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Background Infants with neonatal asphyxia have multiorgan damage, such as to the kidneys (50%), central nervous system (28%), cardiovascular system (25%), and lungs (23%). Neonatal asphyxia reduces kidney perfusion, often leading to acute kidney injury (AKI) after asphyxia. Neutrophil gelatinase-associated lipocalin (NGAL) levels in the blood, urine and kidney tissue increased rapidly in AKI. Urinary NGAL is proposed to have better performance in diagnosing AKI than creatinine due to its earlier, rapid level increase and it is less invasive. Objective To compare urinary NGAL to serum creatinine as a marker to assess kidney function in neonatal asphyxia. Methods Diagnostic comparison study with cross-sectional design was performed at neonatal intensive care unit (NICU) of Prof. Dr. R. D. Kandou Hospital, Manado from November 2015 to February 2016. All subjects had neonatal asphyxia. Data were analyzed using descriptive analysis, receiver-operator characteristic (ROC) curve, and Z-test. Results Urinary NGAL with cut-off point of 652.24 ng/mL can predict AKI in neonates with asphyxia with 100% sensitivity, 75% specificity, 52.3% positive predictive value, and 100% negative predictive value. Chi-square test resulted in a value of x2 = 20.036, P=0.0001).This shows that urinary NGAL levels >652,24 ng/mL can predicts AKI by 20 times in infants with neonatal asphyxia. So, urinary NGAL performs better than serum creatinine, therefore it can replace serum creatinine as an alternative non-invasive diagnostic test for diagnosing AKI in infants with neonatal asphyxia. Conclusion The diagnostic value of urinary NGAL is higher than that of serum creatinine in assessing kidney function in neonatal asphyxia.

Background The prevalence of iron deficiency anemia (IDA) remains high in Indonesian children. When anemia is detected in a patient, the physician’s task is to identify the cause, address it, provide iron therapy, and prevent recurrence. However, prevention is best done by early detection. The reticulocyte hemoglobin equivalent (Ret-He) is a direct measurement of iron level in reticulocytes recently produced in the bone marrow. The Ret-He measurement may be an early indicator of iron deficiency, as it is sensitive at the initial stage of the condition. Objective To assess for a relationship between Ret-He and IDA as well as to evaluate the usefulness of Ret-He for diagnosing IDA in children. Methods This analytic, observational study with cross-sectional approach included 50 children aged 6-12 years and was performed from November 2013 to March 2014. The subjects were divided into IDA or non-IDA groups, based on ferritin levels. A correlation analysis using logistic regression was performed and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and odds ratio (OR) were calculated. Results were considered to be statistically significant for P values

Background Iron deficiency anemia (IDA) is frequently found in school-aged children. The main treatments for IDA are overcoming the causal factors and iron supplementation. Noncompliance in taking iron tablets and the possibility of iron absorbtion or transport difficulties, can reduce efficacy of daily oral iron supplementation. Because excess iron storage in the intestinal cells can lead to mucosal blockage, twice weekly oral iron therapy may be considered instead of daily dosage. Objective To compare the effects of daily vs. twice weekly ferric sodium edetate (NaFeEDTA) on hemoglobin (Hb), hematocrit (Ht), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) levels on children with IDA. MethodsWe conducted an open-label, randomized, prospective study in 36 children with IDA aged 5-11 years. Subjects were divided into two groups. For a one-month period, group I received daily iron therapy (NaFeEDTA) and group II received twice weekly iron therapy. Examinations of Hb, Ht, MCV, MCH, MCHC were performed before and after iron therapy. Results There were no significant differences in Hb, Ht, MCV, MCH or MCHC levels after therapy between the daily and twice weekly NaFeEDTA groups (P > 0.05). Conclusion Twice weekly NaFeEDTA therapy is as effective as daily NaFeEDTA administration in children with IDA.

