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Objective The Indonesia Basic Health Research 2018 indicates that Indonesian children are still among the shortest in the world. When referred to World Health Organization Child Growth Standards (WHOCGS), the prevalence of stunting reaches up to 43% in several Indonesian districts. Indonesian National Growth Reference Charts (INGRC) were established in order to better distinguish between healthy short children and children with growth disorders. We analyzed height and weight measurements of healthy Indonesian children using INGRC and WHOCGS. Methods 6972 boys and 5800 girls (n=12,772), aged 0-59 months old, from Bandung District were measured. Z-scores of length/height and body mass index were calculated based on INGRC and WHOCGS. Results Under 5-year-old Indonesian children raised in Bandung are short and slim. Mean height z-scores of boys is -2.03 [standard deviation (SD) 1.31], mean height z-scores of girls is -2.03 (SD 1.31) when referred to WHOCGS indicating that over 50% of these children are stunted. Bandung children are heterogeneous, with substantial subpopulations of tall children. Depending on the growth reference used, between 9% and 15% of them are wasted. Wasted children are on average half a SD taller than their peers. Conclusion WHOCGS seriously overestimates the true prevalence of undernutrition in Indonesian children. The present investigation fails to support evidence of undernutrition at a prevalence similar to the over 50% prevalence of stunting (WHOCGS) versus 13.3% (INGRC). We suggest refraining from using WHOCGS, and instead applying INGRC that closely mirror height and weight increments in Bandung children. INGRC appear superior for practical and clinical purposes, such as detecting growth and developmental disorders.

Background Menarcheal age is important in adolescent girls due to its associations with health outcomes at adulthood. Modifiable factors that may influence menarcheal age include body fat mass and fat distribution. Objective: To investigate possible correlations between body fat mass and fat distribution with age at menarche in adolescent girls. Methods This study was a cross-sectional study on 32 girls aged 10-15 years in Central Jakarta, who experienced menarche within the time period of July to September 2019. Data on menarcheal age was collected by recall. Body fat mass and distribution were calculated using anthropometric measurements and bioelectrical impedance analyzer (BIA) results. Results The mean age of study subjects was 12.06 (SD 0.82) years and the mean age at menarche was 11.91 (SD 0.83) years. Correlation tests revealed a moderate negative correlation between body mass index-for-age and menarcheal age (r= -0.45; P=0.01) and weak negative correlation between waist-height ratio and menarcheal age (r= -0.37; P=0.03). Conclusion Menarcheal age is correlated with body mass index-for-age and waist-height ratio. However, no significant correlations between menarcheal age and body fat mass or distribution are found.

Latar belakang. Heat shock protein 60 (Hsp60) ditemukan pada individu dengan Diabetes Mellitus (DM) tipe-1 dan merupakan mimikri molecular Hsp65 pada mycobacterium. Fenomena ini dapat menyebabkan penundaan identifikasi mycobacterium dan memperparah kondisi DM tipe-1. Tujuan. Studi ini bertujuan untuk meneliti peran Hsp60 dalam kontrol metabolik terhadap infeksi tuberkulosis (TB) pada anak dan remaja dengan DM tipe-1.Metode. Penelitian ini merupakan studi potong lintang yang dilaksanakan di Rumah Sakit Cipto Mangunkusumo. Anak dan remaja dengan DM tipe I memenuhi kriteria inklusi. Setelah memperoleh data dasar, dilakukan pemeriksaan HbA1c, Hsp60, dan IGRA. Dilakukan analisis data.Hasil. Sebanyak 32 subjek dengan DM tipe-1 diidentifikasi. Insidens infeksi TB yang terdeteksi dengan IGRA pada anak dan remaja dengan DM tipe-1 adalah 12,5%. Tiga dari empat pasien dengan hasil IGRA positif memiliki nilai HbA1c >9.0. Nilai rerata Hsp60 pada subjek IGRA positif lebih rendah dibandingkan subjek IGRA negatif (1.16 ± 0.59 vs 115.18 ± 364.73), dengan nilai P>0,05.Kesimpulan. Tidak didapatkan hubungan signifikan antara Hsp60 dan control glikemik dengan insidens TB pada anak dan remaja dengan DM tipe-1. Hasil ini mungkin dipengaruhi oleh jumlah subjek yang sedikit, penggunaan IGRA untuk mendiagnosis TB pada anak, dan reaktivitas rendah Hsp60 dengan Hsp65.

Insidens Diabetes Mellitus (DM) Tipe-1 pada anak di dunia dan Indonesia terus meningkat. Berdasarkan data Ikatan Dokter Anak Indonesia (IDAI), tercatat 1220 dengan DM tipe-1 pada tahun 2018. Kesadaran masyarakat dan tenaga kesehatan mengenai DM pada anak masih rendah, yang direfleksikan melalui tingginya angka anak yang terdiagnosis dengan DM tipe-1 saat mengalami ketoasidosis diabetikum mencapai 71% pada tahun 2017. Berdasarkan pedoman IDAI, terdapat lima pilar penanganan DM tipe-1 pada anak: injeksi insulin, pemantauan gula darah, nutrisi, aktivitas fisik, dan edukasi. IDAI merekomendasikan insulin minimal dua kali per hari menggunakan insulin basal dan kerja cepat. Pemantauan gula darah mandiri dilakukan minimal 4-6 kali per hari. Keterlibatan pemegang kebijakan, termasuk pemerintah, dan dukungan masyarakat dibutuhkan agar anak dengan DM tipe 1 tertangani dengan baik.

