Pediatrician Neonatologist, Lecturer, Main Clinical Educator MoH Republic of Indonesia, as well as ToT (Trainer of trainers), Registered Lead Instructor of various training programs in the field of neonatology, and became Chair of the Birth Defects Integrated Center at the Harapan Kita National Center for Women and Children's Health.
Edu/professional background: General practitioner graduated from the Faculty of Medicine and Doctoral Degree in Epidemiology at the University of Indonesia and completed the Ph.D. program at UMCG Groningen Netherlands, who was awarded the 1992 National Health Center Exemplary Doctor, with 32 years of working experience in the field of Medical Services, Education and Research Address: Jakarta, Indonesia
Background Chromosomal microarray (CMA) is a genetic test to look for extra (duplicated) or missi... more Background Chromosomal microarray (CMA) is a genetic test to look for extra (duplicated) or missing (deleted) chromosomal segments. The technology can detect microdeletion, microduplication, most abnormalities of chromosome number, most unbalanced rearrangements of chromosome structure, excessive homozygosity, and triploidy.
Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-... more Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants. Objective To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia. Setting Data were collected from 34 hospitals with different levels of care: national referral centres, universitybased hospitals, and public and private hospitals. Methods A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight. Results We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals. Conclusions In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia. HKWCHC, Harapan Kita Women and Children's Hospital (National Centre for Women and Children's Health); OH, other hospitals; ROP, retinopathy of prematurity; RSCM/NRH, Ciptomangunkusumo Hospital (national referral hospital); UBH, university-based hospital.
Abstract
Background: Retinopathy of prematurity (ROP) is a vaso-proliferative disease of the ey... more Abstract
Background: Retinopathy of prematurity (ROP) is a vaso-proliferative disease of the eye, which mainly affects preterm newborn infants with an incompletely vascularized retina. The incidence of ROP has increased in industrialized countries due to the increased survival of extremely low birth weight (ELBW) infants. ROP is also increasing in developing countries like Indonesia, where it is most likely due to the improved survival of ELBW infants.
Objective: To ascertain the incidence of ROP and possible risk factors associated with the development of ROP in preterm infants in Indonesia.
Methods: We reviewed the literature on the incidence and potential risk factors for the development of ROP in Indonesia, obtained data from three referral eye clinics, and added data from our institution.
Results: The reported incidence of all stages of ROP in infants with a gestational age of <32 weeks ranged from 18-30%. One study showed that ROP also occurred at older gestational ages. Blindness due to ROP was seen in infants up to 35 weeks and with a birth weight of 2000 g.
Conclusion: Retinopathy of prematurity is an important cause of ocular morbidity and blindness in Indonesia. The overall incidence of ROP in infants born below 32 weeks in Indonesia is higher than in developed countries, and it is seen in infants with older gestational ages. This might be due to a less strict monitoring during the use of oxygen in Indonesia compared to industrialized countries.
Background Retinopathy of prematurity (ROP) is a well-known complication in preterm infants. Data... more Background Retinopathy of prematurity (ROP) is a well-known complication in preterm infants. Data on the incidence of ROP in Indonesia, in relation to birth weight (BW) and gestational age (GA), are limited. Objective To report the incidence of ROP in one of the oldest and largest neonatal intensive care unit (NICU) in Indonesia. Methods We studied the incidence and severity of ROP in inborn infants with a BW of ≤1500 g and/or GA of ≤32 weeks, who were admitted to the NICU of Harapan Kita Women and Children Hospital, Jakarta. In addition, infants with a higher BW and GA, receiving more than 40% oxygen for a longer period, were screened. Results In 2005–2015, 182 infants were born with a BW of <1000 g and 437 with a weight of 1000–1500 g. In the <1000 g group, 27 (46%) of the screened infants showed no ROP, 22 (37%) showed ROP 1–2 and 10 (17%) showed ROP 3–5. In the 1000–1500 g group, 172 (68%) were without ROP, 71 (28%) with ROP 1–2 and nine (4%) with ROP 3–5. Twenty-two (13%) of the 163 screened infants weighing 1500–2000 g showed ROP 1–2 and two (1.2%) had ROP 3–5. Eight (18%) of the 44 screened infants born with a BW of more than 2000 g showed ROP 1–2 and none showed ROP 3–5. Conclusion The total incidence of ROP as well as severe ROP in infants with a BW of <1000 g and 1000–1500 g in our NICU is higher than in a developed country. ROP in Indonesia is also seen in infants with a BW of 1500–2500 g. Increasing the awareness of the risks of oxygen as well as better equipment to monitor oxygen delivery is essential.
Retinopathy of prematuriQ \OP) is the main cause of visual impairment in premature infants. Incre... more Retinopathy of prematuriQ \OP) is the main cause of visual impairment in premature infants. Increasing sur"vival of premature infants will increase population of infonts at high risk of ROP. In this era, improvement of neonatal care is not balanced with ophthalmolog,, services ihot ,r, occuring in all areas in Indonesia. Policy analysis in ROP mqnagement is very necessary and can be developed through a process of improvi"ng the quality of nZonatal services.
