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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 2 (2007): March 2007" : 9 Documents clear

The association between fever in the first year of life and atopy in children with or without family history of atopic disease Susy P. Wihadi; Budi Setiabudiawan; Cissy B. Kartasasmita
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background The role of repeated infection in early life in thedevelopment of childhood atopy is still controversy. Fever in thefirst year of life which is frequently associated with infections mightdecrease atopy.Objective The aim of this study was to investigate the associationbetween fever in the first year of life and atopy in children.Methods This was an observational clinical epidemiology studyperformed at Puskesmas Garuda, Padasuka, and Babakan Sari,Bandung, from January to March 2006. From 749 children, werandomly chose 150 subjects each from group with and withoutfamily history of atopic disease. Skin prick test and measurementof total serum immunoglobulin (Ig) E were performed on eachchildren. Atopy was defined as the skin prick test result waspositive to >1 allergen. The number of fever episodes in the firstyear of life was based on parents report. The relationship betweenfever and atopy was analyzed using Mantel Haenszel.Results From 284 subjects, atopy was found in 28.2% of children,of which 32.4% with and 23.9% without a family history of atopicdisease. Generally there was no significant association betweenfever and atopy. There was only decreased odds ratio withincreased fever episodes and trend analysis showed this decreasewas significant (P=0.01). The significant association betweenfever and atopy were found only in group without family historyof atopic disease (P=0.03, OR=0.43, CI 95% 0.18;1.01).Conclusion There is a relationship between fever and atopy inchildren without family history of atopic disease.

Treatment of acute lymphoblastic leukemia with protocol Hongkongâ€“Indonesia Acute Lymphoblastic Leukemia 97 Johannes Bondan Lukito
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background The HK-Ina ALL 97 study protocol is based on theTherapy Study ALL-BFM 95 protocol. Basically, this protocolstratifies the patients into three groups, i.e. standard risk for lowrisk group (SR), intermediate risk (IR), and high risk (HR) group,and the treatment is directed according to the risk groups.Objectives To investigate the overall treatment result of childhoodALL in Indonesia and to stratify patients according to biological,clinical criteria, and molecular study that identify the standardand high risk patients with greater precision.Methods Twenty patients entered in this study; 10 SR, 6 IR and 4HR groups. Induction phase for SR group consisted of four drugs(phase Iâ€™a) for five weeks and three drugs combination (phase Iâ€™b)for four weeks. Consolidation phase consisted of four doses of mini-HD MTX (2 gram/m 2 ) (protocol Mâ€™), reinduction phase useddexamethasone for seven weeks, and maintenance phase consistedof 6 MP and MTX. Boys, who were at higher risk of relapse, weregiven pulse dexamethasone and vincristine. Induction phase for IRwas the same as SR, but four doses of daunorubicin were given to IRgroup (Ia). Consolidation phase included four doses HDMTX (5gram/m 2 ). Phase Ib and Protocol II was the same as SR group. Pulsedexamethasone and vincristine was given to all patients. Inductionphase for HR group will be the same as IR group. This followed bythree blocks of very intensive treatment. Two reinduction phasesand maintenance was the same as SR and IR groups.Results Nineteen of 20 patients achieved complete remission (CR).The patient who could not stand was a 10 years old boy with initialWBC 612X10 9 /L, T-lineage marrow. He died 5 months since the initialdiagnosis after treated with HDMTX with dominant CD33 and sepsis.Conclusion The EFS in this study is 95% for the observation of 5months through five years and two months. It is still expected thatthe result fall off in the subsequent year, but it is also expected to becomparable to 70-80%. The very intensive and toxic program forHR group, may improve the EFS, but may also cause secondaryAML in the earlier time.

An overview of an amplitude integrated EEG Setyo Handryastuti
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Amplitude integrated EEG (aEEG) has been used widely in developed countries for years. It was initially developed by Maynard and Prior 1 in the early 1970s and later adapted for neonatal use by Hellstrom-Westas and Svenningsen 2 . It is especially used for monitoring term newborns after having survived from birth asphyxia.During the last decade neonatal health care in Indonesia has developed. Monitoring of physiological parameters such as ECG, heart rate, blood pressure, oxygen saturation and temperature have been integrated inour neonatal intensive care unit but equipments like continuous EEG monitoring and aEEG to evaluate brain function have not been well-known among our neonatologists and pediatricians. The consequence is the de-crease of infant mortality was not associated with the improvement of quality of life of the survivors due to neurodevelopmental problems caused by various diseases during neonatal period. In the future, it can be prevented by using brain function monitoring in high risk newbornfor neurodevelopmental problem in conditions such as hypoxic-ischemic encephalopathy (HIE), prematurity, neonatal seizures, central nervous system infection, metabolic disorders, intraventricular or intracranial bleeding and brain malformation. This article gives an overview about aEEG and its role in newborn.Â

