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"The incidence of infections in preterm infants is still quite high. In this study, oral care with human breast milk was implemented in risk preterm infants as a precaution. The study was conducted using a quasi-experimental method with a non- equivalent control group and posttest only design in 40 risk preterm infants. The participants were divided into two groups of 20. The data were analyzed using independent t-test and a Wilcoxon test. The results show that this intervention has an effect on the incidence of late-onset sepsis in preterm infants. The effect is based on symptoms: body temperature instability (p = 0.021), C-reactive protein (p = 0.006), and leukocytes (p = 0.020) all indicated differences between the two groups. It is recommended that this practice be adopted as a routine therapy program in perinatology."

"Bayi prematur berisiko tinggi mengalami sepsis neonatorum awitan lambat pada minggu-minggu pertama pasca kelahiran. Tujuan dari studi ini adalah mengaplikasikan Teori Konservasi Levine dalam menurunkan kejadian sepsis neonatorum awitan lambat pada bayi baru lahir prematur dengan pemberian oral care ASI. Proses asuhan keperawatan menggunakan pendekatan Teori Konservasi Levine berdasarkan empat konservasi yaitu konservasi energi, konservasi integritas struktural, konservasi integritas personal dan konservasi integritas sosial. Lima kasus terpilih menunjukkan masalah keperawatan gangguan pertukaran gas, pola nafas tidak efektif, defisit nutrisi, termoregulasi tidak efektif, risiko infeksi dan risiko gangguan perlekatan. Hasil implementasi pemberian oral care ASI dapat menurunkan kejadian sepsis awitan lambat, mempercepat bayi minum penuh dan mempercepat proses penyapihan alat bantu pernafasan. Intervensi ini dapat menjadi standar prosedur operasional bagi perawat dalam memberikan asuhan keperawatan pada bayi baru lahir.

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Premature infants are at high risk for late onset neonatal sepsis in the first few weeks after birth. The aim of this study was to apply the Levine rsquo s Conservation Theory to decrease the incidence of late onset neonatal sepsis in preterm newborns by oral care of ASI. The nursing care process uses the Levine rsquo s Conservation Theory approach based on four conservation, such as conservation of energy, conservation of structural integrity, conservation of personal integrity and conservation of social integrity. Five selected cases indicate nursing problems of gas exchange disorders, ineffective breathing patterns, nutritional deficits, ineffective thermoregulation, infection risk and risk of attachment disturbance. The results of ASI oral care implementation may decrease the incidence of late onset sepsis, accelerate full feed and accelerate the weaning process of respiratory aids. This intervention can be standard operating procedure for nurses in providing nursing care to newborns."

"Latar Belakang:. Sepsis neonatorum awitan dini masih menjadi penyebab kesakitan dan kematian yang utama pada neonatus, dengan angka lebih tinggi terjadi pada bayi kurang bulan. Berbagai faktor diketahui berhubungan dengan kejadian sepsis neonatorum awitan dini, namun penelitian yang dilakukan pada bayi prematur masih terbatas. Tujuan:. Mengetahui faktor-faktor risiko yang berhubungan dengan kejadian sepsis neonatorum awitan ini pada bayi kurang bulan di RSCM.Metode:. Penelitian desain case-control dengan mengambil data dari rekam medis bayi lahir kurang bulan di RSCM pada rentang waktu Januari 2016-Desember 2017 sebanyak 186 sampel (93 untuk masing-masing kelompok). Data dianalisis secara bivariat dan multivariat.Hasil: Terdapat perbedaan bermakna dari karakteristik bayi kurang bulan antara kelompok kasus dan kontrol yaitu usia gestasi, jenis kelamin laki-laki, dan berat lahir. Gejala klinis tersering ditemukan adalah sesak napas. Dari 7 faktor yang dianalisis, infeksi intrauterin, nilai APGAR 1 menit pertama, dan nilai APGAR 5 menit pertama pada analisis bivariat dimasukkan ke analisis multivariat (p<0,25) sementara pada faktor lainnya tidak ditemukan hubungan yang bermakna. Pada analisis multivariat, ditemukan bahwa jenis kelamin laki-laki, usia gestasi, infeksi intrauterin, dan nilai APGAR 1 menit pertama memiliki hasil yang bermakna secara statistik.Kesimpulan: Jenis kelamin laki-laki, usia gestasi, infeksi intrauterin, dan nilai APGAR 1 menit pertama merupakan faktor risiko independen sepsis neonatorum awitan dini pada bayi kurang bulan. Penelitian lebih lanjut dibutuhkan untuk mengetahui pengaruh faktor-faktor tersebut terhadap kejadian sepsis neonatorum awitan dini pada bayi kurang bulan.

