Hardiono Pusponegoro - Academia.edu (original) (raw)
Papers by Hardiono Pusponegoro
Acta Paediatrica, 2015
A gluten-and casein-free diet is often given to children with autism spectrum disorder (ASD). We ... more A gluten-and casein-free diet is often given to children with autism spectrum disorder (ASD). We aimed to determine the effect of gluten and casein supplementation on maladaptive behaviour, gastrointestinal symptom severity and intestinal fatty acids binding protein (I-FABP) excretion in children with ASD. Methods: A randomised, controlled, double-blind trial was performed on 74 children with ASD with severe maladaptive behaviour and increased urinary I-FABP. Subjects were randomised to receive gluten-casein or a placebo for seven days. We evaluated maladaptive behaviour before and after supplementation, using I-FABP excretion, the approach withdrawal problem composite subtest of the Pervasive Developmental Disorder Behavior Inventory and the Gastrointestinal Symptom Severity Index. Results: The mean approach withdrawal problem composite score was significantly higher before supplementation than after, both in the placebo and in the gluten-casein group. However, the mean difference was not significant and may have been caused by additional therapy. There was no significant difference in gastrointestinal symptoms and urinary I-FABP excretion. Conclusion: Administrating gluten-casein to children with ASD for one week did not increase maladaptive behaviour, gastrointestinal symptom severity or urinary I-FABP excretion. The effect of prolonged administration or other mechanisms of enterocyte damage in ASD should be explored.
The SAGE Encyclopedia of Human Communication Sciences and Disorders
Een lexicale, morfologische en syntactische comparatieve studie van Nederlandstalige kinderen met... more Een lexicale, morfologische en syntactische comparatieve studie van Nederlandstalige kinderen met en zonder de taalstoornis Masterproef voorgedragen tot het behalen van de graad van Master in de taal-en letterkunde Nederlands-Engels 2013
Paediatrica Indonesiana, 2018
In spite of its long half life, phenobarbital is still given twice-daily in the treatment of gene... more In spite of its long half life, phenobarbital is still given twice-daily in the treatment of generalized tonic-clonic epilepsy. This study aims to determine if daily dose of phenobarbital given once differs to that given twice daily. Subjects of this unblinded controlled clinical trial were generalized tonic-clonic epilepsy patients ranging in age from 1-15 years. There were 40 study cases and 42 controls. We gave phenobarbital 4-6 mg/kg/day once-daily for study group and twice-daily dose for control group. History, physical and EEG examination and phenobarbital plasma measurements were obtained a t the beginning of the study and four weeks later. The ratio of the second to first phenobarbital plasma concentrations in the study group was 0.99 while in the control group it was 1.02. The proportion of seizure-free patients in the study group increased from 70% at the beginning to 85% at the end of study, and in the control group from 64.3% to 83.3%. Hyperactivity and irritability incr...
Paediatrica Indonesiana, 2001
Infiltration of leukemic cells into the central nervous system (CNS) is one of the causes of neur... more Infiltration of leukemic cells into the central nervous system (CNS) is one of the causes of neurological disorders in patients with acute lymphoblastic leukemia (ALL) that worsen the prognosis. This retrospective cohort study aimed to review the clinical manifestations of children with CNS leukemia, their survival pattern and the role of early CNS leukemial. The survival curve was developed by Kaplan-Meier method, while the comparison of survival curves was done with log-rank test. Among 128 new ALL patients, 23 (18.0%) patients suffered from CNS leukemia, while 13 (10.2%) suffered from early CNS leukemia and 10 (7.8%) suffered from relapsing CNS leukemia. CNS leukemia was more common in male, in those aged less than 2 years, in those with white blood cell (WBC) count above 50,000/µl, and in patients type FAB-L2 ALL. The clinical manifestations most commonly found were decrease of consciousness (61%), vomiting (48%), cranial nerve palsy (44%), seizures (39%), and headache (26%). Re...
Background Epilepsy is a chronic disease that requires antiepileptic drugs (AEDs). Only 60-70% of... more Background Epilepsy is a chronic disease that requires antiepileptic drugs (AEDs). Only 60-70% of new patients could be controlled effectively by standard AEDs and this stimulates the search for new, more effective and well-tolerated AEDs. Objective To asses the efficacy and safety of topiramate, as an adjunctive therapy to standard AEDs for children with intractable epilepsy. Methods This was an open label, parallel group study. Forty children with at least 4 seizures during a 4-week baseline period were randomly assigned to topiramate (n=20) or control group (n=20). In the topiramate group, the drug was given in adjunct to AEDs for 2-week titration dosage continued with a 12-week stabilization period, while the control group received only AEDs adjusted to their clinical responses. Results Mean reduction from baseline in monthly seizures frequency was significantly greater in the topiramate group (88.6% vs. 25%; P=0.030). Other variable of efficacy was significantly different (e&q...
