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Abstrak :
Latar belakang: Air susu ibu ASI sangat bermanfat bagi bayi baru lahir, dari aspek komponen nutrisi maupun proteksi. Respon imun innate dan adaptif pada NKB diketahui masih imatur, diantaranya pada saluran cerna adalah antimikrobial peptide termasuk di dalamnya adalah human defensin 2 hBD2 . Pemberian nutrisi pada bayi prematur masih menjadi problematika karena belum semua NKB bisa mendapatkan ASI saja, sementara ASI kaya akan hBD2. Metode: Penelitian ini merupakan penelitian deskriptif analitik menggunakan rancangan studi cross sectional. Dilakukan di ruang neonatologi Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Jakarta pada bulan November 2016 ndash; April 2017. Pemeriksaan laboratorium dilakukan di Laboratorium Prodia. Populasi target NKB dengan usia gestasi 28-34 minggu. Terbagi 4 kelompok ASI, predominan ASI, predominan susu formula dan susu formula saja. Dilakukan pada 44 neonatus kurang bulan. Menggunakan metode ELISA, pemeriksaan radiologis dan pengecekan kadar PCT,CRP dan IT rasio. Metode statistik dengan one way ANOVA. Hasil: Kadar defensin pada masing-masing kelompok terdapat perbedaan yang signifikan dimana rerata kadar defensin terendah pada kelompok ASI sebesar 91,84 diikuti kelompok 2 221,52, kelompok 4 249,46 dan kadar tertinggi tercatat pada kelompok 3 sebesar 344,86 p=0,004 . Pada pemeriksaan Kadar procalcitonin ,CRP dan It rasio tidak terdapat beda yang signifikan. Klebsiella paling rendah populasinya pada kelompok ASI. Kesimpulan: hBD 2 kadarnya ditemukan rendah pada kelompok ASI dan tinggi pada kelompok predominan susu formula dan susu formula saja. Hal ini menunjukkan tingginya proses inflamasi pada kelompok yang mendapat susu formula. Air Susu Ibu masih yang terbaik bagi saluran cerna dengan bukti rendahnya Klebsiela pada Kelompok ASI. ......Background: Breast milk is highly beneficial for newborns, due to its nutritional aspects and protective properties. Innate and adaptive immune responses in preterm newborns are still immature, including the ones in the gastrointestinal system, namely antimicrobial peptide called human defensin 2 hBD2. Nutrition for preterm babies is still a problem because not all of them can get exclusive breast milk, while breast milk is rich in hBD2. Method: This study is an analytic descriptive study with cross sectional design. This study was done in the neonatology room in National Central General Hospital of Cipto Mangunkusumo Jakarta, on November 2016 ndash April 2017. Laboratory examination was performed in Prodia Laboratory. The target population was preterm newborns with gestational age of 28 34 weeks, divided into 4 groups, namely the breast fed group, predominant breast fed group, predominant formula fed group, and exclusively formula fed group. This study was performed in 44 preterm newborns using ELISA method, radiological examinations, and measuring the level of PCT, CRP dan IT ratio. The statistical analysis method used for this study is one way ANOVA. Result: There were significant differences in defensin level among the groups, in which the mean defensin level was lowest in breast fed group 91,84 , followed by the second group 221,52 , the fourth group 249,46 , and the highest in the third group 344,86 p 0,004 . There were no significant differences among groups in IT ratio and procalcitonin and CRP levels. Breastmilk is the best protection for preterm gut which Klebsiella was lowest in breastmilk group. Conclusion: The level of hBD2 was found to be low in breast fed group and high in predominant formula fed group and also in exclusively formula fed group. This showed the high inflammation process happening in the group fed with formula.

