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Abstrak :
Kelainan ginjal pada anak masih menjadi masalah karena berpengaruh pada proses tumbuh kembang serta meningkatkan morbiditas dan mortalitas penyakit ginjal anak. Studi kolaboratif dari tujuh pusat pendidikan Ilmu Kesehatan Anak di Indonesia pada tahun 1984 hingga 1988 memperlihatkan bahwa dari 104.457 kasus yang dirawat map di rumah sakit terdapat 2892 (3%) anak mengalami penyakit ginjal atau saluran kemih. Di Departemen Ilmu Kesehatan Anak RSCM (IKA RSCM) pada tahun 1986 hingga 1988, dari 14.480 pasien rawat map terdapat 489 (3,3%) anak dengan penyakit ginjal dan saluran kemih. Dalam penanganan penyakit ginjal dan saluran kemih diperlukan perhatian yang memadai dan tindak lanjut yang teratur untuk mencegah berlanjutnya perkembangan penyakit Kelainan saluran kemih dapat disertai perubahan pada ukuran ginjal yang dapat dinilai dengan berbagai metode pencitraan. Untuk menentukan adanya perubahan pada ukuran ginjal diperlukan standar ukuran ginjal normal yang dapat dipakai sebagai rujukan. Saat ini pemeriksaan ultrasonografi (USG) telah menjadi pilihan pertama dalam mengevaluasi ukuran ginjal pada anak 5.6 Berbagai penelitian yang mengamati ukuran ginjal normal dengan teknik USG pada neonatus dan anak sehat telah dipublikasikan. Ukuran ginjal yang diukur dengan USG dapat berupa panjang dan volume ginjal, sedangkan parameter ukuran tubuh yang banyak digunakan antara lain tinggi badan, berat badan dan usia kronologis.

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ABSTRAK
Latar belakang: Sejak dilaporkan pertama kali pada tahun 1981 di Amerika Serikat, penyebaran Acquired Immune Deficiency Syndrome (AIDS) di seluruh dunia termasuk Indonesia terjadi dengan pesat. Saluran pencernaan merupakan target utama infeksi HIV. Enteropati terjadi pada 15-70% kasus anak. Enteropati dapat terjadi walaupun tanpa gejala gastrointestinal. Kondisi enteropati dapat menimbulkan perburukan gejala gastrointestinal, kegagalan pertumbuhan dan menyebabkan pasien mengarah pada wasting. Enteropati dideteksi dengan pemeriksaan alpha 1 antitripsin. Tujuan: (1) Mengetahui proporsi enteropati yang terjadi pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. (2) Mengetahui karakteristik enteropati yang terjadi pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. (3) Mengetahui hubungan antara enteropati dengan usia, status gizi, status imunodefisiensi, jenis dan lama terapi ARV serta lama sakit anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. Metode: Penelitian potong lintang deskriptif dan analitik yang dilakukan di Poliklinik Alergi Imunologi Departemen Ilmu Kesehatan Anak FKUI- RSCM antara bulan Agustus sampai dengan November 2015 terhadap anak dengan AIDS stadium lanjut berusia 0 - 18 tahun tanpa gejala gastrointestinal. Faktor risiko dianalisis bivariat dan multivariat. Hasil: Total subjek penelitian berjumlah 70 subjek (35 lelaki dan 35 perempuan). Enteropati terjadi pada 31 subjek. Enteropati lebih banyak ditemukan pada anak perempuan, usia >60 bulan, mengalami malnutrisi, tidak ada imunodefisiensi, obat antiretroviral lini kedua dan ketiga, lama pengobatan 0-59 bulan dan lama sakit 059 bulan. Pada analisis bivariat tidak didapatkan faktor risiko yang bermakna. Pada analisis multivariat didapatkan lama sakit 0-59 bulan dengan nilai OR 3,451 (IK95% 1,026-11,610) merupakan faktor risiko yang berperan dalam terjadinya enteropati pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. Simpulan : Proporsi enteropati pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal sebanyak 31 dari 70 subjek. Faktor risiko yang berperan adalah lama sakit 0-59 bulan. ABSTRACT
Background: HIV/AIDS is a global pandemic. Digestive tract is a major target for HIV infection. The digestive-absorptive functions are impaired, occurring in 1570% of children. Enteropathy contributes to gastrointestinal manifestation, growth failure and further immune derangement, leading to wasting. The diagnostic approach includes alpha 1 antitrypsin fecal level. Objective: (1) to describe frequency of enteropathy in advanced stages of AIDS children without gastrointestinal manifestation, (2) to describe characteristic of children with advanced stages of AIDS without gastrointestinal manifestation who develop enteropathy, (3) to investigate the role of age, nutritional status, immunodeficiency status, type and duration of antiretroviral therapy, and duration of illness as risk for enteropathy in advanced stages of AIDS children without gastrointestinal manifestation. Methods: A descriptive and analytic cross-sectional study was conducted at Pediatric Allergy-Immunology Outpatient Clinic RSCM between August to November 2015. The inclusion criteria was advanced stages of AIDS children age 0-18 years old without gastrointestinal manifestation. Risk factors were analyzed with bivariate