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Abstrak :
Pola isapan nutritif pada neonatus cukup bulan sehat penting untuk diketahui, namun selama ini belum ada bukti ilmiah yang tersedia. Penelitian ini bertujuan untuk mengetahui karakteristik pola isapan nutritif pada neonatus cukup bulan sehat berdasarkan berat badan lahir dan usia gestasi. Desain studi yang digunakan adalah pendekatan potong lintang pada neonatus cukup bulan sehat di beberapa Puskesmas tingkat Kecamatan di Jakarta. Sebanyak 88 neonatus cukup bulan sehat dinilai karakteristik pola isapan nutritif dengan Sucking Mechanism System Equipment. Dari hasil penilaian tersebut, tidak ditemukan adanya perbedaan bermakna pada pola isapan nutritif neonatus cukup bulan sehat berdasarkan usia gestasi dan berat badan lahir. Rerata amplitudo tekanan isapan adalah -86,69 (76.0 – 102,68) mmHg, rerata frekuensi isapan 0,847 (0,717 – 0,97) isapan/detik, rerata durasi satu isapan nutritif 0,858 0,124 detik, rerata durasi satu burst 13,4 (8,49 – 22,48) detik, rerata jumlah burst dalam satu menit 3,74 1,53 burst/menit, rerata jumlah isapan per burst 15,36 (9,19 – 24,45) isapan/burst. Hasil studi ini menunjukkan bahwa pola isapan nutritif terus berkembang seiring dengan peningkatan usia gesatasi dan berat badan lahir. ......Nutritive sucking pattern in healthy term neonates is important to know, but so far there is no scientific evidence available The aim of this study was to determine the characteristics of the nutritive suction pattern in healthy term neonates based on birth weight and gestational age. A cross-sectional approach was applied among healthy term neonates in several sub-district health centres in Jakarta. A total of 88 healthy term newborns were assessed for nutritional sucking pattern characteristics using the Sucking Mechanism System Equipment. The result showed no significant difference in terms of nutritive suction pattern based on gestational age and birth weight. The mean amplitude of suction pressure was -86.69 (76.0 - 102.68) mmHg, mean suction frequency was 0.847 (0.717 - 0.97) sucks/second, mean duration of a nutritional suction was 0.858 ± 0.124 seconds, mean duration of a burst was 13.4 (8.49 - 22.48) seconds, mean number of bursts per minute was 3.74 ± 1.53 bursts/minute, mean number of sucks per burst was 15.36 (9.19 - 24.45) sucks/burst. This study suggests that the nutritional sucking pattern continues to evolve with increasing age and birth weight

Abstrak :
Masalah oksigenasi merupakan salah satu penyebab kematian pada neonatus. Karya ilmiah ini bertujuan memberikan gambaran aplikasi teori Comfort Kolcaba dalam asuhan keperawatan pada neonatus yang mengalami masalah oksigenasi. Empat dari lima kasus adalah bayi prematur. Penerapan teori Comfort pada kelima kasus dapat mendukung terpenuhinya rasa nyaman klien, sehingga konsumsi oksigen menurun, dan dapat mempertahankan saturasi oksigen yang optimal. Dengan penerapan teori ini, maka perawat akan memberikan intervensi yang sesuai dan tepat waktu, penuh perhatian dan empati, serta berfokus pada kenyamanan klien. ......Oxygenation problems are one of the causes of death in neonates.This paper aims to provide an overview of applications Kolcaba Comfort Theory in nursing care to neonates who have oxygenation problems. Four of the five cases were premature babies. Application of the theory of comfort on the fifth case can support the fulfillment of the client’s sense of comfort, so that oxygen consumption decreases, and can maintain optimal oxygen saturation. With the application of this theory, then the nurse will provide appropriate intervention andtimely, attentive and emphatic, and focused on client comfort.

