REVIEW ARTICLE
Evaluation and Management of the Pediatric Patients ZLWK6XVSHFWHG*DVWURHVRSKDJHDO5HÀX['LVHDVHV
Badriul Hegar*, Yvan Vandenplas** *Department of Child Health, Faculty of Medicine, University of Indonesia Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia ** UZ Brussel Kinderen, Vrije Universiteit Brussel, Belgia
ABSTRACT *DVWURHVRSKDJHDOUHÀX[LVDQRUPDOSK\VLRORJLFSURFHVVRFFXUULQJLQKHDOWK\LQIDQWV6\PSWRPVGXHWR JDVWURHVRSKDJHDOUHÀX[GLVHDVHV *(5' DUHWURXEOHVRPHZKHQWKH\KDYHDGYHUVHHIIHFWVRQWKHZHOOEHLQJRI WKHSDWLHQW$WKRURXJKKLVWRU\DQGSK\VLFDOH[DPLQDWLRQLVJHQHUDOO\VXI¿FLHQWWRHVWDEOLVKDFOLQLFDOGLDJQRVLV RIXQFRPSOLFDWHGLQIDQWZLWKJDVWURHVRSKDJHDOUHÀX[3RRUZHLJKWJDLQLVDZDUQLQJVLJQ,UULWDELOLW\DQG UHJXUJLWDWLRQDUHDVVRFLDWHGZLWKDZLGHUDQJHRISK\VLRORJLFDQGSDWKRORJLFFRQGLWLRQV+HDUWEXUQRUVXEVWHUQDO EXUQLQJLVDUHOLDEOHLQGLFDWRUIRU*(5'LQDGROHVFHQWV%DUUHWWHVRSKDJXVGRHVRFFXULQFKLOGUHQZLWKVHYHUH FKURQLFUHÀX[*(5'LVFRPPRQO\FLWHGDVDFDXVHRIG\VSKDJLD KRZHYHUWKHUHDUHQRVWURQJSHGLDWULFGDWD GHPRQVWUDWLQJWKLVUHODWLRQVKLS$QHWLRORJLFUROHIRUUHÀX[LQUHDFWLYHDLUZD\VGLVHDVHVXFKDVDVWKPDKDVQRW EHHQHVWDEOLVKHG1RWHVWFDQGHWHUPLQHZKHWKHUUHÀX[LVFDXVLQJUHFXUUHQWSQHXPRQLD 'DWDVKRZLQJWKHFRUUHODWLRQEHWZHHQUHÀX[DQGXSSHUDLUZD\GLVHDVHLVZHDNFRQVLVWLQJPDLQO\RIFDVH GHVFULSWLRQV6DQGLIHUV\QGURPHLVDQXQFRPPRQEXWVSHFL¿FPDQLIHVWDWLRQRI*(5'&KLOGUHQZLWKFHUHEUDOSDOV\ DUHDWSDUWLFXODUO\KLJKULVNRI*(5'6LPLODUO\FKLOGUHQZLWKFHUWDLQJHQHWLFV\QGURPHVVXFKDV&RUQHOLDGH/DQJH DQG'RZQV\QGURPHDUHSURQHWR*(5'$KLJKHUSUHYDOHQFHRI*(5'DQGLWVFRPSOLFDWLRQVKDVEHHQUHSRUWHGLQ SDWLHQWVZLWKDYDULHW\RIFKURQLFUHVSLUDWRU\GLVRUGHUVLQFOXGLQJEURQFKRSXOPRQDU\G\VSODVLDDQGF\VWLF¿EURVLV *(5'WUHDWPHQWLVIUHTXHQWO\DGPLQLVWHUHGWRSUHPDWXUHLQIDQWV+RZHYHUWKHWUXHSUHYDOHQFHRI*(5'LVXQNQRZQ
Keywords JDVWURHVRSKDJHDOUHÀX[GLVHDVHVLQIDQWVFKLOGUHQ
ABSTRAK *DVWURHVRIDJHDOUHÀXNV *(5 PHUXSDNDQSURVHV¿VLRORJLVSDGDED\L*HMDODNOLQLV\DQJGLVHEDENDQROHK SHQ\DNLWJDVWURHVRIDJHDOUHÀXNVPHUXSDNDQPDVDODKELODPHPEHULNDQHIHNEXUXNSDGDDQDN$QDPQHVLVGDQ SHPHULNVDDQ¿VLVXPXPQ\DFXNXSXQWXNPHQHJDNNDQGLDJQRVD*(5WDQSDNRPSOLNDVLVHFDUDNOLQLVSDGDED\L .HQDLNDQEHUDWEDGDQ\DQJWLGDNDGHNXDWPHUXSDNDQWDQGDSHULQJDWDQ,ULWDELOLWDVGDQUHJXUJLWDVLEHUKXEXQJDQ GHQJDQEHUEDJDLNRQGLVL¿VLRORJLVGDQSDWRORJLV1\HULGDGDDWDXUDVDWHUEDNDUSDGDGDHUDKVXEVWHUQXP PHUXSDNDQLQGLNDWRUSHQ\DNLW*(5SDGDUHPDMD(VRIDJXVµ%DUUHWW¶WHUMDGLSDGDNHDGDDQ\DQJEHUDWGDQNURQLV 3HQ\DNLW*(5VHULQJVHEDJDLSHQ\HEDEGLVIDJLDPHVNLSXQWLGDNWHUGDSDWGDWD\DQJNXDWXQWXNPHQXQMXNNDQ KXEXQJDQWHUVHEXWSDGDDQDN5HÀXNVVHEDJDLSHQ\HEDEDVPDWLGDNGDSDWGLEXNWLNDQ7LGDNDGDSHPHULNVDDQ SHQXQMDQJ\DQJGDSDWPHQXQMXNNDQUHÀXNVVHEDJDLSHQ\HEDESQHXPRQLDEHUXODQJ 