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Saat ini non-alcoholic fatty liver disease (NAFLD) merupakan penyebab terbanyak dari penyakit kronik hati pada anak dan dewasa. Penelitian terbaru memperlihatkan chemerin yang merupakan salah satu zat yang diproduksi oleh jaringan lemak memiliki andil penting pada NAFLD. Tujuan penelitian ini adalah membandingkan kadar chemerin dalam darah dibandingkan enzim transaminase dalam mendeteksi secara dini kerusakan sel hati karena non alcoholic fatty liver disease (NAFLD) pada anak dengan obesitas. Penelitian deskriptif potong lintang (n=57) dilakukan pada 2 buah sekolah di Jakarta pada anak usia 9-12 tahun dengan obesitas. Anak yang masuk kriteria penelitian dilakukan pemeriksaan ultrasonografi hati untuk mendeteksi perlemakan hati. Kedua kelompok tersebut sama sama dilakukan pemeriksan kadar enzim transaminase dan chemerin darah. Hasil dari penelitian ini di dapatkan nilai rerata chemerin pada anak yang menderita NAFLD sebesar 96,71 ng/ml sedangkan yang tidak menderita NAFLD sebesar 92,8 ng/ml dengan P= 0,463. Hal ini menunjukkan nilai rerata anak dengan NAFLD dibandingkan dengan anak tanpa NAFLD tidak terdapat perbedaan bermakna. Pada penelitian ini didapatkan pula bahwa pemeriksaan chemerin darah memiliki nilai AUC 0,52 dimana nilainya lebih rendah dibandingkan nilai AUC pemeriksaan SGOT dan SGPT yakni 0,81 dan 0,90. Hasil ini menunjukkan bahwa kadar chemerin darah tidak dapat menjadi prediktor yang lebih baik untuk mendeteksi perlemakan hati dibandingkan pemeriksaan kadar SGOT dan SGPT pada penelitian ini. Manfaat chemerin sebagai prediktor kelainan hati pada anak dengan obesitas perlu diteliti lebih lanjut. ABSTRACT
Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in both adults and children. Current studies have shown that chemerin, one of the biologically active substance produced by fat tissue, may have an important role in the progression of NAFLD. The aim of this research was to study whether chemerin is able to predict liver abnormalities due to NAFLD in obese children better than serum transaminases. A cross-sectional descriptive study was conducted in 57 obese subjects 9-12 years of age at 2 elementary schools in Jakarta, Indonesia. Liver ultrasound was performed in eligible subjects to detect fatty liver, along with serum chemerin and serum transaminase tests. Mean chemerin level in NAFLD and non-NAFLD children were 96.71 ng/mL and 92.8 ng/mL (p=0.463), showing no significant difference between serum chemerin level in the NAFLD and non-NAFLD group. The area under the curve (AUC) for serum chemerin was 0.52, lower than the AUC for AST (0.81) and AST (0.90). This shows that serum chemerin is not superior in predicting fatty liver compared to serum transaminase levels in this study. The role of chemerin as a marker to predict liver abnormalities in obese children still needs to be further investigated.;Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in both adults and children. Current studies have shown that chemerin, one of the biologically active substance produced by fat tissue, may have an important role in the progression of NAFLD. The aim of this research was to study whether chemerin is able to predict liver abnormalities due to NAFLD in obese children better than serum transaminases. A cross-sectional descriptive study was conducted in 57 obese subjects 9-12 years of age at 2 elementary schools in Jakarta, Indonesia. Liver ultrasound was performed in eligible subjects to detect fatty liver, along with serum chemerin and serum transaminase tests. Mean chemerin level in NAFLD and non-NAFLD children were 96.71 ng/mL and 92.8 ng/mL (p=0.463), showing no significant difference between serum chemerin level in the NAFLD and non-NAFLD group. The area under the curve (AUC) for serum chemerin was 0.52, lower than the AUC for AST (0.81) and AST (0.90). This shows that serum chemerin is not superior in predicting fatty liver compared to serum transaminase levels in this study. The role of chemerin as a marker to predict liver abnormalities in obese children still needs to be further investigated.;Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in both adults and children. Current studies have shown that chemerin, one of the biologically active substance produced by fat tissue, may have an important role in the progression of NAFLD. The aim of this research was to study whether chemerin is able to predict liver abnormalities due to NAFLD in obese children better than serum transaminases. A cross-sectional descriptive study was conducted in 57 obese subjects 9-12 years of age at 2 elementary schools in Jakarta, Indonesia. Liver ultrasound was performed in eligible subjects to detect fatty liver, along with serum chemerin and serum transaminase tests. Mean chemerin level in NAFLD and non-NAFLD children were 96.71 ng/mL and 92.8 ng/mL (p=0.463), showing no significant difference between serum chemerin level in the NAFLD and non-NAFLD group. The area under the curve (AUC) for serum chemerin was 0.52, lower than the AUC for AST (0.81) and AST (0.90). This shows that serum chemerin is not superior in predicting fatty liver compared to serum transaminase levels in this study. The role of chemerin as a marker to predict liver abnormalities in obese children still needs to be further investigated.

