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"[ABSTRAKLatar belakang: Ventilasi mekanik (VM) adalah prosedur yang dipilih untukmenyelamatkan bayi dalam kondisi kritis, tetapi merupakan tindakan invasif danperlu pemantauan ketat untuk menghindari barotrauma dan volutrauma.Ekstubasi merupakan upaya untuk penyapihan VM.Tujuan: Mengetahui berapa prevalens keberhasilan ekstubasi dan prediktor apayang berperan dalam keberhasilan ekstubasi pada bayi di NICU RSCM.Metode: Rancangan penelitian ini merupakan penelitian observasional analitikdengan desain potong lintang. Pengumpulan data dilakukan secara retrospektifdengan menggunakan data RM yang lengkap untuk melihat prediktor keberhasilanekstubasi.Hasil: Dari 60 RM yang dikumpukan, diperoleh data bayi yang berhasildiekstubasi dan data dicatat tanda vital 72 jam kemudian didapatkan 55 (91,7%)bayi yang berhasil diekstubasi dan 5 (8,3%) bayi tidak berhasil. Karakteristiksubyek penelitian adalah semua bayi yang dirawat di NICU, dengan UG antara 22- 41 minggu dan BL berkisar antara 820 g sd 4100 g. Pada bayi yang diekstubasidengan merujuk pada hasil AGD, tidak berbeda bermakna antara keberhasilanekstubasi dengan normal tidaknya nilai AGD. Lama pemakaian VM berkisarantara 1- 30 hari. Prediktor ekstubasi yang diteliti adalah setting VM meliputiFiO2, PIP, flow trigger, IT, napas spontan, dan hasil AGD. Pengolahan datadengan regresi logistik terbukti diantara semua prediktor ekstubasi, hanya FiO2saja yang bermakna dengan p value 0.057 dan OR 0.76.Simpulan: Prevalens keberhasilan ekstubasi adalah 91.7%. Hasil penelitianmenunjukkaan bahwa hanya rendahnya setting FiO2 yang terbukti secara statistiksebagai prediktor keberhasilan ekstubasi.

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ABSTRACTBackground: Mechanical ventilation (VM) is a procedure which is chosen tosave the baby in critical condition, bu it is an invasive procedure and need closemonitoring to avoid barotrauma and volutrauma. Extubation was an attempt toweaning VM.Objective: To determine prevalence and predictors of successful extubation ininfants in the NICU RSCM.Methods: The study was design observational analytic research with crosssectional design. Data collected by retrospectively using complete medical record(MR) data to decided prevalence and predictors of successful extubation.Results: Of the 60 MR was collected, the data obtained were successfullyextubated infants and data recorded vital signs 72 hours later obtained 55 (91.7%)infants were successfully extubated and 5 (8.3%) infants did not succees.Characteristics of the study subjects were all babies admitted to the NICU,with GA between 22-41 weeks and BW ranged from 820 g up to 4100 g. Referto the results of blood gas analysis (BGA) normal or not was not significantlydifferent between succesful extubated. Long of used MV ranging between 1 to30 days. Predictors of extubation were studied were MV settings include FiO2,PIP, flow trigger, IT, spontaneous breath, and the results of BGA. Processing ofdata by logistic regresion among all predictors extubation, only setting FiO2 aresignificant with p value 0.057 and OR 0.76.Conclusion: Prevalence successful extubation is 91.7%. Research results thatonly the low setting FiO2 statistically proven as a predictor of extubation, Background: Mechanical ventilation (VM) is a procedure which is chosen tosave the baby in critical condition, bu it is an invasive procedure and need closemonitoring to avoid barotrauma and volutrauma. Extubation was an attempt toweaning VM.Objective: To determine prevalence and predictors of successful extubation ininfants in the NICU RSCM.Methods: The study was design observational analytic research with crosssectional design. Data collected by retrospectively using complete medical record(MR) data to decided prevalence and predictors of successful extubation.Results: Of the 60 MR was collected, the data obtained were successfullyextubated infants and data recorded vital signs 72 hours later obtained 55 (91.7%)infants were successfully extubated and 5 (8.3%) infants did not succees.Characteristics of the study subjects were all babies admitted to the NICU,with GA between 22-41 weeks and BW ranged from 820 g up to 4100 g. Referto the results of blood gas analysis (BGA) normal or not was not significantlydifferent between succesful extubated. Long of used MV ranging between 1 to30 days. Predictors of extubation were studied were MV settings include FiO2,PIP, flow trigger, IT, spontaneous breath, and the results of BGA. Processing ofdata by logistic regresion among all predictors extubation, only setting FiO2 aresignificant with p value 0.057 and OR 0.76.Conclusion: Prevalence successful extubation is 91.7%. Research results thatonly the low setting FiO2 statistically proven as a predictor of extubation]"

