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"Minum merupakan tantangan bagi bayi prematur karena imaturitas dan penyakit yang menyertainya. Bayi prematur yang dinyatakan siap minum seringkali tidak mampu minum. Saat ini belum terdapat tata laksana yang konsisten dan mempertimbangkan kompleksitas proses minum secara komprehensif. Tujuan penelitian ini adalah menentukan berbagai faktor yang memengaruhi ketidakmampuan minum dan membuktikan efektivitas tata laksana metode baru terhadap kemampuan minum bayi prematur.Penelitian dilakukan di lima rumah sakit di Jakarta pada bulan Agustus–November 2021. Studi potong lintang meneliti faktor yang memengaruhi ketidakmampuan minum 120 bayi prematur siap minum usia kehamilan 28–34 minggu, yaitu tonus postural fleksi fisiologis, stabilitas fisiologis, refleks rooting, kemampuan regulasi diri, morbiditas, dan behavioral state. Selanjutnya dilakukan randomized controlled trial (RCT) membandingkan tata laksana metode baru dan konvensional 70 bayi prematur belum mampu minum dari studi potong lintang. Metode baru mencakup therapeutic positioning fleksi fisiologis melalui pembedongan dan intervensi oromotor berupa stimulasi oral, gerakan sinergis three finger jaw control, dan isapan non-nutritif menggunakan empeng khusus. Metode konvensional mencakup pembedongan tradisional, stimulasi oral, dan isapan non-nutritif menggunakan empeng yang biasa digunakan di ruang perawatan. Analisis data studi potong lintang dilakukan dengan uji bivariat menghitung prevalence ratio (PR) dan nilai p; uji multivariat, penentuan titik potong skor faktor risiko ketidakmampuan minum melalui kurva Receiving Operating Characteristic (ROC), serta penentuan sensitivitas dan spesifisitasnya. Uji klinis membandingkan rentang waktu tercapainya kemampuan minum bayi yang diberikan kedua jenis metode. Data dianalisis dengan program STATA versi 14.2 (tingkat kemaknaan p < 0,05).Hasil studi potong lintang menunjukkan regulasi diri sebagai faktor utama yang memengaruhi ketidakmampuan minum bayi prematur dengan PR 1,96 (1,61–3,34; IK 95%) dan p = 0,012, diikuti tonus postural, behavioral state, dan morbiditas (PR 1,91; 1,59; 1,56). Skor faktor risiko ketidakmampuan minum memiliki area under the curve (AUC) sebesar 0,698, titik potong optimal pada skor ≥ 7 dengan sensitivitas 71,4% dan spesifisitas 54%. Hasil uji klinis membuktikan metode baru lebih efektif dibandingkan metode konvensional (4 vs. 7 hari; p = 0,02).Berbagai faktor yang memengaruhi ketidakmampuan minum bayi prematur siap minum adalah regulasi diri, tonus postural, behavioral state, dan morbiditas. Metode baru lebih efektif dibandingkan metode konvensional.

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Feeding for premature infants is a challenge because of their immaturity and comorbidities. Premature infants who are ready to feed are often not able to feed. Current managements have not been consistent and consider the complexity of the feeding process comprehensively. The purpose of this study was to determine various factors influencing feeding inability of premature infants and to verify the effectiveness of a new method management on the premature infants’ feeding ability.

The study was conducted in five hospitals in Jakarta in August–November 2021. A cross-sectional study examined factors influencing the oral feeding inability on 120 ready to feed premature infants born at 28–34 weeks of gestation. Evaluation of feeding inability risk factors included physiological flexion postural tone, physiological stability, rooting reflex, self-regulation ability, morbidity, and behavioral state. Subsequently, a randomized controlled trial (RCT) comparing the new and conventional method was conducted in 70 premature infants who were not able to feed from the cross-sectional study participants. The new method encompasses physiological flexion therapeutic positioning swaddling, and oromotor intervention consisting of oral stimulation, synergic three finger jaw control, and non-nutritive sucking by using a specific pacifier. The conventional method consists of traditional swaddling, oral stimulation, and non-nutritive sucking using the usual pacifier in the nursery room. In the cross-sectional study, bivariate analysis was done to determine the prevalence ratio (PR) and p value; multivariate analysis, Receiving Operating Characteristic (ROC) curve to determine the scoring system cut-off point, as well as its sensitivity and specificity. Clinical trial data analysis compared the new and conventional method effectivity in terms of duration needed to achieve feeding ability in premature infants. STATA version 14.2 was used for data analysis (level of significance p < 0,05).

The results from the cross-sectional study showed that self-regulation had the highest influence of feeding inability with PR 1,96 (1,61–3,34; IK 95%) and p = 0,012, followed by postural tone, behavioral state, and morbidity (PR 1,91; 1,59; 1,56). The feeding inability risk score had an area under the curve (AUC) of 0.698, an optimal cut–off point of ≥ 7, as well as sensitivity of 71,4%, and specificity of 54%. In clinical trials, it was proven that the new method was more effective than the conventional method (4 vs. 7 days; p = 0,02).

