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"ABSTRAKKebutuhan nutrisi merupakan kebutuhan fisiologis pada anak yang dapat mempengaruhi pertumbuhan dan perkembangan anak. Gangguan nutrisi pada anak merupakan masalah yang serius karena berdampak terhadap tumbuh kembang anak serta kemungkinan kualitas hidup kurang optimal. Pemberian nutrisi enteral melalui NGT dapat memenuhi kebutuhan nutrisi anak, namun pemberian nutrisi melalui NGT juga dapat menyebabkan terjadinya muntah. Untuk mencegah terjadinya muntah pada anak yang diberikan nutrisi enteral melalui NGT diberikan posisi miring kanan. Tujuan penulisan adalah untuk mengetahui efektifitas pengaturan posisi miring kanan untuk mencegah muntah. Metode dilakukan dengan menggunakan pendekatan PICO yang dilaksanakan selama 7 minggu bulan Februari sampai bulan April 2017 pada anak yang dirawat diruang infeksi RSUPN Cipto Mangunkusumo. Hasil didapatkan 40 anak, 20 anak diberikan posisi miring kanan kelompok intervensi 60 tidak muntah, 40 mengalami muntah. 20 anak diberikan posisi miring kiri kelompok kontrol 75 mengalami muntah dan 25 tidak muntah. Kesimpulan pengaturan posisi miring kanan dapat mengurangi muntah pada anak yang diberikan nutrisi enteral melalui NGT. Rekomendasi pengaturan posisi miring kanan dapat dilakukan pada anak stelah pemberian makan selama 30-60 menit untuk mencegah terjadinya muntah.Kata Kunci: Muntah, Nutrisi enteral, Posisi miring kanan

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ABSTRACTNutritional needs is a physiological requirement in children that can affect the growth and development of children. Nutritional disorders in children is a serious problem because it affects the development of children and the possibility of quality of life is less than optimal. Enteral nutrition through NGT can meet the nutritional needs of children, but nutrition through NGT can also cause vomiting. To prevent the occurrence of vomiting in children who are given enteral nutrition through NGT given right side position. The purpose of writing is to determine the effectiveness of the right tilt position to prevent vomiting. Methods were carried out using PICO approach which was carried out for 7 weeks February to April 2017 in the hospitalized child of Cipto Mangunkusumo RSUPN. The results obtained 40 children, 20 children were given right sloping position intervention group 60 did not vomit, 40 experienced vomiting. 20 children were given a left sidet position control group 75 experienced vomiting and 25 did not. The conclusion of right side position adjustment can reduce vomiting in children who are given enteral nutrition through NGT. Recommendation right side positioning may be performed in children after 30 60 minutes after feeding to prevent vomiting. "

"Karya ilmiah ini bertujuan untuk memberikan gambaran asuhan keperawatan pada klien DM tipe 2 dengan ulkus DM yang mengalami penurunan intake oral. Intervensi dilakukan dengan cara menerapkan pemberian nutrisi secara intermittent enteral feeding. Intervensi tersebut bertujuan membantu mengatasi gangguan pemenuhan nutrisi harian klien. Hasil yang tercapai melalui intervensi pemberian nutrisi secara bertahap adalah tercukupinya kebutuhan nutrisi harian klien dan kestabilan kadar gula darah klien. NGT yang terpasang pada klien selalu mebutuhkan evaluasi lebih lanjut untuk menjamin adekuasi nutrisi yang diberikan. Peran perawat selain memastikan kecukupan kebutuhan nutrisi klien yaitu mengevaluasi faktor yang beresiko mengakibatkan intoleransi penerimaan makanan pasien. Oleh karena itu pelayanan rumah sakit diharapkan senantiasa saling berkerjasama melakukan pengkajian dan analisa secara berkesinambungan mengatasi permasalahan kondisi klien setiap hari."

"Diabetics occasionally need enteral nutrition-either as supplement or in situations necessitating total dependency on enteral nutrition to fulfill their energy requirements. Enteral nutrition specifically designed fordiabet-ics is not yet available in our hospital, as sugar is often added to enteral nutrition preparations, subsequently affecting the blood glucose profiles of the patients.

