Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKResusitasi dengan konsentrasi oksigen yang tinggi (100%) pada bayi cukup bulanmeningkatkan angka mortalitas dan morbiditas. Hiperoksia dapat meningkatkan stresoksidatif pada bayi prematur oleh karena kadar anti oksidannya yang rendah. Peningkatanstres oksidatif akan mengakibatkan inflamasi dan berhubungan dengan terjadinya displasiabronkopulmonal dan gangguan integritas usus. Pemberian oksigen yang tinggi juga akanmemengaruhi mikrobiota aerob dan anaerob dalam usus oleh karena oksigen akan berdifusidari mukosa usus ke dalam lumen usus. Belum diketahui berapa kadar FiO2 awal yang tepatpada resusitasi bayi prematur.Penelitian ini bertujuan menelaah dampak perbedaan pajanan konsentrasi oksigen awal padaresusitasi bayi prematur terhadap displasia bronkopulmonal, integritas mukosa, danmikrobiota usus.Penelitian ini merupakan penelitian uji klinis acak terkontrol tidak tersamar di IlmuKesehatan Anak, FKUI-RSCM dan RS Bunda Menteng pada bayi prematur (usia gestasi 25?32 minggu) yang mengalami distres pernapasan yang dirandomisasi untuk diberikanresusitasi dengan FiO2 awal 30% atau 50%. Kadar FiO2 disesuaikan untuk mencapai targetsaturasi oksigen (SpO2) 88?92% pada menit ke-10 dengan menggunakan pulse oxymetry.Luaran primer berupa angka kejadian DBP dan luaran sekunder berupa penanda stresoksidatif (rasio GSH/GSSG dan MDA darah tali pusat dan hari ke-3), penanda gangguanintegritas usus (alpha-1 antitrypsin), dan mikrobiota usus (polymerase chain reaction) padafeses hari 1?3 dan hari ke-7.Selama periode Januari?September 2015, terdapat 84 bayi yang direkrut (masing-masing 42bayi pada kelompok 30% dan 50%). Tidak ada perbedaan bermakna angka kejadian DBPpada kelompok FiO2 30% vs. 50%, yaitu 42,8% vs. 40,5% (intention to treat analysis) dan25% vs. 19,4% (per protocol analysis). Juga tidak ada perbedaan bermakna penanda stresoksidatif (rasio GSH/GSSG dan kadar MDA), kadar AAT, dan mikrobiota usus pada keduakelompok. Mikrobiota anaerob fakultatif lebih tinggi dibandingkan dengan mikrobiotaanaerob pada hari ke-7 pada kedua kelompok.Pada bayi prematur dengan usia gestasi 25?32 minggu yang diresusitasi dengan FiO2 awal30% vs. 50% tidak dijumpai perbedaan yang bermakna angka kejadian DBP, penanda stresoksidatif, gangguan integritas mukosa usus (AAT), dan mikrobiota usus. Oleh karena itu,pemberian FiO2 awal 30% hingga 50% selama resusitasi sama amannya untuk bayi prematur

---

ABSTRACTResuscitation with high oxygen levels (100%) in term infants increases mortality andmorbidity rates. Hyperoxia can increase oxidative stress in premature infants due to its lowantioxidant level. The increased oxidative stress will cause inflammation and it is associatedwith the development of bronchopulmonary dysplasia (BPD) as well as intestinaldysintegrity. The administration of high oxygen levels will also affect aerobic and anaerobicintestinal microbiota as the oxygen will diffuse from intestinal mucosa into the lumen. Theappropriate initial FiO2 level during the resuscitation of premature infants has not beenknown.This study aims to analyze an impact on the difference of exposure to initial oxygenconcentration in resuscitation of premature infants against bronchopulmonary dysplasia,mucosal integrity, and intestinal mucosa.The study was an unblinded randomized controlled clinical trial, in Child Health DepartmentUniversity of Indonesia, Cipto Mangunkusumo Hospital, and Menteng Bunda Hospital inJakarta, which was conducted in premature infants (25?32 weeks of gestational age) whoexperienced respiratory distress and were randomized for receiving resuscitation using 30%or 50% initial FiO2. The FiO2 levels were adjusted to achieve target oxygen saturation (SpO2)of 88?92% on the 10th minute using pulse oximetry. The primary outcome was incidence ofBPD; while the secondary outcome was markers of oxidative stress (ratio of GSH/GSSG andMDA in umbilical cord blood and on the 3rd day), intestinal dysintegrity (AAT) andintestinal microbiota (using PCR) found in fecal examination on day 1?3 and on the 7th day.During the period between January and September 2015, there were 84 infants recruited(there were 42 infants in each group of the 30% and 50% FiO2). There was no significantdifference on BPD incidence between 30% and 50% FiO2 groups, i.e. 42.8% vs. 40.5%(intention to treat analysis) and 25% vs. 19.4% (per protocol analysis). There was also nosignificant difference on oxidative stress markers (ratio of GSH/GSSG and MDA levels),AAT levels, and changes of facultative anaerobic and anaerobic microbiota in both groups.However, there was a higher level of facultative anaerobic microbiota compared to anaerobicmicrobiota on the 7th day in both groups.In premature infants with 25?32 weeks of gestational age who were resuscitated using 30%vs. 50% initial FiO2 level, significant differences were found in terms of BPD incidence,oxidative stress markers (ratio of GSH/GSSG and MDA), AAT (intestinal mucosa integrity)and intestinal microbiota. Therefore, it is concluded that the administration of 30% to 50%initial FiO2 are both equally safe for premature infants during resuscitation."