'DWDPHQXQMXNNDQKXEXQJDQOHPDKDQWDUDUHÀXNVGDQSHQ\DNLWVDOXUDQQDSDVDWDV6LQGURP6DQGLIHU MDUDQJGLWHPXNDQWHWDSLPHUXSDNDQPDQLIHVWDVLNOLQLVVSHVL¿NSHQ\DNLW*(5$QDNGHQJDQSDOVLVHUHEUDOVDQJDW EHULVLNRPHQJDODPLSHQ\DNLW*(5+DO\DQJVDPDDQDNGHQJDQVLQGURPJHQHWLNWHUWHQWXVHSHUWLµ&RUQHOLD GH/DQJH¶GDQ6LQGURPµ'RZQ¶FHQGHUXQJPHQJDODPLSHQ\DNLW*(53UHYDOHQVSHQ\DNLW*(5GDQNRPSOLNDVL \DQJWLQJJLGLODSRUNDQSDGDEHEHUDSDJDQJJXDQSHUQDSDVDQNURQLVWHUPDVXNGLVSODVLDEURQNRSXOPRQDOLVGDQ µF\VWLF¿EURVLV¶7HUDSLSHQ\DNLW*(5VHULQJGLEHULNDQXQWXNED\LSUHPDWXU:DODXSXQGHPLNLDQSUHYDOHQVL SHQ\DNLW*(5VHEHQDUQ\DWLGDNGLNHWDKXL
Kata kunci SHQ\DNLWJDVWURHVRIDJHDOUHÀXNVED\LDQDN
Volume 12, Number 3, December 2011 171 Badriul Hegar, Yvan Vandenplas
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172 The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Evaluation and Management of the Pediatric Patients with Suspected Gastroesophageal Reflux Diseases
Table 2. History of children with suspected gastroesophageal DSSURSULDWH1DVRJDVWULFRUQDVRMHMXQDOIHHGLQJLV UHÀX[GLVHDVH2 RFFDVLRQDOO\QHFHVVDU\WRDFKLHYHZHLJKWJDLQLQWKH Feeding and Amount/frequency (overfeeding) LQIDQWZLWKQRRWKHUFOHDUH[SODQDWLRQIRUSRRUZHLJKW dietary history Preparation of formula Recent changes in feeding type or technique JDLQ Position during feeding Burping Behavior during feeding: choking, gagging, ,1)$17:,7+ 81(;3/$,1('&5<,1*$1'25 cough, arching, discomfort, refusal Pattern of Frequency/amount ',675(66('%(+$9,25 vomiting Pain Forceful ,UULWDELOLW\DQGUHJXUJLWDWLRQDUHQRQVSHFLILF Blood or bile V\PSWRPVWKDWRFFXULQQRUPDOLQIDQWVDQGDUHDVVRFLDWHG Associated fever, lethargy, diarrhea ZLWKDZLGHUDQJHRISK\VLRORJLFDQGSDWKRORJLF Past medical Prematurity history Growth and development FRQGLWLRQV)RUH[DPSOHH[SRVXUHWRHQYLURQPHQWDO Past surgery, hospitalizations IDFWRUVVXFKDVWREDFFRVPRNHPD\UHVXOWLQLUULWDELOLW\ Newborn screen results Recurrent illnesses, especially croup, LQLQIDQWV1RUPDO\RXQJLQIDQWVIXVVRUFU\DQDYHUDJH pneumonia, asthma RIWZRKRXUVGDLO\7KHUHLVVXEVWDQWLDOLQGLYLGXDO Symptoms of hoarseness, fussiness, hiccups, apnea YDULDWLRQDQGVRPHKHDOWK\LQIDQWVFU\DVPXFKDVVL[ Previous weight and height gain KRXUVSHUGD\/LNHZLVHWKHUHLVYDULDWLRQLQSDUHQWDO Other chronic conditions SHUFHSWLRQVUHJDUGLQJWKHVHYHULW\DQGGXUDWLRQRI Medications Current, recent, prescription, non-prescription FU\LQJDQGLWVLPSRUWDQFH7KHDPRXQWRIGDLO\FU\LQJ Family psycho- Sources of stress 5 social history Maternal or paternal drug use W\SLFDOO\SHDNVDWVL[ZHHNVRIDJH $V\PSWRPGLDU\ Post partum depression RUKRVSLWDOREVHUYDWLRQPD\EHXVHIXO$OWKRXJKRQH Family medical 6LJQL¿FDQWLOOQHVVHV VWXG\LQLQIDQWVVKRZHGDFRUUHODWLRQEHWZHHQLQIDQW history Family history of gastrointestinal disorders Family history of atopy JULPDFLQJDQGHSLVRGHVRIUHÀX[PXOWLSOHRWKHUVWXGLHV
