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"Latar Belakang. Bayi kurang bulan (BKB) memiliki risiko tinggi mengalami gangguan neurobehavioral. Gangguan tersebut dapat dipengaruhi oleh faktor prenatal, natal, dan perinatal. Perlu dilakukan deteksi dini gangguan agar dapat dilakukan intervensi dini. Penilaian neurobehavioral metode Dubowitz dapat digunakan untuk deteksi dini gangguan neurobehavioral pada BKB.Tujuan. Mengetahui proporsi dan faktor risiko yang berhubungan dengan gangguan neurobehavioral BKB. Mengetahui hubungan antara kelompok bayi risiko tinggi dengan kejadian gangguan neurobehavioral.Disain Penelitian. Penelitian ini merupakan penelitian dengan studi potong lintang analitik untuk mengetahui karakteristik penilaian neurobehavioral BKB dengan metode Dubowitz dan faktor risiko yang berhubungan. Subjek penelitian adalah BKB yang pernah dirawat di Divisi Perinatologi Rumah Sakit Cipto Mangunkusumo (RSCM). Dilakukan analisis bivariat dengan uji kai kuadarat dan dilanjutkan dengan analisis multivariat dengan uji regresi logistik.Hasil Penelitian. Didapatkan 106 subjek yang sesuai dengan kriteria inklusi dan eksklusi. Proporsi BKB yang mendapat nilai suboptimal pada pemeriksaan neurobehavioral metode Dubowitz adalah 57,5%. Faktor risiko yang berhubungan dengan gangguan neurobehavioral adalah sepsis (OR 6,23 (IK 95% 2,18-17,73); p=0,001), perdarahan intraventrikular (OR 6,23 (IK 95% 2,18-17,73) p=0,007); dan berat lahir ≤1500 gram (OR 3,46 (IK 95% 1,15-10,37), p=0,027). Didapatkan 37 subjek (34,9%) masuk ke dalam kelompok risiko tinggi dan 69 subjek (65,1%) risiko rendah. Terdapat 86,5% bayi di kelompok risiko tinggi mendapatkan penilaian neurobehavioral suboptimal. Terdapat hubungan yang bermakna antara kelompok bayi risiko tinggi dengan penilaian suboptimal metode Dubowitz, dengan p<0,001.Simpulan. Faktor risiko yang berhubungan dengan penilaian suboptimal pada pemeriksaan neurobehavioral adalah sepsis, perdarahan intraventrikular, dan berat lahir ≤1500 gram. Bayi kelompok risiko tinggi berhubungan dengan besarnya penilaian suboptimal pada pemeriksaan neurobehavioral metode Dubowitz.

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Background. Preterm baby tend to be at risk for having neurobehavioral impairment. The risk factors included prenatal, natal, and perinatal factors. Early recognition of infants at risk for development disability is important. The Dubowitz Neurological Assessment can be used to evaluate infants at risk for developmental disabilitiesis.

Objective. To determine proportion and factors that related to Dubowitz Neurobehavioral assesment in preterm baby.

Methods. Cross-sectional study involving preterm baby in Cipto Mangunkusumo Hospital. The Dubowitz Neurobehavioral Assesment was performed to asses the neurobehavioral pattern at 37-40 weeks post menstrual age. The risk factors data was collected retrospectively from the medical record. Statistical analysis was done using bivariate (Chi-square test) and multivariate analysis (logistic regression) analysis.

Results. One hundred and six infants fullfilled the eligibility criteria. Based on The Dubowitz Neurological Assesment, 57,5% subjects got suboptimal score. Logistic regression analysis showed significant association between sepsis (OR 6,23 (IK 95% 2,18-17,73); p=0,001), intraventricular haemorrhage (OR 6,23 (IK 95% 2,18-17,73) p=0,007); and birth weight ≤1500 gram (OR 3,46 (IK 95% 1,15-10,37), p=0,027) and neurobehavioral impairment. There was 86,5% from all high risk babies that got suboptimal score with signifficant association, p<0,001.

Conclusion. In preterm infants, sepsis, intraventricular haemorrhage, and low birth weight can become factors that related to the neurobehavioral impairment. High risk babies potential to have neurobehavioral impairment."