"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.

---

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."

"Latar belakang. Displasia bronkopulmonal (DBP) adalah penyakit multifaktorial kronis akibat inflamasi baik prenatal maupun postnatal. Hal ini akan menyebakan komplikasi jangka panjang dalam hal pernapasan, kardiovaskuler, dan neurodevelopmental. Azitromisin sebagai agen antiinflamasi diharapkan dapat mencegah kejadian DBP.Metode. Uji klinis acak terkontrol tidak tersamar dilakukan selama Juni 2021-April 2022 di unit Neonatologi RSCM Jakarta pada 114 subjek dengan usia gestasi 25 minggu-31 minggu 6 hari yang mengalami distress napas. Pasien yang memenuhi kriteria inklusi dan eksklusi dilakukan randomisasi dan dibagi menjadi dua kelompok yaitu kelompok uji/perlakuan dan kelompok kontrol, masing masing sebanyak 57 subjek. Kelompok uji akan mendapatkan azitromisin dalam usia <24 jam selama 14 hari dengan dosis 10 mg/kgbb/intravena selama 7 hari kemudian dilanjutkan 5 mg/kgbb/intravena selama 7 hari. Pasian akan dipantau sampai dengan usia gestasi 36 minggu untuk melihat outcome primer berupa DBP, dan outcome sekunder berupa IVH, PVL, EKN, lama penggunaan O2, durasi penggunaan ventilator mekanik, lama pencapaian full enteral feeding, serta mortalitas pada kedua kelompok. Diagnosis DBP ditegakkan berdasarkan NICHD 2019.Hasil. Angka kejadian DBP secara umum adalah 34.8%. Angka kejadian DBP pada bayi extremely preterm adalah 58.3%, sedangkan pada bayi very preterm adalah 31%. Kejadian DBP lebih banyak pada kelompok kontrol (63% vs 38%) dengan RR 0.611(0.417-0.896). Durasi penggunaan ventilator mekanik lebih pendek pada kelompok yang mendapatkan azitromisin (5.22 vs 12.75,p 0.025). Lamanya pencapaian full enteral feeding lebih pendek pada kelompok uji/perlakuan (13.38 vs 17.14 hari, p 0.04). Angka kejadian EKN lebih rendah pada kelompok uji/perlakuan (19% vs 40%, nilai p 0.014). Mortalitas lebih rendah pada kelompok uji/perlakuan (25% vs 46% , nilai p 0.019) RR 1.660 (95% CI 1.043-2.642). Kesimpulan. Azitromisin dapat menurunkan angka kejadian DBP, mempercepat pencapaian full enteral feeding, menurunkan mortalitas pada bayi prematur.

---

Background. Bronchopulmonary dysplasia (BPD) is a chronic multifactorial disease caused by inflammation both prenatal and postnatal. This will lead a long-term complications of respiratory, cardiovascular, and neurodevelopmental. Azithromycin as an antiinflammatory agent is expected to prevent BPD.

Methods. A randomized controlled clinical trial, unblinded was conducted during June 2021-April 2022 at the Neonatology unit of RSCM Jakarta on 114 subjects with a gestational age of 25 weeks-31 weeks 6 days who experienced respiratory distress. Patients who met the inclusion and exclusion criteria were randomized and divided into two groups, the intervention group and the control group, each group with 57 subjects. The intervention group will receive azithromycin at the age of <24 hours for 14 days at a dose of 10 mg/kg/intravenous for 7 days then followed by 5 mg/kg/intravenous for 7 days. Patients will be monitored up to 36 weeks' gestation to see the primary outcome in the form of BPD, and secondary outcomes in the form of IVH, PVL, EKN, duration of O2 used, duration of mechanical ventilator used, duration of achieving full enteral feeding, and mortality in both groups. BPD diagnosed based on NICHD 2019.

Results. The incidence of BPD in general is 34.8%. The incidence of BPD in extremely preterm infants is 58.3%, while in very preterm infants it is 31%. The incidence of BPD was more in the control group (63% vs 38%) with an RR 0.611(0.417-0.896). The duration of ventilator mechanic used was shorter in the intervention group (5.22 vs 12.75, p 0.025). The duration of achieving full enteral feeding was shorter in the intervention group (13.38 vs 17.14 days, p 0.04). The incidence of NEC was lower in the intervention group (19% vs 40%, p-value 0.014). Mortality was lower in the intervention group (25% vs 46%, p 0.019) RR 1.660 (95% CI 1.043-2.642).

