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"Displasia bronkopulmonal merupakan salah satu komplikasi dari kelahiran prematur. Faktor risiko DBP pada bayi sangat prematur yaitu kecil masa kehamilan, korioamnionitis, pajanan oksigen FiO2 > 30%, duktus arteriosus persisten hemodinamik signifikan, sepsis neonatorum awitan lambat, volutrauma, surfaktan tidak diberikan, kafein tidak diberikan, dan tidak mendapatkan ASI. Data prevalens DBP yang dipublikasi pada tahun 2015 yaitu 42,8% dan kesintasan bayi sangat prematur di RSCM pada tahun 2020 yaitu 54,17%. Oleh karena itu, studi prevalens dan mempelajari faktor risiko DBP pada bayi sangat prematur yang lahir di RSCM perlu dilakukan. Penelitian ini merupakan studi potong lintang dengan subyek bayi usia gestasi £32 minggu yang lahir di RSCM. Sebanyak 211 subyek memenuhi kriteria inklusi dan eksklusi. Hasil penelitian yaitu prevalens DBP 34,6% (DBP ringan 19%, DBP sedang 8,5%, dan DBP berat 7,1%). Analisis multivariat menunjukkan faktor risiko yang berhubungan dengan DBP yaitu SNAL (aOR 4,455 IK 95% 1,932-10,270; p= <0,001), pajanan volume tidal >5 mL/kg (aOR 3,059 IK 95% 1,491-6,273; p 0,002), asupan ASI predominan (aOR 0,348 IK 95% 0,150-0,808; p 0,014), dan asupan susu formula predominan (aOR 0,280 IK 95% 0,123-0,634; p 0,002). Kesimpulan: Bayi sangat prematur yang mengalami SNAL, pajanan volum tidal >5 mL/kg berisiko mengalami DBP. Namun, asupan asi predominan dan susu formula predominan menurunkan risiko DBP.

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Bronchopulmonary dysplasia is one of the complications of preterm birth. The risk factors for bronchopulmonary dysplasia in very premature infants were small gestational age, chorioamnionitis, oxygen exposure to FiO2 > 30%, hemodynamically significant persistent ductus arteriosus, late-onset neonatal sepsis, volutrauma, no surfactant, no caffeine, and no breastfeeding. Published data of prevalence of DBP in 2015 is 42.8% and the survival data for very premature babies at the CMH in 2020 is 54.17%. Therefore, it is necessary to study the prevalence and study of risk factors for bronchopulmonary dysplasia in very preterm infants born in CMH. This study is a cross-sectional study with 32 weeks gestational age infants born at CMH. A total of 211 subjects met the inclusion and exclusion criteria. The results of the study were the prevalence of DBP 34.6% (mild DBP 19%, moderate DBP 8.5%, and severe DBP 7.1%). Multivariate analysis showed the risk factors associated with DBP were late onset neonatal sepsis (aOR 4,455 CI 95% 1,932-10,270; p= <0,001), tidal volume exposure >5 mL/kg (aOR 3,059 CI 95% 1,491-6,273; p 0,002), human milk predominant (aOR 0,348 CI 95% 0,150-0,808; p 0,014), and formula milk predominant (aOR 0,280 CI 95% 0,123-0,634; p 0,002). Conclusion: In a very premature infants who have SNAL, tidal volume exposure >5 mL/kg are at risk for DBP. However, the predominant human milk intake and predominant formula milk intake decreased the risk of DBP."

