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"[ABSTRAKLatar belakang. Sepsis neonatorum awitan dini (SNAD) adalah sindrom klinisakibat respon sistemik terhadap infeksi pada awal kehidupan. Diagnosis SNADseringkali sulit karena gejala klinisnya tidak spesifik.Tujuan. Mengetahui sensitivitas dan spesifisitas biakan usap telinga dalamdiagnosis SNAD.Metode. Subjek penelitian adalah neonatus yang lahir di RSCM Jakarta dan RSUTangerang Selatan dengan diagnosis SNAD. Dilakukan pengambilan biakan dariusapan telinga dan darah bayi.Hasil. Diantara 50 subjek, terdapat 2 neonatus dengan biakan darah positif, dan 32neonatus dengan biakan usap telinga positif. Hanya 1 subjek yang memilikikesesuaian jenis kuman yang tumbuh dari biakan darah dan biakan usap telinga.Bakteri yang tumbuh pada biakan usap telinga sebagian besar adalah Gram postif(62%). Biakan usap telinga mempunyai sensitivitas 64,7%, spesifisitas 36,4%,nilai duga positif 34,3%, nilai duga negatif 66,6%, rasio kemungkinan positif1,02, rasio kemungkinan negatif 0,97, dan, akurasi 46% untuk mendeteksi SNAD.Simpulan. Ditemukan hasil biakan darah positif pada 2 subjek. Biakan usaptelinga memiliki sensitivitas 64,7%, spesifisitas 36,4%, nilai duga positif 34,3%,nilai duga negatif 66,6%, rasio kemungkinan positif 1,02, rasio kemungkinannegatif 0,97, dan akurasi 46% untuk mendeteksi SNAD.

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ABSTRACTBackground. Early-onset neonatal sepsis (EOS) is a clinical syndrome due tosystemic response to infection in early life. EOS is often difficult to diagnosedbecause the clinical symptoms are not specific.Objective. The study aim to determine sensitivity and specificity of ear swabsculture in the diagnosis of EOS.Methods. Neonates born in the CMH Jakarta and Tangerang Selatan Hospitalwho developed sepsis were studied. Swabs were collected for culture from baby’sear. Bacterias isolated from ear swabs cultured were correlated with those fromblood culture.Results. Among 50 neonates studied, 2 neonates had positive blood cultured and32 neonates had positive ear swabs cultured. Only one subject had suitabilitytypes of bacterias that grew from blood and ear swabs. Bacteria grew from earswab cultured were predominantly Gram-positive (62%). Ear swabs cultured hadsensitivity 64.7%, specificity 36.4%, positive predictive value (PPV) 34.3%,negative predictive value (NPV) 66.6%, positive likelihood ratio (PLR) 1.02,negative likelihood ratio (NLR) 0.97, and accuracy 46% to detect EOS.Conclusions. This study showed positive blood culture results were found in twosubjects. Ear swabs cultured had a sensitivity 64.7%, specificity 36.4%, PPV34.3%, NPV 66.6%, PLR 1.02, NLR 0.97, and accuracy 46% to detect EOS, Background. Early-onset neonatal sepsis (EOS) is a clinical syndrome due tosystemic response to infection in early life. EOS is often difficult to diagnosedbecause the clinical symptoms are not specific.Objective. The study aim to determine sensitivity and specificity of ear swabsculture in the diagnosis of EOS.Methods. Neonates born in the CMH Jakarta and Tangerang Selatan Hospitalwho developed sepsis were studied. Swabs were collected for culture from baby’sear. Bacterias isolated from ear swabs cultured were correlated with those fromblood culture.Results. Among 50 neonates studied, 2 neonates had positive blood cultured and32 neonates had positive ear swabs cultured. Only one subject had suitabilitytypes of bacterias that grew from blood and ear swabs. Bacteria grew from earswab cultured were predominantly Gram-positive (62%). Ear swabs cultured hadsensitivity 64.7%, specificity 36.4%, positive predictive value (PPV) 34.3%,negative predictive value (NPV) 66.6%, positive likelihood ratio (PLR) 1.02,negative likelihood ratio (NLR) 0.97, and accuracy 46% to detect EOS.Conclusions. This study showed positive blood culture results were found in twosubjects. Ear swabs cultured had a sensitivity 64.7%, specificity 36.4%, PPV34.3%, NPV 66.6%, PLR 1.02, NLR 0.97, and accuracy 46% to detect EOS]"