This study was done to determine the glycemic index of 4 kinds of enteraf feeding formulas, conducted among ambulatory diabetics attending the Diabetic Clinic of the Dr Cipto Mangunkusumo General Central National Hospital.

Twenty samples were purposively chosen among the Diabetic Clinic attendees. They were well-controlled non-pregnant diabetics; none of them were having either kidney or liver problems, and were otherwise healthy. Each of the diabetic studied was given 50-g glucose syrup (200 Kcal) as a standard load. With a 3 to 4 days interval, the patients were consecutively given several enteral feeding formulas, i.e., the standard hospital enteral feeding formula (MC-FRS I), a newly developed diabetic formula (MC-FRS II), a frequently-used commercially avai 1-ablepredigested/elemental enteral feeding formula {MC-FK I = Isocal), and a new predigested/elemental enteral feeding formula specifically designed for diabetics (MC-FK II=Diabetasol). All of the formulas tested contained energy equal to 50-g glucose (200 Kcal). Blood glucose was measured with an Accutrend-Ames® glucometer in fasting condition and subsequently 30,60,90 and 120 minutes after the load. Any glucose/enteral feeding loading was given 30 minutes after. Data were presented as a blood glucose curve and glycemic index were calculated as area under the blood glucose curve of each food load compared to the standard glucose load, presented as percentage.

In all the enteral feedings studied, the blood glucose response curves went up and the peaks achieved in 60 minutes, thereafter declined to points above the initial fasting blood glucose values. The glycemic index of the MC-FRS I, MC-FRS II, MC-FK I and MC-FK II were 39.6%, 25%, 45% and 52.1% respectively.

The sugar that was added to the MC-FRS I and MC-FK I did not give rise to higher blood glucose levels as compared to the other non-glucose-added food. All of the enteral feeding formula tested showed low glycemic index (Miller, less than 55%). The difference glycemic index among the formulas studied might be due to different food composition (predigested/elemental component in the commercial enteral feeding formula; no sugar added and higher fiber in MC-FRS II as compared to MC-FRS I; higher fat content in MC-FK 1 as compared to MC-FK II). Glycemic index of enteral feeding formula was particularly determined by the total carbohydrate, total fat and total protein content of the food, as well as the presence of fiber and antinutrient in the food studied."

"Tujuan: Mengetahui efek pemberian nutrisi enteral dua jam pra sectio caesarea terhadap perubahan kadar hsIL-6 pasca sectio caesarea Metode: Penelitian ini merupakan uji klik paralel, yang subyek penelitiannya dipilih secara consecutive sampling, yang dibagi menjadi dua kelompok melalui randomisasi blok masing-masing terdiri dari 10 orang subyek. Data karakteristik awal penelitian meliputi usia, indikasi SC, status gizi berdasarkan KMS ibu hamil dan LiLA, asupan energi dan protein pra SC, lama operasi, jumlah perdarahan, dan hsIL-6 prabedah adalah homogen. Untuk melihat perbedaaan perubahan kadar hsIL-6 dilakukan pemeriksaan hsIL-6 setelah 6 jam pasca insisi. Analisis data dilakukan dengan menggunakan uji t. Batas kemaknaan 5%. Hasil: Peningkatan rerata dan simpang baku kadar hsIL-6 meningkat pada kedua Kelompok. Peningkatan kadar hsIL-6 ( p <0,05) dan perubahan kadar hsIL-6 lebih besar bermakna pada kelompok kontrol dibandingkan kelompok perlakuan (p <0,05). Simpulan: Pemberian nutrisi enteral dua jam pra secfio caesarea dapat menekan peningkatan kadar hsIL-6.

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Objective: To investigate the effect of enteral nutrition that given two hour before caesarean section on changes hsIL-6 levels after caesarean section.

Methods: The design study was a parallel clinical trial, in which the subject were selected by consecutive sampling, each proup consisted of ten subjects. The subject were divided into two groups using block randomization. Data collected including age, indication of CS, nutritional status based on MUAC and KMS chart in pregnancy, energy and protein intakes, duration of surgery, amount of blood loss during surgery, and hsIL-6 serum preoperative, were matched at baseline. To investigated the changes of hsIL-6 levels, the concentrations to assessed six hours post CS. Statistical analysis was measured by t-test. The significance levcl was 5%.