"Neonates Intensive Care Units (NICU) merupakan tempat penting untuk bayi prematur yang sekaligus merupakan tempat berbahaya akibat karakteristik NICU. NICU dapat meningkatkan risiko gangguanperkembangan bayi. Gangguan ini dapat dicegah melalui penerapan asuhan perkembangan. Newborn Individualized Developmental Care and Assessment Program (NIDCAP) merupakan metode asuhan perkembangan yang dianggap sebagai salah satu pendekatan terbaik dalam pemberian asuhan perkembangan dengan pertimbangan NIDCAP mampu memberikan pelayanan secara individual berdasarkan isyarat bayi dengan pendekatan perawatan berfokus keluarga. Pengukuran efektifitas NIDCAP didasarkan pada respon neurobehavioral bayi prematur saat berada di NICU. NIDCAP terbukti dapat memperbaiki pola tidur bayi, dan respons fisiologis bayi seperti saturasi oksigen, pernafasan, dan nadi. Hasil studi literatur menunjukkan bahwa asuhan perkembangan dengan menggunakan metode NIDCAP tidak berpengaruh terhadap hasil perkembangan bayi prematur jangka panjang. Studi dan pengkajian yang mendalam diperlukan untuk menemukan asuhan perkembangan dengan menggunakan metode yang lebih efektif dan efisien.

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A Review: Newborn Individualized Developmental Care and Assessment Program (NIDCAP) to Development of Long-Term Results Premature Infants. Neonatal Intensive Care Unit (NICU) is both vital spot for preterm infant and also dangerous spot which caused by NICU?s characteristics. NICU increases the risk of infant developmental disturbance. Infant developmental disturbance can be prevented by implementing Developmental care in NICU setting. Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is method who beingregarded as one of the best approach for delivering developmental care with those consideration NIDCAP is able to give an individual service base on the infant cues trough family-centered care approach. The measurement of NIDCAP effectiveness is shown by the infant?s neurobehavioral response in the NICU. NIDCAP can repair the baby?s sleep-awake pattern, and her physiological response such as oxygen saturation, respiration rater, and hearth rate. This study show that the implementation of developmental care using the NIDCAP method doesn?t affect to the long-term outcome for the preterm infants. The further research is needed to find out the other developmental care method which is more effective and efficient."

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LATAR BELAKANG: Berbagai studi telah menunjukkan efek potensial probiotik terhadap luaran neuropsikologis melalui aksis usus-otak. Akan tetapi, studi yang menilai efek suplementasi probiotik terhadap fungsi kognitif pada populasi anak dan remaja masih terbatas.

METODE: Peneliti melakukan studi tindak lanjut tahun ke-10 dari uji klinis teracak samar suplementasi probiotik Lactobacillus reuteri DSM 17938 atau Lactobacillus casei CRL 431 pada anak terhadap fungsi kognitif. Dari 494 anak yang mengikuti uji klinis pada 2007–2008, sebanyak 160 anak yang telah berusia 11–17 tahun mengikuti studi tindak lanjut. Pada uji klinis terdahulu, subjek diberikan susu dengan kalsium regular sebanyak 440 mg/hari (kelompok KR; n = 58), kalsium regular dengan L. reuteri DSM 17938 5x10⁸ colony-forming units (CFU) (reuteri; n= 50), atau kalsium regular dengan L. casei CRL 431 5x10⁸ CFU (casei; n= 52) selama 6 bulan pada usia 1–6 tahun. Penelitian ini bertujuan untuk menilai efek suplementasi probiotik masa kanak-kanak tersebut terhadap tingkat intelegensi berdasarkan Standard Progressive Matricesdan kadar brain-derived neurotrophic factor(BDNF) serum pada masa remaja. Berbagai faktor biomedis (kualitas diet, antropometri, kadar hemoglobin, dan lain-lain) dan faktor lingkungan sosial (status pendidikan orangtua, dukungan lingkungan rumah, depresi, dll) terkait fungsi kognitif turut dinilai sebagai variabel perancu.

HASIL:Kadar BDNF serum masa remaja pada kelompok suplementasi probiotik L. reuteri DSM 17938 lebih rendah dibandingkan kelompok kontrol yang secara statistik signifikan (p = 0,036), setelah disesuaikan dengan perancu. Tidak terdapat perbedaan proporsi tingkat intelegensi masa remaja yang bermakna berdasarkan riwayat suplementasi probiotik L. reuteri DSM 17938 maupun L. casei CRL 431 masa kanak-kanak. Pada regresi multipel, dukungan lingkungan rumah memiliki hubungan yang signifikan dan konsisten dengan tingkat intelegensi. Kadar BDNF serum berhubungan dengan status gizi dan kualitas diet.

 

KESIMPULAN: Anak yang mendapat suplementasi L. reuteri DSM 17938 memiliki kadar BDNF serum yang lebih rendah pada masa remaja. Hubungan yang konsisten antara faktor lingkungan sosial dengan fungsi kognitif menunjukkan pentingnya mengintegrasikan intervensi biomedis dengan lingkungan sosial untuk mencapai populasi berdaya.

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BACKGROUND: Available evidence have shown potential effects of probiotics on neurobehavioral outcomes through ‘gut-brain axis’ mechanism. However, studies on cognitive function in children and adolescents are lacking.

