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"TUJUAN (1) Menilai efek pemberian dabutamin data perjalanan penyakitmembran hialin (PMFi)" ringan pada xieonatps kurangislan (NKB) (2) ,Mendeteksi gangguan faal, kardiovaskular pada-PMH ringan; (3}; Menilai respons faal kardiovaskular; pada ..PMH ringan; terhadap pemberiandobutamin; (4).Mendeteksi faktor risiko untuk.terjadinya PMH pada NKB. TEMPAT PENELITIAN: Unit perawatan neonatus tingkat II pada rumah sakit rujukan utama, SUBYEK PENELITIAN: NKB dengan ibunya.PENGURURAN DAN INTERVENSI NKB yang.lahir di RSCM diikuti sampai terjadi PMH atau tidak. Faktor risiko dihitung dengan analisis bivariat dan regresi logistik. Faal ven tnkel dari aliran darah otak (ADO diperiksa dengan teknik" Doppler Faal, diastolik' ventikel varian dari kin diestimasi dengan mengukur puncak E, puncak-A, dan rasio Faal sistolik ventrikel kiri diukur dengan periode praejeksi (PPE) dan waktu ejeksi ventrikel kiri (WEVKi) yang"dikoreksi terhadap laju jantung, serta rasio PPE/WEVKi: ADO'dinilai dengan pengukuran kecepatan aliran darah otak (KADO) maksimal dari Ina1, indeks Pour-ot dan akselerasi aliran Perinrih dobutamin diteliti dengan uji intervensi tersamar ganda dengan desain silang. Pengaruh`dobutamin dalam perjalanan PMI-J dinilai dengan analisis kesintasan pasien yang mendapat dobitamin atau placebo, dengan metode Kaplan Meier dan uji Breslow: Efek pada analisis kesehan adalah saat pasien memerlukan ventilasi mekanik atau mengalami perburukan yang mengancam jiwa.

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PURPOSE To determine: (1) effects of dobutamine administration on the clinical course of preterm infants with mild hyaline membrane disease (HMD); (2) cardiovascular involvement in mild HMD; (3) response of cardiovascular functions in patients with mild HMD to dobutamine administration; (4) risk factors for the development of HMD in preterm infants.

SETTING Level2neonatal unit of a national referral hospital. STUDY SUBJECTS Preterm infants with their respective mothers.

MEASUREMENTS AND INTERVENTION Pre term infants born at Cipto Mangunkuswno Hospital, Jakarta, were followed from birth to detect the development of HMD. The risk or protective factors were calculated by univariate and logistic regression analyses. Right ventricular (RV) and left ventricular (LV) diastolic functions were estimated by measuring points E and A, and E/A ratio_ LV systolic function was estimated by measuring rate-corrected pre-ejection period (PEP) and left ventricular ejection time (LVET), and PEP/ LVET ratio. Cerebral blood flow velocity (CBFV) was determined at the anterior cerebral artery. Maximal and minimal flows were determined and Pourcelot Index calculated; acceleration of the flow was also measured. Comparison of preterms with or without mild HMD was performed in 23 gestational age and birth weight matched pairs infants. Effects of dobutamine were determined by randomized, double-blind, placebo controlled trial in 41 preterm infants with mild HMO. The role of dobutamine in the clinical course of mild HMD was determined by comparing survival curves of placebo-treated and dobutamine-treated patients using Kaplan-Meier method and Breslow hypothesis testing. The need for mechanical ventilation or deterioration of patient's condition was judged as the event of interest.

MAIN RESULTS Eighty-seven out of the 308 preterm infants studied developed HMD. Logistic regression model disclosed that antepartum hemorrhage, mode of delivery, sex, gestational period, and peri natal asphyxia were associated with the development of HMO. RV diastolic function parameters were not significantly different between infants with. or without mild HMD, and dobutamine did not alter the values. In contrast, LV E and A points were significantly different between the 2 groups,, although the E/A ratio was not different. Dobutamine improved the de-pressed LV diastolic function. Infants with mild HMD had significantly longer rate corrected PEP, ' shorter rate corrected LVET, and larger PEP/LVET ratio compared with those without HMD. The dysfunction was improved by dobutamine. CBFV was not significantly different between preterm infants with or without mild HMD, and dobutamine did not alter CBFV but it increased blood flow acceleration. Dabutamine treated infants had a significantly longer mean mechanical-ventilation-free survival than placebo, treated infants, i.e. 78 vs 61 hours.

