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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 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.

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.

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.

Kolonosisasi mikrobiota saluran cerna yang didominasi oleh mikrobiota sehat merupakan aspek penting dalam optimalisasi kesehatan anak. Komposisi mikrobiota saluran cerna selalu berubah pada setiap keadaan karena banyak faktor yang memengaruhinya. Bifidobacteria terdapat dalam Air Susu Ibu dan mendominasi saluran cerna bayi yang mendapat ASI eksklusif, seringkali dikaitkan dengan kesehatan bayi dan anak dikemudian hari. Bifidobacteria dikategorikan dalam dua kelompok, yaitu (1) spesies Bifidobacteria berasal dari manusia (human residential bifidobacteria/HRB) dan (2) spesies Bifidobacteria yang secara alami berkoloni di hewan/ lingkungan (non-HRB). Bifidobacteria breve, B. longum subsp.infantis, dan B. bifidum adalah HRB yang terdapat pada bayi. Kolonisasi usus bayi ASI eksklusif didominasi oleh HRB saat berusia 2 minggu. Suplementasi HRB memberikan efek protektif NEC pada bayi dengan usia gestasi

Disorders of gastric motility are generally manifested by an abnormal rate of gastric emptying. The emptying process of the stomach is very complex, and knowledge is limited to the observation that gastric emptying rate is a highly variable phenomenon, and that delayed gastric emptying is frequently the case. The advances in the knowledge of the physiology of gastric muscle and enteric nerves, and the recognition of the patterns of organization of smooth muscle contractions gave a new input to the study of gastric motility. The gastric emptying can be monitored in various ways, such as manometry, scintigraphy, or electrogastrography (EGG). Recently, EGG has received more attention. There is correlation between the EGG signal obtained from body surface electrodes and signals obtained directly from electrodes locates in the gastric muscle (serosal records). Some studies showed an association between EGG-findings and gastric motility disorders, and indicate that EGG is a reliable, non-invasive, useful method to detect gastric myoelectric activity.

Pada umumnya penyakit diare akut bersifat self limiting disease sehingga seringkali pasien tidak memerlukan pengobatan spesifik. Tata laksana diare akut dengan berbagai derajat dehidrasi telah dibakukan oleh WHO. Tujuan: Penelitian ini bertujuan untuk menilai pola tata laksana diare akut di luar rumah sakit institusi pendidikan. Metoda: Penelitian deskriptif yang dilakukan secara retrospektif di tiga rumah sakit swasta Jakarta sejak 1 Januari sampai 31 Maret 1999 pada 67 pasien diare akut yang dirawat, berumur 0-24 bulan. Hasil: Didapatkan 37 (55%) anak lelaki dan 30 (45%) anak perempuan menderita diare akut, terdiri dari tanpa dehidrasi 6 (9%) anak, dehidrasi ringan-sedang 52 (78%) anak, dan dehidrasi berat 9 (13%) anak. Proporsi rentang usia 0-6 bulan sebanyak 23 (34%) anak, >6-12 bulan 28 (42%), dan >12-24 bulan 16 (24%). Jumlah pasien diare akut tanpa dan dengan dehidrasi ringan-sedang yang mendapat rehidrasi secara parenteral sebanyak 51 (88%) anak dari 58 anak. Sedangkan sisanya menderita dehidrasi berat diberi cairan rehidrasi parenteral yang dibagi dalam 24 jam. Pada keseluruhan pasien rawat hanya 37 (55%) anak yang mendapat cairan rehidrasi oral (oralit/Pedialyte). Penggunaan antibiotik didapatkan pada 55 (82%) anak dan anti diare pada 32 (48%) anak. Pemberian ASI hanya didapatkan pada 41 (61%) anak, dan di antaranya pemberian ASI dilanjutkan pada 36 (88%) anak, serta dihentikan pada 5 (12%) anak; sedangkan 26 (39%) anak sudah tidak mendapatkan ASI. Dari 51 anak yang menggunakan susu formula, didapatkan pemberian susu formula khusus pada 47 (70%) anak dan pengenceran susu formula pada 2 (3%) anak. Lama rawat rerata 3 hari, dengan kisaran 2 sampai 6 hari, dan 1 anak dirawat lebih dari 7 hari. Kesimpulan: tata laksana diare akut di tiga rumah sakit swasta di Jakarta kurang sesuai dengan panduan/protabel WHO, tampak dari hasil pemakaian CRO hanya pada 50% pasien, antibiotik masih banyak dipakai (90%), dan pemakaian susu formula khusus pada 70% anak. Sedangkan pemberian ASI diteruskan cukup baik, yaitu 88%.