Kelainan Bawaan Lahir ditengarai sebagai salah satu faktor penting yang bisa mempengaruhi penurun... more Kelainan Bawaan Lahir ditengarai sebagai salah satu faktor penting yang bisa mempengaruhi penurunan angka kematian bayi diluar penyebab tiga besar yang kita ketahui selama ini, yakni asfiksia, berat badan lahir rendah dan sepsis. Para peneliti melaporkan berbagai paparan lingkungan dan faktor risiko sebagai penyebab kemungkinan Kelainan Bawaan Lahir, termasuk paparan terhadap janin dalam kehamilan serta kesadaran masyarakat akan pentingnya pencegahan Kelainan Bawaan Lahir yang masih cukup rendah (Siswanto JE dkk, 2015). Selama kurang lebih dua dekade Birth Defect Integrated Center (BIDIC) telah dikembangkan dan disempurnakan, kegiatan tersebut diawali dengan Harapan Kita Birth Defects Registry (HKBDR). Dalam kurun waktu satu tahun terakhir pencatatan data dikembangkan menjadi program berbasis populasi yang terintegrasi dengan data surveilans dari Kementrian Kesehatan. Fokus utama surveilans adalah mengidentifikasi 15 kasus yang mudah dikenali pada saat atau segera setelah lahir serta membawa dampak yang bermakna terhadap kesehatan masyarakat. Data dikembangkan dan dianalisis untuk mengevaluasi program pencegahan, deteksi dini dan tata laksana Kelainan Bawaan Lahir. Kata kunci: Kelainan Bawaan Lahir, BIDIC
epsis adalah komplikasi yang sering diketemukan pada unit perawatan intensif, hal tersebut terjad... more epsis adalah komplikasi yang sering diketemukan pada unit perawatan intensif, hal tersebut terjadi pada bayi kecil terutama bayi prematur. Pada umumnya gejala klinik tidak khas dan sulit ditemukan. 1,2,3 Angka kematian bayi (AKB) di negara-negara berkembang seperti India/Asia Tenggara/Pasifik sekitar 10-63 per 1000 kelahiran Latar belakang. Latar belakang. Latar belakang. Latar belakang. Latar belakang. Angka kematian bayi masih tinggi yang umumnya disebabkan infeksi atas septikemia, hal ini terutama pada bayi dengan berat badan lahir rendah. Tujuan. Tujuan. Tujuan. Tujuan. Tujuan. Untuk mengetahui angka kematian pada bayi baru lahir dengan berat badan normal serta berat lahir rendah dan untuk mengetahui angka kematian pada bayi risiko tinggi berdasarkan rujukan. Metoda. Metoda. Metoda. Metoda. Metoda. Penelitian potong lintang terhadap seluruh bayi yang dirawat di NICU (level III) dan ruang perawatan (level II) dari Januari sampai dengan Desember 2004. Datadata bayi yang diambil antara lain temperatur, frekuensi nafas, frekuensi nadi & denyut jantung, aktivitas menyusui & menangis, umur kehamilan dan berat badan, lama dari ketuban pecah dini, warna cairan ketuban, cairan lambung, darah lengkap termasuk neutropil granulotoksik, C-reactive protein, outcome/keluaran. Hasil. Hasil. Hasil. Hasil. Hasil. Angka case fatality rate (CFR) pada BBLR di NICU (yang dicurigai infeksi) adalah 20,3% sedangkan di level II sebesar 8,5% CFR di NICU, untuk BBLR sebesar 15,6% dan di level II sebesar 3,8%. Angka kematian bayi berdasarkan berat lahir antara bayi yang dirujuk dari luar dan tidak, terdapat perbedaan yaitu angka kematian lebih tinggi di dapat pada bayi yang dirujuk untuk bayi dengan BBL < 1500 gr, angka kematian pada bayi yang dirujuk 8,8 %o (non rujukan=3,1%o), BBL 1500-2400 gr sebesar 47,1%o (non rujukan 4,7%o) dan BBL > 2500 gr sebesar 170,1%o (non rujukan 3,1%o). Kesimpulan. Kesimpulan. Kesimpulan. Kesimpulan. Kesimpulan. Angka kematian lebih tinggi ditemukan pada bayi yang datang dari luar rumah sakit (rujukan)
Latar belakang. Retinopati prematuritas (ROP) adalah gangguan perkembangan dari pembuluh darah re... more Latar belakang. Retinopati prematuritas (ROP) adalah gangguan perkembangan dari pembuluh darah retina yang mengenai bayi prematur. Faktor genetik diduga berperan terhadap kejadian ROP. Konsentrasi dan kemurnian DNA hasil isolasi diperlukan untuk analisis pemeriksan genetik pada kasus ROP. Tujuan. Mengetahui konsentrasi dan indeks kemurnian DNA menggunakan sampel whole blood, buffy coat dan swab buccal pada kelompok bayi-bayi prematur yang masuk dalam kriteria penapisan ROP. Metode. Enam puluh dari total 182 subyek yang terdiagnosis ROP terpilih dengan systematic random sampling. Konsentrasi dihitung melalui penyerapan spektrofotometrik sinar ultraviolet. Kemurnian ditentukan dengan menghitung rasio antara OD260 dan nilai OD280. Analisis statistik dilakukan dengan uji Kruskal Wallis dan Mann Whitney. Hasil. Uji konsentrasi DNA menggunakan sampel buffy coat lebih tinggi dibandingkan whole blood dan swab buccal. Sampel whole blood mempunyai indeks kemurnian yang paling baik. Kesimpulan. Konsentrasi DNA sampel buffy coat dan whole blood cukup tinggi dengan indeks kemurnian yang baik untuk analisis genetika.
Artikel Asli I nfeksi neonatal merupakan salah satu penyebab kematian neonatal di negara berkemba... more Artikel Asli I nfeksi neonatal merupakan salah satu penyebab kematian neonatal di negara berkembang. Diperkirakan angka kematian neonatus menyumbang hampir 60% dari kematian bayi Alamat korespondensi
Background and Aims: Retinopathy of prematurity (ROP) is a severe disease in preterm infants. It ... more Background and Aims: Retinopathy of prematurity (ROP) is a severe disease in preterm infants. It is seen more frequently in Low-Middle Income Countries (LMIC) like Indonesia compared to High-Income Countries (HIC). Risk factors for ROP development are -extreme- preterm birth, use of oxygen, neonatal infections, respiratory problems, inadequate nutrition, and blood and exchange transfusions. In this paper, we give an overview of steps that can be taken in LMIC to prevent ROP and provide guidelines for screening and treating ROP.
Methods: Based on the literature search and data obtained by us in Indonesia's studies, we propose guidelines for the prevention, screening, and treatment of ROP in
preterm infants in LMIC.
Results: Prevention of ROP starts before birth with preventing preterm labor, transferring a mother who might deliver <32 weeks to a perinatal center, and giving corticosteroids to mothers that might deliver <34 weeks. Newborn resuscitation must be done using room air or, in the case of very preterm infants (<29-32 weeks) by using
30% oxygen. Respiratory problems must be prevented by starting continuous positive
airway pressure (CPAP) in all preterm infants <32 weeks and in case of respiratory
problems in more mature infants. If needed, the surfactant should be given in a
minimally invasive manner, as ROP's lower incidence was found using this technique.
The use of oxygen must be strictly regulated with a saturation monitor of 91-95%.
Infections must be prevented as much as possible. Both oral and parenteral nutrition
should be started in all preterm infants on day one of life with preferably mothers'
milk. Blood transfusions can be prevented by reducing the amount of blood needed
for laboratory analysis.
Discussion: Preterm babies should be born in facilities able to care for them optimally.
The use of oxygen must be strictly regulated. ROP screening is mandatory in
infants born <34 weeks, and infants who received supplemental oxygen for a prolonged period. In the case of progression of ROP, immediate mandatory treatment is required.
Conclusion: Concerted action is needed to reduce the incidence of ROP in LMIC.
