Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar belakang: Pada tahun 2016, Divisi Perinatologi RS dr. Cipto Mangunkusumo(RSCM) menerapkan panduan asuhan nutrisi terbaru untuk mencegah weight faltering,yang sangat rentan dialami bayi sangat prematur (<32 minggu) atau berat lahir sangatrendah (<1.500 gram). Penelitian ini bertujuan mengevaluasi luaran panduan tersebut.Metode: Penelitian kohort prospektif dilakukan di RSCM sejak Juli 2018 hingga Juni2019. Subyek merupakan bayi lahir hidup dengan usia gestasi <32 minggu atau berat lahir<1.500 gram. Bayi dengan kelainan metabolisme bawaan, kelainan genetik, ataumalformasi kongenital mayor dieksklusi. Data antropometrik mingguan dan komplikasi(enterokolitis nekrotikans, hipertrigliseridemia, kolestasis, dan sindrom refeeding) dicatatsecara berkala. Extrauterine growth restriction (EUGR) adalah berat badan saat pulangkurang dari persentil 10 kurva Fenton 2013 pada kelompok bayi yang lahir sesuai masakehamilan.Hasil: Sebanyak 111 subyek lahir dengan kesintasan hingga pulang sebesar 42,3% danmedian lama rawat 37 (8-89) hari. Median usia mulai diberi nutrisi enteral, mencapai fullenteral feeding, dan durasi nutrisi parenteral adalah 2, 9, dan 6 hari. Insidens EUGRadalah 32%. Rerata kenaikan berat badan pada bayi yang pulang adalah 15 (SB 5,4)g/kg/hari, dan pada bayi kecil masa kehamilan adalah 17 (SB 5,5) g/kg/hari. Insidenshipofosfatemia, enterokolitis nekrotikans, hipertrigliseridemia, hipokalemia, kolestasis,dan hipomagnesemia pada minggu pertama adalah 61,7%; 14,4%; 13,9%; 11,9%; 9,3%;dan 8,2%.Kesimpulan: Bayi sangat prematur dan berat lahir sangat rendah memiliki tingkatmortalitas yang tinggi, terutama pada kelompok ekstrem prematur dan ekstrem rendah.Panduan asuhan nutrisi terbaru dapat mencapai target kenaikan berat badan, dengankomplikasi terbanyak adalah hipofosfatemia.

---

Background and aim: In 2016, a nutritional care guideline was implemented in Cipto

Mangunkusumo Hospital to prevent weight faltering, which was prevalent in very preterm

(< 32 weeks) or very low birth weight/VLBW (<1,500 grams) infants. The objective of

this study was to evaluate its outcome.

Methods: This prospective cohort study was conducted in a national referral hospital

since July 2018 until June 2019. Subjects were live-born infants with gestational age <32

weeks or birth weight <1,500 grams. Infants with inborn errors of metabolism, genetic

abnormalities, and major congenital malformation were excluded. Weekly

anthropometric data and complications (necrotizing enterocolitis, hypertriglyceridemia,

cholestasis, and refeeding syndrome) were recorded. Extrauterine growth restriction

(EUGR) was defined as weight at discharge less than 10th percentile of Fenton 2013

chart.

Results: Among 111 subjects, the survival rate at discharge was 42.3% and median length

of stay was 37 (8-89) days. Median time to start enteral feeding, reach full enteral feeding,

and duration of total parenteral nutrition were 2, 9, and 6 days, respectively. EUGR

incidence at discharge was 32.1%. Mean weight gain among survivors and those who

were small-for-gestational-age were 15 (SD 5.4) and 17 (SD 5.5) g/kg/day, respectively.

The incidence of hypophosphatemia, necrotizing enterocolitis, hypertriglyceridemia,

hypokalemia, cholestasis, and hypomagnesemia were 61.7%, 14.4%, 13.9%, 11.9%,

9.3%, and 8.2%, respectively.

