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Abstrak :
Stimulasi perkembangan yang dilakukan secara terarah pada usia dini meningkatkan kemampuan anak di semua ranah perkembangannya. Kualitas pengasuhan yang dilakukan oleh ibu dan lingkungan keluarga lain berperan dalam menentukan keberhasilan stimulasi. Metode edukasi yang lebih efektif dan informatif dibutuhkan untuk meningkatkan kualitas pengasuhan ibu. Video panduan stimulasi diperkirakan bisa menjadi sarana belajar yang baik. Tujuan. Menilai kenaikan tingkat perkembangan (Developmental Quotient/DQ) bayi usia 6-12 bulan sesudah diberikan stimulasi oleh ibu dengan video panduan stimulasi dibandingkan dengan bayi yang dilakukan stimulasi mandiri oleh ibu berdasarkan buku KIA. Metode. Penelitian uji acak terkendali terbuka (open randomized controlled trial) yang membandingkan kualitas pengasuhan dan tingkat perkembangan bayi usia 6-12 bulan sebelum dan sesudah pemberian video stimulasi perkembangan kepada ibu dibandingkan dengan stimulasi berdasarkan buku KIA. Penilaian kualitas pengasuhan menggunakan instrumen HOME Inventory dan tingkat perkembangan (DQ) menggunakan Griffith-III. Dinilai kualitas pengasuhan anak, DQ anak secara keseluruhan, perbandingan DQ sebelum dan sesudah perlakuan pada kedua kelompok, hubungan kualitas pengasuhan dan DQ, serta kenaikan DQ pada kedua kelompok. Hasil. Skor HOME Inventory kategori baik (skor ≥27) pada kelompok perlakuan sebesar 84,09% dan 15,91% kurang baik (skor <27), sedangkan pada kelompok kontrol 53,45% kategori baik dan 46,55% kurang baik. Tingkat perkembangan anak dalam DQ mendapatkan 16,16% di bawah rerata (<90), 58,82% rata-rata (DQ 90-109), dan 23,23% di atas rerata (>110). Kenaikan DQ dari pretest ke post-test pada kelompok perlakuan sebesar 14,27+12,12 dibandingkan dengan 1,37+18,55 pada kelompok kontrol. Simpulan. Stimulasi dengan panduan video meningkatkan DQ bayi usia 6-12 bulan lebih tinggi daripada stimulasi berdasarkan buku KIA. ......Developmental stimulation at an early age improves children's abilities in all areas of development. The quality of care performed by the mother and other family plays a role in determining the success of stimulation. More effective and informative educational methods are needed to improve the quality of maternal care. Stimulation guide videos are expected to be a good learning tool for mothers and caregivers of the child. Objective. Assessing the increase in the level of development (Developmental Quotient/DQ) infants aged 6-12 months after being given stimulation by mothers who received stimulation guidance videos compared to babies who were self-stimulated by mothers based on the MCH Handbook. Methods. An open randomized controlled trial that compared the quality of care and development levels of infants aged 6-12 months before and after treatment in the form of providing developmental stimulation videos to mothers compared to a control group that performed stimulation based on the MCH book. Assessment of the quality of care using the HOME Inventory instrument, and the level of development (DQ) using Griffith-III. Assessed the quality of childcare, DQ of children as a whole, comparison of DQ before and after treatment in the two groups, the relationship between the quality of care, and DQ and the increase in DQ in both groups. Results. HOME Inventory scores in the good category (score 27 and above) in the treatment group were 84.09% and 15.91% were not good (below 27), while in the control group 53.45% were in good categories and 46.55% were not good. The level of child development in the DQ was 16.16% below the average (<90), 58.82% on average (DQ 90-109) and 23.23% above the average (> 110). The increase in DQ from pretest to posttest in the treatment group was 14.27 + 12.12 compared to 5.02 + 18.55 in the control group. Conclusions. Video stimulation can increase the DQ value of infants aged 6-12 months more than self-stimulated method based on the MCH handbook.