"Latar Belakang:. Sepsis neonatorum awitan dini masih menjadi penyebab kesakitan dan kematian yang utama pada neonatus, dengan angka lebih tinggi terjadi pada bayi kurang bulan. Berbagai faktor diketahui berhubungan dengan kejadian sepsis neonatorum awitan dini, namun penelitian yang dilakukan pada bayi prematur masih terbatas. Tujuan:. Mengetahui faktor-faktor risiko yang berhubungan dengan kejadian sepsis neonatorum awitan ini pada bayi kurang bulan di RSCM.Metode:. Penelitian desain case-control dengan mengambil data dari rekam medis bayi lahir kurang bulan di RSCM pada rentang waktu Januari 2016-Desember 2017 sebanyak 186 sampel (93 untuk masing-masing kelompok). Data dianalisis secara bivariat dan multivariat.Hasil: Terdapat perbedaan bermakna dari karakteristik bayi kurang bulan antara kelompok kasus dan kontrol yaitu usia gestasi, jenis kelamin laki-laki, dan berat lahir. Gejala klinis tersering ditemukan adalah sesak napas. Dari 7 faktor yang dianalisis, infeksi intrauterin, nilai APGAR 1 menit pertama, dan nilai APGAR 5 menit pertama pada analisis bivariat dimasukkan ke analisis multivariat (p<0,25) sementara pada faktor lainnya tidak ditemukan hubungan yang bermakna. Pada analisis multivariat, ditemukan bahwa jenis kelamin laki-laki, usia gestasi, infeksi intrauterin, dan nilai APGAR 1 menit pertama memiliki hasil yang bermakna secara statistik.Kesimpulan: Jenis kelamin laki-laki, usia gestasi, infeksi intrauterin, dan nilai APGAR 1 menit pertama merupakan faktor risiko independen sepsis neonatorum awitan dini pada bayi kurang bulan. Penelitian lebih lanjut dibutuhkan untuk mengetahui pengaruh faktor-faktor tersebut terhadap kejadian sepsis neonatorum awitan dini pada bayi kurang bulan.

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Background: Early onset neonatal sepsis is still considered as a common cause of morbidity and mortality in neonates, with a higher prevalence found in preterm infants. Many factors are known to be correlating to the cases of early onset neonatal sepsis, but research done specifically in preterm infants is limited.

Objective: To determine the factors associated with early onset neonatal sepsis in preterm infants.

Method: This research was done using a case-control design, where the data is taken from the medical record of preterm patients born in RSCM within January 2016-December 2017. The total sample is 186 (93 for each group). Data was then analyzed using bivariate and multivariate analysis.

Result: A significant result was found in characteristic such as gestational age, gender, and birth weight. Out of 7 factors that were analysed, the factors that were analysed using multivariate analysis were intrauterine infection, low APGAR score in the first minute, and low APGAR score in the fifth minute. From multivariate analysis, gender, gestational age, intrauterine inflammation, and low APGAR score in the first minute were stastically significant.

Conclusion: gender, gestational age, intrauterine inflammation, and low APGAR score in the first minute are independent risk factors for early onset neonatal sepsis. Further study is needed to understand the correlation between those factors and early onset neonatal sepsis in preterm infants."

"Sepsis neonatorum awitan lambat (SNAL) masih menjadi penyebab penting kematian dan kesakitan pada bayi kurang bulan. Diagnosis yang cepat penting untuk penatalaksanaan yang sesuai. Diperlukan alat diagnostik yang sederhana, tidak mahal dan cepat hasilnya untuk mendiagnosis SNAL.Tujuan penelitian ini adalah untuk mendapatkan nilai diagnostik rasio netrofil limfosit (RNL) dan kombinasi RNL dan rasio I/T untuk mendiagnosis SNAL. Data penelitian cross sectional ini diambil dari rekam medis pasien bulan januari 2018-Desember 2019 di Divisi Neonatologi Rumah Sakit Cipto Mangunkusumo. Subyek penelitain adalah bayi kurang bulan >30-36 minggu, berusia 7-28 hari dengan klinis sepsis. Dari kultur darah, neonatus dibagi menjadi 2 kelompok, yaitu: proven sepsis dan unproven sepsis. Rasio netrofil limfosit dihitung dari data hitung jenis limfosit. Rasio I/T didapat dari rekam medis. Dari semua 126 subyek penelitian 70 termasuk kelompok proven sepsis dan 56 unproven sepsis. Analisis kurva Receiver operating characteristic RNL didapatkan area under the curve 0.953. Dengan cut off RNL 1.785 didapatkan sensitivitas 78,57%, spesifisitas 92,86%, nilai dugan positif (NDP) 93,22% dan nilai duga negative (NDN) 77,61%. Dengan titik potong rasio I/T > 0,2, didapatkan sensitivitas 55,70 %, spesifitas 83,70%, NDP 81,25% dan NDN 60,26%. Gabungan RNL dan rasio I/T meningkatkan sensitivitas dan NDP rasio I/T berturut-turut menjadi 90% dan 84,44%. Sebagai kesimpulan, RNL dengan titik potong 1,785 mempunyai nilai diagnostik yang baik untuk mendiagnosis SNAL. Kombinasi RNL dan rasio I/T akan meningkatkan nilai diagnostik rasio I/T.