"[ABSTRAKLatar Belakang. Tujuan penelitian untuk melihat faktor ibu dan neonatus yang dapat menyebabkan keberhasilan minum pada neonatus yang lahir dari ibu preeklamsi. Intoleransi minum yang tidak disebabkan sepsis seringkali menyulitkan pemberian makan pada neonatus agar tumbuh kembangnya sempurna. Akan diteliti faktor-faktor yang mempengaruhi kemampuan minum.Metode Penelitian. Dengan menggunakan desain potong lintang dan rumus analisis multivariat didapatkan 72 sampel rekam medik dari ibu dan neonatus yang diambil secara consecutive sampling di rekam medik RSCM kemudian dilakukan analisis univariat, bivariat, dan multivariat.Hasil. Karakteristik ibu dan bayi yaitu sebagian besar bayi lahir dari ibu berusia 31-35 tahun, tingkat pendidikan SMA, memiliki anak usia 1-3 tahun, ANC ≥ 4x, cara persalinan bedah kaisar, kriteria preeklamsia berat, nilai SDAU tidak membuat hipoksia. Sebagian besar bayi lahir usia gestasi ≤ 32 minggu, terbanyak berjenis kelamin perempuan. Proporsi bayi yang lahir dengan dengan berat lahir 1000-1500 gram tidak berbeda dengan 1501-2000 gram, terbanyak tidak PJT, terbanyak menggunakan CPAP, dan nilai APGAR menit ke-5 ≥ 7. Analisis multivariat menunjukkan ada 2 faktor yang dapat dijadikan prediktor keberhasilan minum yaitu usia gestasi dan kondisi klinis. Bayi dapat minum full feed dengan median 9,5 hari dengan rentang 3,5-15,5 hari.Simpulan. Faktor keberhasilan minum adalah usia gestasi ˃ 32 minggu dan tidak ditemukan intoleransi klinis.

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ABSTRACTIntroduction. The aim of this study is to observe predictive factors from mothers and neonates for successful feeding. Feeding intolerance can happen without sepsis and becomes worst in the future. Other factors that influence successful feeding will be assessed in this study.Methods. This study is a cross sectional study using secondary data obtained from medical records of 72 subject, recruited with consecutive sampling. Univariate, bivariate, and multivariate analyses were performed in this study.Results. A large proportion of the babies were born from mothers aged 31-35 years old, senior high school graduated, having an 1-3 year-parity interval, giving birth through sectio caesaria delivery, ANC ≥ 4x, and having severe preeclampsia, and non hypoxic SDAU. The most of the babies born at gestational age ≥ 32 weeks and females. The most of the babies born with a birth weight of 1000-1500 grams and 1501-2000 grams weeks were not different, the most babies not IUGR, being assisted with CPAP, having an APGAR score at the 5th minutes ≥ 7. Multivariate analyses revealed the gestational age and clinical symptoms were predictor factors for successful feeding in neonates. Neonates successful feeding in median 9,5 days and range from 3,5 to 15,5 days.Conclusion. Predictor factors for successful feeding in neonates were gestational age more than 32 weeks and the absence of clinical symptoms, Introduction. The aim of this study is to observe predictive factors from mothers and neonates for successful feeding. Feeding intolerance can happen without sepsis and becomes worst in the future. Other factors that influence successful feeding will be assessed in this study.Methods. This study is a cross sectional study using secondary data obtained from medical records of 72 subject, recruited with consecutive sampling. Univariate, bivariate, and multivariate analyses were performed in this study.Results. A large proportion of the babies were born from mothers aged 31-35 years old, senior high school graduated, having an 1-3 year-parity interval, giving birth through sectio caesaria delivery, ANC ≥ 4x, and having severe preeclampsia, and non hypoxic SDAU. The most of the babies born at gestational age ≥ 32 weeks and females. The most of the babies born with a birth weight of 1000-1500 grams and 1501-2000 grams weeks were not different, the most babies not IUGR, being assisted with CPAP, having an APGAR score at the 5th minutes ≥ 7. Multivariate analyses revealed the gestational age and clinical symptoms were predictor factors for successful feeding in neonates. Neonates successful feeding in median 9,5 days and range from 3,5 to 15,5 days.Conclusion. Predictor factors for successful feeding in neonates were gestational age more than 32 weeks and the absence of clinical symptoms]"

