Search

Background Diphtheria can be effectively prevented by adequate immunization. A combined vaccine against diphtheria toxoid, pertussis, and tetanus toxoid (DPT) is currently used in routine pediatric immunizations. Outbreaks of diphtheria could emerge in Indonesia as a consequence of declining routine vaccination during the COVID-19 pandemic. Objective To analyze the impact of the first (administered at 18-24 months of age ) and second diphtheria boosters (administered at 5-7 years of age ) in retaining protective levels of anti-diphtheria toxoid antibodies. We also investigated for relevant factors associated with anti-diphtheria toxoid antibody titers. Methods This cross-sectional study was conducted in the Senen District of Jakarta, Indonesia. The inclusion criteria were healthy children aged 6 to 7 years with documented history of DPT vaccination. Primary vaccination defined as 3 doses of DPT at age less than 1 year , first booster was DPT vaccination at 18-24 years of age, and second booster was diphtheria-tetanus (DT) vaccination received at 5 to 7 years of age. Peripheral blood specimens were obtained from participating children, after informed consent was provided by their parents. Antibodies against diphtheria in sera specimens were assessed by commercial anti-diphtheria toxoid immunoglobulin G (IgG) enzyme-linked immunosorbent assay. Results There were 154 children included in the study, with a female majority (61%). Overall, specific humoral immunity against diphtheria was observed in 113 children (73.4%). There was no statistical difference in immunity level between genders. Importantly, children who received the first and second diphtheria booster had significantly higher anti-diphtheria antibody level than those who did not receive both diphtheria booster (P

Background Stunting is one of the problems that occurs in children who live in slum areas. Inadequate nutrient intake has been associated with stunting in children. Objective To assess nutrient intake and analyze the differences between stunted and non-stunted children aged 2-5 years. Methods This comparative cross-sectional study compared nutrient intake and stunting among children 2-5 years in slum areas in Kebon Bawang Village North Jakarta. Subjects’ nutrient intake was assessed using the Semiquantitative-Food Frequency Questionnaire (SQ-FFQ). To analyze differences in subject characteristics and nutrient intake in the stunted and non-stunted groups, Chi-square, Mann-Whitney test, and independent T-test were used. Results From a total of 42 respondents, the characteristics of subjects were not significantly different between the stunted and non-stunted groups, in age (P=0.120), gender (P=0.126), maternal occupation (P=0.729), or maternal education (P=0.127). The stunted group had significantly lower intake of energy (P=0.003), carbohydrates (P=0.024), protein (P=0.005), and fat (P=0.001) than that of the non-stunted group. However, the majority of subjects had protein adequacy above the sufficiency level in both groups (P=0.638), while significantly more subjects in the stunted group had insufficient carbohydrate adequacy than in the non-stunted group (P=0.032). Conclusion Overall, nutrient intake in the stunted group is lower than that of the non-stunted group. Protein adequacy is above sufficient for most subjects in both groups, while the significantly more stunted subjects have insufficient carbohydrate adequacy. In carrying out interventions, it is necessary to consider fulfilling a balance of nutrients, especially macronutrients.

Background Expression of breast milk is a strategy to ensures continuous breastfeeding during temporary separation of infant from the mother. Handling and storage of expressed breast milk (EBM) should be based on established recommendations because these practices can affect milk quality and safety. Objective To describe perceptions and practices of EBM handling and storage, compare with commonly used recommendations and associated factors influencing these practices among mothers in Jakarta, Indonesia, Methods Mothers who practiced expressed breastfeeding (EBF) to their 6-12 weeks-old infants completed questionnaires about their peceptions and practices on how they handle and storage EBM. The differences in perceptions and practices about expressed breastfeeding management were analyzed using the Chi-square or Fisher's exact test. Results Among 30 mothers, 14/30 gave EBF exclusively, 19/30 used breast pump, and 26/30 expressed ³6 times/day. Infants in this study received expressed milk 5-10 times per day. Maternal age and resource of information were factors significantly associated with mother’s perceptions, while maternal age, education, and parity were significantly associated with the practices of EBM handling and storage. Conclusion This study reveals inconsistent perceptions and practices on expressed milk handling and storage by the mothers. They have good knowledge about the theoretical aspects of expressed breastfeeding, but some other techniques are poor, which can be detrimental to the health of the infants. Further study is needed to find more efficient and optimal methods of expressed milk handling and storage, necessitating thoughtful consideration of better practices and recommendations.

