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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.

BACKGROUND: There is a lack of local data about recurrent acute respiratory infections in children with congenital heart disease (CHD). This study aims to investigate the incidence and recurrence of acute respiratory infection (ARI) in left-to-right shunt CHD. METHODS: This prospective cohort study investigated children with left-to-right shunt CHD, aged three months to five years, at Dr. Cipto Mangunkusumo Hospital between September 2012 and April 2013. Age and sex-matched participants without CHD were recruited as reference. The occurrence of ARI was observed for six months. Acyanotic CHD patients from 2015 to 2019 were also evaluated to determine the proportion of ARI among this population. RESULTS: A total of 100 subjects were enrolled in the study, 50 in the CHD group and 50 in the non-CHD group, six of whom were later excluded. The monthly incidence of ARI in the CHD group ranged between 40-60% (p=0.027). Subjects with CHD had a cumulative increased risk of 10% for acquiring ARI (RR=1.1; 95% CI=1.02-1.2, p=0.027). The proportion of subjects with a high recurrence of ARI was also higher in the CHD compared to the non-CHD group (67% vs. 30 %, p

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

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.

Recurrent urinary tract infection (UTI) in children is a well-known risk factor of chronic kidney disease. Periurethral area is normally inhabited by non-pathogenic flora, such as Bifidobacterium sp., and pathogenic flora from gastrointestinal tract, such as Escherichia coli (E. coli), which can cause UTI. Dysbiosis between pathogenic and non-pathogenic bacteria leads to infections, but studies regarding dysbiosis and recurrent UTI have not yet been documented. To estimate the proportional differences between gastrointestinal E. coli and Bifidobacterium sp. in children with recurrent UTI, a cross-sectional study was conducted in children from age six months to

Abstract Background Functional abdominal pain disorders (FAPD) have been widely reported as a major group of gastrointestinal disorders across the world. This study describes the prevalence, related factors, symptomatology and its relationship to emotional stress in Indonesian adolescents. Methods This is a cross-sectional study. Adolescents aged 10 to 17 years from nine randomly selected state schools from five districts of Jakarta, Indonesia, were invited to participate. A translated and validated Rome-III self-administered-questionnaire was used to collect data on gastrointestinal symptoms. Data on sociodemographic characteristics, intestinal as well as extra-intestinal symptoms, and exposure to stressful life events were also collected using a separate validated questionnaire. Results A total of 1813 questionnaires were included in the analysis [males 739 (40.8%) mean age of 13.54 years + 0.89]. Of them, 209 children (11.5%) fulfilled Rome III criteria of FAPD. Functional abdominal pain (FAP) was reported as the most prevalent subtype (5.8%), followed by functional dyspepsia (3.3%), irritable bowel syndrome (2%) and abdominal migraine (0.4%). The prevalence was higher in girls (p

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow’s milk and processed to adjust for the nutritional needs of infants. However, cow’s milk is one of the most common causes of food allergy, affecting 2%–5% of all formula-fed infants during their first year of life. One strategy to prevent cow’s milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

Probiotik memiliki kemampuan untuk memengaruhi komposisi mikroflora saluran cerna. Ketika dikonsumsi dalam jumlah adekuat, probiotik memiliki efek positif terhadap kesehatan pejamu. Terdapat beberapa penelitian yang menilai efek terapeutik probiotik terhadap berbagai macam penyakit, termasuk gangguan saluran cerna fungsional pada anak. Gangguan saluran cerna fungsional adalah gangguan yang dianggap terkait dengan saluran cerna, namun tidak dapat dijelaskan oleh kelainan struktural maupun biokimia. Penelitian besar menggunakan probiotik pada gangguan saluran cerna fungsional telah banyak dilakukan. Penggunaan probiotik juga dianggap aman dan hampir tidak pernah dilaporkan efek samping pada rawat jalan. Beragam strain, dosis, dan metodelogi penelitian menjadikan kesulitan dalam menerjemahkan dan menyimpulkan secara keseluruhan hasil penelitian yang ada. Walaupun demikian, beberapa penelitian dengan metodelogi yang baik memperlihatkan fakta bahwa peran probiotik terhadap beberapa gangguan saluran cerna fungsional tidak dapat diabaikan.