Results: There was a significant increasc of hsIL-6 levels (p = 0,001) in both groups. The increased and changes of hsIL-6 levels in the control group was significantly higher than in the treatment group. (p<0.05, and p <0,05 respectively).

Conclusion: Enteral nutrition that was given two hour before caesarean section can suppress the increased of hsIL-6 levels. "

"Stroke merupakan penyakit yang dapat menyebabkan berbagai efek samping misalnya disfagia dan penurunan kesadaran, jika tidak ditangani dengan baik dapat menyebabkan malnutrisi. Pemberian nutrisi enteral merupakan intervensi utama pada pasien yang mengalami ataupun mencegah malnutrisi. Walaupun begitu, nutrisi enteral sebagai intervensi utama ternyata memiliki risiko komplikasi apabila pemberian yang kurang tepat. Untuk itu penting bagi perawat untuk mengedukasi keluarga terkait pemberian NGT di rumah karena keluarga sebagai caregiver informal banyak digunakan khususnya di negara berkembang. Penelitian ini penting karena bertujuan untuk mengetahui gambaran pengetahuan perawat dalam mengedukasi keluarga mengenai pemberian nutrisi enteral melalui Nasogastric Tube pada pasien stroke. Penelitian ini menggunakan desain penelitian deskriptif analitik. Tingkat pengetahuan perawat mayoritas berpengetahuan baik dengan persentase 84,9%. Berdasarkan komponennya nilai rata-rata pengetahuan mengenai peran sebagai edukator 76,12, nilai rata-rata pengetahuan perawat mengenai pemberian nutrisi enteral 88,66, dan nilai rata-rata pengetahuan perawat mengenai pengetahuan dasar stroke 94,08. Sehingga pengetahuan mengenai peran perawat sebagai edukator dapat ditingkatkan.

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Stroke is a condition that can lead to various complications, such as dysphagia and decreased consciousness, if not treated properly can cause malnutrition. Enteral nutrition administration serves as a primary intervention for patients experiencing or at risk of malnutrition. However, enteral nutrition as a primary intervention carries the risk of complications if administered improperly. Therefore, it is essential for nurses to educate families on nasogastric tube (NGT) feeding at home, as family members often serve as informal caregivers, particularly in developing countries. This study is significant as it aims to describe nurses' knowledge in educating families about administering enteral nutrition via NGT for stroke patients. The research employs a descriptive-analytical design. The majority of nurses demonstrated good knowledge, with 84.9% scoring in this category. Based on the components assessed, the average knowledge score regarding the role as an educator was 76.12, the average score on enteral nutrition administration was 88.66, and the average score on basic knowledge of stroke was 94.08. Thus, knowledge about the nurse's role as an educators can be improved.

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"Anak sakit kritis pascabedah memiliki risiko mengalami malnutrisi. Terapi nutrisi optimal mampu mencegah morbiditas dan menurunkan mortalitas. Asupan protein yang adekuat mempercepat tercapainya anabolisme. Saat ini belum ada data yang tersedia mengenai pengaruh suplementasi protein enteral terhadap imbang nitrogen dan kadar Intestinal Fatty Acid Binding Protein (I-FABP). Penelitian ini bertujuan untuk menganalisis apakah peningkatan asupan protein nutrisi enteral berhubungan dengan perbaikan imbang nitrogen dan penurunan kadar serum I-FABP pada anak sakit kritis pascabedah. Penelitian ini merupakan uji klinis acak terkontrol dengan penyamaran ganda, melibatkan anak sakit kritis pascabedah usia 1-5 tahun yang mendapat nutrisi enteral dini. Total 76 subjek dibagi menjadi dua kelompok: kelompok dengan protein standar (3,0 g/100 mL) dan kelompok dengan protein tinggi (4,35 g/100 mL). Penilaian imbang nitrogen dilakukan 24 jam pertama dan ketiga setelah pemberian nutrisi enteral, sedangkan kadar I-FABP diperiksa sebelum dan sesudah 72 jam nutrisi enteral. Terjadi peningkatan signifikan rerata imbang nitrogen pada kelompok protein tinggi 283,4 (SB 82,5) mg/kg/hari, dibandingkan kelompok protein standar dengan nilai 114,7 (SB 53) mg/kg/hari (p<0,0001). Tidak terjadi penurunan signifikan kadar I-FABP pada kelompok peningkatan imbang nitrogen di atas rerata dibandingkan kelompok peningkatan imbang nitrogen di bawah rerata. Pemberian suplementasi enteral protein tinggi meningkatkan imbang nitrogen pada anak sakit kritis pascabedah tanpa efek samping yang merugikan.

