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"Latar belakang. Indonesia merupakan salah satu dari 11 negara di dunia yang memiliki angka kelahiran prematur terbanyak. Salah satu morbiditas bayi prematur yang umum dijumpai adalah anemia. Hal ini menyebabkan mereka sering mendapatkan transfusi darah di minggu-minggu pertama kehidupannya. Mencegah beratnya anemia akan mengurangi kemungkinan tranfusi dan risiko komplikasinya. Tujuan. Mengetahui karakteristik bayi prematur yang mengalami anemia sebelum usia kronologis 4 minggu di unit Perinatologi Departemen Ilmu Kesehatan Anak RSCM Jakarta. Metode. Studi deskriptif retrospektif terhadap rekam medis semua bayi baru lahir prematur yang menjalani perawatan di unit perinatologi RSCM periode 1 Januari 2012 sampai dengan 31 Desember 2013. Pemilihan subyek penelitian secara simple random sampling. Penilaian karakteristik bayi prematur meliputi kadar Hb, berat lahir, usia gestasi, riwayat tranfusi PRC, status sepsis, lama rawat dan status keluar. Hasil. Sebanyak 393 subjek memenuhi kriteria penelitian, terdapat 94 (23,9%) subjek yang mengalami anemia dan 123 (31,3%) subjek yang mendapatkan transfusi PRC minimal satu kali. Frekuensi tersering anemia adalah 4 kali sedangkan frekuensi tersering pemberian PRC adalah 7 kali. Usia pertama kali anemia paling banyak ditemukan pada usia ≤7 hari (66%) serupa halnya dengan usia pertama kali mendapatkan transfusi PRC (51,2%). Perbedaan proporsi karakteristik antara bayi prematur yang mengalami anemia dengan yang tidak mengalami anemia menunjukkan hasil yang bermakna secara statistik pada variabel jenis kelamin, usia gestasi, berat lahir, transfusi PRC, status sepsis, lama rawat, dan status keluar. Hampir sama dengan hal tersebut, perbedaan proporsi karakteristik bayi prematur yang mendapatkan transfusi PRC dengan yang tidak mendapatkan transfusi PRC menunjukkan hasil yang bermakna secara statistik pada variabel usia gestasi, berat lahir, status sepsis, lama rawat, dan status keluar. Simpulan. Insidens bayi prematur yang mengalami anemia adalah 23,9% sedangkan insidens transfusi PRC adalah 31,3%. Kejadian anemia dan transfusi PRC paling banyak dialami pada satu minggu pertama kehidupan. Perbedaan proporsi antar variabel untuk kejadian anemia dan kejadian transfusi PRC secara statistik bermakna ditemukan pada variabel yang sama yaitu usia gestasi, berat lahir, status sepsis, lama rawat, dan status keluar.

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Background. Indonesia is one of 11 countries with high number of premature birth rate. One of the morbidity commonly seen ini premature infants is anemia This cause frequent blood transfusion on their first weeks of life. Anemia prevention will reduce transfusion and its complication.

Objectives. To study characteristics of premature infants with anemia before 4 weeks chronological age in Perinatology Unit Cipto Mangunkusumo Hospital, Jakarta.

Methods. A retrospective descriptive study from medical records of premature infants who had hospitalized from January 1st 2012 until Desember 31st 2013 in Perinatology Unit Cipto Mangunkusumo Hospital, Jakarta. Subjects was selected by simple random sampling. Characteristics evaluation include Hb concentration, birth body weight, gestational age, length of stay, history of PRC transfusion, septic status, and discharge status.

Results. There were 393 subjects fulfilled research criteria. Incidence of anemia was 23,9%, while PRC transfusion was done in 31,3% subjects. The most frequent anemia episode is 4 times and PRC transfusion is 7 times. First episode anemia is mostly found at age ≤7 days (66%) as well as PRC transfusion (51,2%). Proportion difference of characteristic between premature infants with anemia and not anemia revealed statistically significant in gestational age, birth weight, PRC transfusion, septic status, length of stay, and discharge status. Proportion difference of premature infants with PRC transfusioan also statistically significant in gestational age, birth weight, PRC transfusion, septic status, length of stay, and discharge status.

Conclusions. Incidence of anemia in premature infants 23,9% while incidence of PRC transfusion is 31,3%. Anemia and PRC transfusion most frequently happened at first week of life. Characteristic proportion difference with significant result between premature infants who had anemia and got PRC transfusion was similar in gestational age, birth weight, PRC transfusion, septic status, length of stay, and discharge status."

