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Abstrak :
ABSTRAK
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: Hipertensi merupakan salah satu faktor risiko kejadian penyakit kardiovaskular. Hipertensi pada remaja dapat terus berlanjut pada usia dewasa dan menyebabkan morbiditas dan mortalitas yang lebih tinggi. Faktor risiko hipertensi pada remaja multifaktorial. Tujuan: Mengetahui prevalens dan faktor yang memengaruhi kejadian hipertensi pada remaja siswa Sekolah Menengah Pertama (SMP) di Jakarta Pusat. Metode: Studi potong lintang pada 313 anak usia 12-18 tahun siswa SMP. Data riwayat hipertensi dalam keluarga, ras/suku, berat lahir, aktifitas fisis, merokok dan konsumsi alkohol diperoleh dari kuesioner. Pada subjek penelitian juga dilakukan pemeriksaan berat badan, tinggi badan dan tekanan darah. Kriteria hipertensi berdasarkan The Fourth Report of National High Blood Pressure Education Programme Working Group on High Blood Pressure in Children and Adolescent. Hasil: Di antara 313 remaja dengan rerata usia 13,97±1,02 tahun, prevalens hipertensi adalah sebesar 9,6%. Pada analisis bivariat didapatkan hubungan yang bermakna antara riwayat hipertensi dalam keluarga (ayah hipertensi; p = 0,012, IK 95% = 1,20-6,02) dan berat badan lebih/obesitas (p<0,001; IK 95% = 2,99-14,42) dengan hipertensi. Hasil analisis multivariat menunjukkan bahwa berat badan lebih/obesitas mempunyai risiko enam kali mengalami hipertensi dibandingkan remaja dengan berat badan normal. (OR = 6,5; IK 95% = 2,99-14,43). Tidak terdapat hubungan bermakna antara jenis kelamin, berat lahir rendah, ras/suku, aktivitas fisis, dan merokok dengan hipertensi. Simpulan: Prevalens hipertensi pada remaja dalam penelitian ini cukup tinggi. Terdapat hubungan yang bermakna antara riwayat hipertensi dalam keluarga dan berat badan lebih/obesitas dengan hipertensi. Pencegahan berat badan lebih atau obesitas diharapkandapat menurunkan prevalens hipertensi pada remaja. ...... Background: Hypertension in adolescent has been often associated with other cardiovascular risk factors. Contributing factors of hypertension in adolescent are multifactorial. Objectives: To determine the prevalence of hypertension in Junior High School adolescents in Central Jakarta and its potentially associated factors, such as gender, family history of hypertension, race/ethnic, low birth weight, overweight/obesity, physical activity, smoking, and alcohol consumption. Methods: A cross sectional study involved 313 children aged 12-18 years, where were randomly selected from Junior High Schools in Central Jakarta, during March ? May 2014. Information about family history, race/ethnic, birth weight, physical activity levels, smoking and consumption of alcohol was gathered by questionnaire. Body weigth, heigth and blood pressure were measured. Hypertension was defined according to The Fourth Report of National High Blood Pressure Education Programme Working Group on High Blood Pressure in Children and Adolescent. Results: The study included 313 adolescents with mean age 13.97±1.02 years. Prevalence of hypertension was 9.6%. Bivariate analysis showed that family history of hypertension (parental hypertension; p = 0.012; CI 95% = 1.20-6.02) and overweight/obesity (p<0.001; CI 95% = 2.99-14.42) were significantly associated with hypertension. The multivariate analysis indicated that overweight/obese adolescents displayed six times more chance of having hypertension than adolescents with light/normal weight (OR = 6.5; CI 95% = 2.99-14.43). Gender, low birth weight, race/ethnic, physical activity, and smoking were not significantly associated with hypertension. Conclusions: The prevalence of hypertension in the sample studied was high. Overweight/obesity and family history of hypertension were significantly associated with hypertension. The prevention of overweight and obesity can decrease the prevalence of hypertension.