Lactose is the most important source in mammalian milk. In normal children, Lactose is hydrolyzed by lactase, and directly absorbed into bloodstream by an active transport mechanism. The term of lactose malabsorption is reserved to patients in whom impaired intestinal lactose hydrolysis and uptake has been proven by an appropriate test. The severity of lactose malabsorption and the extent of symptoms vary widely and are the results of several factors such as the amount of ingested lactose, gastric emptying time, intestinal transit time, and colonic flora. The diagnosis of lactose malabsorption is based on clinical findings and the results of appropriate tests. The breath hydrogen test has obvious advantages for pediatric population because it is painless, non-invasive, sensitive and specific. In the absence of bacterial colonization in the small intestine, the elevation of the concentration of hydrogen in the expired air implies the arrival of lactose in the colon. The increasing respiratory excretion of hydrogen is indicative of a deficit of lactase in enterocyte brush border. This test can also be used to show the existence of bacterial growth. Dietary fiber, some drugs, preparation for colonoscopy, colonic pH, and diarrhea can influence the result of breath hydrogen test.

Abstract Background We aimed to study the epidemiology and risk factors, including exposure to emotional stress, for constipation in Indonesian children and adolescents of 10–17 year age group. Methods A cross-sectional survey using a validated, self-administered questionnaire was conducted in randomly selected children and adolescents in nine state junior high schools from five districts of Jakarta. All of them were from urban areas. Constipation was defined as a diagnosis by using the Rome III criteria. Results Of 1796 children included in the analysis, 328 (18.3%; 95% CI 016–0.2) had constipation. Females and those residing in North Jakarta showed risks associated with constipation in school-age children and adolescents. Symptoms independently associated with constipation were abdominal pain (64% vs 43.3% of control) and straining (22.9% vs 6.3%). The prevalence of constipation was significantly higher in those with stressful life events such as father’s alcoholism (adjusted OR 1.91, 95% CI 1.27–2.89, P = 0.002), severe illness of a close family member (adjusted OR 1.77, 95% CI 1.12–2.80, P = 0.014), hospitalization of the child for another illness (adjusted OR 1.68, 95% CI 1.22–2.31, P

Infants react sensible to dietary changes because the gut physiology and functionality is not fully mature. The first few months of life is the 'window of opportunity' for optimal physical growth and development, cognitive development, and emotional and social development. Exclusive breastfeeding is recommended for the first 6 months of life. Breast milk is important for the maturation of the infant’s digestive system. Potentially protective factors are present in higher amounts in feces from breast-fed infant than from formula-fed infants. The amount of intestinal bifidobacteria in breastfed infants is higher than in formula-fed babies. Mother's milk protects against infection because it contains different factors with immologic properties. The differences in protein fractions between human and cow milk are impressive. The human milk oligosaccharides are the third most important nutritional component are fermented in the colon, making the environment in the colon suitable for the growth of bifidobacteria and lactobacillus.

Background Exclusive breastfeeding by healthy mothers to their healthy, term babies who underwent vaginal birth, should be readily accomplished. However, exclusive breastfeeding by Indonesian mothers has declined. Objective To assess the monthly success rate prevalences for exclusive breastfeeding for the first 6 months of life, as well as factors that affect exclusive breastfeeding. Methods A prospective cohort study was conducted in 243 healthy mothers with healthy term babies who underwent normal births at Cipto Mangunkusumo Hospital (CMH), Jakarta, Indonesia. Guided interviews were conducted monthly for six months. Bivariate and multivariate analyses were performed on the factors potentially affecting breastfeeding with equal subject numbers. Results Exclusive breastfeeding prevalences were 64.8% (first month), 53.7% (second month), 43% (third month), 30.7% (fourth month), 23.5% (fifth month), and 22.3% (sixth month). Multivariate analysis revealed that the mother’s confidence in breast milk production, as well as husband or family support, affected the success of exclusive breastfeeding for each month. Maternal not working/studying outside the home affected the success of exclusive breastfeeding in the third (RR 3.38; 95%CI 1.21 to 9.43) and fourth months (RR 6.56; 95%CI 1.39 to 30.99). Conclusion Exclusive breastfeeding prevalences in Cipto Mangunkusumo Hospital decrease in a monthly fashion up to the sixth month. Several factors affecte the success rate for each month in the six month period, including maternal confidence in breast milk production and family support.