"STOP - R1O2P3" is an acronym that can help implement standard practices in all
neonatal intensive care units in LMIC to prevent development and progression.
Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-... more Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants. Objective To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia. Setting Data were collected from 34 hospitals with different levels of care: national referral centres, universitybased hospitals, and public and private hospitals. Methods A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight. Results We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals. Conclusions In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia. HKWCHC, Harapan Kita Women and Children's Hospital (National Centre for Women and Children's Health); OH, other hospitals; ROP, retinopathy of prematurity; RSCM/NRH, Ciptomangunkusumo Hospital (national referral hospital); UBH, university-based hospital.
BACKGROUND Risk factors other than supplemental oxygen might play a role in the development of re... more BACKGROUND Risk factors other than supplemental oxygen might play a role in the development of retinopathy of prematurity (ROP). In Indonesia ROP occurs in infants up to 34 weeks and 2000 g. Risk factors for the development of ROP in Indonesian NICUs have not been evaluated. Our aim was to identify other risk factors than the use of oxygen in the development and progression of ROP in preterm infants in Indonesia. METHODOLOGY Data on 98 preterm infants with ROP and 77 controls were collected from four NICUs and two eye centers in Jakarta, Indonesia, between 2009 and 2014. We used multivariate logistic regression analysis to determine the relationship between infants and environmental variables and the development and progression of ROP. We obtained variables for ROP severity by using Cox regression analysis. RESULTS Factors associated with the development of ROP were birthweight (BWt), intrauterine growth retardation (IUGR), exchange transfusion, duration of oxygen supplementation, m...
Latar belakang. Deposit Seng (Zn) berperan terhadap fungsi metabolik tubuh. Bayi kurang bulan mem... more Latar belakang. Deposit Seng (Zn) berperan terhadap fungsi metabolik tubuh. Bayi kurang bulan mempunyai cadangan Zn yang rendah pada masa fetus, kebutuhan Zn yang tinggi setelah lahir, kapasitas untuk mengabsorbsi
dan retensi zat makanan terbatas. Gambaran klinis dari defisiensi Zn yang berat yaitu dermatitis, iritabel, kandidiasis oral, diare, mineralisasi tulang yang buruk, gangguan fungsi motorik dan kognitif, meningkatnya risiko terkena infeksi, dan retardasi pertumbuhan.
Tujuan. Untuk menentukan prevalens dan faktor risiko hipozincemia pada bayi berat lahir rendah.
Metode. Penelitian prospektif, desain penelitian potong lintang. Data dikumpulkan dari 3 rumah sakit di Jakarta. Informasi faktor risiko dicatat dan kadar Zn diperiksa pada bayi dengan berat lahir <2000 g
dan usia gestasi <34 minggu, pada usia koreksi mendekati cukup bulan atau cukup bulan. Hasil dianalisis dengan (T-test, dan Mann-Whitney) (regresi logistik). Defisiensi Zn didiagnosis apabila kadar Zn <55mg/ dl (8,4 μmol/L).
Hasil. Dari 63 bayi yang diteliti terdapat 18 bayi yang hipozincemia sehingga didapatkan prevalens hipozincemia 28%. Dari 18 bayi hipozincemia, 67% disertai dengan gejala yang paling banyak dijumpai adalah gangguan pertumbuhan. Peningkatan usia gestasi, peningkatan kadar kalsium dan pemberian suplemen besi berhubungan dengan penurunan risiko hipozincemia (OR 0,622; 95% CI: 0,42-0,92), (OR 0,376; 95% CI: 0,16 – 0,88) dan (OR 0,062; 95 % CI: 0,008-0,46). Sedangkan jenis kelamin laki laki berhubungan dengan peningkatan risiko hipozincemia(OR 4,764; 95% CI: 0,06-21,40).
Kesimpulan. Prevalens hipozincemia pada bayi usia gestasi <34 minggu dan berat lahir <2000 gram, yang diperiksa pada usia koreksi >35 minggu, didapatkan 28% dengan gejala. Gangguan pertumbuhan merupakan gejala yang paling banyak dijumpai. Faktor risiko hipozincemia ditemukan pada bayi laki-laki, usia gestasi yang lebih rendah, penurunan kadar kalsium dan tanpa pemberian suplementasi besi.
Objective
Retinopathy of prematurity (ROP) is a major cause of blindness in newborn infants, ... more Objective
Retinopathy of prematurity (ROP) is a major cause of blindness in newborn infants, which also occurs in low-income and middle-income countries. Why ROP progresses in some infants while it regresses in others is still presently unknown. Studies suggest that genetic factors might be involved. Mutations in the Norrie disease (ND) gene is suspected to be related to advanced ROP development. Indonesia is a country with a relatively high incidence of ROP, yet the role of these genetic factors in the pathogenesis of ROP cases is still unknown. The study aimed to investigate the presence of mutations in ND on the X chromosome in infants with both non-advanced and advanced ROP in Indonesia.
Methods and Analysis
This is a case-control study of polymorphisms in six variants within the ND gene in exon 3, C597A, L108P, R121W, A105T, V60E, and C110G, in
preterm newborn infants in four major hospitals in Greater Jakarta, Indonesia.
Results
We included 162 preterm newborn infants. ROP was diagnosed in 83 infants, and 79 infants served as controls. Among those with ROP, 57 infants had type 2, while others had type 1. We did not find any gene polymorphisms in any of the infants with ROP nor in the control group.
Conclusion
We conclude that it is very unlikely that the six polymorphisms in exon 3 of the ND gene studied in this paper are involved in the development or progression of ROP in preterm infants in our population sample in Indonesia.
Background Chromosomal microarray (CMA) is a genetic test to look for extra (duplicated) or missi... more Background Chromosomal microarray (CMA) is a genetic test to look for extra (duplicated) or missing (deleted) chromosomal segments. The technology can detect microdeletion, microduplication, most abnormalities of chromosome number, most unbalanced rearrangements of chromosome structure, excessive homozygosity, and triploidy.
Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-... more Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants. Objective To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia. Setting Data were collected from 34 hospitals with different levels of care: national referral centres, universitybased hospitals, and public and private hospitals. Methods A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight. Results We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals. Conclusions In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia. HKWCHC, Harapan Kita Women and Children's Hospital (National Centre for Women and Children's Health); OH, other hospitals; ROP, retinopathy of prematurity; RSCM/NRH, Ciptomangunkusumo Hospital (national referral hospital); UBH, university-based hospital.
