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Risk factors of necrotizing enterocolitis-related mortality in preterm neonates: a preliminary prospective study Risma Karina Kaban; Rinawati Rohsiswatmo; Ahmad Kautsar; Audesia Alvianita Sutrisno; Hardya Gustada Hikmahrachim; Nieta Hardiyanti
Paediatrica Indonesiana Vol 62 No 3 (2022): May 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.3.2022.186-91

Abstract

Background Necrotizing enterocolitis (NEC) is a prematurity-related complication of the gastrointestinal tract that affects 3-15% of preterm infants. Due to its atypical signs and symptoms, NEC is often diagnosed late, leading to mortality and morbidity. Objective To describe the incidence, characteristics, and survival rate of preterm infants with NEC in the Neonatal Unit of Cipto Mangunkusumo Hospital. Methods This prospective cohort study was conducted on preterm infants born in Cipto Mangunkusumo Hospital in 2019 who had NEC Bell stage 2 or higher. Subjects were recruited consecutively. NEC was classified into either early-onset (<14 days of life) or late-onset (?14 days of life). We identified the risk factors of mortality and survival using multiple Cox regression. Results Within the study period, 55/639 preterm infants born in Cipto Mangunkusumo Hospital were diagnosed with NEC. Mean gestational age was 31.16 (SD 2.63) weeks and mean birth weight was 1,378.12 (SD 438.26) grams. The median age at NEC diagnosis was 6 (range 0-24) days. The most common symptoms were gastrointestinal bleeding (29.09%) and abdominal distension (29.09%). Plain abdominal radiographs showed dilated bowels in 92.72%, thickened intestinal walls in 83.63%, and pneumatosis intestinalis in 61.81% of subjects. Positive blood cultures were found in 63.63% of subjects, with Staphylococcus epidermidis and Klebsiella pneumoniae being the predominant organisms. Median survival was 27 days and 31 days for infants born at <32 weeks and ?32 weeks gestational age, respectively (P=0.37). Median survival was 27 and 28 days in infants with early-onset and late-onset NEC, respectively (P=0.07), and 23 and 28 days in infants with birth weight of <1,000 grams and ?1,000 grams, respectively (P=0.14). Conclusion The incidence of NEC among preterm infants born in Cipto Mangunkusumo Hospital in 2019 was 8.6%. The survival rate of infants with NEC was 27.27%. Early-onset and late-onset NEC had similar mortality rates.
Superior mesenteric artery blood flow in infants of very preterm and very low birthweight and its related factors Evita Karianni Bermanshah Ifran; Wresti Indriatmi; Tetty Yuniarti; Nadjib Advani; Saleha Sungkar; Dewi Irawati Soeria Santoso; Rinawati Rohsiswatmo; Yvan Vandenplas; Badriul Hegar
Paediatrica Indonesiana Vol 63 No 2 (2023): March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.2.2023.80-7

