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"ABSTRAKKebutuhan nutrisi merupakan kebutuhan fisiologis pada anak yang dapat mempengaruhi pertumbuhan dan perkembangan anak. Gangguan nutrisi pada anak merupakan masalah yang serius karena berdampak terhadap tumbuh kembang anak serta kemungkinan kualitas hidup kurang optimal. Pemberian nutrisi enteral melalui NGT dapat memenuhi kebutuhan nutrisi anak, namun pemberian nutrisi melalui NGT juga dapat menyebabkan terjadinya muntah. Untuk mencegah terjadinya muntah pada anak yang diberikan nutrisi enteral melalui NGT diberikan posisi miring kanan. Tujuan penulisan adalah untuk mengetahui efektifitas pengaturan posisi miring kanan untuk mencegah muntah. Metode dilakukan dengan menggunakan pendekatan PICO yang dilaksanakan selama 7 minggu bulan Februari sampai bulan April 2017 pada anak yang dirawat diruang infeksi RSUPN Cipto Mangunkusumo. Hasil didapatkan 40 anak, 20 anak diberikan posisi miring kanan kelompok intervensi 60 tidak muntah, 40 mengalami muntah. 20 anak diberikan posisi miring kiri kelompok kontrol 75 mengalami muntah dan 25 tidak muntah. Kesimpulan pengaturan posisi miring kanan dapat mengurangi muntah pada anak yang diberikan nutrisi enteral melalui NGT. Rekomendasi pengaturan posisi miring kanan dapat dilakukan pada anak stelah pemberian makan selama 30-60 menit untuk mencegah terjadinya muntah.Kata Kunci: Muntah, Nutrisi enteral, Posisi miring kanan

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ABSTRACTNutritional needs is a physiological requirement in children that can affect the growth and development of children. Nutritional disorders in children is a serious problem because it affects the development of children and the possibility of quality of life is less than optimal. Enteral nutrition through NGT can meet the nutritional needs of children, but nutrition through NGT can also cause vomiting. To prevent the occurrence of vomiting in children who are given enteral nutrition through NGT given right side position. The purpose of writing is to determine the effectiveness of the right tilt position to prevent vomiting. Methods were carried out using PICO approach which was carried out for 7 weeks February to April 2017 in the hospitalized child of Cipto Mangunkusumo RSUPN. The results obtained 40 children, 20 children were given right sloping position intervention group 60 did not vomit, 40 experienced vomiting. 20 children were given a left sidet position control group 75 experienced vomiting and 25 did not. The conclusion of right side position adjustment can reduce vomiting in children who are given enteral nutrition through NGT. Recommendation right side positioning may be performed in children after 30 60 minutes after feeding to prevent vomiting. "

"Karya ilmiah ini bertujuan untuk memberikan gambaran asuhan keperawatan pada klien DM tipe 2 dengan ulkus DM yang mengalami penurunan intake oral. Intervensi dilakukan dengan cara menerapkan pemberian nutrisi secara intermittent enteral feeding. Intervensi tersebut bertujuan membantu mengatasi gangguan pemenuhan nutrisi harian klien. Hasil yang tercapai melalui intervensi pemberian nutrisi secara bertahap adalah tercukupinya kebutuhan nutrisi harian klien dan kestabilan kadar gula darah klien. NGT yang terpasang pada klien selalu mebutuhkan evaluasi lebih lanjut untuk menjamin adekuasi nutrisi yang diberikan. Peran perawat selain memastikan kecukupan kebutuhan nutrisi klien yaitu mengevaluasi faktor yang beresiko mengakibatkan intoleransi penerimaan makanan pasien. Oleh karena itu pelayanan rumah sakit diharapkan senantiasa saling berkerjasama melakukan pengkajian dan analisa secara berkesinambungan mengatasi permasalahan kondisi klien setiap hari."