"Latar belakang: Bayi prematur rentan kekurangan zat besi karena cadangan besi ibu rendah, kebutuhan besi untuk pertumbuhan dan pengambilan sampel laboratorium. Risiko tersebut meningkat saat bayi prematur berusia 2 bulan. Kecukupan zat besi tubuh dinilai dengan kadar feritin, besi serum (SI), saturasi transferin (Tfsat), total iron binding capacity (TIBC) dan Hb.Tujuan: Mengetahui profil besi pada bayi prematur usia kronologis 2 bulan.Metode: Studi potong lintang dilakukan terhadap bayi usia 2 bulan yang lahir usia gestasi (UG) 32-36 minggu saat berkunjung ke klinik tumbuh kembang. Pemeriksaan darah tepi lengkap, apusan darah tepi, SI, TIBC, Tfsat dan feritin dilakukan pada sampel darah vena. Data lain diperoleh dari wawancara dan telaah rekam medik.Hasil : Studi diikuti oleh 83 subjek yang terdiri dari 51% lelaki dan 93% lahir dari ibu berusia >20 tahun. Berat lahir terkecil adalah 1.180 g dan terbesar adalah 2.550 g. Prevalens ADB sebesar 6% dan DB sebesar 10%. Subjek ADB memiliki kadar Hb terendah 6,8 g/dL dan feritin terendah 8,6 ng/mL. Median kadar SI adalah 48 μg/dL; TIBC 329 μg/dL dan Tfsat 17%. Bayi ADB sebagian besar lelaki (5/5), kenaikan BB ≥2x berat lahir (4/5), tidak disuplementasi besi (3/5), latar belakang pendidikan ibu rendah (3/5) dan golongan sosial-ekonomi rendah- menengah ke bawah (3/5).Simpulan: Prevalens ADB sebesar 6% dan DB sebesar 10%. Sebagian besar subjek yang mengalami DB dan ADB memiliki kadar SI, Tfsat dan feritin rendah serta TIBC meningkat. Subjek lelaki dengan kenaikan BB ≥2x berat lahir, tidak disuplementasi besi, latar belakang pendidikan ibu rendah dan golongan sosial ekonomi rendah-menengah ke bawah lebih banyak yang mengalami ADB.

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Background: Preterm infants are vulnerable to iron deficiency (ID) due to lack of maternal iron stores, phlebotomy and increasing demand during growth. Risk of ID increases when hemoglobin (Hb) level started to decrease at 2 months of age. Iron body adequacy is measured by examining feritin, serum iron (SI), transferrin saturation, total iron binding capcity (TIBC) and Hb.Objective: To describe iron profile in preterm infants at 2 months of chronological age (CA).Methods: A cross-sectional study was conducted to 2 months old infants born at 32-36 gestational age visiting Growth and Development Clinics. Parents interview and medical record review were taken at visit. Complete blood count, blood smear, SI, TIBC, Tfsat and ferritin level were performed.Results: Eighty three subjects were enrolled in this study. Mostly were male (51%) and born from mother >20 years old (93%). The lowest birth weight was 1,180 g and the highest was 2,550 g. Prevalence of IDA is 6% and ID is 10%. The lowest Hb level found in IDA infants was 6.8 g/dL and ferritin level was 8.6 ng/mL. Median of SI level was 48 μg/dL; TIBC 329 μg/dL; and Tfsat 17. Subjects with IDA were mostly men (5/5), achieved more than twice birth weight (4/5), non-iron supplemented (3/5), born from low education background mother (3/5) and has low socio-economic status (3/5).Conclusions: Prevalence of IDA is 6% and ID is 10%. Most subjects with ID and IDA have low SI, high TIBC, low Tfsat and low ferritin level. Male subjects who weigh ≥twice birth weight, non-iron supplemented, born form low educational background and socioeconomic status mother were mostly suffer from IDA."