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ABSTRAK
Latar belakang : Sebanyak 70% dari anemia pada anak merupakan anemia mikrositik hipokrom, dan yang terbanyak adalah anemia defisiensi besi (ADB). Anemia defisiensi besi pada anak sekolah berkaitan dengan penurunan prestasi belajar. Anak dengan masalah nutrisi berisiko mengalami defisiensi besi. Asupan zat besi, pemacu dan penghambat absorpsi besi memengaruhi kadar besi. Sekolah dasar (SD) Pegangsaan 01 Jakarta Pusat merupakan sekolah negeri dengan mayoritas siswa berasal dari sosial ekonomi rendah. Tujuan : Mengetahui status besi pada anak usia 6-12 tahun serta hubungannya dengan status gizi dan asupan diet. Metode : Studi potong lintang dilakukan di SD Negeri Pegangsaan 01, Jakarta Pusat antara bulan Maret-April 2016. Asupan pemacu absorpsi zat besi (vitamin C) dan penghambat (fitat, teh, kopi, susu) dinilai dengan food record selama tiga hari, diolah dengan NutriSurvey®. Darah tepi lengkap, feritin, besi serum, total iron binding capacity (TIBC), saturasi transferin, dan high sensitivity C-reactive protein (hs-CRP) diperiksakan di laboratorium. Hasil : Terdapat 115 subyek berpartisipasi dalam penelitian. Prevalens deplesi besi sebesar 4,3%, defisiensi besi tanpa anemia sebesar 14,8%, ADB sebesar 1,7%. Tidak terbukti ada hubungan antara status gizi kurang dengan status besi [p=0,094; OR=2,29(0,86-6,10)], gizi lebih dan obesitas dengan status besi [p=0,050; OR=0,30(0,09-1,00)], asupan besi total dengan status besi (p=0,260), vitamin C dengan status besi (p=0,740), fitat dengan status besi (p=0,901), teh dengan status besi (p=0,931), kopi dengan status besi (p=0,624), dan susu dengan status besi (p=0,277). Simpulan : Prevalens deplesi besi, defisiensi besi tanpa anemia, dan ADB pada anak usia 6-12 tahun berturut-turut adalah 4,3%, 14,8%, dan 1,7%. Tidak terbukti ada hubungan antara status gizi, asupan zat besi, vitamin C, fitat, teh, kopi, dan susu dengan status besi pada anak usia 6-12 tahun.

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ABSTRACT
Background : Prevalence of anemia in Indonesian school-age children is high. Approximately 70% cases are microcytic hypochromic anemia which iron deficiency anemia (IDA) are the most frequent. Iron deficiency anemia associated with decreased learning achievement. Children with nutritional problems at risk for iron deficiency. Intake of enhancer and inhibitor of iron absorption affects iron body level. Pegangsaan 01 Public School is primary school in Central Jakarta, which most of the students come from low socioeconomic family. Objective: To measure iron status in children aged 6-12 years and its relationship with nutritional status and dietary intake. Methods: A cross-sectional study was conducted in Pegangsaan 01 Primary School, Central Jakarta, on March-April 2016. Dietary iron enhancer (vitamin C) and inhibitor (phytate, tea, coffee, milk) were obtained using a 3-days food record and analyzed with NutriSurvey®. Complete blood count, ferritin, serum iron, total iron binding capacity, transferrin saturation and high sensitivity C-reactive protein were examined. Results: A total of 115 children were studied. Prevalence of iron depletion, iron deficiency without anemia, and iron deficiency anemia were 4,3%, 14,8%, and 1,7% respectively. No evidence of relationship between undernourished and iron status (p=0,094), overweight-obesity and iron status (p=0,050), iron intake and iron status (p=0,260), vitamin C and iron status (p=0,740), phytate and iron status (p=0,901), tea and iron status (p=0,931), coffee and iron status (p=0,624), milk and iron status (p=0,277). Conclusion: Prevalence of iron depletion, iron deficiency without anemia and iron deficiency anemia in children aged 6-12 years were 4,3%, 14,8%, and 1,7% respectively. No evidence of relationship between nutritional status, dietary intake and iron status

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ABSTRAK
