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"Latar belakang: Enterokolitis nekrotikans merupakan salah satu komplikasi pada bayi prematur dengan angka mortalitas tinggi. Patogenesis terjadinya enterokolitis nekrotikans hingga kini belum dipahami namun bersifat multifaktorial. Berbagai penelitian mengaitkan enterokolitis nekrotikans dengan transfusi sel darah merah. Salah satu upaya untuk mencegahnya adalah dengan melakukan puasa saat transfusi, namun hingga kini masih bersifat kontroversial. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan puasa saat menjalani transfusi sel darah merah dengan kejadian enterokolitis nekrotikans pada bayi prematur. Metode: Penelitian menggunakan desain studi kohort retrospektif dilakukan di Rumah Sakit Cipto Mangunkusumo menggunakan data rekam medis. Bayi prematur yang dirawat di Unit Perinatologi RSCM dalam periode Januari 2019 hingga Desember 2023 dan menjalani transfusi sel darah merah, serta memenuhi kriteria inklusi dan eksklusi diikutsertakan dalam penelitian. Subyek kemudian dikelompokkan berdasarkan puasa atau tidak puasa saat menjalani transfusi sel darah merah. Diagnosis enterokolitis nekrotikan ditegakkan melalui hasil foto polos abdomen. Dilakukan pula pencatatan terhadap status maternal, usia gestasi, data antropometri saat lahir, skor APGAR usia 5 menit, jenis nutrisi enteral saat dilakukan transfusi sel darah merah. Hasil: Sebanyak 240 bayi prematur yang menjalani transfusi sel darah merah diikutsertakan dalam analisis. Seratus empat puluh empat bayi lelaki (60,0%), dengan rerata usia gestasi 31 (SD 2,69) minggu dan median berat lahir 1.256 (RIK 1.005-1.653) gram. Enterokolitis nekrotikans ditemukan pada 23,75% subyek dan EKN awitan dini lebih banyak ditemukan yaitu sebanyak 54,39% subyek. Proporsi bayi yang dipuasakan mengalami EKN lebih rendah dibandingkan yang tidak dipuasakan (22,09% dan 27,94%). Tidak ditemukan hubungan bermakna secara statistik antara kejadian EKN pada kelompok puasa dibandingkan kelompok tidak puasa saat menjalani transfusi sel darah merah (RR 1,081 (IK 95% 0,913-1,279). Kesimpulan: Puasa saat transfusi sel darah merah tidak memiliki hubungan bermakna secara statistik menurunkan kejadian enterokolitis nekrotikans.......Background: Complications due to prematurity are major problems for premature infants. Necrotizing enterocolitis has been one of the most considered complication with high mortality rate. Pathogenesis of necrotizing enterocolitis yet to be fully understood, however multiple factors were proven to be associated. Transfusion associated necrotizing enterocolitis has been studied in many researches. Withholding feeds during red blood cell transfusion were postulated to decrease the rate of necrotizing enterocolitis in premature infants, however controversy still found among the research published. Objective: This study aimed to evaluate the association between withholding feeds during red blood cell transfusion and incidence of necrotizing enterocolitis in premature infants. Method: We conducted a retrospective cohort study in Cipto Mangunkusumo Hospital. Premature infants admitted from January 2019 to December 2023 who received red blood cell transfusion were selected according to inclusion and exclusion criteria. Subjects were divided into two group by looking at withholding feeds status during transfusion or fed during transfusion. Necrotizing enterocolitis was diagnosed by radiologist using abdominal radiograph. Maternal status, gestational age, birth anthropometric measurement, 5-minutes APGAR score, and type of enteral nutrition (breast milk or formula) while receiving red blood cell transfusion were recorded. Results: Two hundred and forty subjects included in this study. Among all subjects, male infants 144 (60%), mean gestational age was 31 (SD 2,26) weeks, and median birthweight was 1.256 (IQR 1,005-1.653) grams. Necrotizing enterocolitis were slightly lower in withholding feeds during transfusion group compared to fed group (22,09% and 27,94%, respectively). No association was found between withholding feeds during red blood cell transfusion compared to fed during transfusion with incidence of necrotizing enterocolitis (RR 1,081 (95% CI 0,913-1,279). Conclusion: Withholding feeds during red blood cell transfusion did not significantly decrease the incident of necrotizing enterocolitis in this study."

