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Mekanisme Terjadinya Hiperbilirubinemia pada Bayi Berat Lahir Rendah Grasia P. Gerungan; Rocky Wilar; Max F. J. Mantik
e-CliniC Vol. 11 No. 1 (2023): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v11i1.44319

Abstract: Hyperbilirubinemia is frequently found in newborns, especially in low birth weight (LBW) infants (less than 2,500 g). Hyperbilirubinemia is an increase in bilirubin higher than 5 mg/dL which clinically manifests as icterus. This study aimed to evaluate the relationship between LBW and the incidence of hyperbilirubinemia as well as the underlying mechanism. This was a literature study. Article searching used databases of Pubmed and Google Schoolar and the keywords were Hyperbilirubinemia AND Low birth weight NAD Neonatal Jaundice. The results showed a relationship between LBW and the incidence of hyperbilirubinemia. There were increases of hemoglobin, heme catabolism, and destruction of bilirubin due to liver immaturity, impaired liver function and perfusion and bilirubin conjugation ability, less of albumin as the transportation protein and uridine diphosphate glucuronyltransferase (UDP-GT) to convert indirect bilirubin to direct bilirubin in the liver. In conclusion, there is a relationship between low birth weight and hyperbilirubinemia that occurs due to liver immaturity, impaired liver function and perfusion, and less of albumin and UDP-GT enzyme. Keywords: hyperbilirubinemia; low birth weight; neonatal jaundice Abstrak: Hiperbilirubinemia merupakan masalah yang sering terjadi pada bayi baru lahir terlebih bayi dengan berat lahir rendah (<2.500 gram). Hiperbilirubinemia merupakan peningkatan kadar bilirubin serum >5mg/dL yang bermanifestasi klinis berupa ikterus. Penelitian ini bertujuan untuk mengetahui hubungan antara BBLR dengan kejadian hiperbilirubinemia dan mekanisme terjadinya. Jenis penelitian ialah suatu literature review. Pencarian artikel menggunakan Pubmed dan Google Schoolar dengan kata kunci Hyperbilirubinemia AND Low birth weight AND Neonatal Jaundice. Hasil penelitian mendapatkan adanya hubungan antara BBLR dengan kejadian hiperbilirubinemia. Terdapat peningkatan jumlah hemoglobin, katabolisme heme dan penghan-curan bilirubin yang terjadi antara lain karena imaturitas hati yang belum optimal mengkonju-gasikan bilirubin, terganggunya fungsi dan perfusi hati serta kemampuan mengkonjugasi bilirubin, rendahnya kadar protein albumin sebagai transportasi dan enzim uridin difosfat glukoronid transferase (UDP-GT) untuk mengonversi bilirubin indirek menjadi bilirubin direk di dalam hati. Simpulan penelitian ini ialah terdapat hubungan antara BBLR dengan hiperbilirubinemia yang dapat terjadi karena imaturitas hati, terganggunya fungsi dan perfusi hati, serta kurangnya protein albumin dan enzim UDP-GT. Kata kunci: hiperbilirubinemia; low birth weight; neonatal jaundice

Faktor Risiko COVID-19 pada Anak Debora K. Pangow; Novie H. Rampengan; Rocky Wilar
e-CliniC Vol. 11 No. 1 (2023): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v11i1.44321

Abstract: The prevalence of COVID-19 cases is still increasing in children, as well as the morbidity and mortality rates. Therefore, it is necessary to understand the risk factors involved in the incidence of COVID-19 infection in children. This study aimed to identify and analyze the risk factors for the transmission of COVID-19 in children. This was a literature review study using four databases namely Scopus, ProQuest, Pubmed, and Science Direct. The results obtained 16 literatures about the risk factors for COVID-19 in children with the basic concept of the epidemiological triad of COVID-19 risk factors, namely the host, agent, and environment. The literatures indicated that the host risk factors were gender, vitamin D deficiency, age, asthma comorbid or underlying medical conditions, and race. The agent risk factors were the emergence of the delta virus variant, meanwhile the environmental risk factors were the exposure to viruses in the household or family cluster, exposure to endemic areas, exposure to bus travel, virus transmission at school, and close contact with people diagnosed with COVID-19. In conclusion, risk factors for COVID-19 in children with interaction of transmission factors of COVID-19 which are host, agent, and environment cause the rapid development of new coronavirus cases. Most transmission of COVID-19 in children is derived from family contact (environment). Keywords: risk factors for COVID -19; transmission in children Abstrak: Prevalensi kasus COVID-19 terus meningkat pada anak, demikian pula angka kesakitan maupun angka kematian. Oleh karena itu faktor risiko yang terlibat kejadian infeksi COVID-19 pada anak perlu dipahami secara detil. Penelitian ini bertujuan untuk mengidentifikasi dan menganalisis faktor risiko penularan COVID-19 pada anak. Jenis penelitian ialah suatu literature review yang menggunakan empat pengkajian database yaitu Scopus, ProQuest, Pubmed, dan ScienceDirect. Hasil penelitian mendapatkan 16 literatur yang meneliti faktor risiko COVID-19 pada anak, dengan konsep dasar trias epidemiologi faktor risiko COVID-19 yaitu pejamu, agen, dan lingkungan. Faktor-faktor risiko pejamu yaitu jenis kelamin, defisiensi vitamin D, usia, dan komorbiditas asma atau kondisi medis yang mendasari, dan ras. Faktor risiko agen yaitu muncul-nya varian virus delta, sedangkan faktor lingkungan yaitu paparan virus dalam rumah tangga atau klaster keluarga, paparan daerah endemik, paparan perjalanan bus, penularan virus disekolah dan kontak dekat dengan orang terdiagnosis COVID-19. Simpulan penelitian ini ialah faktor-faktor risiko kejadian infeksi COVID-19 pada anak dengan interaksi faktor penularan COVID-19 yaitu faktor pejamu, agen dan lingkungan, mengakibatkan perkembangan kasus coronavirus baru yang sangat cepat. Penularan pada anak terbanyak berasal dari riwayat kontak keluarga (lingkungan). Kata kunci: faktor risiko COVID-19; penularan pada anak