METHODS: We conducted a 10-year follow-up study of randomised controlled trial of 6-month probiotic supplementation of Lactobacillus reuteri DSM 17938 or Lactobacillus casei CRL 431 in children on cognitive function. Of 494 children enrolled in 2007–2008, we re-enrolled 160 subjects at age 11–17 years. Subjects were given regular calcium milk containing 440 mg/d (RC group; n= 58), regular calcium with L. reuteriDSM 17938 5x10⁸ colony-forming units (CFU) (reuteri; n= 50), or regular calcium with L. casei CRL 431 5x10⁸ CFU (casei; n = 52) for 6 months at the age of 1–6 years. This study aimed to investigate the effect of probiotic supplementation during childhood on cognitive function based on grade of Standard Progressive Matrices and serum brain-derived neurotrophic factor (BDNF) levels in adolescents. We assessed various biomedical factors (ie. diet quality, anthropometry, and hemoglobin level) socio-environmental factors (ie. parental educations, home environment, and depression) related to cognitive outcomes as cofounding variables.

RESULTS: Compared with the RC group, the reuteri group had a significantly lower mean serum BDNF level [adj. difference 3127.5 pg/ml (95% CI: 213,5–6041,6)]. There was no difference in grade of SPM between groups nor difference on serum BDNF level between RC and casei group. In multiple regression models, the home environment had a significant and consistent association with grade of SPM. Serum BDNF level was associated with overweight/obesity and diet quality.

CONCLUSION: L. reuteri DSM 17938 supplementation during childhood was associated with lower serum BDNF level at the age of 11–17 years compared to control. The consistent association between socio-environmental factor and grade of SPM suggests that intervention of biomedical determinants should be integrated with the improvement of socioenvironmental factors to achieve thriving populations.

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"Latar belakang: Perdarahan intraventrikular (PIV) menjadi penyebab morbiditas dan mortalitas bayi prematur. Sekitar 27% bayi dengan BB <1.500 gram mengalami PIV pada berbagai derajat (1–4). Faktor risiko PIV dapat berasal dari maternal, seperti preeklamsia, tanpa steroid antenatal, dan persalinan per vaginam serta berasal dari neonatal, seperti usia gestasi lebih muda, berat badan lahir lebih rendah, jenis kelamin lelaki, nilai Apgar rendah, asfiksia, pemberian inotropik, trombositopenia, ventilasi mekanik invasif, sepsis, sindrom distres pernapasan, dan duktus arteriosus persisten. Identifikasi faktor risiko yang berhubungan dengan PIV penting agar penatalaksanaan yang tepat dapat dilakukan dan sebagai evaluasi pencegahan dan tata laksana PIV yang saat ini sudah diterapkan.Metode: Penelitian kasus kontrol ini melibatkan subjek bayi usia gestasi <35 minggu di RSCM yang diambil retrospektif secara consecutive sampling mulai perawatan Agustus 2022 hingga jumlah sampel terpenuhi. Subjek dibagi menjadi kelompok kasus (dengan PIV) dan kontrol (tanpa PIV) berdasarkan hasil USG kepala selama perawatan. Masing-masing kelompok diidentifikasi faktor risiko yang ada dari rekam medis, baik faktor maternal maupun neonatal. Data kemudian dianalisis menggunakan program SPSS.Hasil: Total 220 subjek diteliti terdiri atas kelompok kasus 110 subjek dan kontrol 110 subjek. Dari 110 kasus didapatkan PIV derajat 1 (69,1%), derajat 2 (12,7%), derajat 3 (10%), dan derajat 4 (8,2%). Analisis bivariat menunjukkan terdapat hubungan bermakna antara PIV dengan usia gestasi <28 minggu (OR 5,44; IK 95% 2,23-13,27; p<0,001), berat badan lahir <1.000 gram (OR 6,23; IK 95% 2,87-13,52; p<0,001), berat badan lahir 1.000-1.499 gram (OR 3,04; IK 95% 1,62-5,71; p=0,001), nilai Apgar menit ke-1 (p=0,004), nilai Apgar menit ke-5 (p=0,03), pemberian inotropik (OR 2,47; IK 95% 1,35-4,53; p=0,005), jumlah trombosit <50.000/μL (OR 2,52; IK 95% 1,17-5,42; p=0,018), jumlah trombosit 50.000-99.000/μL (OR 3,42; IK 95% 1,51-7,74; p=0,003), ventilasi mekanik invasif (OR 3,71; IK 95% 2,11-6,53; p<0,001), sepsis (OR 2,84; IK 95% 1,64-4,90; p<0,001), dan DAP (OR 2,01; IK 95% 1,07-3,79; p=0,042). Analisis multivariat menunjukkan hanya berat badan lahir <1.000 gram (OR 3,93; IK 95% 1,71-9,06; p=0,001), berat badan lahir 1.000-1.499 gram (OR 2,57; IK 95% 1,34-4,92; p=0,004), dan penggunaan ventilasi mekanik invasif (OR 2,49; IK 95% 1,34-4,63; p=0,004) yang mempunyai hubungan bermakna dengan PIV.Kesimpulan: Faktor risiko yang mempunyai hubungan bermakna dengan PIV pada bayi usia gestasi <35 minggu adalah berat badan lahir <1.500 gram dan penggunaan ventilasi mekanik invasif.