and multivariate analysis. Results: Seventy children fulfilled the study criteria (35 males and 35 females). Thirty-one subjects were diagnosed as enteropathy. Most subjects are female, age >60 month-old, malnutritional status, no immunodeficiency, received second and third line antiretroviral regimen with duration 0-59 months and duration of illness 0-59 months. Bivariate analysis showed that no factor was significantly associated with enteropathy. Based on multivariate analysis, duration of illness 0-59 months is a significant risk factor with OR 3.451 (CI 1.026-11.610). Conclusions: The proportion enteropathy in advanced stages of AIDS children without gastrointestinal manifestation is 31/70. Patients who had been diagnosed as advanced stage of HIV/AIDS for 0-59 months are more likely to develop enteropathy.;Background: HIV/AIDS is a global pandemic. Digestive tract is a major target for HIV infection. The digestive-absorptive functions are impaired, occurring in 1570% of children. Enteropathy contributes to gastrointestinal manifestation, growth failure and further immune derangement, leading to wasting. The diagnostic approach includes alpha 1 antitrypsin fecal level. Objective: (1) to describe frequency of enteropathy in advanced stages of AIDS children without gastrointestinal manifestation, (2) to describe characteristic of children with advanced stages of AIDS without gastrointestinal manifestation who develop enteropathy, (3) to investigate the role of age, nutritional status, immunodeficiency status, type and duration of antiretroviral therapy, and duration of illness as risk for enteropathy in advanced stages of AIDS children without gastrointestinal manifestation. Methods: A descriptive and analytic cross-sectional study was conducted at Pediatric Allergy-Immunology Outpatient Clinic RSCM between August to November 2015. The inclusion criteria was advanced stages of AIDS children age 0-18 years old without gastrointestinal manifestation. Risk factors were analyzed with bivariate and multivariate analysis. Results: Seventy children fulfilled the study criteria (35 males and 35 females). Thirty-one subjects were diagnosed as enteropathy. Most subjects are female, age >60 month-old, malnutritional status, no immunodeficiency, received second and third line antiretroviral regimen with duration 0-59 months and duration of illness 0-59 months. Bivariate analysis showed that no factor was significantly associated with enteropathy. Based on multivariate analysis, duration of illness 0-59 months is a significant risk factor with OR 3.451 (CI 1.026-11.610). Conclusions: The proportion enteropathy in advanced stages of AIDS children without gastrointestinal manifestation is 31/70. Patients who had been diagnosed as advanced stage of HIV/AIDS for 0-59 months are more likely to develop enteropathy.;Background: HIV/AIDS is a global pandemic. Digestive tract is a major target for HIV infection. The digestive-absorptive functions are impaired, occurring in 1570% of children. Enteropathy contributes to gastrointestinal manifestation, growth failure and further immune derangement, leading to wasting. The diagnostic approach includes alpha 1 antitrypsin fecal level. Objective: (1) to describe frequency of enteropathy in advanced stages of AIDS children without gastrointestinal manifestation, (2) to describe characteristic of children with advanced stages of AIDS without gastrointestinal manifestation who develop enteropathy, (3) to investigate the role of age, nutritional status, immunodeficiency status, type and duration of antiretroviral therapy, and duration of illness as risk for enteropathy in advanced stages of AIDS children without gastrointestinal manifestation. Methods: A descriptive and analytic cross-sectional study was conducted at Pediatric Allergy-Immunology Outpatient Clinic RSCM between August to November 2015. The inclusion criteria was advanced stages of AIDS children age 0-18 years old without gastrointestinal manifestation. Risk factors were analyzed with bivariate and multivariate analysis. Results: Seventy children fulfilled the study criteria (35 males and 35 females). Thirty-one subjects were diagnosed as enteropathy. Most subjects are female, age >60 month-old, malnutritional status, no immunodeficiency, received second and third line antiretroviral regimen with duration 0-59 months and duration of illness 0-59 months. Bivariate analysis showed that no factor was significantly associated with enteropathy. Based on multivariate analysis, duration of illness 0-59 months is a significant risk factor with OR 3.451 (CI 1.026-11.610). Conclusions: The proportion enteropathy in advanced stages of AIDS children without gastrointestinal manifestation is 31/70. Patients who had been diagnosed as advanced stage of HIV/AIDS for 0-59 months are more likely to develop enteropathy.