Conclusion. Azithromycin can reduce the incidence of BPD, accelerate the achievement of full enteral feeding, reduce mortality in premature infants"

"Latar belakang. Translokasi bakteri dari saluran cerna merupakan masalah yang penting dalam terjadinya infeksi pada pasien dengan kolestasis obstruktif serta sirosis hepatis. Pada studi ini kami bermaksud untuk mempelajari komposisi mikrobiota usus dihubungkan dengan malabsorpsi lemak dan gangguan integritas usus pada anak dengan kolestasis kronis. Metode. Sampel feses dari bayi/anak dengan kolestasis dan anak sehat dikumpulkan untuk dilakukan evaluasi terhadap jumlah sel lemak, komposisi mikrobiota usus serta integritas ususnya. Hasil. Lima puluh tujuh bayi/anak (27 kolestasis dan 30 anak sehat) dilakukan evaluasi. Terdapat perbedaan bermakna pada berat badan, P=0.001; status nutrisi, P=<0.0001; serta konsumsi susu formula dengan bahan dasar middle chain triglyceride, P=<0.0001. Selain itu juga ditemukan bahwa komposisi lemak pada feses serta kadar fecal calprotectin lebih tinggi pada kelompok kolestasis dibandingkan dengan anak sehat, P=<0.0001 dan P=0.021. Sesuai dengan hasil tersebut ditemukan pula perbedaan yang bermakna di antara kedua grup tersebut pada komposisi Bifidobacteria sp. and E. Coli sp., P=0.005. Kesimpulan. Ditemukan perbedaan yang bermakna pada berat badan, status nutrisi, komposisi lemak feses, kadar fecal calprotectin serta profil mikrobiota usus antara kelompok bayi dengan kolestasis dengan bayi sehat. Diperlukan studi lanjutan untuk mempelajari interaksi antara saluran cerna dan hati pada kolestasis.

---

Background. Bacterial translocation from the gastrointestinal tract is central to current concepts of endogenous sepsis in obstructif cholestasis and cirrhosis. In this study we evaluate gut microbiota profile and their correlation with fat malabsorption and gut integrity. Methods. We evaluate feces sampels from chronic cholestasis and healthy infants to know their fat malabsorption, gut microbiota composition, and gut integrity, then compare between the 2 groups.

Results. Fifty-seven infants (27 cholestasis and 30 healthy) were evaluated. There were significant difference in mean body weight 7932.39 (SD: 3416.2) VS 11453.3 (SD: 4012.3) grams, P=0.001; nutritional status, P=<0.0001, and middle chain triglyceride dominant infant formula, P=<0.0001. Feces evaluation showed a significant hinger fat composition (+2 and +3), P=<0.0001 and fecal calprotection level in cholestatic groups (81.32 (SD:61.6) VS 47.37 (SD:47.3) microgram/g faeces), P=0.021. In accordance with fecal calprotectin level, there were a significant difference between the 2 groups in composition of Bifidobacteria sp. and E. Coli sp., P = 0.005.

Conclusions. Significant differences were found in body weight, nutritional status, feces fat composition, fecal calprotection level and gut microbiota profile between chronic cholestasis and healthy infants. Further studies needed to evaluate the interaction between gut and liver axis in infants with cholestasis."

"Pertumbuhan mukosa usus manusia belum sempurna saat dilahirkan, karena itu usus bayi sering dikatakan sebagai leaky gut. Probiotik diketahui dapat membantu maturasi saluran cerna. Apakah dalam ASI memang terdapat probiotik ataukah suatu kontaminasi, masih diperdebatkan.Penelitian ini bertujuan untuk mengetahui apakah probotik ada dalam ASI bila diberikan suplementasi probiotik pada ibu hamil sejak trimester III dan menyusui, efek terhadap probiotik lain dan IL-8 dalam ASI, IFABP urin dan alfa-1-antitripsin (AAT) serta kalprotektin tinja, saat bayi lahir dan usia tiga bulan, dalam rangka menilai integritas mukosa usus.Dilakukan penelitian uji klinis, paralel dua kelompok dengan randomisasi, samar ganda yang dilakukan di RS Budi Kemuliaan dan klinik-klinik satelitnya sejak Desember 2014 sampai dengan Desember 2015. Jumlah subjek 35 per kelompok. Digunakan probiotikBifidobacterium animalis lactis HNO19 karena bukan merupakan resident bacteria.Lima subjek positif DR10 dalam kolostrum (V0) dan 7 subjek positif saat bayi usia 3 bulan (V3) pada kelompok probiotik. Hasil negatif didapati pada kelompok plasebo. Apusan kulit sekitar payudara negatif pada kedua kelompok. Nilai median IL-8 kelompok probiotik dibanding kelompok plasebo pada V0 dan V3 berturut-turut 2810,1 pg/mL vs. 1516,4 pg/mL (p = 0,327) dan 173,2 pg/mL vs. 132,7 pg/mL (p = 0,211). IFABP V0 dan V3 211,7 ng/mL vs. 842,5 ng/mL (p = 0,243) dan 25,3 ng/mL vs. 25,1 ng/mL (p = 0,466). AAT 136,2 mg/dL vs. 148,1 mg/dL (p = 0,466) dan 24 mg/mL vs. 29,72 mg/mL (p = 0,545). Kalprotektin 746,8 ng/mL vs. 4645,2 ng/mL (p = 0,233) dan 378,6 ng/mL vs. 391,3 ng/mL (p = 0,888).Probiotik DR10 yang diberikan pada ibu hamil sejak trimester III dapat ditemukan dalam kolostrum dan usia 3 bulan pada kelompok probiotik, dan bukan suatu kontaminasi .Tidak terdapat perbedaan bermakna terhadap probiotik lain, kadar IL-8 dalam ASI, IFABP urin, AAT dan kalprotektin tinja pada kelompok probiotik dibanding dengan kelompok plasebo.