"Diabetics occasionally need enteral nutrition-either as supplement or in situations necessitating total dependency on enteral nutrition to fulfill their energy requirements. Enteral nutrition specifically designed fordiabet-ics is not yet available in our hospital, as sugar is often added to enteral nutrition preparations, subsequently affecting the blood glucose profiles of the patients.

This study was done to determine the glycemic index of 4 kinds of enteraf feeding formulas, conducted among ambulatory diabetics attending the Diabetic Clinic of the Dr Cipto Mangunkusumo General Central National Hospital.

Twenty samples were purposively chosen among the Diabetic Clinic attendees. They were well-controlled non-pregnant diabetics; none of them were having either kidney or liver problems, and were otherwise healthy. Each of the diabetic studied was given 50-g glucose syrup (200 Kcal) as a standard load. With a 3 to 4 days interval, the patients were consecutively given several enteral feeding formulas, i.e., the standard hospital enteral feeding formula (MC-FRS I), a newly developed diabetic formula (MC-FRS II), a frequently-used commercially avai 1-ablepredigested/elemental enteral feeding formula {MC-FK I = Isocal), and a new predigested/elemental enteral feeding formula specifically designed for diabetics (MC-FK II=Diabetasol). All of the formulas tested contained energy equal to 50-g glucose (200 Kcal). Blood glucose was measured with an Accutrend-Ames® glucometer in fasting condition and subsequently 30,60,90 and 120 minutes after the load. Any glucose/enteral feeding loading was given 30 minutes after. Data were presented as a blood glucose curve and glycemic index were calculated as area under the blood glucose curve of each food load compared to the standard glucose load, presented as percentage.

In all the enteral feedings studied, the blood glucose response curves went up and the peaks achieved in 60 minutes, thereafter declined to points above the initial fasting blood glucose values. The glycemic index of the MC-FRS I, MC-FRS II, MC-FK I and MC-FK II were 39.6%, 25%, 45% and 52.1% respectively.

The sugar that was added to the MC-FRS I and MC-FK I did not give rise to higher blood glucose levels as compared to the other non-glucose-added food. All of the enteral feeding formula tested showed low glycemic index (Miller, less than 55%). The difference glycemic index among the formulas studied might be due to different food composition (predigested/elemental component in the commercial enteral feeding formula; no sugar added and higher fiber in MC-FRS II as compared to MC-FRS I; higher fat content in MC-FK 1 as compared to MC-FK II). Glycemic index of enteral feeding formula was particularly determined by the total carbohydrate, total fat and total protein content of the food, as well as the presence of fiber and antinutrient in the food studied."

"Tujuan: Mengetahui efek pemberian nutrisi enteral dua jam pra sectio caesarea terhadap perubahan kadar hsIL-6 pasca sectio caesarea Metode: Penelitian ini merupakan uji klik paralel, yang subyek penelitiannya dipilih secara consecutive sampling, yang dibagi menjadi dua kelompok melalui randomisasi blok masing-masing terdiri dari 10 orang subyek. Data karakteristik awal penelitian meliputi usia, indikasi SC, status gizi berdasarkan KMS ibu hamil dan LiLA, asupan energi dan protein pra SC, lama operasi, jumlah perdarahan, dan hsIL-6 prabedah adalah homogen. Untuk melihat perbedaaan perubahan kadar hsIL-6 dilakukan pemeriksaan hsIL-6 setelah 6 jam pasca insisi. Analisis data dilakukan dengan menggunakan uji t. Batas kemaknaan 5%. Hasil: Peningkatan rerata dan simpang baku kadar hsIL-6 meningkat pada kedua Kelompok. Peningkatan kadar hsIL-6 ( p <0,05) dan perubahan kadar hsIL-6 lebih besar bermakna pada kelompok kontrol dibandingkan kelompok perlakuan (p <0,05). Simpulan: Pemberian nutrisi enteral dua jam pra secfio caesarea dapat menekan peningkatan kadar hsIL-6.