The SAGE Encyclopedia of Human Communication Sciences and Disorders, 2019
Secara klinis seorang anak disebut mengalami keterlambatan bicara apabila pada umur 2 tahun hanya... more Secara klinis seorang anak disebut mengalami keterlambatan bicara apabila pada umur 2 tahun hanya dapat mengucapkan kurang dari 50 kata dan/ atau belum ada kalimat yang terdiri dari kombinasi dua kata. Prevalens keterlambatan perkembangan bicara mencapai 15% pada anak berumur 2 tahun.1,2 Umumnya orangtua sudah mengeluh mengenai keterlambatan bicara pada umur 2 tahun, namun sebagian dokter memilih “menunggu” berdasarkan fakta bahwa perkembangan bicara masih sangat bervariasi pada umur 2 tahun, 50% anak yang mengalami keterlambatan bicara akan mengejar keterlambatan tersebut pada umur 3 tahun, dan bila keterlambatan bicara hanya disebabkan oleh keterlambatan perkembangan (maturational delay), prognosisnya cukup baik.3-5 Akibat adanya pendapat ini, maka diagnosis keterlambatan bicara seringkali belum ditegakkan pada umur 2-3 tahun.2,3 Meskipun demikian, harus diingat bahwa keterlambatan bicara yang semula diduga hanya merupakan keterlambatan perkembangan ternyata dapat merupakan gejala...
: Acute phase protein plasminogen activator inhibitor type-1 (PAI-1) is a key element in fibrinol... more : Acute phase protein plasminogen activator inhibitor type-1 (PAI-1) is a key element in fibrinolysis inhibition in sepsis-induced disseminated intravascular coagulation (DIC). Elevated PAI-1 level is related to worse outcome in sepsis. The aim of this study was to investigate the relationship between plasma PAI-1 level and clinical outcome in children with sepsis. A total of 35 children with sepsis were enrolled into this prospective study. Plasma PAI-1 was measured on day-1 and day-4. Systemic coagulation profile was measured on day-4. Individuals were followed up until 28 days. The mean PAI-1 from day-1 to day-4 in overt DIC children was not statistically significant. Contrarily, among nonovert DIC individuals, there was a significant difference (P ≤ 0.001) in PAI-1 levels on day-1 compared with day-4 were 95.25 ± 46.57 vs. 60.36 ± 37.31 ng/ml, respectively. Among survivors, mean PAI-1 level on day-1 was statistically higher than PAI-1 level on day-4 (82.47 ± 44.43 vs. 58.39 ± 32.98 ng/ml), P = 0.021. There was no significant difference between PAI-1 levels on day-1 compared with day-4 in nonsurvivors. PAI-1 was correlated to DIC score with r = 0.606 (P ≤ 0.001). PAI-1 levels significantly decreased on day-4 compared with day-1 among nonovert DIC individuals, and not in overt DIC individuals. Changes in PAI-1 levels in nonsurvivors did not differ. PAI-1 level was positively correlated with DIC score.
Neuro-Oncology
Brain tumors are still the second leading cause of death among cancers in children. Based on data... more Brain tumors are still the second leading cause of death among cancers in children. Based on data from National Brain Tumor Society (2019), in United States, there are 28.000 children living with brain tumor with varied clinical, radiological, and histopathological features. The most prevalent children’s brain tumor types in US are gliomas (ependymal tumors, pilocytic astrocytomas) and embroyonal tumors, including medulloblastoma. From 1993–1994 at Department of Child Health Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Tertiary General Hospital, Jakarta, Indonesia, there are 19 patients with brain tumors hospitalized with most of patients with astrocytoma 8 patients (42%), 4 patients (21%) medulloblastoma, 2 patients (11%) neuroblastoma, 2 patients (11%) ependymoma, 2 patients (11%) craniopharyngioma, and one patient (4%) meningioma. Retrospective cohort study (2010–2015) with subjects 100 children revealed that based on the radiographs, the brain tumors were loc...
Paediatrica Indonesiana
Brain tumors are the second most common malignancy and the most common solid tumors found in chil... more Brain tumors are the second most common malignancy and the most common solid tumors found in childhood. During 11 months 19 patients with brain tumors were hospitalized at the Department of Child Health, Dr. Cipto Mangunkusurno Hospital, Jakarta, 10 of them were males. The youngest patient was 5 months old and the oldest was 13 years old. The important signs and symptoms in establishing diagnosis were the non-localizing signs and symptoms, i.e., nausea and vomiting. The most frequent localizing signs and symptoms were papilledema, cranial nerves palsy, ataxia and incoordination, hemiparesis, visual disturbances, and optic atrophy. Focal seizures were rare. Most of the tumors were in infratentorial region, and metastatic tumors were rare. The mortality of this series was high due to the severity of the disease. The most frequent of tumors are astrocytomas and medulloblastomas.