Abstrak :
Indeks antropometri merupakan pengukuran yang mudah, cepat, murah, non-invasif, dan cukup akurat dalam memprediksi lemak viseral tubuh yang berkorelasi erat dengan sindrom metabolik. Lingkar pinggang merupakan salah satu indeks antropometri yang dapat digunakan untuk memprediksi sindrom metabolik dan dapat digunakan sebagai pengukuran alternatif atau tambahan di samping body mass index (BMI)/indeks massa tubuh (IMT), karena terdapat hubungan yang jelas antara Iingkar pinggang, deposisi lemak viseral, dan faktor risiko kardiovaskular pada anak. Selain itu, lingkar pinggang merupakan pengukuran yang membutuhkan peralatan yang sederhana, murah, dan pencatatan nilai tunggal atau rata-rata dari dua atau tiga pengukuran. Beberapa negara, seperti Amerika Serikat, Inggris, Yunani, dan Spanyol telah membuat nilai batasan lingkar pinggang menurut populasi mereka sendiri untuk memprediksi sindrom metabolik. Sayangnya, Indonesia belum mempunyai nilai batasan lingkar pinggang untuk memperkirakan risiko sindrom metabolik pada anak dan remaja obes dengan menggunakan populasi anak dan remaja Indonesia. RUMUSAN MASALAH ? Berapakah proporsi sindrom metabolik pada kelompok remaja obes yang mempunyai lingkar pinggang di atas atau sama dengan persentil 80, dan di bawah persentil 80 menurut Taylor, dkk? ? Bagaimanakah gambaran tebal lemak viseral berdasarkan USG abdomen pada remaja obes, yang mengalami maupun tidak mengalami sindrom metabolik? Tujuan Umum ? Mengetahui manfaat lingkar pinggang persentil 80 menurut Taylor, dkk dalam memprediksi sindrom metabolik pada remaja obes. ? Mengetahui ketebalan lemak viseral pada remaja obes dengan menggunakan USG abdomen. Tujuan Khusus ? Mengetahui proporsi sindrom metabolik berdasarkan kriteria NCEPATP III yang dimodifikasi khusus untuk penelitian ini pada kelompok remaja obes dengan lingkar pinggang di atas atau sama dengan persentil 80 menurut Taylor, dkk. ? Mengetahui proporsi sindrom metabolik berdasarkan kriteria NCEPATP III yang dimodifikasi khusus untuk penelitian ini pada kelompok remaja obes dengan lingkar pinggang di bawah persentil 80 menurut Taylor, dkk. ? Mengetahui gambaran tebal lemak viseral berdasarkan USG abdomen pada kelompok remaja obes yang mengalami sindrom metabolik, dengan lingkar pinggang di atas atau sama dengan persentil 80, dan di bawah persentil 80 menurut Taylor, dkk. ? Mengetahui gambaran tebal lernak viseral berdasarkan USG abdomen pada kelompok remaja obes yang tidak mengalami sindrom metabolik, dengan lingkar pinggang di atas atau sama dengan persentil 80, dan di bawah persentil 80 menurut Taylor, dkk.