Diabetes Mellitus tipe-1 merupakan salah satu penyakit kronis yang sampai saat ini belum dapat disembuhkan. Walaupun demikian, berkat kemajuan teknologi kedokteran kualitas hidup pasien DM tipe-1 dapat terpelihara. Sebagian besar kasus DM pada anak termasuk di dalam DM tipe-1, namun sedikit sekali tulisan di Indonesia mengenai karakteristik klinis dan laboratorium DM tipe-1. Hal ini mengakibatkan banyak tenaga medis yang tidak mengetahuinya sehingga sering sekali salah dalam mendiagnosis pasien DM tipe-1. Pasien DM tipe-1 sebagian besar mempunyai riwayat perjalanan klinis, dengan poliuria, polidipsia, polifagia, dan berat badan yang cepat menurun. Untuk mengurangi keterlambatan diagnosis maka kewaspadaan terhadap DM tipe-1 merupakan kata kunci. Telah dilakukan penelitian deskriptif retrospektif pada semua pasien DM tipe-1 yang berobat ke Bagian IKA-RSCM antara tahun 1989-1999. Seluruh subyek penelitian diambil dari catatan medis dan didapat 41 kasus dengan DM tipe-1 dengan sebagian besar anak perempuan. Usia terbanyak saat datang pertama kali ke Bagian IKA-RSCM pada usia 5-10 tahun (56%). Dari 41 kasus DM tipe-1, hanya 31% yang mempunyai keturunan keluarga DM. Saat datang ke Bagian IKA-RSCM 66% dengan katoasidasis diabetik, 71% menderita gizi kurang dan seluruh pasien datang dengan keluhan poliuria, polidipsia, polifagia dan adanya penurunan berat badan yang progresif. Gangguan kesadaran juga menyertai pasien dengan KAD. Kadar gula darah pasien DM tipe-1 terbanyak antara 300-500 mg/dl (51%). Semua pasien pada saat awal diagnosis kadar HbA1c di atas normal dan C-peptida di bawah normal.

Gejala klinis hipotiroidisme kongenital pada neonatus seringkali tidak begitu jelas dan baru terdeteksi setelah 6-12 minggu. Diagnosis dini sangat penting untuk mencegah timbulnya retardasi mental atau meringankan derajat retardasi mental. Penelitian ini bertujuan untuk mengetahui gambaran klinis awal, laboratorium dan respons terapi awal natrium levotiroksin pada pasien hipotiroidisme kongenital. Data dikumpulkan dari catatan rekam medik kasus-kasus hipotiroidisme kongenital yang berkunjung ke Poliklinik Endokrinologi Anak dan Remaja FKUI/RSCM Jakarta selama kurun waktu 1992-2002. Dalam kurun waktu tersebut terdapat 30 pasien baru, 21 anak (70%) perempuan dan 9 anak (30%) laki-laki. Sebagian besar (53,3%) didiagnosis pada umur 1-5 tahun. Berdasarkan status antropometri menurut NCHS-WHO ditemukan gizi buruk pada 53,3% kasus (berat badan/umur), perawakan pendek paa 90% kasus (tinggi badan/ umur), dan pada 70% kasus perbandingan berat badan/tinggi badan adalah normal. Gejala klinis tersering saat diagnosis adalah perkembangan motorik terlambat (83,3%), konstipasi (73,3%), aktivitas menurun (70%), makroglosia (70%), dan pucat (70%). Ditemukan maturasi tulang terlambat (95,5%), gangguan pendengaran (22,7%), gangguan sistem neuromuskular (16,7%), dan retardasi mental (62,5%). Pada pemeriksaan skintigrafi dijumpai agenesis tiroid pada 11,1% kasus. Sebagian besar (26,7%) mendapat terapi awal dosis tinggi (8-10 mg/kg/hari). Gejala klinis berkurang (36,7%) dalam 4 minggu dan fungsi tiroid kembali normal (33,3%) dalam 1-3 bulan setelah terapi awal.

Latar belakang. Diabetes mellitus tipe 1 (DM tipe-1) adalah kelainan metabolik yang disebabkan oleh reaksi autoimun yang menyebabkan kerusakan sel β pankreas dan terjadi pada hampir semua anak yang menderita diabetes. Dalam perjalanan DM tipe-1, sering timbul komplikasi jangka pendek dan jangka panjang.Tujuan. Mengetahui frekuensi komplikasi jangka pendek yaitu ketoasidosis dan jangka panjang yaitu nefropati dan retinopati berdasarkan kontrol metabolik, lama menderita diabetes, dan biaya pengobatan.Metode. Penelitian deskriptif pada 39 pasien yang terdaftar di IKADAR(Ikatan Keluarga Penyandang Diabetes Anak dan Remaja) selama September – Oktober 2007 di Departemen Ilmu Kesehatan Anak Divisi Endokrin FKUI/ RSCM Jakarta dengan melakukan anamnesis, pemeriksaan laboratorium HbA1c, mikroalbuminuria, dan evaluasi mata di poliklinik mata FKUI RSCM.Hasil. Dari 39 pasien yang diteliti antara umur 5-31 tahun, rerata diagnosis diabetes ditegakkan pada umur (9,8±4,1) tahun, HbA1c (10,1±2,3) % dan menderita diabetes selama (5,6±5,8) tahun, dengan dosis insulin yang dipakai (0,9±0,2) IU/kg/hari. Komplikasi yang ditemukan adalah ketoasidosis diabetik selama sakit pada 30 pasien (76,9 %) dan pada 12 minggu terakhir pada 3 pasien (7,9%), mikroalbuminuria pada 3 pasien (7,9%), sedangkan retinopati tidak ditemukan. Rerata pasien memeriksakan HbA1c 3-4 kali pertahun, memeriksa gula darah secara mandiri 1-2 kali/hari dan sebagian besar berobat dengan biaya sendiri.Kesimpulan. Tidak banyak perubahan karakteristik pasien dibandingkan penelitian yang lalu. Rerata kadar HbA1c masih kurang baik dibandingkan dengan rerata HbA1c di negara maju. Di negara maju sudah banyak perubahan pada cara pemberian insulin dan lebih ditingkatkannya perhatian dan pengetahuan pada pasien dan keluarga pasien diabetes.