Abstrak :
Latar belakang: Bayi prematur, terutama late dan moderately preterm sering mengalami masalah kesehatan terutama masalah pernapasan, yang merupakan penyebab tertinggi kematian. Gangguan pernapasan sering dialami bayi prematur hingga sering membutuhkan bantuan pernapasan. Bantuan pernapasan berupa oksigenasi dan ventilasi membutuhkan pemantauan terhadap tekanan oksigen dan CO2. Analisis gas darah merupakan baku emas untuk memantau oksigenasi dan ventilasi. Saat ini dapat dilakukan pemantauan tekanan CO2 secara non invasif dengan monitor transkutan yang dilakukan secara kontinyu. Namun, penelitian terkait pemantauan CO2 transkutan pada bayi late dan moderately preterm belum banyak dilakukan, karena umumnya penelitian dilakukan pada bayi very dan extremely preterm. Di Indonesia juga belum didapatkan data penelitian pemantauan CO2 transkutan, khususnya pada bayi late dan moderately preterm. Tujuan: Mengetahui karakteristik bayi usia kehamilan 32-36 minggu yang mendapat bantuan pernapasan serta presisi dan akurasi alat ukur tekanan CO2 transkutan pada bayi usia kehamilan 32-36 minggu yang mendapat bantuan pernapasan. Metode: Penelitian ini merupakan penelitian uji diagnostik yang menggunakan desain penelitian cross sectional. Subjek penelitian adalah 35 bayi late dan moderately preterm dengan usia kehamilan 32 – 36 minggu yang mendapatkan bantuan pernapasan di unit Neonatologi Rumah Sakit Cipto Mangunkusumo (RSCM) di Jakarta pada bulan Juli hingga Desember 2019. Bayi tersebut akan dipasangkan alat ukur tekanan CO2 dan dilakukan pengambilan sampel Analisa Gas Darah (AGD) sebanyak tiga kali dan dilakukan pencatatan nilai tekanan CO2 yang didapat dari kedua alat ukur tersebut. Hasil yang didapat kemudian dibandingkan dan diolah secara statistik untuk menentukan akurasi dan presisi dari alat uji tekanan CO2 secara transkutan. Hasil: Berdasarkan data dari tabel korelasi, didapatkan bahwa nilai koefisien korelasi terhadap kadar CO2 pada pemeriksaan melalui AGD dan alat CO2 Transkutan secara total adalah sebesar 0,738 (p <0,001). Berdasarkan hasil ini, didapatkan bahwa alat uji tekanan CO2 secara transkutan memiliki korelasi positif sedang dengan AGD. Hal ini berarti semakin tinggi kadar CO2 pada AGD akan memberikan peningkatan nilai yang terbaca pada alat uji CO2 secara transkutan dengan kekuatan sedang. Berdasarkan grafik Bland – Altman, dapat ditentukan bahwa Level of agreement dari penelitian ini berdasarkan hasil pemeriksaan kedua alat tersebut adalah -14,46 hingga 6,9 dengan nilai mean difference dari hasil penelitian ini adalah -3,78. Simpulan: Alat ini memiliki presisi yang kurang baik. Namun, alat ini juga memiliki korelasi positif yang kuat pada hasil pengujian dengan menggunakan uji korelasi Spearman. Berdasarkan grafik Bland-Altman yang diperoleh dari penelitian, alat ini dapat dikatakan memiliki nilai akurasi yang cukup baik. Alat ini tidak bisa menggantikan pemeriksaan baku emas tetapi hanya bersifat sebagai pelengkap dalam melakukan perawatan bayi di NICU, sehingga dapat mengurangi frekuensi pengambilan sampel darah untuk melakukan pemeriksaan baku emas. ......Background: Neonates who born premature, especially late and moderately preterm, often experience health problems, especially repiratory problems, which are the highest causes of death. Respiratory disorders are often experienced by premature neonates and often need respiratory support device. Respiratory support device in the form of oxygenation and ventilation requires monitoring of oxygen and CO2 pressure. Blood gas analysis is the gold standard for monitoring oxygenation and ventilation. Currently, non-invasive CO2 pressure monitoring can be carried out with