Factors influencing feeding inability in premature infants were self-regulation, postural tone, behavioral state, and morbidity. The new method management was more effective than the conventional method."

"Otitis media supuratif kronik (OMSK) merupakan salah satu gangguan telinga yang sering menimpa anak dan dapat menyebabkan gangguan pendengaran dan penurunan kualitas hidup, serta banyak komplikasi. Kondisi yang terkait dengan OMSK di antaranya alergi, hipertrofi adenoid, dan refluks laringofaring (RLF). Refluks laringofaring pada anak belum banyak dipelajari di Indonesia, dan diagnosis RLF berdasarkan Instrumen Tanda dan Gejala Refluks belum banyak dipelajari. Kejadian RLF juga dikaitkan dengan gangguan saraf autonom, akibat gangguan nervus vagus yang dapat menyebabkan refluksat lambung naik ke nasofaring dan mencapai muara tuba.Penelitian ini bertujuan untuk mengetahui hubungan RLF dengan OMSK tipe aman aktif yang dibahas desain 1 penelitian, yaitu studi kasus kontrol yang menganalisis alergi, hipertrofi adenoid, dan RLF sebagai faktor risiko OMSK tipe aman aktif. Desain kedua penelitian adalah studi kasus kontrol untuk mengetahui hubungan gangguan saraf autonom dengan kejadian RLF. Desain ketiga penelitian merupakan kohort retrospektif untuk mengetahui hubungan RLF dengan gangguan fungsi tuba. Penelitian dilaksanakan Mei 2023–Juni 2024, menyertakan 39 subjek OMSK tipe aman aktif dan 39 subjek kontrol dari pasien Poliklinik THT-KL RSCM, dan direkrut secara consecutive sampling. Subjek juga akan diperiksa kondisi RLF dan gangguan saraf autonom.Hasil penelitian menunjukkan bahwa anak dengan RLF terbukti berisiko 5,59x lebih tinggi untuk terkena OMSK tipe aman aktif (OR: 5,59; 95%CI: 1,247–25,049; p = 0,025). Alergi (OR: 1,433; 95%CI: 0,343–5,981; p = 0,622) dan hipertrofi adenoid (OR: 1,178; 95%CI: 0,584–2,378; p = 0,646) tidak terbukti bermakna secara statistik sebagai faktor risiko OMSK tipe aman aktif. Gangguan saraf autonom juga belum terbukti secara statistik sebagai faktor risiko RLF (OR: 1,086; 95%CI: 0,444– 2,650; p = 0,856). Refluks laringofaring juga tidak terbukti menjadi faktor risiko gangguan fungsi tuba (RR: 1,558; 95%CI: 0,594–4,087; p = 0,367). Dapat disimpulkan bahwa RLF merupakan faktor risiko utama OMSK tipe aman aktif pada anak. Pepsin dan derajat keasaman dari refluksat RLF pada telinga tengah dapat berperan dalam kerusakan telinga tengah.

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Chronic suppurative otitis media (CSOM) is a prevalent ear disorder in children that can lead to hearing impairment, a decline in quality of life, and various complications. Conditions associated with CSOM include allergy, adenoid hypertrophy, and laryngopharyngeal reflux (LPR). The incidence of LPR in children has not been extensively studied in Indonesia, and diagnosis of LPR based on Reflux Symptom and Sign Instrument is yet to be studied. LPR has also been linked to autonomic nervous system dysfunction, as disturbances in the vagus nerve can result in the reflux of gastric contents into the nasopharynx and the opening of the Eustachian tube.

This study aims to investigate the relationship between LPR and active benign type CSOM with the first design being a case-control study that analyzes allergy, adenoid hypertrophy, and LPR as risk factors for active benign type CSOM. The second design, also a case-control study, is to determine the association between autonomic nervous system dysfunction and the occurrence of LPR. The third study design employs a retrospective cohort study to assess the relationship between LPR and Eustachian tube function disorders. The research is conducted from May 2023 to June 2024, including 39 subjects with active benign type CSOM and 39 control subjects from the ENT-HN Polyclinic of RSCM, recruited through consecutive sampling. Subjects will also be evaluated for the presence of LPR and autonomic nervous system dysfunction.

The results indicated that children with LPR were at a 5.59-fold increased risk of developing active safe type CSOM (OR: 5.59; 95% CI: 1.247–25.049; p = 0.025). Allergy (OR: 1.433; 95% CI: 0.343–5.981; p = 0.622) and adenoid hypertrophy (OR: 1.178; 95% CI: 0.584–2.378; p = 0.646) were not found to be statistically significant risk factors for active safe type CSOM. Additionally, autonomic nervous system dysfunction did not show statistical significance as a risk factor for LPR (OR: 1.086; 95% CI: 0.444–2.650; p = 0.856). LPR also did not appear to be a risk factor for Eustachian tube dysfunction (RR: 1.558; 95% CI: 0.594–4.087; p = 0.367). It can be concluded that LPR is a primary risk factor for active safe type CSOM in children. The presence of pepsin and the acidity level of the LPR refluxate in the middle ear may contribute to middle ear damage."