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Does 20 mg long-acting methylphenidate alter blood pressure and heart rate in children with ADHD? Tjhin Wiguna; Sasanto Wibisono; Sudigdo Sastroasmoro; Fransiscus D. Suyatna
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Objective To identify the cardiovascular effects of long-acting methylphenidate administered for twelve weeks in Indonesian children with ADHD.Methods This was an 18-week, time series study on children with ADHD who were given 20 mg of long-acting methylphenidate for twelve weeks. During the study period we made ten serial observations of the subjects, including before, during and 6 weeks following drug administration. We included drug naive children with ADHD between the ages of 7 â€“ 10 years. Children with mental retardation and chronic physical or mental disorders were excluded. Blood pressure was measured by sphygmomanometer with a childâ€™s cuff at the brachial artery. We also collected data on heart rate, side effects, complaints and other medications used during the study. Repeated analysis was performed on the data with a P level of 0.05.Results Twenty-one subjects were recruited for this study. Mean blood pressure fluctuated insignificantly during the research period, for both mean systolic and mean diastolic blood pressures (P=0.115 and P=0.059). Mean heart rate also fluctuated insignificantly (P=0.091). All fluctuations were within the normal ranges. During the study, there were complaints of dizziness, nausea, and gastrointestinal upset, but they were reportedly mild and disappeared before the second week of observation.Conclusion Administration of 20 mg long-acting methylphenidate for twelve weeks in children with ADHD altered mean blood pressures and heart rates, but within the normal range for children of their age. However, cardiovascular risk observation is still needed when administering methylphenidate to children with ADHD, especially for those using the medication long-term.[Paediatr Indones. 2011;51:282-7].

Ventricular function and dimensions in children with human immunodeficiency virus infection Rahmat B. Kuswiyanto; Mulyadi M. Djer; Arwin A. P. Akib; Sudigdo Sastroasmoro
Paediatrica Indonesiana Vol 51 No 3 (2011): May 2011
Publisher : Indonesian Pediatric Society

Background Prevalence of cardiac complications in children 'WithÂ human immunodeficiency virus (HIV) infection have increased,Â in association 'With the availability of antiretroviral (ARV) therapyÂ and the decrease of opportunistic infections. However, studies onÂ cardiac complications in HIV patients in the various HIV clinicalÂ and immunologic categories have been limited. Furthermore,Â cardiac complications in Indonesian HIVinfected children haveÂ never been reported.Objectives To detennine the prevalence of cardiac complicationsÂ in HIVinfected children and to compare ventricular function andÂ dimensions based on HIV clinical and immunologic categories.Â Methods A crossô€sectional study was done in the Department ofÂ Child Health, Cipto Mangunkusumo Hospital, Jakarta betweenÂ October and December 2009 on 7 4 HIVô€infected childrenÂ aged below 15 years. Children with severe chronic or acuteÂ systemic diseases were excluded. Investigations included physicalÂ examinations, 12ô€lead electrocardiography and echocardiographyto assess left ventricular dimension and ventricular function.Â Cardiac findings among children in different clinical andÂ immunological categories were compared.Results Five children showed left ventricular fractional shorteningÂ below 25% and 16 had right ventricular dysfunction. MeanÂ cardiac function and dimension were in the normal range. NoÂ differences in cardiac function and dimension, among the clinicalÂ HIV category groups (p>0.05) or immunologic suppression statusÂ groups (p>0.05) were observed.Conclusion In children 'With HIV infection, the prevalence of left ventricular dysfunction and right ventricular dysfunction was 7% andÂ 22%, respectively. No differences in cardiac function and dimensionÂ were found among the different HIV clinical and immunologicalÂ categories.

Natural history of premature thelarche: review of 60 girls Jose R. L. Batubara; Adji Suranto; Sudigdo Sastroasmoro; Bambang Tridjaja; Aman B. Pulungan
Paediatrica Indonesiana Vol 41 No 11-12 (2001): November 2001
Publisher : Indonesian Pediatric Society