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Background: Intraventricular hemorrhage (IVH) is a cause of morbidity and mortality in preterm infants. Approximately 27% of infants weighing <1,500 gram have PIV in various degrees (1-4). Risk factors for IVH can be maternal origin, such as preeclamsia, absence of steroid antenatal, and vaginal delivery; and also from neonatal origin, such as younger gestational age, lower birth weight, male gender, lower Apgar score, asphyxia, inotropic administration, thrombocytopenia, invasive mechanical ventilation, sepsis, respiratory distress syndrome and patent ductus arteriosus (PDA). Identification of risk factors associated with IVH is important so that appropriate management can be carried out and as an evaluation of IVH’s prevention and treatment that are currently being implemented.

Method: This case-control study involved subjects with gestational age <35 weeks at Cipto Mangunkusumo Hospital who were taken retrospectively by consecutive sampling starting from admission in August 2022 until the number of samples were fulfilled. Subjects were divided into case (with IVH) and control (without IVH) groups based on the results of head ultrasound during hospitalization. Each group was identified existing risk factors from medical record, both maternal and neonatal factor. The data were then analyzed using the SPSS program.

Result: A total 220 subjects were studied, consisting 110 subjects in case group and 110 subjects in control group. Of the 110 cases, IVH grade 1 (69.1%), grade 2 (12.7%), grade 3 (10%), and grade 4 (8.2%). Bivariate analysis showed that PIV was significantly associated with gestational age <28 weeks (OR 5.44; 95% CI 2.23-13.27; p<0.001), birth weight <1,000 grams (OR 6.23; 95% CI 2.87-13.52; p<0.001), birth weight 1,000-1,499 grams (OR 3.04; 95% CI 1.62-5.71; p=0.001), 1st minute Apgar score (p=0.004), 5th minute Apgar score (p=0.03), inotropic administration (OR 2.47; 95% CI 1.35-4.53; p=0.005), platelet count <50,000/μL (OR 2.52; 95% CI 1.17-5.42; p=0.018), platelet count 50,000-99,000/μL (OR 3.42; 95% CI 1.51-7.74; p=0.003), invasive mechanical ventilation (OR 3.71; 95% CI 2.11-6.53; p<0.001), sepsis (OR 2.84; 95% CI 1.64-4.90; p<0.001), and PDA (OR 2.01; 95% CI 1.07-3.78; p=0.042). Multivariate analysis showed only birth weight <1,000 grams (OR 3.93; 95% CI 1.71-9.06; p=0.001), birth weight 1,000-1,499 grams (OR 2.57; 95% CI 1.34-4.92; p=0.004), and the use of invasive mechanical ventilation (OR 2.49; 95% CI 1.34-4.63; p=0.004) were significantly associated with IVH.

Conclusion: Risk factors that significantly associated with IVH in baby with gestational age <35 weeks are birth weight <1,500 grams and the use of invasive mechanical ventilation."

"[ABSTRAKLatar Belakang: Angka kejadian trombositopenia pada neonatus dilaporkan antara 22-35%, dan salah satu komplikasinya adalah perdarahan intraventrikular (PIV). Penelitian sebelumnya di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta melaporkan angka kejadian PIV masih tinggi pada bayi usia gestasi < 35 minggu sebesar 43,47%. Perdarahan intraventrikular menyebabkan dampak yang berat pada perkembangan neurologis dan mortalitas. Di Indonesia, belum ada penelitian mengenai hubungan trombositopenia dan PIV. Tujuan: Mengetahui hubungan trombositopenia dengan PIV pada bayi usia gestasi < 35 minggu dan korelasi antara derajat berat trombositopenia dan derajat berat PIV. Metode: Penelitian potong lintang dengan penelusuran rekam medis dilakukan di Divisi Neonatologi Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia RSCM pada subjek yang dirawat pada bulan Januari 2012 sampai Desember 2014 dengan diagnosis PIV. Subjek dibagi menjadi kelompok PIV ringan sedang (derajat ≤ 2) dan berat (derajat > 2). Nilai trombosit dicatat pada hari yang sama dengan diagnosis PIV. Digunakan uji Pearson?s chi-square, Fischer, analisis multivariat, dan korelasi untuk analisis data. Hasil: Angka kejadian PIV berat dengan trombosit < 100.000/uL sebesar 28,2% dibanding 10,4% pada nilai trombosit ≥ 100.000/uL (p=0,014). Berdasarkan analisis multivariat, faktor yang memiliki pengaruh terhadap terjadinya PIV berat adalah usia gestasi < 32 minggu dan penggunaan alat bantu napas berupa ventilator dan high frequency oscillatory ventilation (HFOV). Derajat berat trombositopenia tidak memiliki korelasi dengan derajat berat PIV (koefisien korelasi 0,21). Simpulan: Trombositopenia tidak memiliki peranan pada terjadinya PIV berat. Derajat berat trombositopenia tidak memiliki korelasi dengan derajat berat PIV.

