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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 53 No 2 (2013): March 2013" : 11 Documents clear

Molecular analyses in Indonesian individuals with intellectual disability and microcephaly Farmaditya EP Mundhofir; Rahajeng N Tunjungputri; Willy M Nillesen; Bregje WM van Bon; Martina Ruiterkamp-Versteeg; Tri I Winarni; Ben CJ Hamel; Helger G Yntema; Sultana MH Faradz
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Background Intellectual disability (ID) often coincides with anabnormal head circumference (HC). Since the HC is a reflectionof brain size, abnormalities in HC may be a sign of a brain anomaly.Although microcephaly is often secondary to ID, hereditary(autosomal recessive) forms of primary microcephaly (MCPH)exist that result in ID.Objective To investigate mutations in MCPH genes in patientswith ID and microcephaly.Methods From a population of 527 Indonesian individuals withID, 48 patients with microcephaly (9.1 %) were selected. Thesepatients were previously found to be normal upon conventionalkaryotyping, fragile X mental retardation 1 (FMRl) gene analysis,subtelomeric deletion, and duplication multiplex ligationdependentprobe amplification (MLPA). Sanger sequencing forabnormal spindle-like microcephaly-associated (ASPM) and WDrepeat domain 62 (WDR62) was performed in all 48 subjects, whilesequencing for microcephalin (MCPHl), cyclin-dependent kinase5 (CDK5) regulatory subunit-associated protein 2 (CD5KRAP2) ,centromere protein} (CENPJ), and SCUfALl interrupting locus(STIL) was conducted in only the subjects with an orbitofrontalcortex (OFC) below -4 SD.Results In all genes investigated, 66 single nucleotide polymorphisms(SNPs) and 15 unclassified variants which were predictedas unlikely to be pathogenic (lN2), were identified. Possiblepathogenic variants (lN3) were identified in ASPM. However,since none of the patients harboured compound heterozygouslikely pathogenic mutations, no molecular MCPH diagnosis couldbe established. Interestingly, one of the patients harboured thesame variants as her unaffected monozygotic twin sister, indicatingthat our cohort included a discordant twin.Conclusions This study is the first to investigate for possible geneticcauses ofMCPH in the Indonesian population. The absenceof causative pathogenic mutations in the MCPH genes tested may originate from several factors. The identification of UV2and UV3 variants as well as the absence of causative pathogenicmutations calls for further investigations.

Duration of peripheral intravenous catheter use and development of phlebitis Rita Andriyani; Hindra Irawan Satari; Pustika Amalia
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Background Phlebitis is a common complication in patients withperipheral intravenous catheters, in addition to extravasation andbacterial colonization. Phlebitis may increase morbidity and lengthof hospitalization. One factor contributing to the rate of phlebitis isthe duration of peripheral intravenous catheter use. Several adultstudies have shown that the risk of developing phlebitis increasedwhen the peripheral intravenous catheter was used for more than72 hours. However, in pediatric patients this risk has not beenconsistently observed. As such, there is no recommendation forroutine catheter removal every 72 hours in children.Objective To assess for a possible relationship between durationof peripheral intravenous catheter use and the development ofphlebitis.Methods This analytic observational study had a case controldesign. Subjects consisted of 73 case subjects and 73 controlsubjects. We collected subj ects' data through history-taking andclinical examinations. The duration of peripheral intravenouscatheter use was reported in hours.Results From October 2011 to February 2012, 146 children fromthe Department of Child Health at Dr. Cipto MangunkusumoHosp ital and Tangerang Hospital who used peripheral intravenouscatheters were enrolled in this study. There was no significantdifference between <7 2-hour and 2: 72-hour duration ofperipheral catheter use (OR 1.31; 95%CI 0.687 to 2.526;P= 0.407) on the development of phlebitis.Conclusion We observe no relationship between duration ofperipheral intravenous catheter use and the development ofphlebitis in our subjects.

