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Abstrak :
Latar belakang. Continuous positive airway pressure (CPAP) dan nasal intermittent positive ventilation (NIPPV) mengurangi intubasi dan ventilasi mekanik pada neonatus dengan gawat napas. Masih sedikit penelitian yang membandingkannya pada neonatus cukup bulan maupun kurang bulan. Tujuan. Mengetahui kejadian intubasi, lama dukungan ventilasi non invasif dan pemakaian oksigen, bronchopulmonary dysplasia (BPD), dan kematian antara CPAP dan NIPPV pada neonatus dengan gawat napas. Metode. Studi kohort retrospektif dilakukan terhadap neonatus dengan gawat napas, usia gestasi 28-40 minggu, lahir di Rumah Sakit Umum Daerah Kota Bekasi pada periode Januari 2013 - Juni 2015. Pengambilan subyek penelitian secara konsekutif, memenuhi kriteria inklusi, dan menggunakan bantuan napas dengan CPAP atau NIPPV, masing-masing 50 subjek. Hasil. Neonatus dengan gawat napas menggunakan CPAP maupun NIPPV disebabkan karena respiratory distress syndrome , transient tachypnea of the newborn, pneumonia neonatal. Rerata usia gestasi dan berat lahir pada kelompok CPAP (34±3,11 minggu, 2018±659 gr) dan NIPPV [34 (28-40) minggu, 2050 (900-3900) gr]. Kejadian intubasi dan kematian berkurang, rerata hari dukungan ventilasi non infasif maupun pemakaian oksigen lebih lama pada NIPPV dibandingkan CPAP. Simpulan. NIPPV mengurangi kejadian intubasi dan kematian pada neonatus dengan gawat napas dibandingkan CPAP. ......Background. Continuous positive airway pressure (CPAP) and nasal intermittent positive ventilation (NIPPV) reduce intubation and mechanical ventilation. Still limited studies compare to CPAP and NIPPV in term and preterm infant with respiratory distress. Purpose. To determine CPAP and NIPPV to the event of intubation, duration non-invasive ventilation and oxygen support, bronchopulmonary dysplasia, and death in neonate. Methods. Retrospective cohort study was conducted to newborn with gestational age 28-40 weeks were born at General Hospital of Bekasi City, January 2013 - June 2015. Consecutive subjects and met inclusion criteria for CPAP and NIPPV group, each one 50 subjects. Results. CPAP and NIPPV were support to neonate with respiratory distress due to respiratory distress syndrome, transient tachypnea of the newborn, and pneumonia. Mean gestational age and birth weight in CPAP group (34 ± 3.11 weeks, 2018 ± 659 gr) and NIPPV [34 (28-40) weeks, 2050 (900-3900) g]. Raduce rate of intubation and death, duration of non-invasive ventilation and oxygen support longer to NIPPV than CPAP in neonate. Conclusion. NIPPV reduce intubation and mortality rate comparison to CPAP in neonate

Abstrak :
ABSTRAK
Soluble CD14-ST presepsin merupakan penanda sepsis baru untuk diagnosis dan prognosis sepsis neonatorum. Kadar presepsin meningkat pada keadaan sepsis disebabkan oleh aktivitas protease di fagolisosom. Penelitian ini bertujuan untuk mengetahui manfaat pemeriksaan serial kadar presepsin sebagai penanda pemantauan respons terapi dan prognosis pada pasien SNAL secara bedside dengan menggunakan sampel darah kapiler. Desain penelitian kohort prospektif. Subjek penelitian terdiri dari 20 neonatus sehat dan 42 pasien SNAL. Pemeriksaan kadar presepsin dengan alat Pathfast pada hari ke-1, ke-3, dan ke-6 setelah diterapi. Kadar presepsin pada pasien SNAL 1104 pg/mL (608 ? 6225 pg/mL) lebih tinggi dibandingkan pada neonatus sehat 448 pg/mL (191 ? 513 pg/mL), nilai p 0,000. Pada pasien SNAL kelompok respons terapi kadar presepsin lebih rendah dibandingkan dengan kelompok non respons pada hari ke-3 dan ke-6 (p<0,05). Pada pasien SNAL kelompok non survivor kadar presepsin lebih tinggi dibandingkan dengan kelompok survivor hari ke-6 (p<0,05). Kadar presepsin berkorelasi positif dengan kadar CRP (r=0,488) dan jumlah leukosit (r=0,321). Nilai cut-off kadar presepsin hari ke-6 untuk penentuan prognosis 1365 pg/mL mempunyai AUC 0,789 (IK 95% 0,652 ? 0.926), sensitivitas 90.9%, dan spesifisitas 67,7%. Pemeriksaan presepsin hari ke-3 atau ke-6 secara bedside dengan darah kapiler bermanfaat untuk pemantauan terapi dan prognostik pasien SNAL.ABSTRACT
Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.;Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.;Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.;Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.