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Critically ill post-surgical children are at risk of malnutrition. Optimal nutritional therapy can prevent morbidity and reduce mortality. Adequate protein intake accelerates the achievement of anabolism. Currently, no data is available regarding the effect of enteral protein supplementation on nitrogen balance and levels of Intestinal Fatty Acid Binding Protein (I- FABP). This study aims to analyze whether increasing protein intake in enteral nutrition is associated with improved nitrogen balance and reduced serum I-FABP levels in critically ill post-surgical children. This was a double-blind, randomized controlled trial involving critically ill post-surgical children aged 1 to 5 years who were receiving early enteral nutrition. A total of 76 subjects were divided into two groups: the standard protein group (3.0 g/100 mL) and the high-protein group (4.35 g/100 mL). Nitrogen balance was assessed on the first and third days, while I-FABP levels were examined before and after 72 hours of enteral feeding. There was a significant increase in the average nitrogen balance in the high protein group, 283.4 (SD 82.5) mg/kg/day, compared to the standard protein group, 114.7 (SD 53) mg/kg/day, with p<0.0001. There was no significant decrease in I-FABP levels in the group with nitrogen balance improvement above the average compared to the group with nitrogen balance improvement below the average. High-protein enteral supplementation improves nitrogen balance in critically ill post-surgical children without adverse side effects."

"Tujuan : Mengetahui pengaruh pemberian NED terhadap status protein penderita luka bakar derajat II, 20-60% dari luas permukaan tubuh (LPT) dan/atau derajat III ≥ 10% LPT usia 18-60 tahun.Tempat : Unit Luka Bakar RSUPNCMBahan dan Cara : Penelitian ini merupakan suatu uji klinik dengan randomisasi yang telah disetujui oleh panitia tetap penilai etik penelitian Fakultas Kedokteran Universitas Indonesia. Duapuluh subyek yang memenuhi kriteria penerimaan dan penolakan dibagi 2 kelompok secara randomisasi blok. Sepuluh subyek perlakuan diberi NED mulai ≤ 8 jam pasca luka bakar, sedangkan 10 subyek kontrol diberi nutrisi enteral/oral 24 jam pasca luka bakar. Pengamatan dilakukan selama 12 hari. Status protein ditetapkan dengan pemeriksaan albumin dan prealbumin serum serta nitrogen urea urin (NUU). Sampel darah untuk pemeriksaan albumin dan prealbumin diambil hari ke-l, 7, dan 12. Urin tampung 24 jam untuk pemeriksaan NUU diambil hari ke-3, 7 dan 12. Uji statistik yang digunakan adalah uji t untuk data berdistribusi normal dan uji Mann Whitney U untuk data berdistribusi tidak normal, batas kemaknaan yang digunakan sebesar 5%.Hasil : Penelitian ini menunjukkan pemberian NED tidak menunjukkan perbedaan bermakna terhadap status protein antara kelompok perlakuan dan kelompok kontrol, tetapi pada kelompok perlakuan didapatkan peningkatan kadar prealbumin dan gambaran penurunan kadar NUU yang lebih tajam.Kesimpulan : NED mempunyai kecenderungan dapat memperbaiki status protein walaupun belum dapat dibuktikan secara statistik.

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The Effect of Early Enteral Nutrition (EEN) on Protein Status in Burn Patients at Burn Unit Dr. Cipto Mangun Kusumo Hospital 1999-2000Objective: To know the effect of EEN on protein status in burn patients with 20-60% total body surface area (TBSA) of second degree burned, and/or ≥ 10% TBSA of third degree burned, age 18-60 years old subjects.

