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[ABSTRAK
Latar belakang. Sepsis neonatorum awitan dini (SNAD) adalah sindrom klinis akibat respon sistemik terhadap infeksi pada awal kehidupan. Diagnosis SNAD seringkali sulit karena gejala klinisnya tidak spesifik. Tujuan. Mengetahui sensitivitas dan spesifisitas biakan usap telinga dalam diagnosis SNAD. Metode. Subjek penelitian adalah neonatus yang lahir di RSCM Jakarta dan RSU Tangerang Selatan dengan diagnosis SNAD. Dilakukan pengambilan biakan dari usapan telinga dan darah bayi. Hasil. Diantara 50 subjek, terdapat 2 neonatus dengan biakan darah positif, dan 32 neonatus dengan biakan usap telinga positif. Hanya 1 subjek yang memiliki kesesuaian 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 positif 1,02, rasio kemungkinan negatif 0,97, dan, akurasi 46% untuk mendeteksi SNAD. Simpulan. Ditemukan hasil biakan darah positif pada 2 subjek. Biakan usap telinga memiliki sensitivitas 64,7%, spesifisitas 36,4%, nilai duga positif 34,3%, nilai duga negatif 66,6%, rasio kemungkinan positif 1,02, rasio kemungkinan negatif 0,97, dan akurasi 46% untuk mendeteksi SNAD.

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ABSTRACT
Background. Early-onset neonatal sepsis (EOS) is a clinical syndrome due to systemic response to infection in early life. EOS is often difficult to diagnosed because the clinical symptoms are not specific. Objective. The study aim to determine sensitivity and specificity of ear swabs culture in the diagnosis of EOS. Methods. Neonates born in the CMH Jakarta and Tangerang Selatan Hospital who developed sepsis were studied. Swabs were collected for culture from baby’s ear. Bacterias isolated from ear swabs cultured were correlated with those from blood culture. Results. Among 50 neonates studied, 2 neonates had positive blood cultured and 32 neonates had positive ear swabs cultured. Only one subject had suitability types of bacterias that grew from blood and ear swabs. Bacteria grew from ear swab cultured were predominantly Gram-positive (62%). Ear swabs cultured had sensitivity 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 two subjects. Ear swabs cultured had a sensitivity 64.7%, specificity 36.4%, PPV 34.3%, 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 to systemic response to infection in early life. EOS is often difficult to diagnosed because the clinical symptoms are not specific. Objective. The study aim to determine sensitivity and specificity of ear swabs culture in the diagnosis of EOS. Methods. Neonates born in the CMH Jakarta and Tangerang Selatan Hospital who developed sepsis were studied. Swabs were collected for culture from baby’s ear. Bacterias isolated from ear swabs cultured were correlated with those from blood culture. Results. Among 50 neonates studied, 2 neonates had positive blood cultured and 32 neonates had positive ear swabs cultured. Only one subject had suitability types of bacterias that grew from blood and ear swabs. Bacteria grew from ear swab cultured were predominantly Gram-positive (62%). Ear swabs cultured had sensitivity 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 two subjects. Ear swabs cultured had a sensitivity 64.7%, specificity 36.4%, PPV 34.3%, NPV 66.6%, PLR 1.02, NLR 0.97, and accuracy 46% to detect EOS]

Abstrak :
Latar Belakang. Sepsis neonatal awitan dini SNAD masih merupakan masalah di Indonesia. Vitamin D memiliki efek pada fungsi imunitas. Neonatus kurang bulan NKB berisiko mengalami defisiensi kadar vitamin D. Hubungan kadar vitamin D dengan kejadian SNAD pada NKB belum jelas. Tujuan. Menganalisis hubungan kadar vitamin D dengan kejadian SNAD pada NKB. Metode. Duapuluh NKB dengan klinis dan pemeriksaan laboratorium menyokong SNAD kelompok kasus dan 20 NKB tanpa hasil laboratorium SNAD kelompok kontrol ikut dalam penelitian ini. Subjek penelitian adalah NKB usia gestasi ge; 28 sampai dengan < 37 minggu dirawat di RSUPN Cipto Mangunkusumo selama bulan Juli - September 2017. Pemeriksaaan kadar vitamin D 25 OH D dengan metode competitive chemiluminescense immunoassay CLIA direk dengan alat Diasorin Liaison. Hasil. Median kadar vitamin D pada NKB dengan SNAD 8,95 4,10 - 16,30 ng/mL dengan rerata usia gestasi 33,25 1,71 minggu dan rerata berat lahir 1863,75 415,06 gram. Median kadar vitamin D tanpa SNAD 11,75 5,80 - 42,80 ng/mL dengan rerata usia gestasi 34,67 1,53 minggu dan rerata berat lahir 2125,0 340,55 gram. Median kadar vitamin D NKB SNAD lebih rendah secara bermakna dibandingkan NKB tanpa SNAD.