continuous transcutaneous monitoring. However, studies related to monitoring of transcutaneous CO2 in late and moderately preterm infants have not been done much, because generally research is conducted on very and extremely preterm infants. In Indonesia there is no research data on transcutaneous CO2 monitoring, especially in late and moderately preterm infants. Objective: To determine the characteristics of 32-36 weeks gestational age neonates who receive respiratory support device and the precision and accuracy of transcutaneous CO2 measuring devices in 32-36 weeks gestational age neonates who receive respiratory support device. Method: This study is a diagnostic test that uses a cross sectional study design. Subjects were 35 late and moderately preterm infants with 32-36 weeks gestational age who received respiratory support device at the Neonatology unit of Cipto Mangunkusumo Hospital (RSCM) in Jakarta on July to December 2019. The neonates would be fitted with a transcutaneous CO2 and taken Blood Gas Analysis (BGA) sample three times and recording the CO2 pressure values obtained from the two measuring devices. The results obtained will be compared and processed statistically to determine the accuracy and precision of the transcutaneous CO2 device. Results: Based on data from the correlation table, it was found that the value of the correlation coefficient on CO2 levels on examination through BGA and the Transcutaneous CO2 device in total was 0.738 (p <0,001). Based on these results, it was found that the transcutaneous CO2 device had a strong positive correlation with BGA. This means that the higher levels of CO2 in the BGA will provide an increase in the value read on the Transcutaneous CO2 device with strong strength of correlation. Based on the Bland-Altman graph, it can be determined that the level of agreement of this study based on the results of the examination of the two measurement is -14.46 to 6.9 with the mean difference from the results of this study is -3.78. Conclusion: Transcutaneous CO2 measurement device has low precision but also has a strong positive correlation on the test results using the Spearman correlation test. Based on Bland – Altman graph from the study, the device can be said to have a good accuracy. This device can’t replace the gold standard examination but can only as a complement in taking care of neonates in the NICU, to reduce the frequency of blood sampling for conducting gold standard examinations.

Abstrak :
Latar Belakang. Sepsis neonatal awitan dini SNAD masih merupakan masalah di Indonesia. Vitamin D memiliki efek pada fungsi imunitas. Neonatus kurang bulan NKB berisiko mengalami defisiensi kadar vitamin D. Hubungan kadar vitamin D dengan kejadian SNAD pada NKB belum jelas. Tujuan. Menganalisis hubungan kadar vitamin D dengan kejadian SNAD pada NKB. Metode. Duapuluh NKB dengan klinis dan pemeriksaan laboratorium menyokong SNAD kelompok kasus dan 20 NKB tanpa hasil laboratorium SNAD kelompok kontrol ikut dalam penelitian ini. Subjek penelitian adalah NKB usia gestasi ge; 28 sampai dengan < 37 minggu dirawat di RSUPN Cipto Mangunkusumo selama bulan Juli - September 2017. Pemeriksaaan kadar vitamin D 25 OH D dengan metode competitive chemiluminescense immunoassay CLIA direk dengan alat Diasorin Liaison. Hasil. Median kadar vitamin D pada NKB dengan SNAD 8,95 4,10 - 16,30 ng/mL dengan rerata usia gestasi 33,25 1,71 minggu dan rerata berat lahir 1863,75 415,06 gram. Median kadar vitamin D tanpa SNAD 11,75 5,80 - 42,80 ng/mL dengan rerata usia gestasi 34,67 1,53 minggu dan rerata berat lahir 2125,0 340,55 gram. Median kadar vitamin D NKB SNAD lebih rendah secara bermakna dibandingkan NKB tanpa SNAD.