---

Newborn infants have intestinal hyperpermeability because their gut mucosa is not fully mature yet. It is known that probiotics helps gut maturity. It remains unclear whether probiotics pass through breast milk or whether the positive cultures are the result of contamination. This study aimed to evaluate the effect of probiotic supplementation in pregnant and lactating mothers, with regards to probiotic presence and IL-8

concentration in breast milk, infant urine intestinal fatty acid binding protein (IFABP), as well as fecal ?-1 anti-trypsin (AAT) and calprotectin at birth (V0) and at infant 3

months of age (V3) .

This randomized, controlled trial was double-blind, two parallel groups, probiotic and placebo with 35 subjects in each group. The sudy was done at Budi Kemuliaan Hospital and it’s satellite clinics from December 2014 until December 2015. We used Bifidobacterium

animalis lactis HNO19 (commonly known as DR10) as the supplemental probiotic, as it is not a member of the normal flora.

Probiotik DR10 were found in colostrum at 5 subjects and 7 subjects in V3 breastmilk probiotics group, but none in placebo group. Skin swab of DR10 were negative in both group. Median breast milk IL-8 in probiotic group compare to placebo group at V0 and V3 respectively were 2810.1 pg/mL vs. 1516.4 pg/mL (p = 0.327) and 173.2 pg/mL vs. 132.7 pg/mL (p = 0.211). Infant urine IFABP 211.7 ng/mL vs. 842.5 ng/mL (p = 0.243) and 25.3 ng/mL vs. 25.1 ng/mL (p = 0.466). Infant stool AAT 136.2 mg/dL vs. 148.1 mg/dL (p = 0.466) and 24 mg/mL vs. 29.72 mg/mL (p = 0.545). Stool calprotectin 746.8 ng/mL vs. 4645.2 ng/mL (p = 0.233) and 378.6 ng/mL vs. 391.3 ng/mL (p = 0.888).

Probiotic DR10 were found in colostrum and 3 month-breast milk of women in the probiotic group, but no DR10 in placebo group. However, breast milk IL-8, the presence of other probiotics, and infant gut mucosal integrity were not significantly different between the two groups."

"Latar Belakang: Air susu ibu merupakan nutrisi ideal untuk bayi yang direkomendasikan untuk diberikan secara eksklusif hingga usia 4-6 bulan. Air susu ibu mengandung zat bioaktif yang dapat mempercepat proses maturasi dan menjaga integritas mukosa usus. Pemeriksaan yang bersifat mudah, cepat, non-invasif dan terpercaya untuk menilai integritas mukosa usus yaitu alfa-1 antitripsin (AAT), calprotectin, dan IgA sekretorik (sIgA) feses. Tujuan: Mengetahui perbedaan integritas mukosa usus dengan mengukur kadar AAT, calprotectin dan sIgA feses pada subjek bayi ASI dan susu formula eksklusif (SF) dan mengetahui hubungan antara jenis asupan nutrisi dengan integritas mukosa usus bayi pada usia 4-6 bulan. Metode: Penelitian dilakukan pada bulan Juni-Oktober 2013. Subjek penelitian adalah bayi sehat berusia 4-6 bulan yang datang ke poliklinik anak RS St Carolus Jakarta dan yang bertempat tinggal di Kecamatan Pasar Minggu dan Cempaka Putih Jakarta. Kadar AAT, calprotectin, dan sIgA feses diukur menggunakan metode enzyme-linked immunosorbent assay (ELISA). Analisis statistik dilakukan untuk mencari hubungan pemberian ASI eksklusif dengan integritas mukosa usus dengan uji Kai kuadrat atau Fisher (analisis bivariat). Hasil: Penelitian dilakukan pada 80 subjek (ASI n=40, SF n=40). Tidak didapatkan perbedaan karakteristik yang bermakna pada kedua kelompok. Kelompok ASI memiliki nilai rerata kadar AAT feses yang lebih tinggi secara bermakna (p=0,02). Kelompok SF memiliki kadar calprotectin yang lebih tinggi namun tidak berbeda bermakna (p=0,443) dibanding dengan bayi ASI. Kelompok ASI memiliki median kadar sIgA yang lebih tinggi secara tidak signifikan (p=0,104) dibandingkan dengan bayi SF. Pada penelitian ini didapatkan hubungan yang bermakna antara pemberian nutrisi dengan peningkatan kadar AAT feses bayi ASI. Tidak didapatkan hubungan yang bermakna antara jenis asupan nutrisi dengan penurunan kadar calprotectin (p=0,65) dan peningkatan kadar sIgA feses (p=0,26). Simpulan: Bayi ASI eksklusif menunjukkan integritas mukosa usus yang lebih baik dari bayi SF eksklusif. Kadar AAT lebih tinggi secara signifikan pada bayi ASI eksklusif diduga berkaitan dengan AAT yang diperoleh dari ASI.

