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Paediatrica Indonesiana

paediatrica-indonesiana
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Published by Ikatan Dokter Anak Indonesia

ISSN : 00309311 EISSN : 2338476X DOI : -

Core Subject : Health,

Health Professions Medicine & Pharmacology

Paediatrica Indonesiana is a medical journal devoted to the health, in a broad sense, affecting fetuses, infants, children, and adolescents, belonged to the Indonesian Pediatric Society. Its publications are directed to pediatricians and other medical practitioners or researchers at all levels of health practice throughout the world.

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Articles 9 Documents

Search results for , issue "Vol 47 No 1 (2007): January 2007" : 9 Documents clear

Factors related to missed opportunities for immunization at urban and suburban primary health centers in Medan Oke Rina Ramayani; Ridwan M. Daulay; Sri Sofyani; Iskandar Z. Lubis
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background Missed opportunites for immunization is one of theimportant causes of low immunization coverage that should beprevented.Objective To investigate missed opportunities for immunizationand related factors at urban and suburban primary health centersin Medan.Methods A cross sectional study was conducted between January-March 2004. Primary health centers in Medan were divided intourban (20 primary health centers) and suburban (19 primaryhealth centers) groups. The sample size was 109 children whovisited primary health centers for immunization. Study was doneby a questionnaire taken after infants received immunization (exitinterview).Results The proportion of missed opportunities in urban andsuburban area was 22.3% (95% CI 16.9%;27.7%) and 29.9% (95%CI 24.0%;35.2%) (P=0.191), respectively. Factors such as age ofstarting immunization, number of children more than 4, and lowparental attitude about immunization (P=0.001) were related tomissed opportunities for immunization.Conclusions There is no difference between proportion of missedopportunities at primary health centers in urban and suburbanarea. Related factors to missed opportunities for immunizationare age of starting immunization older than 3 months, number ofchildren more than 4, and low parental attitude aboutimmunization.

Pattern and influencing factors of breastfeeding of working mothers in several areas in Jakarta Rifan Fauzie; Rulina Suradi; Sri Rezeki S. Hadinegoro
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background Breast milk contains many essential nutrition factorsbest for babies. The 1997 Indonesian Health Demography foundthat the proportion of exclusive breastfeeding was still low (52%)and increased to 55.1% in 2002. Due to increasing number ofworking mothers, promoting breast feeding among them should beperformed properly. There are no data on exclusive breastfeedingrate and pattern among working mothers in Indonesia.Objective To describe exclusive breastfeeding rate and patternamong working mothers in several areas in Jakarta and the influ-encing factors.Methods A descriptive study using a questionnaire was conductedfrom October 2005 to February 2006. Subjects were workingmothers who had 6 to 12 month old baby and breastfed and thebaby had no congenital or chronic disease.Results Among 290 mothers interviewed, 40% worked at banksor insurance business, 34% were private employees, 25% medicalstaffs, and 2% were teachers. Almost 80% have exclusivelybreastfed for less than 4 months, 17% for 4 months, and only 4%for 6 months. Maternal leave, family support, mothersâ€™ knowl-edge, facilities at workplace, media influences, and working hoursseemed to have no relations to breastfeeding rate. There were122 (42%) mothers who had good knowledge about physiologyof lactation, 155 of them (53%) had fair knowledge, and only45% of them had poor knowledge.Conclusions The proportion of working mothers in several areasin Jakarta who have exclusively breastfed for 4 months is 17%, andonly 4% of subjects do exclusive breastfeeding for 6 months. Mostsubjects have a good to fair knowledge about the physiology oflactation but it does not seem to influence the decision to exclu-sively breastfed their babies.

High dose methotrexate in the treatment of children with acute lymphoblastic leukemia Johannes Bondan Lukito
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background It has been claimed that around 70% of childhoodacute lymphoblastic leukemia (ALL) can be cured. One of theimportant role is high dose methotrexate (HDMTX) administrationduring the consolidation therapy.Objective To determine the safety and effectiveness of HDMTXin children with ALL.Methods We reviewed patients with ALL in Pantai Indah KapukHospital, Jakarta during the period August 2000 through July 2005with observation time run through September 2006. Only patientswith normal kidney function were allowed to have HDMTX. Besidesgood hydration and alkalinization, patients were supported with goodhygiene (mouth, skin and anal area). MTX was given in loadingdose of 10% from the total dose in Â½ hour and the rest 23Â½ hours for90%. Leucovorin rescue was started 12 hours after discontinuationof 24 hour MTX IV infusion. Leucovorin was given until the MTXconcentration reached 0.1 uM/L. Patients were stratified to low,intermediate and high risk groups; 2 gram/m 2 was given to low riskgroup and 5 gram/m2 to intermediate and high risk groups.Results There were 20 patients eligible for study. All methotrexatesteady-state plasma concentrations (MTX Cp ss ) were above 16 uM/L, and steady state concentration in CSF was always below 0.5 uM/L for 2 gram/m 2 and above 0.5 uM/L for 5 gram/m 2 doses. All 20cases went through the procedure with only mild side effects i. e,mild mucositis, anal furuncle and diarrhea, which recovered 2 weekslater. Only 1 high risk case with initial WBC 612X10 9 /L, succumbedafter he went through the HDMTX program smoothly and relapsedsubsequently during reinduction phase.Conclusion HDMTX can be given safely to ALL patients with normalkidney function with good supportive care. Five gram/m 2 HDMTXeffectively treat the minor disease and/or prevent CNS and testicularleukemia. This study has also given an impression that HDMTXmay increase event-free survival.