Latar belakang: Palsi serebral PS adalah gangguan fungsi motorik, postur, dan gerak akibat gangguan perkembangan otak. Insidens PS pada bayi risiko tinggi cukup besar. Alat deteksi dini PS yang mudah dilakukan sangat diperlukan untuk aplikasi klinis sehari-hari.Tujuan: 1 menentukan proporsi PS pada bayi risiko tinggi, 2 mengetahui manfaat dan kesesuaian pemeriksaan refleks primitif usia 4 bulan untuk deteksi dini PS pada bayi risiko tinggi usia 6 bulan dan pemeriksaan refleks perkembangan usia 9 bulan untuk deteksi dini PS pada bayi risiko tinggi usia 12 bulan 3 mengetahui waktu yang dibutuhkan untuk melakukan pemeriksaan refleks primitif dan perkembangan.Metode: Penelitian kohort prospektif dilakukan pada 40 bayi risiko tinggi yang berusia koreksi 4 bulan atau 9 bulan dan pernah dirawat di Unit Perinatologi RSCM. Pemeriksaan 3 refleks primitif dilakukan saat usia 4 bulan. Pemeriksaan keterlambatan motorik, 3 refleks primitif, dan 1 reaksi postural dilakukan saat usia 9 bulan. Diagnosis PS ditegakkan saat usia 6 dan 12 bulan.Hasil: Proporsi PS pada bayi risiko tinggi saat usia 6 dan 12 bulan berturut-turut adalah 26 dan 10 . Nilai kemaknaan dan risiko relatif RR pemeriksaan refleks primitif usia 4 bulan dengan kejadian PS pada usia 6 bulan adalah pemeriksaan refleks palmar p 0,04; RR 6,86; IK95 : 0,94-49,82 , respon tarikan p 0,04; RR 6,86; IK95 0,94-49,82 , dan fisting p 0,04; RR 5,63; IK95 1,38-23,01 . Nilai kemaknaan dan RR pemeriksaan refleks perkembangan usia 9 bulan dengan kejadian PS pada usia 12 bulan adalah pemeriksaan refleks palmar p 0,19; RR 9; IK95 : 0,85-94,9 , fisting p 0,19; RR 9; IK95 : 0,85-94,9 , respon tarikan p 0,28; RR 5,67; IK95 : 0,47-68,02 , keterlambatan motorik p 0,19; RR 9; IK95 : 0,85-94,9 , dan reaksi protektif-ekstensi p 0,37; RR 4; IK95 : 0,31-51,03 . Pemeriksaan refleks primitif usia 4 bulan dan refleks perkembangan usia 9 bulan memerlukan waktu berturut-turut 2 menit 37 detik SB 32,3 detik dan 5 menit 18 detik SB 53 detik .Simpulan: Pemeriksaan refleks primitif usia 4 bulan dapat menjadi alat deteksi dini PS untuk usia 6 bulan dan dapat dilakukan dalam waktu singkat. Pemeriksaan refleks perkembangan usia 9 bulan belum dapat digunakan sebagai alat deteksi dini PS untuk usia 12 bulan.

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ABSTRACT
Background Cerebral palsy CP is motor function and postural disorder due to an insult of the developing brain. The incidence of CP is high among high risk infants. A simple and less time consuming tool for early detection of CP is needed in daily clinical practice.Aim 1 to determine proportion of CP in high risk infants, 2 to determine benefit and congruence of primitive reflexes at age 4 months for early detection of CP at age 6 months, and those of developmental reflexes at age 9 months for early detection of CP at age 12 months 3 to know the time required to perform primitive and developmental reflexes.Method A prospective cohort study was conducted in 40 high risk infants with corrected age 4 or 9 months history of admission to Unit of Cipto Mangunkusumo Hospital. Three primitive reflexes were performed at the age of 4 months. Motor delay evaluation, 3 primitive reflexes, and a postural reaction were performed at the age of 9 months. The diagnosis of CP was established at 6 and 12 months of age.Result The proportion of CP in high risk infants was 26 at 6 months of age and 10 at 12 months of age. The p value and relative risk RR of primitive reflexes at age 4 months associated with incidence of CP at age 6 months were palmar grasp p 0.04 RR 6.86 CI95 0.94 49.82 , traction response p 0.04 RR 6.86 CI95 0.94 49.82 , and fisting p 0.04 RR 5.63 CI95 1.38 23.01 . The p value and relative risk RR of developmental reflexes at age 9 months associated with incidence of CP at age 12 months were palmar grasp p 0.19 RR 9 CI95 0.85 94.9 , fisting p 0.19 RR 9 CI95 0.85 94.9 , traction response p 0.28 RR 5.67 CI95 0.47 68.02 , motor delay p 0.19 RR 9 CI95 0.85 94.9 , and protective extension reaction p 0.37 RR 4 CI95 0.31 51.03 . Primitive reflexes at age 4 months and developmental reflexes at age 9 months required 2 minutes 37 seconds SD 32.2 seconds and 5 minutes 18 seconds SD 53 seconds , respectively.Conclusion Primitive reflexes examination at 4 months can be performed for early detection of PS in high risk infants aged 6 months in short time. Developmental reflexes examination at 9 months cannot be applied for early detection of PS in high risk infants aged 6 months yet.