Abstrak :
ABSTRAK Neonatus yang dirawat di rumah sakit sering mendapatkan tindakan yang menimbulkan nyeri. Sukrosa dan nonnutritive sucking (NNS) merupakan analgesik nonfarmakologi. Tujuan penelitian adalah mengetahui efektifitas sukrosa dan NNS terhadap respon nyeri dan lama tangisan neonatus yang dilakukan tindakan invasif. Desain penelitian adalah quasi experimental, rancangan postest only control group design. Teknik pengambilan sampel dengan nonprobability sampling jenis consecutive sampling. Sampel penelitian berjumlah 45 neonatus aterm yang terbagi menjadi tiga kelompok, tiap kelompok 15 neonatus. Hasil penelitian menunjukkan respon nyeri tidak berbeda bermakna antara kelompok sukrosa dan NNS (p=0,635). Lama tangisan tidak berbeda bermakna antara kelompok sukrosa dan NNS (p=0,848). Umur merupakan variabel perancu yang memberikan pengaruh pada respon nyeri. Pemberian sukrosa maupun NNS terbukti dapat menurunkan nyeri dalam manajemen nyeri nonfarmakologi pada neonatus yang dilakukan prosedur invasif.

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ABSTRACT Hospitalized neonates may experience pain caused by invasive procedures. Sucrose and non-nutritive sucking are non-pharmacological analgesics. This study aimed to examine the effectiveness of sucrose and non-nutritive sucking administration on pain and crying duration of neonates during invasive procedures. The study used quasi-experimental design with post-test only control group design approach. This study used nonprobability sampling technic with consecutive sampling. The sample consisted of 45 neonates, divided into three groups, each group of 15 neonates. The study used nonprobability sampling technic with consecutive sampling. The results showed that the pain response and the crying duration were insignificantly different between the sucrose group and the NNS, respectively p=0,635 and p=0,848. Age was identified as a confounding variable that effected pain responses. Provision of sucrose and NNS proven to reduce pain as non-pharmacological pain management for neonates during invasive procedures.

Abstrak :
Respiratory Distress Syndrome (RDS) masih merupakan penyumbang mortilitas tertinggi bagi neonatus yang gagal dalam melakukan adaptasi ektrauterin. Pemasangan Peripheral Intravenous Canulla (PIVC) merupakan tindakan invasif yang lazim digunakan sebagai akses untuk pemberian cairan, nutrisi maupun obat-obatan, namun demikian PIVC memiliki komplikasi seperti plebitis, ekstravasasi/ infiltrat, kebocoran akibat bergesernya kanula. Pemasangan spalk merupakan salah satu intervensi konservasi integritas struktural dalam Model Konservasi Levine dalam asuhan keperawatan guna mempertahankan pengeluaran energi pada bayi RDS dengan menghindarkan bayi dari dwell time yang pendek. Tujuan karya tulis ini adalah untuk memberikan gambaran asuhan keperawatan dengan Model Konservasi Levine terhadap neonatus dengan RDS yang terpasang PIVC menggunakan intervensi spalk. Desain: lima kasus kelolaan dengan menggunakan Model Konservasi Levine. Asuhan keperawatan diberikan selama tiga hari. Hasil: Empat prinsip konservasi telah diterapkan pada kelima kasus kelolaan dan menunjukkan respon organismik yang baik dengan dibuktikan oleh penurunan penggunaan alat bantu pernapasan dan dwell time PIVC lebih dari 72 jam sehingga tidak terdapat pemasangan akses PIVC berulang selama asuhan keperawatan diberikan. Simpulan: Melalui intervensi spalk ini adaptasi dapat tercapai dan keutuhan kesehatan terpenuhi. Model Konservasi Levine dapat direkomendasikan dalam penerapan kasus RDS pada neonatus yang terpasang PIVC. ...... Respiratory Distress Syndrome (RDS) is still the highest contributor to mortality for neonates who fail to make extrauterine adaptations. Proper oxygen support as well as fulfillment of fluids and nutrients is needed in addition to treatment such as giving antibiotics, steroids or caffeine citrate. Installation of Peripheral Intravenous Canulla (PIVC) is an invasive procedure that is commonly used as access, however PIVC has complications such as phlebitis, extravasation/infiltrates, and leaks due to shifting of the cannula. Spalk installation is one of the structural integrity conservation interventions in the Levine Conservation Model in nursing care to maintain energy expenditure in RDS babies by preventing babies from short dwell times. The aim of this paper is to provide an overview of nursing care with the Levine Conservation Model for neonates with RDS attached to PIVC using spalk intervention. PIVC dwell time is more than 72 hours so there is no repeated PIVC access installation while nursing care is given. Through this spalk intervention, adaptation can be achieved and health integrity is fulfilled. The Levine Conservation Model can be recommended in the application of RDS cases in PIVC- attached neonates.

