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Gitta Reno Cempako
Evaluasi penggunaan sefotaksim sebagai antibiotik empiris pada anak gizi buruk = Evaluating the use of cefotaxime as empirical antibiotic in severely malnourished children
"ABSTRAK
Latar belakang: Anak dengan gizi buruk tak hanya rentan terhadap infeksi, keparahan infeksi dan angka kematian akibat infeksi juga meningkat. Sefotaksim merupakan antibiotik empiris yang paling sering digunakan pada anak di Rumah Sakit Cipto Mangunkusumo RSCM tanpa melihat status gizi. Hingga saat ini data mengenai rsepon terhadap sefotaksim pada anak gizi buruk di RSCM serta fokus infeksi dan etiologinya masih terbatas. Tujuan: Mengetahui respon pemberian antibiotik sefotaksim sebagai terapi empiris pada anak gizi buruk yang dirawat inap berikut karakteristik, fokus infeksi, profil kuman dan sensitifitasnya terhadap sefotaksim. Metode: Penelitian prospektif observasional pada anak gizi buruk usia 10 ?g/L dan juga semua subyek dengan HIV positif yang mengalami sepsis tidak berespon dengan terapi sefotaksim. Simpulan: Enam puluh lima persen infeksi pada anak gizi buruk tidak memberikan respon terhadap terapi empiris sefotaksim. Antibiotik sefotaksim sebaiknya tidak digunakan sebagai terapi empiris pada anak gizi buruk dengan sepsis berat atau HIV positif yang mengalami sepsis.
ABSTRACT Background Children with severe malnutrition is vulnerable to infection, increase in its severity and death rate. Cefotaxime has been widely used as empirical antibiotic for children in Cipto Mangunkusumo General Hospital, regardless their nutritional status. However there is little data about etiology of infection in our population and the response to empirical antibiotic cefotaxime. Aim To evaluate the response to empirical antibiotic cefotaxime in children with severe malnutrition, its characteristic, diagnosis of infection, and antibiotic susceptibility profile. Method Children 18 year old hospitalized from October to December 2016 with severe malnutrition and received cefotaxime as empirical antibiotic were included and followed for 5 days. A clinical examination, complete blood count, urinalysis, procalcitonin PCT , c reactive peptide CRP , blood and urine culture were performed systematically on admission. Stool and sputum culture were also done as indicated. Repeated PCT and CRP were done between day 3 to 5. Result Among 40 children included in the study, 50 has more than one infection. The most frequent infection is urinary tract infection 50 , followed by pneumonia 47,5 and acute diarrhea 32,5 . Blood culture was positive only in 4 subjects, 4 5 isolates were gram positive bacteria. Escherecia coli was the most common pathogen in urine 30 . Only 9,5 of all isolated bacteria were sensitive to cefotaxime. Overall, only 35 responded to antibiotic cefotaxime. All patient with PCT 10 g L on admission, and those with HIV positive and sepsis did not respond. Conclusion Sixty five children with severe malnutrition and infection did not respond to empirical antibiotic cefotaxime. Clinician must reconsider giving cefotaxime as empirical antibiotic in severely malnourished children, especially those with severe sepsis and HIV with sepsis. "
2017
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UI - Tugas Akhir  Universitas Indonesia Library
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I Ketut Adi Wirawan
Stimulasi Video Pembelajaran Resusitasi Neonatus Memperbaiki Performa Keterampilan Resusitasi Neonatus Peserta Program Pendidikan Dokter Spesialis Ilmu Kesehatan Anak = Video Stimulation of Neonatal Resuscitation Learning Improving Neonatal Resuscitation Skills Performance for Pediatric Residency Programs
"Proporsi kematian neonatal meningkat dari 40% menjadi 47% di antara kematian Balita. Program Resusitasi Neonatus (PRN) yang terstandar diyakini akan dapat menurunkan kematian neonatal sampai 30%. Pasca pelatihan modul resusitasi neonatus supaya di akhir studi PPDS anak kompeten melakukan resusitasi neonatus. Upaya refreshing dibutuhkan untuk mempertahankan retensi keterampilan resusitasi
Penelitian ini bertujuan mengetahui kompetensi prosedur resusitasi neonatus dan upaya penyegaran untuk memperbaiki performa resusitasi neonatus PPDS anak.
Desain penelitian yang digunakan adalah Quasi experimental. Kelompok intervensi yang mendapatkan penyegaran dengan mengakses video resusitasi neonatus secara aktif pada modul pembelajaran daring.
