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"Penggunaan antibiotik yang tidak rasional menyebabkan resistensi antibiotik di seluruh dunia. Berbagai upaya telah dilakukan untuk mencegah resistensi antibiotik. Penelitian ini bertujuan untuk melakukan evaluasi hubungan antara penggunaan antibiotik sesuai rekomendasi Pedoman Penggunaan Antibiotik (PPAB) dengan luaran klinis, luaran laboratorium, lama rawat dan luaran sekunder yang membaik pada anak dengan infeksi yang di rawat di ruang intensif anak. Penelitian ini menggunakan desain kohort retrospektif pada anak usia 1-18 tahun yang mendapat terapi antibiotik. Hasil penelitian, dari 85 anak, terdapat 126 penggunaan antibiotik, rerata usia 4,9 tahun, sebaran profil bakteri Gram negatif lebih banyak dibanding Gram positif, sebaran penggunaan antibiotik empiris sesuai rekomendasi PPAB (69,8%) menurut alur Gyssens merupakan kategori 0 (penggunaan antibiotik tepat). Berdasarkan analisis bivariat, variabel luaran klinis, luaran laboratorium, lama rawat dan luaran sekunder tidak  memiliki hubungan bermakna dengan penggunaan antibiotik sesuai PPAB (p>0,05). Sebagai saran, sosialisasi rutin oleh tim PPRA, evaluasi panduan PPAB terus diperbarui tiap 3-6 bulan sesuai data uji kepekaan antibiotik terbaru. Penelitian lebih lanjut diperlukan untuk evaluasi penggunaan antibiotik, secara prospektif dengan subyek yang lebih banyak, durasi lebih lama, kriteria inklusi yang lebih spesifik tanpa komorbid untuk memperkuat rekomendasi penggunaan antibiotik yang sesuai PPAB.

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The irrational use of antibiotics causes antibiotic resistance worldwide. Various attempts have been made to prevent antibiotic resistance. This study aims to evaluate the relationship between the use of antibiotics according to PPAB recommendations and improved clinical outcomes, laboratory outcomes, length of stay and secondary outcomes in children with infections treated in the pediatric intensive care unit. This study used a retrospective cohort design in children aged 1-18 years who received antibiotic therapy. The results of the study, of 85 children, there are 126 antibiotic use, the mean age was 4,9 years, the distribution of Gram-negative bacteria profiles was more than Gram-positive, the distribution of empirical antibiotic use according to PPAB recommendations 69.8% according to the Gyssens flow is category 0 (appropriate use of antibiotics). Based on bivariate analysis, the clinical outcome variables, length of stay, laboratory outcomes and secondary outcomes had a p value > 0.05 which were statistically not significantly different to have a relationship with the use of antibiotics according to PPAB. As a suggestion, regular socialization by the PPRA team and evaluation of the PPAB guidelines are continuously updated every 6 months according to the latest antibiotic sensitivity test data. Further research is needed to evaluate the use of antibiotics, prospectively with more subjects, longer duration, more specific inclusion criteria without comorbidities to strengthen recommendations for the use of antibiotics according to PPAB."

"La gestione e la rianimazione del bambino in condizioni critiche coinvolgono un vasto campo di conoscenze, tecniche e terapie che richiedono una prospettiva del tutto specifica. Questo volume, rivolto ad anestesisti rianimatori, chirurghi pediatrici e neonatologi, affronta tutte le principali tematiche legate alla terapia pediatrica d’urgenza: l’inquadramento del paziente, le condizioni critiche provocate da insufficienze d’organo, traumi, ustioni, disordini endocrinologici e gastrointestinali; argomenti delicati e cruciali come la morte cerebrale e la donazione d’organo, le diverse tecniche di rianimazione, i farmaci off label, le criticità specifiche del neonato pretermine.In quest’opera di particolare vastità, che ha coinvolto un gran numero di esperti, si è cercato di includere tutte le tematiche più decisive nella rianimazione pediatrica, e per questo potrà diventare un essenziale riferimento per tutti gli specialisti del settore."