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Background. Early onset neonatal sepsis EONS is still a problem in Indonesia. Vitamin D has effect on immune function. Preterm infants have a risk of deficiency of vitamin D levels. The association between vitamin D levels with EONS were unclear. Objective. To determine the association between vitamin D levels with EONS in preterm infants. Methods. Twenty preterm infants with clinical and laboratory finding of EONS study group and 20 preterm infants with no signs of laboratory infection control group were enrolled this study. The subjects were preterm infants of gestational age ge 28 37 weeks in Cipto Mangunkusumo Hospital during July September 2017. Vitamin D 25 OH D levels were measured using Diasorin Liason with competitive chemilunescence immunoassay CLIA technique. Results. Median vitamin D levels with EONS was 8,95 4,10 16,30 ng mL, mean of gestational age and birth weight were 33,25 1,71 weeks and 1863,75 415,06 g, respectively. Median vitamin D levels without EONS was 11,75 5,80 42,80 ng mL, mean of gestational age and birth weight were 34,67 1,53 weeks and 2125,0 340,55 g, respectively. Median vitamin D levels of preterm infants with EONS was significantly lower than without EONS.Conclusion. Vitamin D levels are associated with EONS in preterm infants.

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Latar belakang: Saat ini prevalensi penyakit tidak menular, salah satunya obesitas, mengalami tren peningkatan. Obesitas dapat menimbulkan berbagai komplikasi dan dapat menjadi penyakit penyulit sehingga menjadi tantangan dalam menata laksana berbagai penyakit. Perubahan fisiologis yang dibawa oleh obesitas dapat menjadi faktor risiko perkembangan kanker endometrium. Obesitas dapat memicu paparan estrogen berlebih dari konversi androgen pada jaringan adiposa perifer. Selain itu, dengan perubahan hormonal akibat menopause, terjadi gangguan keseimbangan hormon yang dapat mencetuskan kanker endometrium. Saat ini masih sedikit sekali penelitian yang meneliti hubungan antara obesitas dan awitan kanker endometrium terutama yang merefleksikan populasi Indonesia. Studi ini bertujuan untuk mendalami topik tersebut berserta hubungannya dengan menopause pada pasien kanker endometrium di RSUPN Cipto Mangunkusumo tahun 2019-2021.  Metode: Penelitian ini dilakukan dengan menggunakan metode potong lintang menggunakan rekam medis pasien yang terdiagnosis kanker endometrium di RSUPN Cipto Mangunkusumo pada tahun 2019-2021. Terdapat 54 subjek penelitian dari sampel tersedia yang memenuhi kriteria inklusi dan eksklusi.  Hasil: Terdapat 122 kasus kanker endometrium yang ditemukan di RSUPN Cipto Mangunkusumo pada tahun 2019-2021. Sebanyak 48,2% dari seluruh subjek tergolong mengalami obesitas berdasarkan kriteria APAC. Sebanyak 40,7% subjek yang mengalami awitan kanker endometrium sebelum menopause dan terdapat 59,3% dari seluruh subjek yang mengalami awitan kanker endometrium setelah menopause.  Kesimpulan: Walaupun tidak terdapat hubungan statistik bermakna antara obesitas dan awitan kanker endometrium terhadap menopause, namun perbandingan proporsi menunjukkan bahwa 50% subjek kelompok obesitas mengalami awitan sebelum menopause dibandingkan 32,1% subjek pada kelompok IMT normal. ......Introduction: Currently, prevalence of non-communicable diseases, including obesity, is increasing. Obesity can present numerous complications and may be comorbidity that can bring challenges in treatments. Physiological changes provoked by obesity can be a risk factor for precipitating endometrial cancer. Obesity can cause excessive estrogen exposure from androgen conversion conveyed in peripheral adipose tissue. In addition, with hormonal changes attributed to menopause, hormonal imbalance may occur and precipitate endometrial cancer. At present, the availability of study discussing obesity and onset of endometrial cancer is still limited. This study is conducted to delve this topic with respect to menopause in patients with endometrial cancer at RSUPN Cipto Mangunkusumo in 2019-2021.  Method: This study is based on cross-sectional design study using health record of patients diagnosed with endometrial cancer at RSUPN Cipto Mangunkusumo in 2019-2021. There are 54 subjects from available sample and complying with inclusion and exclusion criteria.  Result: This study found 122 cases of endometrial cancer diagnosed at RSUPN Cipto Mangunkusumo in 2019-2021. As many as 48,2% of all subjects classified as having obesity in reference to APAC criteria. Proportion of patients with onset before menopause is 40,7% of all subjects while patients with onset after menopause is 59,3% from all subjects.  Conclusion: While this study suggests that there are no significant statistic association between obesity and onset of endometrial cancer compared with menopause, comparison of proportion of endometrial cancer onset shows that 50% of subjects with obesity experience onset before menopause compared to 32,1% subjects with normal BMI.