Background. Stunting is the impairment of growth and development due to malnutrition and/or chron... more Background. Stunting is the impairment of growth and development due to malnutrition and/or chronic disease/infection. According to the Indonesia Basic National Health Survey 2013, prevalence of stunting in Indonesia reached 37.2%. Various studies have shown that impaired cognitive development may be found in children with stunting and malnutrition. This research has purpose to determine cognitive development in stunted children and malnourished children, using Bayley Scale of Infant Development III (Bayley-III). Methods. A cross-sectional study in 51 children aged 6 month to 3 year old who fullfiled the inclusion criteria at the Outpatient Clinic of Dr.Cipto Mangunkusumo National General Hospital from June 2017 until January 2018. Cognitive development was assessed using the Bayley Scale of Infant Development Third Edition (Bayley-III). Results. Twenty six children with stunting and 25 children with malnutrition without stunting with age of subjects were 11.0 month (2.0-34.0) and 1...
Telemedicine and e-Health
Background: Delayed diagnosis of autism spectrum disorder (ASD) remains a persistent pediatric he... more Background: Delayed diagnosis of autism spectrum disorder (ASD) remains a persistent pediatric health problem, due to limited access to competent diagnosticians and tertiary health care. A telemedicine method using a store-and-forward approach presents an opportunity to facilitate early identification and referral for intervention. This study aimed to evaluate the validity of protocol-guided video recording compared with direct assessment (DA) for diagnosing ASD. Materials and Methods: Children aged 18-30 months with chief complaints of delayed speech or social indifference, and Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) score of more than two were included. Parents were instructed to video record certain scenarios, which were assessed by an experienced professional based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) checklist for ASD. DAs using DSM-5 criteria were considered to be the gold standard of diagnosis. Diagnostic agreement, sensitivity, specificity, predictive values, and likelihood ratios were calculated to measure diagnostic validity. Results: The diagnostic agreement between the two methods was 82.5%. The sensitivity of video recording for diagnosing ASD was 91.3% (95% confidence interval [CI] [79.7%-100%]), while the specificity was 70.6% (95% CI [48.9%-92.2%]). The positive predictive value was 80.7% (95% CI [65.6%-95.9%]), while the negative predictive value was 85.7% (95% CI [67.4%-100%]). The positive likelihood ratio was 3.1 (95% CI [1.47-6.5]), while the negative likelihood ratio was 0.16 (95% CI [0.03-0.47]). Conclusions: A telemedicine approach using protocol-guided video recording evaluation has substantial validity compared with DA for diagnosing ASD.
Paediatrica Indonesiana, Oct 8, 2018
Malaysian Journal of Medical Research
The period from birth to two years of age is a "critical window" of opportunity for the promotion... more The period from birth to two years of age is a "critical window" of opportunity for the promotion of optimal growth, health and behavioral development of children. Dietary diversity is an important immediate determinant of stunting children also feeding patterns combined with household food insecurity can lead to stunting children which is a major public health problem in developing countries like Indonesia. A community based cross-sectional study that involved 120 participants from east Jakarta rural were conducted from February to March 2018. A consecutive sampling procedure was employed to select the required households. Multivariable logistic regression analyses were performed to compare stunting by feeding patterns and other characteristics. The prevalence of child stunting in the current study Dietary diversity and child stunting 44 was 43.5%. Dietary diversity has association with stunting especially in the poorest economic status. Dietary education would be the most effective strategy to deliver messages about infant and young child feeding practices, especially on dietary diversity.
Paediatrica Indonesiana
We reviewed clinical and laboratory findings of 12 cases of Subacute sclerosing panencephalitis (... more We reviewed clinical and laboratory findings of 12 cases of Subacute sclerosing panencephalitis (SSPE) hospitalized at our department from 1985 to 1991. All cases were diagnosed and hospitalized at the 2nd stage. The principal clinical manifestations were mental changes, myoclonus, and frequent falls. Other clinical manifestations were ocular changes, involuntary movements, loss of social contact, and spasticity. Diagnosis was based on suppression-burst pattern in EEG and positive antibody titer to measles in serum and cerebrospinal fluid. CT scan was not diagnotic, since it was either normal or showed only non-specific cortical atrophy. Eleven patients (91, 7%) recalled a history of measles in the past. Age of onset of SSPE varied among cases and was difficult to specify precisely due to its subtle nature. None of the cases had been vaccinated against measles. SSPE is a rare disease, but is almost always fatal with prolonged suffering of the patient. Based on our experience with SS...