Tatalaksana Terkini Kejang pada Neonatus Crifer R. J. Rondonuwu; Rocky Wilar; Jeanette I. Ch. Manoppo
Medical Scope Journal Vol. 5 No. 2 (2023): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v5i2.45371

Abstract: Seizures in neonates are caused by a large group of neurons experiencing excessive synchronous depolarization. The therapeutic management of neonates and their prognosis differ, depending on the etiology of the disorder causing the seizures. Management of seizures in neonates use anticonvulsant drugs (phenobarbital, phenytoin, levetiracetam, lidocaine, midazolam, diazepam) so far. This study aimed to determine the current therapy for seizures in neonates. This was a literature review study using the PubMed and Google Scholar databases with the PICOS framework as selection criteria. The results obtained 10 articles to be reviewed. Phenobarbital became the first-line treatment due to its proven efficacy level compared to other anticonvulsant drugs. There were trials of giving levetiracetam as the first-line therapy due to its fewer side effects than phenobarbital. Some other literatures stated that side effects after administration of anti-seizure drugs varied, depending on the underlying etiology. In conclusion, phenobarbital is still the first line treatment for neonatal seizures followed by phenytoin as the second line, midazolam as the third line, and diazepam as the fourth line treatment. However, it is possible that levetiracetam can be used as the first-line anti-seizure drug, or as an alternative treatment. Keywords: neonatal seizures; pharmacologic treatment; current management; anticonvulsant drugs Abstrak: Kejang pada neonatus disebabkan oleh sekelompok besar neuron mengalami depolarisasi sinkron yang berlebihan. Penatalaksanaan terapeutik neonatus dan prognosisnya berbeda, tergantung dari etiologi gangguan yang menyebabkan kejang. Tatalaksana kejang pada neonatus menggunakan obat antikonvulsan (fenobarbital, fenitoin, levetiracetam, lidokain, midazolam, diazepam). Penelitian ini bertujuan untuk mengetahui terapi terkini untuk kejang pada neonatus. Jenis penelitian ialah suatu literatur review dengan pencarian literatur dari database Pubmed dan Google Scholar menggunakan framework PICOS sebagai kriteria seleksi. Hasil penelitian mendapatkan 10 artikel untuk dikaji. Fenobarbital merupakan pengobatan lini pertama karena tingkat efikasi yang terbukti lebih manjur dari pada pengobatan obat antikonvulsan lainnya. Uji coba pemberian levetiracetam sebagai terapi lini pertama telah dilakukan dengan pertimbangan efek samping yang lebih lurang daripada fenobarbital. Beberapa literatur menyatakan efek samping setelah pemberian obat anti kejang bervariasi, tergantung etiologi yang mendasari. Simpulan penelitian ini fenobarbital masih menjadi pilihan pengobatan lini pertama untuk kejang pada neonates, lini kedua fenitoin, lini ketiga midazolam, dan lini keempat diazepam. Tidak menutup kemungkinan jika levetiracetam dapat digunakan sebagai obat anti kejang lini pertama, ataupun dijadikan sebagai pengobatan alternatif. Kata kunci: kejang neonatus; pengobatan farmakologi; tatalaksana terkini; obat antikonvulsan

Peran Neonatal Comfort Care di Neonatal Intensive Care Unit Andhika Wicaksana; Rocky Wilar; Johnny L. Rompis
e-CliniC Vol. 12 No. 1 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i1.45365