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Background: Early onset neonatal sepsis is still considered as a common cause of morbidity and mortality in neonates, with a higher prevalence found in preterm infants. Many factors are known to be correlating to the cases of early onset neonatal sepsis, but research done specifically in preterm infants is limited.

Objective: To determine the factors associated with early onset neonatal sepsis in preterm infants.

Method: This research was done using a case-control design, where the data is taken from the medical record of preterm patients born in RSCM within January 2016-December 2017. The total sample is 186 (93 for each group). Data was then analyzed using bivariate and multivariate analysis.

Result: A significant result was found in characteristic such as gestational age, gender, and birth weight. Out of 7 factors that were analysed, the factors that were analysed using multivariate analysis were intrauterine infection, low APGAR score in the first minute, and low APGAR score in the fifth minute. From multivariate analysis, gender, gestational age, intrauterine inflammation, and low APGAR score in the first minute were stastically significant.

Conclusion: gender, gestational age, intrauterine inflammation, and low APGAR score in the first minute are independent risk factors for early onset neonatal sepsis. Further study is needed to understand the correlation between those factors and early onset neonatal sepsis in preterm infants."

"Pendahuluan: C-reactive protein CRP dan procalcitonin PCT merupakan penanda diagnostik dan pemantauan sepsis neonatorum yang paling banyak digunakan. Saat ini terdapat penanda sepsis baru yaitu Soluble CD14 subtype sCD14-ST presepsin. Penelitian ini bertujuan untuk mengetahui manfaat pemeriksaan serial kadar presepsin, CRP dan PCT serta korelasi antara kadar presepsin dengan kadar CRP dan PCT sebagai penanda respons terapi dan prognosis pasien SNAL pada neonatus prematur. Metode: Desain penelitian kohort prospektif. Subjek penelitian terdiri dari 40 neonatus prematur sehat dan 40 pasien neonatus prematur SNAL dan dilakukan pemeriksaan kadar presepsin, CRP dan PCT, selanjutnya dilakukan pemantauan kadar presepsin, CRP dan PCT pasien neonatus prematur SNAL hari ke-3 dan ke-6 setelah diterapi. Pasien neonatus prematur SNAL dikelompokkan menjadi 20 pasien respons terapi dan 20 pasien non respons. Mortalitas pasien neonatus prematur SNAL ditentukan pada pemantauan hari ke-30. Hasil: Median kadar presepsin, CRP dan PCT pada neonatus prematur SNAL masing-masing adalah 1559 pg/mL 427 ndash; 4835 pg/mL, 16.35 mg/L 0.1 ndash; 245.6 dan 4.11 ng/mL 0.17 ndash; 54.18 lebih tinggi secara bermakna dibandingkan pada neonatus prematur sehat 406 pg/mL 195 ndash; 562 pg/mL, 1.22 mg/L 0.1 ndash; 3.69 dan 0.03 0.01 ndash; 0.04 dengan nilai p.

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Introduction: C reactive protein CRP and procalcitonin PCT are marker of neonatal sepsis diagnostics and monitoring of the most widely used. Currently there is a new marker of sepsis that is Soluble CD14 subtype sCD14 ST presepsin. This study aims to determine the benefits of serial presepsin levels, CRP and PCT as well as the correlation between presepsin with CRP and PCT as a marker of response to therapy and prognosis of patients SNAL in premature neonates.

Methods. This was prospective cohort, from 20 healthy preterm neonates and 40 LOS preterm neonates patient. The concentration of presepsin, CRP and PCT were analysed. Presepsin, CRP and PCT measured in both group and in 3rd 6th day sepsis follow up after therapy. Therapeutic respons was done in 20 LOS preterm neonates patient and 20 preterm neonates patient was not. The mortality of LOS preterm neonates patient saw in 30th day observation.

