Hyperbilirubinemia is an increase of the blood bilirubin level due to physiological or non-physiologic factors, which is clinically characterized by jaundice. Bilirubin is produced in the reticuloendothelial system as the end product of heme catabolism through an oxidation-reduction reaction. Due to its hydrophobic nature, unconjugated bilirubin is carried in the plasma, tightly bound to albumin. In the liver, bilirubin is transported into hepatocytes, bound to ligandin. After being excreted to the small intestine through the bile ducts, bilirubin undergoes a reduction to become colorless tetrapyrole due to the action of intestinal microbes.This unconjugated bilirubin can be reabsorbed into the circulation; therefore, it increases total plasma bilirubin. The treatments of hyperbilirubinemia in neonati are phototherapy, intravenous immunoglobulin (IVIG), replacement transfusion, temporary breastfeeding cessation, and medical therapy. Keywords: hyperbilirubinemia, bilirubin, biliverdin, enterohepatic cycle.     Abstrak: Hiperbilirubinemia ialah terjadinya peningkatan kadar bilirubin dalam darah, baik oleh faktor fisiologik maupun non-fisiologik, yang secara klinis ditandai dengan ikterus. Bilirubin diproduksi dalam sistem retikuloendotelial sebagai produk akhir dari katabolisme heme dan terbentuk melalui reaksi oksidasi reduksi. Karena sifat hidrofobiknya, bilirubin tak terkonjugasi diangkut dalam plasma, terikat erat pada albumin. Ketika mencapai hati, bilirubin diangkut ke dalam hepatosit, terikat dengan ligandin. Setelah diekskresikan ke dalam usus melalui empedu, bilirubin direduksi menjadi tetrapirol tak berwarna oleh mikroba di usus besar. Bilirubin tak terkonjugasi ini dapat diserap kembali ke dalam sirkulasi, sehingga meningkatkan bilirubin plasma total. Pengobatan pada kasus hiperbilirubinemia dapat berupa fototerapi, intravena immunoglobulin (IVIG), transfusi pengganti, penghentian ASI sementara, dan terapi medikamentosa. Kata kunci: hiperbilirubinemia, bilirubin, biliverdin, siklus enterohepatik.

Pneumonia is an acute respiratory tract infection that became a public health problem in the world due to the high mortality in infants and toddlers. This study was aimed to describe the characteristics of pneumonia in children treated at the pediatric intensive care unit Prof. Dr. R. D. Kandou Hospital Manado in 2013 - 2015. This was a descriptive retrospective study with a cross sectional design. Subjects were all children suffering from pneumonia hospitalized at the pediatric intensive care unit Prof. Dr. R. D. Kandou Hospital Manado in 2013 – 2015. There were 158 cases consisted of 62 patients in 2013, 74 patients in 2014, and 22 patients in 2015. Most of them were males (88 patients) and at the age group <1 year (108 patients). The average pulse was 194.75 beats/minute, the average breathing rate was 60.4 breaths/minute, and the average body temperature was 37.8 ° C. The majority showed retraction at the subcostal area (148 patients), crackles (142 patients), inaudible wheezing (147 patients), clinical symptom as shortness of breath (148 patients), chest X-ray as infiltrate (151 patients), laboratory tests as the average value of hemoglobin was 11.3 g / dL, the average hematocrit was 33.3%, the average of leukocyte count was 45,293/mm3, and the average of platelet count was 364.437/mm3. Keywords: pneumonia, children, characteristic features Abstrak: Pneumonia merupakan penyakit infeksi saluran pernapasan akut yang menjadi masalah kesehatan di dunia karena angka kematiannya sangat tinggi pada bayi dan balita. Penelitian ini bertujuan untuk mengetahui gambaran karakteristik pneumonia pada anak yang dirawat di ruang perawatan intensif RSUP Prof. Dr. R. D. Kandou Manado pada tahun 2013-2015. Jenis penelitian ialah deskriptif retrospektif dengan desain potong lintang. Subjek penelitian ialah semua anak yang menderita pneumonia dirawat di ruang perawatan intensif anak di Bagian Ilmu Kesehatan Anak RSUP Prof. Dr. R. D. Kandou Manado selang Januari 2013 – Desember 2015. Terdapat 158 kasus dengan rincian 62 pasien pada tahun 2013, 74 pasien pada tahun 2014, dan 22 pasien pada tahun 2015. Didapatkan anak yang menderita pneumonia paling banyak pada jenis kelamin laki-laki (88 pasien) dan kelompok usia <1 tahun (108 pasien). Nilai rerata denyut nadi didapatkan 194,75 kali/menit, laju pernapasan 60,4/menit, dan suhu badan 37,8 ºC. Sebagian besar kasus memperlihatkan retraksi di bagian subkostal (148 pasien), ronki (142 pasien), tanpa wheezing (147 pasien), gejala klinis sesak nafas (148 pasien), gambaran foto toraks adanya infiltrat (151 pasien). Pemeriksaan laboratorium mendapatkan rerata nilai hemoglobin 11,3 g/dL, hematokrit 33,3%, hitung leukosit 45.293/mm3, dan hitung trombosit 364.437/mm3.Kata kunci: pneumonia, anak, gambaran karakteristik