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Abstract Background Significant hemodynamic changes in preterm infants during early life could have consequences, especially on the intestinal blood flow. Alteration of superior mesenteric artery (SMA) blood flow may lead to impairment in gut function and feeding intolerance. Objectives To assess SMA blood flow velocity in very preterm and/or very low birth weight (VLBW) infants in early life and to elucidate the factors influencing them. Methods This is a cross-sectional study conducted in NICU at Cipto Mangunkusumo Hospital, Jakarta. Superior mesenteric artery (SMA) blood flow was evaluated by peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) measurement using Color Doppler US at < 48 hours after birth. Maternal and neonatal data that could be potentially associated with SMA blood flow were obtained. Bivariate analyses were conducted with a P value of < 0.05 considered significant. Results We examined 156 infants eligible for the study. PSV, EDV, and RI of SMA blood flow were not related to both gestational age and birth weight. Infant with small for gestational age (SGA) showed significantly lower EDV median [15.5 (range 0.0-32.8) vs 19.4 (range 0.0-113.0)] and higher RI [0.80 (range 0.58-1.00) vs 0.78 (range 0.50-1.00)] compared to appropriate for gestational age (AGA). Infants born from mother with preeclampsia showed lower PSV median [(78.2 (range 32.0-163.0) vs 89.7 (range 29.2-357.0)]) and EDV [16.2 (range 0.0-48.5) vs 19.4 (range 0.0-113.0)] compared to without PE, while absent/reverse end-diastolic velocity (AREDV) revealed a lower EDV median [16.9 (range 0.0 – 32.4) vs 19.4 (range 0.0 – 113.0)] compared to no AREDV. Furthermore, infants with hs-PDA showed lower EDV median [16.2 (range 0.0-113.0) vs 19.4 (range 0.0-71.1)] but higher RI median [0.80 (range 0.50-1.00) vs 0.78 (range 0.55-1.00)] compared to non hs-PDA. No difference in SMA blood flow across other factors was observed.
Experiences of Indonesian nurses in improving preterm oral feeding readiness in special care units: A qualitative descriptive study Dyah Dwi Astuti; Rinawati Rohsiswatmo; Dessie Wanda; Diah Mulyawati Utari
Belitung Nursing Journal Vol. 9 No. 5 (2023): September - October
Publisher : Belitung Raya Foundation, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.2772

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Background: Many preterm infants face feeding difficulties during the transition from enteral to oral feeding due to organ immaturity, resulting in aspiration, airway instability, and oral feeding intolerance. These challenges can increase morbidity and mortality among preterm infants. Nurses play a vital role in providing interventions to minimize negative impacts and enhance the safety of preterm oral feeding. Objective: This study aimed to explore the experiences of Indonesian nurses in improving preterm oral feeding readiness. Methods: A qualitative descriptive study was conducted involving ten nurses working in intensive care units as participants through purposive sampling. Data were collected through semi-structured, in-depth interviews conducted from January to March 2023. Thematic analysis was applied for data analysis. Results: Four key themes developed in this study: 1) comprehensive and holistic nursing assessment, 2) challenging and complex nursing issues, 3) the need for nutritional management skills, and 4) the necessity of collaborative support. Conclusion: Nurses play a pivotal role in enhancing oral feeding readiness among premature infants. Their responsibilities include assessing oral feeding readiness, addressing nursing challenges, and implementing multidisciplinary stimulation involving parents. This study provides a foundational framework for developing interventions to improve preterm oral feeding readiness.
Ultrasound vs. standard radiography to determine peripherally-inserted central catheter tip location Thimoty, James; Ifran, Evita Karianni B.; Rohsiswatmo, Rinawati
Paediatrica Indonesiana Vol. 64 No. 2 (2024): March 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.2.2024.126-31

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Background The use of a peripherally-inserted central catheter (PICC) has increased in preterm neonates to facilitate the administration of total parenteral nutrition. Standard radiography (thoracoabdominal X-ray) is the gold standard for determining the position of the PICC tip. However, radiography is not always accurate, influenced by the position of the extremities and anatomic variations, time-consuming procedural process, involves radiation, and is costly. Ultrasonography (USG) may serve as an easier, safer, less costly, and more real-time alternative in the neonatal intensive care unit (NICU) patients. Objective To assess the accuracy of USG use in determining PICC tip position compared to that of standard radiography. Methods This diagnostic study was conducted in the NICU at Dr. Cipto Mangunkusumo Hospital, Jakarta. The PICCs were placed using standard NICU procedure, then the tip position was evaluated using the USG immediately before standard radiography was performed. A 2x2 table was constructed to compare the diagnostic accuracy of the two modalities. Results A total of 29 neonates were included in our study. Subjects’ mean gestational age and weight were 31.7 weeks and 1,618.9 g respectively. Concordance of PICC tip positioning between standard radiography and USG occurred in 27 neonates (93.1%). USG had 88.89% sensitivity, 95% specificity, and 93.1% diagnostic accuracy. Conclusion USG has excellent diagnostic accuracy for confirmation of the PICC tip position.
Gestational age, birth weight, and blood culture microbial patterns in late-onset neonatal sepsis Ramadhika, Muhammad; Iskandar, Stephen Diah; Yapiy, Ivana; Susanti, Yurika Elizabeth; Wijaya, Marcella Amadea; Rohsiswatmo, Rinawati
Paediatrica Indonesiana Vol. 64 No. 1 (2024): January 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.1.2024.51-8