Hemangiomas are the most frequent vascular tumors observed in early childhood. The presentation is unique, with an initial phase of proliferation, followed by a phase of slow, spontaneous regression after the age of 1 year.1,2 Most hemangiomas are uncomplicated and do not require intervention. However, therapy may be needed if the hemangioma is located at certain body sites, such as the face, or if it results in a functional handicap, such as limitation of eye opening. In addition, ulcerated, rapidly growing hemangiomas may require treatment.3

Background Dengue shock syndrome (DSS) is characterized by severe vascular leakage and hemostasis disorder. It is the cause of death in 1 to 5 percent of cases. WH 0 management guidelines for resuscitation remain empirical rather than evidence-based. Objective To find out the alternative fluids to replace plasma leakage in DSS. Methods We performed a prospective study and randomized comparison of plasma and gelatin solution for resuscitation of Indonesian children with DSS. We randomly assigned 25 subjects with DSS to receive plasma and 25 children to receive gelatin fluid. Statistical analyse were performed using chi-square test, Fisher's exact test, t test, Mann-Whitney test. Results The increment of pulse pressure width and the decrement of hematocrit in subjects treated with gelatin were higher than that of plasma atfour-hour therapy (P=0.002 and P=0.017). Only one patient died caused by unusually manifestation of DSS. The increment of body temperature in subjects treated with plasma was higher than that of gelatin at four-hour therapy (P=O.Oll). The decrement of platelet count in subjects treated with gelatin were less than that of plasma (P=0.018). The increment of diuresis rate in subjects treated with gelatin was higher than that of plasma at twenty-hour therapy (P0.05). Conclusions Gelatin solution can be used as volume replacement in resuscitation of DSS if blood plasma is not available especially at four-hour therapy.

Background Febrile neutropenia (FNP) is a common complication of therapy among children with cancer. It is one of the causes of significant morbidity and mortality in children and young adults treated for cancer. With aggressive management of FNP, the outcome of episodes in children has improved dramatically. Objective To determine factors associated with FNP, to assess how varied the current management, and to evaluate the outcome of FNP in childhood leukemia in Manado over the last 10 years. Methods Data from medical records was collected retrospectively from January 1997 to December 2006. Variables studied were: age, sex, nutritional status, sosio-economic status, type of leukemia, degree of fever, ANC at fever, phase of chemotherapy, antibiotic used, episodes ofFNP and the outcome of patients. Results Twenty of ninety one patients were studied. The mortality rate was crucial i.e., 11 of20, it was higher in boys than that in girls. Most children have severe to very severe neutropenia and more than half died (7 /13). Seven out of 12 malnourished patients died. Sixteen children are suffered from acute lymphoblastic leukemia (ALL). The outcome of high risk (HR) patients was worse than that of standard risk (SR). FNP occurred along the phase of chemotherapy. None of the factors studied showed significant difference. The choice of antibiotics is varied. Conclusion The outcome of FNP in our institution is grave. There is a need to evaluate application and compliance to the standard guidelines.

Background Thrombocyte and endothelial cells play an important role in dengue hemorrhagic fever pathogenesis. Thrombomodulin is a part of glycoprotein membrane in endothelial cells. Therefore, thrombomodulin level will increase if endothelial cells disruption occurs. Objective To acknowledge the correlation between the degree of dengue hemorrhagic fever and thrombomodulin level. Methods This was a cross-sectional study. Subjects were hospitalized pediatric patients with age ranging from one to 13 year old in pediatric ward at Pro£ Dr. R.D. Kandou Hospital, Manado, who had fever. Three milliliters of blood were taken from vein, and were divided for two tests which were routine blood analysis and thrombomodulin analysis. Different data resulted from the dengue hemorrhagic fever group were processed, and analyzed statistically using F Test and LSD (least significant difference) test. The relation between dengue hemorrhagic fever and thrombomodulin was analyzed with Spearman correlation coefficient. Results There was a significant result in the difference of thrombomodulin level on four dengue hemorrhagic fever groups which were classified according to the severity of dengue hemorrhagic fever. There was a very significant positive correlation between the severity of dengue hemorrhagic fever and thrombomodulin level in detecting endothelial cells impairment. Conclusion Thrombomodulin level can be used as a marker to detect endothelial cells impairment in dengue hemorrhagic fever. Higher grade of dengue hemorrhagic fever will have higher thrombomodulin level.