Incidence and risk factors of retinopathy of prematurity Rasyidah Rasyidah; Sujan Ali Fing
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Background Retinopathy of prematurity (ROP) is one of themain causes of visual impairment in premature infants.Objective To determine the incidence and risk factors for ROPin premature infants.Methods This retrospective study included premature infantsborn in Stella Maris Women's and Children's Hospital and admittedto the neonatal intensive care unit (NICU) and NeonatologyDepartment from November 2009 to May 2012. We included allpremature infants with body weight (BW) < 1500 g or gestationalage (GA) < 32 weeks, and selected infants with BW 1500 - 2000g or GA > 32 weeks with unstable clinical courses who had beenscreened for ROP. Data was analyzed with Fisher's exact test andindependent t test.Results Of the 48 premature infants in the study, ROP wasdetected in 6 (12.5%) of the subjects. Stages ofROPwere classifiedaccording to the International Classification ofRetinopathyof Prematurity. Stage 1 ROP was detected in 1 (2.1 %) subject;stage 2 ROP was detected in 3 (6.25%) subjects; and stage 3ROP was found in 2 ( 4.2%) subjects. The 2 infants with stage3 ROP required surgery. No ROP was detected in infants withGA ~30 weeks or BW > 1250 g. Respiratory distress syndrome(RDS), sepsis, blood transfusion, and apnea were found to beassociated with development ofROP. Duration of oxygen therapywas found to be a significant risk factor for ROP in a comparisonof the no ROP group to the ROP group: 14.0 (SD 9.508) daysvs. 3.81 (SD 5 .218) days, respectively (P<0.05). In addition,the duration of continuous positive airway pressure (CPAP)usage was also a significant risk factor for ROP, with 1.83 (SD1.329) days in the ROP group vs. 0.76 (SD 1.122) days in theno ROP group (P<0.05).Conclusions The incidence of ROP in the premature infants inour study is 12.5%. Retinopathy of prematurity is associated withlower BW, lower GA, lower Apgar score at the 5th minute, RDS, sepsis, apnea, blood transfusion, aminophylline usage, as well aslonger duration of oxygen therapy and CPAP usages.

Impact of Bifidobacterium lactis supplementation on fecal microbiota in infants delivered vaginally compared to Caesarean section Tetty Yuniaty; Fiva Kadi; Hadyana Sukandar; Mifta Novikasari; Pensri Kosuwon; Enea Rezzonico; Paiboon Piyabanditkul; Leilani Lestarina; Marco Turini
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Background It has been reported that infants born by Caesareansection have altered gut microbiota, with lower n umbers ofbifidobacteria and Bacteroides, compared to that of infants whowere delivered vaginally. Probiotic supplementation has beenreported to have beneficial effects on the immune response,generally in relation to allergies.Objective To assess the effect of Bifidobacterium lactis (B. lactis)supplementation on the presence of B. lactis and bifidobacteriacounts in stool of infants during the first 2 months of life .Methods We conducted an observational study of 122 healthy,breast-fed infants delivered vaginally or by Caesarean section.Infants assigned to the test group received breast milk and formulasupplemented with the B. lactis probiotics. Infants in the controlgroup received breast milk and formula without probiotics.The presence of B. lactis and stool bifidobacteria counts weredetermined at 1 month and 2 months of age. Growth, morbidity,serum immune markers, and stool immunoglobulin (lg) A werealso assessed.Results B. lactis was more frequently detected in the stool ofinfants who received breast milk and probiotic-supplementedformula than in stool of infants who received breast milk andnon-supplemented formula, both at 1 month and 2 months ofage (OR 1,263; 95%Cl 11 to 15 1,030; P=0.003) . Of infants whoreceived probiotic-supplemented formula, B. lactis was detected in80% of those delivered by Caesarean section and in 3 8% of thosedelivered vaginally, at the 1-month mark. In infants delivered byCaesarean section, the mean stool bifidobacteria level at 1 monthwas significantly higher in the probiotic-supplemented groupcompared to that of the non-supplemented group (P=0.021) .Conclusion Early bifidobacteria supplementation of infants,particularly those delivered by Caesarean section, is associatedwith higher levels of stool bifidobacteria. Anthropometric datasuggests beneficial effect s of bifidobacteria supplementationon infant growth, though most are not statistically significant.

