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Maintaining optimal growth of preterm infants after hospital discharge remains a challenge. There has been no data on the long-term growth trajectory of preterm infants in Indonesia. We aimed to describe the growth trajectory of preterm infants up to 24 months of corrected age and its variation among gestational age groups. A longitudinal study was conducted in Cipto Mangunkusumo Hospital, Jakarta, from 2018 to 2020. All preterm infants who were discharged during the study period were included. Growth trajectory analysis used weight-for-age, length-for-age and weight-for-length z-score of 3-month time intervals across gestational age groups using repeated measure ANOVA and generalised estimating equation regression. Length trajectory was specifically reported as a stunted proportion. Among 306 preterm infants included, most were moderate preterm (49·67 %) and low birth weight (69·93 %). Overall weight-for-age at 0 months was in the median of the curve, then decreased at 3 months but consistently increased slowly until 24 months. The weight-for-age trends were unique across gestational age groups but statistically similar ( P = 0·263). The proportion of stunted gradually decreases to 13·40 % at 24 months, mostly among the moderate preterm group in the first 6 months ( P < 0·001), but then becomes similar at 24 months. All subjects were in the normal range for weight-for-length but had variations in trends across gestational age groups ( P < 0·001). Growth trajectory differed between weight, length and weight-for-length in the first 24 months and varied among gestational age groups. Close follow-up is crucial to ensure optimal growth after neonatal intensive care unit discharge.

Background: Indonesia has high numbers of preterm birth, i.e., around 600,000 preterm births annually. It imposes a significant burden on the Indonesia's healthcare system. Indonesia therefore requires its own evidence-based reference to manage premature neonates and ex-preterm infants who subsequently survived. No long-term study on preterm infants in Indonesia has been conducted, therefore we aim to evaluate growth and development on ex-preterm infants until the pre-pubertal stage., Methods: We at the Cipto Mangunkusumo General Hospital (CMGH) designed a prospective cohort study of preterm infants, i.e., the Cohort of Indonesian Preterm Infants for Long-term Outcomes (CIPTO) study. At least 500 subjects will be recruited with an estimation of two-year recruitment (i.e., the recruitment phase will be completed before 2024). The CIPTO study will observe long-term outcomes of ex-preterm infants, primarily on growth and developmental milestones until 8 years old. Aims of this study are to determine the ex-preterm outcomes and to generate an evidence-based reference of preterm care for ensuring optimum outcomes. The pre-specified long-term outcomes in this study are survival rates, growth outcomes, neurodevelopmental outcomes, feeding behavior, as well as hearing and vision impairments. Growth and neurodevelopmental outcomes will be assessed at 0, 2, 4, 6, 9, 12, 15, 18 and 24 months of corrected age as well as at 3, 4, 5, 6, 7 and 8 years old., Discussion: The CIPTO study is the first prospective cohort in Indonesia focusing on preterm infants born at the CMGH. With a follow up until 8 years old, this study may provide useful insights to generate an evidence-based, Indonesia's health care reference in managing premature infants and ensuring the optimum outcomes of ex-preterm infants., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Postnatal growth failure (PGF) frequently occurred among preterm infants with malnutrition. The decline in a weight-for-age z -score of ≥1.2 has been proposed to define PGF. It was unknown whether this indicator would be useful among Indonesian preterm infants., Methods: Infants of <37 weeks of gestational age born between 2020 and 2021, both stable and unstable, were recruited for a prospective cohort study during hospitalization in the level III neonatal intensive care unit at the Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. The prevalence of PGF as defined by a weight-for-age z -score of <-1.28 (<10th percentile) at discharge, a weight-for-age z -score of <-1.5 (<7th percentile) at discharge, or a decline in a weight-for-age z -score of ≥1.2 from birth till discharge was compared. The association between those PGF indicators with the preterm subcategory and weight gain was assessed. The association between the decline in a weight-for-age z -score of ≥1.2 with the duration to achieve full oral feeding and the time spent for total parenteral nutrition was analyzed., Results: Data were collected from 650 preterm infants who survived and were discharged from the hospital. The weight-for-age z -score of <-1.28 or <-1.5 was found in 307 (47.2%) and 270 (41.5%) subjects with PGF, respectively. However, both indicators did not identify any issue of weight gain among subjects with PGF, questioning their reliability in identifying malnourished preterm infants. By contrast, the decline in a weight-for-age z -score of ≥1.2 was found in 51 (7.8%) subjects with PGF, in which this indicator revealed that subjects with PGF had an issue of weight gain. Next, a history of invasive ventilation was identified as a risk factor for preterm infants to contract PGF. Finally, the decline in a weight-for-age z -score of ≥1.2 confirmed that preterm infants with PGF took a longer time to be fully orally fed and a longer duration for total parenteral nutrition than the ones without PGF., Conclusion: The decline in a weight-for-age z -score of ≥1.2 was useful to identify preterm infants with PGF within our cohort. This could reassure pediatricians in Indonesia to use this new indicator., Competing Interests: The authors declare that the study was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rohsiswatmo, Kaban, Sjahrulla, Hikmahrachim, Marsubrin, Roeslani, Iskandar, Sukarja, Kautsar and Urwah.)