Introduction: Dadiah is a fermented milk product derived from the milk of West Sumatran swamp buffaloes. Methods: The manufacture of dadiah pudding used dadiah fermented milk obtained from Bukittinggi, West Sumatra. Levels of carbohydrate, protein, fat, calcium, zinc, and iron were measured according to the Indonesian National Standard, then total calories were determined using 4:4:9 kcal/g conversion. Inoculation of samples on de Man, Rogosa, and Sharpe agar was performed to determine total lactic acid bacteria counts, and Gram staining was done for further morphological confirmation. Results: The result revealed that 100 g dadiah pudding contained 6.49 g of carbohydrates, 6.12 g of protein, 23.31 g of fat, 260.23 kcal of calories, 276.61 mg of calcium, 3.75 mg of zinc, 6.60 mg of iron, and 6.1 × 10⁹ CFU/ml of lactic acid bacteria assuming that modification of the liquid into pudding form has been shown to impact macronutrient, micronutrients, total calories, and total lactic acid bacteria. Conclusion: The nutrient content in dadiah pudding revealed in this study indicates that this dairy product can be used as a nutritious local food source and a potential probiotic.

Background: Routine childhood vaccination, e.g., for diphtheria, tetanus, and pertussis (DTP), might provide additional protection against SARS-CoV-2 infection. This concept of heterologous immunity was explored in healthy children receiving both DTP and inactivated SARS-CoV-2 vaccines. Methods: A cross-sectional study was performed on 154 healthy children aged 6–8 years old in Jakarta, Indonesia. Their vaccination status for the DTP (including a diphtheria–tetanus booster vaccine at 5 years old) and CoronaVac (from 6 years old) vaccines were recorded. Peripheral blood samples were collected from all participants, in which anti-diphtheria toxoid IgG and anti-SARS-CoV-2 S-RBD antibodies and T cell-derived IFN-γ were measured. Results: The study participants with complete DTP vaccination had significantly higher titers of anti-diphtheria toxoid IgG than the ones without (median = 0.9349 versus 0.2113 IU/mL; p < 0.0001). Upon stratification based on DTP and CoronaVac vaccination statuses, the participants with complete DTP and CoronaVac vaccinations had the highest titer of anti-SARS-CoV-2 S-RBD antibodies (median = 1196 U/mL) and the highest concentration of SARS-CoV-2-specific T cell-derived IFN-γ (median = 560.9 mIU/mL) among all the groups. Conclusions: Healthy children aged 6–8 years old with complete DTP and CoronaVac vaccinations exhibited stronger SARS-CoV-2-specific T cell immune responses. This might suggest an additional benefit of routine childhood vaccination in generating protection against novel pathogens, presumably via heterologous immunity.

Background The COVID-19 pandemic necessitated the use of online schooling in order to comply with national and local lockdown guidelines. Online learning required students and teachers to adapt to a new method of schooling. The inability of adolescents to adapt to their environment can interfere with their psychosocial condition and become a risk factor for functional gastrointestinal disorders (FGID). Objective To determine the prevalence of FGID in adolescents and evaluate possible risk factors that existed during online learning. Methods This cross-sectional study was done in children aged 12-18 years who participated in online learning during the COVID-19 pandemic. The diagnosis of FGID was based on Rome IV criteria. Psychosocial problems were assessed using the Pediatric Symptom Checklist Questionnaire–17 (PSC-17) which includes internalization, externalization, and attention subscales. Subjects with a PSC-17 mixed subscale total score of >15 were considered as having an increased likelihood of having a behavioral health disorder. Data were collected by online questionnaires via Google Forms. Results Of 1,413 participants, 23% experienced FGID; of these, 32.6% had >2 FGID diagnostic criteria. Upon multivariate analysis, internalization psychosocial problems were the most common risk factors for FGID, followed by mixed subscale psychosocial problems, unstable internet connection, and not understanding of the material. ConclusionThe prevalence of FGID in adolescents in this study is 23%. Environmental and psychosocial conditions are interrelated as risk factors for FGID in adolescents during online learning in the COVID-19 pandemic.