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Penelitian mengenai asupan serat pangan dan air dan kejadian konstipasi pada remaja masih belum banyak Tujuan penelitian ini untuk mendapatkan profil jumlah asupan serat pangan dan air pada remaja serta hubungan antara asupan serat pangan dan air terhadap pola buang air besar konsistensi tinja dan konstipasi Studi potong lintang dilakukan pada 120 siswa SMU berusia 15 17 tahun dilakukan selama Oktober Desember 2015 Data jumlah asupan energi karbohidrat protein lemak air dan serat bahan makanan dan minuman dikumpulkan dengan menggunakan food record form selama 2x24 jam dan food frequency questionnaire FFQ Subjek terdiri dari 82 anak perempuan 68 3 dan 38 anak lelaki 31 7 sebagian besar dengan gizi baik dan perawakan normal Hanya dua subjek yang mengalami konstipasi Median asupan energi protein lemak dan karbohidrat air dan serat berturut turut sebanyak 1419 3 kalori 54 6 gram 48 4 gram dan 183 2 gram 2079 mL dan 5 1 gram Jumlah asupan energi karbohidrat dan air subjek lelaki secara bermakna lebih tinggi dibandingkan perempuan Tidak didapatkan hubungan bermakna antara asupan serat pangan dan air dengan kejadian konstipasi Data yang didapat menunjukkan jumlah asupan serat pangan remaja usia 15 17 tahun di bawah AKG yang dianjurkan Sebaliknya jumlah asupan air sesuai dengan AKG yang dianjurkan Data yang didapat diharapkan dapat dipergunakan sebagai dasar untuk penelitian selanjutnya ABSTRACT
Indonesian children and adolescent are alleged not to consume sufficient fiber and water while studies show fiber and water affect defecation profile This cross sectional study records the amount of fiber and water intake of Indonesian adolescents aged 15 17 years and their defecation pattern Subjects are 120 SMU 68 students aged 15 17 years 82 girls and 38 boys The study was conducted between October and December 2015 We attempt to find any correlation between fiber and water intake and defecation profile Most of the subjects were well nourished and normal stature Median water and fiber intake were 2079 mL and 5 1 grams The median of energy protein fats and carbohydrates intake were 1419 3 calories 54 6 grams 48 4 grams and 183 2 grams consecutively Only two subjects who experienced constipation About 49 subjects had abdominal pain according to Rome III Criteria We found there is no significant association between dietary fiber intake and water consumption and constipation However we feel that future study should be carried out to encrich our data in this field ;Indonesian children and adolescent are alleged not to consume sufficient fiber and water while studies show fiber and water affect defecation profile This cross sectional study records the amount of fiber and water intake of Indonesian adolescents aged 15 17 years and their defecation pattern Subjects are 120 SMU 68 students aged 15 17 years 82 girls and 38 boys The study was conducted between October and December 2015 We attempt to find any correlation between fiber and water intake and defecation profile Most of the subjects were well nourished and normal stature Median water and fiber intake were 2079 mL and 5 1 grams The median of energy protein fats and carbohydrates intake were 1419 3 calories 54 6 grams 48 4 grams and 183 2 grams consecutively Only two subjects who experienced constipation About 49 subjects had abdominal pain according to Rome III Criteria We found there is no significant association between dietary fiber intake and water consumption and constipation However we feel that future study should be carried out to encrich our data in this field ;Indonesian children and adolescent are alleged not to consume sufficient fiber and water while studies show fiber and water affect defecation profile This cross sectional study records the amount of fiber and water intake of Indonesian adolescents aged 15 17 years and their defecation pattern Subjects are 120 SMU 68 students aged 15 17 years 82 girls and 38 boys The study was conducted between October and December 2015 We attempt to find any correlation between fiber and water intake and defecation profile Most of the subjects were well nourished and normal stature Median water and fiber intake were 2079 mL and 5 1 grams The median of energy protein fats and carbohydrates intake were 1419 3 calories 54 6 grams 48 4 grams and 183 2 grams consecutively Only two subjects who experienced constipation About 49 subjects had abdominal pain according to Rome III Criteria We found there is no significant association between dietary fiber intake and water consumption and constipation However we feel that future study should be carried out to encrich our data in this field

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Latar belakang: Pemberian ASI eksklusif oleh ibu sehat pada bayi sehat cukup bulan sesuai masa kehamilan dengan persalinan normal seharusnya tidak memiliki kendala, namun cakupan pemberian ASI eksklusif di Indonesia semakin menurun.

