Background Thrombocytopenia is the most common hematological abnormality in the neonatal period. Hemorrhagic manifestations are found in 10% cases of thrombocytopenia. Neonatal thrombocytopenia commonly assumed due to sepsis, despite many risk factors that may caused thrombocytopenia. Objective To obtain incidence and risk factors of neonatal thrombocytopenia. Methods A cross sectional study was conducted in April 2009. Complete blood counts investigation was performed before age of 24 hours, medical conditions and risk factors of mothers and subjects were noted, as well as hemorrhagic manifestations. Subjects with thrombocytopenia were followed for 2 weeks. The risk factors consisted of hypertension in pregnancy, pre-eclampsia, eclampsia, intrauterine growth retardation, gestational diabetes mellitus, perinatal infection, asphyxia, sepsis, and necrotizing enterocolitis. Results Neonatal thrombocytopenia was found 17 (12.1%) of 140 subjects, consisted of 88.2% early onset and 11.8% late onset. Significant risk factor of mother was pre-eclampsia (PR 3.97, 95%CI 1.70 to 9.25), while significant risk factors of neonates were asphyxia (PR 5.66, 95%CI 2.49 to 12.86), sepsis (PR 5.33,) and necrotizing enterocolitis (p=0.014; PR 9.2 95% CI 5.17 to14.84). We found 29.4% hemorrhagic cases of neonatal thrombocytopenia (i.e.,. skin, gastrointestinal, intracranial hemorrhage). Conclusions The incidence of neonatal thrombocytopenia was 12.2%. Significant risk factor of mother that caused thrombocytopenia was pre-eclampsia, while risk factors of neonates were asphyxia, sepsis and necrotizing enterocolitis.
Introduction Diarrhea remains a major problem for communityhealth in Indonesia. More than 25% of children with severe diar-rhea suffer from malabsorption syndrome.Objectives This study aimed to determine the age range of chil-dren with acute diarrhea, the prevalence of macronutrient malab-sorption, and the relationship between age and bacterial infec-tion in macronutrient malabsorption.Methods This was a cross-sectional study, subjects were chil-dren aged 0-59 months with acute diarrhea whose stools wereobtained and examined in the laboratory of GastrohepatologyDivision, Department of Child Health, Cipto Mangunkusumo Hospi-tal, Jakarta from January 2002 to December 2003.Results Children with acute diarrhea were mostly in the agerange of 0-11 months (61%). The prevalence of lactose malab-sorption was 11%, carbohydrate malabsorption was 19%, andfat malabsorption was 51%. Moreover, the age group of 0-11months had a 1.5 times greater possibility of lactose and fatmalabsorption compared to that of 12-59 months. The 12-59 monthsage group had a greater possibility of suffering carbohydratemaldigestion (70%). The group of children who did not sufferfrom bacterial infection had a higher prevalence of lactose mal-absorption (54%), carbohydrate maldigestion (65%), and fatmalabsorption (58%).Conclusions Acute diarrhea occurred more frequently in theage of 0-11 months. There was a significant correlation betweenthe age groups of 0-11 months and 12-59 months in experiencingmacronutrient malabsorption. Lactose malabsorption, carbohy-drate maldigestion, and fat malabsorption were encountered morefrequently in the group that did not have bacterial infection
Background Helicobacter pylori infection is a common infection.Risk of infection in rural areas is six times higher than in urbanareas.Objectives To study the prevalence of H. pylori infection in primary school students in rural area and its contributing factors.Methods A cross-sectional study was performed in a rural primaryschool in Serang district, Banten, West Java. Serology of H. pyloriwas tested using Bio M pylori kit (Mataram, Indonesia).Results Forty two of 125 subjects (33.6%) had positive H. pyloriserologies. Bivariate analysis found that the the family habit ofeating together from one container increased the infection risk5.93 times (95% Cl 3.07 to 11.43). Source of drinking waterfrom common river increased the risk 9.88 times (95% CI 3.03to 32.24). Bed and bedroom sharing increased the risk 1.55 times (95% CI 1.23 to 1.95) and 2.22 times (95% CI 1.65 to 2.99), respectively. Multivariate logistic regression analysis including all variables with P <0.25 showed that the most significant factor contributing to H. pylori infection is common river as family drinking water source (OR 24.97, 95% CI 3.9 to 159.76), followed by family habit of eating together from one container (OR 10.23, 95% CI 3.05 to 34.27), and bed or bedroom sharing (OR 9.48, 95% CI 2.4 7 to 36.38).Conclusion Prevalence of H. pylori infection in rural schoolstudents is 33.6%. There are significant associations betweenH. pylori infection and family habit of eating together from onecontainer, bed sharing with other family members, and familydrinking water source from common river.