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ABSTRACTBackground: The prevalence of thrombocytopenia in neonates ranges from 22 to 35%, and the complication could be intraventricular hemorrhage (IVH). The previous research in Cipto Mangunkusumo Hospital (RSCM) Jakarta reported high incidence of IVH until gestational age < 35 weeks which is 43,47%. Intraventricular hemorrhage has caused a significant defect to neurologic development and mortality. In Indonesia, there were no research about the relationsghip between thrombocytopenia and IVH. Objective: To study the relation between thrombocytopenia and IVH in a baby with gestational age < 35 weeks and the correlation between the severity of thrombocytopenia and the severity of IVH. Methods: A cross sectional study was performed by medical records review in Neonatology Division of Child Health Department University of Indonesia RSCM. The subject of this study is neonates who were hospitalized from January 2012 until December 2014 with IVH diagnosis. Subjects were divided into mild moderate IVH (grade ≤ 2) and severe IVH (grade > 2). Thrombocyte count was recorded in the same day with the diagnosis of IVH. Pearson?s chi-squared, Fischer's tests, multivariate analysis, and correlation were used to analyzed the data. Results: Risk of severe IVH was 28,2% in neonates with thrombocyte count < 100,000/uL versus 10,4% in neonates without (p=0.014). From multivariate analysis, gestational age < 32 weeks and the use of respiratory support (ventilator and high frequency oscillatory ventilation) played a significant role in severe IVH. The severity of thrombocytopenia has no correlation with the severity of IVH (correlation coefficient = 0,21). Conclusion: Thrombocytopenia doesn?t have a role in severe IVH based on multivariate anlysis. The severity of thrombocytopenia has no correlation with the severity of IVH., Background: The prevalence of thrombocytopenia in neonates ranges from 22 to 35%, and the complication could be intraventricular hemorrhage (IVH). The previous research in Cipto Mangunkusumo Hospital (RSCM) Jakarta reported high incidence of IVH until gestational age < 35 weeks which is 43,47%. Intraventricular hemorrhage has caused a significant defect to neurologic development and mortality. In Indonesia, there were no research about the relationsghip between thrombocytopenia and IVH. Objective: To study the relation between thrombocytopenia and IVH in a baby with gestational age < 35 weeks and the correlation between the severity of thrombocytopenia and the severity of IVH. Methods: A cross sectional study was performed by medical records review in Neonatology Division of Child Health Department University of Indonesia RSCM. The subject of this study is neonates who were hospitalized from January 2012 until December 2014 with IVH diagnosis. Subjects were divided into mild moderate IVH (grade ≤ 2) and severe IVH (grade > 2). Thrombocyte count was recorded in the same day with the diagnosis of IVH. Pearson’s chi-squared, Fischer’s tests, multivariate analysis, and correlation were used to analyzed the data. Results: Risk of severe IVH was 28,2% in neonates with thrombocyte count < 100,000/uL versus 10,4% in neonates without (p=0.014). From multivariate analysis, gestational age < 32 weeks and the use of respiratory support (ventilator and high frequency oscillatory ventilation) played a significant role in severe IVH. The severity of thrombocytopenia has no correlation with the severity of IVH (correlation coefficient = 0,21). Conclusion: Thrombocytopenia doesn’t have a role in severe IVH based on multivariate anlysis. The severity of thrombocytopenia has no correlation with the severity of IVH.]"