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Objective: To investigate the effect of enteral nutrition that given two hour before caesarean section on changes hsIL-6 levels after caesarean section.

Methods: The design study was a parallel clinical trial, in which the subject were selected by consecutive sampling, each proup consisted of ten subjects. The subject were divided into two groups using block randomization. Data collected including age, indication of CS, nutritional status based on MUAC and KMS chart in pregnancy, energy and protein intakes, duration of surgery, amount of blood loss during surgery, and hsIL-6 serum preoperative, were matched at baseline. To investigated the changes of hsIL-6 levels, the concentrations to assessed six hours post CS. Statistical analysis was measured by t-test. The significance levcl was 5%.

Results: There was a significant increasc of hsIL-6 levels (p = 0,001) in both groups. The increased and changes of hsIL-6 levels in the control group was significantly higher than in the treatment group. (p<0.05, and p <0,05 respectively).

Conclusion: Enteral nutrition that was given two hour before caesarean section can suppress the increased of hsIL-6 levels. "

"Tujuan : Mengetahui pengaruh pemberian NED terhadap status protein penderita luka bakar derajat II, 20-60% dari luas permukaan tubuh (LPT) dan/atau derajat III ≥ 10% LPT usia 18-60 tahun.Tempat : Unit Luka Bakar RSUPNCMBahan dan Cara : Penelitian ini merupakan suatu uji klinik dengan randomisasi yang telah disetujui oleh panitia tetap penilai etik penelitian Fakultas Kedokteran Universitas Indonesia. Duapuluh subyek yang memenuhi kriteria penerimaan dan penolakan dibagi 2 kelompok secara randomisasi blok. Sepuluh subyek perlakuan diberi NED mulai ≤ 8 jam pasca luka bakar, sedangkan 10 subyek kontrol diberi nutrisi enteral/oral 24 jam pasca luka bakar. Pengamatan dilakukan selama 12 hari. Status protein ditetapkan dengan pemeriksaan albumin dan prealbumin serum serta nitrogen urea urin (NUU). Sampel darah untuk pemeriksaan albumin dan prealbumin diambil hari ke-l, 7, dan 12. Urin tampung 24 jam untuk pemeriksaan NUU diambil hari ke-3, 7 dan 12. Uji statistik yang digunakan adalah uji t untuk data berdistribusi normal dan uji Mann Whitney U untuk data berdistribusi tidak normal, batas kemaknaan yang digunakan sebesar 5%.Hasil : Penelitian ini menunjukkan pemberian NED tidak menunjukkan perbedaan bermakna terhadap status protein antara kelompok perlakuan dan kelompok kontrol, tetapi pada kelompok perlakuan didapatkan peningkatan kadar prealbumin dan gambaran penurunan kadar NUU yang lebih tajam.Kesimpulan : NED mempunyai kecenderungan dapat memperbaiki status protein walaupun belum dapat dibuktikan secara statistik.

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The Effect of Early Enteral Nutrition (EEN) on Protein Status in Burn Patients at Burn Unit Dr. Cipto Mangun Kusumo Hospital 1999-2000Objective: To know the effect of EEN on protein status in burn patients with 20-60% total body surface area (TBSA) of second degree burned, and/or ≥ 10% TBSA of third degree burned, age 18-60 years old subjects.

Place: Burn Unit Cipto Mangunkusumo Hospital Material and Methods

The study was a randomized clinical trial, which already certify by the ethical clearance research committee of the Faculty of Medicine University of Indonesia. Twenty subjects were selected by inclusion and exclusion criteria. The subjects were divided into two groups by block randomization. Ten subjects were given enteral nutrition started ≤ 8 hours post burn, while 10 control subjects were given enteral / oral nutrition 24 hours post burn. Observation was done for 12 days. Protein status was determined by the laboratory result of albumin and prealbumin serum and the level of urinary urea nitrogen (UUN). Blood samples for albumin and prealbumin serum were taken on the day 1st, 7th and 12th. Twenty four hours collected urines for UUN examination were taken on the day 3rd, 7th and 12th . Statistical analysis was performed with t-test for data with normal distribution and Mann Whitney U test for data which do not conform to a normal distribution. The level of significance was 5%.