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. Anak dan remaja dengan leukemia limfoblastik akut (LLA) berisiko mengalami osteoporosis sekunder, salah satunya karena pemberian obat kemoterapi metotreksat dan steroid. Saat ini belum terdapat data prevalens osteoporosis sekunder pada anak dengan LLA di Indonesia dan bukti keterkaitan dosis kumulatif metotreksat dan steroid terhadap kejadian osteoporosis sekunder pada anak dengan LLA. Tujuan. Mengetahui ada tidaknya kaitan antara dosis kumulatif metotreksat dan/atau steroid terhadap kejadian osteoporosis sekunder pada anak dan remaja dengan LLA. Metode. Penelitian ini merupakan studi potong lintang terhadap 52 anak dan remaja dengan LLA yang sedang menjalani kemoterapi di Rumah Sakit dr. Cipto Mangunkusumo (RSCM). Pengambilan darah dan foto polos tulang belakang dilakukan untuk menilai parameter kesehatan tulang, serta pemeriksaan dual energy X-ray absorptiometry (DEXA) untuk menilai densitas mineral tulang. Analisis regresi logistik digunakan untuk menganalisis keterkaitan dosis kumulatif metotreksat dan steroid terhadap kejadian osteoporosis sekunder. Hasil. Median usia subyek adalah 10 (7-14) tahun dengan lelaki 54% (n=52). Didapatkan kejadian osteoporosis sekunder 6/52 (11,5%) dan densitas mineral tulang rendah 11/52 (21,2%). Tidak didapatkan kaitan antara dosis kumulatif steroid (adjusted RP 0,474 [0,057-3,935], p = 0,489) dan dosis kumulatif metotreksat (adjusted RP 0,083 [0,006-1,126], p = 0,061)  dengan kejadian osteoporosis sekunder. Pasien berusia di bawah 10 tahun, memiliki kadar vitamin D rendah, dan status prepubertas memiliki kecenderungan mengalami osteoporosis sekunder. Kesimpulan. Tidak didapatkan hubungan yang bermakna secara statistik antara dosis kumulatif steroid dan/atau metotreksat terhadap osteoporosis sekunder pada anak dan remaja dengan LLA. ......Background. Children and adolescents with acute lymphoblastic leukemia (ALL) are at risk of secondary risk, one of which is the administration of chemotherapy drugs (methotrexate and steroids). Currently, there are no data on the prevalence of secondary osteoporosis in children with ALL in Indonesia and evidence about association between methotrexate and steroids with the incidence of secondary osteoporosis with ALL. Objective. To determine whether there is an association between the cumulative dose of methotrexate and/or steroids on the incidence of secondary osteoporosis in children and adolescents with ALL. Methods. This study was a cross-sectional study of 52 children and adolescents with ALL who were undergoing chemotherapy at the Cipto Mangunkusumo Hospital (CMH). Blood sampling and plain radiographs of the spine were performed to assess bone health parameters, as well as dual energy X-ray absorptiometry (DEXA) examination to assess bone mineral density. Logistic regression analysis was used to analyze the association between the cumulative dose of methotrexate and steroids on the incidence of secondary osteoporosis. Result. The median age of the subjects was 10 (7-14) years with 54% men (n=52). The incidence of secondary osteoporosis was 6/52 (11.5%) and low bone mineral density 11/52 (21.2%). There was no association between the cumulative dose of steroids (adjusted PR 1.501 [0.124-18.124], p=0.75) and the cumulative dose of methotrexate (adjusted PR 0.071 [0.005-0.951], p=0.05) and the incidence of secondary osteoporosis. None of the confounding factors (pubertal status, vitamin D levels, income level, age, and sex) were associated with secondary osteoporosis. Patient aged below 10 years old, have prepubertal status, and with low vitamin D serum tends to have osteoporosis more likely. Conclusion. There was no statistically significant relationship between the cumulative dose of steroids and/or methotrexate on secondary osteoporosis in children and adolescents with ALL.