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Latar Belakang. Fibrilasi atrium (FA) awitan dini pascabedah pintas arteri koroner (BPAK) merupakan salah satu komplikasi pascaoperasi yang sering terjadi. Aritmia ini merupakan fenomena sementara dan mayoritas pasien akan mengalami konversi ke irama sinus saat dipulangkan. Meskipun bersifat sementara, FA awitan baru pasca-BPAK berpotensi mengalami rekurensi sehingga dapat meningkatkan risiko mortalitas jangka panjang. Tujuan. Mengetahui peran FA awitan baru pasca-BPAK dalam mempengaruhi kesintasan tiga tahun. Metode. Studi dengan desain kohort retrospektif menggunakan analisis kesintasan yang meneliti 196 pasien yang menjalani BPAK di Rumah Sakit Cipto Mangunkusumo dalam rentang waktu Januari 2012 sampai Desember 2015. Eksklusi dilakukan pada pasien yang memiliki riwayat FA sebelum operasi, menjalani operasi tanpa mesin pintas jantung-paru, dan yang meninggal dalam 30 hari pascaoperasi. Subyek penelitian dibagi menjadi 2 kelompok berdasarkan ada tidaknya FA awitan baru pasca-BPAK, yang selanjutnya ditelusuri status kematiannya dalam tiga tahun sejak operasi. Kurva Kaplan-Meier digunakan untuk menilai kesintasan tiga tahun dan dilakukan uji regresi Cox sebagai uji multivariat terhadap variabel perancu (usia ≥60 tahun, penyakit paru obstruktif kronis, diabetes melitus, gangguan ginjal, dan fraksi ejeksi ventrikel kiri yang rendah) untuk mendapatkan nilai adjusted hazard ratio (HR). Hasil. Sebanyak 29,59% pasien mengalami FA awitan baru pasca-BPAK. Angka mortalitas tiga tahun pasien yang mengalami FA awitan baru pasca-BPAK baru lebih tinggi dibandingkan kelompok yang tidak mengalaminya (15,52% vs 3,62%). Fibrilasi atrium awitan baru pasca-BPAK secara signifikan menurunkan kesintasan tiga tahun (p=0,008; HR. Pada analisis multivariat, FA awitan dini pascaBPAK merupakan faktor independen terhadap penurunan kesintasan tiga tahun (adjusted HR 4,04; IK 95% 1,34-12,14). Simpulan. Fibrilasi atrium awitan baru pasca-BPAK secara independen menurunkan kesintasan tiga tahun.

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Background. New-onset atrial fibrillation after coronary artery bypass grafting (CABG) is a common postoperative complication. This arrhytmia considered as temporary phenomenon which the majority are converted back to sinus rhythm when the patients discharged from the hospital. Despite its transience, those arrhythmia can recur and increasing the long term mortality. Objective. To determine the role of new-onset atrial fibrillation after CABG on three year survival. Method. This is a retrospective cohort study using survival analysis of patients who underwent coronary artery bypass grafting since January 2012 to December 2015 at Cipto Mangunkusumo Hospital. Patients who had atrial fibrillation before surgery, who had surgery without cardiopulmonary bypass machine, and who died in 30 days after surgery were excluded. Subjects were divided into two category based of the presence of newonset atrial fibrillation after CABG and the mortality status was followed up until 3 years post-surgery. The Kaplan-Meier curve was used to determine the three-year survival of the patients who had new-onset atrial fibrillation after CABG and Cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR). Result. New-onset atrial fibrillation after CABG occurred in 29,59% patients. Patients with new-onset atrial fibrillation after CABG had higher three-year mortality (15,52% vs 3,62%). New-onset atrial fibrillation after CABG significantly decreased three-year survival (p=0,008; HR 4,42; 95% CI; 1,49-13,2). In multivariate analysis, it was concluded that new-onset atrial fibrillation after CABG was an independent factor of the three-year survival decline (adjusted HR 4,04; 95% CI; 1,34-12,14). Conclusion. New-onset atrial fibrillation after CABG independently decreased the threeyear survival.