Latar belakang. Dermatitis atopik (DA) merupakan manifestasi awal atopic marchyang berhubungan dengan alergi makanan. Alergen penyebab dan faktor risiko yang memengaruhi penting diketahui. Tujuan. Mengetahui sensitisasi dan faktor risiko alergi pada DA setelah usia 2 tahun. Metode. Penelitian deskriptif potong lintang terhadap 35 subjek DA sejak Januari-Maret 2011. Sensitisasi diketahui dengan uji tusuk kulit. Hasil. Sensitisasi terjadi pada 29 subjek dari 35 subjek, dengan faktor risiko pajanan asap rokok ditemukan pada 21 subjek, faktor risiko alergi sedang dan tinggi 19 subjek, tidak mendapat ASI eksklusif 9 subjek, dan makanan padat usia dini 21 subjek. Sensitisasi alergen makanan ditemukan pada 26 subjek. Kesimpulan. Sebagian besar subjek DA mengalami sensitisasi oleh alergen makanan. Faktor risiko pajanan asap rokok, faktor risiko alergi sedang dan tinggi, tidak mendapat ASI eksklusif, dan mendapat makanan padat usia dini ditemukan lebih sering pada anak DA

Latar belakang. Salah satu komplikasi jangka panjang diabetes melitus tipe 1 (DM tipe 1) pada anak adalah nefropati diabetik. Lama menderita diabetes serta masa pubertas merupakan faktor yang mempengaruhi terjadi komplikasi tersebut. Kejadian nefropati diabetik pada umumnya akan disertai gejala peningkatan tekanan darah. Tujuan. Mengetahui gambaran tekanan darah anak dengan DM tipe 1 berdasarkan umur, jenis kelamin, lama sakit, dan kadar HbA1c. Metode. Studi observational retrospektif pada register nasional DM tipe 1 UKK Endokrin Anak IDAI sampai tahun 2010. Variabel yang diteliti adalah umur, jenis kelamin, lama sakit, kadar HbA1c, serta tekanan darah sistolik (TDS) dan diastolik (TDD). Hasil. Di antara 177 anak dengan DM tipe 1, 118 (66,7%) perempuan dan 59 (33,3%) laki-laki. Rerata umur saat pertama kali didiagnosis adalah 11,8 tahun. Dijumpai 1 (0,6 % ) anak perempuan yang menderita DM tipe 1 lebih dari 5 tahun mempunyai tekanan darah sistolik dan diastoik di atas persentil 95. Kesimpulan. Sebagian besar tekanan darah anak dengan DM tipe 1, normal. Terdapat 0,6% kasus dengan hipertensi (>95 persentil) yaitu seorang anak perempuan yang telah menderita DM lebih dari 5 tahun

CLAN (Caring and Living as Neighbours) is an Australian-based non-governmental organisation (NGO) committed to equity for children living with chronic health conditions in resource-poor settings. Since 2004, CLAN has collaborated with a broad range of partners across the Asia Pacific region to improve quality of life for children living with congenital adrenal hyperplasia (CAH). This exploratory case study uses the Knowledge to Action (KTA) framework to analyse CLAN&rsquo, s activities for children living with CAH in the Asia Pacific. The seven stages of the KTA action cycle inform a systematic examination of comprehensive, collaborative, sustained actions to address a complex health challenge. The KTA framework demonstrates the &ldquo, how&rdquo, of CLAN&rsquo, s approach to knowledge creation and exchange, and the centrality of community development to multisectoral collaborative action across a range of conditions, cultures and countries to redressing child health inequities. This includes a commitment to: affordable access to essential medicines and equipment, education, research and advocacy, optimisation of medical management, encouragement of family support groups, efforts to reduce financial burdens, and ethical, transparent program management as critical components of success. Improvements in quality of life and health outcomes are achievable for children living with CAH and other chronic health conditions in resource-poor settings. CLAN&rsquo, s strategic framework for action offers a model for those committed to #LeaveNoChildBehind.