Various pathogenic bacteria are reported as the cause of infectious colitis in children. Infectious colitis does not have a specific sign, therefore an accurate examination is required. The implementation of fecal cultures accompanied with drug resistance tests often have constraints, beside the relatively expensive costs, longer times are needed, and not all health care facilities have required instruments. On the other hand, this condition requires an immediate antibiotic therapy, so that the infection should not be continued. In daily practice, it is not uncommon to find diarrhea with the amount of fecal leukocyte < 10/hpf with pathogenic bacteria on the examination of the fecal culture.Cross-sectional study was conducted to observe the pattern of bacterial distribution in children’s fecal who have acute diarrhea and the correlation between the existence of pathogenic bacteria and the number of leukocytes in the fecal, as well as antibiotic resistance patterns. The population of this study is children with age of 6 months old - 18 years old who were suffering from acute diarrhea with the amount of fecal leucocyte ≥ 5/hpf, who recruited from polyclinic or patient admitted at Cipto Mangunkusumo Hospital and Fatmawati General Hospital, Jakarta. Based on examinations of fecal cultures and PCR, Salmonella sp and C. dificille were found subsequently in 2 children (33.3%), Enterophatogenic E. Coli(EPEC) and Shigella were found subsequently in 1 child (16.7%). Based on the ROC curve, it was found that there was no intersection of maximum and minimal leukocyte value with the midline, whereas the best sensitivity and specificity value was found at the cut-off point of 8.5, hence the cut-off point of leukocytes was determined at < 8 and > 8. The sensitivity value was 83.3% and the specificity value was 45.1%. The antibiotic sensitivity test showed that one child infected by EPEC was sensitive to ciprofloxacin. Two children infected by Salmonella, were still sensitive to chloramphenicol, cotrimoxazole, cefixime, and ceftriaxone. Two children infected by C. Difficile were sensitive to ceftriaxone, and 1 child infected by Shigella was sensitive to cefixime, ceftriaxone and ciprofloksazine.

Ikatan Dokter Anak Indonesia melalui Satuan Tugas Imunisasi mengeluarkan rekomendasi Imunisasi IDAI tahun 2017 untuk menggantikan jadwal imunisasi sebelumnya. Jadwal imunisasi 2017 ini bertujuan menyeragamkan jadwal imunisasi rekomendasi IDAI dengan jadwal imunisasi Kementerian Kesehatan RI khususnya untuk imunisasi rutin. Jadwal imunisasi 2017 juga dibuat berdasarkan ketersediaan kombinasi vaksin DTP dengan hepatitis B seperti DTPw-HB-Hib, DTPa-HB-Hib-IPV, dan dalam situasi keterbatasan atau kelangkaan vaksin tertentu seperti vaksin DTPa atau DTPw tanpa kombinasi dengan vaksin lainnya. Hal baru yang terdapat pada jadwal 2017 antara lain: vaksin hepatitis B monovalen tidak perlu diberikan pada usia 1 bulan apabila anak akan mendapat vaksin DTP-Hib kombinasi dengan hepatitis B; bayi paling sedikit harus mendapat satu dosis vaksin IPV (inactivated polio vaccine) bersamaan (simultan) dengan OPV-3 saat pemberian DTP-3; vaksin DTPw direkomendasikan untuk diberikan pada usia 2,3 dan 4 bulan. Hal baru yang lain adalah untuk vaksin influenza dapat diberikan vaksin inaktif trivalen atau quadrivalen, vaksin MMR dapat diberikan pada usia 12 bulan apabila anak belum mendapat vaksin campak pada usia 9 bulan. Vaksin HPV apabila diberikan pada remaja usia 10-13 tahun, pemberian cukup 2 dosis dengan interval 6-12 bulan; respons antibodi setara dengan 3 dosis. Vaksin Japanese Encephalitis direkomendasikan untuk diberikan mulai usia 12 bulan pada daerah endemis atau pada turis yang akan bepergian ke daerah endemis. Vaksin dengue direkomendasikan untuk diberikan pada anak usia 9-16 tahun dengan jadwal 0, 6, dan 12 bulan. Dengan pemberian imunisasi sesuai rekomendasi, diharapkan anak-anak Indonesia terlindungi dari penyakit infeksi yang dapat dicegah dengan imunisasi.