Tujuan: Mengetahui insidens keberhasilan pemberian ASI eksklusif di RSCM dan faktor yang memengaruhinya setiap bulan selama 6 bulan.

Metodologi: Studi kohort prospektif analitik pada 243 ibu sehat yang memiliki bayi sehat cukup bulan sesuai masa kehamilan, dengan persalinan normal di RSCM. Wawancara terarah dilakukan setiap bulan selama enam bulan. Analisis bivariat dan multivariat regresi logistik dilakukan pada faktor yang memiliki jumlah subyek seimbang.

Hasil: Insidens ASI eksklusif, yaitu sebesar 64,8% (bulan-1); 53,7% (bulan-2); 43% (bulan-3); 30,7% (bulan-4); 23,5% (bulan-5); dan 22,3% (bulan-6). Keberhasilan ASI eksklusif dipengaruhi oleh inisiasi menyusu dini hingga bulan-2, ibu tidak berkerja/bersekolah pada bulan-3 hingga bulan-6, keyakinan ibu akan produksi ASI hingga bulan-6, dukungan suami/keluarga hingga bulan-6, perasaan tidak stres pada bulan-2 dan bulan-3 (p<0,028). Analisis multivariat menyimpulkan keyakinan ibu akan produksi ASI memengaruhi keberhasilan ASI eksklusif setiap bulan dengan resiko relatif (RR) dan 95% interval kepercayaan (IK) sebesar 14,85 dan 6,9-31,94 (bulan-1); 44,26 dan 10,16-192,75 (bulan-2); 14,62 dan 4,88-43,83 (bulan-3); 32,28 dan 4,23-246,37 (bulan-4); 19,85 dan 2,57-153,16 (bulan-5); 19,02 dan 2,47-146,31 (bulan-6). Dukungan suami/keluarga memengaruhi keberhasilan ASI eksklusif setiap bulan dengan RR dan 95%IK sebesar 4,06 dan 2,06-8,03 (bulan-1); 4,93 dan 2,5-9,73 (bulan-2); 2,35 dan 1,15-4,81 (bulan-3); 5,44 dan 2,03-14,59 (bulan-4); 6,49 dan 1,77-23,75 (bulan-5); 24,43 dan 3,20-186,42 (bulan-6). Ibu bekerja/sekolah memengaruhi keberhasilan ASI eksklusif pada bulan ketiga (RR 3,38; 95%IK 1,21-9,43) and bulan keempat (RR 6,56; 95%IK 1,39-30,99).

Simpulan: Insidens ASI eksklusif di RSCM menurun setiap bulannya hingga 6 bulan. Faktor yang memengaruhi keberhasilan ASI eksklusif setiap bulan selama enam bulan bersifat multifaktorial.

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ABSTRACT
Background: Exclusive breastfeeding by healthy mothers to healthy term babies with normal birth is not supposed to be a problem yet the coverage of exclusive breastfeeding in Indonesia is declining.

Objective: To obtain the success rate incidence for exclusive breastfeeding and its affecting factors in every month for six months

Methods: A prospective analytical cohort study in 243 healthy mothers with healthy term babies with normal birth at CMH. Guided interviews were conducted every month for six months. Bivariate and multivariate were performed on factors with equal subject numbers.

Results: Exclusive breastfeeding incidences are 64.8% (first month); 53.7% (second month); 43% (third month); 30.7% (fourth month); 23.5% (fifth month); and 22.3% (sixth month). The multivariate analysis concluded that the mother’s belief of breastmilk production affects the exclusive breastfeeding success for every month with RR dan 95%CI: 14.85 and 6.9-31.94 (first month); 44.26 and 10.16-192.75 (second month); 14,62 and 4.88-43.83 (third month); 32,28 and 4.3-246.37 (fourth month); 19.85 and 2.57-153.16 (fifth month); 19.02 and 2.47-146.31 (sixth month). The husband/family support affects the exclusive breastfeeding success with RR and 95%CI: 4.06 and 2.06-8.03 (first month); 4.93 and 2.5-9.73 (second month); 2.35 and 1.15-4.81 (third month); 5.44 and 2.03-14.59 (fourt month); 6.49 and 1.77-23.75 (fifth month); 24.43 and 3.20-186.42 (sixth month). Non-working/studying mothers affects the exclusive breastfeeding success for the third month (RR 3.38; 95%CI 1.21-9.43) and fourt month (RR 6.56; 95%CI 1.39-30.99).