Abstract
Background: Retinopathy of prematurity (ROP) is a vaso-proliferative disease of the ey... more Abstract
Background: Retinopathy of prematurity (ROP) is a vaso-proliferative disease of the eye, which mainly affects preterm newborn infants with an incompletely vascularized retina. The incidence of ROP has increased in industrialized countries due to the increased survival of extremely low birth weight (ELBW) infants. ROP is also increasing in developing countries like Indonesia, where it is most likely due to the improved survival of ELBW infants.
Objective: To ascertain the incidence of ROP and possible risk factors associated with the development of ROP in preterm infants in Indonesia.
Methods: We reviewed the literature on the incidence and potential risk factors for the development of ROP in Indonesia, obtained data from three referral eye clinics, and added data from our institution.
Results: The reported incidence of all stages of ROP in infants with a gestational age of <32 weeks ranged from 18-30%. One study showed that ROP also occurred at older gestational ages. Blindness due to ROP was seen in infants up to 35 weeks and with a birth weight of 2000 g.
Conclusion: Retinopathy of prematurity is an important cause of ocular morbidity and blindness in Indonesia. The overall incidence of ROP in infants born below 32 weeks in Indonesia is higher than in developed countries, and it is seen in infants with older gestational ages. This might be due to a less strict monitoring during the use of oxygen in Indonesia compared to industrialized countries.
Background Retinopathy of prematurity (ROP) is a well-known complication in preterm infants. Data... more Background Retinopathy of prematurity (ROP) is a well-known complication in preterm infants. Data on the incidence of ROP in Indonesia, in relation to birth weight (BW) and gestational age (GA), are limited. Objective To report the incidence of ROP in one of the oldest and largest neonatal intensive care unit (NICU) in Indonesia. Methods We studied the incidence and severity of ROP in inborn infants with a BW of ≤1500 g and/or GA of ≤32 weeks, who were admitted to the NICU of Harapan Kita Women and Children Hospital, Jakarta. In addition, infants with a higher BW and GA, receiving more than 40% oxygen for a longer period, were screened. Results In 2005–2015, 182 infants were born with a BW of <1000 g and 437 with a weight of 1000–1500 g. In the <1000 g group, 27 (46%) of the screened infants showed no ROP, 22 (37%) showed ROP 1–2 and 10 (17%) showed ROP 3–5. In the 1000–1500 g group, 172 (68%) were without ROP, 71 (28%) with ROP 1–2 and nine (4%) with ROP 3–5. Twenty-two (13%) of the 163 screened infants weighing 1500–2000 g showed ROP 1–2 and two (1.2%) had ROP 3–5. Eight (18%) of the 44 screened infants born with a BW of more than 2000 g showed ROP 1–2 and none showed ROP 3–5. Conclusion The total incidence of ROP as well as severe ROP in infants with a BW of <1000 g and 1000–1500 g in our NICU is higher than in a developed country. ROP in Indonesia is also seen in infants with a BW of 1500–2500 g. Increasing the awareness of the risks of oxygen as well as better equipment to monitor oxygen delivery is essential.
Retinopathy of prematuriQ \OP) is the main cause of visual impairment in premature infants. Incre... more Retinopathy of prematuriQ \OP) is the main cause of visual impairment in premature infants. Increasing sur"vival of premature infants will increase population of infonts at high risk of ROP. In this era, improvement of neonatal care is not balanced with ophthalmolog,, services ihot ,r, occuring in all areas in Indonesia. Policy analysis in ROP mqnagement is very necessary and can be developed through a process of improvi"ng the quality of nZonatal services.
Kelainan Bawaan Lahir ditengarai sebagai salah satu faktor penting yang bisa mempengaruhi penurun... more Kelainan Bawaan Lahir ditengarai sebagai salah satu faktor penting yang bisa mempengaruhi penurunan angka kematian bayi diluar penyebab tiga besar yang kita ketahui selama ini, yakni asfiksia, berat badan lahir rendah dan sepsis. Para peneliti melaporkan berbagai paparan lingkungan dan faktor risiko sebagai penyebab kemungkinan Kelainan Bawaan Lahir, termasuk paparan terhadap janin dalam kehamilan serta kesadaran masyarakat akan pentingnya pencegahan Kelainan Bawaan Lahir yang masih cukup rendah (Siswanto JE dkk, 2015). Selama kurang lebih dua dekade Birth Defect Integrated Center (BIDIC) telah dikembangkan dan disempurnakan, kegiatan tersebut diawali dengan Harapan Kita Birth Defects Registry (HKBDR). Dalam kurun waktu satu tahun terakhir pencatatan data dikembangkan menjadi program berbasis populasi yang terintegrasi dengan data surveilans dari Kementrian Kesehatan. Fokus utama surveilans adalah mengidentifikasi 15 kasus yang mudah dikenali pada saat atau segera setelah lahir serta membawa dampak yang bermakna terhadap kesehatan masyarakat. Data dikembangkan dan dianalisis untuk mengevaluasi program pencegahan, deteksi dini dan tata laksana Kelainan Bawaan Lahir. Kata kunci: Kelainan Bawaan Lahir, BIDIC
epsis adalah komplikasi yang sering diketemukan pada unit perawatan intensif, hal tersebut terjad... more epsis adalah komplikasi yang sering diketemukan pada unit perawatan intensif, hal tersebut terjadi pada bayi kecil terutama bayi prematur. Pada umumnya gejala klinik tidak khas dan sulit ditemukan. 1,2,3 Angka kematian bayi (AKB) di negara-negara berkembang seperti India/Asia Tenggara/Pasifik sekitar 10-63 per 1000 kelahiran Latar belakang. Latar belakang. Latar belakang. Latar belakang. Latar belakang. Angka kematian bayi masih tinggi yang umumnya disebabkan infeksi atas septikemia, hal ini terutama pada bayi dengan berat badan lahir rendah. Tujuan. Tujuan. Tujuan. Tujuan. Tujuan. Untuk mengetahui angka kematian pada bayi baru lahir dengan berat badan normal serta berat lahir rendah dan untuk mengetahui angka kematian pada bayi risiko tinggi berdasarkan rujukan. Metoda. Metoda. Metoda. Metoda. Metoda. Penelitian potong lintang terhadap seluruh bayi yang dirawat di NICU (level III) dan ruang perawatan (level II) dari Januari sampai dengan Desember 2004. Datadata bayi yang diambil antara lain temperatur, frekuensi nafas, frekuensi nadi & denyut jantung, aktivitas menyusui & menangis, umur kehamilan dan berat badan, lama dari ketuban pecah dini, warna cairan ketuban, cairan lambung, darah lengkap termasuk neutropil granulotoksik, C-reactive protein, outcome/keluaran. Hasil. Hasil. Hasil. Hasil. Hasil. Angka case fatality rate (CFR) pada BBLR di NICU (yang dicurigai infeksi) adalah 20,3% sedangkan di level II sebesar 8,5% CFR di NICU, untuk BBLR sebesar 15,6% dan di level II sebesar 3,8%. Angka kematian bayi berdasarkan berat lahir antara bayi yang dirujuk dari luar dan tidak, terdapat perbedaan yaitu angka kematian lebih tinggi di dapat pada bayi yang dirujuk untuk bayi dengan BBL < 1500 gr, angka kematian pada bayi yang dirujuk 8,8 %o (non rujukan=3,1%o), BBL 1500-2400 gr sebesar 47,1%o (non rujukan 4,7%o) dan BBL > 2500 gr sebesar 170,1%o (non rujukan 3,1%o). Kesimpulan. Kesimpulan. Kesimpulan. Kesimpulan. Kesimpulan. Angka kematian lebih tinggi ditemukan pada bayi yang datang dari luar rumah sakit (rujukan)