CONCLUSIONS (1) Administration of dobutamine to standard treatment delays the deterioration of preteen infants with mild HMD, so that use of dobutamine 10 lrg/kg/min early in the course of the disease is recommended. (2) LV diastolic and systolic functions are depressed in mild HMD, and dobutamine can correct the dysfunction; however; RV diastolic function is not disturbed in mild HMD (3) CBFV is not significantly different between preterm infants vvith or without mild HMD; dobutamine hasnigligible effect on CBPV, but it increases.CBE acceleration: (4) As tepartun hemorrhage, mode of delivery, sex, gestational age, and asphyxia are independently associated with the development of HMOwoRDB Dobutamine prevent infants, hyalin"membranes', rardiovascular involvecerebral blood flow"

"The authors performed 5-year prospective follow-up (retention rate = 92%) with an ethnically diverse sample of girls, aged 11-18 years, who had been diagnosed in childhood with attention-deficit/ hyperactivity disorder (ADHD; N = 140) and a matched comparison group (N = 88). Hyperactive-impulsive symptoms were more likely to abate than inattentive symptoms. Across multiple domains of symptoms and functional impairment, girls with ADHD continued to display deficits of moderate to large effect size in relation to the comparison girls, but few differences emerged between the inattentive versus combined types. Follow-up effects withstood statistical control of crucial covariates for most outcomes, meaning that there were specific effects of childhood ADHD on follow-up status; in other instances, baseline disruptive disorders accounted for adolescent effects. For outcomes identical at baseline and follow-up, girls with ADHD showed more improvement across time than comparison girls (except for math achievement). Overall, ADHD in girls portends continuing impairment 5 years after childhood ascertainment."

"Latar belakang: Prosedur Fontan merupakan tindakan pembedahan bagi penyakit PJB dengan fungsi ventrikel tunggal. Angka mortalitas pasca operasi Fontan di negara maju cukup rendah, sementara di Indonesia berkisar antara 8.6-9.1 . Perbedaan struktur dan karakteristik VKa dan VKi berakibat pada perbedaan kesiapan memerankan fungsi pompa sistemik pada fisiologi PJB dengan ventrikel tunggal dan luaran klinis pascaoperasi Fontan. Pengaruh jenis morfologi ventrikel sistemik terhadap kelangsungan hidup jangka menengah ataupun panjang saat ini masih kontroversial.Tujuan: Mengetahui pengaruh jenis morfologi ventrikel sistemik dan faktor-faktor lain terhadap kelangsungan hidup 10 tahun pasien pascaoperasi Fontan.Metode: Penelusuran data registri, konferensi bedah, rekam medis, laporan bedah, ekokardiografi dan kateterisasi, serta follow up pasien per telepon dilakukan pada 162 pasien yang keluar hidup setelah perawatan pertama pascaoperasi Fontan pada periode 2008 - Februari 2018. Analisis waktu terjadinya event ditentukan berdasarkan titik awal dan titik akhir penelitian. Hasil: Subjek penelitian dibagi menjadi 2 kelompok berdasarkan morfologi ventrikel sistemik, yaitu 74 kasus dengan morfologi VKi dominan dan 88 pasien dengan morfologi VKa dominan. Jenis morfologi ventrikel sistemik tidak berpengaruh terhadap kelangsungan hidup 10 tahun pasien pascaoperasi Fontan. Tromboemboli pascaoperasi berpengaruh terhadap kelangsungan hidup 10 tahun pascaoperasi Fontan HR 4.84, IK 95 1.26-18.55, p = 0.021 Kesimpulan: Jenis morfologi ventrikel sistemik tidak berpengaruh terhadap kelangsungan hidup 10 tahun pasien pascaoperasi Fontan. Namun komplikasi tromboemboli pascaoperasi meningkatkan risiko kematian sebesar 4.84 kali lipat setelah prosedur Fontan.