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[ABSTRAK
Latar belakang: Hiponatremia pasca tindakan operasi mayor pada populasi anak merupakan gangguan elektrolit yang sering terjadi. Penggunaan cairan yang belum tepat sering menimbulkan peningkatan kejadian hiponatremia yang berhubungan erat dengan meningkatnya berbagai komplikasi seperti edema otak, kejang, bahkan kematian. Populasi anak merupakan risiko tinggi karena perbandingan jaringan otak dan tulang tengkorak yang lebih besar sehingga ruang yang tersedia saat terjadi edema otak lebih sempit. Tujuan: Mengetahui insidens hiponatremia pada anak pasca tindakan operasi mayor. Metode: Studi retrospektif potong lintang dilakukan terhadap anak usia 1 bulan hingga 18 tahun yang menjalani tindakan operasi mayor dan masuk ruang perawatan intensif. Penelusuran status medik sesuai kriteria inklusi dilakukan sampai jumlah sampel terpenuhi. Pencatatan terhadap subjek yang meliputi data praoperasi, intraoperasi, serta pemantauan pascaoperasi dilakukan. Subjek yang memenuhi definisi hiponatremia (<135 mEq/L) diklasifikasikan sesuai derajat hiponatremia dan dilakukan pencarian lebih lanjut terhadap komplikasi. Hasil : Studi dilakukan terhadap 90 subjek yang terdiri dari 56,7% lelaki, dengan 51,1% memiliki rentang usia 1 bulan hingga 4 tahun. Sebanyak 47,8% subjek menjalani tindakan laparatomi dengan berbagai indikasi. Hampir semua subjek (93,3%) mendapat cairan hipotonik pascaoperasi. Insidens hiponatremia pascaoperasi sebesar 28,9% dengan 11,1% diantaranya merupakan hiponatremia sedang-berat. Rerata kadar natrium pascaoperasi adalah 130,1 ± 4,1 mEq/L dengan rerata total cairan 79,8 ± 27,4 ml/kg. Sebesar 30,9% subjek yang mendapatkan cairan hipotonik pascaoperasi mengalami kejadian hiponatremia dengan rerata lama rawat 5,6 ± 4 hari. Terdapat 1/26 subjek yang mengalami komplikasi berupa kejang dan edema otak. Simpulan: Insidens hiponatremia pasca tindakan operasi mayor di ruang perawatan intensif hampir mencapai 30% dan sebagian besar mendapat cairan hipotonik pascaoperasi. Penelitian lebih lanjut perlu dilakukan untuk mengevaluasi pemberian cairan pascaoperasi yang tepat untuk mencegah hiponatremia.

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ABSTRACT
Background: Hyponatremia is commonly found post major surgery in pediatric population. The use of improper fluid often leads to increasing incidence of hyponatremia which causes complications such as cerebral edema, seizure, and death. Pediatric is a high risk population due to the large ratio between the brain tissue and skull, so that the availability space. Hyponatremia after major surgery in pediatric population is a common electrolyte disorder. The use of improper fluid often lead to increased incidence of hyponatremia which is closely linked to the increasing variety of complications such as cerebral edema, seizures, and even death. Pediatric is high risk population due to the larger comparison of brain tissue and the skull so that the space available in the event of brain edema narrower. Objective: To describe the incidence of hyponatremia in children after major surgery. Methods: A retrospective cross-sectional study was conducted on children aged 1 month to 18 years who underwent major surgery and entered the intensive care ward. The inclusion subjects was traced from medical records. The data was recorded from preoperative, intraoperative, and postoperative monitoring. Subjects who met hyponatremia (<135 mEq/L) were classified according to the severity of hyponatremia and its complications. Results: Ninety subjects were enrolled in this study (56.7% male, 51.1% age 1 month-4 years). There were 47.8% subjects underwent laparotomy with a variety of indications. Almost all subjects (93.3%) received postoperative hypotonic fluid. The incidence of postoperative hyponatremia was 28.9%, while 11.1% among them were moderate-severe hyponatremia. The mean postoperative sodium levels was 130.1 ± 4.1 mEq/L with a mean total fluid 79.8 ± 27.4 ml/kg. There were 30.9% subjects who received hypotonic fluids and experienced hyponatremia with a mean length of stay 5.6 ± 4 days. One of 26 subjects with hyponatremia suffered from seizures and brain edema. Conclusions: The incidence of postoperative hyponatremia in pediatric intensive care reached nearly 30%, and almost all of them received hypotonic fluid. Therefore, further research should be performed to evaluate the appropriate fluid in order to anticipating postoperative hyponatremia, Background: Hyponatremia is commonly found post major surgery in pediatric population. The use of improper fluid often leads to increasing incidence of hyponatremia which causes complications such as cerebral edema, seizure, and death. Pediatric is a high risk population due to the large ratio between the brain tissue and skull, so that the availability space. Hyponatremia after major