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Late-onset neonatal sepsis (LOS) remains an important cause of death and morbidity among preterm infants. Early diagnostic is important for appropiate management. The simple, inexpensive, and rapid diagnostic tool is required to diagnose LOS. The objective of this study is assesing diagnostic value of NLR and combination of NLR and I/T ratio for diagnosis LOS. The data for this retrospective cross-sectional study was collected from medical record from January 2018 to December 2019 at Neonatology Division Cipto Mangunkusumo Hospital. Preterm infants with >30 -36 gestational weeks, 7-28 days of postnatal age and clinically sepsis were eligible for this study. According to the result of blood cultures, all enrolled infant were classified into 2 groups: proven sepsis and unproven sepsis. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Immature-to-total neutrophil ratio was taken from medical record. A total of 126 subjects were involved: 70 proven sepsis and 56 unproven sepsis. Receiver operating curve analysis for NLR calculated and area under the curve of NLR corresponded to 0.953. Using a cut off point of 1.785 for NLR, the sensitivity was 78,57%, the specificity was 92,86%, positive predictive value (PPV) 93,22% and negative predictive value (NPV) 77,61%. Using cut off > 0,2, I/T ratio has sensitivity 55,70 %, specificity 83,70%, PPV 81,25% and NPV 60,26%. The combination NLR and ratio I/T increased sensitivity and PPV of ratio I/T became 90% and 84,44%, respectively.As conclusion The NLR with cut off 1,785 has good diagnostic value for SNAL. Combination NLR and I/T ratio can increase diagnostic value of I/T ratio."

"Latar belakang: Persalinan prematur semakin banyak dan memiliki tingkat morbiditas dan mortalitas yang tinggi. Prematur menyumbang angka kematian tertinggi selain asfiksia, infeksi dan kelainan kongenital. Korioamnionitis merupakan salah satu penyebab persalinan prematur dan berhubungan dengan kejadian sepsis neonatal awitan dini pada bayi prematur atau berat lahir rendah. Penelitian dilakukan untuk mengetahui korioamnionitis sebagai prediktor sepsis neonatal awitan dini.Metode : Penelitian kohort prospektif dilakukan bekerja sama dengan Departemen Obstetri dan Ginekologi RSCM dan RSUD Koja. Pengumpulan sampel dilakukan selama periode Maret-September 2022. Dilakukan evaluasi terhadap gejala klinis dan pemeriksaan penunjang ibu yang terkait korioamnionitis, dihubungkan dengan gejala klinis dan pemeriksaan penunjang bayi terkait sepsis neonatal awitan dini yang dirawat di NICU.Hasil : Insidens korioamnionitis sebesar 90% dan sepsis neonatus awitan dini 16%. Jenis persalinan spontan dan section caesarea dengan KPD tidak berhubungan dengan kejadian korioamnionitis (RR:1,049; IK 95% 0,982-1,120; p=1,000) and (RR:1,091; IK 95% 0,967-1,231; p=1,000).Korioamnionitis tidak berhubungan dengan sepsis neonatal awitan dini dengan p=0,358. Demam pada ibu berhubungan dengan kejadian SNAD EONS (RR:3,333: CI 95% 1,399-7,942; p=0,022)Simpulan : Korioamnionitis bukan prediktor sepsis neonatal awitan dini pada bayi usia gestasi ≤32 minggu atau bayi berat lahir ≤ 1500 gram.

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Background: Increasing number of preterm birth correlated with high morbidity and mortality rates. Prematurity contributed in high mortality rates alongside asphyxia, infections and congenital malformations. Chorioamnionitis were associated with preterm birth and early onset sepsis in preterm or low birth weight infants. Research was aimed to determine chorioamnionitis as a predictor of early onset neonatal sepsis (EONS) in preterm or low birth weight.

Methodes : Multicentre, Cohort prospective study conducted in collaboration with Obstetrics and Gynaecology Department of Cipto Mangunkusumo National Hospital (CMH) and Koja General Hospital. Samples were obtained in NICU Unit during March - September 2022. Maternal clinical symptoms and diagnostic tests for chorioamnionitis evaluated as a predictor to early onset neonatal sepsis.

Results : The incidence of chorioamnionitis and early onset neonatal sepsis were 90% and 16% respectively. Spontaneous and caesarean section delivery with PPROM is not associated with the incidence of chorioamnionitis (RR:1,049; CI 95% 0,982-1,120; p=1,000) and (RR:1,091; CI 95% 0,967-1,231; p=1,000). Chorioamnionitis is not a predictor of early onset neonatal sepsis with p=0,358. Maternal fever is associated with the incidence of EONS (RR:3,333: CI 95% 1,399-7,942; p=0,022).

Conclusion : Chorioamnionitis is not a predictor on early onset neonatal sepsis in gestational age ≤32 weeks or birth weight of ≤ 1500 grams."