Latar belakang. Bifidobacterium telah diketahui sebagai mikroflora saluran cerna yang dominan padabayi dan mempunyai efek positif bagi kesehatan. Namun, dengan bertambahnya usia jumlah mikrofloratersebut menurun dan digantikan oleh bakteri lain termasuk bakteri patogen.Tujuan Penelitian. Mengetahui pengaruh pemberian susu yang mengandung Bifidobacterium terhadapperkembangan mikroflora saluran cerna dan respon imun pada anak usia 12-24 bulan.Metode. Randomized double blind controlled trial, pengamatan dilakukan selama 4 minggu dengan datayang dikumpulkan meliputi antropometri, jumlah Bifidobacterium dalam tinja, dan titer antibodi.Hasil. Bifidobacterium dalam susu formula dapat meningkatkan jumlah Bifidobacterium dan Lactobacillusdalam saluran cerna anak dan menurunkan jumlah bakteri Coliform. Konsumsi susu formula yangmengandung Bifidobacterium juga dapat meningkatkan sistem imun humoral. PenambahanBifidobacterium ke dalam susu formula tidak mempengaruhi aseptabilitas anak.Kesimpulan. Penambahan Bifidobacterium longum BB536, B. breve M16V, dan B. infantis M63 padasusu formula untuk anak usia di atas 1 tahun dapat meningkatkan mikroflora saluran cerna Bifidobacteriadan Lactobacillus serta menekan pertumbuhan bakteri merugikan, Coliform. Pemberian Bifidobacteriadalam susu formula meningkatkan beberapa komponen sistem imun

Latar belakang. Pemberian cairan rehidrasi parenteral dapat mengatasi gangguan natrium (Na) dan kalium(K) plasma pada anak dengan diare. Status nutrisi dapat mempengaruhi perbaikan gangguan Na dan Kplasma saat rehidrasi. Respon perbaikan kadar Na dan K plasma pada anak diare dengan status nutrisikurang dan buruk (NKB) berbeda dengan anak status nutrisi baik (NB)Tujuan Menilai pengaruh status nutrisi terhadap kadar Na, K plasma, dan perubahannya pada saat dehidrasidan rehidrasi.Metode. Penelitian potong lintang retrospektif terhadap data sekunder pasien diare yang dirawat diDepartemen IKA RSCM dengan rehidrasi mengunakan cairan KAEN 3B. Kelompok penelitian dibagi menjadikelompok nutrisi baik (NB) dan kelompok nutrisi kurang dan buruk (NKB). Jumlah subjek penelitian 32pada setiap kelompok. Faktor perancu yaitu muntah, demam, terapi oralit, dan gambaran klinis diare.Hasil. Status nutrisi BB/TB kelompok NB 105,1±10,7 dan kelompok NKB 78,2±12,0, dengan nutrisi buruknya28,1%. Pada kelompok NB, kadar Na dehidrasi 135,4±8,17 meq/l, rehidrasi 138,6±6,73 meq/l, meningkat3,2±8,70 meq/l. Pada kelompok NKB, kadar Na dehidrasi 134,3±7,12 meq/l, rehidrasi 132,2±5,23 meq/l,menurun 1,8±6,14 meq/l. Pada kelompok NB, kadar K dehidrasi 3,6±0,86 meq/l, rehidrasi 3,9±0,81 meq/l,meningkat 0,36±0,90 meq/l. Pada kelompok NKB, kadar K dehidrasi 3,7± 0,82 meq/l, rehidrasi 3,9±0,70meq/l, meningkat 0,26±0,70 meq/l. Kesemuanya tidak berbeda bermakna (p>0,05) antara gizi baik atau kurang/buruk. Dari semua variabel perancu muntah (p=0,009) dan komplikasi (p=0,026) yang tersebar tidak merata.Kesimpulan. Tidak didapatkan perbedaan kadar Na dan K saat dehidrasi, rehidrasi, dan perubahannyapada kelompok NB dan NKB