Conclusions: Exclusive breastfeeding incidence in CMH declined every month up to sixth month. Factors affecting the success for each month in the six months are multifactorial.

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Latar belakang : Infeksi saluran kemih ISK berulang adalah ISK yang timbul kembali pasca pengobatan, dengan kejadian 40-50 dari ISK pertama. Kekerapan berulangnya ISK meningkatkan komplikasi gagal ginjal kronik. Salah satu faktor penyebab adalah kolonisasi bakteri patogen feses dari saluran cerna di daerah periuretra. Bakteri saluran cerna terdiri dari 3 kelompok, bakteri patogen, komensal dan bakteri menguntungkan. Penelitian membuktikan disbiosis antara bakteri patogen dan menguntungkan berkaitan dengan kejadian penyakit sistemik, namun belum ada penelitian tentang pengaruh hal tersebut pada ISK berulang.Tujuan : Mengetahui kondisi disbiosis yaitu perbedaan proporsi Escherichia coli dan Bifidobacterium sp. saluran cerna pada anak ISK berulang.Metode : Penelitian uji potong lintang pada anak ISK berulang usia 6 bulan sampai dengan

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ABSTRACT
Background Recurrent urinary tract infection UTIr is repeated UTI post antibiotic treatment, with recurrency is 40 50 from the first infection. Recurrency of UTI increases possibility of chronic renal failure as complication. One of the causal factors is colonization of faecal pathogens from gastrointestinal tract in periurethra. Gastrointestinal tract bacteria is divided into 3 groups pathogens, comensal, and beneficial bacteria. Studies proved that imbalance of condition or dysbiosis between pathogens and beneficial bacteria lead to systemic diseases, but there were no studies in UTIr.Objective To know about dysbiosis condition based on proportion differences between gastrointestinal Escherichia coli and Bifidobacterium sp. in UTIr.Methods A cross sectional studies with children with UTIr, aged 6 months old until 18 years old, in Pediatric Departement Cipto Mangunkusumo Hospital as a subject. Healty child which had been matched by sex and age was choosen as a control group. Faecal samples from both groups underwent DNA extractions, using real time PCR method, to look for Escherichia coli and Bifidobacterium sp. amount and proportions.Results There was a total of 25 subjects, 8 32 were classifed as simplex UTI and 17 68 were complex UTI, also 25 healthy children as control. The total amount of Escherichia coli in UTIr compared to control was 1.099.271 vs 453.181 p 0,240. The total amount of Bifidobacterium sp. in UTIr compared to control was 1.091.647 vs 359.336 p 0,148. Escherechia coli proportion in UTIr compared to control was 10,97 vs 4,74 p 0,014 that shown a significant different, while Bifidobacterium sp. 6,54 vs 9,33 p 0,594. In UTIr group, proportion differences beetwen Escherichia coli and Bifidobacterium sp. was 10,97 vs 6,54 p 0,819, while in control group 4,74 vs 9,33 p 0,021 which showed that Bifidobacterium sp. has a significant different. The total amount of Escherichia coli in simplex compared to complex UTIr was 996.004 vs 1.099.271 p 0,798, while amount of Bifidobacterium sp. 835.921 vs 1.196.991 p 0,711. Logarithm of Escherichia coli proportion in simplex and complex UTIr was 5,50 SB 1,45 vs 5,92 SB 0,71 p 0,333, while Bifidobacterium sp. 5,85 SB 0,75 vs 6,04 SB 5,50 p 0,562 showed no significant differences.Conclusions Escherchia coli proportion was higher in UTIr children and Bifidobacterium sp. proportion was higher in healthy children. The proportion of both bacteria was equal in simplex and complex UTIr.

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Latar belakang: Penggunaan media digital, termasuk gawai, telah menjadi bagian penting dalam kehidupan anak. Paparan media digital pada anak dikaitkan dengan risiko keterlambatan perkembangan. Tujuan penelitian ini adalah mengeksplorasi hubungan antara penggunaan gawai dan keterlambatan perkembangan bahasa pada anak usia 2-3 tahun.

Metode: Penelitian kasus kontrol ini mengikutsertakan anak usia 2-3 tahun di Jakarta dan Bekasi yang diambil secara consecutive sampling. Kelompok kasus terdiri dari pasien rawat jalan dari klinik tumbuh kembang dengan diagnosis keterlambatan bahasa; tanpa adanya kelainan bawaan, keterlambatan global, gangguan neurologis, dan gangguan perilaku. Diagnosis ditegakkan oleh dokter anak konsultan tumbuh kembang yang dituliskan pada rekam medis. Kelompok kontrol adalah anak tanpa keterlambatan bahasa yang diambil di klinik vaksinasi. Berdasarkan wawancara orangtua, setiap kelompok diidentifikasi riwayat penggunaan gawai (onset penggunaan, durasi harian, dan pendampingan) dan dianalisis hubungannya dengan perkembangan bahasa anak dengan mempertimbangkan faktor perancu lainnya.