Latar belakang. Retinopati prematuritas (ROP) adalah gangguan perkembangan dari pembuluh darah re... more Latar belakang. Retinopati prematuritas (ROP) adalah gangguan perkembangan dari pembuluh darah retina yang mengenai bayi prematur. Faktor genetik diduga berperan terhadap kejadian ROP. Konsentrasi dan kemurnian DNA hasil isolasi diperlukan untuk analisis pemeriksan genetik pada kasus ROP. Tujuan. Mengetahui konsentrasi dan indeks kemurnian DNA menggunakan sampel whole blood, buffy coat dan swab buccal pada kelompok bayi-bayi prematur yang masuk dalam kriteria penapisan ROP. Metode. Enam puluh dari total 182 subyek yang terdiagnosis ROP terpilih dengan systematic random sampling. Konsentrasi dihitung melalui penyerapan spektrofotometrik sinar ultraviolet. Kemurnian ditentukan dengan menghitung rasio antara OD260 dan nilai OD280. Analisis statistik dilakukan dengan uji Kruskal Wallis dan Mann Whitney. Hasil. Uji konsentrasi DNA menggunakan sampel buffy coat lebih tinggi dibandingkan whole blood dan swab buccal. Sampel whole blood mempunyai indeks kemurnian yang paling baik. Kesimpulan. Konsentrasi DNA sampel buffy coat dan whole blood cukup tinggi dengan indeks kemurnian yang baik untuk analisis genetika.
Artikel Asli I nfeksi neonatal merupakan salah satu penyebab kematian neonatal di negara berkemba... more Artikel Asli I nfeksi neonatal merupakan salah satu penyebab kematian neonatal di negara berkembang. Diperkirakan angka kematian neonatus menyumbang hampir 60% dari kematian bayi Alamat korespondensi
Background and Aims: Retinopathy of prematurity (ROP) is a severe disease in preterm infants. It ... more Background and Aims: Retinopathy of prematurity (ROP) is a severe disease in preterm infants. It is seen more frequently in Low-Middle Income Countries (LMIC) like Indonesia compared to High-Income Countries (HIC). Risk factors for ROP development are -extreme- preterm birth, use of oxygen, neonatal infections, respiratory problems, inadequate nutrition, and blood and exchange transfusions. In this paper, we give an overview of steps that can be taken in LMIC to prevent ROP and provide guidelines for screening and treating ROP.
Methods: Based on the literature search and data obtained by us in Indonesia's studies, we propose guidelines for the prevention, screening, and treatment of ROP in
preterm infants in LMIC.
Results: Prevention of ROP starts before birth with preventing preterm labor, transferring a mother who might deliver <32 weeks to a perinatal center, and giving corticosteroids to mothers that might deliver <34 weeks. Newborn resuscitation must be done using room air or, in the case of very preterm infants (<29-32 weeks) by using
30% oxygen. Respiratory problems must be prevented by starting continuous positive
airway pressure (CPAP) in all preterm infants <32 weeks and in case of respiratory
problems in more mature infants. If needed, the surfactant should be given in a
minimally invasive manner, as ROP's lower incidence was found using this technique.
The use of oxygen must be strictly regulated with a saturation monitor of 91-95%.
Infections must be prevented as much as possible. Both oral and parenteral nutrition
should be started in all preterm infants on day one of life with preferably mothers'
milk. Blood transfusions can be prevented by reducing the amount of blood needed
for laboratory analysis.
Discussion: Preterm babies should be born in facilities able to care for them optimally.
The use of oxygen must be strictly regulated. ROP screening is mandatory in
infants born <34 weeks, and infants who received supplemental oxygen for a prolonged period. In the case of progression of ROP, immediate mandatory treatment is required.
Conclusion: Concerted action is needed to reduce the incidence of ROP in LMIC.
"STOP - R1O2P3" is an acronym that can help implement standard practices in all
neonatal intensive care units in LMIC to prevent development and progression.
Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-... more Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants. Objective To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia. Setting Data were collected from 34 hospitals with different levels of care: national referral centres, universitybased hospitals, and public and private hospitals. Methods A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight. Results We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals. Conclusions In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia. HKWCHC, Harapan Kita Women and Children's Hospital (National Centre for Women and Children's Health); OH, other hospitals; ROP, retinopathy of prematurity; RSCM/NRH, Ciptomangunkusumo Hospital (national referral hospital); UBH, university-based hospital.
BACKGROUND Risk factors other than supplemental oxygen might play a role in the development of re... more BACKGROUND Risk factors other than supplemental oxygen might play a role in the development of retinopathy of prematurity (ROP). In Indonesia ROP occurs in infants up to 34 weeks and 2000 g. Risk factors for the development of ROP in Indonesian NICUs have not been evaluated. Our aim was to identify other risk factors than the use of oxygen in the development and progression of ROP in preterm infants in Indonesia. METHODOLOGY Data on 98 preterm infants with ROP and 77 controls were collected from four NICUs and two eye centers in Jakarta, Indonesia, between 2009 and 2014. We used multivariate logistic regression analysis to determine the relationship between infants and environmental variables and the development and progression of ROP. We obtained variables for ROP severity by using Cox regression analysis. RESULTS Factors associated with the development of ROP were birthweight (BWt), intrauterine growth retardation (IUGR), exchange transfusion, duration of oxygen supplementation, m...