Growth chart KDYHVKRZQQRUHODWLRQVKLSEHWZHHQFU\LQJDQG*(5' including height, 6 Warning signals (see Table 3) RUWKHSUHVHQFHRIHVRSKDJLWLV 7KHDYDLODEOHHYLGHQFH weight and head circumference GRHVQRWVXSSRUWDQHPSLULFWULDORIDFLGVXSSUHVVLRQ LQLQIDQWVZLWKXQH[SODLQHGFU\LQJLUULWDELOLW\RU VOHHSGLVWXUEDQFH2QHSLORWVWXG\VKRZHGGHFUHDVHG Table 3. Warning signals requiring investigation in infants with regurgitation or vomiting2 LUULWDELOLW\LQWKHVXSLQHVOHHSLQJSRVLWLRQ Bilious vomiting Lethargy 'LVRUGHUVRWKHUWKDQ*(5'ZKLFKDUHOLNHO\WR Gastrointestinal bleeding: hematemesis, Hepatosplenomegaly FDXVHLUULWDELOLW\LQFOXGHFRZ¶VPLONSURWHLQDOOHUJ\ hematochezia LQIHFWLRQV HVSHFLDOO\RIWKHXULQDU\WUDFW FRQVWLSDWLRQ Consistently forceful vomiting Bulging fontanelle Onset of vomiting after 6 months of life Macro/microcephaly UHVSLUDWRU\GLVRUGHUVFRQJHQLWDORUDFTXLUHGQHXURORJLF Failure to thrive Seizures DEQRUPDOLWLHVPHWDEROLFGLVHDVHVXUJLFDOHPHUJHQFLHV Abdominal tenderness or distension Diarrhea VXFKDVLQWHUPLWWHQWYROYXOXVRURYDULDQWRUVLRQ Constipation Fever FDUGLDFGLVHDVHFRUQHDODEUDVLRQERQHIUDFWXUHV Documented or suspected genetic/metabolic syndrome KDLUWRXUQLTXHWV\QGURPHWREDFFRVPRNHH[SRVXUH KXQJHUDEXVHRUQHJOHFW$QHPSLULFWRZHHN WULDORIDWKLFNHQHGRUH[WHQVLYHO\K\GURO\VHGIRUPXOD ,1)$17:,7+5(&855(175(*85*,7$7,21$1' RUDPLQRDFLGEDVHGIRUPXODPLJKWEHLQGLFDWHGLQ POOR WEIGHT GAIN LUULWDEOHLQIDQWVDIWHUGLDJQRVWLFHYDOXDWLRQVKDYHEHHQ :KLOHWKHKLVWRU\DQGSK\VLFDOH[DPLQDWLRQPD\ SHUIRUPHGIRURWKHUFRQGLWLRQVFDXVLQJLUULWDELOLW\ EHLGHQWLFDOSRRUZHLJKWJDLQLVDZDUQLQJVLJQ$ 5HÀ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ÀX[HSLVRGHVDQG
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174 The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Evaluation and Management of the Pediatric Patients with Suspected Gastroesophageal Reflux Diseases
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Volume 12, Number 3, December 2011 175 Badriul Hegar, Yvan Vandenplas
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176 The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Evaluation and Management of the Pediatric Patients with Suspected Gastroesophageal Reflux Diseases
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Volume 12, Number 3, December 2011 177 Badriul Hegar, Yvan Vandenplas
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