"Latar belakang. Displasia bronkopulmonal (DBP) adalah penyakit multifaktorial kronis akibat inflamasi baik prenatal maupun postnatal. Hal ini akan menyebakan komplikasi jangka panjang dalam hal pernapasan, kardiovaskuler, dan neurodevelopmental. Azitromisin sebagai agen antiinflamasi diharapkan dapat mencegah kejadian DBP.Metode. Uji klinis acak terkontrol tidak tersamar dilakukan selama Juni 2021-April 2022 di unit Neonatologi RSCM Jakarta pada 114 subjek dengan usia gestasi 25 minggu-31 minggu 6 hari yang mengalami distress napas. Pasien yang memenuhi kriteria inklusi dan eksklusi dilakukan randomisasi dan dibagi menjadi dua kelompok yaitu kelompok uji/perlakuan dan kelompok kontrol, masing masing sebanyak 57 subjek. Kelompok uji akan mendapatkan azitromisin dalam usia <24 jam selama 14 hari dengan dosis 10 mg/kgbb/intravena selama 7 hari kemudian dilanjutkan 5 mg/kgbb/intravena selama 7 hari. Pasian akan dipantau sampai dengan usia gestasi 36 minggu untuk melihat outcome primer berupa DBP, dan outcome sekunder berupa IVH, PVL, EKN, lama penggunaan O2, durasi penggunaan ventilator mekanik, lama pencapaian full enteral feeding, serta mortalitas pada kedua kelompok. Diagnosis DBP ditegakkan berdasarkan NICHD 2019.Hasil. Angka kejadian DBP secara umum adalah 34.8%. Angka kejadian DBP pada bayi extremely preterm adalah 58.3%, sedangkan pada bayi very preterm adalah 31%. Kejadian DBP lebih banyak pada kelompok kontrol (63% vs 38%) dengan RR 0.611(0.417-0.896). Durasi penggunaan ventilator mekanik lebih pendek pada kelompok yang mendapatkan azitromisin (5.22 vs 12.75,p 0.025). Lamanya pencapaian full enteral feeding lebih pendek pada kelompok uji/perlakuan (13.38 vs 17.14 hari, p 0.04). Angka kejadian EKN lebih rendah pada kelompok uji/perlakuan (19% vs 40%, nilai p 0.014). Mortalitas lebih rendah pada kelompok uji/perlakuan (25% vs 46% , nilai p 0.019) RR 1.660 (95% CI 1.043-2.642). Kesimpulan. Azitromisin dapat menurunkan angka kejadian DBP, mempercepat pencapaian full enteral feeding, menurunkan mortalitas pada bayi prematur.

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Background. Bronchopulmonary dysplasia (BPD) is a chronic multifactorial disease caused by inflammation both prenatal and postnatal. This will lead a long-term complications of respiratory, cardiovascular, and neurodevelopmental. Azithromycin as an antiinflammatory agent is expected to prevent BPD.

Methods. A randomized controlled clinical trial, unblinded was conducted during June 2021-April 2022 at the Neonatology unit of RSCM Jakarta on 114 subjects with a gestational age of 25 weeks-31 weeks 6 days who experienced respiratory distress. Patients who met the inclusion and exclusion criteria were randomized and divided into two groups, the intervention group and the control group, each group with 57 subjects. The intervention group will receive azithromycin at the age of <24 hours for 14 days at a dose of 10 mg/kg/intravenous for 7 days then followed by 5 mg/kg/intravenous for 7 days. Patients will be monitored up to 36 weeks' gestation to see the primary outcome in the form of BPD, and secondary outcomes in the form of IVH, PVL, EKN, duration of O2 used, duration of mechanical ventilator used, duration of achieving full enteral feeding, and mortality in both groups. BPD diagnosed based on NICHD 2019.

Results. The incidence of BPD in general is 34.8%. The incidence of BPD in extremely preterm infants is 58.3%, while in very preterm infants it is 31%. The incidence of BPD was more in the control group (63% vs 38%) with an RR 0.611(0.417-0.896). The duration of ventilator mechanic used was shorter in the intervention group (5.22 vs 12.75, p 0.025). The duration of achieving full enteral feeding was shorter in the intervention group (13.38 vs 17.14 days, p 0.04). The incidence of NEC was lower in the intervention group (19% vs 40%, p-value 0.014). Mortality was lower in the intervention group (25% vs 46%, p 0.019) RR 1.660 (95% CI 1.043-2.642).