Paediatrica Indonesiana
During 4 years, 20 patients with brain abscesses were hospitalized in the Departement of Child He... more During 4 years, 20 patients with brain abscesses were hospitalized in the Departement of Child Health, Dr. Cipto Mangunkusumo General Hospital, jakarta. Of those 20 patients 11 were males and 9 were females. The youngest patient was 2 months old and the oldest was 12 years old. The important signs and symptoms in making diagnosis were the sign of injection, increased intracranial pressure, and focal neurological disorders. Laboratory examinations were of little value in establishing the diagnosls of brain abscess. By performing head CT Scan the diagnosis of brain abscess will be confirmed accurately. Of the 20 patients, 15 (75 %) suffered from single abscess and 5 (25 %) suffered from multiple abscesses. The results of treatment by surgical intervention were better than nonsurgical treatment. The high mortallty of the nonsurgical patients was caused by the severity of the disease due to the ignorancy of their parent.
Paediatrica Indonesiana
During 8 years, 405 patients of neonatal tetanus were hospitalized in the Department of Child Hea... more During 8 years, 405 patients of neonatal tetanus were hospitalized in the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta. Diagnosis of neonatal tetanus was based on clinical signs and symptoms. Of the 405 patients, 56.3% were males and 43.7 %. were females. Two hundreds and sixty nine (66.3 %) patients were delivered by traditional birth attendants, and only 33.6% were delivered by midwives or physicians. The overall mortality was 54.4%, with the corrected mortality of 46.7%. Severity of the disease, short incubation period, short period of onset, and the accompanying diseases were responsible for the high mortality of patients with neonatal tetanus.
Sari Pediatri, 2017
Ikatan Dokter Anak Indonesia melalui Satuan Tugas Imunisasi mengeluarkan rekomendasi Imunisasi ID... more 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 bul...
Paediatrica Indonesiana, 2016
Background Hemorrhagic disease of the newborn (HDN) repre-sents a special case of vitamin K defic... more Background Hemorrhagic disease of the newborn (HDN) repre-sents a special case of vitamin K deficiency because the four vita-min K-coagulation factors (factors II,VII,IX,X) are already at physi-ologically low levels in the newborn. It responds to vitamin Ktherapy.Objective The aim of this study was to review the incidence, clini-cal manifestation, and outcome of HDN.Methods This was a retrospective cross sectional study on 22patients hospitalized for HDN in the Department of Child Health,Cipto Mangunkusumo Hospital from January 1997 until Decem-ber 2001. Data were obtained from medical records.Results The commonest age group (17 out of 22) was 1–3 month-old. Normal delivery was found in 19 patients and only 3 patientsreceived prophylaxis vitamin K. Almost all of them (20 out of 22)were exclusively breastfed. Seizure, pallor, decreased conscious-ness, and bulging of the anterior fontanel were significant clinicalmanifestations found in 21, 21, 13, and 9 patients respectively.Based on...
Paediatrica Indonesiana, 2016
The prevalence rate of RS in various coun-tries is from 1:10,000 to 1:23,000 female livebirths. R... more The prevalence rate of RS in various coun-tries is from 1:10,000 to 1:23,000 female livebirths. RS is most often misdiagnosed as autism,cerebral palsy, or non-specific developmental de-lay. While many health professionals may not befamiliar with RS, it is a relatively frequent cause ofneurological dysfunction in females. There are nobiological markers for this disease, the diagno-sis is established by history taking and clinical find-ings. We reported two patients, both girls, with RS.
Paediatrica Indonesiana, 2016
Objective This study aimed to evaluate various types of sei-zures, EEG findings, and last evoluti... more Objective This study aimed to evaluate various types of sei-zures, EEG findings, and last evolution of epileptic seizures foundin children with Rett Syndrome (RTT).Methods A case series of ten female subjects from Sardjito Hos-pital, Yogyakarta; Cipto Mangunkusumo Hospital, Jakarta; andHasan Sadikin Hospital, Bandung from February 2001-April 2004.Diagnosis of RTT was established using necessary and support-ive criteria by the RTT Diagnostic Criteria Work Group and epi-lepsy was diagnosed according to clinical and EEG findings.Results The age during initial diagnosis of RTT ranged from 2years 6 months - 10 years 2 months (average: 4 years 6 months).The diagnosis of epilepsy, on the other hand, was establishedfrom 2 years - 5 years 10 months (average: 3 years 8 months).All subjects (10/10) had abnormal EEG results. Eight out of tenhad epileptiform discharge; the remaining had slowing backgroundactivity. The average age of initial seizure onset was 18 months.Five were diagnosed as epil...