Background Breast milk is the best and most ideal food for babies because it contains all nutrition needed for their optimal growth and development. Babies who receive breast milk will have strong immune system, good brain development, and closer emotional bonding with their mothers. Considering the importance of breast milk, Indonesian government has been campaigning to endorse exclusive breastfeeding up to six months in the last four years. To date, there is no national data available to evaluate the exclusive breastfeeding program. Therefore, Indonesian Pediatric Society (IDAI) conducted a national survey on breastfeeding to investigate exclusive breastfeeding rate in Indonesia.Objective To find out the prevalence of exclusive breastfeeding in Indonesia.Methods This study included 22 provinces in Indonesia and targeted on mothers with infants aged 0-11 months. For the quantitative portion of the study we used simple random sampling design to get the prevalence from the population. For the qualitative interview data we used a stratified random sampling design to ensure that each infant age group was well represented. Survey location in each province was selected based on defining the capital city to be urban area and its sub-urban areas to be rural. This study was performed between October – November 2010.Results We found that the prevalences of breastfeeding among baby 0-11 months was quite high which were 91%, 86%, and 72% in infants aged 0-3 months, 0-6 months, and 6-11 months, respectively. Interestingly, the prevalence of breastfeeding in urban area was higher than in rural area for infants aged 6-11 months. However, despite the high prevalence of giving breast milk, less than half of mothers gave breast milk exclusively, to babies aged 0-3 months and to those aged 0-6 months. The awareness to exclusively breastfeed was greater for urban mothers than for rural ones in those with infants aged 0-6 months. Mothers with high socioeconomic status had the highest prevalence of exclusive breastfeeding. The prevalence of breastfeeding without formula was still the highest up to 12 months but the role of giving formula was increasing especially in rural area. The prevalence of breast milk introduced as the first milk was around 60%. Java and Sumatra had lower prevalence of breast milk introduced as the first milk compared to Kalimantan and Sulawesi. We also found that mothers started giving solid food from an early age, especially in rural areas. With increasing age, the frequency of giving breast milk declined in both urban and rural areas.Conclusion The overall prevalence of exclusive breastfeeding up to 6 months of age in Indonesia was 49.8%. Maternal unemployment and high family socioeconomic status were associated with longer duration of breastfeeding.

Latar belakang. Keberhasilan tata laksana penyakit lupus eritematosus sistemik (LES) memerlukan pemantauan tertentu. Skor systemic lupus erythematosus disease activity index (SLEDAI) adalah alat ukur yang dapat digunakan untuk tata laksana sehari-hari. Saat ini belum ada data mengenai pemantauan aktivitas penyakit LES anak menggunakan skor SLEDAI dengan rentang waktu tertentu. Tujuan. Memantau aktivitas penyakit LES anak dengan skor SLEDAI setiap 3 bulan selama satu tahun pengamatan. Metode. Studi deskriptif retrospektif menggunakan data rekam medik dari 01 Juli 2005 sampai dengan 31 Juli 2013. Hasil. Tigapuluh rekam medik memenuhi kriteria penelitian. Manifestasi awal tersering berdasarkan skor SLEDAI adalah artritis, rash, demam, peningkatan dsDNA, dan komplemen darah rendah. Perubahan skor SLEDAI terutama terlihat pada pengamatan antara bulan ke-0 dengan bulan ke-3. Pada awal pengamatan, mayoritas pasien termasuk high activity, tetapi pada akhir pengamatan menjadi no activity. Kesimpulan. Penilaian skor SLEDAI setiap 3 bulan dapat digunakan untuk memantau aktivitas penyakit LES anak.