"Bayi prematur berisiko tinggi mengalami sepsis neonatorum awitan lambat pada minggu-minggu pertama pasca kelahiran. Tujuan dari studi ini adalah mengaplikasikan Teori Konservasi Levine dalam menurunkan kejadian sepsis neonatorum awitan lambat pada bayi baru lahir prematur dengan pemberian oral care ASI. Proses asuhan keperawatan menggunakan pendekatan Teori Konservasi Levine berdasarkan empat konservasi yaitu konservasi energi, konservasi integritas struktural, konservasi integritas personal dan konservasi integritas sosial. Lima kasus terpilih menunjukkan masalah keperawatan gangguan pertukaran gas, pola nafas tidak efektif, defisit nutrisi, termoregulasi tidak efektif, risiko infeksi dan risiko gangguan perlekatan. Hasil implementasi pemberian oral care ASI dapat menurunkan kejadian sepsis awitan lambat, mempercepat bayi minum penuh dan mempercepat proses penyapihan alat bantu pernafasan. Intervensi ini dapat menjadi standar prosedur operasional bagi perawat dalam memberikan asuhan keperawatan pada bayi baru lahir.

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Premature infants are at high risk for late onset neonatal sepsis in the first few weeks after birth. The aim of this study was to apply the Levine rsquo s Conservation Theory to decrease the incidence of late onset neonatal sepsis in preterm newborns by oral care of ASI. The nursing care process uses the Levine rsquo s Conservation Theory approach based on four conservation, such as conservation of energy, conservation of structural integrity, conservation of personal integrity and conservation of social integrity. Five selected cases indicate nursing problems of gas exchange disorders, ineffective breathing patterns, nutritional deficits, ineffective thermoregulation, infection risk and risk of attachment disturbance. The results of ASI oral care implementation may decrease the incidence of late onset sepsis, accelerate full feed and accelerate the weaning process of respiratory aids. This intervention can be standard operating procedure for nurses in providing nursing care to newborns."

"Latar belakang: Rekomendasi Centers for Disease Control and Prevention (CDC) 2010 (revisi 2002) tidak spesifik memberi panduan dalam pencegahan sekunder sepsis awitan dini (SAD) pada neonatus cukup bulan (NCB), asimtomatik lahir dari ibu yang mengalami KPD < 18 jam.Tujuan: Didapatnya model determinan SAD pada NCB sesuai masa kehamilan (SMK), asimtomatik lahir dari ibu yang mengalami KPD lebih dari 12 jam.Metodologi: penelitian observasional potong lintang untuk mendapatkan model determinan sepsis neonatorum awitan dini (SNAD) yang dilakukan dari Februari 2013 sampai bulan Mei 2014 di RSAB Harapan Kita, RSUD Tarakan, RSIA Budi Kemuliaan. Determinan yang diteliti adalah jenis persalinan, petanda infeksi saluran kemih (ISK) pada ibu, petanda infeksi intra amnion (IIA) seperti demam intrapartum, ibu takikardia, janin takikardia, adanya perubahan warna dan bau cairan ketuban, leukosit darah ibu, dan petanda infeksi darah tali pusat (peningkatan jumlah total leukosit, neutrofil, peningkatan rasio I/T, hs-CRP dan IL-6). Diagnosis sepsis ditegakkan berdasarkan catatan medis bayi yang dipastikan berdasarkan hasil positif biakan darah tali pusat. Model determinan SNAD yang dihasilkan adalah suatu persamaan regresi logistik yang digunakan untuk menentukan probabilitas terjadinya SNAD sebagai acuan terapi antibiotik.Hasil: model determinan SAD pada NCB SMK, asimtomatik lahir dari ibu KPD > 12 jam berupa kalkulator dan sistem skor yang dibentuk dari determinan persalinan per vaginam, perubahan warna dan bau cairan ketuban, leukosit darah ibu, leukosit darah tali pusat, kadar hs-CRP darah tali pusat dan kadar IL-6 darah tali pusat. Model determinan SNAD memiliki dua varian, varian lengkap digunakan untuk fasilitas pelayanan neonatus subspesialistik dan varian alternatif digunakan untuk fasilitas pelayanan spesialistik. Titik potong ideal penentuan probabilitas terjadinya SNAD memiliki sensitivitas di antara 24,2 – 40,3 % dan spesifisitas 87,1 - 94,5 %. Nilai diskriminasi dengan nilai AUC berkisar di antara 0,743 – 0,816 dengan kalibrasi baik berdasarkan uji Hosmer-Lemeshow.Simpulan: Hasil penelitian ini adalah model determinan SAD pada NCB SMK asimtomatik lahir dari ibu yang mengalami KPD > 12 jam, berbentuk kalkulator dan sistem skor yang memiliki varian lengkap dan alternatif untuk menentukan probabilitas terjadinya SNAD sebagai dasar pemberian terapi antibiotik empiris secara rasional.

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Background: Centers for Disease Control and Prevention (CDC) 2010 (revised 2002) recommendations does not specifically provide guidance in secondary prevention of asymptomatic early-onset sepsis (EOS) on term infant born to mother experiencing PROM < 18 hours.