"Salah satu upaya pelayanan kesehatan dasar yang dilakukan di Puskesmas adalah upaya promotif, preventif dan kurdtif yang dilakukan terhadap bayi dan balita, dimana sejak tahun 1996 Departemen Kesehatan bekerjasama dengan WHO, telah mengembangkan suatu pendekatan baru dalam mengklasifikasi dan mengobatl bayi dan balita saki!, yaitu dengan pendekatan Manajemen Terpadu Balita Saki!(MTBS).Manajemen Terpadu Bolita Saki!(MTBS) dilaksanakan untuk memperbaiki dan meningkatkan kualitas manajemen program maupun manajernen kasus yang mengacu pada kualh.as tatalaksana kasus sehingga angka kematian bayi dan balita dapat diturunkan.Tujuan penelitian ini adalah untuk mempero1eb gambaran tingkat kepatuhan petugas terhadap SOP pendekatan MTBS dan faktor-faktor yang mempengarohinya di Kabupaten Majalengka. Penelitian ini menggunakan desain cross sectional dengan pendekatan kuantitatif dengan jumlab sampel 58 petugas pe1aksana MTBS dengan 174 pengama!an. Pengumpulan data dilakukan dengan pengama!an secara langsung pada saat petugas memeriksa balita sakit dengan menggunakan daftar tilik dan waw!lncara dengan petugas MTBS.Hasil penelitian memperlihatkan babwa pada tingkat kepatuhan petugas dengan menggunak.an cut off point 90% dalam nilai kepatuhan tertinggi 96,74% dan terendah 37,52%, dengan rata rata masalah telinga (80,5%) dan terendab pada konseling (17,8%). Dari hasil uji bivariat didapatkan faktor yang berhubungan seca:ra statistik adalah kua1ifikasi tenaga, pengetahuan, motlvasi dan komitmen pimpinan. Hasil ujl statistik secara multivariat didapatkan faktor yang paling dominan berhubungan Oengan kepai.uhan petugas terhadap SOP pendekstan MTBS adalab komitmen pimpinan.Bagi Dinas Kesehatan dan Puskesmas di Kabupaten Majaiengka perlu kiranya mencoba mengadopsi suatu pendekatan bam daiam mengelola program MTBS yaitu dengan menggunakan manajemen mutu terpadu (Iota/ quality manajemen). Pendekatan tersebut lebih mengedepankan terhadap kepuasan pelanggan baik internal maupun ekstemaldan pendekatan budaya organisasi daJam melakukan perbaikan kepatuhan petugasnya. Melibatkan pegawai dalam pengambilan keputusan dan memberikan wewenang yang penuh terhadap stafnya dalam melaksanakan tugas dalam pengambHan keputusan. Lakukan perbaikar. kinelja dan kepatuhan petugas MTBS secara tents menerus: dengan meflggunakan siklus: PDCA (Plan-Do-Check-Act).

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The set of primary health care effort conducted in health center (puskesmas) are promotive, preventive and curative efforts for babies and children under five years (balita). MoH in collaboration with WHO. have developed a new approach in classification and treatment for balita through IMCL lMCl, known as MTBS, was conducted for improving and promoting the quality of program management and also case management which refer quality of operational procedures and so the mortality rate ofbaJita could be reduced.The objective of the study was to have description of the compliance level regarding the SOP of IMCI approach and its influencing factors in Majalengka District. The design of the study was Cross Sectional utilized quantitative approach, the sample size was 58 officials and involved J 74 observations. Data collection was conducted in direct observation while the officials examined the: sick balita by using checklist and also interviewing the officials.The result of the study showed the compliance level of the officials, with cut off point 90%, the highest level was 96?74% and the lowest level was 37,52%, the average level was 76,90%. The highest level of compliance was in eac examination (80,5%)the lowest level was in counseling (17,8%). According to bivariate testing, it showed the corresponding factors statistically in educational level, knowledge, motivation and managerial commitment. In multivariate testing. the dominant factor which was correspond to the compliance level ofthe officials was managerial commitment.Majalengka District Health Office (DHO) WllS proposed to implement the new approach above in IMCI management by using Total Quality Management (TQM). This approach prioritize the internal and external customer satisfaction. perform the organizational culture in improving compliance level of officials, also staff participation in decision making process and fully delegation to the staff in performing the assignment. Continuous improvement of the performance and compliance level of the IMCI officials will he gained by using PDCA (Plan Do Check Action) cycle."