Factors associated with failure to wean children from mechanical ventilators Dyah Kanya Wati; Antonius Pudjiadi; Abdul Latief
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Background Patients with failure to wean from mechanicalventilators in 48 hours have increased risk of morbidity, howeveronly a few protocols can be used for children.Objective To assess possible factors associated with failure towean from mechanical ventilators in the pediatric intensive careunit (PICU).Methods This cross sectional study performed from June 2011 toJune 2012 had 124 subjects with 79 patients who were successfullyweaned and 45 patients who fail to be wean ed from mechanicalventilators. Data was analyzed by 2x2 contingency tables. Resultswith P value <0.05 were further analysis by logistic regressionmultivariate analysis.Results Factors associated with failure to wean from mechanicalventilators were abn ormal electrolyte (P= 0.001) and acidbase status (P <0.001), lower ratio between tidal volume(TV)/inspiration time (IT) (P<0.001), lower mechanical load(P <0.001), and longer duration of mechanical ventilator use(P<0.001). Multivariate analyses revealed that the significantrisk factors for failure to wean were TV/IT (OR6.0; 95%CI3.5 to7.5; P= 0.001) , mechanical load (OR 11.5, 95%CI 10.3 to 15.5;P= 0.002), and duration of mechanical ventilator use (OR 12.5;95%CI 8.5to 14.9; P=0.026).Conclusions Lower ratio of TV /IT and mechanical load, as wellas longer duration of ventilator use are factors associated withfailure to wean from a mechanical ventilator.

Penile length of newborns and children in Surakarta, Indonesia Annang Giri Moelyo; Melita Widyastuti
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Background Penile length is a factor for assessing abnormalities inexternal genitalia. To diagnose micropenis, a condition in whichpenile length is < - 2.5 standard deviations (SD), a reference isrequired for diagnosis. Age and race/ethnic groups are factorsthat contribute to normal penile length. To date, Indon esia doesnot have such a reference for normal penile length in newbornsand children.Objective To assess normal penile length in newborns and childrenin Surakarta, Central Java, in which the majority population isofJavanese ethnicity.Methods We studied male newborns and children who werepatients in Moewardi Hospital from January 2011 to January2012. We included males aged 0-18 years whose parents providedinformed consent. We excluded children with undescendedtestis, hypospadia, ambiguous genitalia, con genital anomalies,or syndromes (such as Down syndrome). For penile len gthmeasurements, we stretched the flaccid penis, depressed thepubic fat and placed a wooden spatula vertically along the dorsalpenis. The penile length was measured from the penile baseto the tip of the glans excluding the prepuce. Measurementswere performed three times and a mean value was calculatedfor each subject.Results Of the 300 subjects, 100 were newborns and 200 werechildren aged 1 month - 18 years. Two hundred ninety-six subjects(98.7%) were Javanese. The mean penile lengths of preterm(gestational age 30-36 weeks) and term (gestational age > 36weeks) newborns were 1.88 (SD 0.14) cm and 2.3 7 (SD 0.26) cm,respectively. The mean penile lengths by age groupings were asfollows: 0-<6 months, 2.67 (SD 0.58) cm; 6- < 12 months, 2.67(SD 0.58) cm; 1- <3 years, 2.80 (SD 0.84) cm; 3-<5 years, 3 .50(SD 0.55) cm; 5- <7 years, 3 .50 (SD 0.71) cm; 7-<9 years, 3 .85(SD 0.53 ) cm; 9-<ll years, 4.50 (SD 0.71) cm; 11-< 13 years,4.63 (SD 1.13) cm; 13-< 15 years, 5.53 (SD 1.45) cm; and 15-18years, 6.16 (SD 1.19) cm.Conclusion Normal penile length in boys in Surakarta is smallerthan the normal range reference currently in use.