Hasil ada 35 PPDS dalam 2 tahun pendidikan, dianalisis pada penelitian ini, 18 kelompok intervensi 17 kelompok kontrol. Hasil penilaian pada base line didapati 16(45,7%) dari 35 PPDS tidak memenuhi standar kelulusan prosedur keterampilan resusitasi neonatus. Penilaian pasca perlakuan didapatkan performa resusitasi kelompok intervensi lebih baik dengan nilai rerata 80 ± 11 sedang pada kelompok kontrol dengan nilai rerata 58 ± 18, berbeda bermakna dengan nilai kemaknaan p < 0,001.
Kesimpulan stimulasi secara audiovisual dangan video pembelajaran resusitasi neonatus secara bermakna memperbaiki performa resusitasi PPDS saat dievaluasi dengan megacode.
The proportion of neonatal deaths increased from 40% to 47% among neonatal deaths. The standardized Neonatal Resuscitation Program (NRP) is believed to reduce neonatal mortality by up to 30%. After the module training, monitoring of skill retention is important to maintain the resuscitation performance of pediatric residents, and refreshing efforts are needed.
This study aimed to determine the competence of neonatal resuscitation procedures and refresher efforts to improve the resuscitation performance of pediatric residents.
The research design used was Quasi-experimental design. The intervention group received a refresher by actively accessing neonatal resuscitation videos in the online learning module.
The results were 35 pediatric residents in 2 years of education, analyzed in this study, divided into 18 intervention groups and 17 control groups. The baseline assessment found that 16 (45.7%) of 35 residents did not meet the graduation standards for neonatal resuscitation skills procedures. Post-intervention showed that the resuscitation performance of the intervention group was better with a mean value of 80 ± 11, while the control group had 58 ± 18, which with a significance value of p <0.001.
Conclusion: Audiovisual stimulation with neonatal resuscitation learning videos significantly improves the resuscitation performance of pediatric residents when evaluated by megacode."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Sandi Nugraha
Korelasi pengukuran IMT dan LLA dengan komposisi tubuh menggunakan Metode Bioelectrical Impedance Analysis dan Air Displacement Plethysmography pada anak dengan penyakit ginjal tahap akhir = Correlation of body mass index and Mid-Upper Arm Circumference Measurements with body composition using Bioelectrical Impedance Analysis and Air Displacement Plethysmography in children with End-stage renal disease
"Latar belakang: Malnutrisi merupakan komplikasi utama anak dengan penyakit ginjal tahap akhir (PGTA) akibat gangguan asupan nutrisi dan metabolisme. Kondisi ini ditandai dengan perubahan cadangan energi dan protein tubuh. Penilaian komposisi tubuh, seperti fat mass (FM) dan fat-free mass (FFM), menjadi indikator penting dalam mengevaluasi status nutrisi. Meskipun antropometri sederhana seperti IMT dan LLA sering digunakan, keduanya memiliki keterbatasan dalam menggambarkan perubahan komposisi tubuh secara akurat. Metode seperti BIA dan ADP merupakan referensi standar dalam menilai komposisi tubuh. Hingga saat ini belum ada studi komposisi tubuh di Indonesia yang mengevaluasi hubungannya dengan antropometri sederhana dan asupan nutrisi, serta membandingkan metode BIA dan ADP pada anak dengan PGTA. Metode: Penelitian ini menggunakan desain studi potong lintang terhadap 40 anak dengan PGTA, usia 5-18 tahun, yang menjalani dialisis di RSUPN Cipto Mangunkusumo. Evaluasi status gizi dengan pengukuran antropometri sederhana (berat badan, tinggi badan, IMT, dan lingkar lengan atas), penilaian komposisi tubuh (fat mass dan fat-free mass) menggunakan BIA (Tanita RG 753) dan ADP (BodPod), serta penilaian asupan nutrisi dilakukan dengan metode 3-day food record. Hasil penelitian: Mayoritas subjek berjenis kelamin laki-laki dengan median usia 14 tahun, terdapat55%diantaranyamengalamimalnutrisidan52,5% perawakanpendek(52,5%).Korelasi yang kuat ditemukan pada pengukuran BB, IMT dan LLA terhadap FM (BIA r=0,713-0,769 dan ADP r=0,626-0,680; p<0,001) dan pengukuran BB dan TB terhadap FFM (BIA r=0,878-0,897 dan ADP r=0,888-0,899; p<0,001). Korelasi lebih kuat ditemukan pada pengukuran IMT dan LLA terhadap FMI (BIA r=0,672-0,736 dan ADP r=0,527-0,579; p<0,001) dan BB terhadap FFMI (BIA r=0,633 dan ADP r=0,730; p<0,001). Metode BIA dan ADP menunjukkan korelasi kuat dalam pengukuran FM (r=0,728) dan FFM (r=0,878) dengan p<0,001. Uji kesesuaian antara BIA terhadap ADP menunjukkan rerata perbedaan -1,23 kg dengan LoA-6.34 kg hingga 3.89 kg, sedangkan pada pengukuran FFM didapatkan bias sebesar 2.16 kg dengan LoA -6.02 kg hingga 10.34 kg. Tidak terdapat korelasi pada seluruh asupan nutrisi makronutrien dan mikronutrien dengan FM dan FFM.