Abstract: Comfort is an important component of the treatment of neonates in the National Intensive Care Unit (NICU). Due to the efforts given in the NICU, neonates tend to be exposed with various surroundings which made them receive excessive stimuli. These can lead to increased level of stress and pain, and have an impact on the health and growth of the neonates in the NICU. Therefore, it is necessary to carry out procedures to keep the baby comfortable by maintaining the stress level through neonatal comfort care. This study aimed to determine the role of neonatal comfort care during the care of neonates in the NICU. This was a literature review study. Literatures were searched in PubMed, Google Scholar, and Clinical Key databases. The results obtained 10 literatures to be reviewed. The statistical results showed that through the implementation of pharmacological and non-pharmacological procedures, neonatal comfort care had a good impact on physiological distress and neonates’ comfort based on the comfort rating scale for neonates in the NICU. In conclusion, neonates’ comfort in the NICU increases significantly after being given neonatal comfort care. Keywords: Neonatal Comfort Care; Neonatal Intensive Care Unit; neonates in care Abstrak: Menjaga kenyamanan neonatus merupakan komponen penting dalam perawatan di lingkungan Neonatal Intensive Care Unit (NICU). Dalam upaya pengobatan yang dilaksanakan di NICU, neonatus akan terpapar lingkungan yang bervariasi hingga menerima stimuli berlebihan yang dapat menyebabkan peningkatan stres maupun rasa nyeri akibat perawatan invasif yang dilaksanakan. Oleh karena itu diperlukan prosedur pelaksanaan dalam memelihara kenyamanan neonatus untuk menjaga tingkat stres melalui neonatal comfort care. Penelitian ini bertujuan untuk mengetahui peran neonatal comfort care pada perawatan neonatus di NICU melalui suatu literature review. Pencarian literatur dilakukan di database PubMed, Google Scholar, dan Clinical Key. Hasil penelitian mendapatkan 10 literatur untuk diulas. Hasil statistik dari artikel yang diulas menunjukkan bahwa neonatal comfort care melalui pelaksanaan prosedur farmakologi dan non-farmakologi memiliki berdampak baik terhadap distres fisiologis dan kenyamanan neonatus berdasarkan skala penilaian kenyamanan terhadap neonatus yang berada di lingkungan NICU. Simpulan penelitian ini ialah kenyamanan neonatus yang berada di lingkungan NICU meningkat bermakna secara statistik setelah pemberian neonatal comfort care. Kata kunci: Neonatal Comfort Care; Neonatal Intensive Care Unit; bayi dalam perawatan

Gangguan Ginjal Akut pada Anak: Faktor Risiko dan Tatalaksana Terkini Virgin V. A. Karundeng; Valentine Umboh; Rocky Wilar
e-CliniC Vol. 12 No. 1 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i1.45368

Abstract: Acute kidney injury (AKI) is defined as an acute drop in renal function and is determined by creatinine serum and urine output. Several studies conclude that the risk factors of AKI in children are differentiated according to its etiology.The management of AKI as recommended by KDIGO is according to the stadium. This study aimed to determine the risk factors and the current management of AKI in children. This was a literature review study conducted by searching literatures from Pubmed and Google Scholar. The results obtained 17 literatures related to the topic. The most common pre-renal and renal risk factors were sepsis and nephrotoxic medications respectively. Sepsis, shock, and gastroenteritis were found significantly related to the stadium of AKI in children. Current management of AKI in children was the use of dextrose in normal saline mixed with 3% of diluted Nacl to correct hypernatremic dehydration; the use of peritoneal dialysis for infant below 5 y.o, and the use of CARPEDIEM as the new CRRT for children <5kg; the use of caffeine citrate for neonates to prevent AKI. In conclusion, the most common risk factor according to the etiology of AKI in children is sepsis. The current managements are to correct AKI according to its etiology and stadium and to prevent AKI occurence in high-risk neonates. Keywords: acute kidney injury; risk factors; current management; children Abstrak: Gangguan ginjal akut (GnGA) didefinisikan sebagai penurunan fungsi ginjal mendadak yang ditentukan oleh serum kreatinin dan output urin. Beberapa penelitian menyimpulkan bahwa faktor risiko GnGA pada anak dibedakan berdasarkan etiologinya, dan tatalaksana GnGA yang direkomendasikan oleh KDIGO disesuaikan dengan stadiumnya. Penelitian ini bertujuan untuk mengetahui faktor risiko dan tatalaksana terkini GnGA pada anak melalui suatu literature review. Hasil penelitian mendapatkan 17 literatur dari Pubmed dan Google Scholar. Faktor risiko pra-renal dan renal dari GnGA pada anak ialah sepsis dan penggunaan obat nefrotoksik secara berurut. Sepsis, syok, dan gastroenteritis berhubungan dengan stadium GnGA pada anak. Terapi terkini GnGA pada anak ialah penggunaan dekstrosa dalam normal salin yang dicampur diluted Nacl 3%, untuk memperbaiki dehidrasi hipernatremik; penggunaan peritoneal dialisis untuk bayi <5 tahun dan penggunaan CARPEDIEM sebagai CRRT untuk bayi <5kg; penggunaan kafein sitrat dapat mencegah GnGA pada neonatus. Simpulan penelitian ini ialah faktor risiko yang paling umum berdasarkan etiologi GnGA pada anak ialah sepsis. Terapi terkini ialah mengoreksi GnGA menurut etiologi dan stadiumnya serta mencegah terjadinya GnGA pada neonatus yang berisiko tinggi. Kata kunci: gangguan ginjal akut; faktor risiko; tatalaksana terkini; anak

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