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"Latar Belakang: Neonatus kurang bulan berisiko mengalami hiperbilirubinemia 12,5 kali lipat lebih besar dibandingkan neonatus cukup bulan, 54% membutuhkan fototerapi. Hiperbilirubinemia dapat menyebabkan neurotoksisitas hingga kematian, sedangkan fototerapi dapat menyebabkan beberapa komplikasi. Terapi ajuvan seperti asam ursodeoksikolat diperlukan untuk meningkatkan klirens bilirubin sehingga mengurangi durasi fototerapi. Saat ini belum ada data yang tersedia mengenai pengaruh penambahan asam ursodeoksikolat terhadap durasi fototerapi pada neonatus kurang bulan dengan hiperbilirubinemia.Tujuan: Penelitian ini bertujuan untuk menentukan durasi fototerapi dan penurunan kadar bilirubin pada neonatus kurang bulan yang mendapat fototerapi dan tambahan asam ursodeoksikolat.Metode: Penelitian ini merupakan uji klinis, terandomisasi, tersamar ganda, dengan kontrol plasebo, mencakup neonatus usia gestasi <37 minggu, mengalami hiperbilirubinemia yang terindikasi fototerapi, dirawat di unit perinatologi Rumah Sakit Dr. Cipto Mangunkusumo sejak bulan Februari-Mei 2024, sudah mendapat minum per oral sebanyak ≥10 mL/kgBB/hari. Grafik American Academy of Pediatrics (AAP) tahun 2022 dan The Royal Women’s Hospital (RWH) tahun 2020 digunakan untuk menentukan batas fototerapi. Total 40 subjek yang dibagi menjadi 2 kelompok. Kelompok intervensi (n=20) mendapat asam ursodeoksikolat 10 mg/kgBB/hari (puyer) dibagi 2 dosis sebagai terapi tambahan fototerapi, sedangkan kelompok kontrol (n=20) hanya mendapat fototerapi. Kadar bilirubin total diukur setiap 24 jam dengan serum dan/atau Bilistick. Hasil: Rerata durasi fototerapi adalah 24 jam pada kelompok intervensi, 36 jam pada kelompok kontrol (p=0,289). Di kelompok intervensi, penurunan kadar bilirubin setelah 24 jam fototerapi 4,15 ± 5,50 mg/dL (p=0,758), setelah 48 jam fototerapi 4,99 ± 7,66 mg/dL (p=0,664). Kadar bilirubin setelah 48 jam fototerapi lebih rendah bermakna pada neonatus yang mendapat asam ursodeoksikolat (p=0,020).Kesimpulan: Penambahan asam ursodeoksikolat tidak mengurangi durasi fototerapi maupun mempercepat penurunan kadar bilirubin pada neonatus kurang bulan dengan hiperbilirubinemia yang mendapat fototerapi setelah 24 jam dan 48 jam. Penelitian lanjutan perlu dilakukan sampai jumlah sampel terpenuhi.

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Background: Preterm neonates have a 12.5 times higher risk of developing hyperbilirubinemia compared to full-term neonates, with 54% requiring phototherapy. Hyperbilirubinemia can lead to neurotoxicity and even death, while phototherapy can cause several complications. Adjuvant therapy, such as ursodeoxycholic acid, is needed to increase bilirubin clearance and reduce the duration of phototherapy. Currently, there is no available data on the effect of adding ursodeoxycholic acid on the duration of phototherapy in preterm neonates with hyperbilirubinemia.

Objective: This study aims to determine the duration of phototherapy and the reduction of bilirubin levels in preterm neonates who receive phototherapy and additional ursodeoxycholic acid.

Method: This study is a randomized, double-blind, placebo-controlled clinical trial, involving neonates with a gestational age of less than 37 weeks who have hyperbilirubinemia requiring phototherapy, treated in the perinatology unit of Dr. Cipto Mangunkusumo Hospital from February to May 2024, and who have been fed orally at least 10 mL/kgBW/day. The 2022 American Academy of Pediatrics (AAP) and 2020 The Royal Women’s Hospital (RWH) charts were used to determine the phototherapy threshold. A total of 40 subjects were divided into 2 groups. The intervention group (n=20) received 10 mg/kgBW/day of ursodeoxycholic acid (powder) divided into 2 doses as an additional phototherapy treatment, while the control group (n=20) received only phototherapy. Total bilirubin levels were measured every 24 hours using serum and/or Bilistick.

Results: The average duration of phototherapy was 24 hours in the intervention group and 36 hours in the control group (p=0.289). In the intervention group, the reduction in bilirubin levels after 24 hours of phototherapy was 4.15 ± 5.50 mg/dL (p=0.758), and after 48 hours of phototherapy was 4.99 ± 7.66 mg/dL (p=0.664). Bilirubin levels were significantly lower after 48 hours of phototherapy in neonates who received ursodeoxycholic acid (p=0.020).

Conclusion: The addition of ursodeoxycholic acid did not reduce the duration of phototherapy nor accelerate the decrease of bilirubin levels in preterm neonates with hyperbilirubinemia who received phototherapy after 24 and 48 hours. Further research needs to be conducted until the sample size is sufficient."