Very preterm infants are at a high risk of developing feeding intolerance; however, there are no widely accepted definitions of feeding intolerance. This study aimed to develop a scoring system for feeding intolerance in very preterm infants by combining clinical symptoms and ultrasonography (US) findings. This prospective cohort study included very preterm and/or very low birth weight infants. We defined feeding intolerance as the inability to achieve full feeding (150 ml/kg/day) by 14 days of life. The clinical findings included vomiting, abdominal distention, and gastric fluid color. US findings included intestinal peristaltic frequency, gastric residual volume, peak systolic velocity, and the resistive index of the superior mesenteric artery. We conducted multivariate analyses to evaluate the potential predictors and developed a scoring system to predict feeding intolerance. A total of 156 infants fulfilled the eligibility criteria; however, 16 dropped out due to death. The proportion of patients with feeding intolerance was 60 (42.8%). Based on the predictive ability, predictors of feeding intolerance were determined using data from the US at 5–7 days of age. According to multivariate analysis, the final model consisted of 5 predictors: abdominal distention (score 1), hemorrhagic gastric fluid (score 2), intestinal peristaltic movement ≤18x/2 min (score 2), gastric fluid residue >25% (score 2), and resistive index >0.785 (score 2). A score equal to or above 5 indicated an increased risk of feeding intolerance with a positive predictive value of 84.4% (95% confidence interval:73.9–95.0) and a negative predictive value of 76.8% (95% confidence interval:68.4–85.3). The scoring system had good discrimination (area under the receiver operating characteristic curve:0.90) and calibration (p = 0.530) abilities. This study developed an objective, accurate, easy, and safe scoring system for predicting feeding intolerance based on clinical findings, 2D US, and color Doppler US.

Abstract Background Significant hemodynamic changes in preterm infants during early life could have consequences, especially on the intestinal blood flow. Alteration of superior mesenteric artery (SMA) blood flow may lead to impairment in gut function and feeding intolerance. Objectives To assess SMA blood flow velocity in very preterm and/or very low birth weight (VLBW) infants in early life and to elucidate the factors influencing them. Methods This is a cross-sectional study conducted in NICU at Cipto Mangunkusumo Hospital, Jakarta. Superior mesenteric artery (SMA) blood flow was evaluated by peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) measurement using Color Doppler US at < 48 hours after birth. Maternal and neonatal data that could be potentially associated with SMA blood flow were obtained. Bivariate analyses were conducted with a P value of < 0.05 considered significant. Results We examined 156 infants eligible for the study. PSV, EDV, and RI of SMA blood flow were not related to both gestational age and birth weight. Infant with small for gestational age (SGA) showed significantly lower EDV median [15.5 (range 0.0-32.8) vs 19.4 (range 0.0-113.0)] and higher RI [0.80 (range 0.58-1.00) vs 0.78 (range 0.50-1.00)] compared to appropriate for gestational age (AGA). Infants born from mother with preeclampsia showed lower PSV median [(78.2 (range 32.0-163.0) vs 89.7 (range 29.2-357.0)]) and EDV [16.2 (range 0.0-48.5) vs 19.4 (range 0.0-113.0)] compared to without PE, while absent/reverse end-diastolic velocity (AREDV) revealed a lower EDV median [16.9 (range 0.0 – 32.4) vs 19.4 (range 0.0 – 113.0)] compared to no AREDV. Furthermore, infants with hs-PDA showed lower EDV median [16.2 (range 0.0-113.0) vs 19.4 (range 0.0-71.1)] but higher RI median [0.80 (range 0.50-1.00) vs 0.78 (range 0.55-1.00)] compared to non hs-PDA. No difference in SMA blood flow across other factors was observed.