---

Background: Breastmilk is recognised for its ideal nutritional benefits for babies and has been recommended to be given exclusively for 6 months of life. Breastmilk also known to have bioactive substances that could modulates the gastrointestinal maturation and maintain its mucosal integrity. Markers that are easy, non-invasive and reliable like fecal alpha-1 antitrypsin (AAT), calprotectin, and secretoric imunoglobulin A (sIgA) have been known as marker to asses gut wall integrity.

Objective: To determine the difference of gut wall integrity based on fecal AAT, calprotectin, and sIg A level of exclusive breastmilk (BF) and formula feeding (FF) infant at 4-6 month of age. To determine the correlation between feeding type with gut wall integrity.

Methods: The study was conducted from June to Oktober 2013. Subjects were babies of 4-6 months old who came to pediatric policlinic at St Carolus hospital, and live in Kecamatan Pasar Minggu and Kecamatan Cempaka Putih, Jakarta. The fecal markers analized with enzyme-linked immunosorbent assay (ELISA) methode. Chi square and Fischer test were used to analyze the correlation between feeding type and gut wall integrity (bivariate analysis).

Results: There were 80 babies recruited (BF=40, FF=40). There were no statisticaly difference between the characteristics of two groups. The BF group showed higher fecal AAT level compared to FF group (p=0,02). The FF group showed a higher fecal calprotectin and the BF group had a higher level of fecal sIgA compared to BF group but not statisticaly different (p=0,443, p=0,104). There was significant correlation between fecal AAT level of babies with breastmilk feeding (p=0,02). There were no significant correlation between fecal calprotectin (p=0,65) and sIgA level with the feeding type (p=0,26).

Conclusion: The BF babies had better mucosal integrity compared to FF babies. The fecal AAT level were significantly higher in breastmilk feeding babies and related with AAT from breastmilk."

"Panduan resusitasi anak umumnya menganjurkan pemberian cairan dalam jumlah besar. Beberapa penelitian memperlihatkan bahwa penggunaan cairan yang agresif meningkatkan mortalitas. Penelitian pada hewan menunjukkan tekanan vena sentral yang tinggi memicu pelepasan atrial natriuretic peptide ANP , sementara penelitian invitro memperlihatkan ANP meluruhkan glycocalyx endotel vaskular dan meningkatkan permeabilitas endotel. ANP juga memicu vasodilatasi. Hemodilusi berpotensi menurunkan pasokan oksigen tubuh DO2 . Penelitian bertujuan untuk melihat pengaruh resusitasi cairan terhadap kadar ANP serum, peluruhan glycocalyx endotel vaskular, extravascular lung water index ELWI , mean arterial pressure MAP , kadar hemoglobin dan pasokan oksigen. Hewan model renjatan adalah 11 ekor Sus scrofa jantan, usia 6-10 minggu. Renjatan dilakukan dengan metode fixed pressure hemorrhage. Resusitasi pertama dilakukan dengan jumlah cairan sesuai darah yang dikeluarkan resusitasi normovolemik , dilanjutkan dengan 40 mL/kg resusitasi hipervolemik . Pengukuran hemodinamik dilakukan dengan PICCO. Serum ANP dan Syndecan-1, petanda peluruhan glycocalyx, dilakukan dengan teknik ELISA. Hasil penelitian menunjukkan terjadinya peningkatan ANP pasca resusitasi normovolemik p = 0,043 , yang kemudian menurun kembali dalam 30 menit. Peluruhan glycocalyx tidak terjadi. Perbedaan ELWI pada 60 menit pasca resusitasi secara statistik bermakna, dengan perbedaan 0,93 mL/kg 95 IK:0,19 -3,62 . Terdapat korelasi kuat antara SVRI dan CI pasca resusitasi hipervolemik r = -0,587 . Tidak ada perbedaan MAP pasca resusitasi normovolemik dan hipervolemik. Kadar hemoglobin pasca resusitasi hipervolemik lebih rendah daripada pasca resusitasi normovolemik p = 0,009 . Pasokan oksigen tubuh pasca resusitasi hipervolemik lebih tinggi daripada pasca resusitasi normovolemik p = 0,012 . Simpulan: Resusitasi cairan pada renjatan akibat perdarahan tidak mengakibatkan peluruhan glycocalyx endotel vaskular. Peningkatan ELWI amat terbatas. SVRI berkorelasi terbalik dengan CI. Tidak ada perbedaan MAP antara resusitasi normovolemik dan hipervolemik. Resusitasi hipervolemik menyebabkan hemodilusi yang diimbangi dengan peningkatan curah jantung.