Acta Paediatrica, 2015
A gluten-and casein-free diet is often given to children with autism spectrum disorder (ASD). We ... more A gluten-and casein-free diet is often given to children with autism spectrum disorder (ASD). We aimed to determine the effect of gluten and casein supplementation on maladaptive behaviour, gastrointestinal symptom severity and intestinal fatty acids binding protein (I-FABP) excretion in children with ASD. Methods: A randomised, controlled, double-blind trial was performed on 74 children with ASD with severe maladaptive behaviour and increased urinary I-FABP. Subjects were randomised to receive gluten-casein or a placebo for seven days. We evaluated maladaptive behaviour before and after supplementation, using I-FABP excretion, the approach withdrawal problem composite subtest of the Pervasive Developmental Disorder Behavior Inventory and the Gastrointestinal Symptom Severity Index. Results: The mean approach withdrawal problem composite score was significantly higher before supplementation than after, both in the placebo and in the gluten-casein group. However, the mean difference was not significant and may have been caused by additional therapy. There was no significant difference in gastrointestinal symptoms and urinary I-FABP excretion. Conclusion: Administrating gluten-casein to children with ASD for one week did not increase maladaptive behaviour, gastrointestinal symptom severity or urinary I-FABP excretion. The effect of prolonged administration or other mechanisms of enterocyte damage in ASD should be explored.
The SAGE Encyclopedia of Human Communication Sciences and Disorders
Een lexicale, morfologische en syntactische comparatieve studie van Nederlandstalige kinderen met... more Een lexicale, morfologische en syntactische comparatieve studie van Nederlandstalige kinderen met en zonder de taalstoornis Masterproef voorgedragen tot het behalen van de graad van Master in de taal-en letterkunde Nederlands-Engels 2013
Paediatrica Indonesiana, 2018
In spite of its long half life, phenobarbital is still given twice-daily in the treatment of gene... more In spite of its long half life, phenobarbital is still given twice-daily in the treatment of generalized tonic-clonic epilepsy. This study aims to determine if daily dose of phenobarbital given once differs to that given twice daily. Subjects of this unblinded controlled clinical trial were generalized tonic-clonic epilepsy patients ranging in age from 1-15 years. There were 40 study cases and 42 controls. We gave phenobarbital 4-6 mg/kg/day once-daily for study group and twice-daily dose for control group. History, physical and EEG examination and phenobarbital plasma measurements were obtained a t the beginning of the study and four weeks later. The ratio of the second to first phenobarbital plasma concentrations in the study group was 0.99 while in the control group it was 1.02. The proportion of seizure-free patients in the study group increased from 70% at the beginning to 85% at the end of study, and in the control group from 64.3% to 83.3%. Hyperactivity and irritability incr...
Paediatrica Indonesiana, 2001
Infiltration of leukemic cells into the central nervous system (CNS) is one of the causes of neur... more Infiltration of leukemic cells into the central nervous system (CNS) is one of the causes of neurological disorders in patients with acute lymphoblastic leukemia (ALL) that worsen the prognosis. This retrospective cohort study aimed to review the clinical manifestations of children with CNS leukemia, their survival pattern and the role of early CNS leukemial. The survival curve was developed by Kaplan-Meier method, while the comparison of survival curves was done with log-rank test. Among 128 new ALL patients, 23 (18.0%) patients suffered from CNS leukemia, while 13 (10.2%) suffered from early CNS leukemia and 10 (7.8%) suffered from relapsing CNS leukemia. CNS leukemia was more common in male, in those aged less than 2 years, in those with white blood cell (WBC) count above 50,000/µl, and in patients type FAB-L2 ALL. The clinical manifestations most commonly found were decrease of consciousness (61%), vomiting (48%), cranial nerve palsy (44%), seizures (39%), and headache (26%). Re...
Background Epilepsy is a chronic disease that requires antiepileptic drugs (AEDs). Only 60-70% of... more Background Epilepsy is a chronic disease that requires antiepileptic drugs (AEDs). Only 60-70% of new patients could be controlled effectively by standard AEDs and this stimulates the search for new, more effective and well-tolerated AEDs. Objective To asses the efficacy and safety of topiramate, as an adjunctive therapy to standard AEDs for children with intractable epilepsy. Methods This was an open label, parallel group study. Forty children with at least 4 seizures during a 4-week baseline period were randomly assigned to topiramate (n=20) or control group (n=20). In the topiramate group, the drug was given in adjunct to AEDs for 2-week titration dosage continued with a 12-week stabilization period, while the control group received only AEDs adjusted to their clinical responses. Results Mean reduction from baseline in monthly seizures frequency was significantly greater in the topiramate group (88.6% vs. 25%; P=0.030). Other variable of efficacy was significantly different (e&q...