Abstrak :
Latar belakang Kemampuan meminta (mand) dan menyebut (tact) adalah kemampuan yang perlu ditingkatkan pada awal terapi verbal behavior pada anak autisme. Metode telehealth oleh orangtua dapat memberikan terapi dini. Tujuan penelitian untuk melihat efektivitas pelatihan yang dilakukan orangtua terhadap peningkatan kemampuan komunikasi awal anak GSA dalam meminta (mand) dan menyebut (tact). Metode Uji klinis acak terkontrol terhadap anak autisme berusia 2-5 tahun. Penilaian kemampuan anak menggunakan instrumen verbal behavior milestones assessment and placement program. Orangtua kelompok perlakuan mendapat modul video pelatihan dan bimbingan dari terapis, sebelum memulai terapi selama 3 bulan pada anak. Penilaian kemampuan ulang dilakukan pada kedua kelompok di akhir periode. Hasil Terdapat 40 subyek yang masuk ke dalam level 1 VBMAPP. Skor VB MAPP sesudah pemberian intervensi meningkat dari 13,83 menjadi 24,43. Peningkatan median skor mand 1 menjadi 2 dan median skor tact 1 menjadi 3 (p<0,001). Perbandingan peningkatan median skor mand antara kedua kelompok menunjukkan hasil bermakna (p=0,003). Kenaikan proporsi skor mand dan tact tampak lebih tinggi pada kelompok perlakuan. Simpulan Pelatihan mand dan tact oleh orangtua pada anak autisme dengan menggunakan metode telehealth efektif dalam meningkatkan kemampuan anak meminta, dan bermakna secara klinis dalam meningkatkan kemampuan anak menyebut. Metode telehealth dapat diterima oleh orangtua. ......Background Mand and tact is a skill in verbal behavior therapy that needs to be improved initially. The telehealth method are helpful for those in rural area. This study aim was to assess effectiveness of telehealth mand and tact training by parents on increasing the child’s mand and tact skill. Methods A randomized controlled clinical trial of 2-5 years old children with ASD. Assessment of children's milestones using verbal behavior milestones assessment and placement program. Parents in the intervention group received video modelling and guidance from a therapist before giving therapy for 3 months. Re-assessment was done in both groups at the end of the period. Results A total of 40 subjects with ASD in level 1 VBMAPP meet criteria. A significant increase in the VB MAPP score after the intervention, namely 13.83 to 24.43. Mand median score increased from 1 to 2, and the tact, 1 to 3 with p<0.001. Comparison of the increase in the median mand score between the two groups showed significant results (p = 0.003). The increase in the proportion of mand and tact scores was higher in intervention group. Conclusion Telehealth mand and tact training by parents for children with ASD effective in improving mand, and clinically meaningful in improving tact. The telehealth method can be accepted by parents.

Abstrak :

Latar belakang: Identifikasi dan deteksi dini keterlambatan perkembangan anak sampai usia 3 tahun membutuhkan alat uji penapisan yang sahih dan andal serta mudah diaplikasikan orangtua. Kesahihan eksterna Ages and Stages Questionnaires-Third Edition (ASQ-3) belum teruji di Indonesia sehingga ASQ-3 belum dapat digunakan secara luas sebagai alat uji penapisan perkembangan anak.

Tujuan: Mengetahui kesahihan eksterna ASQ-3 bahasa Indonesia kelompok usia 24, 30, dan 36 bulan sebagai alat uji penapisan keterlambatan perkembangan anak.

Metode: Uji diagnostik ASQ-3 bahasa Indonesia kelompok usia 24, 30, dan 36 bulan dibandingkan dengan Bayley Scales of Infant Development-III (BSID-III) pada populasi anak sehat maupun yang berisiko keterlambatan perkembangan. Untuk menentukan nilai kesahihan eksterna, dihitung: sensitivitas, spesifisitas, nilai duga positif dan nilai duga negatif.