Defekasi merupakan salah satu aktivitas manusia yang harus dilalui di dalam kehidupan sehari-harinya. Pola defekasi pada anak sangat bervariasi dan sangat bergantung pada fungsi organ, susunan saraf, pola makan, serta usia anak. Menilai pola defekasi pada anak berarti menilai frekuensi defekasi, konsistensi dan warna tinjanya. Berdasarkan penelitian yang telah dilakukan di beberapa negara di Amerika, Eropa, dan Asia-Pasifik diketahui bahwa terjadi penurunan frekuensi defekasi sesuai dengan bertambahnya usia anak, sedangkan perubahan konsistensi dan warna tinja sesuai dengan pola makan. Sejauh ini belum pernah dilaporkan tentang pola defekasi pada anak Indonesia.

Konstipasi merupakan keadaan yang sering ditemukan pada anak dan dapat menimbulkan masalah sosial maupun psikologis. Berdasarkan patofisiologis, konstipasi dapat diklasifikasikan menjadi konstipasi akibat kelainan struktural dan konstipasi fungsional. Konstipasi yang dikeluhkan oleh sebagian besar pasien umumnya konstipasi fungsional yang dihubungkan dengan adanya gangguan motilitas kolon atau anorektal. Konstipasi kronis yaitu kostipasi yang telah berlangsung lebih dari 4 minggu. Dalam mentukan adanya konstipasi terdapat 3 aspek yang perlu diperhatikan, yaitu frekuensi buang air besar (b.a.b), konsistensi tinja, dan temuan pada pemeriksaan fisis. Para ahli gastroenterologi di Eropa dan Amerika telah membuat satu kriteria untuk yang menentukan adanya konstipasi fungsional, yang dikenal dengan kriteria Roma. Meskipun masih terus dalam pengkajian, beberapa negara telah menggunakan kriteria tersebut sebagai upaya menentukan adanya konstipasi fungsional. Dalam menangani anak dengan konstipasi perlu ditekankan tentang pentingnya hubungan yang erat antara dokter, orangtua, dan pasien. Pada dasarnya, terapi konstipasi terdiri dari dua fase, yaitu fase pengeluaran masa tinja dan fase pemeliharaan. Catatan harian tentang b.a.b, latihan b.a.b (toilet training), makan makanan berserat, terapi laksatif, serta pendekatan secara psikiatri/psikologi merupakan upaya yang perlu dilaksanakan untuk memperoleh hasil yang optimal.

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%.

Esofagitis refluks adalah proses inflamasi pada esofagus akibat refluks gastroesofagus. Toksisitas isi refluks, frekuensi, durasi episode refluks, dan resistensi esofagus terhadap isi refluks merupakan faktor yang berperan terhadap kejadian esofagitis. Gejala klinis esofagitis refluks tidak spesifik. Pada bayi sering terlihat muntah disertai gejala klinis iritabel, tidur tidak nyaman, menolak makan, dan gagal tumbuh, sedangkan pada anak yang lebih besar didapatkan keluhan heartburn dan nyeri epigastrium. Esofagitis tersebar secara ‘patchy’ dan tidak merata sehingga ketelitian pemeriksaan sangat diperlukan. Secara makroskopis mukosa esofagus dapat terlihat hiperemis, erosi, atau ulkus, sedangkan pada patologi anatomi terlihat gambaran hiperplasia membran basal dengan papila yang memanjang. Antagonis reseptor H2 dan inhibitor pompa proton (IPP) telah digunakan secara luas untuk terapi esofagitis. Efek jangka pendek, jangka panjang, dan pencegahan relaps obat-obat tersebut memperlihatkan hasil yang memuaskan, walaupun beberapa data menunjukkan keunggulan IPP dibanding antagonis reseptor H2.

