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"Latar belakang: Necrotizing enterocolitis / enterokolitis nekrotikan (NEC/EKN) adalah masalah serius yang sering terjadi pada neonatus, dengan tingkat insiden dan mortalitas yang tinggi, terutama pada bayi berat lahir yang rendah. Beberapa faktor telah diidentifikasi sebagai berpotensi meningkatkan risiko dan derajat keparahan EKN. Meskipun penelitian sebelumnya telah dilakukan di berbagai negara, belum ada penelitian serupa EKN dilakukan di Indonesia untuk memahami faktor-faktor yang berhubungan dengan EKN.Metode: Penelitian ini memiliki desain penelitian kohort retrospektif dan dilakukan di Unit Penelitian Kesehatan Neonatologi FKUI-RSCM dengan pengambilan sampel pada periode tahun 2016-2021 dan penulisan hasil penelitian pada Mei 2022-Desember 2023. Populasi target melibatkan neonatus dengan EKN, dengan populasi terjangkau merupakan pasien neonatus dengan derajat EKN I dan II yang diambil pada periode penelitian. Pasien dengan kelainan kongenital saluran cerna atau menjalani operasi lainnya selain tata laksana EKN dieksklusi dari penelitian. Variabel yang dinilai dalam penelitian ini adalah usia kehamilan, jenis kelamin, jenis kelahiran, skor APGAR, berat lahir rendah, sindrom gawat napas, sepsis, kadar C- reactive protein (CRP), pemberian antibiotik, jenis antibiotik, dan penggunaan ventilator.Hasil: Hasil penelitian menunjukkan bahwa tidak ada hubungan yang signifikan antara faktor-faktor seperti usia kehamilan, jenis kelahiran, skor APGAR, berat lahir rendah, sindrom gawat napas, sepsis, kadar CRP, pemberian antibiotik, jenis antibiotik, penggunaan ventilator, dan jenis kelamin dengan insiden peningkatan derajat keparahan EKN (p > 0,05) maupun waktu peningkatan derajat keparahan EKN (p > 0,05).Kesimpulan: Berdasarkan penelitian ini, dapat disimpulkan bahwa dalam populasi pasien neonatus dengan EKN derajat I dan II di RSCM, faktor-faktor internal dan eksternal yang diteliti tidak berhubungan secara signifikan dengan insiden maupun waktu peningkatan derajat keparahan EKN.

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Background: Necrotizing enterocolitis (NEC) is a serious problem that often occurs in neonates, with a high incidence and mortality rate, especially in neonates with very low birth weight. Several factors have been identified as potentially increasing the risk and severity of NEC. Although previous research has been conducted in various countries, there has been no similar study conducted in Indonesia to understand the factors associated with NEC.

Methods: This study has a retrospective cohort study design and was conducted in the Neonatology Research Center Unit, RSCM-FKUI with subject recruitment during the period of 2016 to 2021 and research report written during the period of May 2022 to December 2023. The target population included neonates with NEC, with the accessible population consisting of neonates with NEC I and II. Patients with congenital gastrointestinal tract disorders or those undergoing surgeries other than NEC management were excluded from the study. Variables assessed in this study included gestational age, sex, type of birth, APGAR score, very low birth weight, respiratory distress syndrome, sepsis, C-reactive protein (CRP) levels, antibiotic use, type of antibiotics, and ventilator use.

Results: The study results showed no significant relationship between factors such as gestational age, type of birth, APGAR score, very low birth weight, respiratory distress syndrome, sepsis, CRP levels, antibiotic use, type of antibiotics, ventilator use, and gender with the incidence of an increase in the severity of NEC (p > 0.05) or the time of the increase in the severity of NEC (p > 0.05).

Conclusion: Based on this study, it can be concluded that in the population of neonatal patients with NEC I and II at RSCM, the examined internal and external factors are not significantly associated with the incidence or time of the increase in the severity of NEC."