Conclusions: Very preterm and/or VLBW infants had high mortality rate, especially in

extremely preterm and/or extremely-low-birth-weight subgroup. The latest nutritional

care guideline reached the target weight gain. The most common complication was

hypophosphatemia."

"Latar Belakang: Enterokolitis nekrotikans (EKN) adalah penyakit peradangan berat pada dinding usus menyebabkan cedera dan nekrosis usus. Foto polos abdomen (FPA) serial masih dianggap sebagai standar diagnosis dan evaluasi penyakit ini, namun pemeriksaan ini tidak akurat dan sering terlambat dalam pelaksanaannya serta mengakibatkan neonatus sangat prematur terpapar dengan radiasi. Karenanya diperlukan alat diagnostik yang lebih aman, non-invasif mudah pelaksanaannya dan akurat. Dua dekade terakhir pemeriksaan ultrasonografi abdomen (USGA) semakin berkembang dan memperlihatkan hasil yang baik dalam diagnosis EKN, akan tetapi penggunaan modalitas ini di Indonesia dan khususnya di RSCM masih belum banyak dilakukan.Tujuan: Mendapatkan akurasi gambaran ultrasonografi abdomen (USGA) dibandingkan dengan foto polos abdomen (FPA) dalam menegakkan diagnosis EKN pada bayi sangat prematur tersangka EKN.Metode: Penelitian uji diagnostik potong lintang ini dilakukan pada 40 neonatus sangat prematur berusia antara 28-32 minggu yang dirawat di RSCM Jakarta pada bulan November sampai Desember 2023. Pada Neonatus sangat prematur tersangka EKN yang memenuhi kriteria inklusi dan eksklusi dilakukan pemeriksaan USGA dan FPA. Kedua hasil pemeriksaan dibandingkan menggunakan tabel kontigensi 2x2. Didapatkan sensitivitas 83% dan spesifisitas 43%. Hasil nilai prediksi positif 38% dan nilai prediksi negatif 86%, dan rasio kemungkinan positif (LR+) 1,45 dan rasio kemungkinan negatif (LR-)  0,39.Kesimpulan: Ultrasonografi abdomen lebih akurat untuk penapisan (screening) menengakkan diagnosis EKN pada Neonatus sangat prematur dibandingkan foto polos abdomen.

---

Background: Necrotizing enterocolitis (NEC) is a condition characterized by severe inflammation of the intestinal wall leading to intestinal injury and necrosis. Plain abdominal radiography has long served as the standard for the diagnosis and evaluation of NEC despite its low diagnostic accuracy, impracticality, and the risk this modality poses from exposing neonates to ionizing radiation. Therefore, a safer, non-invasive, easy-to-implement, and more accurate diagnostic tool is necessary for diagnosing NEC. Over the past two decades, knowledge about abdominal ultrasound has developed greatly and has been shown to be an excellent modality in diagnosing NEC. However, in Indonesia this modality is still not widely used for diagnosing NEC, especially at Cipto Mangunkusomo National Public Hospital (RSCM) Jakarta.

Objective: This study aimed to assess the accuracy of abdominal ultrasonography in diagnosing NEC compared to plain abdominal radiography in very premature neonates suspected of NEC.

Methods: A cross-sectional diagnostic test study was conducted on 40 very premature neonates aged between 28-32 weeks, who were treated at RSCM Jakarta from November to December 2023. Neonates suspected of NEC who met the inclusion and exclusion criteria underwent both abdominal ultrasound and plain abdominal radiography. The findings from these two examinations were compared using a 2x2 contingency table to establish the sensitivity and specificity. A sensitivity of 83% and a specificity of 43% were found for abdominal ultrasound. The study also found a positive predictive value (PPV) of 38%, a negative predictive value (NPV) of 86%, a positive likelihood ratio (LR+) of 1.45, and a negative likelihood ratio (LR-) of 0.39.

Conclusion: Abdominal ultrasonography was found to be a more accurate for screening  NEC in very premature neonates compared to plain abdominal radiography."