Background Gastroesophageal reflux (GER) is reported to be one of the most common causes of chronic recurrent cough (CRC). In Indonesia, so far there is no published data concerning GER in children with CRC. Objectives To determine the prevalence of GER in children with CRC in general, and asthma in particular; and to describe the clinical profile associated with GER in these children. Methods This was a cross sectional study on children with CRC who were investigated for GER using 24-hour esophageal pH monitoring. GER was graded based on reflux index (RI) stated in pHmetry results i.e., mild (RI=5-10%), moderate (RI>10-20%), and severe (RI>20%). Results Among 48 children with CRC, GER was detected in 22 (46%) of them (mild GER in 14, moderate in 3, and severe in 5 children). In 35 children with asthma, which is the most frequent cause of CRC in our hospital, GER was detected in 15. The prevalence of GER increased parallel with the frequency of cough episodes i.e., 10/27 in children with infrequent episodes of cough, 4/ 10 in children with frequent episodes of cough, and 8/11 in children with persistent cough. Clinical profiles associated with GER in these children were persistent/ frequent episodes of CRC and undernutrition. Conclusions The prevalence of GER in children with CRC was 46%, and in those with asthma was 15/35. The clinical profiles associated with GER are persistent/frequent episodes of CRC and undernutrition [Paediatr Indones 2004;44:201-205].

Background Breast milk is the ideal food for infants. According to the 2007 Indonesian National Household Health Survey, only 23% of mothers exclusively breastfeed for six months.Objectives To determine the rate of exclusive breastfeeding in Indonesia, to evaluate factors associated with infant feeding practices, and to compare the nutritional and developmental status between exclusively-breastfed and formula-fed infants.Methods A survey was conducted in hospitals located in 17 provinces in Indonesia. The rate of exclusive breastfeeding was calculated. Many variables were investigated as potential predictors for exclusive breastfeeding using a multivariable logistic regression analysis. Further analysis was performed to compare the nutritional and developmental status between exclusively breastfed and formula-fed infants at the time of survey.Results From 1,804 infant subjects, the overall rate of exclusive breastfeeding was 46.3%, ranging from 10.5% in East Java to 66.9% in Jambi. Predominant breastfeeding, complementary feeding, and formula feeding rates were 14.3%, 8.6%, and 30.7%, respectively. Maternal unemployment was associated with a longer duration of breastfeeding (P=0.000). There were significantly more formula-fed infants who were undernourished compared to exclusively-breastfed infants (14% vs. 8%, P=0.001). There were also significantly more infants in the formula-fed group who had abnormal head circumference compared to those in the exclusively-breastfed group (9% vs. 6%, P=0.031). Child development, as assessed by the Pre-screening Developmental Questionnaire, was similar between the two groups (P=0.996).Conclusion The overall rate of exclusive breastfeeding in Indonesia is 46.3%. Maternal unemployment is associated with longer duration of breastfeeding. Exclusive breastfed infants have significant better growth and head circumference compared to formula fed infants, while the development is similar between the two groups.

Background Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Increasing prevalences have been reported in Asian adolescent populations, however, there have been few reports on Indonesian adolescents. Objective To investigate the prevalence of IBS and associated factors among adolescents in Jakarta. Methods This cross-sectional study included senior high school students in a district of Jakarta. Students were asked to fill questionnaires based on the Rome III criteria for IBS. They were then divided into groups: those with IBS and those without IBS, for the purposes of comparison. Results Out of 232 adolescents (145 females and 87 males) with mean age of 16.06 (SD 0.91) years, 14 (6.0%) had IBS. Eleven out of 14 adolescents with IBS reported upper abdominal pain as well as periumbilical/lower abdominal pain. Irritable bowel syndrome was not associated with socioeconomic status, food and drink habits, the use of antibiotics, or scolding as a parental form of discipline. However, a significant higher proportion in the use of corporal punishment was found in IBS adolescents compared to the non-IBS (P=0.034). In addition, stress related to scolding, as a parental form of discipline was more likely to be found in the IBS group than in the non-IBS group (P=0.019). Conclusion The prevalence of IBS among adolescents in Jakarta is 6%, which is lower compared to those of other Asian countries. Corporal punishment at home and stress related to scolding at home are found to be associated with IBS.