Results: Median of presepsin, CRP and PCT in LOS preterm neonates are 1559 pg mL 427 ndash 4835 pg mL, 16.35 mg L 0.1 ndash 245.6 and 4.11 ng mL 0.17 ndash 54.18, respectively, are significantly higher than healty preterm neonates 406 pg mL 195 ndash 562 pg mL, 1.22 mg L 0.1 ndash 3.69 and 0.03 0.01 ndash 0.04, p value "

"Sepsis neonatorum awitan lambat (SNAL) masih menjadi penyebab penting kematian dan kesakitan pada bayi kurang bulan. Diagnosis yang cepat penting untuk penatalaksanaan yang sesuai. Diperlukan alat diagnostik yang sederhana, tidak mahal dan cepat hasilnya untuk mendiagnosis SNAL.Tujuan penelitian ini adalah untuk mendapatkan nilai diagnostik rasio netrofil limfosit (RNL) dan kombinasi RNL dan rasio I/T untuk mendiagnosis SNAL. Data penelitian cross sectional ini diambil dari rekam medis pasien bulan januari 2018-Desember 2019 di Divisi Neonatologi Rumah Sakit Cipto Mangunkusumo. Subyek penelitain adalah bayi kurang bulan >30-36 minggu, berusia 7-28 hari dengan klinis sepsis. Dari kultur darah, neonatus dibagi menjadi 2 kelompok, yaitu: proven sepsis dan unproven sepsis. Rasio netrofil limfosit dihitung dari data hitung jenis limfosit. Rasio I/T didapat dari rekam medis. Dari semua 126 subyek penelitian 70 termasuk kelompok proven sepsis dan 56 unproven sepsis. Analisis kurva Receiver operating characteristic RNL didapatkan area under the curve 0.953. Dengan cut off RNL 1.785 didapatkan sensitivitas 78,57%, spesifisitas 92,86%, nilai dugan positif (NDP) 93,22% dan nilai duga negative (NDN) 77,61%. Dengan titik potong rasio I/T > 0,2, didapatkan sensitivitas 55,70 %, spesifitas 83,70%, NDP 81,25% dan NDN 60,26%. Gabungan RNL dan rasio I/T meningkatkan sensitivitas dan NDP rasio I/T berturut-turut menjadi 90% dan 84,44%. Sebagai kesimpulan, RNL dengan titik potong 1,785 mempunyai nilai diagnostik yang baik untuk mendiagnosis SNAL. Kombinasi RNL dan rasio I/T akan meningkatkan nilai diagnostik rasio I/T.

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Late-onset neonatal sepsis (LOS) remains an important cause of death and morbidity among preterm infants. Early diagnostic is important for appropiate management. The simple, inexpensive, and rapid diagnostic tool is required to diagnose LOS. The objective of this study is assesing diagnostic value of NLR and combination of NLR and I/T ratio for diagnosis LOS. The data for this retrospective cross-sectional study was collected from medical record from January 2018 to December 2019 at Neonatology Division Cipto Mangunkusumo Hospital. Preterm infants with >30 -36 gestational weeks, 7-28 days of postnatal age and clinically sepsis were eligible for this study. According to the result of blood cultures, all enrolled infant were classified into 2 groups: proven sepsis and unproven sepsis. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Immature-to-total neutrophil ratio was taken from medical record. A total of 126 subjects were involved: 70 proven sepsis and 56 unproven sepsis. Receiver operating curve analysis for NLR calculated and area under the curve of NLR corresponded to 0.953. Using a cut off point of 1.785 for NLR, the sensitivity was 78,57%, the specificity was 92,86%, positive predictive value (PPV) 93,22% and negative predictive value (NPV) 77,61%. Using cut off > 0,2, I/T ratio has sensitivity 55,70 %, specificity 83,70%, PPV 81,25% and NPV 60,26%. The combination NLR and ratio I/T increased sensitivity and PPV of ratio I/T became 90% and 84,44%, respectively.As conclusion The NLR with cut off 1,785 has good diagnostic value for SNAL. Combination NLR and I/T ratio can increase diagnostic value of I/T ratio."