Pertumbuhan anak adalah suatu proses dinamis. Untuk mengetahui bagaimana seorang anak bertumbuh dibandingkan dengan anak sebayanya, diperlukan kurva pertumbuhan sebagai alat pembanding. Kurva pertumbuhan telah digunakan dalam pemantauan perkembangan anak sejak abad ke-18. Berbagai kurva pernah dikembangkan, termasuk kurva referensi dan kurva standar, seperti kurva referensi nasional yang dikembangkan di banyak negara dan kurva standar World Health Organization (WHO) yang digunakan secara internasional sejak tahun 2006. Pemantauan pertumbuhan dilakukan dengan melakukan plot hasil pengukuran ke grafik pertumbuhan, selanjutnya dibandingkan dengan pengukuran sebelumnya. Oleh karena itu, pemantauan pertumbuhan anak secara berkala penting dilakukan. Pengukuran pertumbuhan dengan teknik yang tepat disertai dengan anamnesis dan pemeriksaan fisik dapat mengenali gangguan pertumbuhan sejak dini. Deteksi dini gangguan pertumbuhan menjadi tugas penting orangtua dan tenaga kesehatan. Abnormalitas pertumbuhan juga dapat menandai adanya penyakit dasar yang bersifat kronik serius. Keterlambatan diagnosis dan tata laksana gangguan pertumbuhan menyebabkan potensi genetik anak untuk tinggi tidak tercapai dan anak menjadi pendek.

The prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents has increased globally over the past 2 decades. Metabolic syndrome, including obesity and overweight at a young age, increases the occurrence of T2DM. Studies in Indonesia have found that obese children and adolescents are more likely to have insulin resistance, a risk factor for T2DM. There are no data on the current incidence of T2DM in youth in Indonesia, but there has been a significant rise in the prevalence of overweight in adolescents. The diagnosis of T2DM in youth is similar to that in adults, with special consideration of when to test asymptomatic children. Management of T2DM in Indonesia follows the recommendations of the Indonesian Pediatric Society, which include lifestyle modifications, such as improving dietary habits and exercise, as well as appropriate medications. Metformin is the drug of choice for young T2DM patients; if marked hyperglycemia is present, basal insulin is given with metformin. Monitoring of T2DM is generally done through selfmonitoring of blood glucose and glycosylated hemoglobin.

Background Children with steroid resistant nephrotic syndrome (SRNS) generally survive, although during the course of disease their kidney function may decrease, leading to end-stage renal disease (ESRD). There have been few studies reporting on the survivals of children with SRNS. Objectives To determine patient and kidney survival rates in children with SRNS at the first, second, third, fourth, and fifth years; and to evaluate the effects of age at onset, initial kidney function, hypertension, and type of resistance, on the survivals of children with SRNS. Methods This retrospective cohort study was performed using secondary data obtained from medical records of patients with SRNS in Department of Child Health, Cipto Mangunkusumo Hospira~ between 2004-2011. The outcomes of kidney survivals were defined in two ways: lack of doubling of base creatinine levels and lack of ESRD. Results There were 45 children with SRNS in our study. Their median duration ofillness was 24 (range 12-95) months. Twenty percent of the subjects died, 31.1 % had a doublingofbase creatinine levels, and 13.4% developed ESRD. Life survival rates of subjects at the first, second, third, fourth, and fifth years after diagnosis were 93 %, 84%, 80"/ri, 7 2% ,and 61 %, respectively. Kidney survival rates determined by the lack of doubling of base creatinine levels at the first, second, third, fourth and fifth years were 92%, 72%, 56%, 42%, and 34%, respectively, while kidney survival rates determined by the lack ofESRD were 97%, 88%, 81 %, 70"/o, and 58%, respectively. Age at onset, initial kidney function, hypertension at onset, and type of resistance, did not significantly affect the survivals of children with SRNS. Conclusion Children with SRNS are prone to develop a doubling of base creatinine levels and ESRD. Factors such as age, initial kidney function, hypertension at onset, and type ofresistance, do not significantly affect both, life and kidney survivals of children with SRNS.

Background Head growth and anterior fontanel (AP) closure are passive processes in response to brain growth. The growth of the brain and skull starts in the third week of intrauterine gestation. roth processes run simultaneously as a part of integral growth, along 'With increasing gestational age, until post􀀿birth. Measurement of head circumference (He) and AF in newborns is done to determine if the brain and skull grew normally during the intrauterine period. Objectives To investigate the differences in He and AF size between preterm and full􀀿term infants, and the relationship between gestational age (GA) and birth weight (BW) to He and AF size. Methods This was a descriptive analytic study on preterm and full􀀿term newborns. Measurement of HC and AF was conducted in three phases: just after birth, 1x24 and 2x24 hours of age. Analysis of HC and AF size differences between preterm and full term subjects was performed, as well as analysis of the correlation between GA and BW to HC and AF size. Results Two hundred fifty newborns completed the study. There were 180 full􀀿term and 70 preterm subjects. Median HC in full􀀿 term and preterm male subjects were 34 cm (range 31􀀿37 cm) and 31 cm (27􀀿34 cm), respectively. Median HC in full􀀿term and preterm female subjects were 33 cm (31􀀿36 cm) and 32 cm (27􀀿3S.S cm), respectively. Median AF in full􀀿term and preterm male subjects were 2.17 cm (1.0SA.6 cm) and 2.22 cm (1.3SA.S cm), respectively, and in full􀀿term and preterm female subjects were 2.02 cm (lA.1S cm) and 2.22 cm (0.7SA cm), respectively. The HC of preterms were significantly lower than the fullterms (P