Results: The results showed no significant difference between the two groups, except on day 12th the prealbumin level tends to increase and the UUN level tend to decrease in the study group.

Conclusion : The EEN tend to be able to increase the protein status although has not statistically proven yet."

"Tujuan penelitian uji klinik paralel terbuka ini adalah diketahuinya pengaruhpemberian nutrisi enteral per oral pra Sectio Caesarea (SC) terhadap kadar highsegasfrfvity C-Reactive Protein (hsCRP) serum pasca SC. Penelitian ini telahdisetujui komisi etik penelitian Fakultas Kedokteran Universitas Indonesia.Sebanyak 27 pasien SC elektif di RSUD Bekasi yang memenuhi kriteriapenelitian dibagi dalam dua kelompok sccara randomisasi blok. Sebanyak 13orang subyek mendapat nutrisi enteral 200 mL (kelornpok P) dan 14 orang subyekmendapat teh manis 200 mL (kelompok K) yang diberikan dua jam pra SC. Datayang dikumpulkan meliputi usia, umur kehamilan, status gizi, indikasi SC, lamaSC, pcrdarahan, dan asupan energi, dan protein. Pemeriksaan kadar hsCRPserum dilalcukan dua jam pra SC dan 48 jam pasca SC. Uji statistik yangdigunakan adalah uji t dan uji Man11~Whitney dengan hatas kernalmaan 5%.Sebanyalc 12 orang kelompok P dan 12 orang kelompok K dengan rerata usia29,78 jg 4,41 tahun mengikuti penelitian secara lengkap. Status gizi seluruhSubyek berdasarkan LiLA temmasuk kategori Status gizi balk, sedangkanberdasarkan KMS ibu hamil Depkes termasuk kategori status gizi lebih. Padaawal penelitian, karaktristik data dasar pada kedua kelompolc tidakmemperlihatkan perbedaan yang bermakna (p >0,05). Pada kedua kelompokdidapatkan peningkatan kadar hs,CRP serum pasca SC yang lebih nyata texjadipada kelompok K dan secam statisiik berbeda bermakna (p == 0,00). Pemberian200 mL nutrisi enteral pra SC dapat mengendalikan peningkatan kadar hsCRPserum pasca SC."

"Penulisan karya ilmiah akhir ini bertujuan untuk mengaplikasikan Model Konservasi Myra E Levine dalam pemenuhan kebutuhan nutrisi pada bayi prematur Nutrisi pada bayi prematur penting untuk kelangsungan hidup dan tumbuh kembang yang optimal Tantangan dalam pemberian nutrisi pada bayi prematur adalah adanya imaturitas organ Cara pemberian nutrisi pada bayi prematur tergantung pada keadaan klinis dan usia gestasi Nutrisi pada bayi prematur dapat diberikan secara enteral maupun parenteral Selama menjalani perawatan tiga dari lima bayi prematur dalam uraian karya ilmiah akhir ini menunjukkan status kardiopulmonal yang stabil tidak terdapat instabilitas suhu dan peningkatan berat badan masih dalam rentang normal yaitu 10 15 gram hari

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The aim of this final scientifict report was to apply Myra E Levine Conservation Model rsquo s in feeding intervention preterm infants Nutrition is important for survival optimal growth and development of preterm infants The challenge in feeding preterm infants is the organ immaturity Feeding in preterm infants depends on clinical status and gestasional age Nutrition in preterm infants can be provides by enteral and total parenteral nutrition During treatments three of five preterm infants in this final scientifict report showed cardiopulmonal stability status stability of body temperature and increase of body weights was in the normal range of 10 15 gram day "

"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."

"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."