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Latar Belakang: Pneumonia merupakan penyebab morbiditas dan mortalitas utama pada anak usia di bawah lima tahun (balita). Penelitian terkait faktor prognostik mortalitas pneumonia juga sudah banyak dilakukan sebagai upaya untuk menurunkan angka kematian. Namun, data terkait faktor yang memengaruhi mortalitas balita yang dirawat dengan pneumonia di Indonesia masih terbatas. Tujuan: Penelitian ini bertujuan untuk mengetahui angka mortalitas anak usia balita yang dirawat dengan pneumonia serta faktor prognostik yang memengaruhi luaran tersebut. Metode: Pengambilan data dilakukan di Rumah Sakit Cipto Mangunkusumo pada periode Januari 2019 hingga Maret 2022, dengan metode analisis potong lintang pada populasi anak usia 1-59 bulan yang dirawat dengan pneumonia. Hasil: Dari 600 subyek didapatkan proporsi pneumonia yang tidak berbeda antara usia < 1 tahun (51,8%) dan 1-5 tahun (48,2%). Proporsi pneumonia pada anak balita di RSCM adalah sebesar 5 %, yang sebagian besar merupakaan pneumonia terkait rumah sakit (56,8%). Angka mortalitas yang didapatkan dari penelitian ini adalah sebanyak 195 subyek (32,5%). Faktor prognostik yang terbukti berhubungan dengan mortalitas adalah status imunisasi tidak lengkap (PR 3,706; IK 95% 1,320-10,405; p=0,013), peningkatan nilai prokalstitonin (PR 1,606; IK 95% 1,196-2,154; p=0,002), dan komplikasi sepsis (PR 2,090; IK 95% 1,486-2,940; p<0,0001). Faktor usia, hipoksemia, malnutrisi, anemia, abnormalitas nilai trombosit dan leukosit, peningkatan CRP, dan komorbiditas tidak terbukti berhubungan dengan mortalitas pada anak usia balita yang dirawat dengan pneumonia. Kesimpulan : Proporsi pneumonia pada anak usia balita yang dirawat dengan pneumonia di RSCM adalah 5%, dengan angka kematian mencapai 32,5%. Faktor yang berhubungan dengan mortalitas adalah status imunisasi tidak lengkap, peningkatan nilai prokalsitonin, dan komplikasi sepsis. Kata kunci: pneumonia, faktor prognostik, mortalitas, anak. ......Background: Pneumonia is still a major cause of morbidity and mortality in children under five years of age (toddlers). Research related to prognostic factors that have roles in assessing mortality outcomes has also been carried out in an effort to reduce mortality due to pneumonia. However, until now, data regarding the factors that affect the mortality of children with pneumonia in Indonesia are still limited. Aim: This study aims are to determine the mortality rate of children under five who are treated with pneumonia, as well as prognostic factors that influence the outcome. Method: Data collection was carried out at Cipto Mangunkusumo Hospital in the period from January 2019 to March 2022, using analytic cross sectional on a population of children aged 1-59 months who were treated with pneumonia. Result: Of the 600 subjects, the proportion of pneumonia did not differ between the ages of <1 year (51.8%) and 1-5 years (48.2%). The proportion of pneumonia in children under five at the RSCM was 5%, most of which were hospital associated pneumonia (56.8%). The mortality rate obtained from this study was 195 subjects (32.5%). Prognostic factors that were shown to be associated with mortality outcomes were incomplete immunization (PR 3.706; 95% CI 1.320-10.405; p=0.013), increased procalcitonin value (PR 1.606; 95% CI 1.196-2.154; p=0.002), and complications of sepsis (PR 2.090; 95% CI 1.486-2.940; p<0.0001). Age, hypoxemia, malnutrition, anemia, abnormal platelet count, abnormal leukocyte count, elevated CRP, and comorbidities have not been shown to be associated with increased mortality in children under five who are treated with pneumonia. Conclusions : The proportion of pneumonia in children under five years of age who were treated with pneumonia at the RSCM was 5%, with a mortality rate of 32.5%. Factors