Circumcision in boys with mild Hemophilia A â€“ the Yogyakarta experience Pudjo Hagung Widjajanto; Ridwan Tjandra Sugiarto; Sutaryo Sutaryo; Kaiser Ali
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background In boys with hemophilia, there is a risk ofhemorrhage resulting from circumcision. There has been nostandardised management in Indonesia. We report our experiencewith 4 hemophiliac boys who underwent circumcision at Dr.Sardjito General Hospital, Yogyakarta, in south-central Java.Objective To develop a safe, practical and accessible method toprevent bleeding in boys with hemophilia undergoing circumcisionin Indonesia.Methods Written informed consent was obtained from parentsrequesting the procedure. All boys had mild Hemophilia A (VIII:C level >7.8 U/ml) diagnosed at a median age of 4.4 years (range0.75â€“9 years). Median age at time of circumcision was 7.5 years(range 0.8â€“12 years).Results There were no intraoperative or post-circumcisionbleeding problem encountered in any of the patients, who weredischarged from hospital three days post-surgery. On follow upeight days and 12 days post-circumcision, they remained free ofcomplications.Conclusion Circumcision can be safely performed in boys withmild Hemophilia A following adequate pre-operative planningand prophylactic therapy. A standardised protocol for theYogyakarta Bleeding Disorders Program. evolving from thisexperience, is being planned.

Effect of enalapril in children with steroid resistant primary nephrotic syndrome L. P. Primi Atmikasari; M. P. Damanik; Tonny Sadjimin
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background A significant proportion of children with nephrotic syndrome become steroid dependent or steroid resistant who need further medication with cytostatic or other immunosuppressive drugs such as cyclophosphamide or chlorambucil. Unfortunately studies show that the drugs give no good results and cause adverse effects.Objective To establish the effect of enalapril in decreasing proteinuria in children with steroid resistant nephrotic syndrome.Methods We conducted a clinical trial in Nephrology Division, Pediatrics Department, Dr. Sardjito General Hospital from January 2004 to October 2005. Subjects were randomized to either receive prednisone and enalapril (Enalapril Group) or prednisone and cyclophosphamide (CPA Group). The main parameter was proteinuria level, which was examined at the beginning of the study and then every two weeks for eight weeks.Results Remission rate in enalapril group was 96% whereas in CPA group was 82% (P=0.09). Proteinuria level reduction in Enalapril Group from the beginning until the end was 606.92 mg/dl (99%) whereas in CPA Group the reduction was 712.97 mg/dl (91%). Statistically, there was no significant difference in the average decrease of proteinuria level between both groups (P=0.30). Odds ratio for overall adverse events in combined prednisone and enalapril therapy group compared to combined prednisone and cyclophosphamide therapy group was 0.29 (CI 95% 0.17;0.41).Conclusion Combined prednisone and enalapril has similar effect tocombined prednisone and cyclophosphamide in children with steroidresistant nephrotic syndrome. Overall adverse events in combinedprednisone and enalapril group was lower than that in combinedprednisone and cyclophosphamide group.

Association of HLA class II and history of atopy and frequent relapse of childhood steroid-sensitive nephrotic syndrome Dany Hilmanto
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background The association between HLA class II and frequentrelapse of nephrotic syndrome (FRNS) has been reported.Objective To identify the association between HLA class II,history of atopy, and upper respiratory tract infection (URTI)with FRNS.Methods This was a case control study conducted at theDepartment of Child Health, Hasan Sadikin Hospital Bandungand Cipto Mangunkusumo Hospital Jakarta from November 2002to October 2003 on children aged 1-14 years with FRNS. Thesubjects consisted of 40 FRNS and 84 healthy children. HLAclass II was typed by polymerase chain reaction-sequence specificoligonucleotide (PCR-SSO) in Leiden, the Netherlands. Theassociation between HLA class II and FRNS was expressed byodds ratio (OR). The association between such factors and FRNSwas analyzed by logistic regression.Results Atopy was higher in patients than that in controls(P=0.013). URTI did not differ in both groups (P=0.173). HLA-DRB1*03 and DRB1*04 (OR=4.43, P=0.03), DQB1*02(OR=3.43, P=0.00), and DQB1*04 (OR=12.06, P=0.01) weresignificantly higher among patients than those in controls whereasHLA-DRB1*12 (OR=0.34, P=0.02) and DQB1*0301p(OR=0.35, P=0.02) were significantly lower among patients thanthose in controls. Using logistic regression analysis, only HLA-DRB1*12, DQB1*02 and atopy took part in FRNS.Conclusion HLA-DRB1*12, DQB1*02, and atopy all togetherhave association with FRNS.