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 <0.05. Results A low Ret-He level was significantly associated with IDA in children (P=0.005). The Ret-He cut-off point of 27.8 pg/L had sensitivity of 43.8%, specificity 85.3%, PPV 58.3%, and NPV 76.3%, with OR 4.5 (95%CI 1.1 to 17.7). Conclusion We find a significant positive relationship between Haemoglobin (Hb) and Ret-He in children, A low level of Ret-He is associated with greater risk of IDA in children. The Ret-He has a high specificity. As such, Ret-He may be useful as a screening tool for early detection of IDA in children. [Paediatr Indones. 2016;56:90-4.].

Pulmonary Tuberculosis (Tb) is still a public health problem. The prevalence of pulmonary Tb from year to year in Manado is still high even though the management of strategy is relatively the same- prevention by immunization, case finding, and treatment strategy with supervision and with DOT directly. Prevention with immunization results in better body resistance. Immunization against Tb is required in some countries and is recommended in several other countries. Although the majority of toddlers are already BCG vaccinated there are still many pulmonary Tb cases among children in Manado. This study aimed to obtain the relationship between the BCG immunization and pulmonary TB occurence in children in Tuminting Primary Health Care, Manado. The results showed that at Tuminting Primary Health Care most of the toddlers had been BCG immunized. Tuberculosis was found among toddlers aged >3 years and there was a significant correlation between BCG immunization and the occurence of tuberculosis with an OR 0.804. Keywords: immunization BCG, occurence of TB  Abstrak: Penyakit TB paru sampai saat ini masih menjadi masalah kesehatan masyarakat. Prevalensi TB paru dari tahun ke tahun di Kota Manado tetap tinggi meskipun strategi penanganan yang diterapkan relative sama, yaitu pencegahan dengan imunisasi. penemuan penderita, dan pengobatan dengan strategi DOT atau dengan pengawasan minum obat secara langsung. Pencegahan dengan imunisasi merupakan tindakan yang mengakibatkan seseorang mempunyai ketahanan tubuh yang lebih baik. Imunisasi terhadap penyakit TB telah diwajibkan di beberapa negara serta direkomendasikan di beberapa negara lainnya. Penyakit TB banyak terjadi pada anak di Kota Manado padahal anak balita tersebut sebagian besar sudah divaksinasi BCG. Penelitian ini bertujuan untuk mengetahui hubungan antara pemberian imunisasi BCG dengan kejadian TB Paru pada anak di Puskesmas Tuminting Manado. Hasil penelitian memperlihatkan bahwa sebagian besar anak balita yang berobat di Puskesmas Tuminting telah diberikan imunisasi BCG. Kejadian tuberkulosis ditemukan pada umur >3 tahun dan terdapat hubungan bermakna antara pemberian imunisasi BCG dengan kejadian tuberkulosis paru dengan nilai OR 0,804.Kata kunci: imunisasi BCG, kejadian TB paru