"Latar belakang: Di Indonesia praktik bayi FIV telah berkembang cukup pesat di berbagai klinik dan Rumah Sakit. Namun begitu, belum ada studi terkait luaran pertumbuhan dan perkembangan pada bayi FIV. Tujuan:Mengetahui dan menganalisis profil tumbuh kembang dan hubungan luaran anak usia 0-3 tahun hasil kehamilan FIV dibandingkan hasil kehamilan alami. Metode:Studi potong lintang digunakan untuk menggambarkan data karakterstik, luaran pertumbuhan dan perkembangan, serta morbiditas. Kemudian dilakukan kohort retrospektif pertumbuhan anak sejak lahir sampai usia saat pemeriksaan pada kelompok anak usia 0-3 tahun. Hasil: Tren BB, PB/TB, dan LK antara kedua kelompok cenderung sama sampai usia 30 bulan, usia 15 bulan, dan usia 24 bulan. Uji Capute Scalesdidapatkan hasil gangguan komunikasi pada 9 anak, yaitu 3 anak FIV dan 6 anak non-FIV dengan 66,7% dan 16,7% BBLR late-preterm. Kelompok subjek hasil kehamilan FIV memiliki risiko kehamilan 2,65x multipel dengan nilai interval kepercayaan/IK 1,877-3,762 (p<0,001), risiko seksio sesarean 2,48x nilai IK 1,938-3,190 (p<0,001), 1,8x kelainan kongenital nilai IK 1,296-2,514 (p 0,061),dan risiko ASI tidak eksklusif 2,68x nilai IK1,573-4,593 (p<0,001) dibandingkan kelompok subjek hasil kehamilan alami. Regresi multivariat menunjukkan kelompok subjek FIV memiliki 39,8x risiko kehamilan multipel (p0,001) dan 5x ASI tidak eksklusif (p 0,002) dibandingkan kelompok subjek hasil kehamilan alami. Simpulan:Tren BB, PB/TB, dan LK antara kedua kelompok relatif sama sampai usia tertentu. Gangguan komunikasi cenderung lebih banyak dijumpai pada anak hasil FIV. Anak hasil FIV memiliki risiko lebih tinggi kehamilan multipel, kelahiran SC, kelainan kongenital, dan ASI eksklusif inadekuat dibandingkan anak hasil kehamilan alami.

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Background:The IVF practice has been well developed in a number of health facilities and hospitals in Indonesia. However, the growth and development in children conceived from IVF have not yet been studied. Objective:To understand and analyze the growth and development profile of children aged 0-3 years conceived through IVF method compared to spontaneous pregnancy. Methods: Cross-sectional study was conducted to describe the characteristic, growth and development profile, and morbidities data. Retrospective cohort study on growth data from birth to current age was also performed. Results:The trend of body weight, body length/height and head circumference between the two groups tend to be similar up to 30 months, 15 months, and 24 months of age. Capute Scales test depicted communication disorders in 9 children consisted of 3 IVF and 6 non-IVF children with 66.7% and 16.7%, respectively, were LBW late-preterm. Subjects with IVF had 2.65x higher risk of multiple pregnancies with CI 1.877-3.762 (p<0.001), 2.48x higher risks of SC labour 2.48x CI 1.938-3.190 (p<0.001), risks of congenital anomalies 1.8x CI 1.296-2.514 (p 0.061) and risks of inadequate breast feeding 2.68x CI 1.573-4.593 (p<0.001) than non-IVF subjects. Multivariate regression showed that IVF subjects had higher risks of multiple pregnancy 39.8x (p 0.001) and inadequate breast feeding 5x (p 0.002) than non-IVF subjects. Conclusion:The trend of body weight, body length/height and head circumference between the two groups are relatively similar up to a certain age. Communication disorders are found higher in IVF subjects. Subjects with IVF pregnancy also had higher risks of multiple pregnancies, SC labour, congenital anomalies, and inadequate breast feeding compared to non-IVF subjects."