Factors affecting mortality of neonatal sepsis in Moewardi Hospital, Surakarta Yulidar Hafidh; Dwi Hidayah; Sunyataningkamto Sunyataningkamto
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background Mortality of neonatal sepsis is still a significantproblem. It might be affected by many factors.Objective The purpose of this study was to determine factorswhich affect mortality of neonatal sepsis at neonatal ward ofMoewardi Hospital, Surakarta.Methods Data of neonatal sepsis was obtained from medicalrecords at the neonatal ward of Moewardi Hospital from December2004 to November 2005. We recorded data from 97 neonatalsepsis consisted of 46 male and 52 female babies. Statisticalanalysis had been performed using univariate Chi-square andmultivariate multiple logistic regression analysis.Results Overall neonatal sepsis mortality was about 40%. Therewere no significant difference in factors associated with mortalityof neonatal sepsis such as gender (OR=0.44; 95% CI 0.19;1.014),referral patients (OR=1.61; 95% CI 0.195;.014), and bacterialgrowth culture (OR=1.96; 95% CI 0.856;4.44), except for birthweight which affected mortality (OR=6.29; 95% CI 2.57;15.42).Conclusion Birth weight affects mortality of neonatal sepsis inMoewardi Hospital. Patients with positive bacterial growth culturehas two times higher risk of death, however, it is not statisticallysignificant.

Soy protein sensitization in cowâ€™s milk allergy patients Dina Muktiarti; Zakiudin Munasir; Alan R. Tumbelaka
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background The management of cowâ€™s milk allergy (CMA) isavoidance of cowâ€™s milk as strictly as possible. Extensive hydrolyzedprotein and amino acid based formulas are recommended dietaryproducts for treatment of CMA. However, they have somedisadvantages, such as bitter taste and high cost. Alternativeprotein sources from vegetable proteins, such as soy, can be usedas milk-substitute. Previous studies showed the prevalence of soyallergy in CMA patients in Western countries ranged between 0to 63%, but the prevalence in Asia was not greater than 20% andno data about this prevalence in Indonesia.Objectives To determine the proportion of soy proteinsensitization in CMA patients and characteristics of CMA patientswho were sensitized to soy protein.Methods Fifty seven CMA patients who consumed soy proteinwere taken their blood sample to examine the soy-specific IgE.Results From 57 CMA patients, we found only 18% of patientswho were sensitized to soy protein. Seven out of ten CMA patientswho were sensitized to soy protein were under 12 months old.Atopic dermatitis was the most frequent clinical manifestation(8/10) and all of them had family history of atopic diseases. Soysensitization in IgE-mediated and non-IgE mediated CMA were6/10 and 4/10, respectively.Conclusions Proportion of soy sensitization in CMA patients inthis study was 18%. Soy protein can be used as an alternative forcowâ€™s milk substitute in CMA patients.

The risk factors for febrile neutropenia during chemotherapy in children with malignancy Rini Sulviani; Ponpon Idjradinata; Harry Raspati
Paediatrica Indonesiana Vol 47 No 2 (2007): March 2007
Publisher : Indonesian Pediatric Society

Background Febrile neutropenia is the most common side effectof myelosuppressive chemotherapy. It is important to identify itsrisk factors to decrease the morbidity and mortality of febrileneutropenia.Objective To identify whether age, type of malignancy, phase anddose of chemotherapy, nutritional status, and absolute neutrophylcount are risk factors for febrile neutropenia.Methods A hospital-based case control study was conducted atHasan Sadikin Hospital from June 2000 to July 2005. Data wascollected from medical records. The case group consisted ofchildren with malignancy who received chemotherapy andsuffered from febrile neutropenia, while the control groupconsisted of children without febrile neutropenia. Chi square andlogistic regression analysis were performed to analyze data usingSPSS for Windows version 13.0.Results Eighty-seven cases and 94 controls were evaluated.Analysis showed that malignancy type i.e, hematologicmalignancy, chemotherapy phase, and absolute neutrophyl countmight be the risk factors for febrile neutropenia (OR=4.6, 95%CI 1.3;16.7, P=0.019; OR=8.1, 95% CI 2.2;30.5, P=0.002; andOR=1.0, 95% CI 1.003;1.007, P <0.001, respectively), while age,chemotherapy dose, and nutritional status might not be the riskfactors (median 60, range 6-144, P=0.342; OR=1.9, 95% CI0.8;4.8, P=0.129; and P=0.798, respectively).Conclusion Hematologic malignancy, induction phase ofchemotherapy, and absolute neutrophyl count =250/mm 3 are therisk factors for febrile neutropenia in children with malignancywho received chemotherapy.

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