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Background The three main causes of neonatal deaths in Indonesia according to the WHO are sepsis, prematurity, and asphyxia. A suboptimal hospital environment increases the risk of late-onset neonatal sepsis (LONS), which in turn can prolong hospital stays. Objective To assess for possible associations of bacterial patterns in neonates with LONS, prematurity, and/or low birth weight. Methods Medical record data of 1,706 hospitalized neonates who were treated for sepsis or other disease in the Neonatal Unit, Dr. Cipto Mangunkusumo Hospital (CMH), Jakarta in 2020 were analyzed retrospectively. A total of 262 neonates had proven LONS. We assessed for possible risk factors such as gestational age, birth weight, and cultured blood microbes. Results Out of a total of 1,706 neonates admitted to the neonatal unit, the incidence of proven LONS was 15.4%. LONS was more prevalent (58.4%) in preterm than in full-term (41.6%) neonates. The majority (67.6%) of subjects with proven LONS were neonates with low birth weight (LBW) (<2,500 grams), and the largest percentage of them (35.1%) was in the 1,500-2,500-gram group. Gram negative bacteria emerged as the predominant pathogens of LONS patients in our hospital; the most common were Klebsiella pneumonia, Acinetobacter spp., Escherichia coli, Enterobacter spp., and Pseudomonas aeruginosa. Conclusion The proportion of LONS among LBW and preterm neonates is significantly higher compared to normal birth weight and neonates. In our unit, LONS was mostly caused by Gram-negative bacteria. The antibiotic susceptibility of the various pathogens causing LONS in CMH should be tested and compared to the current empirical antibiotic guidelines used in CMH.
The role of early aggressive nutrition on growth of very preterm or very low birth weight infants Insani, Nadia Dwi; Rohsiswatmo, Rinawati; Sjarif, Damayanti Rusli; Marsubrin, Putri Maharani Tristanita; Yuliarti, Klara; Gultom, Lanny Christine
Paediatrica Indonesiana Vol. 64 No. 4 (2024): July 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.4.2024.318-24

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Background Very preterm infants (<32 weeks gestational age) are at high risk of poor neurodevelopmental outcomes. Early aggressive parenteral nutrition (protein ³ 2g/kg/day) can reduce the incidence of malnutrition in very preterm infants. At present, Fatmawati General Hospital does not have a standard nutritional protocol for preterm infant. Objective To determine the difference in growth (days to regain birth weight and growth velocity) of very preterm (<32 weeks gestational age) or very low birth weight (VLBW) (<1500g) infants who were born and hospitalized in the Neonatal Unit of Fatmawati General Hospital, Jakarta, before and after applying early aggressive parenteral nutrition using a nutrition protocol from Cipto Mangunkusumo Hospital, Jakarta. Methods A quasi-experimental study was conducted on 23 very preterm or VLBW infants in the Neonatal Unit of Fatmawati General Hospital, from July to November 2019. Control group data were taken from medical records of very preterm or VLBW babies discharged from our unit from January 2018 – to June 2019 and compared to those of the intervention group. Results The intervention group regained their birth weight significantly faster than the control group [mean 7.43 (SD 3.5) vs. 16.73 (SD 5.1) days, respectively; (P=0.00)]. Mean growth velocity was also significantly higher in the intervention group than in the control group [14.6 (SD 6.0) vs. 8.9 (SD 6.9) gram/kg/day, respectively; (P=0.002)]. Conclusion Provision of early aggressive parenteral nutrition reduces the time to regain birth weight and leads to higher growth velocity in very preterm/VLBW infants.
Placental nutrient and transport system in fetus with small for gestational age and growth restriction compared to appropriate for gestational age Wibawa, Aria; Wibowo, Noroyono; Timan, Ina Susianti; Rohsiswatmo, Rinawati; Putri, Atikah Sayogo
Medical Journal of Indonesia Vol. 33 No. 3 (2024): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.247361