Background Congenital adrenal hyperplasia (CAH) is the most common cause of ambiguous genitalia in children and 90-95% cases show 21-hydroxylase deficiency. More than 100 mutations have been described and of these, four mutations have been frequently reported in Asia. Those mutations are deletion/large gene conversion (LGC), intron2 splice mutation (I2 splice), point mutations at codon 172 (I172N) and codon 356 (R356W). Genotyping is very valuable since close correlation observed between genotype and phenotype. Objective To identify phenotype and genotype characteristics of CAH due to 21-hydroxylase deficiency (CAH-21OH) and correlation between them. Methods From June to November 2006 we analyzed 37 confirmed CAH-21OH patients treated at the Department of Child Health, Cipto Mangunkusumo Hospital during the period of 1990-2006. Polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) analysis or amplification-created restriction site (ACRS) were performed. We first identified deletion/ LGC and I172N mutation that had been mostly reported in salt wasting (SW) and simple virilizing (SV) form patients respectively. Results There were 37 patients, consisted of 6 males and 31 females with the ratio 1:5.2. Of those, 25, 10, 2 patients were SW, SV and non-classic (NC) form, respectively. PCR-RFLP or ACRS was performed to detect two mutations in 32 patients (64 alleles). Deletion/LGC was found in 6 alleles while I172N mutations in two. All deletion alleles showed SW phenotype but I172 mutated alleles showed SW and SV phenotype. Conclusion There is a consistent close association between genotype and phenotype in our CAH-21OH patients.

The incidence rate of IDDM in our clinic during the period from 1989 to 1998 was 0.028%. There were twentyfour IDDM patients with duration of illness of more than 2 years, with a male to female ratio of 1: 1.5. Most of these patients had no diabetic family history and had good nutritional status. The insulin dosage used by these patients ranged between 0.67 - 0.72 IU/kg/day with a mean of 1.06 IU/kg/day. The average frequency of blood glucose home monitoring was less than ideal. Twenty-two out of the 24 patients were fully controlled metabolically; however, these patients still have polyuria, polydipsia, and polyphagia.

Background The prevalence of underweight children in West Nusa Tenggara is as high as 30%. This region had the third largest number of stunted children in the country. The local government has attempted to tackle this problem by providing supplementary food to underweight children.Objective To assess the success of the community-based food supplementation program onimproving children’s growth in West Nusa Tenggara.Methods We conducted a prospective cohort study for 10 months in Paruga District Primary Health Care Unit, Bima, West Nusa Tenggara, in year 2012. Children were given supplementary food according to the Ministry of Health’s guidelines, consisting of formula milk, high calorie biscuits, and a 60-day supply of eggs, estimated to be sufficient to normalize their weights, for their age and sex. A child’s weight and height were measured every 3 months and the results plotted on WHO growth charts for weight-for-age, height-for-age, and weight-for-height (nutritional status). Z-score -2 SD was classified as normal for all three categories.Results Twenty-five children under five years of age participated in this study. Subjects’ median age was 29 months. None of the subjects had normal weight-for-age Z-score at the beginning of the study. Eighty-four percent (21/25) of the subjects were severely underweight. Only 8% (2/25) of the subjects had normal height-for-age Z-score and 88% (22/25) of them were severely stunted. However, 80% (20/25) of subjects had normal nutritional status (weight-for-height). Changes in weight-for-age Z-score varied throughout the study. The highest median score was in the tenth month of follow up (-3.82). The highest median height-for-age score and weight-for-height score were also in the last month of follow up. At the end of the study, only one subject had normal weight-for-age score (4%) and none of the subjects had normal height-for-age scores. Conclusion The 10-month supplementary food program for under-five children in the Paruga District is not successful in improving body weight and height.

Thyroid hormonal dysfunction, also known as euthyroid sick syndrome or nonthyroidal illness, can be seen in sepsis. There have been few studies on thyroid hormone dysfunction in septic children, as well as on a relationship between their thyroid hormone profiles and pediatric logistic organ dysfunction (PELOD) scores. Procalcitonin (PCT) is one of the sepsis biomarker. Objective To evaluate the thyroid hormone profile in children with sepsis as well as to assess for a correlation between the thyroid levels and PELOD scores, PCT levels, and patient outcomes. Methods This cross-sectional study included children aged 1-18 years admitted to the pediatric intensive care unit (PICU) with a primary diagnosis of sepsis. PELOD scores and thyroid hormonal levels were assessed once during the first 24 hours after PICU admission. Results Thirty subjects were included in the study. The median values of T3, free T4, and TSH were 45 (range 17-133) ng/dL, 0.81 (range 0.3-1.57) ng/dL, and 1.36 (range 0.05-7.78) μIU/L, respectively. The T3, free T4, and TSH levels were decreased in 97%, 50% and 40% of the subjects. There were no significant differences between low and normal to high TSH with regards to the PELOD score (P=0.218), PCT level (P=0.694), or patient outcomes (P=0.55). The risk of death increased by 15 times among the subjects with PELOD score >20 compared to those with PELOD score

In Indonesia report on the natural history of premature thelarche is very limited. Daily practice requires physicians to have some basic practical knowledge, among others the natural history of premature thelarche, in order to manage these patients properly. We reviewed data of 85 premature thelarche patients who visited our department from January 1989 until December 1998. Only 60 patients met the study criteria. The mean chronological age of the patients at diagnosis was 43.4 months. About half of these patients (31/60) were diagnosed before they were 2 years old. Half of the patients had bilateral breast involvement. The hormonal pattern showed 24/48 follicle stimulating hormone predominant-response. Most patients (33/47) showed normal plasma estradiol level. Bone age analysis was normal in 46/57 patients, and only 9 showed accelerated bone age. Pelvic ultrasonography showed prepubertal reproduction organs in 26/35. Vaginal smears showed signs of estrogenization with various degree of stimulation in 13 patients. At the end of observation the outcome of premature thelarche were: 31 regressed, 19 persisted, 6 had progressive breast development and 4 progressed to central precocious puberty. The initial clinical and laboratory characteristics of those who developed CPP varied. Among 31 premature thelarche patients who regressed, 21 had onset of breast enlargement before age of 2 years. In most of the regressed patients (20/31), regression occurred completely within the first year. Most premature thelarche patients with onset before 2 years will regress within one year after diagnosis.