surgery in pediatric population is a common electrolyte disorder. The use of improper fluid often lead to increased incidence of hyponatremia which is closely linked to the increasing variety of complications such as cerebral edema, seizures, and even death. Pediatric is high risk population due to the larger comparison of brain tissue and the skull so that the space available in the event of brain edema narrower. Objective: To describe the incidence of hyponatremia in children after major surgery. Methods: A retrospective cross-sectional study was conducted on children aged 1 month to 18 years who underwent major surgery and entered the intensive care ward. The inclusion subjects was traced from medical records. The data was recorded from preoperative, intraoperative, and postoperative monitoring. Subjects who met hyponatremia (<135 mEq/L) were classified according to the severity of hyponatremia and its complications. Results: Ninety subjects were enrolled in this study (56.7% male, 51.1% age 1 month-4 years). There were 47.8% subjects underwent laparotomy with a variety of indications. Almost all subjects (93.3%) received postoperative hypotonic fluid. The incidence of postoperative hyponatremia was 28.9%, while 11.1% among them were moderate-severe hyponatremia. The mean postoperative sodium levels was 130.1 ± 4.1 mEq/L with a mean total fluid 79.8 ± 27.4 ml/kg. There were 30.9% subjects who received hypotonic fluids and experienced hyponatremia with a mean length of stay 5.6 ± 4 days. One of 26 subjects with hyponatremia suffered from seizures and brain edema. Conclusions: The incidence of postoperative hyponatremia in pediatric intensive care reached nearly 30%, and almost all of them received hypotonic fluid. Therefore, further research should be performed to evaluate the appropriate fluid in order to anticipating postoperative hyponatremia]

Abstrak :
Latar Belakang: Rendahnya ketepatan kultur bakteriologis dan kurangnya fasilitas pencitraan terutama di daerah perifer, mendiagnosis meningitis tuberkulosis (MTB) pada anak menjadi suatu tantangan. Tujuan: untuk membentuk sistem skor yang terdiri dari manifestasi klinis dan pemeriksaan laboratorium sederhana untuk membantu diagnosis MTB pada anak. Metode: Studi retrospektif menggunakan model prediktif diagnostik multivariabel dengan anak usia 3 bulan hingga 18 tahun terdiagnosis meningitis, dirawat inap selama periode Juli 2011 hingga November 2021 di rumah sakit tersier. Hasil: Dari 10 variabel yang memiliki signifikansi statistik dengan TBM, diperoleh 8 variabel untuk membangun model prediksi untuk mengidentifikasi TBM. Variabel ini dibagi menjadi dua bagian skoring yang keduanya memiliki diskriminasi dan kalibrasi yang baik, sistem skoring sistemik (4 parameter, batas nilai skor ³3, sensitivitas 78,8%, spesifisitas 86,6% dengan AUC 89,9% (p<0,001) ) dan sistem skoring neurologis (4 parameter, batas nilai skor ³2, sensitivitas 61,2%, spesifisitas 75,2% dengan AUC 73,3% (p<0,001). Sistem skoring ini bila digunakan bersamaan dan memenuhi batas nilai skor masing-masing, dapat memprediksi diagnosis TBM pada anak dengan baik (sensitivitas 47,1%, spesifisitas 95,1%, dan nilai prediksi positif 90,9%). Kesimpulan: Sistem skoring klinis yang terdiri dari dua bagian, skor sistemik dan skor neurologis, memiliki kemampuan yang baik dalam memprediksi diagnosis TBM pada anak. ......Due to the low accuracy of culture techniques in bacteriological confirmation and the lack of brain imaging facilities especially in peripheral areas, diagnosing tuberculous meningitis (TBM) in children become a challenge Objective : to establish scoring systems consisting of clinical manifestations and simple laboratory examination to help diagnosing TBM in children. Method: Retrospective study using a multivariable diagnostic predictive model with children diagnosed as meningitis aged 3 months to 18 years, hospitalized during July 2011 until November 2021 period in a tertiary hospital. Result: From 10 variables that have statistical significance with TBM, 8 variables were obtained for establishing the predictive model to identify TBM. These variables divided into two scoring parts which both had good discrimination and calibration, the systemic scoring system (4 parameters, total cut-off score ³3, sensitivity of 78.8%, specificity of 86.6% with AUC of 89.9% (p<0.001)) and the neurological scoring system (4 parameters, total cut-off score ³2, sensitivity of 61.2%, specificity of 75.2% with AUC of 73.3% (p<0.001)). Furthermore, these scoring systems when used together and met the cut-off score respectively, can predict the diagnosis of TBM in children well (sensitivity 47.1%, specificity 95.1%, and positive predictive value 90.9%). Conclusion: a clinical scoring systems consist of two parts, systemic score and neurological score, have good ability in predicting the diagnosis of TBM in children.