The SAGE Encyclopedia of Human Communication Sciences and Disorders, 2019
Secara klinis seorang anak disebut mengalami keterlambatan bicara apabila pada umur 2 tahun hanya... more Secara klinis seorang anak disebut mengalami keterlambatan bicara apabila pada umur 2 tahun hanya dapat mengucapkan kurang dari 50 kata dan/ atau belum ada kalimat yang terdiri dari kombinasi dua kata. Prevalens keterlambatan perkembangan bicara mencapai 15% pada anak berumur 2 tahun.1,2 Umumnya orangtua sudah mengeluh mengenai keterlambatan bicara pada umur 2 tahun, namun sebagian dokter memilih “menunggu” berdasarkan fakta bahwa perkembangan bicara masih sangat bervariasi pada umur 2 tahun, 50% anak yang mengalami keterlambatan bicara akan mengejar keterlambatan tersebut pada umur 3 tahun, dan bila keterlambatan bicara hanya disebabkan oleh keterlambatan perkembangan (maturational delay), prognosisnya cukup baik.3-5 Akibat adanya pendapat ini, maka diagnosis keterlambatan bicara seringkali belum ditegakkan pada umur 2-3 tahun.2,3 Meskipun demikian, harus diingat bahwa keterlambatan bicara yang semula diduga hanya merupakan keterlambatan perkembangan ternyata dapat merupakan gejala...
: Acute phase protein plasminogen activator inhibitor type-1 (PAI-1) is a key element in fibrinol... more : Acute phase protein plasminogen activator inhibitor type-1 (PAI-1) is a key element in fibrinolysis inhibition in sepsis-induced disseminated intravascular coagulation (DIC). Elevated PAI-1 level is related to worse outcome in sepsis. The aim of this study was to investigate the relationship between plasma PAI-1 level and clinical outcome in children with sepsis. A total of 35 children with sepsis were enrolled into this prospective study. Plasma PAI-1 was measured on day-1 and day-4. Systemic coagulation profile was measured on day-4. Individuals were followed up until 28 days. The mean PAI-1 from day-1 to day-4 in overt DIC children was not statistically significant. Contrarily, among nonovert DIC individuals, there was a significant difference (P ≤ 0.001) in PAI-1 levels on day-1 compared with day-4 were 95.25 ± 46.57 vs. 60.36 ± 37.31 ng/ml, respectively. Among survivors, mean PAI-1 level on day-1 was statistically higher than PAI-1 level on day-4 (82.47 ± 44.43 vs. 58.39 ± 32.98 ng/ml), P = 0.021. There was no significant difference between PAI-1 levels on day-1 compared with day-4 in nonsurvivors. PAI-1 was correlated to DIC score with r = 0.606 (P ≤ 0.001). PAI-1 levels significantly decreased on day-4 compared with day-1 among nonovert DIC individuals, and not in overt DIC individuals. Changes in PAI-1 levels in nonsurvivors did not differ. PAI-1 level was positively correlated with DIC score.
Neuro-Oncology
Brain tumors are still the second leading cause of death among cancers in children. Based on data... more Brain tumors are still the second leading cause of death among cancers in children. Based on data from National Brain Tumor Society (2019), in United States, there are 28.000 children living with brain tumor with varied clinical, radiological, and histopathological features. The most prevalent children’s brain tumor types in US are gliomas (ependymal tumors, pilocytic astrocytomas) and embroyonal tumors, including medulloblastoma. From 1993–1994 at Department of Child Health Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Tertiary General Hospital, Jakarta, Indonesia, there are 19 patients with brain tumors hospitalized with most of patients with astrocytoma 8 patients (42%), 4 patients (21%) medulloblastoma, 2 patients (11%) neuroblastoma, 2 patients (11%) ependymoma, 2 patients (11%) craniopharyngioma, and one patient (4%) meningioma. Retrospective cohort study (2010–2015) with subjects 100 children revealed that based on the radiographs, the brain tumors were loc...
Paediatrica Indonesiana
Brain tumors are the second most common malignancy and the most common solid tumors found in chil... more Brain tumors are the second most common malignancy and the most common solid tumors found in childhood. During 11 months 19 patients with brain tumors were hospitalized at the Department of Child Health, Dr. Cipto Mangunkusurno Hospital, Jakarta, 10 of them were males. The youngest patient was 5 months old and the oldest was 13 years old. The important signs and symptoms in establishing diagnosis were the non-localizing signs and symptoms, i.e., nausea and vomiting. The most frequent localizing signs and symptoms were papilledema, cranial nerves palsy, ataxia and incoordination, hemiparesis, visual disturbances, and optic atrophy. Focal seizures were rare. Most of the tumors were in infratentorial region, and metastatic tumors were rare. The mortality of this series was high due to the severity of the disease. The most frequent of tumors are astrocytomas and medulloblastomas.