Hasil: ASQ-3 bahasa Indonesia kelompok umur 24 bulan: sensitivitas dan NDN baik (83,3% dan 91,3%), tetapi spesifisitas dan  NDP kurang baik (65,6% dan 47,6%). ASQ-3 bahasa Indonesia kelompok umur 30 bulan: sensitivitas dan NDN baik (84,6% dan 90,9%), tetapi spesifisitas dan  NDP kurang baik (69% dan 55%). ASQ-3 bahasa Indonesia kelompok umur 36 bulan: spesifisitas cukup baik (78,8%) dan NDN baik (86,7%), tetapi sensitivitas dan  NDP kurang baik (66,6% dan 53,3%).

Kesimpulan: Kesahihan eksterna ASQ-3 bahasa Indonesia kelompok usia usia 24, 30, dan 36 bulan pada penelitian ini cukup sahih sebagai alat uji penapisan keterlambatan perkembangan anak.

 

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Background: Identification of children with developmental disabilities is critical step in providing early intervention services. Ages and Stages Questionnaires third edition (ASQ-3), a parent-report questionnaires has been proven to be a valid and reliable screening test and good psychometric properties. This test has not been external validated before in Indonesia.

Aim: Providing the external validated form of the Indonesian version of the Ages and Stages Questionnaires third edition as an appropriate developmental screening tool for evaluation of 24, 30, and 36 months Indonesian children’s development.

Method: The Indonesian ASQ-3 diagnostic test for the age groups of 24, 30, and 36 months compared with Bayley Scales of Infant Development-III (BSID-III) in the population of healthy children and at risk of developmental delays. To determine the value of external validity, calculated: sensitivity, specificity, positive predictive value and negative predictive value.

Results: ASQ-3 Indonesian 24 month: sensitivity and NDN are good (83.3% and 91.3%), but specificity and NDP are poor (65.6% and 47.6%). ASQ-3 Indonesian 30 months: sensitivity and NDN are good (84.6% and 90.9%), but specificity and NDP are poor (69% and 55%). ASQ-3 Indonesian 36 months: specificity is quite good (78.8%) and NDN is good (86.7%), but sensitivity and NDP are poor (66.6% and 53.3%).

Conclusion: The external validity of ASQ-3 Indonesian 24, 30, and 36 months in this study is quite valid as a screening test for children's development delays.

 