Association between the frequency of disposable diaper changing and urinary tract infection in children Meirina Daulay; Rosmayanti Siregar; Oke Rina Ramayani; Supriatmo Supriatmo; Rafita Ramayati; Rusdidjas Rusdidjas
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Background Urinary tract infection (UTI) is the most commoncause of fever in children. Less frequent disposable diaper changingis thought to be a cause ofUTI in children. While wearing a diapei;the perinea! area becomes damp with urine allowing bacteria tomigrate from the anus to the external urethral orifice.Objective To assess for an association between the frequencyof disposable diaper changing and urinary tract infections inchildren.Methods This cross-sectional study was conducted in thechildren's outpatient clinic of Haji Adam Malik Hospital fromApril to June 2010. Urine culture was performed in children withsuspected UTI who wore disposable diapers every day. Subjects'ages ranged from 2 months to 2 years 6 months, with samplesmatched and collected by consecutive sampling. Diagnosis ofUTIwas based on urine cultures with bacterial count 2:: 105/mL. Eightychildren were followed in this study and divided into two groups:positive (n=40) and negative (n=40) urine cultures. Chi squaretest was use d to analyze the association between the frequency ofdaily disposable diapers changing during a one week period andthe urine culture results.Results The frequency of daily disposable diapers changing in80 subjects was as follows: < 4 times (22.5%), 4-5 times (40%),and 2::6 times (37.5%) . The frequency of daily disposable diaperchanging in children with positive urine culture was as fo llows:< 4 times (1 8 out of 40), 4-5 times (22 out of 40), and 2::6 times(O out of 40); (P < 0.0001). The most common bacterial speciesfound in urine cultures was Escherichia coli.Conclusion Lower frequency of daily disposable diaper changingis significantly associated with higher UTI incidence in children.

Effect of lansoprazole on quality of life in adolescents with recurrent abdominal pain Sri Yanti Harahap; Selvi Nafianti; Sri Sofyani; Supriatmo Supriatmo; Atan Baas Sinuhaji
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Background Recurrent abdominal pain (RAP) is one of the mostcommon complaints in adolescents. Treatment for RAP dependson the etiology. Lansoprazole has been shown to be effective ongastroesophageal reflux disease (GERD), but further study isneeded to assess the effects of lansoprazole on RAP.Objective To assess quality of life (QoL) of RAP patients whoreceived lansoprazole compared to placebo treatment.Methods This randomized, clinical trial was conducted in theSecanggang District, Lan gkat Regency, North Sumatera, fromAugust to October 2009. Patients who met the Apley criteria forRAP diagnosis were enrolled in the study. Subj ects were dividedinto two groups: those who received 30 mg lansoprazole daily andthose who received placebo, for 14 days. Quality oflife was assessedusing the Pediatrics Quality of Life (PedsQL) version 4.0 beforeadministration oflansoprazole/placebo and reassessed 30 days aftertreatment. Efficacy of treatment was assessed by comparing theQoL before and after treatment in the two groups.Results A total of 98 adolescents, aged 12 - 18 years, wereenrolled in the study and divided into two groups: lansoprazoleand placebo. There was no significant difference QoL in physicalhealth (mean differences 95%CI -109.19 to 1.02; P=0.054),emotional health (mean differences 95%CI -29.26 to 45.48;P=0.666), social functioning (mean differences 95%CI -42.91to 31.69; P=0.766), and sch ool functioning (mean differences95%CI -56.97 to 24.32; P= 0.430), before and after treatmentin the two groups.Conclusion There is no significant difference in QoL between thetwo groups of adolescents with RAP before and after lansoprazoletreatment.