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Background. Early onset neonatal sepsis EONS is still a problem in Indonesia. Vitamin D has effect on immune function. Preterm infants have a risk of deficiency of vitamin D levels. The association between vitamin D levels with EONS were unclear. Objective. To determine the association between vitamin D levels with EONS in preterm infants. Methods. Twenty preterm infants with clinical and laboratory finding of EONS study group and 20 preterm infants with no signs of laboratory infection control group were enrolled this study. The subjects were preterm infants of gestational age ge 28 37 weeks in Cipto Mangunkusumo Hospital during July September 2017. Vitamin D 25 OH D levels were measured using Diasorin Liason with competitive chemilunescence immunoassay CLIA technique. Results. Median vitamin D levels with EONS was 8,95 4,10 16,30 ng mL, mean of gestational age and birth weight were 33,25 1,71 weeks and 1863,75 415,06 g, respectively. Median vitamin D levels without EONS was 11,75 5,80 42,80 ng mL, mean of gestational age and birth weight were 34,67 1,53 weeks and 2125,0 340,55 g, respectively. Median vitamin D levels of preterm infants with EONS was significantly lower than without EONS.Conclusion. Vitamin D levels are associated with EONS in preterm infants.

Abstrak :
Latar Belakang: Bayi sangat prematur adalah kelompok bayi risiko tinggi yang rentan terhadap luaran neurodevelopmental yang buruk. Penelitian menunjukkan bahwa pemberian nutrisi secara dini dan agresif dapat mengurangi kejadian malnutrisi pada bayi sangat prematur. Saat ini, RSUP Fatmawati belum mempunyai protokol nutrisi yang standar untuk bayi prematurnya dan ingin melakukan perubahan dengan menerapkan protokol standar nutrisi bayi prematur dari RSCM. Tujuan: Untuk mengetahui beda waktu kembali ke berat lahir dan pola pemberian nutrisi bayi sangat prematur/BBLSR yang lahir dan dirawat di Unit Neonatologi RSUP Fatmawati sebelum dan sesudah penerapan protokol standar nutrisi bayi prematur RSCM. Metode: Dilakukan penelitian quasi eksperimental terhadap 23 bayi sangat prematur/berat lahir sangat rendah di Unit Neonatologi RSUP Fatmawati pada bulan Juli – November 2019. Bayi dieksklusi bila orangtua menolak berpartisipasi atau mempunyai kelainan kongenital yang mempengaruhi status nutrisi. Sampel pada kelompok intervensi diberikan nutrisi sesuai protokol standar nutrisi bayi prematur RSCM dan diikuti hingga kembali ke berat lahir dan mencapai fullfeed. Pola pemberian nutrisi yang juga dievaluasi sebagai luaran sekunder (waktu dimulainya nutrisi enteral dan mencapai fullfeed, waktu dimulainya pemberian protein dan lipid, waktu tercapainya protein, lipid dan kalori tertinggi serta jumlah protein, lipid, kalori dan GIR tertinggi). Data pasien pada kelompok kontrol diambil dari data rekam medik bayi sangat prematur/berat lahir sangat rendah yang sudah pulang dari RSUP Fatmawati dari Januari 2016 – Juni 2019 dan dibandingkan dengan kelompok intervensi. Hasil: Penerapan protokol standar nutrisi bayi prematur RSCM dapat mempercepat waktu kembali ke berat lahir (kontrol vs intervensi: 16,7 (5,1) vs 7,4(3,5) hari, p= 0,00) dan mempercepat growth velocity (kontrol vs intervention: 8,9 (6,9) vs 14,6 (6,0), p=0,002) pada bayi sangat prematur/BBLSR yang dirawat di Unit Neonatologi di RSUP Fatmawati. Kesimpulan: Penerapan protokol standar nutrisi bayi prematur RSCM dapat mempercepat waktu kembali ke berat lahir dan growth velocity pada bayi sangat prematur/BBLSR yang dirawat di Unit Neonatologi RSUP Fatmawati. Kata kunci: nutrisi bayi