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"ABSTRAKHipotiroid kongenital (HK) adalah kelainan bawaan yang dapat menimbulkandampak berupa retardasi mental permanen. Pemberian levothyroxine dengan dosis tepat pada usia sedini mungkin, dapat mencegah gangguan pertumbuhan dan perkembangan. Sayangnya, bayi baru lahir tidak menunjukkan gejala HK. Kalaupun ada, berarti sudah ada gangguan pertumbuhan. Perlu skrining hipotiroid kongenital (SHK) untuk menemukan kasus bayi yang menderita HK.Meski sudah dilakukan sejak 2006, baru pada tahun 2014 dikeluarkan Permenkes tentang pelaksanaan SHK di Indonesia. Penelitian evaluasi ekonomi program SHK tahun 2014-2015 ini mencakup analisis biaya skrining dan terapi dini, sedangkan outcome didapat dari systematic review (SR). Asumsi dikembangkan berdasarkan data riil pasien skrining SHK di 2 laboratorium rujukan di Jakarta dan Bandung.Dari total 56.186 bayi yang melakukan skrining, diperoleh 24 pasien positifmenderita HK. Hasil SR menyatakan bahwa semakin dini onset terapi, semakin adekuat dosis inisiasi dan semakin kontinyu terapi dapat memberikan hasil yang baik. Hasil Tersebut berupa pencegahan terhadap komplikasi HK lebih jauh dan perbaikan pada penyimpangan tumbuh kembang.Dari hasil penelitian, didapatkan informasi bahwa baru pada tahun kedua terlihat adanya keuntungan ekonomis SHK. Hal ini berhubungan dengan patologi gejala HK yang umumnya muncul pada usia 3-6 bulan. Orang tua baru mencari pertolongan medis pada tahun kedua dan mengeluarkan lebih banyak biaya. Biaya skrining dan terapi dini menjadi sepadan dibandingkan dengan kerugian yang dapat dicegah akibat gejala gangguan tumbuh kembang.

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ABSTRACTCongenital hypothyroidism (CH) is a congenital disorder that can have an impact in the form of permanent mental retardation. Giving the right dose of levothyroxine at the earliest possible age, can prevent the disruption of growth and development. Newborns do not show symptoms of CH, and unfortunately the symptoms appear in the late period and in many cases it shows growth disorders. The congenital hypothyroidism screening (CHS) program has been implemented to find infant cases with CH, and followed up with treatment.Although it has been made since 2006, Minister of Health just issued the regulation in 2014 on the implementation of CHS in Indonesia. This economic evaluation of the CHS program in 2014-2015 was done using cost analysis, while outcome obtained from the systematic review (SR). The assumptions used in the analysis were developed based on real data from a CHS screening program in two referral laboratories in Jakarta and Bandung. Out of 56.186 screened babies, 24 babies were found as CH positive cases.The result of the SR revealed that the earlier onset of initiation therapy, the more adequate dose and the more continuous therapy given to the patient, the better result will be achieved. It will prevent the patients from severe complications of CH and will improve the quality of thegrowth and development. The study found that the economic benefit is achieved in the second year of CH treatment, since the pathological symptoms generally appear at the age of 3-6 month and parents seek care in the second year. Consequently, cost to treat patients will increase. The cost of screening and early treatment was found worthy as compared to economic loss resulting from growth disorders"

"ABSTRAKLatar Belakang: Hipotiroid kongenital merupakan salah satu penyebab paling umum terjadinya retardasi mental. Padahal, terjadinya komplikasi hipotiroid kongenital dapat dicegah sejak dini. Oleh karena itu, skrining hipotiroid kongenital dengan mengukur kadar TSH menjadi penting terutama pada bayi yang berisiko lebih tinggi terkena hipotiroid kongenital. Usia prematur diduga menjadi salah satu faktor risiko hipotiroid kongenital karena terkait imaturitas organ.Tujuan: Penelitian ini dilakukan dengan tujuan mengetahui persentase bayi prematur, nilai rujukan TSH neonatus di Indonesia, dan hubungan antara kadar TSH neonatus dan status prematuritas.Metode: Desain penelitian yang digunakan adalah studi potong lintang dengan subjek berasal dari data skrining hipotiroid kongenital RSUPN Dr. Cipto Mangunkusumo yang sampel darahnya dianalisis dengan cara Fluorometri dengan reagen Labsystem. Data berasal dari bulan Mei dan Juni 2017 yang diperoleh melalui teknik consecutive sampling. Dari 2987 subjek, terdapat 1700 subjek yang memenuhi kriteria inklusi dan eksklusi. Subjek dibagi menjadi kelompok bayi prematur n=111 dan bayi lahir cukup bulan n=1589 . Sampel kemudian dianalisis menggunakan SPSS versi 20.0 untuk mengetahui hubungan kadar TSH dan status prematuritas dengan uji Mann-Whitney dan uji korelasi, serta MedCalc versi 17.9 untuk mencari nilai rujukan TSH neonatus di Indonesia.Hasil: Persentase bayi prematur yang didapatkan yaitu sebesar 6,5 . Nilai rujukan TSH neonatus berdasarkan kelahiran prematur didapatkan nilai 1,0-8,9 mU/L dengan median 2,5 1,0-12,8 mU/L dan berdasarkan kelahiran cukup bulan sebesar 1,5-8,0 mU/L dengan median 3,2 1,0-19,8 mU/L. Analisis menggunakan uji Mann-Whitney, didapatkan hubungan bermakna antara kadar TSH neonatus dan status prematuritas p.