"Latar belakang: Pullthrough pada zona transisi (ZT) adalah penyebab utama obstruksi pascatindakan definitif pada Morbus Hirschsprung (MH). Penelitian ini dilakukan untuk menggambarkan karakteristik histologi dan panjang ZT pada MH. Dibuat hipotesis bahwa gambaran histologi dan panjang ZT sangat bervariasi dan berhubungan dengan klasifikasi MH, usia, serta keberadaan stoma. Metode penelitian: Dilakukan kajian ulang terhadap sediaan histopatologi dengan pewarnaan hematoksilin eosin pada pasien MH yang telah dilakukan pullthrough. Sampel terbagi dalam kelompok zona transisi lengkap (ZTL) dan zona transisi tidak lengkap (ZTTL) tergantung batas reseksi. Diameter serabut saraf, jarak antar ganglion dan panjang ZT pada lapisan submukosa dan intermuskular diukur dan dinilai hubungannya dengan klasifikasi MH, usia, serta keberadaan stoma. Hasil penelitian: Panjang ZTL berkisar antara 2-16 cm, sedangkan ZTTL berkisar antara 3-33 cm. Secara keseluruhan, tidak didapatkan perbedaan bermakna antara diameter serabut saraf, jarak antar ganglion dan panjang ZT dengan klasifikasi MH, usia, serta keberadaan stoma. Didapatkan hubungan bermakna antara diameter serabut saraf pada lapisan intermuskular dengan usia (p=0,004) dan stoma (p=0,001) pada kelompok ZTTL, serta antara panjang ZT pada lapisan submukosa dengan stoma (p=0,016) pada kelompok ZTTL. Kesimpulan: Panjang ZT sangat bervariasi, cenderung lebih panjang pada MH long segment, seiring pertambahan usia, dan pada kelompok pasien dengan stoma. Direkomendasikan untuk reseksi minimal 10 cm proksimal dari area mulai ditemukannya ganglion dan dikonfirmasi dengan VC sirkumferensial pada batas sayatan paling proksimal untuk meminimalisir pullthrough pada ZT.

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Background: Transition zone (TZ) pullthrough is a leading cause of obstructive symptoms after pullthrough procedure in Hirschsprung disease (HD). The aim of this study is to describe the histologic characteristics and length of TZ in HD. The hypothesis is TZ histology and length varies according to HD classification, age and the presence of stoma. Method: Review of histopathology slides with hematoxylin eosin stain of HD patients who had undergone pullthrough was performed. Sample was sorted into two groups, complete transition zone (CTZ) and incomplete transition zone (ITZ), depending on the margins of resection. Nerve diameter, interganglionic interval, and TZ length in submucosal and intermuscular layer were measured, and their relationship with HD classification, age and presence of stoma, analyzed. Result: The length of CTZ ranges between 2-16 cm, and ITZ ranges between 3-33 cm. Overall, there were no significant relations between nerve diameter, interganglionic interval, and TZ length with HD classification, age and presence of stoma. There were significant nerve diameter difference in the intermuscular layer of ITZ group, in relations with age (p=0,004) and presence of stoma (p=0,001). There was a significant TZ length difference in the submucosal layer of ITZ group in relations with presence of stoma (p=0,016). Conclusion: The length of TZ varies greatly, tends to be longer in long segment HD, increasing with age, and in patients with stoma. It is recommended to resect minimal 10 cm proximal from the most distal ganglionic area, and confirmed with circumferential frozen section study of the most proximal resection margin to minimize risk of TZ pullthrough."

"Latar Belakang: Penyakit Hirschsprung (PH) dihadapkan pada penyulit berupa malnutrisi dan enterokolitis. Meskipun terapi bedah efektif pada PH, 32% pasien memiliki morbiditas pascaoperasi. Panjang segmen usus aganglionik memiliki pengaruh terbesar, pasien dengan aganglionik kolon total memiliki 63% komplikasi pascaoperasi, sedangkan pasien dengan aganglionik rektosigmoid memiliki 17% komplikasi pascaoperasi. Belum pernah ada penelitian yang membuktikan faktor-faktor yang memengaruhi morbiditas penderita PH pascaoperasi definitif yang terjadi di RSCM. Metode: Dilakukan studi kohort retrospektif menilai penyulit berupa ekskoriasi perianal, kebocoran anastomosis dan striktur anastomosis pada 62 kasus PH di Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia yang didiagnosis pada tahun 2015-2019. Data dianalisis dengan uji bivariat Chi-squared, uji Fischer atau uji Mann-Whitney. Hasil: Aganglionik usus segmen pendek memiliki jumlah terbesar (75,8%), diikuti oleh aganglionik usus segmen panjang (19,4%), dan aganglionik kolon total (4,8%). Tidak ada pasien dengan aganglionik kolon total dan usus halus. Dari 62 kasus yang sesuai dengan kriteria inklusi, didapatkan 14 kasus mengalami morbiditas pascaoperasi dan 48 kasus tanpa morbiditas. Morbiditas terbanyak adalah ekskoriasi perianal sebanyak 6 kasus (42,8%), diikuti kebocoran anastomosis sebanyak 4 kasus (28,6%) dan striktur anastomosis sebanyak 4 kasus (28,6%). Panjang usus aganglionik tidak mempunyai hubungan yang bermakna dengan morbiditas pasien pascaoperasi PH (p = 0,098). Kesimpulan: Panjang segmen usus aganglionik tidak menunjukkan asosiasi secara bermakna dengan morbiditas pasien dengan penyakit Hirschsprung pascaoperasi definitif.