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BACKGROUND Fetal growth restriction (FGR) has multifactorial etiology, including nutrition. Fetal nutrient status depends not only on an adequate supply of key nutrients but also optimal delivery, served by the placenta as a major metabolic and transport organ. This study aimed to evaluate the status of placental oxygen and nutrient concentration and their transporters between appropriate for gestational age (AGA), small for gestational age (SGA), and FGR. METHODS This cross-sectional study was conducted at Cipto Mangunkusumo Hospital, Jakarta, from July 2018 to December 2020. Patients were divided into 3 groups, namely AGA, SGA, and FGR. The placental samples were taken following delivery. Placental concentration of glucose, amino acids (AAs), and fatty acids (FAs) were measured by calorimetric assay, liquid chromatography-tandem mass spectrometry, and gas chromatography-mass spectrometry, respectively. Placental concentration of vascular endothelial growth factor (VEGF), glucose transporter 1 (GLUT1), system y+L, and fatty acid transport protein 1 (FATP1) were examined using enzyme-linked immunosorbent assay. RESULTS A total of 57 subjects participated in the study. Compared with the AGA group, the SGA and FGR groups had lower placental AA concentration (p = 0.004), higher placental FA concentration (p = 0.048), higher placental expression of VEGF (p = 0.003), system y+L (p = 0.07), and FATP1 (p = 0.021). No difference in placental glucose and GLUT1 concentration was observed among all groups (p = 0.301). CONCLUSIONS The similar profile of macronutrient concentration with increased expression of oxygen and several nutrient transporters in SGA and FGR groups might indicate similar pathogenesis between these groups.
Gut dysbiosis as a risk factor of neonatal sepsis among preterm infants Marsubrin, Putri Maharani Tristanita; Hikmahrachim, Hardya Gustada; Rohsiswatmo, Rinawati; Yulindhini, Maya; Firmansyah, Agus
Paediatrica Indonesiana Vol. 65 No. 2 (2025): March 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.2.2025.96-102

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Background Preterm infants are at high risk of developing sepsis. An imbalance between the normal gut and pathogenic microbiomes, known as dysbiosis, has been proposed as a condition that leads to neonatal sepsis. Objective To assess for an association between gut dysbiosis and neonatal sepsis. Methods A prospective cohort study was conducted involving very preterm or very low birth weight infants admitted to the Neonatal Unit, Cipto Mangunkusumo Hospital, Jakarta, from November 2019 to January 2021. The primary outcome was proven and/or clinical neonatal sepsis. The independent variable was gut dysbiosis, defined as a ratio of normal-to-pathogenic gut microbiome <1.0. Gut microbiome analysis was performed using a polymerase chain reaction test from a fecal specimen. Multivariate analysis using multiple logistic regression was conducted with adjustments for potential confounders. Results Forty-three infants were recruited during the study period, with a median gestational age of 30 (range 25-36) weeks and birth weight of 1,170 (range 630-1855) grams. Among them, 28 (65.1%) infants had dysbiosis and 25 (58.2%) developed sepsis. The incidence of sepsis was higher among infants with dysbiosis (20 infants; 71.4%) than those without dysbiosis (5 infants; 33.3%). Dysbiosis and hemodynamically significant patent ductus arteriosus increased the risk of sepsis, with aOR 6.93 (95%CI 1.04 to 46.14; P=0.045) and aOR 22.7 (95%CI 1.45 to 355.29; P=0.026), respectively, after adjusting for sex, birthweight, maternal and infant morbidities, as well as maternal and infant vitamin D status. Conclusion Gut dysbiosis is a risk factor for neonatal sepsis. Maintaining the balance of the gut microbiome is essential from the first day of life.
Feasibility Study For Birth Defect’s and Congenital Abnormalities’s Integrated Service In A Low-Middle Income Country Saroyo, Yudianto Budi; Firmansha Dilmy, Mohammad Adya; Salsabila Putri, Cut Tisya; Islamah, Rachelya Nurfirdausi; Budiman, Jenica Xaviera; Rumondang, Amanda; Purwosunu, Yuditiya; Irwinda, Rima; Rohsiswatmo, Rinawati
Indonesian Journal of Obstetrics and Gynecology Volume 13. No. 3 July 2025
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v13i3.2783