Abstrak :
Latar belakang: Ketoasidosis diabetik (KAD) merupakan komplikasi DM tipe-1 yang dapat mengakibatkan kematian atau kecacatan neurologis permanen. Data IDAI tahun 2017 menyatakan sebanyak 71% anak DM tipe-1 pertama kali terdiagnosis dengan KAD yang meningkat dari tahun sebelumnya. Cedera otak merupakan komplikasi KAD berkaitan dengan kerusakan struktural dan fungsional otak sehingga menyebabkan kerusakan fungsi neurokognitif. Anak-anak DM tipe-1 dengan riwayat KAD menunjukkan kesulitan dalam waktu merespon, penalaran abstrak, fleksibilitas kognitif dan memori verbal. Pemeriksaan tingkat kecerdasan intelektual berupa pemeriksaan IQ diperlukan untuk menilai fungsi kognitif. Penelitian ini bertujuan untuk mengetahui gambaran fungsi kognitif berupa nilai IQ pada pasien DM tipe-1 usia sekolah dengan riwayat KAD. Metode: Dilakukan studi potong lintang deskriptif pada pasien DM tipe-1 dengan riwayat KAD yang dilaksanakan pada bulan Februari-Maret 2020 di RSUPN dr. Cipto Mangunkusumo, Jakarta. Sampel penelitian adalah pasien anak berusia 7-18 tahun yang pernah mengalami KAD sejak pertama kali terdiagnosis DM tipe-1 dan kooperatif untuk dilakukan pemeriksaan. Subyek melakukan tes IQ kemudian hasilnya dilaporkan. Hasil: Sebanyak 27 subyek memenuhi kriteria inklusi dengan 14 subyek perempuan dan 13 subyek lelaki. Rerata usia subyek adalah 13,5 tahun dengan rerata usia saat terdiagnosis adalah 8 tahun dan lama menderita DM adalah 48 bulan. Median nilai IQ yang didapatkan 91 (62-120), median verbal IQ 90 (67-113) dan median performance IQ 94 (61-118). Frekuensi KAD  2x, riwayat KAD < 18 bulan dan lama menderita DM tipe-1 5 tahun, usia saat terdiagnosis 7 tahun memiliki kecenderungan nilai IQ lebih rendah dibandingkan kondisi sebaliknya yaitu termasuk dalam kategori IQ di bawah rata-rata skala Wechsler. Kesimpulan: Nilai IQ pasien DM tipe-1 usia sekolah dengan riwayat KAD termasuk dalam kategori IQ rata-rata skala Wechsler. ......Background and aim: Diabetic ketoacidosis (DKA) is a complication of type-1 diabetes that results in death or permanent neurological disability. IDAI data for 2017 stated that 71% of patients with type-1 diabetes were first diagnosed as DKA which increased from the previous year. Brain injury is a complication of DKA associated with structural and functional damage to the brain and causes neurocognitive function impairment. Children with type-1 diabetes with history of DKA show difficulties in response time, abstract reasoning, cognitive flexibility and verbal memory. An examination for the level of intelligence as an IQ examination is needed to assess cognitive function. This study aims to determine the description of cognitive function as IQ scores in school age patients of type-1 diabetes with history of DKA. Method: A cross-sectional descriptive study was performed to type-1 diabetic patients with history of DKA started from February-March 2020 at the RSUPN Dr. Cipto Mangunkusumo, Jakarta. The study subjects were pediatric patients aged 7-18 years who had experienced DKA since they were first diagnosed as type-1 diabetes and were cooperative for examination. Subjects performed an IQ test then the results were reported. Results: A total of 27 subjects met the inclusion criteria with 14 females and 13 males. The mean age was 13.5 years with the average age at diagnosis was 8 years and the duration of diabetes was 48 months. The median IQ score was 91 (62-120), verbal IQ IQ 90 (67-113) and performance IQ 94 (61-118). Frequency of DKA twice or more, history of DKA <18 months, length of suffering of type-1 diabetes 5 years or more and age at diagnosis 7 years or more have a tendency of lower IQ scores which is included in the IQ category below the average for Wechsler scale. Conclusion: The IQ score of type-1 diabetes school-age patients with history of DKA is categorized as the average of Wechsler scale