"Anak yang dirawat di ICU cenderung mengalami malnutrisi sejak masuk atau selama perawatan yang dapat memperberat penyakit dasar, memperpanjang lama rawat serta meningkatkan mortalitas. Baik underfeeding atapun overfeeding dapat terjadi di ICU Anak selama perawatan. Penelitian ini merupakan penelitian potong lintang, menggunakan data rekam medis. Selama 3 bulan penelitian. didapatkan 45 subjek penelitian. Dari 45 data pasien didapatkan 127 peresepan untuk menilai keseuaian peresepan dengan pemberian nutrisi pada pasien. Pemberian nutrisi pada pasien yang dirawat di ICU Anak merupakan hal yang sangat penting. Perlu perhitungan kebutuhan nutrisi yang cermat, pemberian nutrisi tepat yang sesuai kebutuhan pasien agar tidak terjadi malnutrisi yang lebih berat lagi.

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Children admitted to the Pediatric Intensive Care Unit (PICU) are at risk for poor and potentially worsening nutritional status, a factor that further increases comorbidities and complications, prolongs the hospital stay, increases cost and increases mortality. Both underfeeding and overfeeding are prevalent in PICU and may result in large energy imbalance. This was cross sectional study design, with 3 month consecutive sampling in PICU which met 45 patients as the subject and 127 prescription of nutrition. Nutrition support therapies in PICU is very important .Adequate nutrition therapy is essential to improve nutrition outcomes in critically ill children."

"Malnutrisi pada anak sakit kritis dalam perawatan intensif menjadi masalah dalam beberapa dekade terakhir dan berhubungan erat dengan morbiditas dan mortalitas. Hingga kini, Rumah Sakit Cipto Mangunkusumo (RSCM) belum memiliki panduan baku mengenai dukungan nutrisi anak sakit kritis. Penelitian bertujuan untuk mengetahui profil pemberian nutrisi enteral (NE) dan waktu pencapaian resting energy expenditure (REE) di Pediatric Intensive Care Unit (PICU) RSCM dan faktor-faktor yang memengaruhi. Penelitian dilakukan secara retrospektif dengan menggunakan data rekam medis anak sakit kritis yang dirawat di PICU RSCM pada tahun 2017-2018. Waktu inisiasi pemberian NE dan pencapaian REE serta faktor-faktor yang memengaruhi pemberian tersebut dicatat dan dilakukan analisis multivariat untuk mencari faktor risiko yang bermakna. Terdapat 203 pasien yang memenuhi kriteria inklusi. Terdapat 120 subyek berjenis kelamin lelaki (59,1%), dengan median usia adalah 35 bulan (rentang usia 1-209 bulan). Kasus bedah terdapat pada 125 subyek (61,6%) dan status gizi normal terdapat pada 87 subyek (42,9%). Prevalensi pemberian NE dini adalah 63,1%, dan pencapaian kalori REE ≤72 jam adalah 67,5%, dengan median 48 jam. Faktor risiko yang menghambat pemberian NE dini adalah pasca-bedah abdomen, penggunaan inotropik, penggunaan ventilator, gejala gastrointestinal sebelum inisiasi, dan status gizi tidak normal dengan odds ratio (OR) 10,89 (IK 95% 4,31-27,50; p=0,009), 4,60 (IK 95% 1,78-11,90; p=0,002), 4,18 (IK 95% 1,56-11,17; p=0,004), 3,40 (IK 95% 1,59-7,29; p=0,002), 2,49 (IK 95% 1,09-5,72; p=0,031). Faktor risiko yang menghambat pencapaian kalori REE ≤72 jam adalah pemberian NE lambat, intoleransi pemberian enteral berupa gejala gastrointestinal dan skor PELOD-2 ≥7 dengan OR 20,62 (IK 95% 6,48-65,65; p=0,000), 14,77 (IK 95% 4,40-49,60; p=0,000), 3,98 (IK 95% 1,01-15,66; p=0,048). Prevalensi pemberian NE dini pada anak sakit kritis di PICU RSCM cukup baik dengan waktu pencapaian REE sesuai dengan target. Faktor terbanyak penghambat pemberian NE dini adalah kondisi pasca-bedah abdomen, sedangkan faktor penghambat pencapaian REE ≤ 72 jam terbanyak adalah pemberian NE lambat.