Background The diagnostic criteria of infant regurgitation have been well elucidated in the Rome IV criteria and pediatricians have been informed of them. However, as a functional disorder, infant regurgitation is susceptible to misdiagnosis and inappropriate management. Objective To assess pediatricians’ diagnostic knowledge of and therapeutic approach to infant regurgitation. Methods We conducted a cross-sectional, analytical study using a questionnaire based on Rome IV criteria for infant regurgitation diagnosis and standardized guidelines for management. The questionnaire was face-level validated by an expert and tested for both reliability and correlation using 30 test respondents. The questionnaire was then distributed electronically to 131 randomized pediatricians, who were members of the Indonesian Pediatric Society DKI Jakarta branch and graduated from pediatric residency within year 2005-2019. Results Sixty-seven (51%) pediatricians reported applying the Rome IV criteria in daily clinical practice. Pediatricians who used Rome IV as their source of knowledge achieved mean and median diagnostic knowledge scores of 14.87 (SD 2.540) and 16 (range 8–20), respectively, with no significant correlation between the usage of ROME IV and the pediatricians’ diagnostic understanding (P=0.110), and mean and median therapeutic knowledge scores of 9.10 (SD 2.264) and 10 (range 4–12), respectively, with no significant correlation between the usage of ROME IV and the pediatricians’ therapeutic approach (P=0.486). Pediatricians’ diagnostic knowledge and therapeutic approach were not significantly different with regards to their practice experience, specialist institution, workplaces, and source of information. Conclusion The majority of pediatricians surveyed have good diagnostic and therapeutic knowledge scores with regards to handling of Rome IV infant regurgitation.

Background: Functional constipation is one of the most common functional gastrointestinal disorders in children under 4 years of age. The Rome IV Criteria have standardized diagnostic criteria for functional constipation. The purpose of the study was to determine the knowledge and therapeutic approach of Indonesian pediatricians to functional constipation. Method: A cross-sectional analytic observational study with the target of 101 pediatricians practicing in the DKI Jakarta area. This study provides an electronic questionnaire which was validated with facial and construct validity and the reliability was determined by Alpha-Cronbach value. Results: The average duration of experience practicing as pediatricians was 6.83 ± 3.96 years, with a range of 5-15 years (66.3%) with the majority working in non-teaching institutions (83.2%). Pediatricians’ knowledge of functional constipation did not show a significant difference in score based on length of experience practicing as a pediatrician (p = 0.738) and place of daily practice (p = 0.690). A Significant difference was seen based on the use of Rome Criteria as a source of information on functional constipation (p = 0.047). Five to fifteen years of experience practicing and teaching hospital as place of daily practice showed a higher therapeutic approach score, although this was not statistically significant. It turned out that using Rome Criteria as a source of information does not give higher therapeutic approach scores. Conclusion: Periodic evaluation of pediatrician's knowledge and therapeutic approach is needed to maintain the quality of functional constipation care.

Background Infantile colic is a functional gastrointestinal disorder (FGID) that occurs in approximately 20% of infants under 6 months. Even though this condition is self-limiting, inappropriate therapy affects the baby’s future quality of life. Therefore, it is essential for physicians, especially pediatricians, to employ a correct diagnosis based on the currently accepted Rome IV criteria and an appropriate therapeutic approach. Objective To assess the gaps in Indonesian pediatricians’ understanding of infantile colic according to Rome IV criteria, their therapeutic approach in managing the condition, and associated factors. Methods We randomly selected 131 pediatricians from the Jakarta Chapter of the Indonesian Pediatric Society to complete a questionnaire aimed at assessing their knowledge on the diagnosis of and therapeutic approach to infantile colic. The questionnaire was scored on a scale of 0 to 20. We evaluated the association between questionnaire scores and their association with several variables, including years of clinical experience, accreditation of pediatric residency institution, type of hospital, and guidelines used. Results Out of the 131 pediatricians selected, 75 (57.3%) had used the Rome IV criteria. The mean knowledge score of those participants was 14.24 (SD 3.32) out of 20. Mean therapeutic approach score of all participants was 11.50 (SD 2.80) out of 16 points. There was no significant association between either knowledge or therapeutic approach score with length of clinical experience, accreditation of pediatric residency institution, hospital type, or guidelines used. Conclusions Most surveyed pediatricians who have used the Rome IV criteria have fairly good knowledge of infantile colic. Overall, pediatricians also have a fairly sound therapeutic approach to infantile colic. However, with mean scores of approximately 70% of the maximum score, education is needed to improve on these areas. Knowledge of and therapeutic approach to infantile colic are not associated with length of clinical experience, accreditation of pediatric residency institution, hospital type, or guidelines used.