"Latar belakang: Bayi prematur rentan kekurangan zat besi karena cadangan besi ibu rendah, kebutuhan besi untuk pertumbuhan dan pengambilan sampel laboratorium. Risiko tersebut meningkat saat bayi prematur berusia 2 bulan. Kecukupan zat besi tubuh dinilai dengan kadar feritin, besi serum (SI), saturasi transferin (Tfsat), total iron binding capacity (TIBC) dan Hb.Tujuan: Mengetahui profil besi pada bayi prematur usia kronologis 2 bulan.Metode: Studi potong lintang dilakukan terhadap bayi usia 2 bulan yang lahir usia gestasi (UG) 32-36 minggu saat berkunjung ke klinik tumbuh kembang. Pemeriksaan darah tepi lengkap, apusan darah tepi, SI, TIBC, Tfsat dan feritin dilakukan pada sampel darah vena. Data lain diperoleh dari wawancara dan telaah rekam medik.Hasil : Studi diikuti oleh 83 subjek yang terdiri dari 51% lelaki dan 93% lahir dari ibu berusia >20 tahun. Berat lahir terkecil adalah 1.180 g dan terbesar adalah 2.550 g. Prevalens ADB sebesar 6% dan DB sebesar 10%. Subjek ADB memiliki kadar Hb terendah 6,8 g/dL dan feritin terendah 8,6 ng/mL. Median kadar SI adalah 48 μg/dL; TIBC 329 μg/dL dan Tfsat 17%. Bayi ADB sebagian besar lelaki (5/5), kenaikan BB ≥2x berat lahir (4/5), tidak disuplementasi besi (3/5), latar belakang pendidikan ibu rendah (3/5) dan golongan sosial-ekonomi rendah- menengah ke bawah (3/5).Simpulan: Prevalens ADB sebesar 6% dan DB sebesar 10%. Sebagian besar subjek yang mengalami DB dan ADB memiliki kadar SI, Tfsat dan feritin rendah serta TIBC meningkat. Subjek lelaki dengan kenaikan BB ≥2x berat lahir, tidak disuplementasi besi, latar belakang pendidikan ibu rendah dan golongan sosial ekonomi rendah-menengah ke bawah lebih banyak yang mengalami ADB.

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Background: Preterm infants are vulnerable to iron deficiency (ID) due to lack of maternal iron stores, phlebotomy and increasing demand during growth. Risk of ID increases when hemoglobin (Hb) level started to decrease at 2 months of age. Iron body adequacy is measured by examining feritin, serum iron (SI), transferrin saturation, total iron binding capcity (TIBC) and Hb.Objective: To describe iron profile in preterm infants at 2 months of chronological age (CA).Methods: A cross-sectional study was conducted to 2 months old infants born at 32-36 gestational age visiting Growth and Development Clinics. Parents interview and medical record review were taken at visit. Complete blood count, blood smear, SI, TIBC, Tfsat and ferritin level were performed.Results: Eighty three subjects were enrolled in this study. Mostly were male (51%) and born from mother >20 years old (93%). The lowest birth weight was 1,180 g and the highest was 2,550 g. Prevalence of IDA is 6% and ID is 10%. The lowest Hb level found in IDA infants was 6.8 g/dL and ferritin level was 8.6 ng/mL. Median of SI level was 48 μg/dL; TIBC 329 μg/dL; and Tfsat 17. Subjects with IDA were mostly men (5/5), achieved more than twice birth weight (4/5), non-iron supplemented (3/5), born from low education background mother (3/5) and has low socio-economic status (3/5).Conclusions: Prevalence of IDA is 6% and ID is 10%. Most subjects with ID and IDA have low SI, high TIBC, low Tfsat and low ferritin level. Male subjects who weigh ≥twice birth weight, non-iron supplemented, born form low educational background and socioeconomic status mother were mostly suffer from IDA."

"[ABSTRAKBayi prematur dapat mengalami hambatan kenaikan berat badan yang disebabkan oleh usia gestasi, penyakit penyerta, dan pengalaman nyeri atau stres. Hambatan kenaikan berat badan dapat diatasi dengan asuhan keperawatan yang tepat dalam pemenuhan kebutuhan nutrisi pada bayi prematur. Asuhan keperawatan dengan Model Konservasi Levine telah digunakan pada aplikasi praktik residensi di Ruang Neonatus Rumah Sakit Cipto Mangunkusumo dalam menganalisis kenaikan berat badan bayi prematur pada lima kasus terpilih mulai dari Bulan Maret-Mei tahun 2015. Analisis kasus didapatkan dari tahap pengkajian, tropikognosis, hipotesis, intervensi, dan evaluasi. Tropikognosis yang telah teridentifikasi yaitu risiko gangguan pemenuhan kebutuhan nutrisi. Intervensi telah dilakukan berdasarkan prinsip konservasi dan hasil evaluasinya yaitu bayi prematur mengalami kenaikan berat badan dengan konservasi energi. Kenaikan berat badan pada bayi prematur menunjukkan keberhasilan dari penerapan asuhan keperawatan berbasis Model Konservasi Levine.

