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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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Search results for , issue "Vol 48 No 5 (2008): September 2008" : 11 Documents clear

Meningoencephalitis tuberculosis as a paradoxical response to anti-tuberculous therapy in a child with pulmonary tuberculosis - a case report Heda Melinda Nataprawira
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

This paper reports a case of meningoencephalitistuberculosis as a paradoxical response to anti-tubercu-lous therapy in a child with pulmonary tuberculosis.

Association between obesity and lipid profile in children 10--12 years of age Ruqoyatul Himah; Endy P. Prawirohartono; Madarina Julia
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Worldwide prevalence of obesity in children hasbeen increasing. Together with dyslipidemia and hypertension,obesity is associated with higher risk of cardiovascular morbiditylater in life.Objective The aim of this study was to assess associationbetween obesity and occurrence of dyslipidemia in 10-12 yearsold children.Methods We performed a cross sectional study on 53 obese and53 non-obese children matched for age and gender in Yogyakarta.Obesity was defined as body mass index (BMI) at or above the95th percentile of the CDC 2000 reference. The levels of totalcholesterol, LDL-cholesterol, HDL-cholesterol and triglyceridewere measured. Dyslipidemia was defined as increased level oftotal cholesterol, LDL-cholesterol, triglyceride and decreasedlevel of HDL-cholesterol.Results Obese children had higher risk of increased level oftriglyseride, i.e. RR 2.6 (95% CI 1.6 to 4.4), P<O.OOl anddecreased level ofHDL-cholesterol, i.e. RR 17.8 (95%CI 14.0 to20.1), P=0.003. Overall, relative risk for dyslipidemia in obesechildren was 5.2 (95%CI 4.2 to 5.9), P=0.002, higher than innon-obese children.Conclusion Compared to non-obese children, obese children havehigher risk of dyslipidemia, particularly hypertriglyceridemia andhypo-HDL.

Association between neutropenia and death rate of bacterial neonatal sepsis Elly Noer Rochmah; Ekawaty Lutfia Haksari; Sri Mulatsih
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Neonatal sepsis remains a crucial problem with highmorbidity and mortality. Not less than four million neonates dieevery year, 99% of which occur in developing countries withinfection as the main cause (36%) of death. The prognosticfactors of bacterial neonatal sepsis vary. However the death ratein neonatal sepsis with neutropenia is suspected to be higher thanthat in non-neutropenic condition.Objectives The purpose of this study was to identify whetherneutropenia would increase the death risk of bacterial neonatalsepsis.Methods We conducted a retrospective cohort study. Subjectswere neonates at Instalasi Maternal Perinatal (IMP) of Dr. SardjitoHospital in Yogyakarta who met the eligibility criteria. Duringthe five-year period Qanuary 2002- January 2007), out of 1821cases of suspected neonatal sepsis, 365 (16.7%) were found tohave bacterial cause in the culture of body's fluid (blood, urine,and cerebrospinal). Out of these 16.7% patients suffering fromneutropenia, 39.6% patients died, whereas 9.1 o/o patients weresurvive [RR 4.72, (95% CI: 2.49 to 8.93), P < 0.01].Conclusion Neonates suffering bacterial sepsis with neutropeniahad death risk 4.7 times higher than those who did not haveneutropenia.

Role of sublingual immunotherapy and probiotics in clinical improvements of childhood asthma Mira lrmawati; Anang Endaryanto; Arijanto Harsono
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Sublingual immunotherapy (SLIT) is an effectivesecondary prevention to improve natural course of asthma. Itsefficacy is limited to allergic asthma caused by inhalant allergen.Recent studies showed that probiotic as immunomodulatordecreases inflammatory process induced by food allergy. No suf-ficient clinical evidence reported about the efficacy of combinationsublingual immunotherapy and probiotics or probiotics only inclinical improvement of childhood asthma.Objective To investigate the role of SLIT and probiotic on clinicalparameters of childhood asthma (FEVl reversibility, medicationscore, and symptom score).Methods A randomized single blind clinical trial was conductedon 6-17 year-old asthmatic children sensitive to food and aero-allergens. Subjects were allocated to Group A receiving SLIT,Group B receiving probiotics and SLIT, Group C receiving probiot-ics only. All parameters were evaluated in week 0 untill4.Results FEVl reversibility improved in all groups. Medicationscore and symptom score was also decreased in all groups. Themost marked decrease of FEVl reversibility and symptom scorewere found in probiotics group. Statistical analysis revealedthat the difference of each parameter between groups were notsignificant.Conclusion Combination of SLIT and probiotics and probiot-ics are only similarly effective to improve clinical symptoms aschildhood asthma. Hence, information about probiotics as im-munomodulator was proved to be an excellent alternative therapyfor childhood asthma has been obtained.