prematur, nutrisi agresif dini, waktu kembali ke berat lahir, growth velocity. .....Background: Very premature infants are a group of high-risk infants who are vulnerable to poor neurodevelopmental outcomes. Research shows that early and aggressive nutrition can reduce the incidence of malnutrition in very premature infants. At present, Fatmawati Hospital does not yet have a standard nutritional protocol for premature infants and want to make changes by implementing a standard protocol for preterm infant nutrition from RSCM. Objective: To determine the difference in days to regain birth weight and the pattern of nutrition for very premature/very low birth weight infants who were born and hospitalized in the Neonatology Unit of RSUP Fatmawati before and after the application of the standard protocol of premature infant nutrition of RSCM. Methods: A quasi-experimental study of 23 very preterm/very low birth weight infants in the Neonatology Unit of Fatmawati Hospital from July to November 2019. Infants were excluded if parents refused to participate or had congenital abnormalities that affects nutritional status. Samples in the intervention group were given nutrition according to RSCM premature infant nutrition protocol and followed until they return to birth weight and achieve fullfeed. Nutritional patterns were also evaluated as secondary outcome (day to begin enteral nutrition, growth velocity, days to reach fullfeed, days to start protein and lipid, days to reach the highest protein, lipid and calorie intake and the highest amount of protein, lipid, calories and GIR given). Data of samples in the control group were taken from medical records of very premature/very low birth weight babies discharged from Fatmawati Hospital from January 2016 - June 2019 and compared with the intervention group. Results: The application of RSCM premature infant nutrition protocol can shorten the days to regain birth weight (control vs intervention: 16.73 vs 7.43 days, p = 0.00) and fasten growth velocity (control vs intervention: 8,9 (6,9) vs 14,6(6,0), p=0,002) in very premature/low birth weight infant who were treated in the Neonatology Unit of Fatmawati. Conclusion: The application of RSCM premature infant nutrition standard protocol can accelerate time to regain birth weight and growth velocity in very premature/low birth weight infant in the Neonatology Unit, Fatmawati Hospital.

Abstrak :
Latar belakang: Dukungan respiratori pada neonatus saat lahir dan stabilisasi bertujuan mencegah terjadinya hipoksia. Hingga saat ini, pemantauan status oksigenasi masih menggunakan saturasi oksigen perifer (SpO2). Akan tetapi, SpO2 dan tekanan parsial oksigen (PaO2) tidak berhubungan secara linier sehingga apabila terjadi peningkatan PaO2 >80 mmHg, maka SpO2 akan mengalami plateau >95%. Oxygen reserve index (ORI) merupakan parameter baru yang dapat menilai simpanan oksigen di jaringan. Pengaplikasian ORI diharapkan dapat melengkapi kelemahan SpO2 untuk mencegah hiperoksia. Namun, penelitian mengenai ORI pada neonatus masih sangat terbatas. Metode: Rancangan penelitan ini menggunakan analitik korelatif dengan desain penelitian potong lintang. Kriteria inklusi adalah neonatus mendapatkan dukungan respiratori dengan pemantuan SpO2 secara kontinu pada monitor >95% dan direncanakan pemeriksaan gas darah arteri. Nilai ORI diambil selama 30 menit. Setiap perubahan nilai ORI dan SpO2 dicatat dan dihitung untuk mendapatkan rerata nilai. Data diolah berdasarkan uji korelasi. Hasil: Dari 205 neonatus yang lahir/dirujuk ke Unit Neonatologi RSUPN Cipto Mangukusumo diperoleh 23 