Hasil: Sebanyak 43 subjek kelompok kasus dan 104 subjek kelompok kontrol diikutsertakan dalam penelitian ini. Durasi penggunaan gawai lebih dari 4 jam per hari disertai faktor pengasuhan utama meningkatkan risiko terjadinya keterlambatan bahasa anak usia 2-3 tahun (adjusted OR 6,899; IK 95% 1,655 – 28,757; p 0,008). Onset penggunaan gawai tidak meningkatkan risiko keterlambatan bahasa anak, dengan atau tanpa mempertimbangkan pendidikan ibu dan pengasuh utama anak (OR 2,162; IK 95% 0,961 – 4,867; p 0,063). Pendampingan penggunaan gawai tidak meningkatkan risiko keterlambatan bahasa anak secara signifikan, dan terdapat peranan pengasuh utama dalam hubungan tersebut (adjusted OR 1,972; IK 95% 0,631 – 6,162; p 0,243). Pada variabel perancu, pengasuh utama anak memiliki peranan penting dalam hubungan antara durasi harian dan pendampingan penggunaan gawai terhadap keterlambatan bahasa anak, sedangkan pendidikan ibu tidak berperan dalam hubungan tersebut.

Kesimpulan: Durasi penggunaan gawai lebih dari 4 jam per hari disertai faktor pengasuhan utama meningkatkan risiko terjadinya keterlambatan bahasa anak usia 2-3 tahun. ......Background: The use of digital media, including gadgets, has become an important part of children's daily lives. Exposure to digital media in children is associated with the risk of developmental delays. The aim of this research is to explore the relationship between gadget use and delayed language development in children aged 2-3 years.

Methods: This case control study included children aged 2-3 years in Jakarta and Bekasi using consecutive sampling. The case group consists of outpatients from growth and developmental clinic with diagnosis of language delay; in the absence of congenital abnormalities, global delays, neurological disorders, and behavioral disorders. The diagnosis was made by a growth and development consultant pediatrician and written in the medical record. The control group was children without language delays taken at vaccination clinic. Through parent interviews, each group's history of device use has been identified (onset of use, daily duration, and parental supervision) and its relationship with children's language development has been analyzed by considering other confounding factors.

Results: A total of 43 case group subjects and 104 control group subjects were included in this study. The duration of daily gadget use exceeds 4 hours, combined with primary caregiver factors, increases the risk of language delay in children aged 2-3 years (adjusted OR 6.899; 95% CI 1.655 – 28.757; p 0.008). The onset of gadget use does not increase the risk of child language delay, regardless of whether maternal education and primary caregiver are considered (OR 2.162; 95% CI 0.961 – 4.867; p 0.063). Parental supervision of gadget use does not significantly increase the risk of language delay in children, and the primary caregiver plays a role in this relationship (adjusted OR 1.972; 95% CI 0.631 – 6.162; p 0.243). In terms of confounding variables, the primary caregiver plays an important role in the relationship between duration of daily gadget use and parental supervision regarding child language delay, while maternal education does not influence this association.

Conclusion: The duration of daily gadget use exceeds 4 hours, combined with primary caregiver factors, increases the risk of language delay in children aged 2-3 years.