"Secara global, sebanyak 15 juta bayi lahir secara prematur setiap tahunnya. Indonesia menempati peringkat kelima negara dengan angka kelahiran prematuritas tertinggi di dunia. Salah satu komplikasi utama pada bayi prematur adalah sepsis neonatorum. Sepsis neonatorum adalah respon inflamasi sistemik yang dapat terjadi pada neonatus diakibatkan oleh transmisi infeksi secara vertikal maupun melalui lingkungan. Dikarenakan oleh temuan klinis sepsis yang variatif, menyebabkan upaya mendiagnosis sepsis menjadi sullit dilakukan. Oleh karena itu, perlu diberlakukan profilaksis sepsis neonatorum pada bayi prematur, sehingga muncul prosedur oral care. Pemahaman mengenai kebermanfaatan dan keamanan prosedur oral care masih diperlukan untuk dapat menggunakan prosedur ini secara optimal. Tujuan. (1) Mengetahui karakteristik subjek penelitian berdasarkan karakteristik jenis kelamin, usia gestasi, berat lahir, usia ibu, dan jenis persalinan. (2) Mengetahui angka kejadian sepsis neonatorum pada bayi prematur yang mendapat dan tidak mendapat oral care. (3) Mengetahui hubungan antara pemberian oral care dengan kejadian sepsis neonatorum pada bayi prematur. Metode penelitian. Sebuah studi cross-sectional dilakukan pada populasi bayi prematur yang lahir di RSCM pada tahun 2015-2017. Sebanyak 42 sampel yang dipilih secara simple random sampling. Pengambilan data dilakukan pada bulan Januari hingga Agustus 2018 dengan melihat rekam medis subjek penelitian yang dilanjutkan dengan analisis bivariat. Hasil penelitian. Jumlah total subjek yang memenuhi kriteria inklusi dan eksklusi pada penelitian ini adalah 42 bayi prematur. Karakteristik penelitian ini adalah jenis kelamin laki-laki sebesar 52,4%, rerata usia gestasi 33 (24-36) minggu, rerata berat lahir 1569,24±493,3 gram, rerata usia ibu 30,5238±6,67 tahun, dan jenis persalinan sectio caesaria sebesar 85,7%. Didapatkan hubungan bermakna antara pemberian oral care dengan kejadian sepsis neonatorum (P=0,030 ; RR=0,533 ; IK 95%=0,290-0,980). Didapatkan hubungan bermakna antara usia gestasi dengan kejadian sepsis neonatorum pada subjek yang mendapat oral care (UG: 32-37 minggu = 91,7% subjek tidak sepsis ; P=0,003), serta hubungan bermakna antara berat lahir dengan kejadian sepsis neonatorum pada subjek yang mendapat oral care (BL: 1500-2499 gram = 100% subjek tidak sepsis ; P=0,002). Kesimpulan. Terdapat hubungan yang signifikan antara pemberian oral care dengan kejadian sepsis neonatorum pada bayi prematur di RSCM, terdapat penurunan kemungkinan terkena sepsis neonatorum sebesar 0,533 kali lipat.

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Introduction. Globally, it is estimated that there are 15 million premature infants born every year. Indonesia ranks fifth in the incidence of prematurity worldwide. One of the major complications of premature infants is neonatal sepsis. Neonatal sepsis is a systemic inflammatory response on infants caused by infections acquired vertically and enviromentally. Sepsis has a wide range of clinical findings, therefore it is hard to diagnose precisely. Therefore, profilactic measures to prevent neonatal sepsis is needed, and oral care rises as one of the solution. The understanding in regards of efficacy and safety of oral care is needed in order to be able to optimally utilize this procedure.

Objectives. (1) To determine the subject characteristic based on gender, gestational age, birth weight, maternal age, and mode of delivery. (2) To determine the incidence of neonatal sepsis in premature infants with or without the administration of oral care. (3) To determine the association between oral care administration and the incidence of neonatal sepsis in premature infants.

Methods. A cross-sectional study is done to premature infants born in RSCM in 2015-2017. 42 samples are chosen by simple random sampling. Data is collected from January to August 2018 by observing the medical records of the subject, and then continued to be analyzed using bivariate analysis.