Abstrak :
Latar Belakang: Gangguan pernapasan memiliki angka morbiditas dan mortalitas yang tinggi pada neonatus. Saat ini rontgen toraks merupakan modalitas yang dianggap sebagai standar emas untuk mendiagnosis penyakit paru pada gangguan pernapasan. Namun pemeriksaan ini mengandung radiasi yang dapat meningkatkan kejadian kanker pada neonatus di kemudian hari. Lung ultrasound (LUS) merupakan modalitas non-invasif yang terus berkembang dalam mengevaluasi kelainan paru, khusunya pada neonatus. Pemeriksaan ini tidak mengandung radiasi, mudah dioperasikan, dan hasil yang real-time. Meskipun LUS menunjukkan banyak manfaat, penggunaannya masih belum dikenal secara luas, terutama di Indonesia. Tujuan: Mengetahui gambaran LUS pada neonatus dengan gangguan pernapasan berdasarkan hasil rontgen toraks. Metode: Penelitian potong lintang deskriptif yang dilakukan di Unit Perinatologi Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia, RS Cipto Mangunkusumo Jakarta. Sebanyak 69 neonatus dengan gangguan pernapasan yang didiagnosis berdasarkan klinis dan rontgen toraks dimasukkan dalam penelitian ini. Pemeriksaan LUS dilakukan secara bedside menggunakan transduser linear frekuensi tinggi (5-18 MHz). Toraks dibagi menjadi 6 regio yang terdiri dari anterior atas, anterior bawah, dan lateral kanan dan kiri. Hasil: Terdapat 69 subjek yang ikut serta pada penelitian ini, terdiri dari 53 neonatus prematur dan 16 neonatus cukup bulan dengan rentang usia 2 jam hingga 38 hari. Hasil pemeriksaan rontgen toraks terdiri dari 26 subjek dengan respiratory distress syndrome (RDS), 20 subjek dengan infiltrat, 11 subjek dengan pneumonia, 6 subjek dengan transient tachypnea of the newborn (TTN), 3 subjek dengan efusi pleura, dan 2 subjek masing-masing dengan meconium aspiration syndrome (MAS), atelektasis, dan pneumotoraks. Terdapat 2 subjek dengan hasil rontgen toraks normal, namun pada LUS memperlihatkan gambaran abnormal yaitu ditemukan pleura abnormal, B-lines, double lung point, dan konsolidasi. Abnormalitas pleura dan konsolidasi ditemukan pada RDS, pneumonia, infiltrat, dan MAS. B-lines ditemukan pada RDS, TTN, pneumonia, infiltrat, dan MAS. Double lung point hanya ditemukan pada TTN. Quad sign sebagai penanda efusi pleura ditemukan pada TTN dan pneumonia. Konsolidasi yang berbatas jelas disertai air bronchogram statis dan lung pulse hanya ditemukan pada atelektasis. Absent lung sliding, lung point dan stratosphere sign hanya ditemukan pada pneumotoraks. Kesimpulan: LUS merupakan modalitas pencitraan non-invasif yang dapat digunakan dalam membantu menegakkan diagnosis gangguan pernapasan pada neonatus. .....Background: Respiratory distress has high morbidity and mortality rates in neonates. Chest X-ray is a modality considered the gold standard for diagnosing lung diseases in respiratory distress. However, this examination uses ionizing radiation that can increase the incidence of cancer in the future. Lung ultrasound (LUS) is a non-invasive modality that has rapidly developed in recent years in evaluating lung abnormalities, especially in neonates. This examination contains no radiation, easy to operate, and results are real- time. Although LUS shows many benefits, its use is still not widely known, especially in Indonesia. Objective: To determine the LUS sign in neonates with respiratory distress based on chest X-ray. Method: Descriptive cross-sectional research conducted at the Perinatology Unit of the Department of Pediatrics, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta. A total of 69 neonates with respiratory distress diagnosed on