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Latar Belakang: Sepsis neonatorum diagnosisnya sulit ditegakkan karena gejala klinis dan laboratorium yang tidak spesifik. Pengobatan utama sepsis neonatorum adalah antibotik untuk menurunkan mortalitas, namun penggunaan antibiotik sering berlebihan, sehingga menyebabkan resistensi bahkan meningkatkan mortalitas. Objektif: Mengetahui tingkat kepatuhan dokter penanggung jawab pasien DPJP terhadap pedoman antibiotika pada tata laksana sepsis neonatorum, faktor-faktor yang mempengaruhi keputusan DPJP untuk memulai pemberian antibiotik, proses evaluasi pemberian dan penghentian antibiotik, kepatuhan pemilihan antibiotik empirik serta mengetahui faktor-faktor risiko apa saja yang dipakai dalam menegakkan diagnosis sepsis neonatorum awitan dini (SNAD) maupun sepsis neonatorum awitan lambat (SNAL). Metode: Studi dengan uji potong lintang menggunakan kuesioner wawancara pada subyek, data sekunder rekam medik serta melakukan Indepth Interview pada DPJP. Sampel penelitian adalah semua bayi baru lahir baik di RSCM maupun dari luar, diputuskan mendapat terapi antibiotik empirik lalu diberi stempel antibiotik periode bulan Desember 2017-Februari 2018 di divisi Neonatologi RSCM. Sebanyak 113 subyek dengan 167 kejadian dilakukan analisis. Hasil: Terdapat keragaman pemeriksaan septic screening awal yaitu 1-6 jam setelah lahir dan pemeriksaan ulangan rerata 56,45 37,40 jam pada SNAD dan pada SNAL 72,00 50,91 jam, antibiotik yang dilanjutkan sesuai antara klinis dan laboratorium pada SNAD 43 52,43 dari 82 subyek, dan SNAL 7 50 dari 14 subyek, namun 100 patuh pada regimen antibiotik empirik ampisilin dan gentamisin untuk tatalaksana SNAD ringan pada 86 51,49 kasus, rerata hari konsul ke divisi Infeksi adalah 9,53 5,39 pada SNAD dan 9,63 3,89 pada SNAL. Dan tidak didapatkannya hubungan antara faktor risiko dengan kesesuaian laboratorium dan klinis sepsis p=0.869. Kesimpulan: Terdapat perbedaan pertimbangan para DPJP dalam mendiagnosis sepsis, sehingga menyebabkan ketidak patuhan terhadap pedoman antibiotik yang ada.

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Background: Establishing diagnosis of neonatal sepsis is difficult due to non-specific clinical symptoms and laboratorial results. The key management for neonatal sepsis is antibiotic administration, decreasing mortality rate. However, over administration of antibiotic may lead to resistance and even increasing the mortality rate. Objectives: To evaluate the adherence of attending physicians to the neonatal sepsis guideline; To know factors that influence the attending physicians 39; decision in administrating the antibiotics; And to know risk factors that are considered by attending physicians to diagnose both early-onset neonatal sepsis EOS and late-onset neonatal sepsis (LOS). Methods: Cross-sectional study was performed using questionnaire taken from the subjects, secondary data in form of medical records, and in-depth interview on the attending physicians. Data collection was done in December 2017-February 2018, in Cipto Mangunkusumo Hospital Neonatologi Division. Total subjects of the research was 113, with 167 cases recorded, were then analyzed. Results: Various results were found regarding the early screening 1-6 hours after birth and follow-up screening for EOS 56,45 37,40 hours and LOS 72,00 50,91 hours. Appropriate administration of antibiotic, based on clinical and laboratorial data, are found in 43 52,43 from 82 case of EOS and 7 50 from 14 cases of LOS. All of attending physicians followed the guidelines regarding empirical antibiotic regiments for mild EOS, which is Ampicillin and Gentamicin on 86 cases 51.49. Average management time before attending physicians started to ask for consultation for EOS and LOS are 9,53 5,39 days and 9,63 3,89 days respectively. No relation were found between risk factors with laboratorial results and clinical sepsis p=0.869. Conclusion: Low level of adherence toward the antibiotic guideline is due to different considerations of attending physicians in diagnosing neonatal sepsis.

