentration in 21 days after IM injection was 1579.6(SD 4265.7) and in 28 days was 2417 (SD 6849.4) and it was notstatistically different (p=0.2276).Conclusion This study concluded that there was no significantdifference in the inhibiting ability of benzathine penicillin G to-wards group A Streptococcus Î² -hemolyticus between 21 and 28days after a single intramuscular injection

Stent implantation into ductus arteriosus: a new alternative of palliative treatment of duct-dependent pulmonary circulation Mulyadi M Djer; Bambang Madiyono; Sudigdo Sastroasmoro; Sukman T Putra; Ismet N Oesman; Najib Advani; Mazeni Alwi
Paediatrica Indonesiana Vol 44 No 1 (2004): January 2004
Publisher : Indonesian Pediatric Society

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

Periventricular leucomalacia in premature infants in neonatal ward, Cipto Mangunkusumo Hospital: A preliminary study Kemas Firman; Idham Amir; Nia Kurniati; Sudigdo Sastroasmoro
Paediatrica Indonesiana Vol 44 No 3 (2004): May 2004
Publisher : Indonesian Pediatric Society

Introduction Periventricular leucomalacia (PVL) is a major causeof neurodevelopment delay in premature infants, so early detec-tion of the preterm infant at high risk for the subsequent develop-ment of this lesion is critical.Objectives To determine the prevalence of PVL in premature in-fants hospitalized in neonatal ward, Cipto Mangunkusumo Hospi-tal using cranial ultrasound scans and define its characteristicsMethods Premature infants hospitalized in the neonatal ward fromJanuary to July 2003 were included in this study. Clinical featureswere retrieved from medical charts. Ultrasound scan was performedonce, after the age of 7 days and interpretations were read sepa-rately by two consultants of the radiology division.Results Fifty-one infants were included, 21 with <32-week gesta-tion, 30 with >32-week gestation; birth weight range were 1000 to2600 gram. Nineteen infants had cystic lesion and/or dilatation ofthe ventricle from the cranial ultrasound scan. The prevalence ofPVL in gestational age (GA) of <32 weeks was 6/21 and that in GAof >32 weeks was 13/30. Risk factors found in infants with PVLwere maternal infection, respiratory distress, sepsis and circula-tory failure.Conclusion The prevalence of PVL in preterm infants in CiptoMangunkusumo neonatal ward was higher than that was reportedin developed countries. Maternal infection, respiratory distress,sepsis, and circulatory failure which were commonly found in theseinfants were factors to be considered as risks for PVL

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