Abstract

Background: Congenital abnormalities are anatomical and physiological abnormalities that are present in babies from birth. One of the main causes of high infant mortality and neonatal mortality in Indonesia is congenital abnormalities in babies. This study describes the prevalence of congenital abnormalities in Dr. Cipto Mangunkusumo Hospital, as a tertiary referral hospital in Indonesia, which requires integrated healthcare service to be treated well. Methods: Data obtained from 323 patients at Dr. Cipto Mangunkusumo General Hospital are collected in a year, to be further analyzed in retrospective cohort study. Collected data includes the patients’ age, birth date, reproductive history, gestational age, and congenital abnormalities of the baby. Results: The data shows that patients with the age group of 30-39 years old dominated the cases of pregnancy with congenital abnormalities. Cases are also more dominant in the gestational age of 13 – 28 weeks (second-trimester). Most cases of abnormalities are from the central nervous system with 159 cases and followed by cardiovascular system with 130 cases. Overall prevalence of congenital abnormalities are detected within patients during prenatal screening in Dr. Cipto Mangunkusumo General Hospital. Conclusion: This study highlights the importance in managing congenital abnormalities and birth defects by developing an integrated service in the healthcare system to lower infant and neonatal mortality. Keywords: birth defect, congenital abnormalities, prenatal screening
The Association between Hypothermia during Emergency Room Admission and Newborn Mortality at Dr. Moewardi Hospital Hidayah, Dwi; Rohsiswatmo, Rinawati; Hafidh, Yulidar
Journal of Maternal and Child Health Vol. 8 No. 4 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/thejmch.2023.08.04.06