Abstrak :
Latar belakang: Penilaian usia tulang dengan metode Greulich and Pyle merupakan metode yang paling sering digunakan. Namun metode ini bersifat subjektif dan ahli yang dapat membaca usia tulang dengan metode ini belum tersebar merata. Saat ini, penilaian usia tulang melalui metode deep learning artificial intelligence mulai banyak digunakan. Metode ini dinilai lebih objektif dan memiliki akurasi yang setara atau lebih baik dibandingkan metode Greulich and Pyle. Tujuan: Penelitian ini bertujuan untuk mengetahui akurasi deep learning artificial intelligence dibandingkan Greulich and Pyle dalam menilai usia tulang. Metode: Penelitian merupakan studi potong lintang yang dilakukan di Rumah Sakit Cipto Mangunkusumo menggunakan foto tangan dan pergelangan tangan di Divisi Pencitraan yang diambil pada Desember 2022 sampai November 2023. Subjek yang diteliti adalah anak berusia 1 – 18 tahun yang diindikasikan untuk dilakukan pemeriksaan usia tulang. Akurasi dinilai melalui korelasi, perbedaan rerata, dan kesesuaian antara dua metode. Hasil: Sebanyak 275 foto dalam kurun waktu 12 bulan dimasukkan ke dalam penelitian dengan nilai tengah 9,5 tahun. Korelasi antara kedua metode pembacaan usia tulang adalah 0,971 (IK95% 0,963 – 0,977 ; p < 0,001) yang berarti memiliki korelasi positif kuat. Perbedaan rerata hasil pembacaan kedua metode adalah 0,53 tahun (IK95% 0,45 – 0,62; p < 0,001). Walaupun bermakna secara statistik, perbedaan rerata ini tidak bermakna secara klinis karena usia tulang yang abnormal harus lebih dari 2 standar deviasi. Kesesuaian pembacaan usia tulang antara kedua metode baik dengan nilai kappa 0,752 (IK95% 0,675 – 0,828; p < 0,001). Kesimpulan: Penilaian usia tulang dengan metode deep learning artificial intelligence memiliki akurasi yang sama dengan metode Greulich and Pyle. ......Background: Bone age assessment using the Greulich and Pyle method is the most frequently used. However, this method is subjective and experts who can read bone age using this method are not evenly distributed. Currently, bone age assessment using deep learning artificial intelligence methods is starting to be widely used. This method is considered more objective and has equivalent or better accuracy. Objective: This study aims to determine the accuracy of deep learning artificial intelligence compared to Greulich and Pyle in assessing bone age. Method: This was a cross-sectional study conducted at Cipto Mangunkusumo Hospital using radiology of the hands and wrists in the Imaging Division taken from December 2022 to November 2023. The subjects studied were children aged 1 – 18 years who were indicated for bone age examination. Accuracy was assessed through correlation, mean difference, and agreement between the two methods. Results: A total of 275 photos over a 12 month period were included in the study with a median value of 9.5 years. The correlation between the two bone age assessment methods was 0.971 (95% CI 0.963 – 0.977; p < 0.001), which showed a strong positive correlation. The mean difference between the two methods was 0.53 years (95% CI 0.45 – 0.62; p < 0.001). Although it had statistically significant, this mean difference was not clinically significant because the abnormal bone age must be more than 2 standard deviations. The agreement between bone age readings between the two methods was good with a kappa value of 0.752 (95% CI 0.675 – 0.828; p < 0.001). Conclusion: Bone age assessment using the deep learning artificial intelligence method has the same accuracy as the Greulich and Pyle method.