Abstrak :
Latar belakang: Resistensi antibiotik merupakan ancaman kesehatan global. Tingginya tingkat reproduksi mikroorganisme dan kemampuan tekanan selektif yang kuat dari mikroorganisme menghadapi antibiotik pilihan merupakan permasalahan penggunaan antibiotik saat ini. Salah satu cara agar dapat menguatkan pemahaman dan ketaatan staf medis adalah melalui edukasi. Pemanfaatan teknologi seperti e-learning merupakan salah satu cara untuk meningkatkan tingkat pengetahuan dan ketepatan penggunaan antibiotik. Metode: Penelitian intervensi ini melibatkan seluruh DPJP dan PPDS Sp1 Ilmu Kesehatan Anak yang berstatus aktif di FKUI RSCM. Intervensi e-learning dilakukan terhadap DPJP dan PPDS dengan topik Antimicrobial Stewardship (AMS) via website EMAS UI kemudian dinilai tingkat pengetahuan pra- dan pasca-intervensi. Penggunaan antibiotik satu bulan pra- dan pasca-intervensi dinilai dengan alur Gyssens untuk menilai ketepatan penggunaan antibiotik. Hasil: Total penggunaan antibiotik pra- dan pasca-intervensi berturut-turut adalah 248 dan 229 antibiotik. Sebanyak 135 (54,4%) penggunaan antibiotik pra-intervensi dan 170 (72,24%) penggunaan antibiotik pasca-intervensi dinilai tepat. Analisis bivariat terhadap ketepatan penggunaan antibiotik menunjukkan terdapat hubungan bermakna pra- dan pasca-intervensi (OR= 0,537, IK 95% 0,363-0,795; p< 0,002). Sebanyak 42 dari total 56 DPJP anak dan 119 dari total 123 PPDS Sp1 Ilmu Kesehatan Anak mengikuti intervensi e-learning. Analisis bivariat menunjukan terdapat hubungan bermakna terhadap tingkat pengetahuan DPJP pra- dan pasca-intervensi (1 vs 32; p<0,001) dan PPDS pra- dan pasca-intervensi (10 vs 66; p<0,001). Kesimpulan: Terdapat peningkatan signifikan tingkat ketepatan penggunaan antibiotik pada pasien anak di ruang perawatan RSCM dan tingkat pengetahuan ketepatan pemberian antibiotik pada DPJP dan PPDS setelah dilakukan intervensi edukasi melalui metode e-learning. ......Backgorund: Antibiotic resistance is a global health threat. The high rate of reproduction of microorganisms and the strong selective pressure ability of microorganisms against antibiotics are the problems of the current use of antibiotics. Education is a way to strengthen the understanding and obedience of medical staff. Utilization of technology such as e-learning can be used to increase the level of knowledge and the effectiveness of using antibiotics. Method: This intervention study involved all active pediatric staff and pediatric residents from the Department of Child Health in FMUI-CMH. Staff and residents underwent intervention through e-learning on the topic of Antimicrobial Stewardship (AMS) via the EMAS UI website, and then the level of their pre- and post-intervention knowledge was assessed. The use of antibiotics one month pre- and post-intervention was assessed by Gyssen's flowchart to assess the appropriateness of the antibiotics usage. Result: A total of 135 (54.4%) uses of pre-intervention antibiotics and 170 (72.24%) uses of post-intervention antibiotics were considered appropriate. Bivariate analysis of the appropriate use of antibiotics showed that there was a significant relationship pre- and post-intervention (135 vs. 170, 95% CI 0.363-0.795; p 0.002). Forty two out of 56 staff and 119 out of 123 residents participate in e-learning. Bivariate analysis showed that there was a significant relationship between the level of knowledge of pre- and post-intervention in pediatric staff (1 vs. 32; p 0.001) and pre- and post-intervention pediatric residents (10 vs. 66; p 0.001). Conclusion: There was a significant increase in the appropriateness level of using antibiotics in pediatric patients at CMH and the level of knowledge about the appropriateness of giving antibiotics to staff and residents after educational interventions were carried out through the e-learning.