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Background: Hirschsprung's disease (HD) was faced with malnutrition and enterocolitis. Although surgical therapy is effective at HD, 32% of patients have postoperative morbidity. The length of the aganglionic bowel segment had the greatest influence, patients with total colonic aganglionic had 63% postoperative complications, whereas patients with rectosigmoid aganglionic had 17% postoperative complications. There has never been a study that proves the factors that influence the morbidity of postoperative HD patients who occur in RSCM.

Method: Conducted a retrospective cohort study assessing complicaion of the occurrence of perianal excoriation, anastomotic leak, and anastomotic stricture in 62 cases of PH at Cipto Mangunkusumo Hospital, Jakarta, Indonesia who were diagnosed in 2015-2019. Data were analized by using Chi-squared test, Fisher test or Mann-Whitney test.

Result: Short segment intestinal aganglionic had the largest number (75.8%), followed by long segment intestinal aganglionic (19.4%), and total colonic aganglionic (4.8%). There were no patients with total colon and small intestine aganglionic. Of the 62 cases that met the inclusion criteria, 14 cases experienced postoperative morbidity and 48 cases without morbidity. The most morbidity was perianal excoriation (6 cases, 42.8%), anastomotic leak (4 cases, 28.6%) and anastomotic stricture in 4 cases (28.6%). Aganglionic bowel length did not have a significant association with postoperative PH morbidity ( p = 0.037).

Conclusion: Aganglionic bowel segment length is not significantly associated with morbidity, which is perianal excoriation, anastomotic leakage, and anastomotic stricture following definitive operative surgery for Hirschsprung disease."

"Latar Belakang: Dalam penanganan hernia ventralis, penggunaan mesh menjadi standar untuk menutup defek dinding abdomen anterior. Mesh komposit yang sesuai untuk penutupan defek dinding abdomen anterior saat ini harganya mahal dan sulit didapatkan di daerah-daerah terpencil di Indonesia. Penelitian ini mengembangkan mesh komposit triple layer dari amniotic membrane coated polypropylene mesh with adhesion barrier sebagai alternatif penutup defek dinding abdomen anterior pada hernia ventralis.Metode: Penelitian eksperimental ini dilakukan terhadap tikus Sprague-Dawley pasca dilakukan pembentukan hernia ventralis mekanik buatan, lalu dibagi menjadi empat kelompok yang masing-masing mendapatkan sham surgery¸mesh polypropylene, mesh komposit amniotic membrane coated polypropilene mesh (AMPM), dan mesh komposit Amniotic membrane coated polypropylene mesh with adhesion barrier (mesh komposit triple layer). Pada hari ke-7 dan hari ke-30 pasca perlakuan, dilakukan penilaian rekurensi defek dinding abdomen anterior baru; gambaran histologis derajat jumlah sel polimorfonuklear (PMN), foreign body giant cells (FBGC), fibroblas dan neovaskularisasi, dan adhesi mesh dengan jaringan sekitar pada masing-masing kelompok.Hasil: Terdapat 20 tikus Sprague-Dawley dengan usia 4-5 minggu yang diikutsertakan dalam studi. Seluruh tikus tidak mengalami rekurensi defek dinding abdomen anterior baru pada hari ke-7 maupun 30 pasca perlakuan. Tidak ditemukan perbedaan derajat histologis jumlah sel PMN, FBGC, dan fibroblast antar kelompok perlakuan, namun terdapat perbedaan signifikan antara kelompok mesh polypropylene dengan mesh AMPM dan dengan mesh komposit triple layer untuk derajat histologis neovaskularisasi (p=0.025) dan adhesi (p=0.025 dan p=0.034 secara berurutan). Perbandingan gambaran histologis setiap kelompok perlakuan pada hari ke-7 dan 30 tidak menunjukkan adanya perbedaan yang signifikan. Kesimpulan: Mesh komposit triple layer dapat digunakan sebagai alternatif penutup defek dinding abdomen anterior.Tidak ada perbedaan dalam rekurensi pada dinding abdomen di semua kelompok perlakuan. Kelompok mesh komposit triple layer dan AMPM menunjukkan derajat neovaskularisasi yang signifikan lebih tinggi serta derajat adhesiyang siginifikan lebih rendah dibandingkan kelompok polypropylene mesh.

