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Abstrak :
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. ......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.

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

Abstrak :
Latar Belakang : Tingkat konsumsi susu formula bubuk di kalangan bayi masih tinggi sementara sosialisasi   petunjuk WHO terkait penyiapan, penyajian dan penyimpanan susu formula bubuk  formula masih sangat kurang. Susu formula bubuk walau diproduksi dengan teknologi termutakhir sekalipun,  masih belum terbebas dari kontaminasi bakteri E. Sakazakii. Kedua hal tersebut membuat morbiditas bayi terkait konsumsi susu formula bubuk akibat kontaminasi intrinsik maupun ekstrinsik seperti sepsis, enterokolitis dan meningitis tetap tidak bisa berkurang.  Tujuan : Mengetahui derajat pengetahuan dan perilaku ibu dalam menyiapkan, menyajikan dan menyimpan susu formula bubuk dan faktor-faktor yang mempengaruhinya di  Kelurahan Pisangan Timur Kecamatan Pulogadung Jakarta Timur. Metode : Penelitian bersifat deskriptif potong lintang dengan pengumpulan data dilakukan secara survei dan observasi pada bulan Juli hingga Oktober 2012. Subyek penelitian adalah ibu yang memiliki anak berusia 0-12 bulan, tinggal di Kelurahan Pisangan Timur Kecamatan Pulogadung yang dipilih berdasarkan teknik purposive sampling. Data kemudian ditabulasi untuk mendapatkan derajat pengetahuan dan perilaku ibu tekait penyiapan, penyajian dan penyimpanan susu formula. Analisis statistik dilakukan untuk mencari faktor-faktor yang berhubungan dangan pengetahuan dan perilaku ibu terkait penyiapan, penyajian dan penyimpanan susu formula dengan cara uji kai kuardat (analisis bivariat) dan uji regresi logistik (analisis multivariat). Hasil : Dari 248 ibu yang mengikuti penelitian, pengetahuan kurang dalam menyiapkan, menyajikan dan menyimpan susu formula masing-masing didapati pada 68,1%, 26,2%, 87,5% ibu.  Perilaku buruk dalam menyiapkan, menyajikan dan menyimpan susu formula masing-masing didapati pada  69%, 60,9%, 84,3% ibu. Faktor yang mempengaruhi pengetahuan ibu dalam menyiapkan, menyajikan dan menyimpan susu formula adalah usia ibu, tingkat pendidikan, status ekonomi, status pekerjaan ibu.Faktor-faktor yang mempengaruhi perilaku ibu terkait perilaku menyiapkan, menyajikan dan menyimpan susu formula adalah usia ibu, status pendidikan, status ekonomi dan sumber air minum.  Hubungan pengetahuan dengan perilaku ibu dalam menyiapkan, menyajikan dan menyimpan susu formula  berturut-turut adalah kuat (r= 0,68), sedang (r= 0,52) dan kuat (r= 0,73 ) Simpulan : Masih rendahnya derajat pengetahuan dan perilaku ibu dalam penyiapan, penyajian dan penyimpanan susu formula di Kelurahan Pisangan Timur membutuhkan intervensi penyuluhan dan sosialisasi lebih gencar mengenai anjuran WHO terkait penyiapan, penyajian dan penyimpanan susu formula terutama pada ibu-ibu dari golongan berusia kurang dari 25 tahun, pendidikan rendah, ekonomi kurang, tidak bekerja dan mengkonsumsi bukan air mineral kemasan. Produsen susu formula harus memperbaiki lembar informasi terkait penyiapan penyajian dan penyimpanan susu formula yang tertera pada kemasann susu formula agar lebih jelas, lengkap dan mudah dimengerti oleh ibu. ......Background: Until to day, the consumption rate of powdered infant formula is still high, neverthenless socialization of WHO’s guidance related to the preparation, serving and storage of powdered infant formula are very limited. Eventhought manufacturend by the latest technology, powder infant formula, cannot be free from E. Sakazakii contamination, hence the potential risk for infant morbidity caused by intrinsic or extrinsic contamination such as sepsis, enterocolitis and meningitis never been low . Objective: To know the degree of mother’s knowledge and behavior in preparing, serving and storing powdered infant formula and their related factors in Pisangan Timur Village, Pulogadung District, East Jakarta. Methods: The study was a crossectional-observation data survey which conducted fom July until October 2012. Subjects were mothers of children aged 0-12 months, living in Pisangan Timur Village, Pulogadung District which selected by purposive sampling technique. The data was then tabulated and calculated to meassure the degree of knowledge and maternal behavior about preparation, serving and storage of infant formul., Chi Square (bivariat) and logistic regression (multivariates) analysis was performed to elaborate factors that related to mother’s knowledge and behaviour in preparation, serving and storage of infant formula. Results: The study was conducted on 248 mothers. Lack of knowledge in preparing, serving and storing infant formula, was found in 68.1%, 26.2%, 87.5% mothers respectively. Unappropriate behavior regarding to WHO guidance in preparing, serving and storing infant formula was found in 69%, 60.9%, 84.3% mothers respectively. Factors related to maternal knowledge in preparing, serving and storing infant formula were the mother's age, education level, economic status, employment status. Factors related to maternal behavior in preparing, serving and storing infant formula were educational level, economic status and source of drinking water. The relationship between mothers’s knowledge to mother’s behavior in preparing, serving and storing infant formula respectively were strong (r= 0,68 ), moderate (r= 0,52 ) and strong (r= 0,73 ). Conclusion The lack of mother’s knowledge and inapproriate mother’s behavior in the preparation, serving and storage of infant formula in the Pisangan Timur Village requires intervention, counseling and socialization of WHO’s recommendation about preparation, serving and storage of infant formula more intensively, especially to the mothers that less than 25 years, low education level, low economic’s status , jobless and not consume bottled mineral water whoose giving their baby infant formula. Manufactures should changed and standardized their instruction so it can be easily understand by mother.