Should formula for infants provide arachidonic acid along with DHA? A position paper of the European Academy of Paediatrics and the Child Health Foundation

Recently adopted regulatory standards on infant and follow-on formula for the European Union stipulate that from 2021 onwards, all such products marketed in the European Union must contain 20-50 mg/100 kcal of omega-3 docosahexaenoic acid (DHA), which is equivalent to about 0.5-1 % of fatty acids and thus higher than typically found in human milk and current infant formula products, without the need to also include omega-6 arachidonic acid (ARA). This novel concept of infant formula composition has given rise to concern and controversy since there is no accountable evidence on the suitability and safety in healthy infants. Therefore, international experts in the field of infant nutrition were invited to review the state of scientific research on DHA and ARA, and to discuss the questions arising from the new European regulatory standards. Based on the available information, we recommend that infant and follow-on formula should provide both DHA and ARA. The DHA should equal at least the mean content in human milk globally (0.3 % of fatty acids) but preferably reach a level of 0.5 % of fatty acids. While optimal ARA intake levels remain to be defined, we strongly recommend that ARA should be provided along with DHA. At levels of DHA in infant formula up to about 0.64%, ARA contents should at least equal the DHA contents. Further well-designed clinical studies should evaluate the optimal intakes of DHA and ARA in infants at different ages based on relevant outcome

Masalah Tidur pada Anak

Tidur merupakan salah satu kebutuhan dasar manusia, kebutuhan tidur untuk semua umur berbeda. Tidur merupakan keadaan berkurangnya tanggapan dan interaksi dengan lingkungan yang bersifat reversibel dan berlangsung cepat. Gangguan tidur dapat terjadi pada anak dengan manifestasi kesulitan pada saat mulai tidur, mempertahankan tidur, atau gangguan yang berhubungan dengan pernapasan. Penyebab gangguan tidur dapat bersifat internal maupun eksternal. Faktor lingkungan dapat mempengaruhi kualitas tidur pada anak, demikian pula perilaku dan kebiasaan dapat dihubungkan dengan gangguan tidur. Pengukuran kualitas tidur dapat dilakukan menggunakan polisomnografi (PSG) dan aktigrafi (ACG). Cara lain untuk mendeteksi gangguan tidur menggunakan kuesioner atau interview. Brief screening questionnaire for infants sleep problem merupakan kuesioner yang sudah divalidasi terhadap ACG. Tidur yang buruk berdampak negatif terhadap mood dan perilaku bahkan dapat bermanifestasi sebagai gejala psikiatrik. Penanganan bersifat multifaktor, kadang - kadang terapi medikamentosa dapat digunakan pada kasus khusus

Nutritional status and physical activity of childhood leukemia survivors

Background Acute lymphoblastic leukemia (ALL), the most common malignancy of childhood, has an overall cure rate of approximately 80%. Long-term survivors of childhood ALL are at increased risk for obesity and physical inactivity that may lead to the development of diabetes, dyslipidemia, metabolic syndrome, as well as cardiovascular dis eases, and related mortality in the years following treatment. Objective To evaluate the physical activity and the propensity for developing obesity longer term in ALL survivors. Methods This retrospective cohort study included all ALL survivors from Pantai Indah Kapuk (PIK) Hospital. We assessed their physical activity and nutritional status at the first time of ALL diagnosis an d at the time of interview. Results Subjects were 15 ALL survivors aged 7 to 24 years. The median fo llow up time was 6.4 years (range 3 to 10 years). Only 2 out of 15 survivors were overweight and n one were obese. All survivors led a sedentary lifestyle. Most female subjects had increased BMI, though most were not overweight/obese. Steroid therapy in the induction phase did not increase the risk of developing obesity in ALL survivors. Conclusion Lon g-term survivors of childh ood ALL do not meet physical activity recommendations according to the CDC (Centers for Disease Control). Howevei; steroid therapy do not seem to lead to overweight/obesity in ALL survivors

Predictors for the recurrent febrile seizures after the first complex febrile seizures