subyek yang memenuhi kriteria inklusi. Diperoleh total 70 pengukuran dari 23 subyek. Insidens hiperoksia ditemukan pada 40 pengukuran (57%). Kekuatan korelasi antara ORI dan PaO2 diperoleh r = 0,687 dengan p <0,001. Analisis multivariat memerlihatkan apabila ORI digunakan bersama SpO2 menunjukkan hasil koefisiens determinasi yang cukup rendah (R2 adjusted = 28,4%). Nilai cut-off ORI 0,21 dapat memprediksi PaO2 >80 mmHg dengan dengan sensitivitas 82,5% dan spesifisitas 76,6%. Simpulan: Terdapat korelasi yang bermakna antara ORI dan PaO2. Pengaplikasian ORI secara klinis dapat memprediksi PaO2 pada neonatus dalam rentang hiperoksia yang tidak dapat ditunjukkan SpO2. ORI tidak dapat menggantikan SpO2. ......Background: Respiratory support in the delivery room and NICU is an effort to prevent hypoxia at birth and during stabilization. Until recently, peripheral oxygen saturation (SpO2) is used to monitor oxygenation status non-invasively. However, the relationship between SpO2 and arterial partial pressure of oxygen (PaO2) is not linear but sigmoidal. If the level of PaO2 >80 mmHg, SpO2 reaches a plateau at the range >98-100%. Oxygen reserve index (ORI) could assess oxygen reserve at the tissue level which is undetected using pulse oximetry. ORI application may complete SpO2 weakness in detecting hyperoxia. Nevertheless, studies about ORI in neonate is still limited. Method: In this cross-sectional correlational study, we included neonates receiving oxygen therapy whose SpO2 monitor continuously showed >95%. Arterial blood gas analysis was done according to the attending’s order. The ORI value was taken for 30 minutes. Any change in the ORI and SpO2 value was recorded and calculated to get an average value. Data were analyzed based on a correlation test. Result: From 205 inborn and outborn at Neonatal Unit Cipto Mangunkusumo Hospital, 23 subjects met the inclusion criteria. There were 70 measurements of ORI, SpO2 and PaO2 in 23 subjects. Hyperoxia was observed in 40 measurements (57%). The correlation between ORI and PaO2 was r = 0,687 (p <0,0001). Multivariate analysis showed ORI together with SpO2 has a low coefficient of determination of R2 adjusted = 28,4%. The cut-off ORI value to predict PaO2 >80 mmHg when SpO2 >95% was 0,21 with a sensitivity of 82,5% and specificity of 76,6%. Conclusion: ORI and PaO2 are significantly strongly correlated in neonates. ORI is able to predict hyperoxia that goes undetected by SpO2. However, ORI cannot replace the role of SpO2.

Abstrak :
Manuver rekrutmen paru (MRP) adalah strategi mencegah kerusakan paru saat bayi menggunakan ventilator mekanis (VM). Dengan meningkatkan tekanan akhir ekspirasi (TAE) secara bertahap, MRP membuka alveolus, menurunkan kebutuhan oksigen hirup (FiO2) sekaligus meningkatkan ambilan oksigen paru. Hingga kini, belum cukup bukti ilmiah terkait pengaruh MRP menggunakan VM terhadap luaran bayi prematur. Penelitian ini adalah uji klinis tidak tersamar, dilakukan di RS Cipto Mangunkusumo dan RSIA Bunda Menteng, bertujuan mencari hubungan MRP dengan kejadian DBP dan atau kematian, curah jantung, cedera alveolus-endotel, penurunan diameter duktus arteriosus (DA), dan mikrosirkulasi kulit. Penelitian berlangsung Maret 2021–April 2022. Subjek penelitian adalah bayi prematur 24–32 minggu yang menggunakan ventilator mekanis saat usia < 48 jam. Protein surfaktan-D (SP-D) diukur menggunakan metode ELISA, mikropartikel endotel (CD-31+/CD-42–) menggunakan flowsitometri, curah jantung dan diameter DA menggunakan ekokardiografi, TcCO2–PaCO2, TcO2/PaO2 menggunakan monitor gas darah transkutan dan gas