Objective: to develop early-onset neonatal sepsis (EONS) determinant model as a rational basis for determining the empirical antibiotic therapy in asymptomatic, term infant born to mother with PROM > 12 hours.

Method: A cross-sectional observational study to obtain an EONS determinant model which was conducted from February 2013 to May 2014 in RSAB Harapan Kita, Tarakan Hospital, RSIA Budi Kemuliaan. The determinant factor is the type of delivery, marker of maternal urinary tract infection (UTI), intra-amniotic infection markers (intrapartum fever, maternal tachycardia, fetal tachycardia, change in the color and odor of amniotic fluid, maternal blood leukocytes), and umbilical cord blood infection marker (increased the total number of leukocytes, neutrophils, an increase in the ratio of I / T, hs-CRP and IL-6). Early-onset neonatal sepsis was diagnosed base on infant medical record on 72 hours afeter birth and confirmed by the positive results of umbilical cord blood cultures. The resulting of EONS determinants model is a logistic regression equation used to determine the probability of the occurrence of EONS as reference rational basis empirical antibiotic therapy.

Results: The EOS determinants model on asymptomatic term infant born to mothers with PROM> 12 hours is a calculator and scoring system that is formed from the determinant of vaginal delivery, change the color and odor of amniotic fluid, maternal blood leukocytes, cord blood leukocytes, the levels of hs-CRP and IL-6 umbilical cord blood level. Early-onset neonatal sepsis determinant model has two variants, the full variant used for subspecialty neonatal care facilities and alternative variant is used for specialty neonatal care facilities. Ideal cutoff point probability of occurrence SNAD has sensitivity range of 24.2 to 40.3% and specificity of 87.1 to 94.5%. The model performe is good based on Hosmer-Lemeshow test anda discrimination value AUC in in range of 0.743 to 0.816.

Conclusion: The EOS determinant model of asymptomatic term infant born to mothers with PROM > 12 hours is a calculator and scoring system that is used to determine the probability of EONS occurrence as the basis of determining the rational empirical antibiotic therapy."

"Prevalens SNAD NKB < 34 minggu dan atau BLSR di Indonesia masih tinggi. Asuhan antenatal yang tidak adekuat, gejala infeksi saat lahir yang sulit dibedakan dengan prematuritas, dan modalitas diagnostik yang suboptimal membuat diagnosis SNAD pada populasi ini sulit. Presepsin salah satu marker infeksi meningkat saat awal infeksi berpotensi dijadikan salah satu parameter diagnostik SNAD. Tujuan penelitian ini adalah untuk melihat akurasi presepsin sebagai salah satu parameter diagnosis SNAD dan dibandingkan dengan CRP. Studi ini merupakan studi potong lintang terhadap 71 NKB < 34 minggu dan atau BLSR dengan faktor risiko SNAD lebih tinggi atau faktor risiko SNAD rendah yang menunjukkan gejala sepsis di Unit Perinatologi RSCM. Penelitian ini mencari nilai batas presepsin sebagai parameter diagnostik SNAD pada berbagai waktu pengambilan, kemudian membandingkannya dengan CRP. Kurva ROC dikerjakan untuk menentukan nilai batasan optimal presepsin. Penelitian ini mendapat nilai presepsin lebih tinggi pada kelompok SNAD dibandingkan dengan non-sepsis (median 814, 802, dan 693 pg/mL, p<0,05). Presepsin mencapai nilai puncaknya pada T1 sedangkan CRP pada T24. Nilai batas optimal, batas bawah dan batas atas presepsin T1 adalah 621,5, 458, 808 pg/mL. Pada T4 yaitu 733, 518,5, 733 pg/mL serta T24 yaitu 667,5, 556,5, 820,5 pg/mL. Nilai batas presepsin T1 memiliki sensitivitas 82,14%, spesifisitas 81,4%, NDP 74,19%, NDN 87,5%, dan akurasi 81,69%. Sedangkan presepsin T4 memiliki sensitivitas 60,71%, spesifisitas 93,02%, NDP 85%, NDN 78,43% dan akurasi 80,28%. Nilai batasan presepsin T24 memiliki sensitivitas 64%, spesifisitas 86%, NDP 75% dan NDN 78,7% dan akurasi 77,46%. Sebagai kesimpulan, presepsin meningkat sesaat setelah lahir jika terjadi infeksi. Presepsin T1 dapat digunakan sebagai parameter skrining SNAD dengan menggunakan nilai batasan optimal 621,5 pg/mL. Presepsin dengan berbagai nilai batasan tertentu memiliki fungsi yang berbeda dan dapat diaplikasikan ke dalam alur diagnosis dan tata laksana SNAD berdasarkan faktor risiko populasi tersebut.