Regurgitasi seringkali menyebabkan keadaan tidak nyaman pada bayi dan orangtua. Pendekatan diagnosis dan terapi yang rasional diperlukan agar kualitas hidup bayi dan ibu tetap terjaga. Kriteria diagnosis regurgitasi berdasarkan Kriteria Rome IV. Deteksi alarm sign menjadi bagian pendekatan diagnosis regurgitasi atau gastroesophageal reflux (GER). Alarm signs dapat dibagi menjadi dua kelompok, yaitu (1) kemungkinan GER Diseases (GERD) dan kelainan anatomi atau (2) kemungkinan alergi protein susu sapi. Bayi menangis berkepanjangan, iritabel, dan rewel tidak dapat dipakai sebagai gejala satu-satunya untuk menegakkan diagnosis GERD. Beberapa pendekatan terapi direkomendasikan saat ini, yaitu (1) parental reassurance, (2) teknik pemberian minum, (3) thickening milk, (4) alternatif susu formula, (5) posisi bayi, dan (6) tidak memberikan obat. Pemberian small frequent feeding mungkin akan mengurangi frekuensi regurgitasi, tetapi juga akan meningkatkan frekuensi GER. Proton pump inhibitor (PPI) bukan prokinetik sehingga pemberian pada bayi yang mengalami regurgitasi adalah sikap yang tidak rasional. Bayi dengan regurgitasi disertai menangis berkepanjangan tidak dapat dipakai sebagai dasar untuk memberikan terapi PPI empiris.

Background Preterm infants are susceptible to the damaging effects of hyperoxia which may lead to bronchopulmonary dysplasia (BPD) and intestinal damage. Hyperoxia also affects intestinal microbiota. The optimal initial FiO2 for the resuscitation of premature infants is unknown. Objective To determine the effect of different initial oxygen concentrations on BPD, oxidative stress markers, damage to the gastrointestinal mucosa, and the intestinal microbiome. Methods We conducted an unblinded, randomized controlled clinical trial in premature infants requiring supplemental oxygen in the first minutes of life. Infants started at an FiO2 of either 30% (low) or 50% (moderate), which was adjusted to achieve target oxygen saturations (SpO2) of 88-92% by 10 minutes of life using pulse oximetry. The primary outcome was incidence of BPD. Secondary outcomes included markers of oxidative stress [oxidized glutathione (GSH)/reduced glutathione (GSSG) ratio and malondialdehyde (MDA)], intestinal integrity indicated by fecal alpha-1 antitrypsin (AAT), and intestinal microbiota on fecal examination. Results Eighty-four infants were recruited. There was no significant difference in rates of BPD between the 30% FiO2 and 50% FiO2 groups (42.8% vs. 40.5%, respectively). Nor were there significant differences in GSH/GSSG ratios, MDA concentrations, fecal AAT levels, or changes in facultative anaerobic and anaerobic microbiota between groups. Conclusion In premature infants resuscitated using low vs. moderate initial FiO2 levels, we find no significant differences in BPD incidence, markers of oxidative stress, intestinal mucosa integrity, or intestinal microbiota.