Clinical risk factors for dengue shock syndrome in children Jujun Junia; Herry Garna; Djatnika Setiabudi
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background Dengue shock syndrome (DSS) is a seriouscomplication of dengue hemorrhagic fever (DHF) which maycause death in more than 50% cases if not treated properly andpromptly. Clinical, viral, and epidemiological risk factorsdetermine the occurrence of DSS. Identifying risk factors for thedevelopment of shock in patients with DHF can increase theawareness of clinicians to perform a close monitoring.Objective To determine the clinical risk factors for DSS.Methods This case control study was conducted on DHF andDSS patients admitted to the Department of Child Health,Medical School, University of Padjadjaran, Dr. Hasan SadikinHospital Bandung from January 2004 to December 2005. Thesubjects were patients aged less than 14 years who fulfilled WHOcriteria (1997). The exclusion criteria were history of asthma,diabetes mellitus, sickle cell anemia, typhoid, sepsis, and measles.The risk factors for DSS were analyzed using chi-square test,calculation of odds ratio, and logistic regression analysis.Results Of 1,404 patients with suspected DHF, 600 met the studycriteria; 200 patients of DSS and 400 patients of DHF as controlgroup were identified. Univariate analysis showed that there wasassociation between DSS and age 5-9 years (OR=1.67, 95%CI1.08;2.58), overweight (OR=1.88, 95%CI 1.22;2.90), vomiting(OR=1.44, 95%CI 1.02;2.04), abdominal pain (OR=2.07,95%CI 1.46;2.92), and severe bleeding (OR=13.6, 95%CI5.96;31.03). By logistic regression analysis, it was found that age5-9 years (OR=1.62, 95%CI=1.03â€“2.53), overweight (OR=1.97,95%CI=1.29â€“3.08), and persistent abdominal pain (OR=2.08,95%CI =1.44â€“2.99) were independent risk factors for DSS.Conclusion Age 5-9 years, overweight, and persistent abdominalpain are the risk factors for DSS.

Efficacy of lidocaine-prilocaine combination cream in reducing pain caused by hepatitis B injection in neonates: a randomized control trial Nugroho Karyadiguna; Soetjiningsih Soetjiningsih; W. Retayasa; M. Kardana
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background Many invasive medical procedures cause pain inneonates. Pain in this age group increases morbidity, impairsemotional bonding, and causes hyperalgesia. Combination oflidocaine and prilocaine cream is one of the topical analgesicsthat are easy to use and safe for neonates.Objective To assess the efficacy of lidocaine-prilocainecombination cream in reducing pain caused by intramuscularinjection of hepatitis B and to find out the correlation of sex,gestational age, birth weight, chronological age, and method ofdelivery with infantâ€™s pain response.Methods A double blind randomized controlled trial wasconducted on term neonates. Subjects were selected consecutivelyand every subject was randomized to either receive lidocaine-prilocaine cream or placebo one hour prior to administration ofintramuscular hepatitis B vaccine. The administration wasrecorded by a handycam and the intensity of pain responses wasevaluated using DAN (Douleur Aigue Nouveau-ne) scale.Results Of 67 subjects, the mean of DAN scale was 7.60 (95%CI 7.27;7.95) in the lidocaine-prilocaine cream group and thiswas significantly lower (P<0.0001) than in placebo group, whichwas 8.82 (95% CI 8.56;9.09). ANCOVA showed that there wereno associations between sex, gestational age, birth weight,chronological age, and method of delivery with infantâ€™s painresponse.Conclusion Lidocaine-prilocaine combination cream can reducethe pain caused by intramuscular injection of hepatitis B vaccineon term neonates.