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Early onset neonatal sepsis prevalence in Indonesia remains high among preterm neonates born at <34 weeks' gestation and or VLBW. Inadequate antenatal care, infectious symptoms at birth that are confusing to distinguish from prematurity, and poor predictive performance of laboratory tests made diagnosis of EOS is wearisome. Presepsin, one of the biomarkers, increases early in onset of infection has potential to become diagnostic tools for EOS. The objective of this study is to find the accuracy of presepsin as one of EOS diagnostic tools and compared it with CRP. This study is a cross-sectional study of of 71 neonates born at < 34 weeks' gestation and or VLBW at higher risk of EOS or at lower risk for EOS that showing some degree of respiratory or systemic instability. Presepsin which was collected in different time interval (T1, T4 and T24), compared to diagnostic criteria of sepsis as the gold standard. The accuracy of CRP with currently cut-off points also analyzed in this study. The ROC curve was performed to determine the optimal cut-off points of presepsin. Presepsin values were higher in the EOS group than in uninfected group at T1(median 814 vs 438 pg/mL; p<0.05) T4 (802 vs 445 pg/mL; p<0.05), and T24 (693 vs 469 pg/ mL; p <0.05). Presepsin achieved best accuracy at T1 and reaches its peak value at T1 while CRP have it at T24. Optimal cut-off points, the lower limit and the upper limit of presepsin at T1 are 621.5, 458, 808 pg/mL. At T4 are 733, 518.5, 733 pg/mL and T24 are 667.5, 556.5, 820.5 pg/mL. With those optimal cut-off value, presepsin has 82.14% sensitivity, 81.4% specificity, 74.19% PPV, 87.5% NPV, and accuracy of 81.69%. Whereas presepsin at T4 has 60.71% sensitivity, 93.02% specificity, 85% PPV, 78.43% NPV and an accuracy of 80.28%. Presepsin at T24 has a sensitivity of 64%, a specificity of 86%, an NDP of 75% and an NDN of 78.7% and an accuracy of 77.46%. In conclusion, presepsin increases shortly after birth in EOS group. Presepsin at T1 can be used as EOS screening tools by using an optimal cut-off value of 621.5 pg/mL. Presepsin with certain boundary values have different functions and perhaps can be applied to the EOS diagnosis and management pathways in RSCM."

"Latar Belakang: Sepsis Awitan Dini (SNAD) merupakan salah satu penyebab terbesar mortalitas neonatus prematur. Riset mengenai SNAD mengatakan bahwa ada faktor ibu yang berasosiasi dengan kemungkinan kasus SNAD. Faktor tersebut adalah, paritas, umur ibu, kelahiran Bedah Kaisar, frekuensi kunjungan antenatal, keputihan patologis, infeksi saluran kemih, ketuban pecah dini, leukositosis ibu, dan preklampsia. Meskipun tinggi angka kelahiran prematur di Rumah Sakit Cipto Mangunkusumo (RSCM), belum ada studi yang mempelajari faktor ibu terhadap SNAD di bayi prematur. Sehingga peneliti berusaha untuk membuat riset yang akan menyajikan data deskriptif dari faktor ibu yang berasosiasi dengan SNAD pada bayi prematur di RSCM pada tahun 2020. Metode: Penilitian kohort retrospeltif ini mengumpulkan 101 kasus kelahiran prematur pada tahun 2020 di RSCM. Dengan persetujuan komite etik, data akan dikumpulkan dari rekam medis dan infromasi mengenai faktor ibu akan diulas. Penelitian ini akan melakukan analitik untuk faktor maternal yang berhubungan dengan SNAD. Hasil: Hasil desrkiptif penilitian ini menunjukan, kelahiran Bedah Kaisar(79.2%), paritas primipara (60.4%), Umur ibu diatas 30 tahun (45.5%), Kunjungan antenatal tidak lengkap (8.9%), ketuban pecah dini (40.4%), preklampsi (26.7%), keputihan patologis (44.6%), infeksi saluran kemih (44.6%) dan jumlah leukosit ibu (27.7%). Studi analitik menunjukan bahwa tidak hubungan faktor maternal yang berhubungan bedasarkan statistik secara signifikan dengan SNAD pada bayi prematur. Konklusi: Tidak ada hubungan faktor maternal paritas, umur ibu, kelahiran bedah kaisar, frekuensi kunjungan antenatal, keputihan patologis, infeksi saluran kemih, leukositosis ibu, dan preklampsia, dengan kejadian SNAD pada bayi prematur di RSCM pada tahun 2020.