Kesimpulan:
Antropometri sederhana menunjukkan korelasi kuat dengan komposisi tubuh yang diukur menggunakan BIA dan ADP pada anak dengan PGTA. Kedua metode memiliki kesesuaian baik, meskipun BIA memberikan estimasi sedikit lebih rendah untuk FM dan lebih tinggi untuk FFM dengan variabilitas yang cukup luas. Antropometri sederhana dapat digunakan sebagai deteksi awal terjadinya malnutrisi pada anak PGTA.
Background: Malnutrition is a major complication in children with end-stage renal disease (ESRD) due to impaired nutritional intake and metabolism, marked by changes in body energy and protein reserves. Body composition assessment, including fat mass (FM) and fat-free mass (FFM), is an important indicator for evaluating nutritional status. Although conventional anthropometric measurements such as BMI and mid-upper arm circumference (MUAC) are commonly used, they have limitations in accurately depicting body composition changes. Methods like bioelectrical impedance analysis (BIA) and air displacement plethysmography (ADP) are reference standards for body composition assessment. To date, no studies in Indonesia have examined the correlation between conventional anthropometry and body composition using BIA and ADP, the correlation and agreement between BIA and ADP in measuring body composition, or the correlation between nutritional intake and body composition as assessed by BIA and ADP in children with ESRD.
Methods: This cross-sectional study involved 40 pediatric patients with ESRD aged 6–18 years undergoing dialysis at Cipto Mangunkusumo National Referral Hospital. Nutritional status was evaluated using conventional anthropometry (weight, height, BMI, and MUAC), body composition assessment (FM and FFM) using BIA (Tanita RG 753) and ADP (BodPod), and macronutrient and micronutrient intake assessment (vitamin D, calcium, phosphate) using the 3- day food record method.
Results: The majority of the subjects were male, with a median age of 14 years. Of these, 55% were malnourished and 52.5% were stunted. Stronger correlations were observed between weight, BMI, and MUAC measurements with fat mass (FM) (BIA r=0.713–0.769; ADP r=0.626–0.680; p<0.001), as well as between weight and height with fat-free mass (FFM) (BIA r=0.878–0.897; ADP r=0.888–0.899; p<0.001). Similarly, BMI and MUAC showed stronger correlations with fat mass index (FMI) (BIA r=0.672–0.736; ADP r=0.527–0.579; p<0.001), and weight showed stronger correlations with fat-free mass index (FFMI) (BIA r=0.633; ADP r=0.730; p<0.001). Both BIA and ADP exhibited strong correlations for FM (r=0.728) and FFM (r=0.878; p<0.001). Agreement testing revealed a mean difference of -1.23 kg (LoA -6.34 kg to 3.89 kg) for FM, while FFM showed a bias of 2.16 kg (LoA -6.02 kg to 10.34 kg). Weak correlations were found between macronutrient intake and %FM (r=0.320–0.374; p<0.005), while no significant correlations were observed between micronutrient intake (vitamin D, calcium, phosphate) and body composition.
Conclusion: Conventional anthropometric measurements strongly correlate with body composition assessed using BIA and ADP in children with ESRD. Both methods show strong correlations and good agreement, though BIA tends to underestimate FM and overestimate FFM with wide variability. Macronutrient and micronutrient intake shows no significant correlations with body composition. While conventional anthropometry can be used as an alternative for early nutritional evaluation."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2025
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UI - Tugas Akhir  Universitas Indonesia Library