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Latar belakang: Renjatan merupakan masalah utama di ruang emergensi dan rawat intensif anak. Resusitasi cairan pada renjatan hanya memberikan repons pada 50% pasien. Pemberian cairan yang berlebih akan meningkatkan morbiditas dan mortalitas. Indeks dinamis memiliki keterbatasan dalam memprediksi fluid responsiveness. Left Ventricular End Diastolic Volume Index (LVEDVI) belum banyak diteliti dan dapat mengatasi keterbatasan indeks dinamis. Tujuan: Mengidentifikasi peran LVEDVI sebagai prediktor fluid responsiveness terhadap pemberian cairan resusitasi pada anak dengan renjatan. Metode: Ini adalah penelitian uji diagnostik-potong lintang pada anak dengan renjatan di ruang emergensi dan rawat intensif anak RSUPN Cipto Mangunkusumo Juni hingga November 2018. Pengukuran LVEDVI dilakukan menggunakan USCOM dan dibandingkan dengan peningkatan isi sekuncup ≥15% setelah fluid challenge sebagai kriteria fluid responsive. Sampel dimasukkan ke dalam kelompok fluid responsive dan fluid nonresponsive. Hasil: Dari 40 subyek penelitian, didapatkan 60 sampel fluid challenge. Terdapat 31 sampel di kelompok fluid responsive dan 29 sampel di kelompok fluid nonresponsive. Tidak terdapat perbedaan bermakna rerata LVEDVI pada kedua kelompok (p=0,161). Nilai AUROC LVEDVI 40,9% pada titik potong 68,95 mL/m², dengan sensitivitas 45,16% dan spesifisitas 44,83%. Simpulan: Penelitian ini tidak dapat membuktikan LVEDVI dapat berperan sebagai prediktor fluid responsiveness.

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Background: Shock is a major problem in the Pediatric Emergency and Intensive Care Unit. Fluid resuscitation for shock only provides response in 50% of patients. Excessive fluid administration will increase morbidity and mortality. Dynamic indexes have limitations in predicting fluid responsiveness. Left Ventricular End Diastolic Volume Index (LVEDVI) has not been widely studied and can overcome the limitations of dynamic indexes. Objective: To identify LVEDVI as a predictor of fluid responsiveness in children with shock. Method: This was a cross-sectional diagnostic study in children with shock in the emergency room and pediatric intensive care unit of Cipto Mangunkusumo Hospital RSUPN from June to November 2018. The LVEDVI measurements were performed using USCOM and compared with an increase in stroke volume ≥15% after fluid challenge as fluid responsiveness criteria. Sample then categorized into fluid responsive and fluid nonresponsive group. Results: Of 40 subjects, 60 fluid challenge samples were obtained. There were 31 samples in the fluid responsive group and 29 in the fluid nonresponsive group. There was no significant mean difference of LVEDVI in the two groups (p=0.161). The AUROC of LVEDVI is 40,9% with cut off value of 68,95mL/m². The sensitivity and specificity are 45,16% and 44,83% respectively. Conclusion: This study cannot prove LVEDVI can act as a predictor of fluid responsiveness.