Conclusion. Azithromycin can reduce the incidence of BPD, accelerate the achievement of full enteral feeding, reduce mortality in premature infants"

"ABSTRAKResusitasi dengan konsentrasi oksigen yang tinggi (100%) pada bayi cukup bulanmeningkatkan angka mortalitas dan morbiditas. Hiperoksia dapat meningkatkan stresoksidatif pada bayi prematur oleh karena kadar anti oksidannya yang rendah. Peningkatanstres oksidatif akan mengakibatkan inflamasi dan berhubungan dengan terjadinya displasiabronkopulmonal dan gangguan integritas usus. Pemberian oksigen yang tinggi juga akanmemengaruhi mikrobiota aerob dan anaerob dalam usus oleh karena oksigen akan berdifusidari mukosa usus ke dalam lumen usus. Belum diketahui berapa kadar FiO2 awal yang tepatpada resusitasi bayi prematur.Penelitian ini bertujuan menelaah dampak perbedaan pajanan konsentrasi oksigen awal padaresusitasi bayi prematur terhadap displasia bronkopulmonal, integritas mukosa, danmikrobiota usus.Penelitian ini merupakan penelitian uji klinis acak terkontrol tidak tersamar di IlmuKesehatan Anak, FKUI-RSCM dan RS Bunda Menteng pada bayi prematur (usia gestasi 25?32 minggu) yang mengalami distres pernapasan yang dirandomisasi untuk diberikanresusitasi dengan FiO2 awal 30% atau 50%. Kadar FiO2 disesuaikan untuk mencapai targetsaturasi oksigen (SpO2) 88?92% pada menit ke-10 dengan menggunakan pulse oxymetry.Luaran primer berupa angka kejadian DBP dan luaran sekunder berupa penanda stresoksidatif (rasio GSH/GSSG dan MDA darah tali pusat dan hari ke-3), penanda gangguanintegritas usus (alpha-1 antitrypsin), dan mikrobiota usus (polymerase chain reaction) padafeses hari 1?3 dan hari ke-7.Selama periode Januari?September 2015, terdapat 84 bayi yang direkrut (masing-masing 42bayi pada kelompok 30% dan 50%). Tidak ada perbedaan bermakna angka kejadian DBPpada kelompok FiO2 30% vs. 50%, yaitu 42,8% vs. 40,5% (intention to treat analysis) dan25% vs. 19,4% (per protocol analysis). Juga tidak ada perbedaan bermakna penanda stresoksidatif (rasio GSH/GSSG dan kadar MDA), kadar AAT, dan mikrobiota usus pada keduakelompok. Mikrobiota anaerob fakultatif lebih tinggi dibandingkan dengan mikrobiotaanaerob pada hari ke-7 pada kedua kelompok.Pada bayi prematur dengan usia gestasi 25?32 minggu yang diresusitasi dengan FiO2 awal30% vs. 50% tidak dijumpai perbedaan yang bermakna angka kejadian DBP, penanda stresoksidatif, gangguan integritas mukosa usus (AAT), dan mikrobiota usus. Oleh karena itu,pemberian FiO2 awal 30% hingga 50% selama resusitasi sama amannya untuk bayi prematur