Functional constipation and posture in defecation Fahrul Azmi Tanjung; Supriatmo Supriatmo; Atan Baas Sinuhaji; Hakimi Hakimi
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Background Functional constipation is often a consequence ofhabitual bowel elimination while sitting on common toilet seats.A considerable proportion of the population with n ormal bowelmovement frequency has difficulty emptying their bowels. Theprincipal cause of this problem may be the obstructive nature ofthe rectoanal angle and its relationship to the posture normallyused in defecation.Objective To assess the relationship between functional constipationwith the posture (sitting vs squatting) during defecationin children.Methods We conducted a cross-sectional study in November2010. Participants aged 12- 15 years were selected consecutivelyfrom a junior high school in Medan . Parents and children filledquestionnaires and were interviewed. Functional constipation wasassessed based on the Rome III criteria.Results Sixty-five students enrolled in the study. There was nostatistically significant diffe rences in subjects' characteristics.T here was a significant correlation between functional constipationwith posture during defecation in children (RR= 0.06, 95%CI0.02 to 0.25; P=0.0001). Functional constipation was more likelyoccured in children with sitting (12/20) th an squatting posture(4/45) during defecation.Conclusion We found th at posture in defecation is correlatedto functional con stipation in children.

Comparison of surgical vs. non-surgical closure procedures for secundum atrial septal defect Mazdar Helmy; Mulyadi M. Djer; Sudung O. Pardede; Darmawan B. Setyanto; Lily Rundjan; Hikari A. Sjakti
Paediatrica Indonesiana Vol 53 No 2 (2013): March 2013
Publisher : Indonesian Pediatric Society

Backgi-ound Surgery has been the standard therapy for secundumatrial septa! defect (ASD) closure, but it has significant associatedmorbidities related to st ernotomy, car diopulmonary bypass,complications, residual scars, and trauma. A less invasive nonsurgicalapproach with transcatheter devices was developed toocclude ASD. AmplatzerÂ® septa! occluder (ASO) is a commondevice in transcatheter closure.Objective To compare two secundum ASD closure procedures,transcatheter closure by ASO and surgical closure, in terms ofefficacy, complications, length of hospital stay, and total costs.Methods A retrospective analysis was performed on childrenwith secundum ASD admitted to the Cardiology Center ofCipto Mangunkusumo Hospital from January 2005 to December2011. Patients received either transcatheter closure with ASOor surgical closure procedures. Data was obtained from patients'medical records.Results A total of 112 secundum ASD cases were included in thisstudy, consisting of 42 subjects who underwent transcatheter closureprocedure by ASO and 70 subjects who underwent surgical closureprocedure. Procedure efficacies of surgery and ASO were not significantlydifferent (98.6% vs 95.2%, respectively, P= 0.555). However,subjects who underwent surgical procedures had significantly morecomplication s than subjects who underwent transcatheter closureprocedure (60% vs 28.6%, respectively, OR 1.61; 95%CI 1.19 to2.18; P= 0.001). Hospital stays were also significantly longer forsurgical patients than for transcatheter closure patients (6 days vs2 days, respectively, P< 0.0001). In addition, all surgical subjectsrequired intensive care. Transcatheter closure had a mean total costof 52.7 (SD 6.7) million Rupiahs while the mean cost of surgery was47 (SD 9.2) million Rupiahs (P< 0.0001) . Since the ASO devicecost represented 58% of the total cost of transcatheter closure, themean cost of transcatheter closure procedure without the deviceitself was less costly than surgery.Conclusion Transcatheter closure using ASO has a similar efficacyto that of surgical closure procedure. However, subjects whounderwent transcatheter closure have lower complication ratesand shorter length ofhosp ital stays than subjects who had surgery,but transcatheter closure costs are higher compared to the surgicalprocedure.

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