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Latar Belakang: Pasien sindrom Down (Down?s syndrome/DS) berbeda dari anak normal karena memiliki banyak kelainan selain defek jantung yang dapat memengaruhi luaran pasca-operasi jantung. Sampai saat ini belum ada penelitian mengenai luaran pasca-operasi penyakit jantung bawaan (PJB) pada DS di pusat-pusat pelayanan jantung di Indonesia. Tujuan: Untuk mengetahui luaran jangka pendek dan mortalitas pada pasien DS yang dilakukan operasi jantung di RSUPN Cipto Mangunkusumo, Jakarta. Metode: Studi kohort retrospektif dan prospektif pada subjek anak dengan DS yang menjalani operasi koreksi PJB. Kontrol adalah anak tanpa DS yang masuk kriteria inklusi dan eksklusi, dengan matching rentang usia dan jenis penyakit jantung yang sama dengan pasien DS. Hasil: Sebanyak 57 pasien DS dan 43 non-DS yang telah menjalani operasi koreksi PJB diikutkan dalam penelitian. Karakteristik dasar antar kelompok tidak berbeda bermakna. Jenis PJB terbanyak pada DS adalah defek septum atrioventrikular (AVSD) dan defek septum ventrikel (VSD) masing-masing sebesar 31,6%, tetralogi Fallot (TF) 21%, defek septum atrium (ASD) 7%, duktus arteriosus persisten (PDA) 7% dan transposisi arteri besar (TGA)-VSD 1,8%. Lama rawat ruang rawat intensif (ICU) pada DS 1,9 (0,6-34) hari dibanding non-DS 1 (0,3-43), p=0,373. Lama penggunaan ventilator pada DS 19,9 (3-540) jam, non-DS 18 (3-600), p=0,308. Krisis hipertensi pulmoner (PH) tidak terjadi pada kedua kelompok, proporsi komplikasi paru pada DS 24,6% dibanding non-DS 14%, dan sepsis pada DS 28,1% dibanding non-DS 14% tidak berbeda bermakna. Proporsi blok atrioventrikular (AV) komplit pada DS 10,5% dan non-DS tidak ada, dengan p=0,036. Kematian di rumah sakit (RS) pada DS 8,8%, non-DS tidak ada, dengan p=0,068. Simpulan: Morbiditas dan mortalitas pasca-operasi jantung pada DS tidak terbukti lebih sering terjadi dibandingkan dengan non-DS. ......Background: Down syndrome patients different from normal child because many other genetic related aspects that can affect outcome after congenital heart surgery. Until now there has been no research on the outcome after congenital heart surgery on paediatric Down syndrome patients in Indonesia. Objective: To determine the short term outcomes and mortality in DS patients who underwent heart surgery at Cipto Mangunkusumo hospital, Jakarta. Methods: A prospective and retrospective cohort study was conducted to subject with DS who underwent heart surgery from July 2007- April 2015. Control group was patients without DS who underwent heart surgery with matching on age and type of heart defects. Results: A total of 57 DS patients and 43 non-DS patients were recruited during study period. Basic characteristics between groups were not significantly different. Most type of CHD in patients with DS were AVSD and VSD respectively in 18 (31,6%), tetralogi of Fallot 12 (21%), ASD 4 (7%), PDA 4 (7%) and TGA-VSD 1 (1,8%) patients. Duration of ICU stay in patients with DS was 1,9 (0,6-34) days compared to non-DS patients 1 (0,3-43) days, p=0,373. Duration of mechanical ventilation in patients with DS was 19,9 (3-540) hours, compared to non-DS patients 18 (3-600) hours, p=0,308. Pulmonary hypertension crisis was not occurred in both groups. Pulmonary complication in patients with DS was 14 (24,6%) compared to non-DS 6 (14%) patients, and sepsis in patients with DS was 16 (28,1%) compared to non-DS 6 (14%) patients, there was no difference. Complete AV block in patients with DS was 6 (10,5%) compared none in patients with non-DS, p=0,036. In-hospital mortality in patients with DS was 5 (8,8%), compared none in patients with non-DS, significantly different with p=0,068. Conclusion: Morbidity and mortality after cardiac surgery in DS is not proven to be more frequent compared to non-DS.