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ABSTRACTThe preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine?s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine?s Conservation Model. ;The preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine?s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine?s Conservation Model. , The preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine’s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine’s Conservation Model. ]"

"Karya ilmiah akhir ini memberikan gambaran penerapan Model Konservasi Levine pada asuhan keperawatan pada bayi dengan risiko kerusakan integritas kulit dan pencapaian kompetensi sebagai spesialis keperawatan anak. Trophicognosis risiko kerusakan integritas kulit menurut Levine merupakan gangguan pada integritas struktur. Intervensi keperawatan dilakukan untuk mengatasi masalah integritas struktur tersebut dengan memperhatikan pula konservasi energi, konservasi integritas personal dan konservasi integritas sosial. Intervensi dilakukan dengan menerapkan aspek perawatan kulit dan cara memposisikan yang benar. Evaluasi yang dilakukan dengan mengkaji respon organismik bayi, menunjukkan bahwa belum semua bayi mampu mencapai wholeness yang ditandai dengan cedera pada nares, namun sudah mengalami perbaikan. Perawat memegang peranan yang sangat penting dalam pencegahan cedera pada nares yaitu pemilihan alat yang tepat, pemantauan dan pemenuhan kenyamanan bayi sehingga bayi tidak banyak bergerak dan mempercepat proses penyapihan continuous positive airway pressure (CPAP).

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This Final Assignment gave an overview about the application of Levine's Conservation Model in nursing care of baby with risk of skin integrity breakdown and competency achievement as a pediatric nurse specialist. According to Levine, trophicognosis of skin integrity breakdown was the structure integrity impaiment. Nursing interventions was undertaken to solve structure integrity problem, and also energy conservation, personal conservation and social conservation. Nursing interventions applied the skin care aspetcs and positioning. Evaluation had been done by evaluate the organismic responses of the baby, showed that not all the baby got wholenes, was marked by nares injury, but getting better. Nurse had the crucial role to prevent nares injury, that to choise the appropriate tool, monitored ang gave baby’s comfort so the baby did not much to move and weaned the continuous positive airway pressure (CPAP) as soon as possible."

"Kelahiran preterm merupakan penyebab tertinggi kematian pada bayi. Angka preterm di negara berkembang masih tinggi dan terus meningkat. Oleh sebab itu, dibutuhkan penelitian untuk mengetahui prevalensi kelahiran preterm di Indonesia beserta anemia pada ibu sebagai salah satu faktor risiko. Desain penelitian ini adalah potong lintang menggunakan data sekunder yang diperoleh dari rekam medis ibu yang melahirkan di RSCM tahun 2011. Data diambil dengan jumlah sampel 2.184 ibu dan diuji dengan uji kai-kuadrat untuk menentukan ada atau tidaknya hubungan kelahiran preterm dan anemia pada ibu. Hasil penelitian menunjukkan prevalensi anemia pada ibu melahirkan di RSCM tahun 2011 adalah 29,1% dan prevalensi kelahiran preterm di RSCM tahun 2011 adalah 26,9%. Pada uji kai-kuadrat, didapatkan terdapat perbedaan bermakna (nilai p<0,001) antara kelahiran preterm dengan anemia pada ibu melahirkan di RSCM tahun. Dapat disimpulkan bahwa terdapat perbedaan bermakna antara anemia pada ibu dengan kelahiran preterm.

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Preterm labor is one of the highest causes of babies’ mortality. Prevalence of preterm in developing countries is still high and keeps growing. Therefore, we need a research to find out prevalence of preterm labor in Indonesia with maternal anemia as one of the risk factors. Research design used is cross-section using secondary data from medical record of patients delivering in RSCM in year 2011. The data had been taken with 2184 mothers as the samples and was tested with chi-square test to reveal if there is association between preterm labor and maternal anemia.

Result of this research shows that prevalence of maternal anemia of patients delivering in RSCM in year 2011 is 29,1% while prevalence of preterm labor in RSCM in year 2011 is 26,9%. From chi-square test, there is significant difference (p<0,001) between preterm labor with maternal anemia of patients delivering in RSCM in year 2011. We conclude that there is significant difference between maternal anemia and preterm labor."