In Indonesia report on the natural history of premature thelarche is very limited. Daily practice requires physicians to have some basic practical knowledge, among others the natural history of premature thelarche, in order to manage these patients properly. We reviewed data of 85 premature thelarche patients who visited our department from January 1989 until December 1998. Only 60 patients met the study criteria. The mean chronological age of the patients at diagnosis was 43.4 months. About half of these patients (31/60) were diagnosed before they were 2 years old. Half of the patients had bilateral breast involvement. The hormonal pattern showed 24/48 follicle stimulating hormone predominant-response. Most patients (33/47) showed normal plasma estradiol level. Bone age analysis was normal in 46/57 patients, and only 9 showed accelerated bone age. Pelvic ultrasonography showed prepubertal reproduction organs in 26/35. Vaginal smears showed signs of estrogenization with various degree of stimulation in 13 patients. At the end of observation the outcome of premature thelarche were: 31 regressed, 19 persisted, 6 had progressive breast development and 4 progressed to central precocious puberty. The initial clinical and laboratory characteristics of those who developed CPP varied. Among 31 premature thelarche patients who regressed, 21 had onset of breast enlargement before age of 2 years. In most of the regressed patients (20/31), regression occurred completely within the first year. Most premature thelarche patients with onset before 2 years will regress within one year after diagnosis.Â

Factors affecting school performance in children with rheumatic heart disease Arief Hermanu S.; Sudigdo Sastroasmoro; Bambang Madiyono; Ismet N. Oesman
Paediatrica Indonesiana Vol 41 No 11-12 (2001): November 2001
Publisher : Indonesian Pediatric Society

The aim of this study was to determine the association between school performance and age, sex, duration of illness, educational achievement prior to illness, socioeconomic status of family, parentâ€™s educational level, number of children in the family and severity of the disease of patients with rheumatic heart disease (RHD). Subjects were patients with RHD treated at the Division of Cardiology, Department of Child Health, Cipto Mangunkusumo Hospital Jakarta. The parameters of school performance were educational achievement, absent of school and dropout. All data were processed by using Epi-Info program to find out bivariate analysis and Statistic Program for Social Sciences (SPSS) for multivariate analysis. We obtained 80 patients with RHD; most of them were of mild severity (64 of 80%) and the remainder 16 (20%) with severe disease. There were 44 (55%) males and 36 (45%) females. Most parents (42 or 53%) had junior high school educational level, most of them, 23 (29%) had elementary school education, and 3 (4%) illiterate. Bivariate and multivariate analyses showed that severity of disease and parental educational level were associated withschool performance of patients with RHD, but age, sex, duration of disease, premorbid educational achievement, socio-economic level of the family and number of children in family were not. Â

Benefits of infant calendar action poster to improve the compliance of growth and development monitoring Sudiyanto Darmosubroto; Sudigdo Sastroasmoro; Rini Sekartini
Paediatrica Indonesiana Vol 39 No 1-2 (1999): January - February 1999
Publisher : Indonesian Pediatric Society

A community based study was conducted among infants between 0-12 months old about the compliance of growth and development monitoring, with the provision of infant calendar action postern. The subjects of study residing at Cipinang Cempedak areas,Mere fonowed-up from March 1997 until March 1998. One hundred infants providedÂ· with the action postern comprised the intervention group, and 100 infants not provided with the action posters comprised the non intervention or the control group. Twenty infants of the control group and 18 infants of the intervention group dropped out because they moved out areas or didn't show up at the subsequent visit. More than half of the parents has middle income with Rp 134,832.35 â€“ Rp 1,664,733.75 per month, 75.3% the fathers were employees of private enterprises. Eighty two of the intervention group (36 male infants or 43.9% and 46 female infants or 56.1 %) and 80 of the non intervention group d (39 male infants or 48.8 % and 41 female infants or 51.2%) participated in this study. The results showed that the compliance of periodical visits of growth and development monitoring of the intervention group was significantly better than that of the control group. Other results show that the intervention group got proper feeding, had adequate nutritional status, and had complete immunizations as recommended. And sustained contraceptive practice by the mothers.

Bacterial endocarditis in children: clinical and laboratory findings, and the role of echocardiography in its diagnosis and management Sudigdo Sastroasmoro; Bambang Madiyono; Ismet N. Oesman; Sukman Tulus Putra
Paediatrica Indonesiana Vol 29 No 9-10 (1989): September - October 1989
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi29.9-10.1989.188-98