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ABSTRACTResuscitation with high oxygen levels (100%) in term infants increases mortality andmorbidity rates. Hyperoxia can increase oxidative stress in premature infants due to its lowantioxidant level. The increased oxidative stress will cause inflammation and it is associatedwith the development of bronchopulmonary dysplasia (BPD) as well as intestinaldysintegrity. The administration of high oxygen levels will also affect aerobic and anaerobicintestinal microbiota as the oxygen will diffuse from intestinal mucosa into the lumen. Theappropriate initial FiO2 level during the resuscitation of premature infants has not beenknown.This study aims to analyze an impact on the difference of exposure to initial oxygenconcentration in resuscitation of premature infants against bronchopulmonary dysplasia,mucosal integrity, and intestinal mucosa.The study was an unblinded randomized controlled clinical trial, in Child Health DepartmentUniversity of Indonesia, Cipto Mangunkusumo Hospital, and Menteng Bunda Hospital inJakarta, which was conducted in premature infants (25?32 weeks of gestational age) whoexperienced respiratory distress and were randomized for receiving resuscitation using 30%or 50% initial FiO2. The FiO2 levels were adjusted to achieve target oxygen saturation (SpO2)of 88?92% on the 10th minute using pulse oximetry. The primary outcome was incidence ofBPD; while the secondary outcome was markers of oxidative stress (ratio of GSH/GSSG andMDA in umbilical cord blood and on the 3rd day), intestinal dysintegrity (AAT) andintestinal microbiota (using PCR) found in fecal examination on day 1?3 and on the 7th day.During the period between January and September 2015, there were 84 infants recruited(there were 42 infants in each group of the 30% and 50% FiO2). There was no significantdifference on BPD incidence between 30% and 50% FiO2 groups, i.e. 42.8% vs. 40.5%(intention to treat analysis) and 25% vs. 19.4% (per protocol analysis). There was also nosignificant difference on oxidative stress markers (ratio of GSH/GSSG and MDA levels),AAT levels, and changes of facultative anaerobic and anaerobic microbiota in both groups.However, there was a higher level of facultative anaerobic microbiota compared to anaerobicmicrobiota on the 7th day in both groups.In premature infants with 25?32 weeks of gestational age who were resuscitated using 30%vs. 50% initial FiO2 level, significant differences were found in terms of BPD incidence,oxidative stress markers (ratio of GSH/GSSG and MDA), AAT (intestinal mucosa integrity)and intestinal microbiota. Therefore, it is concluded that the administration of 30% to 50%initial FiO2 are both equally safe for premature infants during resuscitation."