Sakit perut berulang (SPB) merupakan masalah yang sering ditemukan pada anak terutama dalam hal pendekatan diagnosis dan tatalaksana. Sebagian besar penyebab SPB adalah gangguan fungsional dan hanya sebagian kecil (10%) yang disebabkan oleh kelainan organik. Intoleransi laktosa dilaporkan merupakan penyebab SPB terbanyak pada anak berusia di atas 5 tahun. Intoleransi laktosa terjadi akibat ketidakmampuan laktase menghidrolisis laktosa yang masuk ke dalam usus halus. Manifestasi klinis yang diperlihatkan sangat bervariasi seperti mual, muntah, sakit perut, kembung, sering flatus dan diare. Berbagai pemeriksaan penunjang dapat digunakan untuk mendiagnosis keadaan intoleransi laktosa. Uji hidrogen napas merupakan alat diagnostik pilihan saat ini, karena bersifat non invasif dan mempunyai nilai sensitifitas dan spesifisitas yang tinggi, serta sangat mudah dan aman dilakukan pada anak. Biopsi usus masih merupakan uji diagnostik baku emas untuk mengukur aktivitas laktase. Prevalens intoleransi laktosa di berbagai tempat di dunia sangat beragam. Ras dan pola hidup dalam mengkonsumsi susu/produk susu dilaporkan berperan pada aktivitas laktase. Di Indonesia, prevalens intoleransi laktosa pada anak pernah dilaporkan dengan memperlihatkan peningkatan prevalens sesuai dengan bertambahnya usia, tetapi prevalens intoleransi laktosa pada anak yang menderita SPB belum pernah dilaporkan.

Helicobacter pylori (H. pylori) berkolonisasi di dalam lambung manusia, terutama pada anak. Infeksi H. pylori pada umumnya asimtomatis. Vacuolating cytotoxin A (Vac A) dan cytotoxic-associated gene A (CagA) merupakan faktor virulensi yang dihubungkan dengan manifestasi klinis yang berbeda. Kejadian infeksi ini sangat tinggi di negara berkembang yang dihubungkan dengan kondisi sosial ekonomi dan kebersihan lingkungan. Biakan biopsi jaringan lambung merupakan uji diagnostik baku emas terhadap infeksi H. pylori. Uji urea napas sangat berguna untuk mengevaluasi eradikasi. Tingkat sensitivitas dan spesifisitas pada uji serologi rendah pada masa anak-anak, sedangkan terapi eradikasi yang direkomendasi saat ini terdiri dari proton pump inhibitors (PPI) yang dikombinasi dengan 2 jenis antibiotik (klaritromisin, amoksisilin atau metronidazol).

Ulkus Duodenum merupakan kerusakan lapisan mukosa sampai lapisan otot duodenum yang dihubungkan dengan proses inflamasi kronis. Berbagai faktor diduga sebagai penyebab keadaan ini, salah satu yang menjadi perhatian pada saat ini adalah infeksi Heliobacter pylori (H.pylori). Meskipun jarang ditemukan pada anak, kelainan ini dapat menyebabkan pendarahan dan perforasi saluran cerna. Ulkus duodenum lebih sering merupakan ulkus peptik primer. Manifestasi gejala klinis bervariasi mulai dari rasa mual, muntah, nyeri perut berulang, anemia, gagal tumbuh, hingga hematemasis dan melena. Endoskopi merupakan tindakan diagnostik pilihan pada kasus yang dicurigai kelainan organik,termasuk ulkus duodenum. Terapi yang diberikan berupa pemberian antagonis reseptor H2 atau proton pump inhibitor (PPI). Eradikasi terhadap H.Pylori harus segera dilaksanakan bila ditemukan bakteri tersebut sebagai penyebabnya.