darah arteri, strong ion difference (SID) menggunakan elektrolit darah arteri. Pada usia koreksi 36 minggu, tidak terdapat perbedaan bermakna kejadian DBP atau kematian antara kelompok MRP dan tanpa MRP 38 (69,09%) vs. 43 (78,18%), p = 0,216. Pada 72 jam pasca-penggunaan VM, tidak didapati perbedaan kadar SP-D, CD 31+, Diameter DA, curah jantung, TcCO2 gap dan SID antara kelompok MRP dan tanpa MRP . Terdapat perbedaan bermakna TcO2 indeks 1,00 (1,00; 1,02) vs. 1,00 (0,99; 1,00), p = 0,009* antara kelompok MRP dibanding tanpa MRP. Pada bayi penyintas, MRP mempercepat waktu untuk mencapai FiO2 ter-rendah 60,0 (54,00; 75,00) vs. 435,00 (375,00; 495,00) menit, p < 0,0001 dan lama penggunaan alat bantu napas 25,0 (19,00; 37,00) vs. 36,83 (SB 19,11) hari, p = 0,044. Simpulan, MRP bayi prematur tidak terbukti mengurangi kejadian DBP dan atau kematian pada usia 36 minggu. Tidak ada perbedaan cedera alveolar-endotel, curah jantung kiri-kanan, dan diameter DA pada usia 72 jam. Tindakan MRP meningkatkan mikrosirkulasi. Pada kelompok penyintas, MRP mempersingkat waktu mencapai FiO2 terendah dan penggunaan alat bantu napas. ......Lung recruitment maneuver (LRM) is a strategy during mechanical ventilation which aim to open collapsed alveolus in order to increased oxygenation. This maneuver could be done by application of a stepwise increments of positive end expiratory pressure (PEEP) until lowest FiO2 (< 30%) is achieved. There is still lack of evidence regarding relationship between LRM and neonatal outcome. This study aimed to evaluate effectivity of LRM in order to reduce chronic lung disease and it’s influence to neonatal hemodynamic as well. This was unblinded randomized clinical trial which aimed to investigate relationship between LRM and neonatal death, bronchopulmonary dysplasia (BPD), cardiac output, reduction of ductus arteriosus (DA) diameter, skin microcirculations and alveolar-endotel injury. The study was conducted on March 2021 until April 2022 in Cipto Mangunkusumo and Bunda Menteng Hospital. Plasma surfactant protein-D (SP-D) was measured with ELISA, Microparticel endotel (CD-31+) with flowcytometri, left and right cardiac output (LVO and RVO) and DA diameter were measured by echocardiography, TcCO2–PaCO2, tcO2/PaO2 were measured form arterial blood gas and transcutaneous monitor and strong ion difference (SID) from plasma electrolyte. At 36 weeks follow up, there ware no significant difference of incident of DBP and/or death between MRP vs. without MRP groups 38 (69.09%) vs. 43 (78.18%), p = 0.216 (CI 95% 0.141–0.295). There were no difference between MRP and without MRP group at 72 hours, regarding : plasma SP-D, microparticle endotel, cardiac output, DA diameter, tcCO2 gap and SID. At. 72 hours, tcO2 index was better in MRP compared to control group 1.00 (1.00; 1.02) vs. 1.00 (0.99; 1.00), p = 0.009. There were no significant difference regarding other neonatal morbidity between the two group. Among survival subject, LRM reduced time to achieved lowest FiO2 60.00 (54.00; 75.00) vs. 435.00 (375.00; 495.00) hours, p < 0.0001 and length of respiratoy support 25.0 (19.00; 37.00) vs. 36.83 (SD 19.11) days, p=0.044. Conclusion When applied to 24–32 weeks preterm baby with invasive mechanical ventilation, LRM could not reduced DBP or death at 36 weeks of age. There was no any difference at 72 hours regarding alveolar and endothelial injury, left and right cardiac output and diameter DA. LRM was associated with better microcirculation. Among the survivor, LRM reduced high oxygen concentration exposure time and length of respiratory support.