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Background: Hypothermia in newborns continues to be a significant issue and a leading cause of morbidity and mortality. The incidence of hypothermia in referral newborns is still high during hospital admission. Subjects and Method: This is a prospective cohort study conducted at Dr. Moewardi Hospital. Data collection was carried out on January 1, 2015, until March 31, 2015, for referred newborns. The dependent variable was mortality and the independent variables included gestational age, birth weight, sepsis, severe respiratory distress, and temperature at the time of admission at the ER. The chi-square test and logistic regression were used to analyze the data, with a cut-off value of p<0.05 cut off and a confidence interval of 95%. Results: There were 56 newborn referrals, with 60.7% incidence of hypothermia and 19.6% inci­dence with mortality. From the chi-square analysis, the variable of gestational age and weight did not meet the requirements of multivariate analysis (p> 0.25). The multivariate logistic regression analysis revealed a non-significant association between severe respiratory distress and mortality in referred newborns (OR= 5.25; 95% CI= 0.89 to 30.82; p= 0.066). After performing multivariate logistic regression analysis to obtain controlled ORs, there was a significant relationship between newborn referrals mortality and temperature at the time of ER admission (OR= 8.75; 95% CI= 1.07 to 3.26; p= 0.047) and sepsis (OR= 6.25; 95% CI= 150 to 28.69; p= 0.012) with mortality of referred newborns. Conclusion: The incidence of hypothermic referred newborns is high. Hypothermia during admission at the ER and sepsis are both associated with increased mortality in referred newborns. Keywords: newborns, hypothermia, mortality. Correspondence:Dwi Hidayah. Department of Child Health, Faculty of Medicine, Sebelas Maret University and Dr. Moewardi General Hospital, Jalan Kolonel Sutarto No.132, Surakarta 57126, Indonesia. Mobile: 08122623728 Email: dwihidayah_dr2020@staff.uns.ac.id
Co-Authors Abdurahman Sukadi Agnes Yunie Purwita Sari Agus Firmansyah Agus Firmansyah Ahmad Kautsar Ahmad Kautsar Albert You Amarila Malik Andiani Wanda Putri Angelina Arifin Anita Halim Aria Wibawa Aryono Hendarto Asril Aminullah Audesia Alvianita Sutrisno Badriul Hegar Bambang Tridjaja AAP, Bambang Tridjaja Benedica M. Suwita Bernie Endyami Budiman, Jenica Xaviera Christopher S. Suwita Damayanti R. Sjarif Damayanti Rusli Sjarif Darlan Darwis Darmawan B Setyanto Desiana Dharmayani Diah Mulyawati Utari Dian Artanti Dina Indah Mulyani Dinarda Ulf Nadobudskaya Dion Darius Samsudin Djajadiman Gatot Djajadiman Gatot Djajadiman Gatot Dwi Hidayah Dyah Dwi Astuti Ellya Marliah Endang Windiastuti Enty Tjoa Enty, Enty Evita Karianni Bermanshah Fatima Safira Alatas, Fatima Safira Felix F. Widjaja Firmansha Dilmy, Mohammad Adya Gultom, Lanny Christine Hanifah Oswari Hardiono Pusponegoro Hardya Gustada Hikmahrachim Hardya Gustada Hikmahrachim Hardya Gustada Hikmahrachim Hikmahrachim, Hardya Gustada Hindra Irawan Satari Ifran, Evita Karianni B. Imral Chair Ina Susianti Timan Insani, Nadia Dwi Intan Alita Putri Tumbelaka Irawan Mangunatmadja Iskandar, Stephen Diah Islamah, Rachelya Nurfirdausi Isman Jafar James Thimoty Laila Laila Larashintya Rulita Lily Rundjan Lucky H. Moehario Lucky H. Moehario Made Sukmawati Marianna Yesy Marsubrin, Putri Maharani Tristanita Mulyadi M. Djer Mulyadi M. Djer Mustarim Mustarim Nadjib Advani Najib Advani Naomi Esthemita Dewanto Ni Ketut Prami Rukmini Nieta Hardiyanti Nikmah S. Idris Nila Kusumasari Nilam Sartika Noroyono Wibowo Nusarintowati Ramadhina Peter Graham Davis Pramita Gayatri Purwosunu, Yuditiya Pustika Amalia Wahidiyat Putri M.T Marsubrin, Putri M.T Putri Maharani Tristanita Marsubrin Putri Maharani Tristanita Marsubrin Putri, Atikah Sayogo Putu Junara Putra Rachma F. Boedjang Radhian Amandito Radhian Amandito Ramadhika, Muhammad Reni Fahriani Rima Irwinda, Rima Risma Karina Kaban Rismala Dewi Rizalya Dewi Rizky Adriansyah Ronny Suwento, Ronny Rosalina D. Roeslani Rosalina Dewi Roeslani Rosalina Dewi Roeslani Rubiana Sukardi Rudolf Tuhusula Rulina Suradi Rumondang, Amanda Safarina G. Malik Saleha Sungkar Salsabila Putri, Cut Tisya Santoso, Dewi Irawati Soeria Sarah R. Nursyirwan Sarah Rafika Sarah Rafika, Sarah Saroyo, Yudianto Budi Soedjatmiko Soedjatmiko Sonia Miyajima Anjani Stanislaus Djokomuljanto Sudarto Ronoatmodjo Sudigdo Sastroasmoro Sudjatmiko Sudjatmiko Sukman T. Putra Sukman T. Putra Sukman Tulus Putra Susanti, Yurika Elizabeth Teny Tjitra Tetty Yuniarti Tetty Yuniati Titi S Sularyo Wanda , Dessie Wijaya, Marcella Amadea Wresti Indriatmi Yapiy, Ivana Yuditiya Purwosunu Yuliarti, Klara Yulidar Hafidh Yulindhini, Maya Yuni Astria Yuyun Lisnawati Yvan Vandenplas Zakiudin Munasir Zakiudin Munasir Zakiudin Munasir