"Latar belakang: Pengembangan pengetahuan dan keterampilan petugas kesehatan di Puskesmas masih belum rutin dilakukan, sehingga umumnya belum mampu melakukan tatalaksana awal pada bayi bermasalah.Tujuan: Mengetahui pengetahuan dan keterampilan petugas kesehatan di Puskesmas wilayah Tangerang mengenai resusitasi, stabilisasi, dan transportasi neonatal, menganalisis faktor-faktor yang memengaruhinya, serta mengetahui profil SNAPPE II neonatal yang dirujuk dari Puskesmas tersebut.Metode: Metode yang digunakan adalah mixed method yaitu penelitian kuantitatif desain kuasi-eksperimental (pretest-posttest) yang menilai pengetahuan dan keterampilan petugas kesehatan, serta SNAPPE II neonatal yang dirujuk sebelum dan sesudah intervensi, disertai pendalaman kualitatif melalui wawancara sistem kesehatan meso dan makro, serta focus group discussion sistem kesehatan mikro.Hasil: Penelitian dilakukan di 12 puskesmas wilayah Tangerang, dengan subjek 36 petugas kesehatan, dan wawancara mendalam kepada 17 sistem kesehatan meso dan makro. Pengetahuan dan keterampilan petugas kesehatan mengalami peningkatan bermakna sebelum dan sesudah pelatihan (p<0,001 dan p=0,002), namun nilai rerata stabilisasi dibawah batas lulus. Dalam pemantauan selama 3 bulan pasca pelatihan, retensi keterampilan penanganan kegawatan neonatal cukup baik dan didapatkan perbedaan bermakna sebelum dan sesudah intervensi (p<0,001). Pada VTP terdapat perbedaan bermakna dengan penurunan di bulan kedua (90,4 dan meningkat kembali di bulan ketiga (93.5 sedangkan nilai rerata pemberian CPAP dan stabilisasi selalu dibawah batas lulus. Nilai SNAPPE II pada neonatal yang dirujuk ke rumah sakit menunjukkan perbaikan prognosis yang bermakna secara statistik (p=0,013). Analisis kualitatif menemukan 3 akar masalah utama yaitu keterbatasan sumber daya manusia, kualifikasi SDM yang belum mengikuti pelatihan maupun resertifikasi, dan monitoring evaluasi berkelanjutan, dengan 3 alternatif solusi berupa pelatihan dan update klinis berbasis teknologi (daring), pendampingan Dokter Spesialis Anak (Konsultan Neonatologi), serta supervisi Dinas terkait bekerjasama dengan organisasi profesi.Simpulan: Terdapat perbedaan bermakna pengetahuan dan keterampilan petugas kesehatan di Puskesmas wilayah Tangerang mengenai resusitasi, stabilisasi, dan transportasi neonatal sebelum (pretest) dan sesudah (posttest) intervensi. Terdapat tiga faktor utama yang memengaruhi pengetahuan dan keterampilan petugas kesehatan antara lain jumlah SDM, kualifikasi SDM dan monitoring evaluasi yang berkesinambungan. Terdapat peningkatan profil SNAPPE II pada neonatal yang dirujuk ke rumah sakit oleh Puskesmas yang dilatih sesudah intervensi dibandingkan sebelumnya.Kata kunci: Pengetahuan dan keterampilan petugas kesehatan, pelatihan, pendampingan tata kelola klinis, kegawatdaruratan neonatal.

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Background: The development of knowledge and skills of health workers at public health centers is not yet routinely carried out, so generally they are not able to carry out initial management of neonatal emergencies.

Objective: To determine the knowledge and skills of health workers at Tangerang district public health centers regarding neonatal resuscitation, stabilization and transportation, to analyze the influencing factors, and to determine the profile of SNAPPE II neonates referred from the public health centers.

Methods: A mixed method, quantitative research with a quasi-experimental design (pretest-posttest) that assesses the knowledge and skills of health workers, SNAPPE II for referred neonates before and after intervention, accompanied by qualitative deepening through interviews of meso and macro health systems, and focus group discussion on micro health systems.

Result: The study was conducted in 12 public health centers in Tangerang area, with 36 health workers as subjects, and in-depth interviews with 17 meso and macro health systems. Knowledge and skills of health workers experienced a significant increase before and after training (p<0.001 and p=0.002), but the mean value of stabilization was below the pass threshold. In monitoring for 3 months after training, the retention of neonatal emergency handling skills was quite good and there were significant differences before and after intervention (p<0.001). In VTP there is a significant difference with a decrease in the second month (90.4 ± 9.0) and increase again in the third month (93.5 ± 7.8), while the mean value of CPAP and stabilization is always below the pass limit. The SNAPPE II value for neonatal admissions to hospital showed a statistically significant improvement in prognosis (p=0.013). Qualitative analysis found 3 main root problems, namely limited human resources, qualifications of human resources who have not attended training or recertification, and continuous evaluation monitoring, with 3 alternative solutions in the form of training and technology-based clinical updates (online), assistance of Pediatricians (Neonatology Consultants), and the supervision of related agencies in collaboration with professional organizations.

Conclusion: There were significant differences in the knowledge and skills of health workers at the Tangerang district public health centers regarding resuscitation, stabilization, and neonatal transportation before (pretest) and after (posttest) intervention. There are three main factors that affect the knowledge and skills of health workers, including the number of human resources, qualifications of human resources and continuous monitoring and evaluation. There is an increase in the SNAPPE II profile among neonates referred to hospital by public health centers trained after intervention compared to before."