a clinical and chest X-ray were included in the study. LUS were performed at bedside using a high-frequency linear transducer (5-18 MHz). The thorax is divided into 6 regions consisting of the upper anterior, lower anterior, and right and left lateral. Results: There were 69 subjects who participated in this study, consisting of 53 premature neonates and 16 full-term neonates with an age range of 2 hours to 38 days. The results of the chest X-ray consisted of 26 subjects with respiratory distress syndrome (RDS), 20 subjects with infiltrates, 11 subjects with pneumonia, 6 subjects with transient tachypnea of the newborn (TTN), 3 subjects with pleural effusion, and 2 subjects with meconium aspiration syndrome (MAS), atelectasis, and pneumothorax. There were 2 subjects with normal chest X-ray, but showed abnormal LUS sign, consisting of abnormal pleura line, B-lines, double lung point, and consolidation. Abnormal pleura line and consolidation are found in RDS, pneumonia, infiltrates, and MAS. B-lines are found in RDS, TTN, pneumonia, infiltrates, and MAS. Double lung point is only found in TTN. Quad sign as a marker of pleural effusion is found in TTN and pneumonia. Clearly bounded consolidation accompanied by static air bronchogram and lung pulse is found only in atelectasis. Absent lung sliding, lung point and stratosphere sign are found only in pneumothorax. Conclusion: LUS is a non-invasive imaging modality that can be used to help diagnose respiratory disorders in neonates.

Abstrak :
ABSTRAK
Nyeri adalah pengalaman tidak menyenangkanakibat kerusakan jaringan bersifa tsubjektif dapat dinilai dari ekspresi wajah, gerakant ubuh, menangis dan istirahat dengan skala nyeri yang dapat digunakan adalah Neonatal Infant Pain Scale (NIPS).Terapi non farmakologis mandiri dapat dilakukan perawat untuk meminimalisir nyeri neonatussete lah tindakan invasif. Pemberian kombinasi NNS dansukrosaefektifmengurangiresponnyerineonatussetelahpemasanganinfus. Penelitianinimerupakanpenelitianquasi experimental post test only control group design. Sampelpenelitiansebanyak 20 respondendibagimenjadikelompokintervensidankelompokkontrol. Analisis data menggunakanujiindependent ttest. Kelompokintervensidengannilairesponnyeriterendah 0 dantertinggi 2 dengannilaitengah 0,5. Kelompokkontroldengannilainyeriterendah 5 dantertinggi 7 dengaannilaitengah 0,5. Rekomendasihasilpenelitianini, pemberiankombinasi NNS dansukrosasebagaiterapi non farmakologisuntukmengurangiresponnyerineonatussetelahpemasanganinfus.

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Abstract
Pain is an unpleasant subjective response due to tissue disruption. In neonates, it can be assessed by Neonatal Infant Pain Scale (NIPS) from the facial expression, body movement, crying or resting behavior of the infant. Nurses may carry on the non-pharmacological intervention to minimize the pain of the neonates after invasive procedures. One of the interventions is the combination of Non Nutritive Sucking (NNS) and sucrose. This research was designed as the quasi experimental post test only control group research involving 20 participants in the control and intervention group. The data were analyzed using independent t-test. The research found the lowest pain response scale was 0 and the highest was 2, with the median 0.5, in the intervention group. Whereas, in the control group, the lowest and highest pain scales were 5 and 7, respectively, with median 0.5. This research suggests this combination of NNS and sucrose to reduce the pain response in neonates after intravenous catheter insertion.