Latar belakang. Deposit Seng (Zn) berperan terhadap fungsi metabolik tubuh. Bayi kurang bulan mem... more Latar belakang. Deposit Seng (Zn) berperan terhadap fungsi metabolik tubuh. Bayi kurang bulan mempunyai cadangan Zn yang rendah pada masa fetus, kebutuhan Zn yang tinggi setelah lahir, kapasitas untuk mengabsorbsi
dan retensi zat makanan terbatas. Gambaran klinis dari defisiensi Zn yang berat yaitu dermatitis, iritabel, kandidiasis oral, diare, mineralisasi tulang yang buruk, gangguan fungsi motorik dan kognitif, meningkatnya risiko terkena infeksi, dan retardasi pertumbuhan.
Tujuan. Untuk menentukan prevalens dan faktor risiko hipozincemia pada bayi berat lahir rendah.
Metode. Penelitian prospektif, desain penelitian potong lintang. Data dikumpulkan dari 3 rumah sakit di Jakarta. Informasi faktor risiko dicatat dan kadar Zn diperiksa pada bayi dengan berat lahir <2000 g
dan usia gestasi <34 minggu, pada usia koreksi mendekati cukup bulan atau cukup bulan. Hasil dianalisis dengan (T-test, dan Mann-Whitney) (regresi logistik). Defisiensi Zn didiagnosis apabila kadar Zn <55mg/ dl (8,4 μmol/L).
Hasil. Dari 63 bayi yang diteliti terdapat 18 bayi yang hipozincemia sehingga didapatkan prevalens hipozincemia 28%. Dari 18 bayi hipozincemia, 67% disertai dengan gejala yang paling banyak dijumpai adalah gangguan pertumbuhan. Peningkatan usia gestasi, peningkatan kadar kalsium dan pemberian suplemen besi berhubungan dengan penurunan risiko hipozincemia (OR 0,622; 95% CI: 0,42-0,92), (OR 0,376; 95% CI: 0,16 – 0,88) dan (OR 0,062; 95 % CI: 0,008-0,46). Sedangkan jenis kelamin laki laki berhubungan dengan peningkatan risiko hipozincemia(OR 4,764; 95% CI: 0,06-21,40).
Kesimpulan. Prevalens hipozincemia pada bayi usia gestasi <34 minggu dan berat lahir <2000 gram, yang diperiksa pada usia koreksi >35 minggu, didapatkan 28% dengan gejala. Gangguan pertumbuhan merupakan gejala yang paling banyak dijumpai. Faktor risiko hipozincemia ditemukan pada bayi laki-laki, usia gestasi yang lebih rendah, penurunan kadar kalsium dan tanpa pemberian suplementasi besi.
Objective
Retinopathy of prematurity (ROP) is a major cause of blindness in newborn infants, ... more Objective
Retinopathy of prematurity (ROP) is a major cause of blindness in newborn infants, which also occurs in low-income and middle-income countries. Why ROP progresses in some infants while it regresses in others is still presently unknown. Studies suggest that genetic factors might be involved. Mutations in the Norrie disease (ND) gene is suspected to be related to advanced ROP development. Indonesia is a country with a relatively high incidence of ROP, yet the role of these genetic factors in the pathogenesis of ROP cases is still unknown. The study aimed to investigate the presence of mutations in ND on the X chromosome in infants with both non-advanced and advanced ROP in Indonesia.
Methods and Analysis
This is a case-control study of polymorphisms in six variants within the ND gene in exon 3, C597A, L108P, R121W, A105T, V60E, and C110G, in
preterm newborn infants in four major hospitals in Greater Jakarta, Indonesia.
Results
We included 162 preterm newborn infants. ROP was diagnosed in 83 infants, and 79 infants served as controls. Among those with ROP, 57 infants had type 2, while others had type 1. We did not find any gene polymorphisms in any of the infants with ROP nor in the control group.
Conclusion
We conclude that it is very unlikely that the six polymorphisms in exon 3 of the ND gene studied in this paper are involved in the development or progression of ROP in preterm infants in our population sample in Indonesia.
Uploads
Background: Retinopathy of prematurity (ROP) is a vaso-proliferative disease of the eye, which mainly affects preterm newborn infants with an incompletely vascularized retina. The incidence of ROP has increased in industrialized countries due to the increased survival of extremely low birth weight (ELBW) infants. ROP is also increasing in developing countries like Indonesia, where it is most likely due to the improved survival of ELBW infants.
Objective: To ascertain the incidence of ROP and possible risk factors associated with the development of ROP in preterm infants in Indonesia.
Methods: We reviewed the literature on the incidence and potential risk factors for the development of ROP in Indonesia, obtained data from three referral eye clinics, and added data from our institution.
Results: The reported incidence of all stages of ROP in infants with a gestational age of <32 weeks ranged from 18-30%. One study showed that ROP also occurred at older gestational ages. Blindness due to ROP was seen in infants up to 35 weeks and with a birth weight of 2000 g.
Conclusion: Retinopathy of prematurity is an important cause of ocular morbidity and blindness in Indonesia. The overall incidence of ROP in infants born below 32 weeks in Indonesia is higher than in developed countries, and it is seen in infants with older gestational ages. This might be due to a less strict monitoring during the use of oxygen in Indonesia compared to industrialized countries.
Keywords: Indonesia; ROP; Risk-factors; incidence.
Objective To report the incidence of ROP in one of the oldest and largest neonatal intensive care unit (NICU) in Indonesia.
Methods We studied the incidence and severity of ROP in inborn infants with a BW of ≤1500 g and/or GA of ≤32 weeks, who were admitted to the NICU of Harapan Kita Women and Children Hospital, Jakarta. In addition, infants with a higher BW and GA, receiving more than 40% oxygen for a longer period, were screened.
Results In 2005–2015, 182 infants were born with a BW of <1000 g and 437 with a weight of 1000–1500 g. In the <1000 g group, 27 (46%) of the screened infants showed no ROP, 22 (37%) showed ROP 1–2 and 10
(17%) showed ROP 3–5. In the 1000–1500 g group, 172 (68%) were without ROP, 71 (28%) with ROP 1–2 and nine (4%) with ROP 3–5. Twenty-two (13%) of the 163 screened infants weighing 1500–2000 g showed ROP 1–2 and two (1.2%) had ROP 3–5. Eight (18%) of the
44 screened infants born with a BW of more than 2000 g showed ROP 1–2 and none showed ROP 3–5.
Conclusion The total incidence of ROP as well as severe ROP in infants with a BW of <1000 g and 1000–1500 g in our NICU is higher than in a developed country. ROP in Indonesia is also seen in infants with a
BW of 1500–2500 g. Increasing the awareness of the risks of oxygen as well as better equipment to monitor oxygen delivery is essential.