Abstrak :
Resistensi antibiotik merupakan ancaman kesehatan global. Tingginya tingkat reproduksi mikroorganisme dan kemampuan tekanan selektif yang kuat dari mikroorganisme menghadapi antibiotik pilihan merupakan permasalahan penggunaan antibiotik saat ini. Salah satu cara menguatkan pemahaman dan ketaatan staf medis adalah melalui edukasi. E-learning merupakan salah satu cara untuk meningkatkan tingkat pengetahuan dan ketepatan penggunaan antibiotik. Penelitian intervensi ini melibatkan seluruh DPJP dan PPDS Sp1 Ilmu Kesehatan Anak yang berstatus aktif di FKUI RSCM. Intervensi e-learning dilakukan terhadap DPJP dan PPDS dengan topik Antimicrobial Stewardship (AMS) melalui website EMAS UI kemudian dinilai tingkat pengetahuan pra- dan pasca-intervensi. Penggunaan antibiotik satu bulan pra- dan pasca-intervensi dinilai dengan alur Gyssens untuk menilai ketepatan penggunaan antibiotik. Sebanyak 135 (54,4%) penggunaan antibiotik pra-intervensi dan 170 (72,24%) penggunaan antibiotik pasca-intervensi dinilai tepat. Analisis bivariat terhadap ketepatan penggunaan antibiotik menunjukkan terdapat hubungan bermakna pra- dan pasca-intervensi (OR= 0,537, IK 95% 0,363-0,795; p< 0,002). Sebanyak 42 dari total 56 DPJP anak dan 119 dari total 123 PPDS Sp1 Ilmu Kesehatan Anak mengikuti intervensi e-learning. Analisis bivariat menunjukan terdapat hubungan bermakna terhadap tingkat pengetahuan DPJP pra- dan pasca-intervensi (1 vs 32; p<0,001) dan PPDS pra- dan pasca-intervensi (10 vs 66; p<0,001). Terdapat peningkatan signifikan tingkat ketepatan penggunaan antibiotik pada pasien anak di ruang perawatan RSCM setelah dilakukan intervensi edukasi melalui metode e-learning. ......Antibiotic resistance is a global health threat. The high rate of reproduction of microorganisms and the strong selective pressure ability of microorganisms against antibiotics are the problems of the current use of antibiotics. Education is a way to strengthen the understanding and obedience of medical staff. E-learning can be used to increase the level of knowledge and the effectiveness of using antibiotics. This intervention study involved all active pediatric staff and pediatric residents from the Department of Child Health in FMUI-CMH. Staff and residents underwent intervention through e-learning on the topic of Antimicrobial Stewardship (AMS) via the EMAS UI website, and then the level of their pre- and post-intervention knowledge was assessed. The use of antibiotics one month pre- and post-intervention was assessed by Gyssen's flowchart to assess the appropriateness of the antibiotics usage. A total of 135 (54.4%) uses of pre-intervention antibiotics and 170 (72.24%) uses of post-intervention antibiotics were considered appropriate. Bivariate analysis of the appropriate use of antibiotics showed that there was a significant relationship pre- and post-intervention (135 vs. 170, 95% CI 0.363-0.795; p 0.002). Forty two out of 56 staff and 119 out of 123 residents participate in e-learning. Bivariate analysis showed that there was a significant relationship between the level of knowledge of pre- and post-intervention in pediatric staff (1 vs. 32; p 0.001) and pre- and post-intervention pediatric residents (10 vs. 66; p 0.001). The total use of pre- and post-intervention antibiotics being, respectively, 248 and 229 antibiotics. There was a significant increase in the appropriateness level of using antibiotics in pediatric patients at CMH after educational interventions were carried out through the e-learning.