Latar belakang. Diare persisten menjadi perhatian setelah WHO berhasil menurunkan kejadian diare akut dengan upaya rehidrasi oral. Sepuluh persen diare akut karena infeksi berlanjut menjadi diare persisten dengan angka kematian pada balita 35%. Tujuan. Mengetahui karakteristik pasien, manifestasi klinis, laboratorium, dan penyakit penyerta diare persisten Metode. Studi prospektif terhadap anak dengan diare persisten yang berobat di rumah sakit Dr. Cipto Mangunkusumo, Jakarta, sejak 1 Juni sampai 31 Agustus 2005. Data diperoleh dengan mengisi formulir kuesioner yang ditanyakan kepada ibu pasien dan catatan medis pasien saat pertama datang. Hasil. Didapatkan 41 anak menderita diare persisten, usia terbanyak di bawah 5 tahun. Pendidikan ibu terbanyak sekolah menengah atas (48,7%) dengan tingkat ekonomi rendah (80,5%). Sebagian besar anak telah mendapat antibiotik sebelumnya (48,2%). Demam ditemukan pada 63,4% anak, mual dan muntah 48,8%, dan tinja berlendir 53,7%. Penyakit penyerta, gizi buruk 36,6% anak, alergi susu sapi 31,7%, infeksi saluran kencing 24,4%, dan infeksi HIV 19,5%. Anemia dan hipoalbuminemia ditemukan beturut-turut pada 71,4% dan 64,7% anak. Kesimpulan. Diare persisten terutama mengenai balita dengan tingkat ekonomi keluarga dan pendidikan ibu rendah. Demam dan tinja berlendir merupakan manifestasi klinis yang paling sering dijumpai, sedangkan gizi buruk, alergi susu sapi, infeksi saluran kemih dan infeksi HIV merupakan penyakit yang paling sering menyertai diare persisten. Anemia dan hipoalbumineia merupakan kelainan laboratorium yang paling sering ditemukan.

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 K plasma saat rehidrasi. Respon perbaikan kadar Na dan K plasma pada anak diare dengan status nutrisi kurang dan buruk (NKB) berbeda dengan anak status nutrisi baik (NB) Tujuan Menilai pengaruh status nutrisi terhadap kadar Na, K plasma, dan perubahannya pada saat dehidrasi dan rehidrasi. Metode. Penelitian potong lintang retrospektif terhadap data sekunder pasien diare yang dirawat di Departemen IKA RSCM dengan rehidrasi mengunakan cairan KAEN 3B. Kelompok penelitian dibagi menjadi kelompok nutrisi baik (NB) dan kelompok nutrisi kurang dan buruk (NKB). Jumlah subjek penelitian 32 pada 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 buruknya 28,1%. Pada kelompok NB, kadar Na dehidrasi 135,4±8,17 meq/l, rehidrasi 138,6±6,73 meq/l, meningkat 3,2±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±0,70 meq/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 perubahannya pada kelompok NB dan NKB

Latar belakang. Refluks gastroesofagus (RGE) yang berlangsung lama, baik durasi maupun frekuensi dapat menyebabkan berbagai derajat kerusakan mukosa esofagus atau esofagitis. Esofagitis atau penyakit refluks gastroesofagus (PRGE) yang tidak segera ditangani dapat mempengaruhi kualitas hidup anak. Oleh karena itu pembuktian kerusakan mukosa esofagus pada setiap anak yang secara klinis dicurigai mengalami esofagitis menjadi amat penting. Tujuan. Menilai derajat kerusakan mukosa esofagus atau esofagitis pada anak yang secara klinis memperlihatkan gejala PRGE. Metode. Penelitian deskriptif yang dilakukan secara retrospektif terhadap data hasil pemeriksaan endoskopi dari pasien dengan gejala klinis PRGE, dilakukan pada 1 Januari sampai 31 Desember 2009, di Divisi Gastrohepatologi Departemen Ilmu Kesehatan Anak FKUI/RSCM. Derajat kerusakan mukosa esofagus ditentukan berdasarkan kriteria Los Angeles. Hasil. Di antara 58 pasien dengan gejala klinis PRGE yang dilakukan endoskopi, didapatkan 51 pasien (87,9%) mengalami kerusakan mukosa esofagus (esofagitis), yang mencakup 21,6% esofagitis derajat A, 33,3% esofagitis derajat B, 25,5% esofagitis derajat C, dan 19,8% esofagitis derajat D. Tujuh pasien (12,1%) tidak ditemukan kerusakan mukosa esofagus. Gejala klinis terbanyak adalah mual dan muntah pada 25pasien (43,1%), diikuti nyeri perut berulang daerah ulu hati dan regurgitasi, masing-masing pada 20 pasien (34,5%). Kesimpulan.Kerusakan mukosa esofagus akibat refluks gastroesofagus pada anak merupakan keadaan yang perlu diwaspadai pada setiap anak dengan gejala klinis regurgitasi dengan volume dan frekuensi berlebihan, serta gejala klinis PRGE.