"Latar Belakang : Pasien anak dengan keganasan yang mendapatkan pengobatan kemoterapi sering mengalami episode demam neutropenia. Kondisi ini akan meningkatkan risiko infeksi yang berat akibat penurunan fungsi utama neutrofil sebagai pertahanan terhadap mikroorganisme asing. Rondinelli, dkk telah mengusulkan suatu sistem skoring untuk memprediksikan terjadinya komplikasi infeksi berat pada pasien keganasan dengan demam neutropenia selama pemberian kemoterapi sehingga diperoleh tata laksana yang sesuai. Faktor risiko prediktif terjadinya infeksi berat tersebut meliputi usia < 5 tahun, penggunaan kateter vena sentral, suhu tubuh > 38,50 C, kadar hemoglobin < 7 g/dL, adanya fokus infeksi, dan terdapatnya infeksi saluran nafas akut bagian atas. Tujuan : Mengetahui apakah sistem skoring Rondinelli dapat membantu mendeteksi risiko terjadinya komplikasi infeksi berat pada anak dengan LLA-L1 yang mengalami demam neutropenia selama pemberian kemoterapi fase induksi di Divisi Hematologi-Onkologi IKA FKUI/RSCM. Metode : Penelitian ini adalah uji diagnostik dengan metode potong lintang retrospektif dengan membandingkan sistem skoring Rondinelli terhadap baku emas terjadinya komplikasi infeksi berat berupa kondisi septikemia disertai terdapatnya bakteremia pada kultur darah. Sampel diambil dari data sekunder berupa rekam medis pasien-pasien LLA-L1 yang menjalani rawat inap di bangsal Departemen IKA FKUI/RSCM mulai bulan Januari 2010 hingga bulan Agustus 2012. Subyek penelitian adalah pasien anak berusia 0 hingga 18 tahun dengan Leukemia limfoblastik akut L1 (LLA-L1) yang mengalami episode demam neutropenia yang pertama kali selama pemberian kemoterapi fase induksi. Hasil : Penelitian dilakukan pada 30 subyek yang memenuhi kriteria inklusi. Insidens komplikasi infeksi berat saat episode demam neutropenia yang pertama kali pada pasien LLA-L1 selama pemberian kemoterapi fase induksi sebesar 30%. Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, rasio kemungkinan positif, dan rasio kemungkinan negatif skoring Rondinelli untuk mendeteksi komplikasi infeksi berat pada pasien LLA-L1 dengani demam neutropenia selama pemberian kemoterapi fase induksi berturut-turut adalah 66,7%; 90,5%; 75%; 86,3%; 6,94; dan 0,36. Area di bawah kurva ROC pada penelitian ini 0,759. Simpulan : Sistem skoring Rondinelli merupakan instrumen yang cukup baik untuk mendeteksi komplikasi infeksi berat pada anak dengan LLA-L1 yang mengalami demam neutropenia selama pemberian kemoterapi fase induksi.

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Background: Pediatric patients with malignancy who are receiving chemotherapy often experience febrile neutropenia episodes. This condition increase the risk of serious infection due to decreased of neutrophil which have primary function as a defense against foreign microorganisms. Rondinelli, et al have been proposed a scoring system for predicting the occurrence of severe infection complications in malignancy patients with febrile neutropenia after receiving chemotherapy in order to obtain appropriate treatment. Predictive risk factors for severe infection include age < 5 years, use of central venous catheter, body temperature > 38.50 C, hemoglobin level < 7 g/dL, the presence clinical focus of infection, and the absence of upper respiratory tract infection. Objective: To know whether Rondinelli scoring system can help in detecting the risk of severe infection complications in ALL-L1 with febrile neutropenia during the induction phase chemotherapy in the Pediatrics Hematology-Oncology Division, Universitas Indonesia Faculty of medicine / CMH. Method: This is a diagnostic study with a retrospective cross-sectional method by comparing the Rondinelli scoring system with the gold standard of severe infection complications such as septicemia condition and bacteremia in blood culture. Subjects were taken from the medical record of LLA-L1 patients in Pediatric Department, Universitas Indonesia Faculty of medicine / CMH starting from January 2010 until August 2012. Subjects were pediatric patients aged 0 to 18 years with ALL-L1 who experienced the first episodes of febrile neutropenia during the induction phase chemotherapy. Results: The study was conducted in 30 subjects who met the inclusion criteria. The incidence of severe infectious complications at the first episode of febrile neutropenia in patients ALL- L1 during the induction phase of chemotherapy was 30%. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio Rondinelli scoring for detecting severe infection complications in ALL-L1 neutropenia patients with febrile neutropenia during the induction phase of chemotherapy respectively are 66.7%; 90.5%, 75%, 86.3%, 6.94, and 0.36. In this study, area under the ROC curve was 0.75. Conclusion: Rondinelli scoring system is fairly good instrument for detecting complications of severe infections in ALL-L1 with febrile neutropenia during the induction phase chemotherapy"