"Latar belakang: Hipotermia merupakan penyebab utama morbiditas dan mortalitas pada bayi, terutama pada bayi prematur dan atau dengan berat lahir kurang. Membungkus bayi menggunakan plastik terbukti mengurangi hipotermia. Saat ini terdapat Neohelp suatu plastik dengan desain baru yang diharapkan lebih efektif mencegah hipotermia. Tujuan: Mengetahui angka kejadian hipotermia bayi baru lahir dan waktu yang dibutuhkan untuk mencapai normotermia pada resusitasi bayi prematur menggunakan plastik polietilen lembaran dibandingkan dengan plastik Neohelp, serta mengetahui faktor risiko dan komplikasi hipotermia. Metode: Dilakukan randomized controlled trial pada 48 bayi baru lahir usia gestasi ≤ 32 minggu, pada 5 rumah sakit. Faktor lingkungan berupa suhu ruangan, kelembaban, waktu transport dari ruang bersalin ke ruang perawatan serta penggunaan 2 macam plastik untuk mencegah hipotermia, dianalisis secara bivariate menggunakan Uji Chi-square, Fisher exact, t-test dan Man-Whitney test. Hasil: Didapatkan nilai angka hampir sama antara kelompok plastik poietilen lembaran dibanding Neohelp untuk mencapai normotermi di ruang bersalin (4,5 menit vs 5 menit), serta rerata suhu tubuh ketika tiba di ruang perawatan (35,6⁰C vs 35,4⁰C). Suhu dan kelembaban ruangan, waktu tempuh dari ruang bersalin ke ruang perawatan, dan 2 jenis plastik tidak terbukti merupakan faktor risiko terjadinya hipotermia. Kesimpulan: Plastik Neohelp tidak terbukti lebih unggul dibanding polietilen lembaran dalam mencegah hipotermia. Peranan petugas kesehatan sangat besar dalam mencegah hipotermia, apapun jenis plastik yang digunakan.

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Background: Hypothermia is one of the primary causes of morbidity and mortality in newborn period, particularly preterm and low birth weight babies. Prevention of hypothermia by wrapping newborns with plastic sheets has been proven helpful. Neohelp is a specially designed plastic wrap for neonates to prevent hypothermia. Aim: We aimed to determine the prevalence of hypothermia of the newborn and time to reach normothermia on preterm newborn resuscitation using polyethylene plastic sheet compared to Neohelp. We also aimed to determine the risk factors and complications of hypothermia following the resuscitation. Method: This is a randomized control trial of 48 newborn ≤ 32 weeks age of gestation in 5 hospitals. The environmental factors assessed were room temperature, humidity, time of travel from delivery room to the care unit and the use of two types of plastic wrap to prevent hypothermia. All of the variables were analyzed using Chi-square, Fischer exact, t-test, and Mann-Whitney. Result: We found only slight difference between polyethylene plastic sheet and Neohelp to reach normothermia in delivery room (4.5 minutes vs 5 minutes). Average temperature on arrival in care unit was not also not significantly different (35.6 centigrade vs 35.4 centigrade). Room temperature, humidity, time of travel from delivery room to care unit, and the type of plastic wrap used were not proven as risk factors of hypothermia. Conclusion: Neohelp was not proven to be superior to polyethylene sheet in preventing hypothermia. Skill of the healthcare personnel has been the biggest role in preventing hypothermia, regardless of the type of plastic used."

"Prematuritas merupakan penyebab mortalitas dan morbiditas neonatus tertinggi. Sebagian besar prematur mendapat transfusi PRC berulang selama perawatan. Sementara itu, transfusi PRC berulang dapat meningkatkan kadar zat besi. Namun, hingga saat ini belum ada konsensus mengenai suplementasi besi pada prematur yang telah mendapat transfusi PRC berulang. Penelitian ini bertujuan untuk mengetahui status besi pada bayi prematur usia gestasi 28-32 minggu yang telah mendapat transfusi PRC berulang dan membuat rekomendasi mengenai pemberian suplementasi besi. Penelitian ini adalah penelitian kohort prospektif terhadap 70 bayi prematur yang lahir di RSCM bulan Maret 2021 – Mei 2021. Profil besi diperiksa usia kronologis 1, 2 dan 3 bulan. Hasil penelitian menunjukkan profil besi bayi prematur yang mendapat transfusi PRC > 2 kali lebih tinggi secara signifikan dibandingkan ≤ 2 kali (p<0,05). Titik potong total volume transfusi PRC yang menyebabkan status besi berlebih adalah PRC ≥ 50 mL/kgBB. Median feritin serum pada usia kronologis 1 bulan adalah 498,11 µg/L (358-885,62 µg/L), dua bulan adalah 232,66 µg/L (60,85-538,44 µg/L), tiga bulan adalah 42 µg/L (40,1-168,63 µg/L). Faktor risiko yang memengaruhi status besi berlebih pada bayi prematur adalah riwayat sepsis (OR 5,918 (IK 95%: 2,027-17,277)). Dari hasil penelitian disimpulkan bahwa bayi prematur yang mendapat transfusi PRC >2 kali memiliki profil besi yang lebih tinggi dibandingkan ≤ 2 kali pada usia kronologis 1 bulan. Bayi premtur yang mendapat transfusi PRC ≥ 50 mL/kgBB memiliki status besi berlebih di usia kronologis 1 bulan sehingga suplementasi besi sebaiknya diberikan pada usia kronologis 2 bulan.