Latar belakang: kriptorkismus merupakan kelainan organ seksual lelaki yang seringditemukan. Sampai berapa tahun terapi hormonal dan pembedahan dilakukan masihkontroversial.Tujuan: penelitian ini bertujuan untuk mengetahui umur saat berobat pertama kali, asalrujukan, lokasi testis, peran perabaan, penyakit penyerta, dan peran terapi hormonalpada kriptorkismus.Cara kerja: Penelitian dilakukan secara retrospektif dari semua pasien baru yang didiagnosiskriptorkismus di Poliklinik Endokrinologi Anak RSCM selama 5 tahun (Januari 1998 –Desember 2002).Hasil: diteliti 63 pasien baru, 58 pasien diantaranya dengan kriptorkismus murni, dan 5 pasientestis retraktil. Didapat 22,4% kriptorkismus bilateral, 77,6% kriptorkismus unilateral,kriptorkismus kanan dan kiri jumlahnya hampir sama. Pasien yang dirujuk oleh spesialis anak33,3%. Umur pertama datang di poliklinik 9 bulan-2 tahun 24,1%, dan >2 tahun 56,9%.Pada perabaan, lokasi testis paling banyak tak teraba 74,1%, setelah dikonfirmasi dengan USG75% hasilnya sama dengan perabaan. Kriptorkismus disertai skrotum bifidum dan hipospadia12,6%, mikropenis 11,1%, sindrom Prader Willi, sindrom Noonan, sindrom Kallmann masingmasing1,6% dan merupakan penyakit dasar kriptorkismus. Keberhasilan Terapi hormonal65% ( inguinal 77,8% dan pada testis tak teraba 50%) , terapi dimulai sejak umur 9 bulan.Kesimpulan: sebagian besar pasien datang pada umur >2 tahun, sedangkan terapihormonal dimulai pada umur 9 bulan dengan keberasilan 65%. Pemeriksaan fisik samaakurat dibandingkan dengan pemeriksaan USG. Terapi hormonal pada kriptorkismusumur 6 bulan - 2 tahun masih efektif sebelum terapi bedah dilakukan.

Mikropenis atau hipogenitalism adalah suatu keadaan penis dengan bentuk normalnamun dengan ukuran kurang dari 2.5 SD di bawah rerata menurut umur dan statusperkembangan pubertas. Pengukuran penis dilakukan secara fully stretched, menggunakanspatula kayu yang diletakkan sejajar dengan dorsum penis dan ditekan sampai simfisispubis. Panjang penis adalah jarak dari simfisis pubis sampai ujung glans penis dan tidakdalam keadaan ereksi. Pengobatan mikropenis terhadap 23 anak dengan rerata usia 9.6tahun dilakukan dengan pemberian testosteron ester intramuskular setiap 3 minggusebanyak 4 kali. Pasca terapi penis bertambah panjang 85% dibandingkan sebelum terapi.Tidak terlihat adanya pertambahan usia tulang dengan protokol yang digunakan.

Latar belakang. Diabetes melitus tipe-1 (DM tipe-1) merupakan penyakit kronis yang dapat mempengaruhiemosi dan perilaku anak dan remaja. Pasien mengalami tekanan yang berhubungan dengan bagaimanamengontrol metabolik dan tumbuh kembang yang sedang berlangsung.Tujuan. Mengetahui gangguan perilaku pasien DM tipe-1 dan faktor-faktor yang berhubungan dengangangguan perilaku.Metode. Penelitian dilakukan secara potong lintang pada bulan Agustus 2006 di poliklinik EndokrinologiDepartemen IKA FKUI RSCM. Subjek penelitian adalah pasien DM tipe-1 umur 4-18 tahun yang diambilsecara purposive sampling. Sumber data diperoleh dari orangtua/ wali responden dengan wawancaraterpimpin, menggunakan Pediatric Symptom Check List-17 (PSC-17) dan Kuesioner Masalah MentalEmosional (KMME).Hasil. Prevalensi gangguan perilaku pasien DM tipe-1 dijumpai kemungkinan gangguan psikososial 45,8%,paling banyak adalah gangguan internalisasi (33,3%). Kemungkinan gangguan mental emosional 41,7%.Lama sakit lebih dari 5 tahun dan pernah mengalami komplikasi memiliki risiko lebih besar mengalamigangguan mental emosional.Kesimpulan. Kemungkinan gangguan perilaku pada diabetes tipe-1 45,8%. Skrining gangguan perilakupada pasien DM tipe-1 perlu dilakukan secara rutin di pusat pelayanan kesehatan sehingga dapat segeradievaluasi lebih lanjut.