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Syok pada anak masih menjadi masalah utama karena mortalitas yang tinggi. Penilaian respons terhadap resusitasi cairan dapat menggunakan parameter klinis dan parameter hemodinamik invasif maupun non-invasif. Modalitas ultrasound cardiac output monitor (USCOM) pada populasi anak dengan syok memiliki korelasi yang baik dengan baku emas parameter hemodinamik invasif, tetapi memiliki beberapa keterbatasan. Modalitas lain yang semakin berkembang yaitu menggunakan point of care ultrasound (POCUS), dengan salah satu penilaian yang dapat dilakukan adalah pemeriksaan indeks kolapsibilitas vena jugularis interna (IKVJI). Tujuan penelitian ini adalah mengetahui hubungan antara stroke volume dengan IKVJI dalam menilai respons resusitasi cairan pada anak syok. Penelitian ini menggunakan desain observasional analitik, dilakukan di RSUPN Cipto Mangunkusumo pada bulan Maret hingga Juni 2024. Subyek penelitian adalah anak usia 1 bulan hingga 18 tahun yang mengalami syok yang memenuhi kriteria inklusi. Parameter klinis, penilaian stroke volume dengan USCOM dan IKVJI dinilai sebelum dan sesudah resusitasi cairan. Berdasarkan analisis studi didapatkan 47 subyek sampel penelitian, 27 orang perempuan (57,4%), dengan median usia 82,9 (4,0–212,0) bulan. Status gizi, terbanyak adalah gizi baik (42,6%). Diagnosis terbanyak adalah syok hipovolemik (74,5%) diikuti syok sepsis (25,5%). Sebanyak 2 pasien meninggal dalam 24 jam pertama.  Pemantuan post-resusitasi cairan menunjukkan perbaikan laju nadi, tekanan darah, dan mean arterial pressure (p<0,0001), peningkatan nilai stroke volume (p<0,0001), dan perubahan nilai IKVJI (p<0,0001). Korelasi delta stroke volume dan delta IKVJI adalah negatif lemah (r=-0,309, p=0,035). Korelasi MAP dan IKVJI juga negatif lemah  (r=-0,359, p=0,013).

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Shock in children is still a major problem due to high mortality. Assessment of the response to fluid resuscitation can be done using clinical and hemodynamic parameters through invasive and non-invasive tools. The ultrasound cardiac output monitor (USCOM) among children with shock has a good correlation with the gold standard of invasive hemodynamic parameters but has some limitations. Another commonly used modality is point-of-care ultrasound (POCUS), with one of the assessments being the examination of the internal jugular vein collapsibility index (IJV-CI). The aim of this study is to determine the correlation between stroke volume and IJV-CI changes in order to assess fluid responsiveness in children with shock. Between March and June 2024, an analytical observational study was undertaken in the emergency department and pediatric intensive care unit of a tertiary referral hospital. The study subjects were children aged 1 month to 18 years who experienced shock and met the inclusion criteria. A thorough history taking, physical examination, and stroke volume assessment using the Ultrasonic Cardiac Output Monitor, and IJV-CI utilizing ultrasound before and after fluid resuscitation were conducted. This study included 47 subjects, of which there were 27 females (57.4%), with a median age of 82.9 (4.0–212.0) months. For nutritional status, most were normal (42.6%). The most common diagnosis was hypovolemic shock (74.5%) followed by septic shock (25.5%). Mortality in the first 24 hours was 2 patients. After fluid resuscitation, there was an improvement in pulse rate, blood pressure, and mean arterial pressure (p<0.0001), as well as increased stroke volume post fluid resuscitation (p<0.0001) and changes in IJV-CI post fluid resuscitation (p<0.0001). The correlation between stroke volume delta and IJV-CI delta was negative and weak (r=-0.309, p=0.035). The correlation between IJV-CI and MAP was also negative and weak (r=-0.359, p=0.013).

 

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