"ABSTRAKKeterlambatan diagnosis gangguan spektrum autisme (GSA) masih menjadi masalah kesehatan anak di seluruh dunia hingga saat ini. Tenaga kesehatan yang kompeten dalam diagnosis GSA masih terbatas di pusat kesehatan tersier yang seringkali sulit dijangkau. Penggunaan telemedicine sebagai alat diagnosis dengan berbagai metode mulai diteliti; namun keterbatasan aplikasi menyebabkan telemedicine belum digunakan secara luas. Penelitian ini bertujuan untuk mengetahui efektivitas aplikasi telemedicine menggunakan rekaman video yang direkam dengan protokol khusus dibandingkan dengan observasi langsung terhadap aktivitas pasien dalam menegakkan diagnosis GSA. Sebanyak 40 subyek berusia 18-30 bulan yang datang dengan keluhan keterlambatan bicara atau perilaku acuh dan mendapat skor M-CHAT-R lebih dari dua mengikuti penelitian ini. Hasil rekaman video menurut protokol khusus dinilai berdasarkan kriteria GSA menurut DSM-5, kemudian subyek dinilai menurut kriteria yang sama pada observasi langsung. Tingkat kesesuaian diagnosis pada kedua metode mencapai 82,5%. Sensitivitas rekaman video dalam diagnosis GSA mencapai 91,3% (IK 95% 79,7% sampai 100%) dan spesifisitas 70,6% (IK 95% 48,9% sampai 92,2%). Nilai duga positif mencapai 80,7% (IK 95% 65,6% sampai 95,9%), sedangkan nilai duga negatif 85,7% (IK95% 67,4% sampai 100%). Rasio kemungkinan positif adalah 3,1 (IK 95% 1,47 sampai 6,5), sedangkan rasio kemungkinan negatif adalah 0,16 (IK 95% 0,03 sampai 0,47). Berdasarkan hasil di atas, telemedicine berbasis rekaman video cukup baik dalam mendiagnosis GSA, meskipun spesifisitas tidak tinggi. Pada kasus yang meragukan, observasi langsung tetap perlu dilakukan.

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ABSTRACTDelayed diagnosis of autism spectrum disorder (ASD) remains as a persisting child health problem throughout the world until now. Competent professionals in diagnosing ASD are limited in tertiary health care centers which are usually hard to access. The use of telemedicine as a diagnostic tool using various methods has been investigated; however, application limitations cause the telemedicine has not widely used. This study aimed to evaluate the effectiveness of telemedicine using video recording with special protocol compared to direct observation of patient s activities in diagnosing ASD. We included forty subjects aged 18-30 months old with chief complaints of delayed speech or ignoring behavior and M-CHAT-R score more than two. Video records guided by special protocol were assessed using DSM-5 criteria of ASD and the subjects were assessed using the same criteria during direct observation. Diagnostic agreement between the two methods was 82.5%. The sensitivity of video recording in diagnosing ASD was 91.3% (95% CI 79.7% to 100%), while the specificity was 70.6% (95% CI 48.9% to 92.2%). The positive predictive value was 80.7% (95% CI 65.6% to 95.9%), while the negative predictive value was 85.7% (95% CI 67.4% to 100%). The positive likelihood ratio was 3.1 (95% CI 1.47 to 6.55), while the negative likelihood ratio was 0.16 (95% CI 0.03to 0.47). Based on the results, telemedicine using video recording is effective for diagnosing ASD, despite its low specificity. In uncertain cases, direct observation is still need to be done. "

"Latar belakang: Kelahiran prematur menjadi salah satu penyebab utama kematian pada neonatus. Risiko mortalitas neonatus prematur akan menurun dengan bertambahnya usia kehamilan. Kondisi hipoksia akut akan menyebabkan insufisiensi plasenta, sehingga transfer nutrisi dari maternal ke janin akan terganggu. Hipoksia menstimulasi ekspresi faktor transkripsi HIF-1α, dan renin akan di ekspresikan lebih tinggi pada kondisi hipoksia.Renin angiotensin system (RAS) berperan dalam menjaga tekanan darah dan homeostasis elektrolit dalam tubuh.Renin dapat menstimulasi prostaglandin sebagai salah satu pencetus kelahiran diduga menjadi penyebab kelahiran prematur. Tujuan: Mengukur ekspresi renin pada usia kehamilan dan berat lahir pada jaringan plasenta neonatus prematur. Metode: Desain penelitian menggunakan cross sectional, plasenta neonatus prematur dibagi menjadi dua kelompok berdasarkan usia kehamilan (28-32 minggu dan 33-36 minggu) dan berat lahir neonatus (<1500 dan 1500-2500 gram) untuk neonatus prematur yang disertai preeklampsia maupun tanpa disertai preeklampsia. Pengukuran ekspresi relatif mRNA renin menggunakan metode two step RT-PCR. Pengukuran protein renin menggunakan metode ELISA. Hasil: Ekspresi renin yang lebih tinggi dijumpai pada plasenta neonatus prematur disertai preeklampsia usia kehamilan 28-32 minggu dan plasenta neonatus prematur tanpa disertai preeklampsia usia kehamilan 33-36 minggu. Ekspresi renin lebih tinggi pada plasenta neonatus prematur dengan berat lahir<1500 gram, baik pada prematur yang disertai preeklampsia maupun tanpa disertai preeklampsia. Kesimpulan: Tingginya ekspresi renin menunjukkan adanya penghambatan transfer nutrisi dari maternal ke janin sehingga janin tidak berkembang dengan optimal.Ekspresi renin lebih tinggi dijumpai pada neonatus dengan SGA. Ekspresi renin seluruh plasenta neonatus prematur lebih rendah dari plasenta aterm.