We report clinical and laboralory findings of 15 children with bacterial endocarditis, admitted ro the Department of Child Health, University of Indonesia/Cipto Mangunkusumo Hospital from February, 198710 June, 1989.There were 8 boys and 7 girls with bacterial endocarditis, ranging in age from 10 weeks 10 16 years. The diagnosis was suspected because of prolonged fever, with or without other manifestations, i.e. congestive heart failure, refractory anemia, or paroxysmal atrial tachycardia. The underlying heart disease was congenital in 12 cases and rheumatic heart disease in 3 cases.The clinical, electrocardiographic, and radiologic manifestations were generally predominated by the pre-existing heart disease. No characteristic findings of bacterial endocarditis, i.e. Osler's nodes, Janeway lesions or splinter haemorrhages were detected.Positive bacterial culture was obtained in 12 cases; the most frequent bacteria isolated was Pseudomonas aeruginosa (4 cases), Streptococcus viridans was isolated in 2 cases only.Vegetation was visualized echocardiographically in 12 cases; 9 with clear cut evidence of large vegetation, and the other 3 the vegetation was equivocal. On follow-up they disappeared gradually with clinical improvemenl. Large vegetation might need 2 full months 10 disappear echocardiographically.

Early detection of cerebral palsy in high-risk infants: diagnostic value of primitive and developmental reflexes as well as ultrasound Setyo Handryastuti; Ghaisani Fadiana; Sofyan Ismael; Sudigdo Sastroasmoro; Asril Aminulah; Ferial Hadipoetro Idris; Adji Saptogino; Sunartini Hapsara
Paediatrica Indonesiana Vol 58 No 1 (2018): January 2018
Publisher : Indonesian Pediatric Society

Background The incidence of cerebral palsy (CP) has increased due to better survival of high-risk babies. A simple assessment method is needed for the early detection of CP, which can be performed by general practitioners and pediatricians in daily practice.Objectives To assess motor delay, primitive and developmental reflexes, and cerebral ultrasound abnormalities as simple methods for early detection of CP in high-risk infants. We also aimed to evaluate the ease and consistency of the methods for use in daily practice, as well as determine risk factors associated with CP.Methods A prospective cohort study was done on 150 high-risk babies starting from the age of 4 months up to 12 months. We obtained subjectsâ€™ histories of motor ability and assessed primitive reflexes and postural reactions at the ages of 4, 6, 9 and 10 months. The diagnosis of CP was established at 6 and 12 months of age. We also determined Kappa test for inter-rater reliability between pediatric residents and pediatric neurologist.Results In 88.7% of subjects, CP was detected in the first 6 months. At 4 months, positive palmar reflex, head lag, and fisting were predictive of CP at 6 months of age. Motor delay, positive palmar grasp reflex, head lag, fisting, and absent protective extension reflex at 6 months were predictive of CP at 12 months. At 9 to 10 months, motor delays, absent protective extension reflex, and negative parachute reaction were predictive of CP at 12 months. Cerebral ultrasound abnormalities were predictive of CP at 6 and 12 months of age. Kappa test result was 0.9, indicating the ease and consistency of these methods for daily medical practice.Conclusion Cerebral palsy can be detected as early as the first 6 months of life. Assessment for motor delays, physical examination for asssessing primitive and developmental reflexes, and cerebral ultrasound can be used for this purpose.

Risk factors and the occurrence of cerebral palsy in high risk infants Setyo Handryastuti; Sofyan Ismael; Sudigdo Sastroasmoro; Asril Aminulah; Ferial Hadipoetro Idris; Adji Saptogino; Sunartini Hapsara
Paediatrica Indonesiana Vol 58 No 2 (2018): March 2018
Publisher : Indonesian Pediatric Society

Background The incidence of cerebral palsy (CP) has increased due to better survival rates of high-risk babies. Early detection and time to the occurrence of CP in the first year of life is important in order to provide early intervention.Objectives To determine the proportion of CP in high-risk babies, the time to the occurrence of CP in the first year, and assess possible associations between risk factors of CP and time to the occurrence of CP.Methods A prospective cohort study was done on 150 high-risk babies up to the age of 12 months. We obtained history of motor ability and assessed primitive reflexes and postural reactions of subjects at the ages of 4 and 6 months. The diagnosis of CP was established at 6 and 12 months of age.Results The proportion of CP was 26% at 6 months and 24% at 12 months of age. Significant risk factors associated with CP at 6 and 12 months of age were cerebral ultrasound abnormalities, hypoxic-ischemic encephalopathy, and intracranial hemorrhage. In 88.7% of subjects with CP, CP was detected in the first 6 months. Mean age at the occurrence of CP was 9.99 months (95%CI 9.46 to 10.53). Risk factors that significantly affected the time to the occurrence of CP by survival analysis were ultrasound abnormalities and hypoxic-ischemic encephalopathy.Conclusions Cerebral palsy can be detected as early as the first 6 months of life. Cerebral ultrasound abnormalities and hypoxic ischemic encephalopathy are the risk factors associated with CP.

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