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Background: Early onset Neonatal Sepsis (EOS) is one of the biggest cause of morbidity in neonates, especially premature neonates. Previous researches stated that there are maternal risks that are associated with EOS. These risks are parity, maternal age, route of birth, completion antenatal care, presence of pathological vaginal discharge, urinary tract infection, premature rupture of membrane, maternal leukocytosis and preeclampsia. Despite the high numbers of premature births in CMH, there hasn’t been a study about maternal risks associated with EOS in preterm neonates. Hence the writer proposes a study on EOS on preterm neonates association with maternal risks. Method: This retrospective cohort study is conducted on 101 preterm neonates CMH Neonatal Unit, on the year of 2020. With the approval of the ethics committee, information regarding presence of maternal risk associated is reviewed. Results: The descriptive result of the maternal risk associated with shows caesarean section (79.2%), primiparity (60.4%), advanced maternal age (45.5%), incomplete antenatal care (8.9%), premature rupture of membrane more than 18 hours (40.4%), preeclampsia (26.7%), pathological vaginal discharge (44.6%), urinary tract infection (31.7%), and maternal leukocyte (27.7%). The analytical study shows, none of these maternal risks associated with EOS have statistical significance to preterm neonates with EOS. Conclusion: There is no significance of maternal risk associated with EOS, primiparity, advanced maternal age, incomplete antenatal care, premature rupture of membrane more than 18 hours, preeclampsia, pathological vaginal discharge, UTI and maternal leukocytes to the incidence of EOS in preterm neonates in CMH Neonatal Unit in the year 2020."

"Latar belakang: Menurut data WHO, sebanyak 15 juta bayi di dunia dilahirkan kurang bulan setiap tahunnya, dan Indonesia menduduki peringkat ke-5 di dunia. Salah satu komplikasi pada bayi kurang bulan yang sering terjadi adalah sepsis. Sepsis Neonatorum Awitan Dini (SNAD) merupakan infeksi sistemik pada bayi pada usia kurang dari 72 jam yang seringkali disebabkan oleh transmisi patogen secara vertikal sebelum atau saat proses kelahiran. Strategi utama dalam penanggulangan kejadian SNAD bergantung pada identifikasi faktor risiko, termasuk ketuban pecah berkepanjangan. Namun, sampai saat ini masih belum ada kesepakatan terkait ambang batas waktu ketuban pecah yang meningkatkan risiko kejadian SNAD secara signifikan pada populasi bayi kurang bulan. Tujuan: (1) Mengetahui sebaran subjek penelitian berdasarkan karakteristik jenis kelamin, usia gestasi, usia ibu, berat lahir dan metode persalinan. (2) Mengetahui sebaran subjek penelitian berdasaran gejala klinis dan hasil pemeriksaan kultur. (3) Mengetahui hubungan antara waktu ketuban pecah dengan kejadian SNAD pada ambang batas waktu 24 jam, 18 jam dan 12 jam di RSCM. Metode penelitian: Sebuah studi kasus-kontrol dilakukan pada populasi bayi kurang bulan yang lahir di RSCM dari tahun 2016-2017. Subjek dibagi menjadi 2 kelompok: (1) kelompok kasus yang mengalami SNAD; dan (2) kelompok kontrol yang tidak mengalami SNAD; dipilih secara simple random sampling. Jumlah total subjek pada penelitian ini adalah 154 bayi kurang bulan (77 kasus dan 77 kontrol). Pengambilan data dilakukan pada Januari-Agustus 2018 dengan melihat rekam medis subjek penelitian, dilanjutkan dengan analisis bivariat menggunakan uji Chi Squared dan analisis multivariat menggunakan regresi logistik. Hasil penelitian: Semua karakteristik tidak memiliki perbedaan yang bermakna, kecuali usia gestasi (p=0,012) dan berat lahir (p=0,02). Gejala klinis yang paling sering ditemukan dan memiliki hubungan yang bermakna adalah sesak napas (63,0%; p<0,001) dan instabilitas suhu (40,9%; p<0,001). Kesimpulan: Terdapat hubungan yang signifikan antara waktu ketuban pecah dengan kejadian SNAD pada bayi kurang bulan di RSCM pada ambang batas waktu 12 jam, 18 jam dan 24 jam. Ketuban pecah lebih dari 12, 18 dan 24 jam meningkatkan risiko SNAD pada bayi kurang bulan 2,3 kali lipat, dan ketuban pecah lebih dari  12 jam meningkatkan risiko 2,9 kali lipat setelah adjustment.

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Introduction: According to WHO, 15 million babies are born premature annually, and  Indonesia ranks 5th worldwide. One of the most frequent complications in preterm infants is sepsis. Early onset neonatal sepsis (EONS) is defined as the systemic infection in infants less than 72 hours old which is often caused by vertical transmission of pathogens before or during labour. With the current lack of consensus in the definition of neonatal sepsis, identification risk factors, including prolonged premature preterm rupture of membranes (ROM), becomes the main strategy. Unfortunately, there is also currently lack of worldwide agreement in the threshold of duration of ROM which significantly increases the risk of EONS in preterm infants.

Objectives: (1) To determine the distribution of subjects based on selected characteristics: gender, gestational age, maternal age, birth weight and mode of delivery. (2) To determine the distribution of subjects based on clinical symptoms and bacterial culture examination. (3) To determine the association between the duration of ROM and the incidence of EONS in preterm infants, at the thresholds of 24 hours, 18 hours and 12 hours, in RSCM.