Abstrak :
Latar Belakang: Pajanan nyeri menimbulkan efek merugikan baik pada neonatus kurang bulan maupun neonatus cukup bulan. Efek analgesik sukrosa pada penyuntikan intramuskular masih kontroversial. Efektivitas sukrosa untuk mengatasi nyeris saat vaksinasi hepatitis B pada neonatus cukup bulan belum pernah diteliti di Indonesia. Tujuan: untuk mengetahui efek analgesik pemberian sukrosa disertai empeng saat vaksinasi hepatitis B pada neonatus cukup bulan. Metode: penelitian ini menggunakan metode uji klinis acak tersamar ganda. Subjek secara random dibagi menjadi kelompok intervensi yang mendapatkan 2 mL sukrosa 24% disertai empeng, serta kelompok kontrol yang mendapatkan 2 mL aquabidestilata disertai empeng. Rasa nyeri yang dirasakan subjek dievaluasi dengan skor nyeri premature infant pain profile (PIPP). Hasil: median skor PIPP pada kelompok yang diberikan sukrosa lebih rendah dibandingkan kelompok kontrol (6 (2-15) vs 11 (2-15), p <0,0001). Lama tangis subjek pada kelompok yang mendapat sukrosa lebih singkat dibandingkan kelompok kontrol (11 (0-33) detik vs 19 (0-100) detik, p <0,0001). Pemberian empeng tidak memberikan efek sinergis dalam menurunkan skor nyeri maupun lama tangis subjek. Pada penelitian ini ditemukan satu subjek yang mengalami desaturasi hingga saturasi oksigen <88% saat pemberian sukrosa, namun efek samping ini tidak memerlukan terapi khusus. Simpulan: sukrosa secara statistik menurunkan skor nyeri PIPP dan lama tangis saat vaksinasi hepatitis B pada neonatus cukup bulan. ...... Background: Pain causes adverse effect for preterm and also term newborn. Analgesic effect of sucrose during intramuscular injection is still a controversy. Sucrose effectivity in reducing pain in term newborn during hepatitis B vaccination has not been studied in Indonesia. Objective: to examine analgesic effect of sucrose with pacifier during hepatitis B vaccination in term newborn. Method: we used consecutive sampling to reach 70 subjects. Subject was randomised into intervension group receiving 2 mL of 24% sucrose solution with pacifier, and control group receiving 2 mL aquadest with pacifier. Pain was evaluated with the premature infant pain profile (PIPP) scoring system. Result: median PIPP score in intervension group was significantly lower than control group (6 (2-15) vs 11 (2-15), p <0,0001). Cry duration in intervension group was significantly shorter than control group (11 (0-33) second vs 19 (0-100) second, p <0,0001). Pacifier had no synergistic effect in lowering PIPP score and cry duration. Decreased oxygen saturation below 88% was found in one subject receiving sucrose but additional therapy was not needed. Conclusion: Sucrose was statistically significant in reducing pain score and cry duration during hepatitis B vaccination in term newborn.

Abstrak :
Latar belakang. Dermatitis atopik (DA) merupakan penyakit kulit kronik residif dengan manifestasi utama berupa gatal dan iritasi kulit yang berkepanjangan. Antihistamin oral telah digunakan secara luas untuk mengurangi gatal pada DA namun efektivitasnya masih kontroversial. Setirizin merupakan antihistamin-1 generasi kedua yang digunakan pada penyakit alergi, termasuk gatal yang berhubungan dengan DA. Tujuan. Untuk menilai efektivitas penggunaan setirizin dibandingkan dengan plasebo dalam terapi DA. Metode. Studi klinis acak terkontrol dilakukan selama Agustus 2014 sampai Mei 2015. Subjek yang memenuhi kriteria inklusi usia 6 bulan sampai 15 tahun dengan DA derajat sedang dibagi menjadi kelompok perlakuan dan kelompok kontrol. Kelompok perlakuan diterapi dengan setirizin (0,25mg/kgBB, dua kali sehari untuk pasien < 2 tahun dan sekali sehari untuk pasien > 2 tahun) sedangkan kelompok kontrol mendapat plasebo. Derajat keparahan DA pada kedua kelompok diukur dengan indeks SCORAD dan kekambuhan DA dievaluasi setiap bulan selama 6 bulan. Hasil penelitian. Total 38 subjek penelitian (18 plasebo, 20 setirizin) ikut serta dalam penelitian dan dianalisis dengan per protocol analysis. Karakteristik dasar meliputi usia, jenis kelamin dan riwayat atopi tidak berbeda di kedua kelompok. Derajat keparahan DA berdasarkan indeks SCORAD pada kedua kelompok adalah derajat sedang (kelompok kontrol 31,5 vs kelompok perlakuan 34,75). Selama pengobatan 6 bulan derajat keparahan DA menurun bertahap dengan tidak ada perbedaan bermakna antara kelompok kontrol dan perlakuan (31,5 menjadi 0 vs 34,75 menjadi 0, p=0,200). Kekambuhan DA pada kelompok setirizin tidak lebih rendah daripada kelompok kontrol dengan tidak terdapat perbedaan bermakna (2 dari 17 subjek vs 2 dari 14 subjek, p=1,000). Simpulan. Pengobatan setirizin selama 6 bulan pada anak dengan DA derajat sedang tidak dapat mengurangi kekambuhan maupun derajat keparahan penyakit. ......Background. Atopic dermatitis (AD) is chronic relapsing skin disease, characterized by intense itching and inflammation. Oral antihistamine has been widely used to reduce pruritus of AD but the effectiveness is still controversial. Cetirizine is a second generation H1 selective antagonist that has been used in allergic diseases, including AD-associated pruritus. Objective. To assess the efficacy of cetirizine compared with placebo for the treatment of AD. Method. A randomized clinical controlled trial was performed during August 2014 until May 2015. Eligible patients aged 6 months ? 