Human breast milk contains numerous biomolecules. Human milk oligosaccharides (HMOs) are the third most abundant component of breast milk, after lactose and lipids. Amongst the synthetized HMOs, 2′-fucosyllactose (2′-FL) and lacto-N-neotetraose (LNnT) are widely studied and are considered safe for infant nutrition. Several studies have reported the health benefits of HMOs, which include modulation of the intestinal microbiota, anti-adhesive effect against pathogens, modulation of the intestinal epithelial cell response, and development of the immune system. The amount and diversity of HMOs are determined by the genetic background of the mothers (HMO secretors or non-secretors). The non-secretor mothers secrete lower HMOs than secretor mothers. The breastfed infants of secretor mothers gain more health benefit than those of non-secretor mothers. In conclusion, supplementation of infant formula with 2′-FL and LNnT is a promising innovation for infant nutrition.

AIMTo assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.METHODSA comprehensive questionnaire was distributed to general pediatricians from several teaching hospitals and government hospitals all over Indonesia.RESULTSData were obtained from 100 pediatricians, with a mean of 78.34 ± 18.00 mo clinical practice, from 20 cities throughout Indonesia. Suspicion of constipation in a child over 6 mo of age arises when the child presents with a decreased frequency of bowel movements (according to 87% of participants) with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools (83%), blood in the stools (36%), fecal incontinence (33%), and/or difficulty in defecating (47%). Only 26 pediatricians prescribe pharmacologic treatment as first therapeutic approach, while the vast majority prefers nonpharmacologic treatment, mostly (according to 68%) The preferred nonpharmacologic treatment are high-fiber diet (96%), increased fluid intake (90%), toilet training (74%), and abdominal massage (49%). Duration of non-pharmacological treatment was limited to 1 to 2 wk. Seventy percent of the pediatricians recommending toilet training could only mention some elements of the technique, and only 15% was able to explain it fully and correctly. Lactulose is the most frequent pharmacologic intervention used (87% of the participants), and rectal treatment with sodium citrate, sodium lauryl sulfo acetate, and sorbitol is the most frequent rectal treatment (85%). Only 51% will prescribe rectal treatment for fecal impaction. The majority of the pediatricians (69%) expect a positive response during the first week with a mean (± SD) of 4.1 (± 2.56) d. Most participants (86%) treat during one month or even less. And the majority (67%) stops treatment when the frequency and/or consistency of the stools have become normal, or if the patient had no longer complaints.CONCLUSIONThese data provide an insight on the diagnosis and management of constipation in childhood in Indonesia. Although general pediatricians are aware of some important aspects of the diagnosis and mangement of constipation, overall knowledge is limited. Efforts should be made to improve the distribution of existing guidelines. These findings highlight and confirm the difficulties in spreading existing information from guidelines to general pediatricians.

PurposeThe aim of this study was to identify the minimally meaningful dosage of inulin leading to a prebiotic effect in Indonesian infants.MethodsIn a randomized controlled double-blinded, parallel, 3-arm intervention study, 164 healthy formula-fed infants aged 3 to 5 months first obtained formula-A (without inulin) during a 4-week adaptation period. Subsequently, 142 subjects were subjected to a 4-week feeding period by administering either formula-A (no inulin), formula-B (0.2 g/100 mL inulin) or formula-C (0.4 g/100 mL inulin). The primary outcome parameter was %-bifidobacteria in faecal samples determined using quantitative polymerase chain reaction analyses. Secondary outcome parameters were faecal %-lactobacilli, pH and stool frequency, and consistency. Growth and tolerance/adverse effects were recorded as safety parameters.ResultsTypical %-bifidobacteria and %-lactobacilli at the end of the adaptation period in the study population were 14% and 2%, respectively. For faecal pH, significant differences between formula groups A vs. C and A vs. B were found at the end of the intervention period. Testing for differences in faecal %-bifidobacteria and %-lactobacilli between groups was hampered by non-normal data set distributions; no statistically significant differences were obtained. Comparisons within groups revealed that only in formula group C, all the three relevant parameters exhibited a significant effect with an increase in faecal %-bifidobacteria and %-lactobacilli and a decrease in pH.ConclusionA consistent prebiotic effect along with a decrease in pH and increase in %-bifidobacteria and %-lactobacilli was found only in the group administered 0.4 g inulin/100 mL.

Demam merupakan sebuah proses alamiah yang timbul sebagai mekanisme pertahanan tubuh terhadap patogen, namun terkadang suhu yang terlalu tinggi seringkali menjadi suatu dilema sendiri yang menimbulkan kekhawatiran pada orangtua. Demam terjadi karena peningkatan pusat pengatur suhu di hipotalamus yang dipengaruhi oleh Interleukin-1 (IL-1). Terdapat berbagai variasi kisaran suhu normal pada anak menurut tempat pengukurannya. Tatalaksana demam yang terutama yaitu pemberian antipiretik seperti parasetamol atau ibuprofen. Beberapa studi menemukan bahwa penggunaan metode kombinasi antipiretik memberikan efek antipiretik yang lebih tinggi, namun hal ini belum dapat direkomendasikan karena belum ada studi mengenai keamanannya. Metode kompres hangat juga dapat diberikan sebagai terapi tambahan untuk membantu menurunkan demam pada anak. Penggunaan antipiretik sesuai dosis yang direkomendasikan ditambah dengan kompres hangat sudah terbukti lebih efektif untuk menurunkan demam pada anak terutama di 30 menit pertama. Kata Kunci : Demam, Interleukin-1, Kompres, Tepid Sponging

Diare masih menjadi penyebab utama morbiditas dan mortalitas pada anak di negara berkembang. Etiologi diare pada anak didominasi oleh patogen enterik seperti virus, bakteri dan parasit. Organisme patogen enterik yang cukup sering menjadi penyebab diare adalah rotavirus, E. coli, Shigella spp., Salmonella spp., Vibrio cholerae, Entamoeba histolytica. Tiap organisme menyebabkan gejala diare yang berbeda. Walaupun penyebab diare berbeda-beda, tatalaksana diare yang utama adalah rehidrasi dengan cairan rehidrasi oral.