Abstrak :
Latar Belakang: Sepsis neonatorum diagnosisnya sulit ditegakkan karena gejala klinis dan laboratorium yang tidak spesifik. Pengobatan utama sepsis neonatorum adalah antibotik untuk menurunkan mortalitas, namun penggunaan antibiotik sering berlebihan, sehingga menyebabkan resistensi bahkan meningkatkan mortalitas. Objektif: Mengetahui tingkat kepatuhan dokter penanggung jawab pasien DPJP terhadap pedoman antibiotika pada tata laksana sepsis neonatorum, faktor-faktor yang mempengaruhi keputusan DPJP untuk memulai pemberian antibiotik, proses evaluasi pemberian dan penghentian antibiotik, kepatuhan pemilihan antibiotik empirik serta mengetahui faktor-faktor risiko apa saja yang dipakai dalam menegakkan diagnosis sepsis neonatorum awitan dini (SNAD) maupun sepsis neonatorum awitan lambat (SNAL). Metode: Studi dengan uji potong lintang menggunakan kuesioner wawancara pada subyek, data sekunder rekam medik serta melakukan Indepth Interview pada DPJP. Sampel penelitian adalah semua bayi baru lahir baik di RSCM maupun dari luar, diputuskan mendapat terapi antibiotik empirik lalu diberi stempel antibiotik periode bulan Desember 2017-Februari 2018 di divisi Neonatologi RSCM. Sebanyak 113 subyek dengan 167 kejadian dilakukan analisis. Hasil: Terdapat keragaman pemeriksaan septic screening awal yaitu 1-6 jam setelah lahir dan pemeriksaan ulangan rerata 56,45 37,40 jam pada SNAD dan pada SNAL 72,00 50,91 jam, antibiotik yang dilanjutkan sesuai antara klinis dan laboratorium pada SNAD 43 52,43 dari 82 subyek, dan SNAL 7 50 dari 14 subyek, namun 100 patuh pada regimen antibiotik empirik ampisilin dan gentamisin untuk tatalaksana SNAD ringan pada 86 51,49 kasus, rerata hari konsul ke divisi Infeksi adalah 9,53 5,39 pada SNAD dan 9,63 3,89 pada SNAL. Dan tidak didapatkannya hubungan antara faktor risiko dengan kesesuaian laboratorium dan klinis sepsis p=0.869. Kesimpulan: Terdapat perbedaan pertimbangan para DPJP dalam mendiagnosis sepsis, sehingga menyebabkan ketidak patuhan terhadap pedoman antibiotik yang ada.

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Background: Establishing diagnosis of neonatal sepsis is difficult due to non-specific clinical symptoms and laboratorial results. The key management for neonatal sepsis is antibiotic administration, decreasing mortality rate. However, over administration of antibiotic may lead to resistance and even increasing the mortality rate. Objectives: To evaluate the adherence of attending physicians to the neonatal sepsis guideline; To know factors that influence the attending physicians 39; decision in administrating the antibiotics; And to know risk factors that are considered by attending physicians to diagnose both early-onset neonatal sepsis EOS and late-onset neonatal sepsis (LOS). Methods: Cross-sectional study was performed using questionnaire taken from the subjects, secondary data in form of medical records, and in-depth interview on the attending physicians. Data collection was done in December 2017-February 2018, in Cipto Mangunkusumo Hospital Neonatologi Division. Total subjects of the research was 113, with 167 cases recorded, were then analyzed. Results: Various results were found regarding the early screening 1-6 hours after birth and follow-up screening for EOS 56,45 37,40 hours and LOS 72,00 50,91 hours. Appropriate administration of antibiotic, based on clinical and laboratorial data, are found in 43 52,43 from 82 case of EOS and 7 50 from 14 cases of LOS. All of attending physicians followed the guidelines regarding empirical antibiotic regiments for mild EOS, which is Ampicillin and Gentamicin on 86 cases 51.49. Average management time before attending physicians started to ask for consultation for EOS and LOS are 9,53 5,39 days and 9,63 3,89 days respectively. No relation were found between risk factors with laboratorial results and clinical sepsis p=0.869. Conclusion: Low level of adherence toward the antibiotic guideline is due to different considerations of attending physicians in diagnosing neonatal sepsis.