"ABSTRAK Latar Belakang. Kemajuan dalam penanganan bayi prematur menyebabkan angka kesintasan meningkat. Akibatnya, angka kesakitan bayi prematur jugameningkat, salah satunya adalah osteopenia of prematurity (OOP). Pemeriksaankadar kalsium, fosfat, dan fosfatase alkali serum saat usia kronologis 4 minggudigunakan sebagai indikator awal sebelum osteopenia tampak secara klinis.Diagnosis sedini mungkin dan pengendalian faktor risiko perlu dilakukansehingga komplikasi dapat dicegah.Tujuan. Mengetahui prevalens dan faktor risiko terjadinya OOP.Desain Penelitian. Penelitian dengan desain potong lintang ini dilaksanakanpada bayi prematur dengan usia gestasi ≤32 minggu di Divisi Perinatalogi RS Dr.Cipto Mangunkusumo. Subyek diperiksa kadar kalsium serum, fosfat inorganikserum, dan fosfatase alkali serum. Pada subyek dilakukan pencatatan faktor risikoOOP untuk menilai hubungan antar variabel dan dilakukan analisis bivariatdengan uji chi square. Hasil Penelitian. Terdapat 80 subyek yang memenuhi kriteria penelitian.Delapan dari 80 subyek (10%) ditemukan menderita OOP. Faktor risiko yangdianalisis dalam penelitian ini ditemukan tidak memiliki hubungan bermaknadengan kejadian OOP, yakni lama penggunaan nutrisi parenteral total (p=0,457),lama penggunaan metilsantin (p=1,000), berat lahir (p=0,459), preeklampsiaberat pada ibu (p=0,344), korioamnionitis pada ibu (p=0,261), dan pemberiannutrisi enteral (p=0,797).Simpulan. Prevalens OOP di RS Dr. Cipto Mangunkusumo adalah 10%. Faktorlama penggunaan nutrisi parenteral total, penggunaan metilsantin, berat lahir,preeklampsia berat pada ibu, korioamnionitis, dan pemberian nutrisi enteral tidak memiliki hubungan bermakna dengan kejadian OOP.ABSTRACT Background. Advances in management of premature infants had increased the survival rate of these infants. However there is also increase of morbidity such as osteopenia of prematurity (OOP). Laboratory examination of serum calcium,phosphate, and alkaline phosphatase at the chronological age of 4 weeks is usedas early indicator before osteopenia become clinically appearant. Early diagnosisand risk control are needed to prevent complication. Objective. To evaluate the prevalence and risk factors of OOP.Methods. A cross sectional study was done in premature infants <32 weeks ofgestational age in Perinatalogy Division of Cipto Mangunkusumo Hospital.Laboratory examination of serum calcium, phosphate, and alkalinephosphatasewere conducted toward these subjects. Risk factors of OOP were alsoevaluated. Bivariat analysis was analysed by chi square test.Results. There are 80 subjects who meet the study criteria. Eight of 80 subjects(10%) was diagnosed as OOP. No risk factors have significant relationship withOOP incidence, which include duration of total parenteral nutrition (p=0,457),duration of methylxanthine usage (p=1,000), birth weight (p=0,459), severepreecalampsia in the mother (p=0,344), chorioamnionitis in the mother(p=0,261), and enteral nutrition (p=0,797).Conclusion. Prevalence of OOP in Cipto Mangunkusumo Hospital is 10%. Thereare no significant relationship between OOP incidence and duration of totalparenteral nutrition, methylxanthine usage, birth weight, severe preeclampsia in the mother, chorioamnionitis, and enteral nutrition.;Background. Advances in management of premature infants had increased the survival rate of these infants. However there is also increase of morbidity such as osteopenia of prematurity (OOP). Laboratory examination of serum calcium,phosphate, and alkaline phosphatase at the chronological age of 4 weeks is usedas early indicator before osteopenia become clinically appearant. Early diagnosisand risk control are needed to prevent complication. Objective. To evaluate the prevalence and risk factors of OOP.Methods. A cross sectional study was done in premature infants <32 weeks ofgestational age in Perinatalogy Division of Cipto Mangunkusumo Hospital.Laboratory examination of serum calcium, phosphate, and alkalinephosphatasewere conducted toward these subjects. Risk factors of OOP were alsoevaluated. Bivariat analysis was analysed by chi square test.Results. There are 80 subjects who meet the study criteria. Eight of 80 subjects(10%) was diagnosed as OOP. No risk factors have significant relationship withOOP incidence, which include duration of total parenteral nutrition (p=0,457),duration of methylxanthine usage (p=1,000), birth weight (p=0,459), severepreecalampsia in the mother (p=0,344), chorioamnionitis in the mother(p=0,261), and enteral nutrition (p=0,797).Conclusion. Prevalence of OOP in Cipto Mangunkusumo Hospital is 10%. Thereare no significant relationship between OOP incidence and duration of totalparenteral nutrition, methylxanthine usage, birth weight, severe preeclampsia in the mother, chorioamnionitis, and enteral nutrition."

"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.

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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."

"Latar belakang. Continuous positive airway pressure (CPAP) dan nasal intermittent positive ventilation (NIPPV) mengurangi intubasi dan ventilasi mekanik pada neonatus dengan gawat napas. Masih sedikit penelitian yang membandingkannya pada neonatus cukup bulan maupun kurang bulan. Tujuan. Mengetahui kejadian intubasi, lama dukungan ventilasi non invasif dan pemakaian oksigen, bronchopulmonary dysplasia (BPD), dan kematian antara CPAP dan NIPPV pada neonatus dengan gawat napas. Metode. Studi kohort retrospektif dilakukan terhadap neonatus dengan gawat napas, usia gestasi 28-40 minggu, lahir di Rumah Sakit Umum Daerah Kota Bekasi pada periode Januari 2013 - Juni 2015. Pengambilan subyek penelitian secara konsekutif, memenuhi kriteria inklusi, dan menggunakan bantuan napas dengan CPAP atau NIPPV, masing-masing 50 subjek. Hasil. Neonatus dengan gawat napas menggunakan CPAP maupun NIPPV disebabkan karena respiratory distress syndrome , transient tachypnea of the newborn, pneumonia neonatal. Rerata usia gestasi dan berat lahir pada kelompok CPAP (34±3,11 minggu, 2018±659 gr) dan NIPPV [34 (28-40) minggu, 2050 (900-3900) gr]. Kejadian intubasi dan kematian berkurang, rerata hari dukungan ventilasi non infasif maupun pemakaian oksigen lebih lama pada NIPPV dibandingkan CPAP. Simpulan. NIPPV mengurangi kejadian intubasi dan kematian pada neonatus dengan gawat napas dibandingkan CPAP.