The efficacy of trimethoprim-sulfamethoxazole treatment in children with acute bloody diarrhea Selvi Nafianti; Oke R. Ramayani; Dedy G. Daulay; Supriatmo Supriatmo; Berlian Hasibuan; Atan B. Sinuhaji
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background The etiologies of bloody diarrhea are shigella,amoeba, enterocolitis, trichuriasis, and other causes i.e, EIEC,Campylobacter jejuni or rotavirus. In developing countries,trimetroprim-sulfamethoxazole (TMP-SMP) is effective in 80%of children with bloody diarrhea.Objective To determine the efficacy of trimethoprim-sulfa-methoxazole (TMP-SMX) treatment in children with acute bloodydiarrhea.Methods A randomized double blind clinical trial was conductedin Adam Malik Hospital and Dr. Pirngadi Hospital Medan duringSeptember 2003-March 2004. Children aged 2-24 months oldwith diagnosis of acute bloody diarrhea were randomized into twogroups to either receive TMP-SMX or placebo for 5 days.Microscopic fecal analysis was performed on the first, second,fifth and twelfth day, and the results were compared.Results A total of 68 children consisted of 48 (71%) boys and 20(29%) girls were enrolled. Each group had 34 participants.Analysis of the first day showed leukocyte and erythrocyte in thestool specimens, which were all absent on the twelfth day in bothgroups. There was no difference in stool analysis between TMP-SMX and placebo group in day two (P=0.758), day five (P=0.341)and day twelve. Diarrhea duration in TMP-SMX and placebogroup was 7.18 days and 6.65 days, respectively. This differentwas statistically not significant (P=0.385).Conclusion There is no difference in the efficacy of trimethoprim-sulfamethoxazole treatment compared to placebo in children withacute bloody diarrhea.

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.

Hyperlactacemia in critically ill children: comparison of traditional and Fencl-Stewart methods Hari Kushartono; Antonius H. Pudjiadi; Susetyo Harry Purwanto; Imral Chair; Darlan Darwis; Abdul Latief
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background Base excess is a single variable used to quantifymetabolic component of acid base status. Several researches havecombined the traditional base excess method with the Stewartmethod for acid base physiology called as Fencl-Stewart method.Objective The purpose of the study was to compare two differentmethods in identifying hyperlactacemia in pediatric patients withcritical illness.Methods The study was performed on 43 patients admitted tothe pediatric intensive care unit of Cipto MangunkusumoHospital, Jakarta. Sodium, potassium, chloride, albumin, lactateand arterial blood gases were measured. All samples were takenfrom artery of all patients. Lactate level of >2 mEq/L was definedas abnormal. Standard base excess (SBE) was calculated fromthe standard bicarbonate derived from Henderson-Hasselbalchequation and reported on the blood gas analyzer. Base excessunmeasured anions (BE UA ) was calculated using the Fencl-Stewartmethod simplified by Story (2003). Correlation between lactatelevels in traditional and Fencl-Stewart methods were measuredby Pearsonâ€™s correlation coefficient .Results Elevated lactate levels were found in 24 (55.8%) patients.Lactate levels was more strongly correlated with BE UA (r = - 0.742,P<0.01) than with SBE (r = - 0.516, P<0.01).Conclusion Fencl-Stewart method is better than traditionalmethod in identifying patients with elevated lactate levels, so theFencl-Stewart method is suggested to use in clinical practice.

Shigellosis in children less than five years in urban slum area: a study at primary health care in Jakarta Junita Elvira; Agus Firmansyah; Arwin A. P. Akib
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background Shigellosis has a global distribution especially incountries with poor hygiene and sanitation. The most commonmanifestation of shigellosis in children is diarrhea with broadspectrum manifestations from watery diarrhea to classicaldysentery. Appropriate antibiotic management is important toeradicate Shigella spp.Objective To find out shigellosis prevalence and manifestationsand also Shigella spp. resistance pattern in children less than 5years with acute diarrhea in certain district urban slum areas inJakarta.Methods This cross sectional study involved 475 outpatients ofless than 5 years old with acute diarrhea who visited primary healthcares in Jakarta from Julyâ€“ October 2005. Stool for culture andantibiotic resistance test was taken with single rectal swab.Results Shigella spp. was found only in 3 (0.6%) patients. Thesubjects were between 6 to 24 months. Watery diarrhea was foundin 1 subject and so was the classical dysentery manifestation offever and bloody diarrhea. Two strains were found, 2 cases of S.sonnei and 1 case of S. flexneri. They were resistance tocotrimoxazole, tetracycline, and colistine.Conclusion Shigella spp. was not the main cause of acute diarrheain children less than 5 years old. Due to the small number ofcases, we could not find the most common manifestation andresistance pattern of shigellosis in these children.

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