Background Tuberculosis (TB) in is children different from TB in adults in terms of the difficulty in making prompt diagnosis, the more progressive course of disease and the high-risk for the occurrence of disseminated TB. Transmission of TB in children mostly originates from adults, which the biggest risk is the index case with positive sputum smear.Objective To find out the incidence of TB in children who have close contact with adult TB patients and to determine some risk factors for the development of childhood TB.Method This cross-sectional study was conducted between March to July 2009. We studied children aged less than 5 years old with close contact, living in the same house with adult TB patients. The diagnosis of TB was made based on National TB scoring system for children.Results Of the 50 children, we obtained 17 (34%) positive children with TB after going through with national TB scoring system for children. There was a significant relationship between AFB positive sputum, passive smokers and residential density (overcrowding), but there was no significant relationship between age, nutritional status, gender of the contact source, and family income per month.Conclusion Only the positive sputum smear has a significant correlation associated with the occurrence of TB in children who have close contact with adult TB patients.

Asthma is a heterogen disease marked by chronic inflammation in the respiratory tract with a history of disturbance of breathing such as wheezing, dyspnea, and cough. This disease can occur at any age. The etiology of asthma is still unclear but there are various risk factors which can cause asthma inter alia sex, history of atopy, change of weather, dust mites, smoke, pet, and food. This study was aimed to obtain the prevalence of asthma and its risk factors in patients aged 0-18 years at GMIM Bethesda Hospital in Tomohon. This was a descriptive retrospective study. Samples were patients aged 0-18 years admitted at the Pediatric Division of GMIM Bethesda Hospital from August 2011 to July 2016. The results showed that the highest prevalence was from August 2011 to July 2012 (21.62%) and the risk factors which affected asthma in children were as follows: male (55.41%), age 5-9 years old (31.08%), history of atopy (52.70%), and change of weather (55.40%). Conclusion: The highest prevalence of ashmatic patients was 21.62% from August 2011 to July 2012. The majority of risk factors were male sex, change of weather, history of atopi, and dust mites.Keywords: asthma, prevalence, risk factor, children Abstrak: Asma merupakan penyakit heterogen yang biasanya ditandai oleh peradangan kronik pada saluran napas dengan riwayat gejala pernapasan seperti mengi, sesak napas, dan batuk yang dapat terjadi pada semua kelompok usia. Etiologi asma masih belum jelas namun terdapat berbagai faktor risiko yang dapat memicu terjadinya asma seperti jenis kelamin, usia, riwayat atopi, perubahan cuaca, tungau debu rumah, paparan asap rokok, binatang piaraan, dan makanan. Penelitian ini bertujuan untuk mengetahui prevalensi asma dan faktor-faktor risiko yang memengaruhi terjadinya athat the highest prevalence wassma di RSU GMIM Bethesda Tomohon. Jenis penelitian ialah deskriptif retrospektif. Sampel penelitian ialah pasien anak usia 0-18 tahun dengan diagnosis utama asma yang dirawat di Bagian Ilmu Kesehatan Anak RSU GMIM Bethesda Tomohon pada periode Agustus 2011-Juli 2016. Hasil penelitian menunjukkan prevalensi terbanyak pada periode Agustus 2011-Juli 2012 (21,62%) dan faktor risiko yang memengaruhi asma pada anak berupa jenis kelamin laki-laki (55,41%), usia 5-9 tahun (31,08%), riwayat atopi (54,05%), tungau debu rumah (52,70%), dan perubahan cuaca (55,40%). Simpulan: Kejadian asma terbanyak terjadi pada periode Agustus 2011-Juli 2012 sebesar 21,62%. Faktor risiko tersering ditemukan ialah jenis kelamin laki-laki, perubahan cuaca, riwayat atopi, dan tungau debu rumah. Kata kunci: asma, prevalensi, faktor risiko, anak