Background. Stunting is the impairment of growth and development due to malnutrition and/or chron... more Background. Stunting is the impairment of growth and development due to malnutrition and/or chronic disease/infection. According to the Indonesia Basic National Health Survey 2013, prevalence of stunting in Indonesia reached 37.2%. Various studies have shown that impaired cognitive development may be found in children with stunting and malnutrition. This research has purpose to determine cognitive development in stunted children and malnourished children, using Bayley Scale of Infant Development III (Bayley-III). Methods. A cross-sectional study in 51 children aged 6 month to 3 year old who fullfiled the inclusion criteria at the Outpatient Clinic of Dr.Cipto Mangunkusumo National General Hospital from June 2017 until January 2018. Cognitive development was assessed using the Bayley Scale of Infant Development Third Edition (Bayley-III). Results. Twenty six children with stunting and 25 children with malnutrition without stunting with age of subjects were 11.0 month (2.0-34.0) and 1...
Telemedicine and e-Health
Background: Delayed diagnosis of autism spectrum disorder (ASD) remains a persistent pediatric he... more Background: Delayed diagnosis of autism spectrum disorder (ASD) remains a persistent pediatric health problem, due to limited access to competent diagnosticians and tertiary health care. A telemedicine method using a store-and-forward approach presents an opportunity to facilitate early identification and referral for intervention. This study aimed to evaluate the validity of protocol-guided video recording compared with direct assessment (DA) for diagnosing ASD. Materials and Methods: Children aged 18-30 months with chief complaints of delayed speech or social indifference, and Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) score of more than two were included. Parents were instructed to video record certain scenarios, which were assessed by an experienced professional based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) checklist for ASD. DAs using DSM-5 criteria were considered to be the gold standard of diagnosis. Diagnostic agreement, sensitivity, specificity, predictive values, and likelihood ratios were calculated to measure diagnostic validity. Results: The diagnostic agreement between the two methods was 82.5%. The sensitivity of video recording for diagnosing ASD was 91.3% (95% confidence interval [CI] [79.7%-100%]), while the specificity was 70.6% (95% CI [48.9%-92.2%]). The positive predictive value was 80.7% (95% CI [65.6%-95.9%]), while the negative predictive value was 85.7% (95% CI [67.4%-100%]). The positive likelihood ratio was 3.1 (95% CI [1.47-6.5]), while the negative likelihood ratio was 0.16 (95% CI [0.03-0.47]). Conclusions: A telemedicine approach using protocol-guided video recording evaluation has substantial validity compared with DA for diagnosing ASD.
Paediatrica Indonesiana, Oct 8, 2018
Malaysian Journal of Medical Research
The period from birth to two years of age is a "critical window" of opportunity for the promotion... more The period from birth to two years of age is a "critical window" of opportunity for the promotion of optimal growth, health and behavioral development of children. Dietary diversity is an important immediate determinant of stunting children also feeding patterns combined with household food insecurity can lead to stunting children which is a major public health problem in developing countries like Indonesia. A community based cross-sectional study that involved 120 participants from east Jakarta rural were conducted from February to March 2018. A consecutive sampling procedure was employed to select the required households. Multivariable logistic regression analyses were performed to compare stunting by feeding patterns and other characteristics. The prevalence of child stunting in the current study Dietary diversity and child stunting 44 was 43.5%. Dietary diversity has association with stunting especially in the poorest economic status. Dietary education would be the most effective strategy to deliver messages about infant and young child feeding practices, especially on dietary diversity.
Paediatrica Indonesiana
We reviewed clinical and laboratory findings of 12 cases of Subacute sclerosing panencephalitis (... more We reviewed clinical and laboratory findings of 12 cases of Subacute sclerosing panencephalitis (SSPE) hospitalized at our department from 1985 to 1991. All cases were diagnosed and hospitalized at the 2nd stage. The principal clinical manifestations were mental changes, myoclonus, and frequent falls. Other clinical manifestations were ocular changes, involuntary movements, loss of social contact, and spasticity. Diagnosis was based on suppression-burst pattern in EEG and positive antibody titer to measles in serum and cerebrospinal fluid. CT scan was not diagnotic, since it was either normal or showed only non-specific cortical atrophy. Eleven patients (91, 7%) recalled a history of measles in the past. Age of onset of SSPE varied among cases and was difficult to specify precisely due to its subtle nature. None of the cases had been vaccinated against measles. SSPE is a rare disease, but is almost always fatal with prolonged suffering of the patient. Based on our experience with SS...