Abstrak :
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. ......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.

Abstrak :
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.

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Latar belakang: Infeksi saluran kemih ISK merupakan salah satu penyakit infeksi yang paling sering pada anak usia 2 bulan ndash; 2 tahun. Infeksi saluran kemih sulit dideteksi karena gejalanya yang tidak khas. Diagnosis pasti dengan biakan urin membutuhkan waktu yang lama, sedangkan pemeriksaan urinalisis sulit mendeteksi ISK karena pengosongan kandung kemih yang cepat. Pewarnaan Gram urin lebih mudah dilakukan, cepat, dan murah sehingga diajukan sebagai metode diagnosis alternatif. Tujuan: Mengetahui kesesuaian pemeriksaan pewarnaan Gram urin dibandingkan dengan biakan urin dalam mendiagnosis ISK pada anak usia 2 bulan - 2 tahun. Metode: Studi potong lintang, di RSCM Jakarta, bulan Mei hingga Desember 2016. Penelitian melibatkan 59 anak usia 2 bulan ndash; 2 tahun dengan klinis tersangka ISK. Urin diambil dengan teknik kateterisasi peruretra. Sampel urin diperiksakan pewarnaan Gram, biakan urin dan urinalisis. Biakan urin sebagai baku emas pemeriksaan, dinyatakan sebagai ISK apabila tumbuh kuman dengan koloni >50.000 cfu/mL. Pewarnaan Gram dinyatakan positif ISK apabila ditemukan satu jenis bakteri per lapang pandang besar. Hasil: Prevalens ISK pada penelitian ini sebesar 38,9. Sensitivitas pewarnaan Gram urin sebesar 47,8 IK 95 26,8-69,4, spesifisitas 97,2 IK 95 85,5-99,9, NDP 91,7 IK 95 60,3-98,8, NDN 74,5 IK 95 60,3-98,8, LR 17,2 IK 95 2,4-124,6, LR - 0,54 IK 95 0,36-0,8, akurasi 78. Simpulan: Terdapat kesesuaian antara pemeriksaan pewarnaan Gram urin dengan biakan urin dalam mendiagnosis ISK. Terapi antibiotik dapat segera diberikan apabila hasil pemeriksaan Gram urin positif menunjukkan hasil positif. Pemberian antibiotik dapat ditunda menunggu hasil biakan urin, apabila gejala klinis ISK tidak terlalu khas dan tidak ditemukan bakteri dari pewarnaan Gram urin. ...... Background: Urinary tract infection UTI one of the most common disease in children age 2 months 2 years. Urinary tract infection in children is often difficult to diagnose because of the atypical symptoms. The definitive diagnosis with urine culture has its limitations because it takes a long time to get results, while it is difficult to detect UTI using urinalysis due to the rapid bladder emptying. Gram staining of urine is thought to be easier, faster, and cheaper, therefore it is proposed as an alternative method for early diagnosis of UTI. Objective: To compare the diagnostic accuracy of urine Gram staining with urine culture to diagnose UTI in children aged 2 months to 2 years. Methods: A cross sectional study was conducted at Cipto Mangunkusumo Hospital from May to December 2016. The study involved 59 children aged 2 months 2 years drawn through consecutive sampling method with clinically suspected UTI. Urine sample was taken with per urethra catheterization techniques. Urine samples were examined by Gram staining, urine culture and urinalysis. Urine culture as a gold standard examination is expressed as UTI when colonies of bacterias grow 50,000 cfu mL. Gram stain tested positive for UTI if one type of bacteria is found per high power field. Results: The prevalence of UTI in this study is 38.9. The sensitivity of urine Gram staining is 47.8 95 CI 26.8 to 69.4, specificity of 97.2 95 CI 85.5 to 99.9, NDP 91.7 CI 95 from 60.3 to 98.8, NDN 74.5 95 CI 60.3 to 98.8, LR 17.2 95 CI 2.4 to 124.6, LR 0.54 95 CI 0.36 to 0.8, and accuracy of 78. Conclusion There is a correlation between the urine Gram staining with urine culture in diagnosing UTI in children aged 2 months 2 years. Antibiotics may be administered immediately when urine Gram staining shows positive result. Antibiotics for UTI may be delayed until the results of urine culture, if clinical symptoms of UTI is not very distinctive and urine Gram staining shows negative result.