Latar belakang. Sindrom Turner adalah kumpulan gejala dengan karakteristik fisik dan hilangnya satukromosom X baik secara komplit maupun parsial, dan sering pula berupa sel mosaik.Tujuan. Untuk mengetahui karakteristik pasien sindrom Turner yang meliputi kariotip, umur saatdiagnosis, perawakan, kelainan penyerta, status pubertas, kadar follicle stimulating hormone (FSH), danusia tulang.Metode. Penelitian merupakan studi deskriptif. Data diperoleh dari Perkumpulan Turner Jakarta dancatatan medik pasien yang berkunjung ke Poliklinik Endokrin Anak RSCM dari tahun 1997-2006.Hasil. Dari 20 kasus yang berhasil dikumpulkan, 17 di antaranya dengan kariotip 45,X, sisanya mosaik.Rerata umur saat diagnosis adalah 7,75 tahun (rentang 0-15 tahun); rerata berat lahir 2590 gram; perawakanpendek 18 pasien (18/20). Terdapat 8 pasien dengan kelainan penyerta yaitu 4 anak kelainan jantung, 3gangguan telinga, dan 1 orang dengan hipertensi. Saat diagnosis tujuh pasien, mengalami pubertas terlambat.Rerata kadar FSH dari 16 pasien adalah 82,94 IU/liter (rentang 13,8-188 IU/liter). Data usia tulang (16pasien) menunjukkan retarded (11 pasien), dan sisanya average.Kesimpulan. Pada penelitian ini karakteristik utama sindrom Turner adalah kariotip 45,X dengankarakteristik fisik perawakan pendek dan pubertas terlambat disertai kelainan penyerta

Prevalens dan insidens diabetes mellitus tipe 2 (DMT2) pada anak terus mengalami peningkatan di seluruhdunia. Data di Indonesia menunjukkan prevalens diabetes pada anak di daerah perkotaan Jakarta meningkatdari 1,7% pada tahun 1982 menjadi 5,7% pada tahun 1995, namun sayangnya tidak ada data lebih lanjutmengenai prevalens DMT2. Sampai saat ini, obat anti diabetik oral yang sudah disetujui penggunaannyapada anak oleh oleh Food and Drug Administration (FDA) hanya metformin. Sedangkan obat anti diabetikoral golongan lain masih dalam perdebatan. Dari penelusuran literatur didapatkan bahwa secara umummekanisme kerja obat-obat tersebut dalam mengontrol kadar gula darah yaitu dengan meningkatkan sekresiinsulin seperti obat golongan sulfonylurea, menurunkan resistensi insulin seperti obat golongan biguaniddan menurunkan absorpsi glukosa postprandial seperti obat golongan inhibitor􀀀􀁁-glucosidase. Keberhasilanterapi dinilai berdasarkan kadar glukosa darah, kadar HbA1c, dan sindrom metabolik yang menyertainyaseperti obesitas, hipertensi dan hiperlipidemia. Sampai saat ini belum ada data mengenai efektifitas dankeamanan penggunaan obat anti diabetik oral selain biguanid metformin. Uji klinis mengenai penggunaanobat-obatan anti diabetik oral selain metformin pada anak dengan DMT2 masih perlu dilakukan untukdapat dijadikan suatu rekomendasi terapi. Selain mengontrol kadar gula darah, tata laksana DMT2 jugameliputi modifikasi gaya hidup dan mengatasi gejala sindrom metabolik yang menyertainya.

Latar belakang. Indonesia merupakan salah satu negara di dunia dengan angka kelahiran prematur terbanyak. Salah satu morbiditas yang umum dijumpai adalah anemia. Akibatnya, pasien sering mendapatkan transfusi PRC di minggu pertama kehidupannya. Mencegah anemia akan mengurangi kemungkinan tranfusi dan risiko komplikasinya. Tujuan. Mengetahui karakteristik bayi prematur yang mengalami anemia dan transfusi PRC sebelum usia kronologis 4 minggu Metode. Studi potong lintang terhadap rekam medis semua bayi baru lahir prematur yang menjalani perawatan di Unit Perinatologi RSCM periode 1 Januari 2012 sampai dengan 31 Desember 2013. Penilaian karakteristik bayi prematur meliputi kadar Hb, berat lahir, usia gestasi, riwayat tranfusi PRC, status sepsis, lama rawat, dan status keluar. Hasil. Didapatkan 393 subjek memenuhi kriteria penelitian, 94 (23,9%) anemia dan 123 (31,3%) minimal satu kali mendapatkan transfusi PRC. Frekuensi tersering anemia dan mendapatkan transfusi PRC berturut-turut adalah 4 dan 7 kali. Usia pertama kali mengalami anemia dan transfusi PRC adalah usia 􀁤7 hari Variabel dengan perbedaan proporsi karakteristik yang sama menunjukkan hasil bermakna secara statistik adalah variabel usia gestasi, berat lahir, transfusi PRC, status sepsis, lama rawat, dan status keluar. Kesimpulan. Insiden bayi prematur yang mengalami anemia 23,9%, sedangkan insiden transfusi PRC 31,3%. Kejadian anemia dan transfusi PRC paling banyak dialami pada satu minggu pertama kehidupan. Perbedaan proporsi antar variabel untuk kejadian anemia dan kejadian transfusi PRC secara statistik bermakna ditemukan pada variabel yang sama, yaitu usia gestasi, berat lahir, status sepsis, lama rawat, dan status keluar.

