Bayi prematur apabila usia gestasi kurang dari 37 minggu saat lahir. Strategi yang telah terbukti untuk mengurangi kejadian risiko infeksi,dan gangguan saluran pencernaan pada bayi prematur adalah konsumsi air susu ibu (ASI). Saluran cerna dipengaruhi proses regulasi sitokin proinflamasi dan antiflamasi. Hasil penelitian menunjukkan interleukin-4 dan interleukin-8 berperan pada kondisi inflamasi saluran cerna. Penelitian ini untuk membuktikan adanya perbedaan kadar interleukin 4 (IL-4) dan interleukin 8 (IL-8) pada feses neonatus prematur yang mendapatkan ASI, predominan ASI, predominan susu formula, dan susu formula (SF), serta membandingkan kadar IL-4 dan IL-8 feses yang menggunakan ASI dibandingkan predominan ASI, predominan SF, dan SF. Penelitian ini menggunakan desain cross sectional. Populasi penelitian adalah bayi prematur yang dirawat di ruang Neonatologi RS. Dr. Saiful Anwar Malang selama periode Maret-April 2018, dengan jumlah sampel 24 pasien. Hasil analisis statistik mendapatkan perbedaan yang signifikan kadar IL-4 feses (p = 0,007) dan IL-8 feses (p = 0,014) pada keempat kelompok nutrisi dengan nilai p < 0,05. Kadar IL-4 dan IL-8 feses kelompok ASI dibandingkan predominan SF dan SF didapatkan nilai p < 0,05. Dapat disimpulkan bahwa ada perbedaan kadar IL-4 dan kadar IL-8 feses antara kelompok bayi prematur yang mendapatkan ASI, predominan ASI, predominan SF, dan SF. Kadar IL-4 feses kelompok ASI lebih tinggi dibandingkan kelompok predominan SF dan kelompok SF, dan kadar interleukin-8 feses kelompok ASI lebih rendah dibandingkan kelompok predominan SF dan SF.

BackgroundThe incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants.ObjectiveTo evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia.SettingData were collected from 34 hospitals with different levels of care: national referral centres, university-based hospitals, and public and private hospitals.MethodsA survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016–2017 in relation to gestational age and birth weight.ResultsWe identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28–32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%–5%. Both mortality and the incidence of ROP were highest in university-based hospitals.ConclusionsIn the 2016–2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016–2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia.

ABSTRAKKejadian ikterus pada bayi aterm di beberapa rumah sakit di Indonesia bervariasi antara 13,7-85%. Jenis ikterus patologis dapat menyebabkan hiperbilirubinemia. Penelitian ini dilakukan untuk mengetahui pengaruh karakter demografi, usia klinis dan laboratorium terhadap bayi hiperbilirubinemia yang dirawat di rumah sakit umum Dr. Saiful Anwar, Malang. Penelitian ini merupakan penelitian observasional retrospektif. Data-data diambil dari rekam medis sejak Januari 2010-Oktober 2010. Dari analisis regresi multiple dengan confident interval 95% (CI 95%) dan p<0,05, ada empat faktor signifikan yang mempengaruhi tingkat bilirubin. Faktor-faktor yang berpengaruh adalah instrumen persalinan (p=0,006), asfiksia (p=0,013), kadar hemoglobin (p=0,047), dan ASI eksklusif (p=0,049). Asfiksia, persalinan dengan instrumen, ASI eksklusif, dan tingkat hemoglobin merupakan faktor penting yang mempengaruhi tingkat bilirubin pada neonatus

Hyperbilirubinemia in the newborn occurs more frequently in Indonesia. Therefore, it is important that pediatric residents in Indonesia acquire adequate knowledge of hyperbilirubinemia management. This study aims to determine the pediatric residents' knowledge on hyperbilirubinemia management, whether they follow recommended guidelines, and whether differences exist between five large Indonesian teaching hospitals. We handed out a 25-question questionnaire on hyperbilirubinemia management to pediatric residents at five teaching hospitals. A total of 250 questionnaires were filled in completely, ranging from 14 to 113 respondents per hospital. Approximately 76% of the respondents used the Kramer score to recognize neonatal jaundice. Twenty-four percent correctly plotted the total serum bilirubin levels (TSB) on the phototherapy (PT) nomograms provided by the American Academy of Pediatrics (AAP) and the National Institute for Health and Care Excellence (NICE) for full-term and nearly full-term infants. Regarding preterm infants <35 weeks' gestational age, 66% of the respondents plotted TSB levels on the AAP nomogram, although this nomogram doesn't apply to this category of infants. Seventy percent of residents knew when to perform an exchange transfusion whereas 27% used a fixed bilirubin cut-off value of 20 mg/dL. Besides PT, 25% reported using additional pharmaceutical treatments, included albumin, phenobarbitone, ursodeoxycholic acid and immunoglobulins, while 47% of the respondents used sunlight therapy, as alternative treatment. The limited knowledge of the pediatric residents could be one factor for the higher incidence of severe hyperbilirubinemia and its sequelae. The limited knowledge of the residents raises doubts about the knowledge of the supervisors and the training of the residents since pediatric residents receive training from their supervisors.

Background High incidence of late-onset sepsis (LOS) in preterm infants contributes to neonatal morbidity. Therapeutic outcomes of LOS have deteriorated as a result of increased antibiotic resistance problems, mainly from ESBL isolates. Controlling risk factors is important in reducing morbidity and mortality as well as providing guidance for antibiotic selection. Objectives To determine the risk factors of LOS due to ESBL-producing bacteria in preterm infants. Methods This is a retrospective study. The inclusion criteria was neonates diagnosed with late-onset neonatal sepsis by clinical signs and a positive blood culture. The blood culture result and characteristics patients as secondary data were extracted from medical records within the hospital facilities and the institutional database of the Neonatology Department of Universitas Brawijaya (January 2019 to March 2021). Statistical analysis was done to compare characteristics of the patients in the ESBL positive group to those in the ESBL negative group to assess the potential risk factors. Results Among 124 preterm infants with LOS, 62 of them were ESBL-positive case subjects and the other 62 were non-ESBL-producing control subjects. Gram-negative bacteria were the most common pathogens identified, with 96% (n=59) of them being the ESBL-producing strain, predominated by Klebsiella pneumoniae (n=56). Factors significantly correlated with the occurrence of LOS-ESBL included prior history of invasive procedures (OR 3.13; 95%CI 1.45 to 6.73; P=0.00), central access insertion (OR 9.54; 95%CI 3.7 to 24.2; P=0.00), and parenteral nutrition (OR 6.03; 95%CI 2.77 to 13.16; P=0.00). Central access insertion had the strongest influence (Exp(B) 6.98; P= 0.00). Conclusion Prior invasive procedures, central access insertion, and parenteral nutrition had significant correlations with the occurrence of LOS-ESBL in preterm infants. Central access insertion is a predictive factor for LOS-ESBL.