Prognostic factors of refractory epilepsy in children Ramzi Ramzi; Yati Soenarto; Sunartini Sunartini; M Hakimi
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Epilepsy is one of the most common pediatricneurological disorders. Twenty percent of patients will developrefractory epilepsy. Early identification of refractory epilepsy willbe helpful to conduct adequate counseling and selecting patientswho need more intensive investigation and treatment.Objective To identify the clinical characteristics and other factorsthat are related to refractory epilepsy in children.Methods We conducted a case control study in patients of two to18 years old with epilepsy that admitted to Dr. Sardjito Hospital.There were 4 7 children with refractory epilepsy compared with122 subjects who have been one year free of seizure.Results Strong association had been noted between refractoryand several clinical factors: early onset of seizure, high initialseizure frequency, neonatal asphyxia, symptomatic etiology, statusepilepticus, abnormal neurodevelopmental status, and earlybreakthrough seizures after treatment initiation. On multivariateanalysis, more than 20 seizures prior to treatment initiation (OR3.40, 95% CI 1.03 to 11.3), and more than three seizures in thesubsequent six month after treatment initiation (OR 16.02, 95%CI 4.98 to 51.5) were independent prognostic factors related torefractory epilepsy.Conclusion Children who present high frequency seizures atonset and more than 3 breakthrough seizures subsequent to sixmonth after treatment have risks of developing refractory epilepsy.

Relationship between fat distribution ratio and blood pressure in obese adolescents Henny Marina; Dany Hilmanto; Julistio Tb Djais
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background The incidence of obesity in big cities increasessignificantly. The association between obesity and increased riskof cardiovascular disease and hypertension in adults has beenknown but less information is available in adolescents. Similarly,the relationship between body-fat distribution and cardiovasculardiseases in adolescents is less clear tha that in adults.Objective This study aimed to determine the association betweenbody fat distribution and increased blood pressure in obeseadolescents in Bandung.Methods This cross-sectional study was conducted from June toAugust 2006. Subjects were students aged 15-18 years at highschools in Bandung with body mass index (BMI) measured usingCDC chart 2000 (> P95) and increased blood pressure (> P90)depended on age and gender according to National High BloodPressure Education Program Working Group on High BloodPressure in Children and Adolescents 2004. Waist-to-hip ratio(central fat), and subscapula skinfold-to-triceps skinfold ratio(peripheral fat) were used to measure fat distribution. Correlationbetween body fat distribution and blood pressure was analyzedusing Pearson correlation statistical test.Results Out of 3170 adolescents examined, 34 obese adolescentgirls and 43 obese adolescent boys had increased blood pressure.Correlation between waist-to-hip ratio and systole blood pressurein boys showed by r=0.495; P=0.003 and girls showed r=0.494;P=O.OOl. Correlation between subscapula skinfold-to-tricepsskinfold ratio in boys showed r=0.289; P=0.097 and girls showedby r=0.248; P=0.109.Conclusion Central fat is moderately correlated with increasedblood pressure in obese adolescents.

Cognitive development in babies with exclusive breastfeeding using Mullen Scale test I G. Maharditha; Soetjiningsih Soetjiningsih; I K. G. Suandi
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Breast milk is the best nutrition for babies' growthand development. There are many reasons for discontinuation ofexclusive breastfeeding (BF).Objective To evaluate the impact of exclusive breastfeeding onbabies' cognitive development.Methods A cohort study was conducted for full term newbornbabies. They were evaluated for cognitive development usingMullen scale test at of 6 and 9 months; t test was used to obtainmean difference of cognitive values. Logistic regression analysiswas performed to distinguish factors associated with the cognitivedevelopment.Results One hundred and forty babies were enrolled to this study(70 babies with exclusive BF and 70 babies with non-exclusiveBF). There were 34 boys (49%) in exclusive and 37 boys (53%) innon-exclusive BF group. Mean cognitive score at age six monthswas 1.41 points higher for exclusive BF group, mean rate 174.31(SO 4.89) and 172.90 (SO 4.19) for exclusive and non-exclusive BF,respectively. Mean cognitive score at nine months was 1.49 pointhigher in exclusive BF group with mean rate 175.28 (SO 4.39) and173.82 (SO 3.80) for exclusive and non-exclusive BF respectively.Logistic regression analysis showed that exclusively breastfed babieshad higher mean Mullen cognitive score of 4. 761 (95% CI 1.341;16.907) and 4.431 (95% CI 1.313; 14.949) times at sixth and ninthmonth respectively than non-exclusive BEConclusion Exclusively breastfed babies may have higher meanscore of Mullen cognitive score at sixth and ninth months whencompared with those who are non exclusively breastfed.