---

Many pediatric guidelines recommend liberal fluid resuscitation, but recent studies showed that aggressive fluid resuscitation might increase mortality. Animal studies showed that high central venous pressure induced ANP secretion. Invitro studies showed convincing evidence that ANP induced glycocalyx shedding. ANP also induced vasodilatation through cGMP signal transduction pathways. Hemodilution due to a large amount of resuscitation fluid potentially decreasing oxygen delivery.The objectives of this study were investigating the effect of fluid resuscitation, in the animal model, with special concern on serum ANP, glycocalyx shedding indicate by serum Syndecan-1 , changes in extravascular lung water, systemic vascular resirtance and mean arterial pressure, hemoglobin level and oxygen delivery DO2 . The animal models were 11 male domestic pigs, 6 -10 weeks old. The shock was induced with fixed pressure hemorrhage method. Fluid resuscitation was done in 2 phases. On the first attempt, we replaced total numbers of blood that withdrawn normovolemic resuscitation . On the second attempt, we gave 40 mL/kg resuscitation fluids hypervolemic resuscitation . The hemodynamic measurements were done with PICCO. Serum ANP and Syndecan-1 were measure with ELISA method.We found that serum ANP increased after normovolemic resuscitation p = 0.043 and immediately back to base level in 30 minutes. Glycocalyx shedding did not occur. Extravascular lung water index minimally increased. There was a strong correlation between SVRI and CI at hypervolemic resuscitation r = -0.587 . There was no difference in mean arterial pressure between normovolemic and hypervolemic resuscitation. Hemoglobin level after hypervolemic resuscitation was lower than after normovolemic resuscitation p = 0.009 . Oxygen delivery was higher after hypervolemic resuscitation p = 0.012 .Conclusions: Hypervolemic resuscitation in this hemorrhagic shock model did not induce glycocalyx shedding, extravascular lung water index minimally increased. Systemic vascular resistance index negatively correlated to cardiac index. Fluid resuscitation may induce hemodilution, but oxygen delivery can be compensated by increasing cardiac output. "

"Diare merupakan salah satu penyakit yang sering diderita oleh balita. Feses yang berbentuk cair pada anak dapat menyebabkan cedera kulit akibat seringnya kontak berulang, sehingga dapat merusak jaringan perianal. Penelitian ini bertujuan untuk mengidentifikasi dampak edukasi perawatan perianal dan pemberian VCO pada anak balita dengan diare terhadap risiko kerusakan integritas kulit di RSUD Lampung. Desain penelian yang digunakan dalam penelitian ini yaitu quasi experiment dengan pre-post test without control grup design dengan 48 responden dipilih menggunakan teknik consecutive sampling. Hasil penelitian menujukkan adanya perbedaan selisih yang bermakna antara pengetahuan dan risiko kerusakan integritas kulit setelah perlakuan pada kelompok kontrol dan kelompok intervensi (p<0,05). Berdasarkan hasil ini maka edukasi perawatan perianal dan pemberian VCO dapat direkomendasikan menjadi salah satu alternatif asuhan keperawatan dalam mengatasi masalah risiko kerusakan integritas kulit.

---

Diarrhea is one of the diseases that are often suffered by toddlers. Liquid feces in children can cause skin injuries due to frequent repeated contact, which can damage the perianal tissue. This study aims to identify the impact of perianal care education and the provision of VCO in children under five with diarrhea against the risk of skin integrity damage in RSUD Lampung.

The research design used in this research is quasi experiment with pre-post test without control group design with 48 respondents selected using consecutive sampling technique.

The results showed a significant difference between the knowledge and the risk of skin integrity damage after treatment in the control group and the intervention group (p <0.05). Based on these results, perianal care education and VCO administration can be recommended to be an alternative nursing care in addressing the risk of skin integrity damage."