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ntroduction: In the management of ventral hernia, the use of mesh for anterior abdominal wall defect closure has become a standard. Currently, a suitable composite mesh for anterior abdominal wall defect closure is expensive and not always available in every hospital. This study aimed to develop triple-layer composite mesh made from amniotic membrane coated polypropylene mesh with adhesion barrier as an alternative for anterior abdominal wall defect closure.

Method: This experimental study was conducted using Sprague-Dawley mice, inflicted with mechanical ventral hernia, and then divided into four groups given different treatments after: sham surgery, mesh polypropylene, amniotic membrane coated polypropylene mesh (AMPM) composite, and amniotic membrane coated polypropylene mesh with adhesion barrier (triple-layer composite mesh). After 7 and 30 days of procedure, we estimated the recurrence of new anterior abdominal wall defect, histological profile of polymorphonuclear (PMN) cells, foreign body giant cells (FBGC), fibroblast cells, neovascularization, and adhesion of mesh with surrounding tissue in each group.

Result: Twenty Sprague-Dawley mice aged 4-5 weeks were included in our study. We recorded no recurrence of anterior abdominal wall defect in all groups, both in 7- and 30-days post-procedure. This study found no significant difference in histological profiles of PMN, FBGC, and fibroblast cells from each group, but we found statistically significant difference in the histological profile of neovascularization (p=0.025) and adhesion rate (p-0.025 and p=0.034 respectively) of polypropylene mesh group with AMPM mesh group and triple-layer composite group. Histological profile comparison of each group in 7- and 30-days post-procedure showed no significant difference.

Conclusion: Triple layer composite mesh can be used as an alternative to cover anterior abdominal wall defects. There was no difference in abdominal wall recurrence in all treatment groups. Triple-layer composite mesh group and AMPM mesh group significantly showed higher rate of neovascularization and lower rate of adhesion compared to polypropylene mesh group."

"Pendahuluan: Saat penutupan primer tidak dapat dilakukan, defek diafragma hernia diafragma kongenital (HDK) memerlukan penutup prosthesis. Mesh organik-absorbable memungkinkan tumbuhnya jaringan host seiring proses degradasi mesh. Bahan sintetik non-absorbable tidak terdegradasi namun cenderung menyusut sehingga seiring perkembangan anak dapat terjadi rekurensi dan deformitas muskuloskeletal. Peneliti menyusun mesh komposit tiga lapis dari polypropylene-human amniotic membrane (HAM)-oxygenated regenerated cellulose (ORC) sebagai anti-adhesi. Efektifitas mesh ini sebagai alternatif penutup defek diafragma dan bagaimana reaksi histologis host terhadap mesh ini akan dinilai.Metode: dibuat defek hemi-diafragma kiri pada 20 tikus Sprague Dawley (SD) yang dibagi menjadi tiga kelompok perlakuan (KP). Defek diafragma KP-1 ditutup dengan polypropylene mesh, KP-2 dengan tiga lapis HAM, dan KP-3 dengan polypropylene-HAM-ORC. Pada hari ke-7 dan 30, dinilai ada-tidaknya rekurensi, asimetri hemithorax, dilanjutkan pemeriksaan histologis derajat jumlah polymorphonuclear cells (PMN), fibroblas, foreign body giant cells (FBGC), angiogenesis, muskularisasi, dan adhesi. Hasil: Tidak terjadi rekurensi defek diafragma dan asimetri hemithorax pada ketiga KP. Gambaran histologis ketiga KP tidak berbeda bermakna kecuali dalam hal angiogenesis pada kelompok yang menggunakan HAM. Kelompok yang menggunakan bahan anti-adhesi (KP-3) mengalami derajat adhesi teringan. Kesimpulan: mesh komposit tiga lapis dapat digunakan sebagai alternatif penutup defek diafragma SD. Mesh ini tidak menimbulkan reaksi inflamasi dan reaksi benda asing secara berlebihan.