Methods: A case-control study was done on preterm infants born in RSCM in 2016-2017. The subjects were divided into 2 groups: (1) the case group for preterm infants who had EONS; and (2) the control group for preterm infants who did not have EONS; each selected by simple random sampling. The total number of subjects in the study was 154 preterm infants (77 in the case group and 77 in the control group). Data collection from the medical records of the subjects was performed in January-August 2018, followed by bivariate analysis using Chi Square Test and  multivariate analysis using logistic regression.

Result: Characteristics had insignificant differences, except gestational age (p=0,012) and birth weight (p=0,02). The clinical symptoms which were most frequent and had significant associations with EONS were respiratory instability (63,0%, p<0,001) and temperature instability (40,9%, p<0,001).

Conclusion. There is a significant association between the duration of ROM at 12, 18 and 24 hours, and the incidence of EONS in preterm infants, especially at duration of more than 12 hours. Prolonged PPROM for 12, 18, and 24 hours increases the risk of EONS in preterm infants 2.3 times (unadjusted) and PPROM for 12 hours increases the risk of EONS in preterm infants 2.9 times after adjustment for other factors."

"Latar Belakang: Sepsis menjadi masalah karena merupakan salah satu penyebab terbesar kematian bayi prematur. Terdapat beberapa risiko terhadap neonatus yang berhubungan dengan sepsis awitan dini pada neonatal prematur di Rumah Sakit Cipto Mangunkusumo diantaranya adalah Small Gestational Age (SGA), berat badan rendah dibawah 1500 gram, kembar, jenis kelamin, APGAR skor rendah, asfiksia, derajat prematur, intubasi dan gawat janin. Metode: Penelitian ini menggunakan rekam medis sebagai sumber data untuk dianalisis setelah mendapat persetujuan dari komite etik RSCM. Penelitian ini memiliki target untuk mengetahui hubungan bermakna antara risiko neonatus dengan sepsis awitan dini pada neonatus prematur di RSCM dengan penyajian deskriptif dan analisis menggunakan retrospective cohort. Rekam medis berasal dari neonatus yang lahir pada tahun 2020 dan masuk kedalam kriteria inklusi. Penelitian ini menggunakan total 101 sampel dan menggunakan SPSS sebagai software analisis. Hasil: Data deskriptif yang diperoleh mendapatkan hasil dengan neonatus yang lahir pada bulan Desember (23.7%), bertahan hidup (66.3%), hasil kultur positif (10.9%), neonatus dengan kelahiran section cesaria (80.2%), trombosit >100.000/μL (85.1%), nilai CRP <10 mg/dL (80.2%) dan leukosit 4.000 - 34.000/μL (90.1%). Faktor yang berhubungan dalam kejadian sepsis pada prematur adalah intubasi dalam 24 jam setelah bayi lahir menunjukan nilai yang signifikan dengan nilai p sebesar 0.009. Faktor risiko lain yaitu jenis kelamin, SGA, berat badan rendah, asfiksia, APGAR skor rendah, lahir kembar, derajat premature rendah dan gawat janin tidak menunjukan data yang signifikan dalam penelitian ini. Kesimpulan: Ditemukan adanya faktor signifikan yang berhubungan antara sepsis awitan dini pada neonatus prematur dengan tindakan intubasi dalam 24 jam setelah kelahiran.

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Background: Sepsis is one of the deadly causes of death in pre-term neonates has become alarming. Several risk factors towards neonates contribute to the Early Onset Sepsis (EOS) in Cipto Mangunkusumo Hospital. Those are Small Gestational Age (SGA), low birth weight (LBW), twin birth, low APGAR score, gender, birth asphyxia, premature degree category, intubation and fetal distress. Method: This research used the medical record after being approved by the ethics committee CMH. The writer aims to identify the relation between the neonates’ risk factors with EOS in pre-term neonates through this retrospective cohort study by serving the descriptive and analytical data. All the medical records are obtained from 2020 period and incorporated in the inclusion criteria. In this research, there are a total of 101 samples used. The analysis engine utilized in this research is the SPSS software. Results: The demographic data shows that the neonates were mostly born in December 2020 for (23.7%), surviving outcomes (66.3%), positive culture results (10.9%), C section delivery (80.2%), thrombocyte >100.000/μL (85.1%), CRP value <10 mg/dL (80.2%) and leukocyte level 4.000 - 34.000/μL (90.1%). The descriptive data show that intubation within 24 hours ought to be significant as it is supported by the p-value of 0.009. Meanwhile, other risk factors of gender, twin birth, low APGAR score, birth asphyxia, fetal stress, premature degree category, LBW and SGA are not showing the significant number in this research. Conclusion: There is a significant correlation between EOS in pre-term neonates and intubation within 24 hours after birth."