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Rinawati Rohsiswatmo
Departemen Ilmu Kesehatan Anak FKUI RSCM
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Other

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Efek ASI Eksklusif terhadap Stunting pada Anak Usia 6-59 bulan di Kabupaten Bogor tahun 2019 Hardya Gustada Hikmahrachim; Rinawati Rohsiswatmo; Sudarto Ronoatmodjo
Jurnal Epidemiologi Kesehatan Indonesia Vol 3, No 2 (2019)
Publisher : Department of Epidemiology, FoPH, UI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/epidkes.v3i2.3425

Abstract

Stunting, atau perawakan pendek, berhubungan erat dengan hambatankemampuan kognitif dan kualitas hidup. Prevalensi stunting di Indonesiamencapai 30,8% tahun 2018. Stunting dipengaruhi pemenuhan nutrisi diawal kehidupan, salah satunya melalui ASI eksklusif. Meskipun cakupan ASIeksklusif di Indonesia sudah 74,5%, hubungan stunting dengan ASI eksklusifseringkali tidak konsisten akibat keberagaman kuantitas dan kualitas ASI.Penelitian ini ingin mengetahui efek ASI eksklusif terhadap stunting diKabupaten Bogor, sebagai salah satu daerah tinggi stunting di Indonesia.Penelitian dengan desain potong lintang ini dilaksanakan di PuskesmasKecamatan Ciampea, Kabupaten Bogor, pada Februari sampai April 2019.Kriteria inklusi adalah balita usia 6-59 bulan yang berkunjung ke poliklinik.Informasi pemberian ASI eksklusif diperoleh dari wawancara terstruktur,sementara stunting ditetapkan dengan antropometri terstandar. Dari 162balita, 117 (72,22%) mendapat ASI eksklusif dan 64 subjek (39,51%)mengalami stunting. Pada analisis multivariat, ditemukan interaksi padastrata usia ibu saat hamil > 30 tahun dan < 30 tahun, sehingga rasioprevalens (PR) ASI eksklusif terhadap kejadian stunting adalah 0,41 IK95%0,23-0,74 dan 1,74 IK95% 0,93-3,24; p Mantel-Haenszel < 0,001 secaraberturut-turut. Penelitian ini menyimpulkan bahwa ASI eksklusif dapatbersifat protektif terhadap stunting bila usia ibu saat hamil > 30 tahun.Selain meningkatkan cakupan, diperlukan upaya meningkatkan kualitasASI eksklusif untuk mengoptimalkan upaya pencegahan stunting
Nutritional Management and Recommendation for Preterm Infants: A Narrative Review Rinawati Rohsiswatmo
Amerta Nutrition Vol. 5 No. 1SP (2021): AMERTA NUTRITION SUPPLEMENTARY EDITION
Publisher : Universitas Airlangga, Kampus C, Mulyorejo, Surabaya-60115, East Java, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/amnt.v5i1SP.2021.1-13

Abstract

Background: Preterm birth is defined as birth before 37 completed weeks of pregnancy. It is the most important predictor of adverse health and development infant outcomes that extend into the early childhood and beyond. It is also the leading cause of childhood mortality under 5 years of age worldwide and responsible for approximately one million neonatal deaths. It is also a significant contributor to childhood morbidities, with many survivors are facing an increased risk of lifelong disability and poor quality of life. Purpose: In this article, we aimed to describe features of preterm infants, what makes them different from term infants, and what to consider in nutritional management of preterm infants through a traditional narrative literature review. Discussion: Preterm infants are predisposed to more health complications than term infants with higher morbidity and mortality. This morbidity and mortality can be reduced through timely interventions for the mother and the preterm infant. Maternal interventions, such as health education and administration of micronutrient supplementation, are given before or during pregnancy and at delivery, whereas appropriate care for the preterm infants should be initiated immediately after birth, which include early breastfeeding and optimalization of weight gain. Conclusion: Essential care of the preterm infants and early aggressive nutrition should be provided to support rapid growth that is associated with improved neurodevelopmental outcomes. The goal is not only about survival but making sure that these preterm infants grow and develop without any residual morbidity.
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.
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 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 Yulindhini, Maya Yuni Astria Yuyun Lisnawati Yvan Vandenplas Zakiudin Munasir Zakiudin Munasir Zakiudin Munasir