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ABSTRAK
Latar Belakang. Penggunaan peripherally inserted central catheter PICC semakin meningkat sesuai kebutuhan bayi prematur dalam pemberian nutrisi parenteral. Penggunaan radiografi standar Rontgen torako abdomen dalam menilai posisi tip PICC yang tepat merupakan baku emas. Namun demikian, radiografi standar tidak selalu akurat dalam memperkirakan posisi tip PICC, tergantung pada posisi ekstremitas dan variasi anatomi masing-masing neonatus, menyebabkan radiasi, membutuhkan biaya yang lebih tinggi, waktu yang lebih lama dan membutuhkan pemeriksaan ulangan apabila posisi tip PICC terlalu dalam masuk ke jantung. Ultrasonografi USG semakin banyak digunakan untuk diagnostik dan prosedur di neonatal intensive care unit NICU karena lebih mudah, aman, murah dan real-time.Tujuan. Penelitian ini bertujuan untuk menilai akurasi penggunaan USG dalam menentukan ketepatan posisi tip PICC dibandingkan dengan radiografi standar. Metode. Penelitian ini merupakan studi diagnostik yang dilakukan pada bulan April-Mei 2017 di NICU. Pemasangan PICC menggunakan prosedur standar di NICU dan kemudian posisi tip PICC dievaluasi menggunakan USG sebelum dilakukan radiografi standar. Analisis menggunakan table 2x2 untuk menilai akurasi diagnostik USG dibandingkan radiografi standar dalam menilai posisi tip PICC.Hasil. Sebanyak 29 neonatus termasuk dalam penelitian ini dengan rerata usia gestasi 31,7 minggu 26 sampai 41 minggu dan rerata berat lahir 1618,9 g 600 sampai 3750 g . Kesesuaian antara radiografi standar dan ultrasonografi untuk posisi tip PICC terjadi pada 27 neonatus 93,1 . Sensitivitas ultrasonografi dalam menentukan tip PICC adalah 88,89 , dengan spesifisitas 95 dan ultrasonografi memiliki akurasi diagnostik 93,1 .Simpulan. USG memiliki akurasi diagnostik yang baik untuk mengindentifikasi posisi tip PICC, meminimalkan paparan radiasi dan meminimalkan manipulasi PICC di NICU.Kata kunci: USG, Radiografi, PICC, Neonatus, NICU

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ABSTRACT
Background. The use of peripherally inserted central catheter PICC has became increasingly common to facilitate the administration of parenteral nutrition in preterm neonates. The use of standard radiograph X ray of the abdominal thorax in assessing the correct position of peripherally inserted central catheter PICC line tips is a gold standard. However, standard radiograph can not always be accurate depending on the position of the extremities and variations of anatomy of each neonates, cause radiation, require higher cost, longer time and repeat when position is not appropriate. Ultrasound are becoming increasingly use for diagnostic and procedure in neonatal intensive care unit NICU because more easy, safer, cheaper, and real time.Objectives. This study aims to assess the accuracy of ultrasound use in determining the accuracy of PICC tip positions compared to standard radiograph.Methods. This was a diagnostic study to examine the placement of PICC in neonates between April and May 2017 in NICU. PICC were placed using standard procedure in NICU and then position of PICC tip were evaluated using ultrasound immediately before standard radiograph is performed. A 2x2 table was constructed to compare the two modalities ability to detect tip PICC position.Results. A total of 29 neonates were included in this study with mean of gestation of 31.7 weeks 26 to 41 weeks and mean of birth weight 1618.9 g 600 to 3750 g . Concordance between standard radiograph and ultrasound for PICC tip position occurred in 27 neonates 93.1 . Sensitivity of ultrasound in determining PICC tip was 88.89 , with a specificity of 95 and ultrasound had a diagnostic accuracy 93.1 .Conclusion. Ultrasound has a good diagnostic accuracy to indentify tip position of PICC, minimizing exposure of radiation and minimize manipulation of PICC in NICU. Keywords Ultrasound, Radiograph, PICC, Neonates, NICU