"Manuver rekrutmen paru (MRP) adalah strategi mencegah kerusakan paru saat bayi menggunakan ventilator mekanis (VM). Dengan meningkatkan tekanan akhir ekspirasi (TAE) secara bertahap, MRP membuka alveolus, menurunkan kebutuhan oksigen hirup (FiO2) sekaligus meningkatkan ambilan oksigen paru. Hingga kini, belum cukup bukti ilmiah terkait pengaruh MRP menggunakan VM terhadap luaran bayi prematur. Penelitian ini adalah uji klinis tidak tersamar, dilakukan di RS Cipto Mangunkusumo dan RSIA Bunda Menteng, bertujuan mencari hubungan MRP dengan kejadian DBP dan atau kematian, curah jantung, cedera alveolus-endotel, penurunan diameter duktus arteriosus (DA), dan mikrosirkulasi kulit. Penelitian berlangsung Maret 2021–April 2022. Subjek penelitian adalah bayi prematur 24–32 minggu yang menggunakan ventilator mekanis saat usia < 48 jam. Protein surfaktan-D (SP-D) diukur menggunakan metode ELISA, mikropartikel endotel (CD-31+/CD-42–) menggunakan flowsitometri, curah jantung dan diameter DA menggunakan ekokardiografi, TcCO2–PaCO2, TcO2/PaO2 menggunakan monitor gas darah transkutan dan gas darah arteri, strong ion difference (SID) menggunakan elektrolit darah arteri. Pada usia koreksi 36 minggu, tidak terdapat perbedaan bermakna kejadian DBP atau kematian antara kelompok MRP dan tanpa MRP 38 (69,09%) vs. 43 (78,18%), p = 0,216. Pada 72 jam pasca-penggunaan VM, tidak didapati perbedaan kadar SP-D, CD 31+, Diameter DA, curah jantung, TcCO2 gap dan SID antara kelompok MRP dan tanpa MRP . Terdapat perbedaan bermakna TcO2 indeks 1,00 (1,00; 1,02) vs. 1,00 (0,99; 1,00), p = 0,009* antara kelompok MRP dibanding tanpa MRP. Pada bayi penyintas, MRP mempercepat waktu untuk mencapai FiO2 ter-rendah 60,0 (54,00; 75,00) vs. 435,00 (375,00; 495,00) menit, p < 0,0001 dan lama penggunaan alat bantu napas 25,0 (19,00; 37,00) vs. 36,83 (SB 19,11) hari, p = 0,044.Simpulan, MRP bayi prematur tidak terbukti mengurangi kejadian DBP dan atau kematian pada usia 36 minggu. Tidak ada perbedaan cedera alveolar-endotel, curah jantung kiri-kanan, dan diameter DA pada usia 72 jam. Tindakan MRP meningkatkan mikrosirkulasi. Pada kelompok penyintas, MRP mempersingkat waktu mencapai FiO2 terendah dan penggunaan alat bantu napas.

---

Lung recruitment maneuver (LRM) is a strategy during mechanical ventilation which aim to open collapsed alveolus in order to increased oxygenation. This maneuver could be done by application of a stepwise increments of positive end expiratory pressure (PEEP) until lowest FiO2 (< 30%) is achieved. There is still lack of evidence regarding relationship between LRM and neonatal outcome. This study aimed to evaluate effectivity of LRM in order to reduce chronic lung disease and it’s influence to neonatal hemodynamic as well. This was unblinded randomized clinical trial which aimed to investigate relationship between LRM and neonatal death, bronchopulmonary dysplasia (BPD), cardiac output, reduction of ductus arteriosus (DA) diameter, skin microcirculations and alveolar-endotel injury. The study was conducted on March 2021 until April 2022 in Cipto Mangunkusumo and Bunda Menteng Hospital. Plasma surfactant protein-D (SP-D) was measured with ELISA, Microparticel endotel (CD-31+) with flowcytometri, left and right cardiac output (LVO and RVO) and DA diameter were measured by echocardiography, TcCO2–PaCO2, tcO2/PaO2 were measured form arterial blood gas and transcutaneous monitor and strong ion difference (SID) from plasma electrolyte. At 36 weeks follow up, there ware no significant difference of incident of DBP and/or death between MRP vs. without MRP groups 38 (69.09%) vs. 43 (78.18%), p = 0.216 (CI 95% 0.141–0.295). There were no difference between MRP and without MRP group at 72 hours, regarding : plasma SP-D, microparticle endotel, cardiac output, DA diameter, tcCO2 gap and SID. At. 72 hours, tcO2 index was better in MRP compared to control group 1.00 (1.00; 1.02) vs. 1.00 (0.99; 1.00), p = 0.009. There were no significant difference regarding other neonatal morbidity between the two group. Among survival subject, LRM reduced time to achieved lowest FiO2 60.00 (54.00; 75.00) vs. 435.00 (375.00; 495.00) hours, p < 0.0001 and length of respiratoy support 25.0 (19.00; 37.00) vs. 36.83 (SD 19.11) days, p=0.044.

Conclusion When applied to 24–32 weeks preterm baby with invasive mechanical ventilation, LRM could not reduced DBP or death at 36 weeks of age. There was no any difference at 72 hours regarding alveolar and endothelial injury, left and right cardiac output and diameter DA. LRM was associated with better microcirculation. Among the survivor, LRM reduced high oxygen concentration exposure time and length of respiratory support."