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Background Fontan procedure has been applied to many patients with single ventricle physiology with quite low mortality rate all over the world, with 8.6 9.1 rate in Indonesia. Structure and characteristic difference of morphologically left and right ventricle influence systemic ventricle role of functionally univentricular heart and impacts on postoperative outcomes. The question regarding mid and long term survival based on dominant ventricle morphology remains controversial. Objectives To investigate the impact of dominant ventricle morphology on ten year survival after Fontan procedure.Methods 162 patients who underwent Fontan operation at our institution between 2008 and February 2018 and survived after first hospital postoperative care were reviewed and followed up until March 2018. Data were extracted from registry and pediatric surgical conference, medical record, surgery report, echocardiography, catheterization report, and follow up call at the end of time cohort. Median follow up period was 816 340 1660 days.Results Subjects are divided into 2 groups based on dominant ventricle morphology. Seventy four patients are included in left morphology group and 88 patients in right morphology group. There were no difference on 10 year survival rate after Fontan between the two type of dominant ventricle morphology. Postoperative thromboembolic event influenced 10 year survival rate after Fontan procedure HR 4.84, CI 95 1.26 18.55, p 0.021 Conclusion Dominant ventricle morphology was not associated with 10 year survival rate after Fontan procedure. Postoperative thromboembolic event increase mortality risk 4.84 times higher after Fontan procedure. "

"Transposition of Great Arteries (TGA) adalah kelainan penyakit jantung bawaan sianotik kedua yang paling sering ditemukan. Tatalaksana definitif saat ini adalah Arterial Switch Operation (ASO). Angka mortalitas pasca ASO di negara maju cukup rendah, sementara di negara berkembang sekitar 15%. Pada TGA Intact Ventricular Septum (TGA IVS), sebaiknya ASO dilakukan ≤ 3 minggu. Sedangkan, di negara berkembang, karena berbagai hal multifaktorial, ASO sering dilakukan saat usia > 3 minggu. Pengaruh usia saat operasi > 3 minggu terhadap kelangsungan hidup jangka panjang sampai saat ini masih kontroversial. Penelitian ini bertujuan untuk mengetahui pengaruh usia saat operasi > 3 minggu terhadap kelangsungan hidup 10 tahun pasien TGA yang menjalani operasi ASO. Penelitian ini merupakan studi kohort retrospekstif yang dilakukan pada pasien TGA IVS yang keluar hidup setelah operasi ASO selama periode Januari 2008-Desember 2018. Pasien kemudian dilakukan follow up untuk mengetahui kondisi hidup dan meninggal. Analisis waktu terjadinya event ditentukan berdasarkan titik awal dan titik akhir penelitian. 71,9 % pasien menjalani operasi ASO > 3 minggu. Angka kelangsungan hidup 10 tahun keseluruhan pasien pasca operasi Arterial Switch Operation sebesar 90%. Walaupun mean survival time kelompok usia operasi ≤ 3 minggu lebih panjang dibandingkan dengan kelompok usia operasi > 3 minggu (113 bulan vs 107 bulan), tetapi secara statistik tidak berbeda bermakna. Usia saat operasi > 3 minggu mempunyai risiko meningkatkan risiko kematian sebesar HR 0,49 (IK95% 0,11-2,27; p=0.86).

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Transposition of Great Arteries (TGA) is the second most common found cyanotic congenital heart disease. The current definitive management is Arterial Switch Operation (ASO). Early and long term mortality rates after ASO in developed countries are quite low, while in developing countries the number is around 15%. In TGA Intact Ventricular Septum (TGA IVS), ASO should be done in ≤ 3 weeks. However, in developing countries, due to various multifactorial causes, it is often being done at the age of > 3 weeks. The effect of age at surgery > 3 weeks on long-term survival is still controversial. This study aims to determine the effect of age at surgery and other factors on the 10-year survival of patients after ASO. A retrospective cohort study was done on TGA IVS patients that survived ASO surgery during the period of January 2008-December 2018. Patients were being followed up to find out if they are still alive. Analysis of the time to evaluate the event is determined based on the starting point and end point of the study. 71,9% patients underwent ASO surgery > 3 weeks. The overall 10-year survival rate of patients after Arterial Switch Operation is 90%. Even though the mean survival time of the operating age group ≤ 3 weeks is longer than the operation age group > 3 weeks (113 months vs 107 months), but it is not statistically significant. Age at surgery > 3 weeks had a risk of increasing the risk of death by HR 0,49 (IK95% 0,11-2,27; p=0.86).

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