Kegawatan demam berdarah dengue (DBD) yang mengancam nyawa adalah disfungsi sirkulasi atau syok hipovolemik yang disebabkan oleh peningkatan permeabilitas kapilar dan perdarahan, sehingga terjadi plasma leakage, penurunan perfusi organ, penurunan suplai oksigen dan nutrien untuk sel yang dapat berlanjut dengan gagal organ multiple dan kematian. Tata laksana kegawatan DBD berorientasi pada pendekatan patofisiologik multi system terpadu yang diarahkan pada pemenuhan kebutuhan oksigen dan nutrien, termasuk didalamnya tunjangan ventilasi, pemberian oksigen, resusitasi cairan dan obat resusitasi. Resusitasi cairan paling baik diberikan saat syok kompensasi, dengan pemberian cairan kristaloid atau koloid secara agresif 10-30 ml/kgbb dalam 6-10 menit untuk meningkatkan preload, curah jantung, volume sirkulasi efektif, memperbaiki perfusi organ, sehingga mekanisme homeostatis atau mekanisme kompensasi tidak digunakan lagi dan kesembuhan segera pasien sindrom syok dengue dapat diharapkan.Kata kunci: disfungsi sirkulasi, syok hipovolemik, preload. Sari Pediatri, Vol. 4, No. 4, Maret 2003: 156 -162 A pelepasan oksigen di organ vital secara optimal.5,10 Pada keadaan suplai oksigen rendah, mekanisme neurohumoral terutama sistem saraf simpatis diaktifkan sehingga terjadi vasokonstriksi dan pengalihan aliran darah dari kulit, ginjal, saluran cerna dan otot rangka ke otak dan jantung. Perangsangan sistem saraf simpatis juga menyebabkan pelepasan norepinefrin dan epinefrin, katekolamin yang memberi efek serupa dengan stimulasi sistem saraf simpatis. 5Penurunan perfusi ginjal menyebabkan pelepasan renin, angiotensin II, aldosteron dan arginine vasopressin (AVP) sehingga terjadi retensi air dan sodium serta peningkatan volume intravaskular. Penurunan pH susunan saraf pusat merangsang kemoreseptor di daerah medula sehingga terjadi peningkatan volume tidal, frekuensi pernapasan, hiperventilasi, volume pernapasan semenit, dan alkalosis respiratorik. Secara umum pada anak sakit gawat, peningkatan aktivitas neurohumoral membantu pelepasan oksigen melalui hiperventilasi, vasokonstriksi, redistribusi aliran darah, peningkatan volume intravaskular, tekanan darah, denyut jantung dan kontraktilitas miokard. 5,10Penanganan awal seorang anak sakit gawat dilakukan melalui pendekatan pada disfungsi multisistem. Diarahkan pada optimalisasi mekanisme nak sakit gawat ialah anak nyawanya terancam oleh kekurangan suplai oksigen dan nutrien yang disebabkan oleh disfungsi respirasi dan kardiovaskular atau peningkatan kebutuhan oksigen pada berbagai keadaan stres seperti trauma, tindakan bedah, luka bakar, sepsis, demam tinggi, keracunan, syok, malformasi kongenital, keganasan, henti jantung-paru dan sakit gawat lain.
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