Results. There are 42 subjects that met the inclusion and exclusion criteria. The characteristics of this study are, 52,4% subject is male, mean gestational age is 33 (24-36) weeks, mean birth weight is 1569,24±493,3 gram, mean maternal age is 30,5238±6,67 years, and 85,7% subject delivered by sectio caesaria mode. There is a significant association between oral care administration and the incidence of neonatal sepsis (P=0,030 ; RR=0,533 ; CI 95%=0,290-0,980). There is a significant association between gestational age and the incidence of neonatal sepsis in subjects receiving oral care (GA: 32-37 weeks = 91,7% subjects without neonatal sepsis ; P = 0,003), and a significant association between birth weight and the incidence of neonatal sepsis in subjects receiving oral care (BW: 1500-2499 gram = 100% subjects without neonatal sepsis ; P = 0,002).

Conclusion. There is a significant association between oral care administration and the incidence of neonatal sepsis in premature infants in RSCM, with the reduction of probability of the incidence of neonatal sepsis as much as 0,533 times higher."

"Latar belakang: Sepsis neonatorum awitan lambat SNAL , merupakan penyebab morbiditas dan mortalitas terpenting bayi berat lahir rendah di rumah sakit. Klinisnya tidak spesifik sehingga membutuhkan pemeriksaan penunjang untuk mendiagnosisnya. Baku emas kultur darah memiliki nilai diagnostik yang rendah dan hingga kini belum ada penanda infeksi tunggal yang dapat mendiagnosis sepsis neonatorum. Toll-like receptor TLR berperan dalam mengenali patogen dan memulai respon imun. Ekspresi TLR2 dan TLR4 diharapkan dapat menjadi penanda sepsis neonatorum. Tujuan: Mengetahui ekspresi TLR2 dan TLR4 neutrofil dan monosit serta nilai diagnostiknya pada SNAL. Metode: Studi potong lintang pada Mei-Juni 2017 yang melibatkan 52 neonatus >72 jam dengan klinis sepsis. Pemeriksaan darah perifer lengkap, rasio I/T, CRP, PCT, TLR2 dan TLR4 menggunakan flow cytometry dilakukan dan dibandingkan dengan kultur darah. Hasil: Insidens SNAL penelitian ini sebesar 32,6 . Terdapat penurunan ekspresi TLR2 neutrofil maupun monosit pada kasus SNAL. Peningkatan ekspresi TLR4 neutrofil memiliki sensitivitas 88,2 , spesifisitas 20 , dan AUC 0,541. Ekspresi TLR4 monosit memiliki sensitivitas 92,1 , spesifisitas 11,4 , dan AUC 0,528 jika dibandingkan kultur darah. Nilai AUC CRP meningkat hingga lebih dari 0,75 setelah dikombinasikan dengan TLR4. Simpulan: Pada SNAL, ekspresi TLR4 memiliki sensitivitas yang baik namun kurang spesifik. Pemeriksaan TLR4 dapat menunjang nilai diagnostik CRP.

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Background Late onset neonatal sepsis LONS , is the major morbidity and mortality in low birth weight. Unspecific clinical manifestation make laboratory examination is needed to establish the diagnosis. Unfortunately, blood culture as a gold standard has low diagnostic value. While, there is no single infection marker to diagnose neonatal sepsis. TLRs are a sensor to recognize the pathogens and trigger the immune response. Expression of TLR2 and TLR4 are promising to be a septic marker. Aim To know the expression of TLR2 and TLR4 neutrophil and monocyte and their diagnostic value in LONS. Methods A cross sectional study was conducted from May June 2017 which involved 52 neonates 72 hours with clinically sepsis. Complete blood count, I T ratio, CRP, PCT, TLR2 and TLR4 by flow cytometry already done and compared to blood culture. Result The incidence of LONS is 32.6 . There is TLR2 down expression in LONS. Expression of TLR4 neutrophil has sensitivity 88.2 , specificity 20 , and AUC 0.541. While TLR4 monocyte has sensitivity 92.1 , specificity 11.4 , and AUC 0.528. AUC of CRP is increased over to 0.75 after combined with TLR4. Conclusion Expression of TLR4 have good sensitivity but less specific. TLR4 expression could increase the diagnostic value of CRP."