Abstrak :
Latar Belakang: Penelitian mengenai proporsi dan faktor prediksi karier Streptococcus beta-hemolyticus grup A di faring belum banyak di Indonesia. Karier Streptococcus beta-hemolyticus grup A tersebut dapat menjadi sumber penularan terutama untuk lingkungan terdekat. Pada individu yang rentan, demam reumatik akut dapat terjadi pasca-faringitis Streptococcus beta-hemolyticus grup dengan komplikasi jangka panjang yaitu penyakit jantung reumatik. Tujuan: Mengetahui faktor prediksi dan proporsi karier Streptococcus beta-hemolyticus grup A, mengetahui proporsi karditis subklinis dan mengetahui pola sensitivitas antibiotik terhadap Streptococcus beta-hemolyticus grup A. Metode: Penelitian ini adalah studi analitik potong lintang di SDN 05 Manggarai Jakarta Selatan terhadap 201 subyek anak usia 6-12 tahun pada November-Desember 2019. Pada seluruh subyek tidak dijumpai riwayat infeksi saluran napas akut maupun riwayat penggunaan antibiotik dalam dua minggu terakhir dan tidak terdapat penyakit jantung bawaan/penyakit jantung reumatik. Subyek menjalani pemeriksaan fisis, pemeriksaan laboratorium (darah perifer lengkap, LED, CRP, ASTO, kultur usap tenggorok) dan ekokardiografi. Analisis bivariat faktor prediksi terdapatnya karier Streptococcus beta-hemolyticus grup A yang bermakna dimasukkan ke dalam analisis regresi logistik multipel. Hasil analisis multivariat dilaporkan sebagai odds ratio (OR). Hasil: Dari 201 subyek, 54,7% subyek berjenis kelamin perempuan dan median usia adalah 9,6 tahun. Proporsi karier Streptococcus beta-hemolyticus grup A dan proporsi karditis subklinis adalah 13,9% IK 95% (9,2%-18,6%) dan 0,5%. Faktor prediksi terdapatnya karier Streptococcus beta-hemolyticus grup A adalah pembesaran tonsil (p=0,03). Pembesaran kelenjar getah bening servikal, status ekonomi, status gizi, jumlah saudara kandung dalam 1 rumah, jenis kelamin, jumlah orang dalam 1 rumah, kondisi rumah, dan pendidikan ibu tidak terbukti menjadi faktor prediksi terdapatnya karier Streptococcus beta-hemolyticus grup A. Pola sensitivitas antibiotik penisilin G, eritromisin, vankomisin, klindamisin, kloramfenikol, azitromisin, dan tetrasiklin terhadap Streptococcus beta-hemolyticus grup A berturut-turut adalah 100%, 89%, 86%, 75%, 68%, 68% dan 32%. Simpulan: Proporsi karier Streptococcus beta-hemolyticus grup A dan proporsi karditis subklinis adalah 13,9% dan 0,5%. Faktor prediksi terdapatnya karier Streptococcus beta-hemolyticus grup A yang bermakna adalah pembesaran tonsil. Penisilin G memiliki sensitivitas 100% terhadap Streptococcus beta-hemolyticus grup A. Background: Published data from Indonesia is rare regarding proportion and predicting factors of group A Streptococcal (GAS) carrier. There is risk of streptococcal transmission from GAS carrier to surrounding environment. Among highly susceptible patient, rheumatic fever could happen after GAS pharyngitis episode and also poses long-term morbidity of rheumatic heart disease. Objective: To know predicting factors and proportion of GAS carrier, proportion of subclinical carditis and antibiotic sensitivity pattern of GAS. Methods: Cross-sectional analytic study was performed from November till December 2019 at SDN 05 Manggarai Jakarta Selatan Indonesia. We enrolled 201 subjects who were asymptomatic, no history of antibiotic use in the last 2 weeks nor history of rheumatic fever or rheumatic heart disease. All subjects underwent physical examination, laboratory examination (complete blood count, erythrocyte sedimentation rate, c-reactive protein, ASTO, pharyngeal swab culture) and echocardiography. Statistical analysis included bivariate and multivariate analysis (logistic regression). Results: Of the 201 subjects, 54.7% were female and median age were 9.6 years. Proportion of GAS carrier and subclinical carditis were 13.9% (CI 95% 9.2%-18.6%) and 0.5%. Predicting factor for GAS carrier was tonsil enlargement (p=0.03). Cervical node enlargement, economics status, nutritional status, number of siblings, sex, number of people in the house, house density, and mother‟s education were statistically insignificant. Antibiotic sensitivity pattern of penicillin G, erythromycin, vancomycin, clindamycin, chloramphenicol, azithromycin, and tetracycline respectively were 100%, 89%, 86%, 75%, 68%, 68% and 32%. Conclusion: Proportion of GAS carriage and subclinical carditis are 13.9% and 0.5%. Predicting factor for GAS carrier is tonsil enlargement. Penicillin G has good sensitivity (100%) to GAS.