D-dimer is a molecule as result of breaking down of excessive fibrin formation from the activation of coagulation system. There is evidence of increased activation of coagulation in patients with acute leukemia which was showed by the increment of d-dimer levels. Objective To evaluate the incidence of activation of coagulation system in children with acute leukemia before receiving chemotherapy. Method This cross-sectional study was performed at Dr. Cipto Mangunkusumo Hospital. All newly-diagnosed children with acute leukemia were included in this study, prior to their receiving any chemotherapy treatment. Blast count, prothrombin time (PTT), activated partial thromboplastin time (APTT), and D-dimer levels were examined after the diagnosis was confirmed by morphology and immunophenotyping studies on bone marrow specimens. Results Out of 22 subjects, 13 subjects had increased D-dimer values. The median D-dimer level of this elevated group was 1,000 (range 500-14,700) ng/mL. In the acute myeloblastic leukemia (AML) patients, activation of coagulation was found in 7 out of 8 subjects. The median D-dimer levels was 950 (range 100-14,700) ng/mL. In the acute lymphocytic leukemia (ALL) patients, 6 out of 14 subjects had increased activation of coagulation with median D-dimer level of 300 (range 100-3,800) ng/mL. Nine out of 10 subjects with blast cells on peripheral blood smear had a median D-dimer level of 1,000 (range 500-3,800) ng/mL. Both PT and APTT were found normal in all subjects. Conclusion Activation of coagulation system occurs at the time of diagnosis as shown by increased D-dimer levels. The characteristics of activation of coagulation system are different between ALL and AML subjects, as well as between subjects with positive and negative blast counts on peripheral blood smears. Despite the increased activation of coagulation, PT and APTT remain normal. (Paediatr Indones. 2014;54:227-31.).

Dietary consumption of soy varies worldwide. In Asia, people traditionally consume large quantities of soy, while in Europe, soy is not part of the traditional or daily eating habits. The USA is a major soy producer. The mean intake of isoflavones by an adult is 8 - 50 mg/day in Asia but only 0.5 - 3.5 mg/day in the Western world.1 The soy intake of a vegetarian is 3 - 12 mg/day and a vegan achieves an intake of 15-60 mg/day.2 In the early 1900s, soy-protein preparations were the only option for the treatment of cow's milk protein allergy (CMPA) . The first report of the use of a soybean -based formula for infants dates from 1909.3 Most soy drinks are not enriched with zinc, iron, calcium, phosphorous, methionine, or carnitine. Soy drinks also do not contain soy isolate. Soy products that do not fulfill the criteria to be an infant formula are not adapted for infant feeding.

Background Glucocorticoids play an important role in the treatment ofacute lymphoblastic leukemia (ALL), but can cause side effects such as suppression of the hypothalamic-pituitaryadrenal (HPA) axis. Suppression of the HPA axis causes adrenal insufficiency, disturbs the cortisol response to stress, and may be a cause of morbidity and mortality in children with ALL. Objective To evaluate adrenal function in children with ALL after induction chemotherapy with high dose glucocorticoids. Methods The adrenal function of 20 children with ALL was evaluated using a standard dose (250 μ g) adrenocorticotropin hormone (ACTH) test performed before and after a 6 week of treatment with glucocorticoids induction phase chemotherapy, which was followed by a week period tapering off. Adrenal insuffien cy was defined as blood cortisol level of < 18 μg/dL Results Adrenal insufficiency was found in 14/20 subjects after the induction phase followed by a week period of tapering off. Median cortisol levels pre- and post-stimulation before induction phase were 14.72 (range 2.0 1- 46. 1) μg/dL and 29.29 (range 21.65 - 55 .15) μg/dL, respectively. Median cortisol levels pre- and poststimulation after induction phase were 5.87 (range 0.2 - 20.53) μg/dL and 10.49 (range 0.33 - 28.69) μg/dL, respectively. Clinical signs and symptoms did not differ between those with and without adrenal insufficiency. Conclusion Of 20 children with ALL, 14 develop adrenal insufficiency after a 6-week induction therapy with glucocorticoids and followed by a week period of tapering off. No specific clinical signs and symptoms are identified to be related to the adrenal insufficiency.