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ABSTRAK
Latar Belakang. Penggunaan peripherally inserted central catheter PICC semakin meningkat sesuai kebutuhan bayi prematur dalam pemberian nutrisi parenteral. Penggunaan radiografi standar Rontgen torako abdomen dalam menilai posisi tip PICC yang tepat merupakan baku emas. Namun demikian, radiografi standar tidak selalu akurat dalam memperkirakan posisi tip PICC, tergantung pada posisi ekstremitas dan variasi anatomi masing-masing neonatus, menyebabkan radiasi, membutuhkan biaya yang lebih tinggi, waktu yang lebih lama dan membutuhkan pemeriksaan ulangan apabila posisi tip PICC terlalu dalam masuk ke jantung. Ultrasonografi USG semakin banyak digunakan untuk diagnostik dan prosedur di neonatal intensive care unit NICU karena lebih mudah, aman, murah dan real-time.Tujuan. Penelitian ini bertujuan untuk menilai akurasi penggunaan USG dalam menentukan ketepatan posisi tip PICC dibandingkan dengan radiografi standar. Metode. Penelitian ini merupakan studi diagnostik yang dilakukan pada bulan April-Mei 2017 di NICU. Pemasangan PICC menggunakan prosedur standar di NICU dan kemudian posisi tip PICC dievaluasi menggunakan USG sebelum dilakukan radiografi standar. Analisis menggunakan table 2x2 untuk menilai akurasi diagnostik USG dibandingkan radiografi standar dalam menilai posisi tip PICC.Hasil. Sebanyak 29 neonatus termasuk dalam penelitian ini dengan rerata usia gestasi 31,7 minggu 26 sampai 41 minggu dan rerata berat lahir 1618,9 g 600 sampai 3750 g . Kesesuaian antara radiografi standar dan ultrasonografi untuk posisi tip PICC terjadi pada 27 neonatus 93,1 . Sensitivitas ultrasonografi dalam menentukan tip PICC adalah 88,89 , dengan spesifisitas 95 dan ultrasonografi memiliki akurasi diagnostik 93,1 .Simpulan. USG memiliki akurasi diagnostik yang baik untuk mengindentifikasi posisi tip PICC, meminimalkan paparan radiasi dan meminimalkan manipulasi PICC di NICU.Kata kunci: USG, Radiografi, PICC, Neonatus, NICU

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ABSTRACT
Background. The use of peripherally inserted central catheter PICC has became increasingly common to facilitate the administration of parenteral nutrition in preterm neonates. The use of standard radiograph X ray of the abdominal thorax in assessing the correct position of peripherally inserted central catheter PICC line tips is a gold standard. However, standard radiograph can not always be accurate depending on the position of the extremities and variations of anatomy of each neonates, cause radiation, require higher cost, longer time and repeat when position is not appropriate. Ultrasound are becoming increasingly use for diagnostic and procedure in neonatal intensive care unit NICU because more easy, safer, cheaper, and real time.Objectives. This study aims to assess the accuracy of ultrasound use in determining the accuracy of PICC tip positions compared to standard radiograph.Methods. This was a diagnostic study to examine the placement of PICC in neonates between April and May 2017 in NICU. PICC were placed using standard procedure in NICU and then position of PICC tip were evaluated using ultrasound immediately before standard radiograph is performed. A 2x2 table was constructed to compare the two modalities ability to detect tip PICC position.Results. A total of 29 neonates were included in this study with mean of gestation of 31.7 weeks 26 to 41 weeks and mean of birth weight 1618.9 g 600 to 3750 g . Concordance between standard radiograph and ultrasound for PICC tip position occurred in 27 neonates 93.1 . Sensitivity of ultrasound in determining PICC tip was 88.89 , with a specificity of 95 and ultrasound had a diagnostic accuracy 93.1 .Conclusion. Ultrasound has a good diagnostic accuracy to indentify tip position of PICC, minimizing exposure of radiation and minimize manipulation of PICC in NICU. Keywords Ultrasound, Radiograph, PICC, Neonates, NICU