Abstrak :
Angka kesintasan dan kualitas hidup anak dengan penyakit hepatobilier kronik meningkat seiring dengan berkembangnya transplantasi hati. Insidens infeksi bakteri 36–79% pada 6 bulan pascatransplantasi dan mortalitasnya 3,0–10,6% pada 3 bulan pascatransplantasi. Pencegahan infeksi bakteri yang adekuat akan menurunkan angka morbiditas dan mortalitas serta meningkatkan kesintasan pasien. Penelitian ini bertujuan untuk mengetahui faktor risiko infeksi bakteri pada anak pascatransplantasi hati di Indonesia. Penelitian kohort retrospektif ini melibatkan pasien anak pascatransplantasi hati di RSUPN Dr. Cipto Mangunkusumo (RSCM) mulai Desember 2010 s/d April 2023 dengan metode total sampling. Subjek dibagi menjadi kelompok infeksi bakteri dan tanpa infeksi bakteri. Prevalens infeksi bakteri dari 63 subjek penelitian ini adalah 84,13%. Infeksi bakteri didominasi oleh hospital acquired infection (HAI) berupa infeksi daerah operasi (29,63%), ventilator-associated pneumonia (14,81%), dan catheter-related urinary tract infection (13,58%). Angka mortalitas terkait infeksi bakteri adalah 12,70%. Analisis multivariat menunjukkan lama rawat ICU ≥ 20 hari (RR 1,212, IK 95% 1,028 −1,426, p = 0,022) dan volume kehilangan darah selama operasi ≥ 70 mL/kg (RR 1,283, IK 95% 1,009 −1,631, p = 0,042) adalah faktor risiko infeksi bakteri pascatranspantasi hati. Besar post-hoc power dari masing-masing uji hipotesis yang digunakan adalah 5,07−71,50%. Hasil analisis subgrup menunjukkan lama rawat ICU ≥ 20 hari memiliki risiko 2,479 kali lebih besar untuk mengalami infeksi bakteri multi-drug resistance (IK 95% 1,185 – 5,187, p = 0,016). Sebagai kesimpulan, prevalens infeksi bakteri pada anak dalam kurun waktu 0–6 bulan pascatransplantasi hati di RSCM adalah sebesar 84,13%, dengan faktor risiko berupa lama rawat ICU ≥ 20 hari dan volume kehilangan darah selama operasi ≥ 70 mL/kg. Penelitian lanjutan dengan desain lebih baik dan subjek lebih banyak diperlukan. ......Survival rate and quality of life of children with chronic hepatobiliary disease has improved since the development of liver transplantation. Incidence of bacterial infection is 36–79% at 6 months post-transplantation and mortality of 3.0–10.6% at 3 months post-transplantation. Adequate prevention of bacterial infection will reduce morbidity and mortality and increase survival. This study aimed to determine the risk factors for bacterial infection in children who underwent liver transplantation in Indonesia. This retrospective cohort study includes pediatric recipients who underwent liver transplantation in Cipto Mangunkusumo Hospital (CMH) during December 2010 – April 2023 with total sampling method. Subjects were classified into groups with and without bacterial infection. Prevalence of bacterial infection of the 63 subjects was 84.13%. A majority of the bacterial infection cases were hospital-acquired infections (HAIs), comprising of surgical site infections (29.63%), ventilator-associated pneumonia (14.81%), and catheter-related urinary tract infections (13.58%). Multivariate analysis showed ICU length of stay ≥20 days (RR 1.212; CI 95% 1.028 −1.426; p = 0.022) and volume of blood loss volume during surgery ≥70 mL/kg (RR 1.283; CI 95% 1.009 −1.631; p = 0.042) were risk factors risk factors for bacterial infection following liver transplantation. Post-hoc power of each hypothesis test was 5.07−71.50%. Subgroup analysis presented ICU length of stay ≥20 days increased risk of multi-drug resistance bacterial infection by 2.479 times (CI 95% 1.185 – 5.187; p = 0.016). Conclusions, Bacterial infection prevalence at six-months post-liver transplantation of children in CMH was 84.13% with ICU length of stay ≥20 days and volume of blood loss volume during surgery ≥70 mL/kg  as risk factors. Further studies with better design and more participants are needed.