Latar belakang. Pemberian terapi hormonal pada undesensus testis (UDT) masih direkomendasikan di Indonesia sedangkan Consensus Report of Nordic Countries menyatakan bahwa terapi lini pertama untuk undesensus testis adalah operasi dan terapi hormonal tidak direkomendasikan lagi. Tujuan. Mengevaluasi dampak samping terapi hormonal dan pembedahan pada undesensus testis berdasarkan bukti ilmiah. Metode. Penelusuran pustaka database elektronik : Pubmed, Cochrane, Medline, Pediatrics. Hasil . Terdapat 11 penelitian mengenai dampak terapi pada UDT. Lima penelitian prospektif melakukan pemantauan sampai usia pasien 3 tahun sedangkan 6 penelitian lainnya merupakan studi potong lintang pada pria dewasa dengan riwayat undesensus testis. Volume testis dan kualitas sperma lebih rendah pada pasien yang memiliki riwayat terapi hormonal dibandingkan dengan pasien yang menjalani pembedahan saja. Risiko infertilitas meningkat (OR 4,7) pada pasien yang menjalani terapi hormonal. Risiko keganasan meningkat jika pembedahan dilakukan lebih dari usia 10 tahun. Kesimpulan. Terapi hormonal pada UDT dapat meningkatkan risiko infertilitas di kemudian hari oleh karena itu terapi hormonal sebaiknya tidak dianjurkan. Pasien dengan UDT berisiko menderita keganasan testis di usia dewasa dan orkiopleksi dini (sebelum usia 12 bulan) terbukti menurunkan risiko tersebut.

The condition of 5-alpha-reductase type 2 deficiency (5-ARD) is an inherited disorder resulting in the inability to convert testosterone to dihydrotestosterone (DHT). This disorder was previously termed as familial incomplete male pseudohermaphroditism type 2, pseudovaginal perineoscrotal hypospadias. Clinical manifestation of 5-ARD is limited to male genetic. The affected males are usually identified as female in childhood but undergo striking virilization at puberty. While overall incidence for various countries are not established, increased incidence is reported in the Dominican Republic, some highland tribes in New Guinea, Lebanon and Turkey. This was the first documented case in Cipto Mangunkusumo (CM) Hospital.

Background Childhood obesity is a global health problem, with the prevalence is differed in each country and affected by many factors, such as lifestyle and physical activity. Insulin resistance (IR) as a basic mechanism of several metabolic diseases in obesity, is related with metabolic syndrome (MetS) along with its long term complications, such as type 2 diabetes mellitus (T2DM). Several factors are known to be associated with IR, and the presence of acanthosis nigricans (AN) has an important meaning in predicting IR. Objectives To assess the prevalence of IR, MetS in obese adolescents and its potentially associated factors, such as gender, signs of AN, and family history of metabolic diseases. Methods A cross-sectional study was performed in obese adolescents, aged 12-15 years, over a two-month period. Fasting blood glucose, insulin, and lipid profiles were measured. Obesity was defined using body mass index (BMI). Insulin resistance was quantified by the homeostasis model assessment for IR (HOMA-IR) . Metabolic syndrome was defined according to the International Diabetes Federation (IDF) 2007 criteria. Results Of92 obese adolescents, IR was found in 38% of subjects, with females predominating (57.2%). Signs of AN were seen in 71. 4% of subj ects and a positive family history of metabolic diseases was found in 82.8% of subjects, including family history of obesity, type 2 diabetes mellitus (T2DM), and hypertension. Less than 10% of subjects were considered to be in a prediabetic state, and none had T2DM. No statistical significance was found between gender, family history, or signs of AN and IR (P>0.05). Metabolic syndromes was found in 19.6% of subjects, with the fo llowing prevalences for each component: 34.8% for hypertension, 78.3% for central obesity, 8.7% for impaired fasting glucose (IFG), 22.8% for low levels of HDL, and 2 1. 7% for high triglyceride levels. A strong correlation was found between IR and IFG with OR= 5 .69 (95%CI 1.079 ~ 29.993, P= D.04). Conclusion We find a high prevalence ofIRin obese adolescents, and IR increases the risk of prediabetes. Thus, prevention strategies are needed to overcome the long term impact of obesity on health.

Background Type 1 diabetes mellitus (T1DM) is an emerging disease worldwide. Glycemic control in pediatric T1DM patients is a challenge in diabetes management. Attending diabetic camp has been associated with improved glycemic control in diabetic children and adolescents.Objective To determine the effect of diabetic camp attendance on glycemic control in children and adolescents with T1DMMethods A cross-sectional, non-experimental study was done in December 2010 at a diabetic camp held in Bogor, Indonesia. The two-day camp educated diabetics about T1DM, including insulin use, meal planning, exercise, monitoring and complications. The diabetic camp was attended by 28 children and adolescents, consisting of 5 boys and 23 girls, aged 7 – 18 years. Eighteen participants completed the requested data for our study. Glycosylated hemoglobin (HbA1c) was measured before and 3 months after subjects attended the camp. Participants also filled the Pediatric quality of life (PedsQL) questionnaire. We compared HbA1c levels before camp and 3 months after, by Stata 19.Results Before camp, the mean HbA1c was 9.18% (SD 2.48) and 3 months after camp it was 8.67% (SD 1.62), a statistically significant improvement (P=0.004). The PedsQL revealed that none of the subjects had poor quality of life.Conclusion Glycemic control in T1DM children and adolescents was significantly improved 3 months after attending diabetic camp compared to that before attending camp. According to subjects’ self-assessment by PedsQL questionnaire, no subjects indicated a poor quality of life for the duration of their illness. [Paediatr Indones. 2011;51:294-7].