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Prematurity is the most common cause of neonatal mortality and morbidity. Most of the preterm infants received multiple PRC transfusions during hospitalization. Meanwhile, multiple PRC transfusions can increase iron levels. However, to date there is no consensus regarding iron supplementation in preterm who have received multiple PRC transfusions. The objective of this study are to determine iron status in premature infants aged 28-32 weeks who have received multiple PRC transfusions and make recommendations regarding iron supplementation. This study is a prospective cohort study of 70 preterm infants born at the Cipto Mangunkusumo Hospital in March 2021 – May 2021. Iron profiles were examined chronologically age at 1, 2 and 3 months of age. The result are the iron profile of preterm infants who received PRC transfusion was > 2 times significantly higher than ≤ 2 times (p<0.05). The cut-off point for the total volume of PRC transfusion that causes iron overload status is ≥ 50 mL/kgBW. The median serum ferritin at 1 month of age was 498.11 g/L (358-885.62 g/L), two months was 232.66 g/L (60.85-538.44 g/L), three months is 42 g/L (40.1-168.63 g/L). The risk factor influencing iron overload status in preterm infants was a history of neonatal sepsis (OR 5.918 (95% CI: 2.027-17.277)). The conclusion of this study are preterm infants who received PRC transfusion >2 times had a higher iron profile than ≤ 2 times at 1 month chronological age. Preterm infants who received PRC transfusions ≥ 50 mL/kgBW had iron overload status at 1 month of chronological age and therefore iron supplementation should be given at 2 months of chronological age."

"Latar Belakang : Kelahiran prematur saat ini menjadi penyebab utama kematian pada bayi. Bayi yang dapat bertahan hidup memiliki kemungkinan cacat dan keterlambatan perkembangan. Di Indonesia, data dari Maternal Perinatal Death Notification Kementerian Kesehatan tahun 2023 tercatat 29.945 kematian bayi disebabkan bayi berat lahir rendah (BBLR), prematuritas dan asfiksia. Pada bayi prematur sering terjadi gangguan hemodinamik yang memengaruhi aliran darah ke otak. Keadaan ini disertai belum maturnya autoregulasi pada bayi prematur menyebabkan mudah terjadi GM-IVH. Sebagian besar GM-IVH tidak muncul segera setelah lahir. Beberapa penelitian menyebutkan 50% GM-IVH muncul 48 jam pertama setelah lahir dan 90% pada 72 jam pertama setelah lahir. Kesulitan di lapangan adalah 25 - 50 % bayi tidak menunjukkan gejala dan tanda manifestasi GM-IVH pada fase awal. USG kepala Doppler warna diketahui dapat melihat perubahan aliran darah dengan menilai perubahan parameter Doppler warna.Tujuan : Mendapatkan nilai parameter USG kepala Doppler warna sebagai prediktor GM-IVH pada bayi prematur usia gestasi kurang dari sama dengan 34 minggu dalam 24 jam pertama kehidupan.Metode : Penelitian ini merupakan suatu penelitian kohort prospektif untuk mendapatkan prediktor GM-IVH pada 75 bayi prematur usia 24 jam pertama setelah lahir dengan usia gestasi kurang dari sama dengan 34 minggu yang dirawat di RSCM. Satu orang bayi meninggal, sehingga 74 bayi sebagai subjek yang diikutsertakan hingga penelitian selesai. Studi menggunakan Analitik Multivariat Prediktif Kategorik.Hasil : Distribusi karakteristik dalam penelitian ini sebanyak 74 subjek yang diikutsertakan dalam penelitian, diantaranya 60 (81,1%) didiagnosis GM-IVH pada usia antara 2-7 hari. Didapatkan bayi lahir dengan usia gestasi kurang dari sama dengan 34 minggu dalam usia 24 jam pertama menunjukkan parameter RI yang berperan dalam memprediksi GM-IVH dengan titik potong nilai parameter RI >0,69 pada USG kepala Doppler warna. Berdasarkan nilai titik potong RI > 0,69, pada AUC didapatkan sensitivitas 85,0 % dan spesifisitas 71,43%, nilai duga positif sebesar 92% dan nilai duga negatif 52%, kemaknaan p <0.0001.Simpulan: USG kepala Doppler warna dapat digunakan sebagai alat untuk memprediksi GM- IVH pada bayi prematur yang lahir dengan usia gestasi kurang dari sama dengan 34 minggu dalam usia 24 jam pertama kehidupan dengan nilai parameter RI > 0,69 sebagai parameter yang berperan memprediksi GM-IVH.

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Background: Premature delivery nowadays has become the primary cause of death in infants. The survivor infants can have some disabilities and developmental delays. In Indonesia, Maternal Perinatal Death Notification data from Health Ministry in 2023 report 29.945 number of death in infants caused by underweight, prematurities and asphixia. Premature infants often have haemodinamic abnormalities that can influence blood flow to the brain. This condition followed by the immature of the autoregulation in premature infants that can caused GM-IVH easyly. Most of GM-IVH did not appear directly after birth. A number of studies showed that GM-IVH 50% occured at 48 hours and 90% at 72 hours after birth. Difficulties in the field is 25 - 50 % infants do not show symptoms and signs of GM-IVH manifestation at early phase. Color Doppler head ultrasound could detect the early changes in the brain blood flow.