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Introduction: When primary closure is not possible, autologous flap or mesh repair is indicated for congenital diaphragmatic hernia (CDH) repair. Absorbable-organic meshes allow ingrowth of host tissue as they are degraded, creating natural and durable neodiaphragm. Non-absorbable synthetic patches act as strengthening replacement for diaphragm but have propensity to shrink and there is concern as the infant grows, musculoskeletal deformity and recurrence may occur. We investigated a composite mesh consist of polypropylene-human amniotic membrane (HAM)-oxygenated regenerated cellulose (ORC) as adhesion barrier. The aim of the study was to evaluate the effectiviness and host reaction to the implantated mesh.

Methods: a defect on left hemi-diaphragm of 20 Sprague Dawley were made. The first group received polypropylene mesh, second group triple layer of HAM, and the third group received HAM-polypropylene-ORC. After 7 and 30 days, reccurence, hemithorax asymmetry, and histological features of neodiaphragm were evaluated.

Results: There were no patch disruption and asymmetries of hemithorax occurred in all groups. There were no significant differences in polymorphonuclear cells (PMN), foreign body giant cell (FBGC), fibroblast, and muscularization degree. However angiogenesis were better in groups who used HAM material. Adhesions in mildest degree were found at group who used ORC.

Conclusion: Triple layer composite mesh can be used as an alternative for diaphragmatic defect repair. There was no exaggerated inflammation or foreign body reaction"

"Pendahuluan: Transpor neonatus dari unit neonatologi ke kamar operasi dan sebaliknya memiliki risiko terjadinya KTD (Kejadian tidak diharapkan) yang tinggi. Akan tetapi, belum ada studi terperinci yang mempelajari tentang hal tersebut. Studi ini ditujukan untuk mengetahui faktor-faktor risiko yang berperan dalam terjadinya KTD pada transfer perioperatif neonatus. Metode: Kami melakukan studi kohort retrospektif di RSUPN dr. Cipto Mangunkusumo. Neonatus yang memenuhi kriteria inklusi dan melalui kriteria eksklusi dilibatkan dalam penelitian ini. Faktor-faktor risiko serta profil KTD dihimpun dari neonatus yang terlibat. Analisis dilakukan secara komparatif univariat, bivariat, dan multivariat. Studi ini memiliki izin etik dari RSUPN dr. Cipto Mangunkusumo. Hasil: Tercatat sebanyak 87 KTD pada 56 neonatus yang menjadi subjek di dalam penelitian ini. Diketahui bahwa 51,79% subjek adalah perempuan, dengan 48,21% prematur, 58,93% berat badan lahir rendah, dengan rata-rata berat badan lahir 2.138 gram. Gambaran KTD terbanyak adalah desaturasi, mencakup 71,43%. Terdapat hubungan antara respiratory support invasif dengan hipotermia (OR = 0,052; IK 95% = 0,005 – 0,506). Terdapat hubungan antara respiratory support invasif dengan medical device adverse event (OR = 0,175; IK 95% = 0,043 – 0,707). Respiratory support invasif merupakan faktor yang paling berperan dalam medical device adverse event berdasarkan analisis multivariat (aOR = 0,023; IK 95% = 0,054–0,995). Angka kejadian KTD paling banyak pada kelompok satu kali transfer (64,29%), yaitu sebanyak 36 kasus dengan 13 (23,21%) di antaranya mengalami desaturasi. Terdapat hubungan antara frekuensi transfer pasien operasi unit neonatologi dan desaturasi (p-value = 0,047; Crude OR : 5,727 dan 95% CI : 1,148 - 28,573). Kesimpulan: Prematuritas, BBLR, dan kelainan kongenital tidak berhubungan dengan KTD. Sedangkan, penggunaan respiratory support invasif berhubungan dengan hipotermia dan medical device adverse event pada pasien transfer operasi unit neonatologi. Terdapat hubungan antara frekuensi transfer pasien dan KTD desaturasipada proses transfer neonates.