Background Anemia of chronic disease (ACD) is commonly found in patients with chronic inflammation or infection. By examining soluble transferrin receptor or bone marrow iron, ACD was found in 80% of anemic adult tuberculosis (TB) patients. Iron profile, another tool to differentiate ACD from iron deficiency anemia (IDA), is both less expensive and less invasive. Few studies have been reported on iron profiles of anemic children with TB in Indonesia.Objective We aimed to use iron profiles to determine the proportion of ACD in anemic children with tuberculosis.Methods A cross-sectional study on anemic children with TB who came to Cipto Mangunkusumo Hospital and Tebet Puskesmas (community health center) was performed in September-November 2010. Iron profiles included the measurements of serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TF), and serum ferritin (SF).Results Our study comprised of 66 subjects, with a median age of 3.8 years (6 months–18 years). Most subjects had normal SI (85%), normal TIBC (71%), low transferrin saturation (51%), and normal SF (71%). Only 10 children had iron homeostasis disorder and 6 of these were diagnosed as having ACD. Thus, iron profiles failed to prove that iron metabolism was disturbed. The profile of children with organ-specific TB was more consistent with ACD compared to the profile of childhood TB. [SI 29.1 (11-83) vs 44 (10-151) μg/dL; TIBC 239.3 (100.80) vs 299.0 (58.51) μg/dL; TF 18.3 (4-100) vs 15 (1-53) %; and SF 154 (34.9-655) vs 36.1 (2.5-213.4) μg/L].Conclusion The proportion of ACD (9%) diagnosed by using iron profiles was not as high as previously reported. Further research using newer techniques is needed to detect ACD in anemic children with TB. [

Background Rotavirus is still a major cause of acute diarrhea in children around the world, both in developed and developingcountries. WHO Surveillance from 2001 to 2008 showed that in children under five years of age treated for acute diarrhea, on average 40% of cases were caused by rotavirus. A previous study in Indonesia showed that the incidence of rotavirus diarrhea in children ranged from 20%􀁑60% of diarrhea cases. However, there have been few studies identifying the genotypes of rotavirus strains in Indonesia. This infonnation is indispensable for manufacturing vaccines.Objective To examine the epidemiology of rotavirus diarrhea, including genotypes and clinical characteristics, in children under five years who were hospitalized in Jakarta.Methods This study was a prospective surveillance conducted at Cipto Mangunkusumo Hospital, Jakarta from January to December 2007 investigating hospitalized children under five years of age who suffered from acute diarrhea.Results Ninety􀁑nine patients joined the study. The incidence of rotavirus infection in this study was 67%. The youngest was 2months of age and the oldest 54 months of age, Mth an average age of 13.6 months. As much as 92% of rota virus diarrhea was found in subjects aged 3􀁑23 months, Mth a peak age of 12􀁑23 months. Nutritional status, degree of dehydration, bloating, fever, blood in stool, and mucus in the feces were not significantly different between rotavirus and non􀁑rotavirus diarrhea. Vomiting tended to be more frequently experienced by children Mth rotavirus diarrhea than those with non􀁑rotavirus (88% vs. 67%). There was no clear, seasonal pattern for rotavirus diarrhea. Most G genotypes in this study were G1 (35%), G9 (12.5%), G2 (7.5%) and the majority of P genotypes were P6 (52.5%), P8 (17.5%) and P4 (10%).Conclusions The incidence of rotavirus diarrhea in hospitalized children under five years of age in Jakarta was 67%, with apredominance ofG1, G9 and G2 genotypes.