Aim : To have parameters values in color Doppler head ultrasound as predictor GM-IVH in premature infants at gestational ages less than equal 34 weeks and earlier than the first 24 hours of life.

Methods : A cohort prospective study to obtained GM-IVH predictors at 75 premature infants in gestation ages less than equal 34 weeks and age earlier than 24 hours of life, being treated at Cipto Mangunkusumo General Hospital. One baby died. Study was done using Multivarians Predictives Analitics Categories.

Result: There were 74 subject participated. Among the 60 (81,1%) were diagnosed GM-IVH at the age between 2-7 days. We found that premature infants in gestation ages less than equal 34 weeks and earlier than 24 hours of life, showed that the RI parameter played a significant role to predict GM-IVH. The cutoff point for color Doppler head ultrasound value was RI > 0,69, AUC revealed a sensitivity of 85,0 % and a specificity of 71,43 %, positive predictive value of 92% and negative predictive value of 52%, p <0.0001.

Conclusion: Color Doppler head ultrasound could be used as a tool to predict GM-IVH for prematures infants at gestation age less than equal 34 weeks and earlier than 24 hours of life."

"Displasia bronkopulmonal merupakan salah satu komplikasi dari kelahiran prematur. Faktor risiko DBP pada bayi sangat prematur yaitu kecil masa kehamilan, korioamnionitis, pajanan oksigen FiO2 > 30%, duktus arteriosus persisten hemodinamik signifikan, sepsis neonatorum awitan lambat, volutrauma, surfaktan tidak diberikan, kafein tidak diberikan, dan tidak mendapatkan ASI. Data prevalens DBP yang dipublikasi pada tahun 2015 yaitu 42,8% dan kesintasan bayi sangat prematur di RSCM pada tahun 2020 yaitu 54,17%. Oleh karena itu, studi prevalens dan mempelajari faktor risiko DBP pada bayi sangat prematur yang lahir di RSCM perlu dilakukan. Penelitian ini merupakan studi potong lintang dengan subyek bayi usia gestasi £32 minggu yang lahir di RSCM. Sebanyak 211 subyek memenuhi kriteria inklusi dan eksklusi. Hasil penelitian yaitu prevalens DBP 34,6% (DBP ringan 19%, DBP sedang 8,5%, dan DBP berat 7,1%). Analisis multivariat menunjukkan faktor risiko yang berhubungan dengan DBP yaitu SNAL (aOR 4,455 IK 95% 1,932-10,270; p= <0,001), pajanan volume tidal >5 mL/kg (aOR 3,059 IK 95% 1,491-6,273; p 0,002), asupan ASI predominan (aOR 0,348 IK 95% 0,150-0,808; p 0,014), dan asupan susu formula predominan (aOR 0,280 IK 95% 0,123-0,634; p 0,002). Kesimpulan: Bayi sangat prematur yang mengalami SNAL, pajanan volum tidal >5 mL/kg berisiko mengalami DBP. Namun, asupan asi predominan dan susu formula predominan menurunkan risiko DBP.

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Bronchopulmonary dysplasia is one of the complications of preterm birth. The risk factors for bronchopulmonary dysplasia in very premature infants were small gestational age, chorioamnionitis, oxygen exposure to FiO2 > 30%, hemodynamically significant persistent ductus arteriosus, late-onset neonatal sepsis, volutrauma, no surfactant, no caffeine, and no breastfeeding. Published data of prevalence of DBP in 2015 is 42.8% and the survival data for very premature babies at the CMH in 2020 is 54.17%. Therefore, it is necessary to study the prevalence and study of risk factors for bronchopulmonary dysplasia in very preterm infants born in CMH. This study is a cross-sectional study with 32 weeks gestational age infants born at CMH. A total of 211 subjects met the inclusion and exclusion criteria. The results of the study were the prevalence of DBP 34.6% (mild DBP 19%, moderate DBP 8.5%, and severe DBP 7.1%). Multivariate analysis showed the risk factors associated with DBP were late onset neonatal sepsis (aOR 4,455 CI 95% 1,932-10,270; p= <0,001), tidal volume exposure >5 mL/kg (aOR 3,059 CI 95% 1,491-6,273; p 0,002), human milk predominant (aOR 0,348 CI 95% 0,150-0,808; p 0,014), and formula milk predominant (aOR 0,280 CI 95% 0,123-0,634; p 0,002). Conclusion: In a very premature infants who have SNAL, tidal volume exposure >5 mL/kg are at risk for DBP. However, the predominant human milk intake and predominant formula milk intake decreased the risk of DBP."