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Introduction: Transport of neonates from the neonatology unit to the operating room and vice versa carries a high risk of adverse events (KTD). However, there have been no detailed studies studying this. This study aims to determine the risk factors that play a role in the occurrence of adverse events during perioperative transfer of neonates. Methods: We conducted a retrospective cohort study at RSUPN dr. Cipto Mangunkusumo. Neonates who met the inclusion criteria and the exclusion criteria were included in this study. Risk factors and adverse event profiles were collected from the study subjects. Analysis was carried out using univariate, bivariate and multivariate analyses. This study was approved by RSUPN dr. Cipto Mangunkusumo. Results: A total of 87 adverse events were recorded in the 56 neonates who were subjects in this study. Fifty one point seventy nine percent of the subjects were female, 48.21% of the subjects were premature, 58.93% had low birth weight, with an average birth weight of 2,138 grams. The most common adverse event features were desaturation, covering 71.43% of the study subjects. There is a significant association between invasive respiratory support and hypothermia (OR = 0.052; 95% CI = 0.005 – 0.506). There is a significant association between invasive respiratory support and medical device adverse events (OR = 0.175; 95% CI = 0.043 – 0.707). Invasive respiratory support is the factor that plays the most role in medical device adverse events based on multivariate analysis (aOR = 0.023; 95% CI = 0.054–0.995). The highest incidence of adverse events (AEs) occurred in the single-transfer group (64.29%), with 36 cases, 13 (23.21%) of which experienced desaturation. There is a relationship between the frequency of patient transfers in the neonatal surgery unit and desaturation (p-value = 0.047; Crude OR: 5.727 and 95% CI: 1.148 - 28.573). Conclusion: Prematurity, LBW, and congenital abnormalities were not associated with adverse events. Meanwhile, the use of invasive respiratory support is associated with hypothermia and medical device adverse events in neonatology unit surgery transfer patients. There is a significant association between the frequency of patient transfers and desaturation adverse events during the transfer process of neonates. "

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Introduksi: Relaparotomi dini pascatransplantasi hati donor hidup pada anak kerap dihadapkan pada luaran yang lebih buruk dibandingkan dengan pasien pascatransplantasi hati yang tidak memerlukan relaparotomy dini. Penelitian ini dilakukan untuk mengetahui faktor yang berhubungan dengan relaparotomi dini pascatransplantasi donor hidup pada anak

Metode: Penelitian potong lintang ini melibatkan seluruh resipien anak pascatransplantasi donor hidup di RSCM. Berdasarkan data rekam medis, setiap pasien dinilai skor PELD, lama operasi, jumlah perdarahan intraoperasi, warm ischemic time, dan cold ischemic time. Keempat faktor tersebut kemudian dianalisis hubungannya dengan kejadian relaparotomi dini.

Hasil: Terdapat 50 resipien anak pascatransplantasi donor hidup di RSCM dengan median usia subjek 17 bulan (5-61 bulan). Dari 50 subjek, 14 diantaranya memerlukan relaparotomi pascatransplantasi. Setelah dilakukan analisis, dari keempat faktor yang dinilai, hanya jumlah perdarahan intraoperasi yang bermakna secara statistik berhubungan dengan kejadian relaparotomi (p= 0.014).

Konklusi: Perdarahan intraoperasi merupakan salah satu faktor yang memengaruhi kejadian relaparotomi dini pada pasien anak dengan transplantasi hati donor hidup. Akan tetapi perlu diperhatikan faktor lain seperti power penelitian yang dapat memengaruhi hasil dan masih perlu ditingkatkan pada studi ini.

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Introduction: Early relaparotomy post living donor liver transplant in children usually faced with poor outcome compare to liver transplant patient without early relaparotomy. This study aims to identify factors associated with early relaparotomy in children undergone living donor liver transplant.

Methods: This is a cross sectional study including all of the children recipient of living donor liver transplant in Cipto Mangunkusumo Hospital (RSCM). Using the medical records, the PELD score, duration of the operation, total intraoperation blood loss, warm ischemic time, and cold ischemic time were measured. All of these factors were analyzed with the incidence of relaparotomy.

Results: Fifty children recipient of living donor liver transplant in RSCM were included in this study. The median age of the subject was 17 months old (5-61 months old). From 50 subjects, 14 of them were undergone relaparotomy post liver transplant. The total intraoperation blood loss has statistically significant associated with the incidence of relaparotomy (p= 0.014)

Conclusion: Intraoperation blood loss is one of the factors associated with the incidence of relaporotomy in children recipient of living donor liver transplant. Other factors associated with early relaparotomy still need to be explored to improve the power of this study.

 