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Background: Preterm birth has become a main cause of neonanus mortality. Preterm neonatus mortality risk will decrease along with the increasing gestational age. Acute hypoxia will lead placental insufficiency, which results disruption on transfer nutrition from maternal to fetus. Hypoxia stimulates expression HIF-1α transcription factor, and renin will be highly expressed in hypoxia. Renin angiotensin system (RAS) plays a role in maintaining blood pressure and electrolyte homeostatic in the body. Renin stimulates prostaglandin synthesis that induces labor, and it was suspected as a cause of preterm birth.

Objective: Measure renin expression in gestational age and birth weight of preterm neonates placental tissue.

Methods: The research design used cross sectional, placental preterm neonates were divided into two groups based on gestational age (28-32 and 33-37 weeks) and birth weight (<1500 and 1500-2500 grams), preterm neonates with and without preeclampsia. Renin mRNA relative expression was measured by two step RT-PCR method. Renin protein was measuredby ELISA method.

Results: Renin expression is found higher in placental preterm neonates with preeclampsia 28-32 weeks gestational age, placental preterm neonates without preeclampsia 33-36 weeks gestational age. Renin expression was higher in placental preterm neonates <1500 grams birth weight, for both placental preterm neonates with and without preeclampsia.

Conclusion: The high renin expression showed inhibition nutrition transfer from maternal to fetus, so that the fetus does not optimally being develop.The higher renin expression found in fetus with SGA. Renin expression in preterm neonates placenta is lower than at term neonates placenta."

"Latar belakang : Skor PELOD-2 digunakan untuk mengetahui prognosis disfungsi organ pada anak sakit kritis. Hasil skor PELOD-2 terkadang tidak berbanding lurus dengan luaran perawatan sehingga tidak selalu dapat digunakan sebagai prediktor luaran pasien yang dirawat di PICU. Tujuan : Mengetahui profil dan luaran pasien sakit kritis yang dirawat di PICU RSCM berdasar skor PELOD-2. Metode : Penelitian retrospektif dengan mengambil data rekam medis pasien rawat di PICU RSCM, periode Januari-Desember 2018 secara total sampling. Penilaian skor PELOD-2 pada 24 jam pertama perawatan, komorbid dan luaran subjek dicatat dalam rekam medis. Hasil : Diperoleh 477 subjek yang memenuhi kriteria. Pasien sakit kritis yang dirawat di PICU RSCM sebagian besar berjenis kelamin laki (56,4%) dan berusia <1 tahun (27,9%), dengan bedah sebagai diagnosis terbanyak (65%). Sebagian besar pasien memiliki penyakit kronik (70,4%). Nilai median skor PELOD-2 2 untuk pasien hidup dan median skor 8 untuk pasien meninggal. Angka mortalitas adalah 10,7%. Sebagian besar subjek memiliki lama rawat <7 hari (75,5%). Subjek dengan lama rawat >14 hari memiliki median skor PELOD-2 tiga kali lipat dari subjek dengan lama rawat <7 hari. Subjek meninggal memiliki median skor PELOD-2 empat kali lipat lebih tinggi dari subjek hidup. Adanya luaran mortalitas dan lama rawat subjek yang tidak sesuai dengan skor PELOD-2 kemungkinan dipengaruhi oleh status nutrisi dan status imun. Titik potong mortalitas skor PELOD-2 pada penelitian ini adalah >5, dan titik potong mortalitas skor PELOD-2 pasien sepsis >7. Simpulan : Skor PELOD-2 dapat digunakan untuk memprediksi prognosis disfungsi organ yang mengancam kehidupan pada anak tanpa imunosupresi, semakin tinggi skor PELOD-2 akan diikuti peningkatan lama rawat dan mortalitas.