Abstrak :
Latar belakang. Enterokolitis nekrotikan (EKN) merupakan penyakit inflamasi akut pada saluran cerna neonatus, terutama neonatus kurang bulan (NKB). Penyebab terjadinya EKN hingga saat ini belum diketahui tetapi terdapat beberapa faktor risiko yang berhubungan dengan kelainan tersebut. Tujuan. Mengetahui rerata usia dan faktor risiko terjadinya EKN pada NKB. Metode. Penelitian ini merupakan penelitian kohort retrospektif berdasarkan data rekam medis NKB yang dirawat selama periode Januari 2017-Desember 2019 di Divisi Neonatologi Rumah Sakit Cipto Mangunkusumo (RSCM). Analisis faktor risiko menggunakan analisis bivariat dan multivariat. Hasil. Sampel yang didapatkan sebanyak 160 subyek. Rerata usia terjadinya EKN adalah 11,38 hari. Analisis bivariat didapatkan faktor risiko berat lahir <1500 gr (p=0,006, RR 2,623, IK 95% 1,302-5,282), usia gestasi <32 minggu (p=0,009, RR 2,531, IK 95% 1,246-5,141), dan pemberian antibiotik ≥5 hari (p=0,007, RR 4,831, IK 95% 1,391-16,780) meningkatkan risiko terjadinya EKN. Hasil analisis multivariat pada faktor risiko berat lahir, usia gestasi, pemberian antibiotik, dan jenis nutrisi enteral tehadap terjadinya EKN, tidak didapatkan hasil yang bermakna secara statistik. Faktor prenatal dan intrapartum tidak dapat diketahui karena keterbatasan data. Kesimpulan. Rerata usia terjadinya EKN adalah usia 2 minggu pertama kehidupan neonatus. Faktor risiko terjadinya EKN bersifat multifaktorial dan terdapat kecenderungan dipengaruhi oleh berat lahir rendah, usia gestasi yang muda, serta pemberian antibiotik ≥5 hari. ......Background. Necrotizing enterocolitis (NEC) is an acute inflammatory disease of gastrointestinal tract that commonly occurs in newborns, particularly with preterm birth. To date, the cause of NEC is not known, however several risk factors contribute to the occurrence of this disease. Objective. To investigate mean age and risk factors of NEC in premature newborns. Methods. A retrospective cohort study was conducted using secondary data from medical records of premature infants hospitalised since January 2017 until December 2019 in Neonatology Division, Cipto Mangunkusumo Hospital, Jakarta. Risk factors was analysed using bivariate and multivariate analysis. Results. A total of 160 subjects were obtained and analysed. Mean age of NEC occurrance is 11,38 days. Bivariate analysis showed birth weight <1500 gram (p=0,006, RR 2,623, 95% CI 1,302-5,282), gestational age <32 weeks (p=0,009, RR 2,531, 95% CI 1,246-5,141), and antibiotics administration ≥5 days (p=0,007, RR 4,831, 95% CI 1,391-16,780) were associated with increased risk of NEC. However multivariate analysis revealed birth weight, gestational age, antibiotics administration, and enteral nutrition type showed no association with NEC occurrence. Prenatal and intrapartum factors were not studied due to lack of data. Conclusion. Mean age of occurrence is within the first 2 weeks of life. Risk factors of NEC are multifactorial and tend to be related with smaller gestational age, low birth weight, and antibiotic use ≥5 days.

Abstrak :
Latar Belakang : Tingginya prevalensi stunting di Indonesia dipengaruhi oleh kebutuhan gizi yang meningkat disertai kuantitas dan kualitas MPASI yang terbatas. Pemberian protein hewani yang mengandung asam amino esensial lengkap dan berjumlah cukup diharapkan mendukung pertumbuhan linear adekuat. Penelitian mengenai efektivitas PMT protein hewani terhadap pertumbuhan linear pada setting komunitas belum pernah dilakukan di Indonesia. Metode : Penelitian ini merupakan non-randomised controlled trial di Kelurahan Warakas Jakarta Utara pada bulan Agustus-November 2022 dengan subjek antara berusia 6-59 bulan mendapat intervensi PMT protein hewani (telur dan/atau susu) selama 4 bulan serta edukasi, dibandingkan dengan mendapatkan edukasi saja. Analisis dilakukan dengan membandingkan insidens stunting, delta WAZ dan LAZ, weight increment, dan length increment antara kedua kelompok. Hasil : Analisis dilakukan terhadap 56 subjek kelompok intervensi dan 67 subjek kelompok kontrol. Insidensi stunting baru di akhir penelitian ditemukan sebanyak 11,9% pada kelompok kontrol dibandingkan kelompok intervensi 0% memiliki hasil berbeda bermakna (p=0,021, OR IK 95% 1,13). Median delta WAZ kelompok intervensi (0,13 SD) berbeda bermakna (p=0,01) dibandingkan dengan kelompok kontrol (-0,09 SD). Analisis kelompok intervensi delta WAZ menunjukkan perbedaan yang signifikan (p=0,01) dibandingkan dengan kelompok kontrol, namun hasil delta LAZ secara statistik tidak berbeda bermakna tetapi secara klinis intervensi ini bermanfaat. Persentase subjek mencapai weight increment dan length increment adekuat lebih besar pada kelompok intervensi dan berbeda bermakna dibandingkan kelompok kontrol. Kesimpulan : Pemberian edukasi dan PMT protein hewani mampu mencegah terjadinya stunting dengan mendukung tercapainya weight increment dan length increment adekuat dan memberikan efek bermakna terhadap perubahan WAZ. ......Background : The high prevalence of stunting in Indonesia is influenced by increasing nutritional needs and the limited quantity and quality of complementary food. Supplementary feeding of animal proteins containing complete and sufficient amounts of essential amino acids is expected to support adequate linear growth. Research on the effectiveness of animal protein supplementation on linear growth in community settings has never been conducted in Indonesia. Methods : This study is a non-randomized controlled trial in Warakas, North Jakarta, from August-November 2022. Subjects between 6-59 months in intervention group received supplementary feeding of animal proteins (egg and/or milk) for four months and education, meanwhile the control group received education only. Analysis was conducted by comparing the incidence of stunting, delta WAZ and LAZ, weight increment, and length increment. Result : Analysis was conducted on 56 subjects of the intervention group and 67 subjects of the control group. The incidence of stunting at the end of the study (11.9%) was found in the control group compared to the intervention group (0%) has significant results (p=0.021, OR CI 95% 1.13). Analysis of the delta WAZ intervention group showed a significant difference (p=0.01) compared to the control group, however, the delta LAZ result was not statistically different but clinically the intervention was beneficial. The average of endline LAZ subjects at risk of stunting in the intervention group (-0.24 SD) differed significantly (p=0.001) compared to the control group (-0.93 SD). The percentage of subjects achieving adequate weight increment and length increment was greater in the intervention group and showed a significant difference from the control group. Conclusion : The intervention of education and animal protein supplementation can prevent occurrence of stunting by promoting adequate weight increment and length increment and also has a meaningful effect on changes of WAZ.