"ABSTRAK Latar Belakang. Kemajuan dalam penanganan bayi prematur menyebabkan angka kesintasan meningkat. Akibatnya, angka kesakitan bayi prematur jugameningkat, salah satunya adalah osteopenia of prematurity (OOP). Pemeriksaankadar kalsium, fosfat, dan fosfatase alkali serum saat usia kronologis 4 minggudigunakan sebagai indikator awal sebelum osteopenia tampak secara klinis.Diagnosis sedini mungkin dan pengendalian faktor risiko perlu dilakukansehingga komplikasi dapat dicegah.Tujuan. Mengetahui prevalens dan faktor risiko terjadinya OOP.Desain Penelitian. Penelitian dengan desain potong lintang ini dilaksanakanpada bayi prematur dengan usia gestasi ≤32 minggu di Divisi Perinatalogi RS Dr.Cipto Mangunkusumo. Subyek diperiksa kadar kalsium serum, fosfat inorganikserum, dan fosfatase alkali serum. Pada subyek dilakukan pencatatan faktor risikoOOP untuk menilai hubungan antar variabel dan dilakukan analisis bivariatdengan uji chi square. Hasil Penelitian. Terdapat 80 subyek yang memenuhi kriteria penelitian.Delapan dari 80 subyek (10%) ditemukan menderita OOP. Faktor risiko yangdianalisis dalam penelitian ini ditemukan tidak memiliki hubungan bermaknadengan kejadian OOP, yakni lama penggunaan nutrisi parenteral total (p=0,457),lama penggunaan metilsantin (p=1,000), berat lahir (p=0,459), preeklampsiaberat pada ibu (p=0,344), korioamnionitis pada ibu (p=0,261), dan pemberiannutrisi enteral (p=0,797).Simpulan. Prevalens OOP di RS Dr. Cipto Mangunkusumo adalah 10%. Faktorlama penggunaan nutrisi parenteral total, penggunaan metilsantin, berat lahir,preeklampsia berat pada ibu, korioamnionitis, dan pemberian nutrisi enteral tidak memiliki hubungan bermakna dengan kejadian OOP.ABSTRACT Background. Advances in management of premature infants had increased the survival rate of these infants. However there is also increase of morbidity such as osteopenia of prematurity (OOP). Laboratory examination of serum calcium,phosphate, and alkaline phosphatase at the chronological age of 4 weeks is usedas early indicator before osteopenia become clinically appearant. Early diagnosisand risk control are needed to prevent complication. Objective. To evaluate the prevalence and risk factors of OOP.Methods. A cross sectional study was done in premature infants <32 weeks ofgestational age in Perinatalogy Division of Cipto Mangunkusumo Hospital.Laboratory examination of serum calcium, phosphate, and alkalinephosphatasewere conducted toward these subjects. Risk factors of OOP were alsoevaluated. Bivariat analysis was analysed by chi square test.Results. There are 80 subjects who meet the study criteria. Eight of 80 subjects(10%) was diagnosed as OOP. No risk factors have significant relationship withOOP incidence, which include duration of total parenteral nutrition (p=0,457),duration of methylxanthine usage (p=1,000), birth weight (p=0,459), severepreecalampsia in the mother (p=0,344), chorioamnionitis in the mother(p=0,261), and enteral nutrition (p=0,797).Conclusion. Prevalence of OOP in Cipto Mangunkusumo Hospital is 10%. Thereare no significant relationship between OOP incidence and duration of totalparenteral nutrition, methylxanthine usage, birth weight, severe preeclampsia in the mother, chorioamnionitis, and enteral nutrition.;Background. Advances in management of premature infants had increased the survival rate of these infants. However there is also increase of morbidity such as osteopenia of prematurity (OOP). Laboratory examination of serum calcium,phosphate, and alkaline phosphatase at the chronological age of 4 weeks is usedas early indicator before osteopenia become clinically appearant. Early diagnosisand risk control are needed to prevent complication. Objective. To evaluate the prevalence and risk factors of OOP.Methods. A cross sectional study was done in premature infants <32 weeks ofgestational age in Perinatalogy Division of Cipto Mangunkusumo Hospital.Laboratory examination of serum calcium, phosphate, and alkalinephosphatasewere conducted toward these subjects. Risk factors of OOP were alsoevaluated. Bivariat analysis was analysed by chi square test.Results. There are 80 subjects who meet the study criteria. Eight of 80 subjects(10%) was diagnosed as OOP. No risk factors have significant relationship withOOP incidence, which include duration of total parenteral nutrition (p=0,457),duration of methylxanthine usage (p=1,000), birth weight (p=0,459), severepreecalampsia in the mother (p=0,344), chorioamnionitis in the mother(p=0,261), and enteral nutrition (p=0,797).Conclusion. Prevalence of OOP in Cipto Mangunkusumo Hospital is 10%. Thereare no significant relationship between OOP incidence and duration of totalparenteral nutrition, methylxanthine usage, birth weight, severe preeclampsia in the mother, chorioamnionitis, and enteral nutrition."