Place: Burn Unit Cipto Mangunkusumo Hospital Material and Methods

The study was a randomized clinical trial, which already certify by the ethical clearance research committee of the Faculty of Medicine University of Indonesia. Twenty subjects were selected by inclusion and exclusion criteria. The subjects were divided into two groups by block randomization. Ten subjects were given enteral nutrition started ≤ 8 hours post burn, while 10 control subjects were given enteral / oral nutrition 24 hours post burn. Observation was done for 12 days. Protein status was determined by the laboratory result of albumin and prealbumin serum and the level of urinary urea nitrogen (UUN). Blood samples for albumin and prealbumin serum were taken on the day 1st, 7th and 12th. Twenty four hours collected urines for UUN examination were taken on the day 3rd, 7th and 12th . Statistical analysis was performed with t-test for data with normal distribution and Mann Whitney U test for data which do not conform to a normal distribution. The level of significance was 5%.

Results: The results showed no significant difference between the two groups, except on day 12th the prealbumin level tends to increase and the UUN level tend to decrease in the study group.

Conclusion : The EEN tend to be able to increase the protein status although has not statistically proven yet."

"Tujuan penelitian uji klinik paralel terbuka ini adalah diketahuinya pengaruhpemberian nutrisi enteral per oral pra Sectio Caesarea (SC) terhadap kadar highsegasfrfvity C-Reactive Protein (hsCRP) serum pasca SC. Penelitian ini telahdisetujui komisi etik penelitian Fakultas Kedokteran Universitas Indonesia.Sebanyak 27 pasien SC elektif di RSUD Bekasi yang memenuhi kriteriapenelitian dibagi dalam dua kelompok sccara randomisasi blok. Sebanyak 13orang subyek mendapat nutrisi enteral 200 mL (kelornpok P) dan 14 orang subyekmendapat teh manis 200 mL (kelompok K) yang diberikan dua jam pra SC. Datayang dikumpulkan meliputi usia, umur kehamilan, status gizi, indikasi SC, lamaSC, pcrdarahan, dan asupan energi, dan protein. Pemeriksaan kadar hsCRPserum dilalcukan dua jam pra SC dan 48 jam pasca SC. Uji statistik yangdigunakan adalah uji t dan uji Man11~Whitney dengan hatas kernalmaan 5%.Sebanyalc 12 orang kelompok P dan 12 orang kelompok K dengan rerata usia29,78 jg 4,41 tahun mengikuti penelitian secara lengkap. Status gizi seluruhSubyek berdasarkan LiLA temmasuk kategori Status gizi balk, sedangkanberdasarkan KMS ibu hamil Depkes termasuk kategori status gizi lebih. Padaawal penelitian, karaktristik data dasar pada kedua kelompolc tidakmemperlihatkan perbedaan yang bermakna (p >0,05). Pada kedua kelompokdidapatkan peningkatan kadar hs,CRP serum pasca SC yang lebih nyata texjadipada kelompok K dan secam statisiik berbeda bermakna (p == 0,00). Pemberian200 mL nutrisi enteral pra SC dapat mengendalikan peningkatan kadar hsCRPserum pasca SC."

"Penulisan karya ilmiah akhir ini bertujuan untuk mengaplikasikan Model Konservasi Myra E Levine dalam pemenuhan kebutuhan nutrisi pada bayi prematur Nutrisi pada bayi prematur penting untuk kelangsungan hidup dan tumbuh kembang yang optimal Tantangan dalam pemberian nutrisi pada bayi prematur adalah adanya imaturitas organ Cara pemberian nutrisi pada bayi prematur tergantung pada keadaan klinis dan usia gestasi Nutrisi pada bayi prematur dapat diberikan secara enteral maupun parenteral Selama menjalani perawatan tiga dari lima bayi prematur dalam uraian karya ilmiah akhir ini menunjukkan status kardiopulmonal yang stabil tidak terdapat instabilitas suhu dan peningkatan berat badan masih dalam rentang normal yaitu 10 15 gram hari

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The aim of this final scientifict report was to apply Myra E Levine Conservation Model rsquo s in feeding intervention preterm infants Nutrition is important for survival optimal growth and development of preterm infants The challenge in feeding preterm infants is the organ immaturity Feeding in preterm infants depends on clinical status and gestasional age Nutrition in preterm infants can be provides by enteral and total parenteral nutrition During treatments three of five preterm infants in this final scientifict report showed cardiopulmonal stability status stability of body temperature and increase of body weights was in the normal range of 10 15 gram day "