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Background. Continuous positive airway pressure (CPAP) and nasal intermittent positive ventilation (NIPPV) reduce intubation and mechanical ventilation. Still limited studies compare to CPAP and NIPPV in term and preterm infant with respiratory distress.

Purpose. To determine CPAP and NIPPV to the event of intubation, duration non-invasive ventilation and oxygen support, bronchopulmonary dysplasia, and death in neonate.

Methods. Retrospective cohort study was conducted to newborn with gestational age 28-40 weeks were born at General Hospital of Bekasi City, January 2013 - June 2015. Consecutive subjects and met inclusion criteria for CPAP and NIPPV group, each one 50 subjects.

Results. CPAP and NIPPV were support to neonate with respiratory distress due to respiratory distress syndrome, transient tachypnea of the newborn, and pneumonia. Mean gestational age and birth weight in CPAP group (34 ± 3.11 weeks, 2018 ± 659 gr) and NIPPV [34 (28-40) weeks, 2050 (900-3900) g]. Raduce rate of intubation and death, duration of non-invasive ventilation and oxygen support longer to NIPPV than CPAP in neonate.

Conclusion. NIPPV reduce intubation and mortality rate comparison to CPAP in neonate"

"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."

"Infeksi adalah invasi mikroorganisme ke dalam tubuh Istilah sepsis digunakan untuk menggambarkan respon sistemik neonatus terhadap infeksi Kelahiran prematur merupakan faktor risiko yang berhubungan signifikan dengan kejadian sepsis Tujuan karya ilmiah ini adalah memberi gambaran aplikasi Model Konservasi Levine pada bayi prematur dengan masalah risiko infeksi Asuhan keperawatan pada kasus kelolaan tersangka sepsis neonatorum awitan dini SNAD menggunakan 4 prinsip konservasi Empat dari 5 bayi mampu beradaptasi dengan lingkungan ekstrauteri penyakit dan pengobatan sehingga tercapai suatu keutuhan diri wholeness Perawat profesional perlu memahami pola klinis bayi prematur yang berisiko mengalami sepsis dan dapat memberikan asuhan keperawatan yang tepat dan cepat Kata Kunci Bayi prematur Sepsis Keperawatan dan Model Konservasi Levine.

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Infection is the invasion of microorganisms into the body The term sepsis is often used to describe the neonatal systemic response to infection Preterm birth is a significant risk factor associated with the incidence of sepsis The purpose of this final scientific report is illustrates the application of Levine rsquo s Conservation Model in preterm infants with infection risk issues Nursing care in the management preterm infant in the diagnosis with suspected early onset neonatal sepsis EOS used four conservation principles Four of five neonates were capable to adapt to extrauterine environment disease and treatment in order to reach wholeness Professional nurse have to understand the clinical pattern of preterm infants sepsis experience and provide an accurate nursing care fastly."

"Bayi prematur menghadapi banyak tantangan ketidakseimbangan cairan untuk bertahan di lingkungan ekstrauterin, sehingga membutuhkan pendekatan asuhan keperawatan yang komprehensif. Studi kasus ini menggambarkan proses keperawatan menggunakan model Konservasi Levine untuk merawat lima bayi prematur dengan ancaman keseimbangan cairan. Pengkajian mengidentifikasi triphocognosis meliputi risiko kekurangan volume cairan dan masalah cairan lainnya. Perawat anak merawat sesuai kompetensi, seperti pemantauan kesesuaian cairan masuk dan kebutuhan, pengurangan jumlah insensible water loss, blood management, dan peningkatan kemampuan minum melalui mulut. Intervensi membantu bayi prematur dan keluarga berhasil beradaptasi untuk mencapai wholeness. Penerapan model ini menyediakan pengalaman asuhan keperawatan yang komprehensif sebagai referensi untuk kasus serupa selanjutnya.