Paediatrica Indonesiana
During 4 years, 20 patients with brain abscesses were hospitalized in the Departement of Child He... more During 4 years, 20 patients with brain abscesses were hospitalized in the Departement of Child Health, Dr. Cipto Mangunkusumo General Hospital, jakarta. Of those 20 patients 11 were males and 9 were females. The youngest patient was 2 months old and the oldest was 12 years old. The important signs and symptoms in making diagnosis were the sign of injection, increased intracranial pressure, and focal neurological disorders. Laboratory examinations were of little value in establishing the diagnosls of brain abscess. By performing head CT Scan the diagnosis of brain abscess will be confirmed accurately. Of the 20 patients, 15 (75 %) suffered from single abscess and 5 (25 %) suffered from multiple abscesses. The results of treatment by surgical intervention were better than nonsurgical treatment. The high mortallty of the nonsurgical patients was caused by the severity of the disease due to the ignorancy of their parent.
Paediatrica Indonesiana
During 8 years, 405 patients of neonatal tetanus were hospitalized in the Department of Child Hea... more During 8 years, 405 patients of neonatal tetanus were hospitalized in the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta. Diagnosis of neonatal tetanus was based on clinical signs and symptoms. Of the 405 patients, 56.3% were males and 43.7 %. were females. Two hundreds and sixty nine (66.3 %) patients were delivered by traditional birth attendants, and only 33.6% were delivered by midwives or physicians. The overall mortality was 54.4%, with the corrected mortality of 46.7%. Severity of the disease, short incubation period, short period of onset, and the accompanying diseases were responsible for the high mortality of patients with neonatal tetanus.
Sari Pediatri, 2017
Ikatan Dokter Anak Indonesia melalui Satuan Tugas Imunisasi mengeluarkan rekomendasi Imunisasi ID... more 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 bul...
Paediatrica Indonesiana, 2016
Background Hemorrhagic disease of the newborn (HDN) repre-sents a special case of vitamin K defic... more Background Hemorrhagic disease of the newborn (HDN) repre-sents a special case of vitamin K deficiency because the four vita-min K-coagulation factors (factors II,VII,IX,X) are already at physi-ologically low levels in the newborn. It responds to vitamin Ktherapy.Objective The aim of this study was to review the incidence, clini-cal manifestation, and outcome of HDN.Methods This was a retrospective cross sectional study on 22patients hospitalized for HDN in the Department of Child Health,Cipto Mangunkusumo Hospital from January 1997 until Decem-ber 2001. Data were obtained from medical records.Results The commonest age group (17 out of 22) was 1–3 month-old. Normal delivery was found in 19 patients and only 3 patientsreceived prophylaxis vitamin K. Almost all of them (20 out of 22)were exclusively breastfed. Seizure, pallor, decreased conscious-ness, and bulging of the anterior fontanel were significant clinicalmanifestations found in 21, 21, 13, and 9 patients respectively.Based on...
Paediatrica Indonesiana, 2016
The prevalence rate of RS in various coun-tries is from 1:10,000 to 1:23,000 female livebirths. R... more The prevalence rate of RS in various coun-tries is from 1:10,000 to 1:23,000 female livebirths. RS is most often misdiagnosed as autism,cerebral palsy, or non-specific developmental de-lay. While many health professionals may not befamiliar with RS, it is a relatively frequent cause ofneurological dysfunction in females. There are nobiological markers for this disease, the diagno-sis is established by history taking and clinical find-ings. We reported two patients, both girls, with RS.
Paediatrica Indonesiana, 2016
Objective This study aimed to evaluate various types of sei-zures, EEG findings, and last evoluti... more Objective This study aimed to evaluate various types of sei-zures, EEG findings, and last evolution of epileptic seizures foundin children with Rett Syndrome (RTT).Methods A case series of ten female subjects from Sardjito Hos-pital, Yogyakarta; Cipto Mangunkusumo Hospital, Jakarta; andHasan Sadikin Hospital, Bandung from February 2001-April 2004.Diagnosis of RTT was established using necessary and support-ive criteria by the RTT Diagnostic Criteria Work Group and epi-lepsy was diagnosed according to clinical and EEG findings.Results The age during initial diagnosis of RTT ranged from 2years 6 months - 10 years 2 months (average: 4 years 6 months).The diagnosis of epilepsy, on the other hand, was establishedfrom 2 years - 5 years 10 months (average: 3 years 8 months).All subjects (10/10) had abnormal EEG results. Eight out of tenhad epileptiform discharge; the remaining had slowing backgroundactivity. The average age of initial seizure onset was 18 months.Five were diagnosed as epil...