Background In cases of acute diarrhea, it is difficult to distinguishbetween bact erial and non-bacterial causes . Increased fecalcalprotectin (f-CP) level is a marker of neutrophil migration in theintestinal lumen and is associated with intes tinal inflammation.Previous studies reported an increase in f-CP levels in childrenwith acute diarrhea, which is caused by bacteria, but only fewhave studied the relationship between intestinal pathogens withf-CP levels in acute diarrhea.Objective To assess for a correlation between gut pathogens andfecal calprotectin levels in children with acute diarrhea.Methods We conducted a cross-sectional study between Julyto November 2012 on children aged 1-5 ye ars with acutediarrhea, and underwent routine blood tests, stool microscopy,f-CP tests, and stool cultures. We used a simple linear regressionand correlation analysis with a significance level of P< 0.05.Results Forty-two children enrolled in this study. The mean age ofsubjects was 2.27 (SD 134) years. Theirmeanf-CP level was 93.88(SD 14.68) μg/g. On microscopic stool examination, 26 patients( 61.9%) had positive leukocytes, 1 had Ancy lo stoma duodenale, 1had Ascaris lumbricoides, and 2 had Blastocystis hominis. Positivestool cultures were found in 14 children (33.3%) with acutediarrhea. There was a significant positive correlation between gutpathogens and f-CP levels (r=0.605; P< 0.0001).Conclusion In young children with acute diarrhea, the averagef-CP levels are higher in those with positive intestinal pathogens.

Abstrack: Background : Pneumonia is an important cause of neonatal infection. Neonatal mortality rate in pneumonia ranged from 750,000 to 1.2 million deaths and the number of deaths is unknown at birth each year. Methods : This study uses a retrospective descriptive. Results : 95.31% occurred in the age group 0-7 days. 85.94% with normal leukocyte levels. 54.69% trombist normal levels. 40.62% increase hemoglobin levels. On examination CRP increased 67.86%. 54.69% IT ratio <0.2. 96.87% with clinical symptoms of tachypnea. 45.83% using the first linea (amoxycillin + gentamicin). 53.12% of patients were healed with the state. Conclusions : Neonatal pneumonia is most prevalent in early onset (0-7 days). Normal leukocytes are most found. While the platelets also found in most normal limits. The hemoglobin most commonly found an increase. Examination results are most CRP increased. Furthermore, the examination and the ratio of immature neutrophils total (IT ratio) is most commonly found <0.2. Tachypnea is the most clinical symptoms found. Patients with pneumonia were cured many neonates using the first linea treatment combinations (amoxycillin + gentasmisin). Mortality rates were obtained from neonates suffering from pneumonia at 4.69%. Key words : Pneumonia, neonates.  Abstrak: Latar Belakang : Pneumonia merupakan penyebab penting infeksi neonatal. Angka kematian neonatal pada penyakit pneumonia berkisar antara 750.000 sampai 1,2 juta kematian dan jumlah kematian saat dilahirkan tidak diketahui setiap tahunnya. Metode : Penelitian ini menggunakan metode deskriptif retrospektif. Hasil : 95,31 % terjadi pada kelompok umur 0 – 7 hari. 85,94 % dengan kadar leukosit normal. 54,69 % kadar trombist normal. 40,62 % kadar hemoglobin meningkat. Pada pemeriksaan CRP 67,86 % meningkat. 54,69 % IT Rasionya <0,2. 96,87 % dengan gejala klinis takipnea. 45,83 % menggunakan linea pertama (amoxycillin+gentamisin).  53,12 % dengan keadaan penderita yang sembuh. Kesimpulan : Pneumonia neonatus paling banyak ditemukan pada onset awal (0-7 hari). Leukosit ditemukan paling banyak normal. Sementara trombosit juga ditemukan paling banyak dalam batas normal. Hemoglobin paling banyak ditemukan adanya peningkatan. Pemeriksaan CRP hasilnya paling banyak mengalami peningkatan. Selanjutnya pada pemeriksaan Rasio imatur dan neutrofil total (Rasio IT) yang paling banyak ditemukan <0,2. Takipnea merupakan gejala klinis yang paling banyak ditemukan. Penderita pneumonia neonatus banyak yang sembuh dengan menggunakan pengobatan linea pertama kombinasi (amoxycillin+gentasmisin). Angka kematian yang didapatkan dari neonatus yang menderita pneumonia sebesar 4,69%. Kata Kunci : Pneumonia, neonatus.