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Abstrak :
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

Abstrak :
ABSTRAK
Sesak napas bayi baru lahir merupakan morbiditas tersering pada bayi prematur < 35 minggu. Sesak napas harus ditangani secepatnya dengan pemberian tekanan jalan napas positif. Sampai saat ini, nCPAP merupakan pilihan pertama terapi ventilasi non-invasive untuk bayi prematur. Walaupun efektif, nCPAP sering memberikan efek samping berupa trauma hidung. Heated humidified high flow nasal cannulae merupakan metode terapi oksigen beraliran tinggi yang tanpa sengaja mampu memberikan tekanan jalan napas positif, namun keamanan dan efektifitasanya masih belum banyak diteliti. Mengetahui efektifitas dan keamanaan HHHFN dibanding nCPAP pada bayi prematur usia > 28 minggu dan < 35 minggu yang mengalami sesak napas derajat sedang. Penelitian ini merupakan uji klinis non-inferioritas, acak, tidak tersamar yang membandingkan HHHFN dan nCPAP pada bayi prematur usia yang mengalami sesak napas sejak dari kamar bersalin Tidak ada perbedaan insiden intubasi endotrakeal pada pemakaian < 72 jam HHHFN 20 dibanding nCPAP 18 p = 0,799 . Terdapat perbedaan proporsi trauma hidung derajat 2 pada penggunaan nCPAP 14 dibanding HHHFN 0 . Tidak terdapat perbedaan pH, pCO2, pO2 darah arteri, lama capaian minum enteral penuh, lama penggunaan alat, lama perawatan metode kanguru, dan insiden komplikasi BPD, IVH, PDA, NEC dan SNAL antara pengguna nCPAP dan HHHFN. HHHFN tidak lebih inferior ditinjau dari efektivitas dan keamanan dibanding nCPAP sebagai terapi non-invasif pada bayi pada bayi prematur usia > 28 minggu dan < 35 minggu dengan berat lahir > 1000 gram yang mengalami sesak napas derajat sedang jika diberikan sedini mungkinABSTRACT
Respiratory distress in new borns are the most common morbidity in premature babies 35 weeks. It should be treated immediately with positive airway pressure. Nasal CPAP is still the first choice of treatment for these cases. Despite its effectivity, nCPAP is proved causing nasal trauma as side effect. Meanwhile Heated Humidified high flow nasal cannula is an alternative oxygen therapy which also could generate inadvertent positive pressure airway, but the effectivity and safety has not been widely studied. The goal of this study is s identifying the effectivity and safety of HHHFN and nCPAP in premature babies ages 28 weeks and 35 weeks with moderate respiratory distress. This research is a random, non inferiority, clinical trial which compares safety and effectivity between HHHFN and nCPAP in treating babies with moderate respiratory distress since in the delivery room. There is no difference in incidence of endotracheal intubation in 72 hours of HHHFN 20 compared to nCPAP 18 p 0,799 . There is a significant difference of moderate nasal trauma in nCPAP 14 compared to HHHFN 0 . There are no statistically differences of pH, pCO2, pO2 time to full enteral feeding, length of Kangaroo Mother care, length of using the devices, and rate of in complication BPD, IVH, PDA, NEC and SNAL between nCPAP dan HHHFN user. HHHFN is not inferior than nCPAP in terms of safety and effectivity as primary noninvasive therapy in premature babies age 28 weeks and 35 weeks with moderate respiratory distress if given as early as possible.