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"Latar Belakang: Penolakan cangkok akut pascatransplantasi hati anak dapat berakibat cangkok tidak berfungsi. Angka kejadian yang mencapai 31% di Rumah Sakit Cipto Mangunkusumo (RSCM) membutuhkan evaluasi faktor risiko untuk mengurangi morbiditas dan mortalitas. Metode: Rekam medis 44 resipien anak pascatransplantasi hati donor hidup dari tahun 2010-Januari 2020 dievaluasi, dan dianalisa menggunakan fisher test. Hasil: Sebelas subjek (25%) mengalami penolakan cangkok akut pascatransplantasi dengan median waktu 12 hari (jarak waktu 6-70 hari) pascatransplantasi. Total 44 subjek, 29 (65,9%) berusia > 1 tahun dan 30 (68,1%) bergizi kurang. Kejadian penolakan cangkok akut pada kelompok usia ≤1 tahun, adalah 5 (33%) dan pada usia >1 tahun, 6 (20%). Penolakan cangkok akut terjadi pada 6 subjek (20%) dengan gizi kurang, dan 5 subjek (35,7%) dengan gizi baik. Hasil analisa menunjukkan tidak ada hubungan antara usia (p= 0,468; 95% CI 0,47-0,77; OR 1,917) dan status gizi (p=0,287; 95% CI 0,11- 1,85; OR 0,450) terhadap reaksi penolakan cangkok akut pascatransplantasi hati donor hidup anak di RSCM. Hasil observasi tiga bulan pertama memperlihatkan rerata kadar tacrolimus darah 6-8 ng/mL pada hari 12-15, tidak mencapai target untuk mendapatkan efek imunosupresi yang adekuat. Kesimpulan: Pada penelitian ini status gizi kurang dan usia resipien saat transplantasi hati tidak signifikan sebagai faktor risiko independen reaksi penolakan cangkok akut, tetapi dapat dipikirkan bahwa kedua faktor ini mempengaruhi imunitas resipien, yang selanjutnya berperan dalam reaksi penolakan cangkok akut. Penggunaan imunosupresan yang adekuat juga harus diperhatikan dalam menekan reaksi penolakan cangkok pascatransplantasi hati.

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Background: Acute rejection post-liver transplant in children may result in graft failure. The incidence rate of up to 31% at Cipto Mangunkusumo Hospital (RSCM) needs further evaluation of risk factors to lower morbidity and mortality.

Methods: 44 medical records of post living donor liver transplant pediatric recipients between 2010 until January 2020 were evaluated and analyzed using Fisher’s test.

Results: Eleven subjects (25%) were found to experience acute rejection post-transplant with a median time of 12 days (range 6-70 days) after surgery. Of the 44 recipients, 29 subjects (65,9%) were >1 year old and 30 subjects (68,1%) were undernourished. Acute rejection occurred in 5 subjects (33%) ≤1 year-old and in 6 subjects (20%) that were >1 year old. Acute rejection of the transplant occurred in 6 subjects (20%) that were undernourished and in 5 subjects (35,7%) with good nutritional status. Analysis of the data found no relationship between age (p= 0,468; 95% CI 0,47-0,77; OR 1,917) and nutritional status (p=0,287; 95% CI 0,11-1,85; OR 0,450 to acute rejection in pediatric living donor liver transplant at RSCM. Observation in the first three months post-transplant reveal that mean levels of tacrolimus in the blood were 6-8 ng/mL on days 12-15, insufficient of reaching the target of obtaining an adequate immunosuppressive effect.

Conclusion: In this study, age and nutritional status of recipients during the time of transplant were found to be insignificant independent risk factors of liver transplant acute rejection. However, these two factors can be thought to effect recipients’ immune status, which plays a role in acute rejection post-transplant. The use of adequate immunosuppressant needs to be carefully monitored in suppressing rejection reactions post-liver transplant."

"Latar Belakang: Di negara maju, angka mortalitas gastroskisis adalah 5-10%, berbeda dengan di negara berkembang. Angka mortalitas gastroskisis mencapai 52% di Brazil, 43% di Afrika Selatan, 35% di Iran, dan 79% di Jamaika. Di RSUPN Cipto Mangunkusumo (RSCM), sampai saat ini belum ada data mengenai angka mortalitas gastrosksis. Angka mortalitas gastroskisis di RSCM perlu diketahui karena karakteristik pasien yang diperkirakan berbeda dengan di negara maju. Tujuan dari penelitian ini adalah untuk mengetahui angka mortalitas gastroskisis di RSCM serta mengidentifikasi faktor risiko yang berpengaruh terhadap mortalitas gastroskisis, antara lain: usia kehamilan, berat badan lahir, jumlah operasi, usia saat operasi pertama kali, serta gastroskisis komplikata.Metode: Metode penelitian ini adalah studi kohort retrospektif dengan total sampling seluruh neonatus yang menjalani operasi penutupan defek di RSCM dari Januari 2015 – September 2020. Analisis bivariat dilakukan menggunakan uji Chi Square atau uji Fisher. Didapatkan 49 subjek neonatus dengan 7 data masuk kategori drop out sehingga 42 subjek diambil untuk dianalisis.Hasil: Angka mortalitas neonatus dengan gastroskisis di RSCM tahun 2015-2020 adalah 69% (29 dari 42 subjek). Pada penelitian ini didapatkan usia saat operasi (<1 hari) berpengaruh menurunkan angka mortalitas gastrosksis (p = 0,005). Usia kehamilan, berat badan lahir, jumlah operasi, dan gastroskisis komplikata didapatkan tidak berpengaruh terhadap angka mortalitas gastroskisis.Kesimpulan: Angka mortalitas gastrokisis di RSCM adalah 69% dan dipengaruhi oleh usia saat operasi.