Abstrak :
Latar belakang Gagal tumbuh atau failure to thrive adalah kondisi keterlambatan pertumbuhan fisik pada anak, dimana terjadi kegagalan penambahan berat badan yang sesuai dengan grafik pertumbuhan normal, dibandingkan dengan tinggi badan. Beberapa kondisi menjadi faktor risiko terjadinya gangguan pertumbuhan terutama pada neonatus. Studi ini memberikan gambaran penerapan Model Adaptasi Roy dalam asuhan keperawatan pada lima kasus neonatus dengan risiko gangguan pertumbuhan. Presentasi kasus Kasus 1 neonatus laki-laki, dengan extremely preterm usia gestasi 27 minggu, berat badan lahir 870 gram, neonatus kurang bulan kecil masa kehamilan (NKB-KMK), RDS, TTN, septikemia, tersangka SNAD, neonatal jaundice, terpasang ventilator mode high frequency oscilation (HFO), terpasang orogastric (OGT), diet ASI 12x1 ml, TPN PG 2 dengan GIR 4,7, kebutuhan kalori kurang dari target, interpretasi kurva Fenton dibawah persentil 50, berat badan menurun, usia enam hari 860 gram. Kasus 2 perempuan, extremely preterm usia gestasi 26 minggu, berat badan lahir 744 gram, NKB-KMK, RDS, tersangka SNAD, PDA, neonatal jaundice. Terpasang ventilator, sementara puasa, grafik Fenton berada dibawah persentil 50, kebutuhan kalori kurang dari target. Kasus 3 dan 4 neonatus berjenis kelamin perempuan, lahir dengan extremely preterm dan very preterm, terpasang ventilator, kebutuhan kalori kurang dari target, sementara dipuasakan karena kondisi belum stabil. Kasus 5 perempuan, usia gestasi 37 minggu, BBL 2610 gram, berat badan saat dikaji 2340 gram. Diagnosis medis gastroschizis post tutup defek hari ke 27, terpasang non invasif ventilasi, sementara puasa produksi OGT kehijauan, BB/PB berada di -3SD s/d <-2 SD (gizi kurang). Evaluasi respons adaptif dari kelima pasien didapatkan kebutuhan kalori terpenuhi sesuai target. Kesimpulan Hasil pengkajian perilaku dan stimulus mode fisiologis-fisik kelima kasus didapatkan empat kasus berisiko mengalami gangguan pertumbuhan dari kondisi neonatus lahir prematur, terpasang ventilator, penundaan pemberian makan karena kondisi klinis, risiko infeksi/sepsis serta kondisi medis lain yang mempengaruhi. Satu neonatus aterm gagal tumbuh karena gastroschizis post tutup defek, dengan produksi OGT kehijauan. Nutrisi optimal baik enteral maupun parenteral diperlukan pada kondisi neonatus tersebut untuk meningkatkan respons adaptif. ...... Background Failure to thrive or failure to thrive is a condition of delayed physical growth in children, in which there is a failure to gain weight according to the normal growth chart, compared to height. Several conditions are risk factors for growth disorders, especially in neonates. This study provides an overview of the application of the Roy Adaptation Model in nursing care to five cases of neonates with a risk of growth retardation. Case presentation Case 1 male neonate, with extremely preterm gestational age 27 weeks, birth weight 870 gram, small preterm neonate for gestational age (NKB-KMK), RDS, TTN, septicemia, TSK SNAD, neonatal jaundice, put on ventilator mode high frequency oscillation (HFO), installed orogastric (OGT), diet ASI 12x1 ml, TPN PG 2 with GIR 4.7, caloric requirement less than target, interpretation of Fenton curve below 50th percentile, decreased body weight, age six days 860 gram. Cases of 2 women, extremely preterm, gestational age 26 weeks, birth weight 744 grams, NKB-KMK, RDS, suspected SNAD, PDA, neonatal jaundice. Installed on a ventilator, while fasting, the Fenton chart is below the 50th percentile, calorie needs are less than the target. Cases 3 and 4 female baby were born extremely preterm and very preterm, were attached to a ventilator, their caloric needs were less than the target, while they were fasted because their condition was not yet stable. Case 5 female, gestational age 37 weeks, BBL 2610 grams, body weight when studied 2340 grams. Medical diagnosis of gastroschizis post closed defect on day 27, installed non-invasive ventilation, while fasting green OGT production, BB/PB was in -3SD to <-2 SD (malnutrition). Evaluation of the adaptive response of the five patients found that the calorie needs were fulfilled according to the target. Conclusion The results of the assessment of the behavior and stimulus of the physiological-physical mode of five cases found that four cases were at risk of experiencing growth retardation from the condition of the neonate born prematurely, being placed on a ventilator, delaying feeding due to clinical conditions, risk of infection/sepsis and other affecting medical conditions. One term neonate failed to thrive because of a closed post gastroschizis defect, with greenish OGT production. Optimal nutrition, both enteral and parenteral, is needed in these neonatal conditions to increase adaptive responses.