"Pemantauan Terapi Obat pada Neonatus Kurang Bulan, Bayi Berat Lahir Rendah, dan Sepsis di Ruang Neonatus Intensive Care Unit (NICU) RSUP Fatmawati Bulan September 2020.

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Neonates, especially preterm infants have weak physical defenses and immature immune function, making them susceptible to bacterial invasion. One of the efforts to achieve the Sustainable Development Goals (SDGs), which is to reduce the incidence of neonatal mortality to 12 per 1,000 live births, it is necessary to collaborate between health workers in treating patients. Pharmacists in hospitals need to carry out their roles, one of which is by monitoring the therapy given. Data were collected directly by looking at the cardex and patient's medical records with the following criteria: less-month neonatal patients, receiving polypharmacy, patients with antibiotic therapy, and length of stay in the hospital ≥5 days. The data obtained were analyzed using the SOAP method and identified problems related to drugs. From the Monitoring of Drug Therapy (PTO), it was found that drug-related problems that occurred were dose mismatches and frequency mismatches, and analysis of the evaluation of antibiotic administration (EPA) with the Gyssens method found that the use of antibiotics was found in category IIIa, namely giving meropenem too long and category IIa, which was not the right dosage."

"Latar Belakang. Sepsis neonatal awitan dini SNAD masih merupakan masalah di Indonesia. Vitamin D memiliki efek pada fungsi imunitas. Neonatus kurang bulan NKB berisiko mengalami defisiensi kadar vitamin D. Hubungan kadar vitamin D dengan kejadian SNAD pada NKB belum jelas.Tujuan. Menganalisis hubungan kadar vitamin D dengan kejadian SNAD pada NKB.Metode. Duapuluh NKB dengan klinis dan pemeriksaan laboratorium menyokong SNAD kelompok kasus dan 20 NKB tanpa hasil laboratorium SNAD kelompok kontrol ikut dalam penelitian ini. Subjek penelitian adalah NKB usia gestasi ge; 28 sampai dengan < 37 minggu dirawat di RSUPN Cipto Mangunkusumo selama bulan Juli - September 2017. Pemeriksaaan kadar vitamin D 25 OH D dengan metode competitive chemiluminescense immunoassay CLIA direk dengan alat Diasorin Liaison.Hasil. Median kadar vitamin D pada NKB dengan SNAD 8,95 4,10 - 16,30 ng/mL dengan rerata usia gestasi 33,25 1,71 minggu dan rerata berat lahir 1863,75 415,06 gram. Median kadar vitamin D tanpa SNAD 11,75 5,80 - 42,80 ng/mL dengan rerata usia gestasi 34,67 1,53 minggu dan rerata berat lahir 2125,0 340,55 gram. Median kadar vitamin D NKB SNAD lebih rendah secara bermakna dibandingkan NKB tanpa SNAD.

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Background. Early onset neonatal sepsis EONS is still a problem in Indonesia. Vitamin D has effect on immune function. Preterm infants have a risk of deficiency of vitamin D levels. The association between vitamin D levels with EONS were unclear.Objective. To determine the association between vitamin D levels with EONS in preterm infants.Methods. Twenty preterm infants with clinical and laboratory finding of EONS study group and 20 preterm infants with no signs of laboratory infection control group were enrolled this study. The subjects were preterm infants of gestational age ge 28 37 weeks in Cipto Mangunkusumo Hospital during July September 2017. Vitamin D 25 OH D levels were measured using Diasorin Liason with competitive chemilunescence immunoassay CLIA technique.Results. Median vitamin D levels with EONS was 8,95 4,10 16,30 ng mL, mean of gestational age and birth weight were 33,25 1,71 weeks and 1863,75 415,06 g, respectively. Median vitamin D levels without EONS was 11,75 5,80 42,80 ng mL, mean of gestational age and birth weight were 34,67 1,53 weeks and 2125,0 340,55 g, respectively. Median vitamin D levels of preterm infants with EONS was significantly lower than without EONS.Conclusion. Vitamin D levels are associated with EONS in preterm infants."