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

Latar belakang. Infeksi luka operasi (ILO) merupakan salah satu komplikasi pasca-bedah abdomen yang dapat meningkatkan morbiditas, mortalitas, dan biaya pengobatan. Diperlukan data prevalens ILO pasca-bedah abdomen pada anak di RSCM dan faktor risiko yang memengaruhinya. Tujuan. Mengetahui prevalens dan karakteristik ILO serta hubungan antara usia, jenis kelamin, status nutrisi, skor PELOD, skor ASA, jenis operasi, kategori luka operasi, dan lama operasi dengan ILO pasca-bedah abdomen pada anak. Metode. Data penelitian dari rekam medis tahun 2009-2011 pada anak pasca-bedah abdomen dengan besar sampel 180 subjek. Analisis statistik dengan uji Chi-square/Fisher dan regresi logistik. Hasil. Prevalens ILO pasca-bedah abdomen pada anak di RSCM selama tiga tahun 7,2%. Infeksi luka operasi merupakan 23,6% dari total infeksi nosokomial pasca-bedah abdomen di RSCM. Enam dari 13 subjek dengan ILO mengalami sepsis dan 2 di antaranya meninggal karena sepsis. Tiga jenis ILO, yaitu ILO insisional superfisial (9 subjek), ILO insisional dalam (2 subjek), dan ILO organ (2 subjek). Terdapat hubungan bermakna antara jenis operasi cito dengan ILO (p=0,007, RO 4,72;95%IK 1,54-14,42). Sedangkan variabel lainnya tidak berhubungan bermakna. Kesimpulan. Jenis operasi cito merupakan faktor risiko ILO pasca-bedah abdomen pada anak di RSCM Jakarta. Perlu penelitian prospektif dengan sampel yang lebih besar.

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.

Latar belakang. Eritromisin merupakan salah satu obat prokinetik untuk mengatasi intoleransi minum pada bayi prematur karena imaturitas sistem pencernaan. Beberapa penelitian mengenai efektifitas eritromisin dalam mengatasi intoleransi minum akibat imaturitas saluran cerna masih merupakan kontroversi. Tujuan. Mengetahui peran eritromisin dalam meningkatkan toleransi minum bayi prematur. Metode. Penelitian uji kinis prospektif acak terkontrol tersamar ganda pada bulan September 2011-Februari 2012 dengan subyek bayi prematur usia gestasi (UG) 28-36 minggu. Diagnosis intoleransi minum ditetapkan bila residu lambung lambung ≥25% jumlah pemberian minum 6 jam sebelumnya Hasil. Terdapat 36 subyek bayi prematur dengan intoleransi minum yang dibagi menjadi 2 kelompok yaitu 19 subyek mendapat eritromisin (3 mg/kgbb/dosis, 4x sehari selama 7 hari) dan 17 subyek mendapat plasebo berupa larutan sukrosa. Tidak terdapat perbedaan bermakna jumlah episode terjadinya residu pada kedua kelompok (p=0,271), demikian juga dengan analisis subgrup pada UG ≤32 minggu dan >32 minggu (p=0,25) dan (p=0,39). Median lama hari mencapai nutrisi enteral penuh antara kedua kelompok tidak terbukti bermakna secara statistik (p=0,82). Hasil yang tidak bermakna juga didapatkan pada UG ≤32 minggu dan >32 minggu (p=0,61) dan (p=0,60.) Kesimpulan. Pada penelitian ini pemberian eritromisin dosis rendah (3 mg/kgbb/dosis, setiap 6 jam) per oral selama 7 hari tidak terbukti dapat mengurangi residu lambung maupun mempercepat pencapaian nutrisi enteral penuh pada bayi prematur dengan UG 28-36 minggu yang mengalami intoleransi minum.