Abstrak :
Neonatus prematur seringkali mengalami gagal napas dan gangguan ventilasi spontan akibat dari kegagalan adaptasi ekstrauterin, sehingga membutuhkan bantuan ventilasi mekanik. Extremely preterm, very preterm, dan kondisi klinis yang kompleks dapat mengakibatkan perlunya dukungan ventilasi mekanis yang berkepanjangan, kadangkadang membutuhkan trakeostomi. Tujuan karya ilmiah ini untuk mengaplikasikan Model Adaptasi Roy dalam asuhan keperawatan pada neonatus dengan gangguan ventilasi spontan. Desain yang digunakan adalah studi kasus terhadap lima neonatus prematur yang mengalami gangguan ventilasi spontan dengan pendekatan proses keperawatan. Aplikasi Model Adaptasi Roy diimplementasikan untuk meningkatkan respons adaptif dan menurunkan respons inefektif pada empat mode adaptasi fisiologisfisik, konsep diri, fungsi peran, dan interdependensi. Intervensi keperawatan berdasarkan evidence-based nursing practice seperti manajemen ventilasi mekanik, pemantauan respirasi, dan perawatan rutin trakeostomi dengan menggunakan bundel TRACHE-T, serta intervensi lainnya. Pada evaluasi, dua neonatus menunjukkan respons adaptif meningkat dan gangguan ventilasi spontan teratasi. Tiga neonatus lainnya menunjukkan respons inefektif. Respons inefektif tersebut dipengaruhi oleh imaturitas dengan PMA kurang dari 28 minggu pada dua neonatus, dan satu neonatus dengan BPD berat dengan trakeostomi. Edukasi perawatan trakeostomi neonatal dengan menggunakan game terbukti efektif meningkatkan pengetahuan dan keterampilan perawat di ruang perinatologi. ......Premature neonates often experience respiratory distress and spontaneous ventilation disorders due to the failure of extrauterine adaptation, which requires mechanical ventilation. Extremely preterm, very preterm, and medically complex infants need prolonged mechanical ventilation support, sometimes tracheostomy. This study aims to apply Roy's Adaptation Model in nursing care for neonates with impaired spontaneous ventilation. We adopted a case study of five premature neonates who experience impaired spontaneous ventilation through a nursing process approach. The application of Roy's Adaptation Model is implemented to increase adaptive responses and reduce ineffective responses there are four adaptation modes: physiological-physical mode, self-concept mode, role function mode, and interdependence mode. Nursing interventions are based on evidence-based nursing practice such as mechanical ventilation management, respiratory monitoring, and routine tracheostomy care using the TRACHE-T bundle, and other interventions. On evaluation, two neonates showed an increased adaptive response and resolved impaired spontaneous ventilation. Three neonates had ineffective responses to impaired spontaneous ventilation that have not resolved. The ineffective response was caused by immaturity at Post-menstrual Age (PMA) less than 28 weeks in two neonates, one neonate with severe BPD, and tracheostomy. Neonatal tracheostomy care education using games has been proven effective in improving the knowledge and skills of nurses in the perinatology ward.