Abstrak :
Minum merupakan tantangan bagi bayi prematur karena imaturitas dan penyakit yang menyertainya. Bayi prematur yang dinyatakan siap minum seringkali tidak mampu minum. Saat ini belum terdapat tata laksana yang konsisten dan mempertimbangkan kompleksitas proses minum secara komprehensif. Tujuan penelitian ini adalah menentukan berbagai faktor yang memengaruhi ketidakmampuan minum dan membuktikan efektivitas tata laksana metode baru terhadap kemampuan minum bayi prematur. Penelitian dilakukan di lima rumah sakit di Jakarta pada bulan Agustus–November 2021. Studi potong lintang meneliti faktor yang memengaruhi ketidakmampuan minum 120 bayi prematur siap minum usia kehamilan 28–34 minggu, yaitu tonus postural fleksi fisiologis, stabilitas fisiologis, refleks rooting, kemampuan regulasi diri, morbiditas, dan behavioral state. Selanjutnya dilakukan randomized controlled trial (RCT) membandingkan tata laksana metode baru dan konvensional 70 bayi prematur belum mampu minum dari studi potong lintang. Metode baru mencakup therapeutic positioning fleksi fisiologis melalui pembedongan dan intervensi oromotor berupa stimulasi oral, gerakan sinergis three finger jaw control, dan isapan non-nutritif menggunakan empeng khusus. Metode konvensional mencakup pembedongan tradisional, stimulasi oral, dan isapan non-nutritif menggunakan empeng yang biasa digunakan di ruang perawatan. Analisis data studi potong lintang dilakukan dengan uji bivariat menghitung prevalence ratio (PR) dan nilai p; uji multivariat, penentuan titik potong skor faktor risiko ketidakmampuan minum melalui kurva Receiving Operating Characteristic (ROC), serta penentuan sensitivitas dan spesifisitasnya. Uji klinis membandingkan rentang waktu tercapainya kemampuan minum bayi yang diberikan kedua jenis metode. Data dianalisis dengan program STATA versi 14.2 (tingkat kemaknaan p < 0,05). Hasil studi potong lintang menunjukkan regulasi diri sebagai faktor utama yang memengaruhi ketidakmampuan minum bayi prematur dengan PR 1,96 (1,61–3,34; IK 95%) dan p = 0,012, diikuti tonus postural, behavioral state, dan morbiditas (PR 1,91; 1,59; 1,56). Skor faktor risiko ketidakmampuan minum memiliki area under the curve (AUC) sebesar 0,698, titik potong optimal pada skor ≥ 7 dengan sensitivitas 71,4% dan spesifisitas 54%. Hasil uji klinis membuktikan metode baru lebih efektif dibandingkan metode konvensional (4 vs. 7 hari; p = 0,02). Berbagai faktor yang memengaruhi ketidakmampuan minum bayi prematur siap minum adalah regulasi diri, tonus postural, behavioral state, dan morbiditas. Metode baru lebih efektif dibandingkan metode konvensional. ......Feeding for premature infants is a challenge because of their immaturity and comorbidities. Premature infants who are ready to feed are often not able to feed. Current managements have not been consistent and consider the complexity of the feeding process comprehensively. The purpose of this study was to determine various factors influencing feeding inability of premature infants and to verify the effectiveness of a new method management on the premature infants’ feeding ability. The study was conducted in five hospitals in Jakarta in August–November 2021. A cross-sectional study examined factors influencing the oral feeding inability on 120 ready to feed premature infants born at 28–34 weeks of gestation. Evaluation of feeding inability risk factors included physiological flexion postural tone, physiological stability, rooting reflex, self-regulation ability, morbidity, and behavioral state. Subsequently, a randomized controlled trial (RCT) comparing the new and conventional method was conducted in 70 premature infants who were not able to feed from the cross-sectional study participants. The new method encompasses physiological flexion therapeutic positioning swaddling, and oromotor intervention consisting of oral stimulation, synergic three finger jaw control, and non-nutritive sucking by using a specific pacifier. The conventional method consists of traditional swaddling, oral stimulation, and non-nutritive sucking using the usual pacifier in the nursery room. In the cross-sectional study, bivariate analysis was done to determine the prevalence ratio (PR) and p value; multivariate analysis, Receiving Operating Characteristic (ROC) curve to determine the scoring system cut-off point, as well as its sensitivity and specificity. Clinical trial data analysis compared the new and conventional method effectivity in terms of duration needed to achieve feeding ability in premature infants. STATA version 14.2 was used for data analysis (level of significance p < 0,05). The results from the cross-sectional study showed that self-regulation had the highest influence of feeding inability with PR 1,96 (1,61–3,34; IK 95%) and p = 0,012, followed by postural tone, behavioral state, and morbidity (PR 1,91; 1,59; 1,56). The feeding inability risk score had an area under the curve (AUC) of 0.698, an optimal cut–off point of ≥ 7, as well as sensitivity of 71,4%, and specificity of 54%. In clinical trials, it was proven that the new method was more effective than the conventional method (4 vs. 7 days; p = 0,02). Factors influencing feeding inability in premature infants were self-regulation, postural tone, behavioral state, and morbidity. The new method management was more effective than the conventional method.