Kata kunci: Kelainan Bawaan Lahir, BIDIC
Methods: Based on the literature search and data obtained by us in Indonesia's studies, we propose guidelines for the prevention, screening, and treatment of ROP in
preterm infants in LMIC.
Results: Prevention of ROP starts before birth with preventing preterm labor, transferring a mother who might deliver <32 weeks to a perinatal center, and giving corticosteroids to mothers that might deliver <34 weeks. Newborn resuscitation must be done using room air or, in the case of very preterm infants (<29-32 weeks) by using
30% oxygen. Respiratory problems must be prevented by starting continuous positive
airway pressure (CPAP) in all preterm infants <32 weeks and in case of respiratory
problems in more mature infants. If needed, the surfactant should be given in a
minimally invasive manner, as ROP's lower incidence was found using this technique.
The use of oxygen must be strictly regulated with a saturation monitor of 91-95%.
Infections must be prevented as much as possible. Both oral and parenteral nutrition
should be started in all preterm infants on day one of life with preferably mothers'
milk. Blood transfusions can be prevented by reducing the amount of blood needed
for laboratory analysis.
Discussion: Preterm babies should be born in facilities able to care for them optimally.
The use of oxygen must be strictly regulated. ROP screening is mandatory in
infants born <34 weeks, and infants who received supplemental oxygen for a prolonged period. In the case of progression of ROP, immediate mandatory treatment is required.
Conclusion: Concerted action is needed to reduce the incidence of ROP in LMIC.
"STOP - R1O2P3" is an acronym that can help implement standard practices in all
neonatal intensive care units in LMIC to prevent development and progression.
dan retensi zat makanan terbatas. Gambaran klinis dari defisiensi Zn yang berat yaitu dermatitis, iritabel, kandidiasis oral, diare, mineralisasi tulang yang buruk, gangguan fungsi motorik dan kognitif, meningkatnya risiko terkena infeksi, dan retardasi pertumbuhan.
Tujuan. Untuk menentukan prevalens dan faktor risiko hipozincemia pada bayi berat lahir rendah.
Metode. Penelitian prospektif, desain penelitian potong lintang. Data dikumpulkan dari 3 rumah sakit di Jakarta. Informasi faktor risiko dicatat dan kadar Zn diperiksa pada bayi dengan berat lahir <2000 g
dan usia gestasi <34 minggu, pada usia koreksi mendekati cukup bulan atau cukup bulan. Hasil dianalisis dengan (T-test, dan Mann-Whitney) (regresi logistik). Defisiensi Zn didiagnosis apabila kadar Zn <55mg/ dl (8,4 μmol/L).
Hasil. Dari 63 bayi yang diteliti terdapat 18 bayi yang hipozincemia sehingga didapatkan prevalens hipozincemia 28%. Dari 18 bayi hipozincemia, 67% disertai dengan gejala yang paling banyak dijumpai adalah gangguan pertumbuhan. Peningkatan usia gestasi, peningkatan kadar kalsium dan pemberian suplemen besi berhubungan dengan penurunan risiko hipozincemia (OR 0,622; 95% CI: 0,42-0,92), (OR 0,376; 95% CI: 0,16 – 0,88) dan (OR 0,062; 95 % CI: 0,008-0,46). Sedangkan jenis kelamin laki laki berhubungan dengan peningkatan risiko hipozincemia(OR 4,764; 95% CI: 0,06-21,40).
Kesimpulan. Prevalens hipozincemia pada bayi usia gestasi <34 minggu dan berat lahir <2000 gram, yang diperiksa pada usia koreksi >35 minggu, didapatkan 28% dengan gejala. Gangguan pertumbuhan merupakan gejala yang paling banyak dijumpai. Faktor risiko hipozincemia ditemukan pada bayi laki-laki, usia gestasi yang lebih rendah, penurunan kadar kalsium dan tanpa pemberian suplementasi besi.
Retinopathy of prematurity (ROP) is a major cause of blindness in newborn infants, which also occurs in low-income and middle-income countries. Why ROP progresses in some infants while it regresses in others is still presently unknown. Studies suggest that genetic factors might be involved. Mutations in the Norrie disease (ND) gene is suspected to be related to advanced ROP development. Indonesia is a country with a relatively high incidence of ROP, yet the role of these genetic factors in the pathogenesis of ROP cases is still unknown. The study aimed to investigate the presence of mutations in ND on the X chromosome in infants with both non-advanced and advanced ROP in Indonesia.
Methods and Analysis
This is a case-control study of polymorphisms in six variants within the ND gene in exon 3, C597A, L108P, R121W, A105T, V60E, and C110G, in
preterm newborn infants in four major hospitals in Greater Jakarta, Indonesia.
Results
We included 162 preterm newborn infants. ROP was diagnosed in 83 infants, and 79 infants served as controls. Among those with ROP, 57 infants had type 2, while others had type 1. We did not find any gene polymorphisms in any of the infants with ROP nor in the control group.
Conclusion
We conclude that it is very unlikely that the six polymorphisms in exon 3 of the ND gene studied in this paper are involved in the development or progression of ROP in preterm infants in our population sample in Indonesia.
Background: Retinopathy of prematurity (ROP) is a vaso-proliferative disease of the eye, which mainly affects preterm newborn infants with an incompletely vascularized retina. The incidence of ROP has increased in industrialized countries due to the increased survival of extremely low birth weight (ELBW) infants. ROP is also increasing in developing countries like Indonesia, where it is most likely due to the improved survival of ELBW infants.
Objective: To ascertain the incidence of ROP and possible risk factors associated with the development of ROP in preterm infants in Indonesia.
Methods: We reviewed the literature on the incidence and potential risk factors for the development of ROP in Indonesia, obtained data from three referral eye clinics, and added data from our institution.
Results: The reported incidence of all stages of ROP in infants with a gestational age of <32 weeks ranged from 18-30%. One study showed that ROP also occurred at older gestational ages. Blindness due to ROP was seen in infants up to 35 weeks and with a birth weight of 2000 g.
Conclusion: Retinopathy of prematurity is an important cause of ocular morbidity and blindness in Indonesia. The overall incidence of ROP in infants born below 32 weeks in Indonesia is higher than in developed countries, and it is seen in infants with older gestational ages. This might be due to a less strict monitoring during the use of oxygen in Indonesia compared to industrialized countries.
Keywords: Indonesia; ROP; Risk-factors; incidence.