Background Diagnosing Helicobacter pylori infection in children is still a problem. Urea breath test is the gold standard for noninvasive diagnostic test, but it is expensive and not available in most hospitals. The Bio M Pylori serologic test has good diagnostic value in adults, less expensive and more practical, but had never been evaluated in children. Objective To determine the prevalence of H. pylori infection and the diagnostic accuracy of Bio M Pylori serologic test in children with recurrent abdominal pain. Methods This study was conducted in May - June 2009. Children aged 12-15 years with recurrent abdominal pain were examined with urea breath test and the Bio M Pylori serologic test. Sensitivity, specificity, area under the curve (AUC), predictive values, and likelihood ratios were calculated for the Bio M Pylori serologic test. Results Most subjects aged 13 years (83%). Girls outnumbered boys, and most were undernourished. The prevalence ofH. pylori infection detected by urea breath test and Bio M Pylori serologic test was 8% and 52%, respectively. The Bio M Pylori serologic test had sensitivity and specificity of 100% and 53%, respectively. Area under the curve (AUC) was 0.764. Positive and negative predictive values were 16 and 100%, whereas positive and negative likelihood ratios are 2.12 and 0. The overall accuracy of this test is 5 7% Conclusions The Bio M Pylori serologic test has high sensitivity value (100%). This diagnostic kit can be considered as a good pre-endoscopic screening tool in children with recurrent abdominal pain caused by H. pylori infection.

Inflammatory bowel disease (IBD) is a term used to describe two disorders associated with gastrointestinal inflammation: Crohn’s disease (CD) and ulcerative colitis (UC). The incidence of IBD is higher in developed countries, while there is unpublished data of pediatric IBD in Indonesia. Clinical manifestations of IBD vary, consist of gastrointestinal (such as diarrhea and abdominal pain) and extraintestinal manifestations. Definite diagnosis of IBD is based on endoscopy and histopathology. The management includes pharmacotherapy, nutrition, surgery, and psychotherapy. This disorder has a high recurrence rate, where CD’s recurrence rate is higher than UC.1,2

Many studies showsthat rice starch is well-absorbed in gastrointestinaltract, even better as a composition with electrolyte to overcome diarrhea. Although in small number, there is still a various prevalence of carbohydrate malabsorption, both with rice starch and with other starch. Khin-Maung-U found significant (66.5%) prevalence of rice starch in Burmese children malabsorption, whereas rice starch is readily obtained in countries with rice as the population staple food,so thatability to absorb rice starch in Indonesian children need to be studied. Breath hydrogen test (BHT) was performed in 86 Indonesian children aged 1-3 years on Pejaten Barat Subdistrict, Pasar Minggu, South Jakarta. Among the 86 children given meal test with rice starch cakes 80 g for eachchildren, 82 children (95.3%) can absorb rice starch well, but 4 children (4.7%) suffered from rice starch alabsorption. Currentlyit is unknown certainly the type of the malabsorption. Previous researchers found that rice malabsorption is due to enzyme deficiency and intestinal motility disturbance. In this study there were 16 children (18.6%) coming from social-economically underprivileged family, most of the mothers with junior high school and lower educational level, and the majority of parent occupation were on private and labor sectors. There was no significant relation (p >0.05) between diarrhea effects on rice starch malabsorption in 6 children (7%), history of low birth weight baby (15.1%), undernourished or malnutrition status in 35 children (40.7%), and worm and/or fungal infection in 17 children (19.8%).found that rice malabsorption is due to enzyme deficiency and intestinal motility disturbance. In this study there were 16children (18.6%) coming from social-economically underprivileged family, most of the mothers with junior high school andlower educational level, and the majority of parent occupation were on private and labor sectors. There was no significantrelation (p >0.05) between diarrhea effects on rice starch malabsorption in 6 children (7%), history of low birth weight baby(15.1%), undernourished or malnutrition status in 35 children (40.7%), and worm and/or fungal infection in 17 children(19.8%). [