**Background:** Cow’s milk protein allergy is very common in early childhood. Extensively hydrolyzed formulas are recommended in the first-line management of cow’s milk protein allergy in non-breastfed children. Choice of formulas should be informed by efficacy and cost data. **Objectives:** This study aims to compare the cost-effectiveness of extensively hydrolyzed casein formula with _Lacticaseibacillus rhamnosus_ Gorbach Goldin (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), amino acid formula, and soy formula in the first-line management of cow’s milk protein allergy in non-breastfed children in Indonesia. **Methods:** A trial-based decision analytic cohort model was adapted to simulate the occurrence of cow’s milk protein allergy symptoms or being symptom free. The model was based on a prospective nonrandomized study that followed up children for 36 months. Costs and health consequences were discounted at 3% annually. Resources required to manage cow’s milk protein allergy and unit costs for clinical appointments and exams were based on a panel of 15 clinicians, from a private payers’ perspective. Other unit costs were based on publicly available national data. Results were reported as cost per additional child free from allergic manifestations or per additional immunotolerant child at 3 years, and per life-years under the same conditions. Uncertainty was assessed using deterministic and probabilistic sensitivity analysis. **Results:** Children receiving EHCF+LGG were associated with more symptom-free time, a higher probability of cow’s milk tolerance at 3 years, and lower healthcare resources and transportation use when compared with children receiving other formulas (with 38%-49% lower costs). Formula costs were lower for soy, but EHCF+LGG was predicted to save 9% and 54% of overall costs compared with extensively hydrolyzed whey formula and amino acid formula, respectively. Results were robust to sensitivity analyses. **Conclusion:** Use of EHCF+LGG resulted in more symptom-free time and the highest 3-year probability of cow’s milk tolerance. It also led to healthcare resource and transportation savings when compared with other hypoallergenic milk formulas. Soy formula remained an alternative if formula price represents a major constraint.

Regurgitation, colic, and constipation are frequently reported Functional Gastrointestinal Disorders (FGIDs) in the first few years of life. In 2016, the diagnostic criteria for FGIDs were changed from ROME III to ROME IV. This review assesses the prevalence of the most frequent FGIDs (colic, regurgitation and constipation) among children aged 0–5 years after the introduction of the later criteria. Articles published from January 1, 2016 to May 1, 2021 were retrieved from PubMed and Google Scholar using relevant keywords. A total of 12 articles were further analyzed based on the inclusion and exclusion criteria. This review consists of two studies (17%) from the Middle East, three (25%) from Asia, two (17%) from the USA, three (25%) from Europe, and one (8%) from Africa. Three studies (25%) were based on data obtained from healthcare professionals, while the rest were parent or caregiver reports. About half of the retrieved studies used the ROME IV criteria. Among infants aged 0–6 months, the reported prevalence of colic ranged between 10–15%, whilst that of regurgitation was 33.9%, and constipation was 1.5%. Among infants aged 0–12 months, the reported prevalence of regurgitation and constipation were 3.4–25.9% and 1.3–17.7%, respectively. The reported prevalence of constipation was 1.3–26% among children aged 13–48 months and 13% among children aged 4–18 years. Despite the large variations due to differences in diagnostic criteria, study respondents and age group, the prevalence of infantile colic was higher, while that for infantile regurgitation and constipation were similar using the ROME IV or III criteria.

Food-based approaches using locally available food escalates the feasibility and the sustainability of nutrition intervention. A complementary feeding recommendation (CFR) integrated with the food multi-mix (FMM) formulation was targeted to fulfill micronutrient and amino acid requirements for stunted non-wasted (SNW) children aged 12–23 months living in agricultural areas. A seven-day estimated food record (EFR) of 87 children was used to design the CFR and 4 identified underutilized foods were integrated as the FMM. A linear programming approach using Optifood was applied to optimize the CFR and FMM. CFR alone successfully fulfills the vitamin C, riboflavin, iron, and zinc, but it cannot fulfill calcium, thiamin, niacin, vitamin B6, folate, vitamin B12, and histidine. With the incorporation of the selected underutilized cowpea, buncis batik, wader fish, and cows’ milk in the FMM development, the nutrients that are challenging in CFR development, can be fulfilled. Therefore, these findings present evidence that food multi-mix developed based on locally available nutrient-dense food sources can help to meet the nutrient gaps, which often remained even after a complementary feeding diet is optimized. Efficacy study using the developed CFR and FMM is recommended to assess effect in improving intake of micronutrients and amino acids and improving the linear growth of stunted, non-wasted children.