"Pelibatan ibu dalam perawatan bayi prematur merupakan salah satu komponen konsep family centered care. Penelitian ini bertujuan untuk mengidentifikasi pengaruh pelibatan ibu terhadap interaksi ibu-bayi dan kepercayaan diri ibu dalam merawat bayi prematur. Desain penelitian yang digunakan adalah kuasi eksperimen one-group pretest-posttest design. Penelitian ini melibatkan 16 orang ibu-bayi yang dipilih dengan teknik konsekutif di ruang Perinatologi RSUP Fatmawati Jakarta selama bulan Mei-Juni 2013. Hasil analisis statistik menunjukkan bahwa skala interaksi ibu-bayi dan kepercayaan diri ibu meningkat secara signifikan (p=0,0005). Hasil penelitian ini merekomendasikan upaya peningkatan pelibatan ibu dalam perawatan bayi prematur di ruang Perinatologi.

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Mothers involvement in premature infant care is a component of the family centered care. The purpose of this study was to identify the impact of mothers involvement on mother-infant interactions and maternal confidence in premature infant care. This study used a quasy experimental with one-group pretest-posttest design. Sixteen partisipants were choosed using consecutive sampling technique in Neonatal Unit Level I-II RSUP Fatmawati Jakarta during May-June 2013. The result of statistic analysis showed that mother-infant interactions scale and maternal confidence increase significantly (p=0,0005). This study recommends the improvement of mothers involvement in premature infant care in neonatal unit."

"Intoleransi minum merupakan masalah yang umum terjadi pada bayi prematur. Tujuan penulisan Karya Ilmiah Akhir ini adalah memberikan gambaran penerapan Model Konservasi Levine pada bayi prematur dengan intoleransi minum dan gambaran pelaksanaan Praktik Residensi Keperawatan Anak. Model Konservasi Levine berfokus pada peningkatan adaptasi melalui prinsip konservasi untuk mencapai integritas diri. Penerapan Model Konservasi Levine tertuang dalam lima kasus terpilih. Pada lima kasus terpilih tersebut ditemukan masalah gangguan pemenuhan kebutuhan nutrisi yang disebabkan oleh intoleransi minum. Adapun masalah keperawatan lainnya adalah bersihan jalan napas tidak efektif, gangguan pola napas, gangguan termoregulasi, risiko infeksi, risiko gangguan perkembangan dan gangguan proses keluarga. Masalah-masalah tersebut dapat memperberat intoleransi minum dan menghambat proses pemulihan pada bayi prematur. Asuhan keperawatan pada kasus terpilih diberikan oleh residen dengan melaksanakan perannya sebagai pemberi asuhan, pendidik, konsultan, koordinator, pengambil keputusan etik, legal, dan sebagai peneliti.

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Feeding intolerance is a common problem in premature infants. The purpose of this Final Scientific Work is to describe the application of Levine Conservation Model in preterm infants with feeding intolerance and the implementation of Pediatric Nursing Residency Practice. Levine Conservation Model focuses on the adaptation improvement through conservation principles to achieve wholeness. Levine Conservation Model was implemented in five selected cases. In the five selected cases, there was a nutritional intake problem caused by feeding intolerance. The other problems were ineffective airway clearance, ineffective breathing pattern, ineffective thermoregulation, risk for infection, risk for developmental disorder and altered family process. These problems can aggravate the feeding intolerance and inhibit the healing process of premature infants. The nursing care to selected cases was given by the resident by implementing the roles as a caregiver, an educator, a consultant, a coordinator, an ethical and legal decision maker, and a researcher."

"Intoleransi minum merupakan masalah yang umum terjadi pada bayi prematur Tujuan penulisan Karya Ilmiah Akhir ini adalah memberikan gambaran penerapan Model Konservasi Levine pada bayi prematur dengan intoleransi minum dan gambaran pelaksanaan Praktik Residensi Keperawatan Anak Model Konservasi Levine berfokus pada peningkatan adaptasi melalui prinsip konservasi untuk mencapai integritas diri Penerapan Model Konservasi Levine tertuang dalam lima kasus terpilih Pada lima kasus terpilih tersebut ditemukan masalah gangguan pemenuhan kebutuhan nutrisi yang disebabkan oleh intoleransi minum Adapun masalah keperawatan lainnya adalah bersihan jalan napas tidak efektif gangguan pola napas gangguan termoregulasi risiko infeksi risiko gangguan perkembangan dan gangguan proses keluarga Masalah masalah tersebut dapat memperberat intoleransi minum dan menghambat proses pemulihan pada bayi prematur Asuhan keperawatan pada kasus terpilih diberikan oleh residen dengan melaksanakan perannya sebagai pemberi asuhan pendidik konsultan koordinator pengambil keputusan etik legal dan sebagai peneliti.