Latar belakang. Program pengobatan rehidrasi oral telah berhasil mengontrol kematian akibat diare akut. Sekitar 3%-20% kasus diare akut pada anak akan berkembang menjadi diare persisten. Kematian akibat diare persisten cukup tinggi ± 65% dari seluruh kematian akibat diare. Tujuan. Menentukan faktor risiko terjadinya diare persisten dan mengukur besar pengaruh tiap faktor risiko tersebut terhadap terjadinya diare persisten pada anak yang dirawat di ruang rawat inap bagian anak RS Dr. Cipto Mangukusumo Jakarta. Metode. Rancang penelitian retrospektif, kasus-kontrol. Data penelitian diperoleh dari catatan medik pasien, semua pasien (54 pasien) diare persisten yang dirawat mulai 1 Januari 2004-30 Juni 2007 yang memenuhi kriteria inklusi dipilih sebagai kasus dan 108 pasien diare akut dipilih secara consecutive sampling sebagai kontrol. Hasil. Pada analisis univariat didapatkan perbedaan bermakna antara 54 pasien dengan diare persisten (kasus) dan 108 pasien dengan diare akut (kontrol) dalam hubungan melanjutnya diare akut menjadi diare persisten pada faktor risiko: pemberian antibiotik (p=0,042, RO :1,984, IK : 0,021-3,854), anemia (p=0,005, RO :2,568, IK : 1,313-5,024 ) dan malnutrisi (p= 0,001, RO : 10,974, IK :3,442-34,814). Pada regresi logistik multivariat, dua faktor risiko memperlihatkan hubungan yang bermakna yaitu anemia (p=0,025, RO :2,374, IK : 1,117-5,047) dan malnutrisi (p= 0,001, RO : 12,621, IK :3,580-44,814). Kesimpulan. Anemia dan malnutrisi pada diare akut merupakan faktor risiko untuk melanjutnya diare akut menjadi diare persisten.

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.

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 clini- cal 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 preva- lence of GER increased parallel with the frequency of cough epi- sodes i.e., 10/27 in children with infrequent episodes of cough, 4/ 10 in children with frequent episodes of cough, and 8/11 in chil- dren 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

Background The prevalence of lactose malabsorption varies widely throughout the world. Only people of Caucasian genetic background continue to produce high amount of lactase throughout adulthood. Previous studies in Indonesia revealed that the prevalence of lactose malabsorption was 21-58% in children aged 3-11 years. Objective To determine the prevalence of lactose malabsorption in the older age group and whether a change in milk drinking habit can affect it. Methods A cross sectional descriptive study was conducted on 98 children aged between 12 and 14 years (junior high school) in Jakarta. Lactose malabsorption was evaluated with Lactometer Breath Hydrogen Test (Hoek Loes, Amsterdam). Milk drinking habit was recorded, and drinking at least 1 glass of milk everyday since 6 months or more before the study was considered as regular milk drinking. Results This study showed 73% of the children had lactose malabsorption. Regular milk drinking habit was found in 32 (33%) children and lactose malabsorption occurred in 26. From 66 children who were irregular milk drinkers, lactose malabsorption was found in 46 (70%). Lactose intolerance was about the same in both groups. Conclusion There was an increasing prevalence of lactose malabsorption in older children. Milk drinking habit is a major concern to review the practical implications of lactose malabsorption.

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

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.

Background 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 sys tem 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 (PTI), activated partial thromboplastin time (APTf), 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) n gfmL. 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) ngfmL. 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 sys tem 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 subj ects with positive and negative blast counts on peripheral blood smears. Despite the increased activation of coagulation, PT and APTf remain normal.