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ABSTRACTBackground Congenital hypothyroid is one of the most common causes of mental retardation. Actually, this complication can be prevented since earlier. Therefore, congenital hypothyroid screening by measuring TSH level is important to every infants, especially in higher risk of developing congenital hypothyroid. Prematurity is hypothesised as one of risk factor for congenital hypothyroid related to organ immaturity.Objective The aim of this study is to determine the percentage of preterm birth, neonatal TSH reference values in Indonesia, and association between neonatal TSH level with prematurity status.Methods This cross sectional study used subjects which was obtained from congenital hypothyroid screening data in General National Hospital Dr. Cipto Mangunkusumo from May to June 2017 by consecutive sampling. The screening of congenital hypothyroid used Fluorometry with Labsystem reagen to analyse blood samples. From 2987 subjects, 1700 subjects fulfilled the inclusion and exclusion criteria. Subjects were divided into two groups preterm infants n 111 and term infants n 1589 . Then, samples were analysed with SPSS version 20.0 to investigate association between neonatal TSH level with prematurity status by Mann Whitney test and correlation test, also MedCalc version 17.9 to calculate neonatal TSH reference values.Results The percentage of preterm infants was 6.5 . Neonatal TSH reference values based on preterm birth infants were 1.0 8.9 mU L with median 2.5 1.0 12.8 mU L and based on term infants were 1.5 8.0 mU L with median 3.2 1.0 19.8 mU L. There was also a significant association between neonatal TSH level and prematurity status Mann Whitney test, p"

"ABSTRAKLatar Belakang: Program Skrining Hipotiroid Kongenital Nasional di Indonesia menunjukkan angka insidensi hipotiroid kongenital cukup tinggi. Salah satu faktor risiko yang bertanggung jawab adalah bayi berat lahir rendah. Pada bayi berat lahir rendah, maturitas organ relatif belum matur, sehingga mengganggu fungsi organ termasuk kelenjar tiroid dan hipofisis.Tujuan: Penelitian cross-sectional ini bertujuan untuk mengetahui persentase bayi berat lahir rendah di Indonesia, nilai rujukan TSH neonatus berdasarkan berat lahir, korelasi antara berat lahir bayi dengan fungsi kelenjar tiroid, serta hubungan antara status berat lahir dengan nilai rerata TSH neonatus.Metode: Dari 2.987 subjek yang didapatkan dari 10 provinsi pada program skrining hipotiroid kongenital nasional pada bulan Mei sampai Juni 2017 di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, sebanyak 1.700 subjek memenuhi kriteria inklusi dan eksklusi yang diperoleh melalui teknik consecutive sampling. Nilai TSH didapatkan melalui metode Fluorometri dengan reagen Labsystem. Subjek dibagi menjadi dua kelompok yaitu 1.573 subjek untuk kelompok bayi berat lahir normal dan 127 subjek untuk kelompok bayi berat lahir rendah. Sampel kemudian dianalisis menggunakan uji Mann-Whitney dengan SPSS versi 20.0 untuk diketahui hubungannya dengan nilai rerata TSH neonatus dan MedCalc versi 17.9 untuk menghitung nilai rujukan TSH neonatus.

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ABSTRACTBackground: National Congenital Hypothyroidism Screening Program in Indonesia showed high incidence of Congenital Hypothyroidism. One of responsible risk factors is low birth weight. In low birth weight, organ maturity is relatively immature, thus disrupting organ function including thyroid and hypophysis gland. Objective: This cross-sectional study was aimed to determine the percentage of low birth weight in Indonesia, neonatal TSH reference values based on birth weight, the correlation between birth weight and thyroid gland function, as well as the association between birth weight status with neonatal TSH level.Methods: Of the 2,987 subjects obtained from 10 provinces in national congenital hypothyroidism screening program data from May to June 2017 in Dr. Cipto Mangunkusumo National General Hospital, as many as 1,700 subjects fulfilled the inclusion and exclusion criteria obtained through consecutive sampling. TSH value was obtained by Fluorometri method with Labsystem reagent. Subjects were divided into two groups, 1,573 subjects for normal birth weight and 127 subjects for low birth weight. Then, samples were analyzed by Mann-Whitney test with SPSS version 20.0 to investigate association to neonatal TSH level and MedCalc version 17.9 to calculate neonatal TSH reference values.Results: Low birth weight was 7.5%. The TSH reference value in all neonates, normal birth weight, and low birth weight were 1.40-8.04 mU/L with median 3.10 (1.00-19.80), 1.50-8.06 mU/L with median 3.20 (1.00-19.80), and 1.00-9.06 mU/L with median 2.50 (1.00-13.80) respectively. There was a positive significant correlation between low birth weight and thyroid function (r = 0.367, P<0.001). There was also a significant difference between birth weight status with neonatal TSH level (P<0.001). Discussion: The percentage of low birth weight in Indonesia is half the percentage of babies born in the world according to WHO. The neonatal TSH reference values in Indonesia is close to 10 mU/L as cut off in developed countries. Birth weight influences neonatal TSH level. It correlates with delayed in hypothalamus-hypophysis-thyroid axis maturity."