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Feeding intolerance is a common problem in premature infants The purpose of this Final Scientific Work is to describe the application of Levine Conservation Model in preterm infants with feeding intolerance and the implementation of Pediatric Nursing Residency Practice Levine Conservation Model focuses on the adaptation improvement through conservation principles to achieve wholeness Levine Conservation Model was implemented in five selected cases In the five selected cases there was a nutritional intake problem caused by feeding intolerance The other problems were ineffective airway clearance ineffective breathing pattern ineffective thermoregulation risk for infection risk for developmental disorder and altered family process These problems can aggravate the feeding intolerance and inhibit the healing process of premature infants The nursing care to selected cases was given by the resident by implementing the roles as a caregiver an educator a consultant a coordinator an ethical and legal decision maker and a researcher"

"Pelibatan ibu dalam perawatan bayi prematur merupakan salah satu komponen konsep family centered care. Penelitian ini bertujuan untuk menguji pengaruh pelibatan ibu terhadap interaksi ibu dan bayi dan kepercayaan diri ibu dalam merawat bayi prematur. Desain penelitian yang digunakan adalah kuasi eksperimen one-group pretest-posttest. Penelitian ini melibatkan 16 orang ibu dan bayinya yang dipilih dengan teknik konsekutif di ruang Perinatologi di sebuah RSUP di Jakarta, selama sebulan. Instrumen yang digunakan untuk menilai interaksi ibu-bayi adalah terjemahan Modified Observation of Communication Interaction dan kepercayaan diri ibu diukur menggunakan Maternal Confidence Questionaire yang juga diterjemahkan. Hasil analisis statistik menunjukkan bahwa skala interaksi ibu-bayi dan kepercayaan diri ibu meningkat secara signifikan (p= 0,0005). Hasil penelitian ini merekomendasikan upaya peningkatan pelibatan ibu dalam perawatan bayi prematur di ruang Perinatologi.

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Enhancement of Mother-Infant Interaction and Maternal Confidence: The Impact of Mother Involvement in Infant Care in the Neonatology Unit. Mothers? involvement in premature infant care is one of components of the family centered care. The purpose of this study was to examine the impact of mothers? involvement on mother-infant interactions and maternal confidence in premature infant care. This study used a quasy experimental with one-group pretest-posttest design. Sixteen participants were selected using consecutive sampling technique in Neonatal Unit Level I-II in General Hospital in Jakarta during one month. Modified Observation of Communication Interaction was translated in to Indonesian and used to observe mother-infant interaction and maternal confidence measured by translated Maternal Confidence Questionaire. The result of statistic analysis showed that mother-infant interactions scale and maternal confidence increase significantly (p= 0.0005). This study recommends the improvement of mothers? involvement in premature infant care in neonatal unit."

"Tesis ini bertujuan untuk mengetahui pengaruh pemberian stimulasi auditorivisual-taktil-kinestetik terhadap perkembangan perilaku neonatus prematur di ruang perinatologi RSCM Jakarta. Penelitian ini adalah penelitian quasi experiment dengan disain one group pre and post test. Sampel penelitian berjumlah 18 responden. Hasil penelitian terdapat perbedaan yang signifikan antara perilaku neonatus prematur sebelum dan setelah diberi stimulasi (p = 0,0005). Hasil seleksi bivariat menunjukkan bahwa usia gestasi, berat badan lahir dan jenis kelamin bukan merupakan faktor perancu pada perilaku neonatus prematur setelah diberi stimulasi. Hipotesis berupa adanya pengaruh pemberian stimulasi auditori-visual-taktil-kinestetik terhadap perkembangan perilaku neonatus prematur dapat dibuktikan dalam penelitian ini.

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This thesis aims to investigate the influence of stimulation of auditory-visualtactile-kinesthetic to the behaviour development of premature neonate. This study is a quasi-experimental research with one group pre and post test design. The samples were 18 respondents. The results there are significant differences between the behavior of preterm neonates before and after a given stimulation (p = 0.0005).

Bivariate selection results showed that gestational age, birth weight and gender is not a confounding factor in the premature neonate behavior after a given stimulation. The hypothesis of the existence of the effect of stimulation of auditory-visual-kinesthetic-tactile to the development of a premature neonate behavior could be demonstrated in this study."