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Background: PELOD-2 score is stated can be used to discover prognosis of organ dysfunction in critically ill child. Sometimes PELOD-2 score does not always directly proportional to critically ill child s outcome, therefore sometimes can not be used as outcome and mortality predictor. Objective: To describe critically ill patient s profile and outcome of based on PELOD-2 score. Methods: This descriptive study was retrospective, conducted from January to December 2018 in PICU RSCM by total sampling. Evaluation of PELOD-2 score were performed in the first 24 hours. Subjects comorbid and outcome were stated in medical record. Results: There were 477 subjects that fulfilled the criteria. Most of the subjects were boys (56,4%) and under 1 year of age (27,9%) with surgical were the most common diagnosis (65%). Most of the subject have chronic illness as comorbid (70,4%). Median of PELOD-2 score were 2 for subjects that lived and 8 for subjects that died. Mortality rate is 10,7%. Most of the subjects were stayed in PICU for < 7 days (75,5%). Subjects with length of stay >14 days had median PELOD-2 score 3 times higher than the subjects with length of stay <7 days. Died subjects had median PELOD-2 score 4 times higher than the subjects that lived. The subjects mortality and length of stay that not in accordance with the PELOD-2 score may be influenced by subjects nutritional and immunity status. Mortality cut off point for PELOD-2 score in this study is >5. Mortality cut off point for PELOD-2 for subjects with sepsis is >7 Conclusion: PELOD-2 score is feasible to be used to predict life threatening organ dysfunction in critically ill children without immunosuppression, the higher the PELOD-2 score is equal to higher mortality and longer length of stay."

"Defisiensi besi adalah defisiensi mikronutrien yang paling sering ditemui. Jika tidak diobati, dapat menyebabkan anemia defisiensi besi dan gangguan kognitif, terutama pada anak usia sekolah, yang ireversibel. Diagnosis defisiensi besi rumit, tidak praktis, dan mahal. Organisasi AAP merekomendasikan RET-He sebagai pemeriksaan laboratorium untuk skrining defisiensi besi. Tujuan penelitian adalah untuk mencari nilai batasan RET-He untuk skrining status besi pada anak usia 6 – 18 tahun. Studi ini merupakan studi potong lintang terhadap 207 anak sehat usia 6 - 18 tahun di Indonesia. Penelitian ini mencari nilai batasan RET-He untuk skrining status besi, kemudian dibandingkan dengan hemoglobin, mean corpuscular volume, feritin, dan saturasi transferin. Kurva ROC dikerjakan untuk menentukan nilai batasan RET-He untuk skrining status besi dengan menggunakan IBM SPSS versi 22. Pemeriksaan RET-He mendapatkan nilai batasan ≤ 30,3 pg (sensitivitas 100%, spesifisitas 19,7%, NDN 100%, NDP 5,4%) untuk skrining deplesi besi; nilai batasan RET-He ≤ 28,9 pg (sensitivitas 78,9%, spesifisitas 56,2%, NDN 92,2%, dan NDP 28,9%) untuk defisiensi besi; dan nilai batasan RET-He ≤ 27 pg (sensitivitas 75%, spesifisitas 80%, NDN 98,1%, dan NDP 18,7%) untuk anemia defisiensi besi. Peneliti menarik kesimpulan bahwa RET-He dapat digunakan sebagai parameter skrining defisiensi besi dengan nilai batasan ≤ 28,9 pg. Skrining untuk anemia defisiensi besi dapat menggunakan RET-He dengan nilai batasan ≤ 27 pg, namun harus dilakukan dengan parameter lain, seperti Hb. Pemeriksaan RET-He dengan nilai batasan ≤ 30,3 pg tidak dapat digunakan untuk skrining deplesi besi.

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Iron deficiency (ID) is the most common micronutrient deficiency in the world. Left untreated, ID will lead to iron deficiency anemia (IDA) and other irreversible consequences. Screening iron deficiency is complex, impractical, and expensive. The AAP recommended RET-He as an alternative laboratory examination to screen ID. The objective is to find RET-He cut-off value to screen for iron status in healthy children, aged 6 – 18 years old. This study is a cross-sectional study of 207 children aged 6 – 18 years old in Indonesia. RET-He was compared with hemoglobin, mean corpuscular volume, ferritin to assess iron status in children. Receiver operating curve was performed to determine the optimal cut-off value for RET-He using IBM SPSS 22. Reticulocyte hemoglobin equivalent with cut-off value ≤ 30.3 pg was established to screen iron depletion (100% sensitivity, 19.7% specificity, 100% NPV, 5.4% PPV); meanwhile RET-He ≤ 28.9 pg to screen iron deficiency (78.9% sensitivity, 56.2% specificity, 92.2% NPV, 28.9% PPV); and RET-He ≤ 27 pg to screen IDA (75% sensitivity, 80% specificity, 98.1% NPV, 18.7% PPV). The researcher concluded that RET-He can be used as an iron deficiency screening parameter with a cut-off value ≤ 28.9 pg. Screening for IDA with RET-He ≤ 27 pg need to be done with other parameters, such as Hb. RET-He ≤ 30.3 pg cannot be used for iron depletion."