Reverse Transcription Polymerase Chain Reaction (RT-PCR) as an influenza diagnostic test among children in Yogyakarta Eva Musdalifah; M. Juffrie; Purnomo S; Amalia Amalia
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Influenza virus type A, especially H5Nl subtype oravian influenza, is a highly pathogenic agent that causes epidemicin the world with high mortality. Most cases are preschool andschool children. Anti-viral drug is effective when given at earlyphase. The gold standard for the diagnosis of influenza is viralculture, which takes 2 to 10 days. A rapid and accurate diagnostictest is needed to control further viral infection.Objective To determine the accuracy of RT-PCR as a diagnostictest for children with influenza compared with viral culture.Methods A cross-sectional study was conducted in primary healthcares of Jetis I, Godean I, II and Dr Sardjito Hospital Yogyakartabetween January 2005 and May 2007. The specimens, taken bytrained health personnel, were collected from both anterior naresand throat of children aged from birth to 14 years who met theeligibility criteria, then were stored in a frozen extraction tubeand sent to Jakarta for RT-PCR and viral culture as the goldstandard.Results There were 34 7 children enrolled in this study. Influenzainfection was confirmed in 63 children (18.2%). There were 24children with H3N2 subtype of influenza virus, 13 children withHINI subtype, and one child with H5Nl subtype. The sensitivity,specificity, positive and negative predictive value, positive andnegative likelihood ratio of RT-PCR test were 89%, 90%, 67%,97%, 9, 3, 0, and 12 respectively.Conclusions RT-PCR is accurate enough as influenza diagnostictest in children.

Assessment of the quality of general movements in newborn infants: a tool to predict developmental disorders at an early age Ahmad Suryawan; Bambang Permono; Komang Ayu Witarini; Risa Etika; Fatimah lndarso; Moersintowarti B. Narendra
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Nowadays, quality assessment of general movements(GMs) in infants can be used as a tool to predict developmentaloutcome. Until now, there is no published study in this field inIndonesia.Objectives The aim of this study was to evaluate the quality ofGMs of newborn infants.Methods A prospective study was done at neonatal ward, Dr.Soetomo Hospital in Surabaya, between December 2006 andJanuary 2007. A single supine position video recording of newbornsat GMs preterm and writhing age was made using Precthl's method.Infants were chosen consecutively among singletons above 28week gestational age. The quality of GMs was assessed by meansof Gestalt perception by one of the authors, who had been trainedand certified in GMs. GMs were classified into: normal-optimal,normal-suboptimal, mildly-abnormal, and definitely-abnormal.Correlation tests were used to assess the relationship betweenperinatal conditions and the quality of GMs.Results 106 videos were recorded, and 100 were assessedcompletely. Abnormal GMs were found in both 35 pretermage (normal-optimal 2.9%; normal-suboptimal 28.6%; mildly-abnormal45. 7o/o; definitely-abnormal22.9o/o) and 65 writhing age(3.1 o/o; 41.5%; 41.5%; 13.8%, respectively) (P=0.285). There wasa weak negative correlation between birth weight and the qualityofGMs (r=-0.20, P=0.044).Conclusions The quality ofGMs in Indonesian newborn infants inour study was predominantly abnormal, which puts these infantsat high risk for later developmental disorders. The lower theinfants'birth weight, the more likely for abnormal GMs.

Diagnostic accuracy of septic markers for neonatal sepsis Thermiany AS; W Retayasa; M Kardana; IN Lila
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Neonatal sepsis is a major cause of morbidity andmortality. A positive blood culture is the gold standard fordiagnosis of neonatal sepsis. The signs and symptoms suggestingneonatal sepsis are non-specific. There is no rapid and reliablelaboratory test findings for confirmation of etiologic diagnosis.Clinical signs, symptoms, and laboratory examinations are notperceived as sensitive or specific for diagnosis of sepsis.Objective The purpose of this study was to evaluate the accuracyof the septic markers for diagnosis of neonatal sepsis.Methods Blood culture was used as gold standard to compareseptic markers to diagnose neonatal sepsis. Sensitivity, specificity,positive predictive value (PPV), negative predictive value (NPV),positive and negative likelihood ratio (LR), and accuracy werecalculated.Results We identified 130 cases suspected of neonatal sepsis duringSeptember 2005 until March 2006. Four patients were excludedbecause of major congenital anomalies. The mean age was 2.2 daysand 51.6% were boys. We found fifty six (44.4%) neonates havepositive blood culture. All of septic markers had sensitivity morethan 80%. Immature to Total Neutrophil ratio (Iff) ratio had thehighest sensitivity (96.4%) and C-Reactive Protein (CRP) had thelowest sensitivity (80.4o/o). Combination among leukocyte count,thrombocyte, and Iff ratio had the highest sensitivity (sensitivitywas 85. 7%, specificity was 97.1 o/o, positive predictive value was95.9%, negative predictive value was 89.5%, accuracy was 94.4%,and positive likelihood ratio was 30.0).Conclusion Septic markers can be used in the diagnosticevaluation of neonates with suspected sepsis.

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