15 years with moderate AD was divided into treatment group and control group. Treatment group were treated for 6 months with cetirizine (0.25 mg/kg twice daily for patients < 2 years old, once daily for patients > 2 years old), while the control group was given placebo. The severity of AD between both groups was measured by SCORAD index and recurrence was evaluated every month for 6 month-period. Results. A total of 38 subjects (18 with placebo, 20 with cetirizine) participated in this study and a per protocol analysis was performed. The baseline characteristics, including age, gender and atopic history were similar in both groups. The severity of AD according to SCORAD index were moderate (control group 31,5 vs treatment group 34,75). During 6 month-study period, the severity of AD decreased steadily with no statistical differences between placebo and treatment group (31,5 to 0 vs 34,75 to 0, p=0,200). The recurrence of AD in cetirizine group were not lower than control group with no statistical differences (2 from 17 subject vs 2 from 14 subject, p=1,000). Conclusion. Cetirizine treatment in children with atopic dermatitis for 6 month-period cannot reduce reccurence and disease severity of moderate AD.

Abstrak :
Latar Belakang : Asfiksia neonatorum menyebabkan gangguan multiorgan, salah satunya adalah gangguan ginjal. Belum adanya kesepakatan dalam menentukan gangguan ginjal akut (acute kidney injury, AKI) pada neonatus menyebabkan kesulitan dalam mendiagnosis dan selanjutnya menghambat tata laksana AKI. Acute Kidney Injury Network (AKIN) merekomendasikan kriteria AKI berdasarkan peningkatan kadar kreatinin serum dan penurunan luaran urin. Tujuan : Mengetahui prevalens AKI dengan menggunakan kriteria AKIN pada asfiksia neonatorum, dan mengetahui perbedaan stadium AKI antara asfiksia sedang dan berat. Metode : Studi ini merupakan potong lintang analitik yang berlangsung selama Juli 2012 hingga Januari 2013. Subjek penelitian adalah semua bayi baru lahir usia gestasi >35 minggu dengan asfiksia yang lahir dan dirawat di Divisi Neonatologi RS Cipto Mangunkusumo dan RSUD Koja. Analisis menggunakan uji hipotesis Chi-square dengan SPSS versi 20. Hasil : Penelitian dilakukan pada 94 subjek yang terdiri atas 70 neonatus asfiksia sedang dan 24 neonatus asfiksia berat. Prevalens AKI berdasarkan kriteria AKIN pada asfiksia neonatorum adalah 63%. Prevalens bayi dengan asfiksia berat dan sedang yang mengalami AKI berturut-turut adalah 21 dari 24 subjek (88%) dan 38 subjek (54%). Prevalens bayi dengan asfiksia berat mengalami AKI stadium 3 yang terbanyak yaitu 14 dari 21 subjek (67%). Stadium AKI yang lebih berat lebih banyak dijumpai pada bayi dengan asfiksia berat dibandingkan asfiksia sedang (P<0,001). Simpulan : Prevalens AKI pada asfiksia neonatorum cukup tinggi. Makin berat derajat asfiksia neonatorum, makin berat stadium AKI. ......Background: Asphyxia neonatorum may result in multiorgan disfunction including renal disfunction. There is no consensus on the determination of acute kidney injury (AKI) in neonates making establishment of the diagnosis and its management difficult. The Acute Kidney Injury Network (AKIN) recommends AKI criteria based on increased serum creatinine level and reduced urine output. Objective: To identify the prevalence of AKI in asphyxiated neonates using the AKIN criteria and to recognize the difference of AKI stadium between moderate and severe asphyxia. Methods: The study was a cross-sectional analytical study, which was conducted between July 2012 and January 2013. The study subjects were all asphyxiated neonates with gestational age of >35 weeks who were delivered and hospitalized in Cipto Mangunkusumo Hospital and Koja District Hospital. Analysis was performed by hypothesis Chi-square test using SPSS version 20. Results: Of 94 subjects participated in the study, there were 70 and 24 neonates with moderate and severe asphyxia, respectively. The prevalence of AKI was 63%. The prevalence of neonates with severe and moderate asphyxia who experienced AKI was 21 out of 24 subjects (88%) and 38 subjects (54%), respectively. The prevalence of AKI in neonates with severe asphyxia who had stage 3 AKI was 14 out of 21 subjects (67%). More severe AKI stage was found more common in neonates with severe asphyxia (P<0.001) Conclusions: The prevalence of AKI in neonatal asphyxia is high. The more severe stage of neonatal asphyxia, the more severe the AKI stage