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Background: Unlike developing countries, the mortality rate of gastroschizis in developed countries is much lower, accounting at 5-10%. In developing countries, for example, Brazil, the mortality rate can reach up to 52%, 43% in South Africa, 35% in Iran, and 79% in Jamaica. Until recently, there are no data regarding gastrochizis-related mortality rate in Cipto Mangkunkusumo National Referral Hospital, Indonesia. This is important as it reflects patient characteristics that is different with developed countries. The objective of this research is to find out the mortality rate of gastroschizis in Indonesia along with other possible influencing risk factors such as; gestational age, birth weight, number of operations, age at closure, and the presence of complicated gastroschizis.

Methods: A cohort retrospective study with total sampling is used to document all neonates who undergo defect closure surgery from January 2015 to September 2020. Bivariate analysis is done using Chi Square test or Fisher test. A total of 49 neonates were documented, however 7 neonates were excluded due to drop out criteria, resulting in 42 neonates who were included in the analysis.

Results: The mortality rate of gastroschizis in Cipto Mangkunkusumo National Referral Hospital is 69% (29 out of 42 subjects). The age at closure is related to lower mortality rate (p = 0.005), while other factors such as gestational age, birth weight, number of operations, and the presence of complicated gastroschizis has no impact on mortality.

Conclusions: The mortality rate of gastroschizis in Cipto Mangkunkusumo National Referral Hospital is 69% and is influenced by age at closure."

"Introduksi: Transplantasi hati merupakan terapi definitif pasien dengan penyakit hati stadium akhir. Peningkatan lama rawat inap berhubungan dengan luaran yang lebih buruk. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang berhubungan dengan peningkatan lama rawat inap pada pasien anak pascatransplantasi donor hidup di RSUPN Dr. Cipto Mangunkusumo. Metode: Penelitian potong lintang ini dilakukan dengan subjek seluruh pasien anak (<18 tahun) pascatransplantasi donor hidup di RSUPN Dr. Cipto Mangunkusumo pada tahun 2020-2018. Data social demografis dan klinis didapatkan pada penelitian ini. Uji T berpasangan dan uji T independent dilakukan pada subjek. Analisis multivariat dilakukan pada variabel dengan nilai p <0,25 dianggap signifikan. Hasil: Terdapat 32 subjek pada penelitian ini. Graft-to-recipient weight ration (GRWR) berkorelasi terbalik dengan lama rawat inap (p= 0,010, r = -0,447). Variabel lain, jenis kelamin, umur, durasi operasi, waktu iskemia, status nutrisi, rasio graft-to-weight, etiologi, aliran vena porta, dan komplikasi tidak berkorelasi secara signifikan dengan peningkatan lama rawat inap (p>0,05). Konklusi: Peningkatan lama rawat inap berkorelasi terbalik secara signifikan dengan GRWR.

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Introduction: Liver transplantation is a definitive treatment for pediatric end-stage liver disease. Increased length of stay (LOS) was associated with worse outcome. The study was aimed to analyze the factors related to the increase of LOS in pediatric patients receiving LDLT in Cipto Mangunkusumo General Hospital.

Methods: A cross-sectional study was performed, with patients collected from children (<18 years old) receiving LDLT in Cipto Mangunkusumo General Hospital in 2010 - 2018. Sociodemographic and clinical data were collected in the study. Paired t-test and independent t-test was performed on the patients included in the study. Multivariate analyses were performed for variables with p value <0.25. P value of < 0.05 was deemed significant.

Results: There were 32 subjects included in the study. Graft-to-recipient weight ratio (GRWR) had significant inverse correlation to LOS (p = 0.010, r = -0.447). Other variables, namely sex, age, surgery duration, ischemia time, nutritional status, graft-to-weight ratio, etiology, portal vein flow, and complications were not significantly correlated with increased LOS (p > 0.05).

Conclusion: Increased LOS was significantly and inversely correlated with GRWR."