Objective To report the incidence of ROP in one of the oldest and largest neonatal intensive care unit (NICU) in Indonesia.
Methods We studied the incidence and severity of ROP in inborn infants with a BW of ≤1500 g and/or GA of ≤32 weeks, who were admitted to the NICU of Harapan Kita Women and Children Hospital, Jakarta. In addition, infants with a higher BW and GA, receiving more than 40% oxygen for a longer period, were screened.
Results In 2005–2015, 182 infants were born with a BW of <1000 g and 437 with a weight of 1000–1500 g. In the <1000 g group, 27 (46%) of the screened infants showed no ROP, 22 (37%) showed ROP 1–2 and 10
(17%) showed ROP 3–5. In the 1000–1500 g group, 172 (68%) were without ROP, 71 (28%) with ROP 1–2 and nine (4%) with ROP 3–5. Twenty-two (13%) of the 163 screened infants weighing 1500–2000 g showed ROP 1–2 and two (1.2%) had ROP 3–5. Eight (18%) of the
44 screened infants born with a BW of more than 2000 g showed ROP 1–2 and none showed ROP 3–5.
Conclusion The total incidence of ROP as well as severe ROP in infants with a BW of <1000 g and 1000–1500 g in our NICU is higher than in a developed country. ROP in Indonesia is also seen in infants with a
BW of 1500–2500 g. Increasing the awareness of the risks of oxygen as well as better equipment to monitor oxygen delivery is essential.
Kata kunci: Kelainan Bawaan Lahir, BIDIC
Methods: Based on the literature search and data obtained by us in Indonesia's studies, we propose guidelines for the prevention, screening, and treatment of ROP in
preterm infants in LMIC.
Results: Prevention of ROP starts before birth with preventing preterm labor, transferring a mother who might deliver <32 weeks to a perinatal center, and giving corticosteroids to mothers that might deliver <34 weeks. Newborn resuscitation must be done using room air or, in the case of very preterm infants (<29-32 weeks) by using
30% oxygen. Respiratory problems must be prevented by starting continuous positive
airway pressure (CPAP) in all preterm infants <32 weeks and in case of respiratory
problems in more mature infants. If needed, the surfactant should be given in a
minimally invasive manner, as ROP's lower incidence was found using this technique.
The use of oxygen must be strictly regulated with a saturation monitor of 91-95%.
Infections must be prevented as much as possible. Both oral and parenteral nutrition
should be started in all preterm infants on day one of life with preferably mothers'
milk. Blood transfusions can be prevented by reducing the amount of blood needed
for laboratory analysis.
Discussion: Preterm babies should be born in facilities able to care for them optimally.
The use of oxygen must be strictly regulated. ROP screening is mandatory in
infants born <34 weeks, and infants who received supplemental oxygen for a prolonged period. In the case of progression of ROP, immediate mandatory treatment is required.
Conclusion: Concerted action is needed to reduce the incidence of ROP in LMIC.
"STOP - R1O2P3" is an acronym that can help implement standard practices in all
neonatal intensive care units in LMIC to prevent development and progression.
dan retensi zat makanan terbatas. Gambaran klinis dari defisiensi Zn yang berat yaitu dermatitis, iritabel, kandidiasis oral, diare, mineralisasi tulang yang buruk, gangguan fungsi motorik dan kognitif, meningkatnya risiko terkena infeksi, dan retardasi pertumbuhan.
Tujuan. Untuk menentukan prevalens dan faktor risiko hipozincemia pada bayi berat lahir rendah.
Metode. Penelitian prospektif, desain penelitian potong lintang. Data dikumpulkan dari 3 rumah sakit di Jakarta. Informasi faktor risiko dicatat dan kadar Zn diperiksa pada bayi dengan berat lahir <2000 g
dan usia gestasi <34 minggu, pada usia koreksi mendekati cukup bulan atau cukup bulan. Hasil dianalisis dengan (T-test, dan Mann-Whitney) (regresi logistik). Defisiensi Zn didiagnosis apabila kadar Zn <55mg/ dl (8,4 μmol/L).
Hasil. Dari 63 bayi yang diteliti terdapat 18 bayi yang hipozincemia sehingga didapatkan prevalens hipozincemia 28%. Dari 18 bayi hipozincemia, 67% disertai dengan gejala yang paling banyak dijumpai adalah gangguan pertumbuhan. Peningkatan usia gestasi, peningkatan kadar kalsium dan pemberian suplemen besi berhubungan dengan penurunan risiko hipozincemia (OR 0,622; 95% CI: 0,42-0,92), (OR 0,376; 95% CI: 0,16 – 0,88) dan (OR 0,062; 95 % CI: 0,008-0,46). Sedangkan jenis kelamin laki laki berhubungan dengan peningkatan risiko hipozincemia(OR 4,764; 95% CI: 0,06-21,40).
Kesimpulan. Prevalens hipozincemia pada bayi usia gestasi <34 minggu dan berat lahir <2000 gram, yang diperiksa pada usia koreksi >35 minggu, didapatkan 28% dengan gejala. Gangguan pertumbuhan merupakan gejala yang paling banyak dijumpai. Faktor risiko hipozincemia ditemukan pada bayi laki-laki, usia gestasi yang lebih rendah, penurunan kadar kalsium dan tanpa pemberian suplementasi besi.
Retinopathy of prematurity (ROP) is a major cause of blindness in newborn infants, which also occurs in low-income and middle-income countries. Why ROP progresses in some infants while it regresses in others is still presently unknown. Studies suggest that genetic factors might be involved. Mutations in the Norrie disease (ND) gene is suspected to be related to advanced ROP development. Indonesia is a country with a relatively high incidence of ROP, yet the role of these genetic factors in the pathogenesis of ROP cases is still unknown. The study aimed to investigate the presence of mutations in ND on the X chromosome in infants with both non-advanced and advanced ROP in Indonesia.
Methods and Analysis
This is a case-control study of polymorphisms in six variants within the ND gene in exon 3, C597A, L108P, R121W, A105T, V60E, and C110G, in
preterm newborn infants in four major hospitals in Greater Jakarta, Indonesia.
Results
We included 162 preterm newborn infants. ROP was diagnosed in 83 infants, and 79 infants served as controls. Among those with ROP, 57 infants had type 2, while others had type 1. We did not find any gene polymorphisms in any of the infants with ROP nor in the control group.
Conclusion
We conclude that it is very unlikely that the six polymorphisms in exon 3 of the ND gene studied in this paper are involved in the development or progression of ROP in preterm infants in our population sample in Indonesia.