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Malnutrition of critically ill children remains a major problem that is closely related to high morbidity and mortality in pediatric intensive care unit (PICU) during the last decades. The protocol of nutritional support for critically ill children in Cipto Mangunkusumo Hospital (CMH) has not yet been developed. The study is aimed to evaluate the enteral nutrition (EN) profile, the duration to achieve resting energy expenditure (REE) and number of influencing factors associated with the late EN administration and late REE achievement. The data were collected retrospectively from medical records during the year 2017 to 2018 in PICU CMH. We assessed the timing of EN given and the duration of REE achieved from EN. We performed multivariate analysis to determined significant factors associated with late EN and late REE achievement. Two hundred three subjects were included. One hundred twenty subjects (59%) were boys, with median age of 35 (1-209) months old. One hundred twenty five subjects (61.6%) were post-surgical period and 87 subjects (42.9%) were in good nutritional status. The prevalence of early EN was 63.1%, and REE ≤72 hours was achieved in 67.5% subjects, with the median time was 48 hours. Significant factors inhibit early EN administration were post-abdominal surgery, ventilator use, inotropic use, gastrointestinal symptoms before initiation, and abnormal nutritional status; with OR 10.89 (95% CI 4.31 to 27.50; p=0.009), 4.60 (95% CI 1.78 to 11.90; p=0.002), 4.18 (95% CI 1.56 to 11.17; p=0.004), 3.40 (95% CI 1.59 to 7.29; p=0.002), 2.49, 95% CI 1.09 to 5.72; p=0.031), respectively. While factors inhibit the achievement of REE ≤72 hours were the late EN initiation, enteral intolerance, and PELOD-2 score ≥7 with OR 20.62 (95% CI 6.48 to 65.65; p=0.000), 14.77 (95% CI 4.40 to 49.60; p=0.000), 3.98 (95% CI 1.01 to 15.66; p=0.048), respectively. The prevalence of early EN administration with the duration to achieve REE among critically ill children in the PICU CMH was quite satisfying. The most influencing factor inhibit early EN administration was post-abdominal surgery, while the most significant factor inhibit the achievement of REE ≤72 hours was the late NE administration."

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Pasien anak sakit kritis yang memakai ventilasi mekanik maupun tidak, membutuhkan obat penenang dan atau analgesik untuk mengurangi kecemasan atau rasa sakit. Perawat memiliki peranan penting dalam penilaian sedasi secara kontinu, perawat bertanggung jawab memantau tingkat sedasi pasien sehingga mampu melaporkan status sedasi pasien secara tepat. Studi literatur ini bertujuan untuk meninjau lebih lanjut validitas dan reliabilitas instrumen Comfort Behaviour Scale. Pencarian literatur dilakukan dengan memanfaatkan platform publikasi internet periode studi 2011-2020 melalui Scopus, Proquest, Wiley Online library, serta sumber tambahan dari Researchgate dengan kata kunci pain assessment, COMFORT Behaviour Scale, sedation, children, PICU. Hasil studi literatur ini menunjukkan berbagai penelitian di beberapa negara dan instrumen Comfort Behaviour Scale terbukti valid dan reliabel digunakan dalam mengukur tingkat sedasi anak sakit kritis. Perawat disarankan menggunakan instrumen ini dalam manajemen nyeri dan sedasi yang komprehensif.

 

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Critically ill pediatric patients induced with or without mechanical ventilation need sedatives or analgesics to reduce their anxiety or pain. Nurses have an important role to asses sedation continuously and responsible to monitor patients sedation level, in order to record the patients sedation status appropriately. This literature study aims to profoundly review the validity and reliability of the Comfort Behavior Scale instrument. The literature research is carried out by utilizing the internet publication platform from 2011 to 2020 through Scopus, Proquest, Wiley Online library, as well as additional resources from Researchgate with the keywords pain assessment, COMFORT Behavior Scale, sedation, children and PICU. The results of this literature study show various studies in several countries have proven the validity and reliability of Comfort Behavior Scale instrument as the instrument to measure the sedation level of critically ill children. Nurses are considered to utilize this instrument in pain management and in conducting comprehensive sedation

 

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