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Preterm infants faces many challenges of fluid imbalance for survive in the extrauterine environment. It needs comprehensive nursing care approach. This study describes a nursing process using Levine’s Conservation model to care five preterm infants with threat to fluids imbalance. The assessments identified triphocognosis including risk of deficient fluid volume and other related problems. Pediatric nurse care according to competencies, such as monitoring the suitability of fluid intake and requirement, reducing the amount of insensible water loss, blood management, and increased oral feeding ability. The interventions helped the preterm infant and family adapt successfully to achieve wholeness. This application of model provides a comprehensive nursing care experience as reference for future similar cases."

"Latar Belakang :Insidensi terjadinya ketuban pecah dini (KPD) pada kehamilan preterm adalah 3-10,% dari semua persalinan. Lama terjadinya ketuban pecah dini berpengaruh pada kejadian infeksi maternal dan sepsis pada bayi. Sepsis, termasuk sepsis neonatal awitan dini (SNAD), masih menjadi penyebab utama kematian bayi prematur. Vitamin D berperan meningkatkan imunitas tubuh terutama saat menghadapi infeksi. Tujuan penelitian ini ingin mengetahui hubungan antara lama KPD, leukosit maternal, kadar vitamin D maternal dan tali pusat dengan luaran sepsis awitan dini pada bayi prematur.Metode : Desain penelitian kohort retrospektif dengan menggunakan rekam medis dan data penelitian sebelumnya. Mencatat lama ketuban pecah dini, kadar leukosit maternal, kadar vitamin D maternal dan tali pusat dankejadian sepsis pada bayi yang dilahirkan usia 28-34 minggudi Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo dan Rumah Sakit Umum Pusat Persahabatan, Jakarta. Subjek penelitian diambil secaraConsecutivesampling.Hasil : Selama periode penelitian didapatkan 72 subjek bayi yang dilahirkan dari ibu dengan KPD, 22 bayi (31%) diantaranya mengalami SNAD, sedangkan 50 bayi lainnya tidak mengalami SAD. Tidak terdapat hubungan antara lama KPD, jumlah leukosit maternal dengan kejadian SNAD tetapi didapatkan hubungan yang bermakna antara kadar vitamin D maternal dan tali pusat dengan kejadian SNAD.

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Background:The incidence of premature rupture of membranes (PROM) in preterm pregnancy is 3-10,% of all deliveries. The duration of premature rupture of the membranes affects the incidence of maternal infection and sepsis in infants. Sepsis, including early onset neonatal sepsis (EONS), is still the main cause of premature infant mortality. Vitamin D acts to increase the body s immunity, especially when facing infection. The purpose of this study was to determine the relationship between the length of the ROM, maternal leukocytes level, maternal and umbilical cord vitamin D levels with early onset sepsis in premature infants.

Method:Design of a retrospective cohort study using medical records and previous research data. Note the duration of premature rupture of the membranes, maternal leukocyte levels, maternal vitamin D levels and umbilical cord and the incidence of sepsis in infants born 28-34 weeks at the National Center General Hospital Dr. Cipto Mangunkusumo and Center General Hospital Pesahabatan, Jakarta. The research subjects were taken by consecutive sampling.

Results: During the study period 72 subjects were born from mothers with ROM, 22 infants (31%) among them experienced EONS, while 50 other infants did not experience EONS. There was no relationship between the duration of ROM, the number of maternal leukocytes with the incidence of EONS, but a significant relationship was found between maternal vitamin D levels and umbilical cord with EONS events."