Background Complex febrile seizures (CFS) have been shown to be related to recurrence and epilepsy. Many studies were done to determine the predictors of recurrence in both simple and com- plex febrile seizures. To our knowledge until now there is no pub- lished data that specially looks for predictors of recurrence after a first CFS. Objective To find out clinical and demographical characteristics of a first CFS and to define the predictors for the recurrent febrile seizures. Methods Prospective survival analysis study was done in chil- dren with first CFS who visited Cipto Mangunkusumo Hospital, Jakarta, over 14 months periods. The predictors for development of recurrence were analyzed by SPSS for Windows 11.5 using Kaplan-Meier test and Cox regression model with a level of signifi- cance <0.05. Results There were 62 subjects completed this study. Male-to- female ratio was 1.4:1. The mean age at onset was 18.2 months. Recurrence occurred in 9 subjects (14.5%). Body temperature between 38-38.5°C (7 of 26 subjects, P=0.02), upper motor neu- ron type of delayed development (3 of 7 subjects, P=0.03), and epileptic history in the family (2 of 2 subjects, P<0.05) were asso- ciated with recurrence in bivariate analysis. In multivariate analy- sis only body temperature between 38-38.5°C (HR 1.6, 95% CI 1.0;23.9) and epileptic history in the family (HR 16.9, 95% CI 2.8;101.4) were identified as predictors. Conclusion Low body temperature at the first seizures and epi- leptic history in the family were independent predictors for the re- currence after a first CF

Do the acute lymphoblastic leukemia and non-hodgkin lymphoma patients have a worse prognosis of COVID-19 infection in children?: a case report

Background: Coronavirus Disease 2019 (COVID-19) is a contagious disease caused by a new type of Coronavirus namely Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Children with tumors or autoimmune diseases are more susceptible, because of suppression of their immune system, chemotherapy, radiotherapy, or surgery on tumors. Case presentation: We present the clinical features 3 Acute Lymphoblastic leukemia and 1 Non-Hodgkin lymphoma patients who were infected with COVID-19 since July to August 2020 in our hospital. These were the first four cases identified as COVID-19 positive in Dr Wahidin Sudirohusodo Hospital. Case 1, 2, and 4 were diagnosed as moderate and common type of COVID-19, while case 3 was classified as severe type. They may be transmitted COVID-19 infection during hospitalization. All cases were recovered from COVID-19 after a combination therapy against virus, bacteria, and also respiratory support. Conclusion: Our case series of four pediatric cancer patients showed a good outcome after prompt treatment, suggesting that malignancy in children may not be a contributor factor for COVID-19 recovery. Keywords: COVID-19; acute lymphoblastic leukemia; non-hodgkin lymphoma; children &nbsp; Abstrak Latar belakang: Covid-19 (Coronavirus disease 2019) adalah penyakit menular yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Anak yang menderita kanker atau penyakit autoimun lebih rentan tertular karena penurunan system kekebalan tubuh, dampak kemoterapi, radioterapi, atau operasi tumor. Penyajian kasus: Kami melaporkan 3 pasien leukemia limfoblastik akut&nbsp; dan 1 pasien limfoma non-Hodgkin yang terinfeksi Covid-19 sejak Juli-Agustus 2020. Kasus tersebut adalah 4 kasus pertama yang teridentifikasi Covid-19 di Rumah Sakit Dr. Wahidin Sudirohusodo. Kasus 1,2, dan 4 terdiagnosis positif Covid -19 derajat sedang, sedangkan kasus 3 tergolong berat. Mereka kemungkinan terinfeksi Covid-19 saat perawatan. Semua kasus dinyatakan sembuh dari Covid-19 setelah pemberian obat anti virus, antibiotik, dan alat bantu pernapasan. Kesimpulan: Serial kasus dari 4 pasien kanker anak dengan outcome yang baik setelah pengobatan yang cepat mengindikasikan bahwa penyakit keganasan pada anak kemungkinan bukan faktor yang berkontribusi dalam kesembuhan Covid-19. Kata kunci:&nbsp; COVID-19; leukemia limfoblastik akut; limfoma non-hodgkin; anak &nbsp; &nbsp

Should formula for infants provide arachidonic acid along with DHA? A position paper of the European Academy of Paediatrics and the Child Health Foundation

Recently adopted regulatory standards on infant and follow-on formula for the European Union stipulate that from February 2020 onwards, all such products marketed in the European Union must contain 20-50 mg omega-3 DHA (22:6n-3) per 100 kcal, which is equivalent to about 0.5-1% of fatty acids (FAs) and thus higher than typically found in human milk and current infant formula products, without the need to also include ω-6 arachidonic acid (AA; 20:4n-6). This novel concept of infant formula composition has given rise to concern and controversy because there is no accountable evidence on its suitability and safety in healthy infants. Therefore, international experts in the field of infant nutrition were invited to review the state of scientific research on DHA and AA, and to discuss the questions arising from the new European regulatory standards. Based on the available information, we recommend that infant and follow-on formula should provide both DHA and AA. The DHA should equal at least the mean content in human milk globally (0.3% of FAs) but preferably reach 0.5% of FAs. Although optimal AA intake amounts remain to be defined, we strongly recommend that AA should be provided along with DHA. At amounts of DHA in infant formula up to ∼0.64%, AA contents should at least equal the DHA contents. Further well-designed clinical studies should evaluate the optimal intakes of DHA and AA in infants at different ages based on relevant outcomes