Abstrak :
Latar belakang. Pandemi akibat COVID-19 telah menyebabkan jutaan kematian di seluruh dunia, termasuk Indonesia. Anak, sebagai salah satu kelompok berisiko juga rentan terinfeksi. Hingga saat ini belum ada bukti definitif pengobatan etiologi terhadap COVID-19. Pemberian vitamin C dosis tinggi, yang diketahui memiliki efek antivirus, antioksidan, antiinflamasi, dan imunomodulator, menjadi salah satu pilihan terapi potensial pada pengelolaan COVID-19. Akan tetapi, belum ada data terkait pengaruhnya pada anak dengan COVID-19 dalam mempercepat penyembuhan. Metode. Penelitian uji klinis acak tersamar tunggal dilakukan pada anak dengan COVID-19 derajat ringan-sedang di RSCM antara Oktober 2021 sampai Maret 2022. Kelompok perlakuan diberikan vitamin C dosis maksimal, sedangkan kelompok kontrol diberikan vitamin C dosis berdasarkan angka kecukupan gizi. Luaran yang dinilai adalah durasi konversi menjadi negatif dan perbaikan gejala batuk, demam, diare, serta penggunaan oksigen. Analisis dilakukan untuk membandingkan pengaruh vitamin C yang diberikan pada kedua kelompok. Hasil. Sebanyak 40 subjek terlibat dalam penelitian, terbagi atas 20 subjek pada kelompok perlakuan dan 20 subjek pada kelompok kontrol. Median durasi terjadinya viral clearance pada kelompok perlakuan adalah 12 hari sedangkan pada kelompok kontrol 15,5 hari (p=0,588). Durasi gejala batuk pada kelompok perlakuan dibanding kontrol memiliki median 6 dibanding 5 hari (p=0,629), pada gejala demam 2 dibanding 3 hari (p<0,05), pada keluhan diare 2 dibanding 4 hari (p=0,172), dan lama penggunaan oksigen pada kedua kelompok adalah 5 hari (p=0,647). Simpulan. Pada penelitian ini, vitamin C oral dosis maksimal dapat mempersingkat durasi demam serta memiliki kecenderungan untuk mempercepat durasi terjadinya viral clearance dan hilangnya diare dibandingkan pemberian vitamin C dosis sesuai angka kecukupan gizi. ......Background. COVID-19 pandemic has caused millions of deaths worldwide, including Indonesia. Children, as one of the risk groups are also susceptible to infection. To date, there is no definitive evidence of an etiologic treatment for COVID-19. Administration of high doses of vitamin C, which is known to have antiviral, antioxidant, anti-inflammatory, and immunomodulatory effects, is a potential therapeutic option in the management of COVID-19. However, there is no data regarding its effect in children with COVID-19 in accelerating healing. Methods. A single-blind randomized clinical trial study was conducted on children with mild-moderate COVID-19 at Cipto Mangunkusumo hospital between October 2021 and March 2022. The treatment group was given the maximum dose of vitamin C, while the control group was given a dose of vitamin C based on recommended dietary allowance. The outcomes assessed were duration of negative conversion and improvement in symptoms of cough, fever, diarrhea, and oxygen use. An analysis was carried out to compare the effect of vitamin C administered on the two groups. Result. A total of 40 subjects were involved in the study, divided into 20 subjects in intervention group and 20 subjects in control group. The median duration of viral clearance in the treatment group was 12 days while that in the control group was 15.5 days (p=0.588). The duration of cough symptoms in the treatment group compared to the control group had a median of 6 vs 5 days (p=0.629), for fever symptoms 2 vs 3 days (p<0.05), diarrhea complaints 2 vs 4 days (p=0.172), and duration oxygen use in both groups was 5 days (p=0.647). Conclusion. In this study, the maximum dose of oral vitamin C can shorten the duration of fever and has a trend in accelerating the duration of viral clearance and diarrhea compared to recommended dietary allowance of vitamin C.