Background: Neonatal jaundice is a transitional phenomenon affecting three out of five full-term newborns globally. Ursodeoxycholic acid could be beneficial in neonatal jaundice needing phototherapy.  METHODS: We searched PubMed, EBSCO, ProQuest, and Cochrane Library up to August 21 st , 2021, for articles to be reviewed. Meta-analysis using random-effects model was performed., Results: Eight studies involving 1116 neonates were chosen in this review; however, only five studies were included for meta-analysis. Phototherapy duration was significantly lower in the interventional group with high heterogeneities. Subgroup analysis of the phototherapy duration based on the risk of bias resulted in a shorter duration (mean difference (MD) = -17.82; 95% CI = -20.17 to -15.47; p =  < 0.001) with low heterogeneity in the treatment group. Secondary outcome focusing on mean total serum bilirubin showed a lower mean total serum bilirubin in 48 h post-treatment (MD = -0.43; 95% CI = -0.64 to -0.22; p =  < 0.0001) with low heterogeneities in Asian countries.", Conclusions: Ursodeoxycholic acid might be considered as a novel adjuvant therapy in neonatal indirect hyperbilirubinemia to shorten the phototherapy duration and lower the mean total serum bilirubin., (© 2022. The Author(s).)

Background: All sectors are affected due to COVID-19 pandemic occurring worldwide, including the education industry. School closure had been taking place for more than a year in Indonesia. Despite the controversies, Indonesian government had decided to begin school reopening., Objectives: This study aims to assess parental readiness for school reopening, and factors affecting parental attitude toward school reopening., Methods: A cross-sectional study using online questionnaire distributed via official Indonesian Pediatric Society (IPS) official social media account collected between March and April 2021. The questionnaire contained the general characteristics of study participants, parents' knowledge, and perspectives on COVID-19, and health protocols for school reopening., Results: A total of 17,562 responses were collected, of which 55.7% parents were ready to send their children to school should school reopens. Factors significantly contribute to parental decision to keep their child at home were: presence of vulnerable population at home [OR = 1.18 (1.10-1.27), p < 0.001], children with comorbidities [OR = 2.56 (2.29-2.87), p < 0.001], perception of COVID-19 as a dangerous disease [OR = 28.87 (14.29-58.33), p < 0.001], experience with COVID-19 positive cases in the community [OR = 1.75 (1.61-1.90), p < 0.001], COVID-19 related death in the community [OR = 2.05 (1.90-2.21), P < 0.001], approval for adult COVID-19 vaccination [OR = 1.69 (1.53-1.87), p < 0.001], and ownership of private transportation [OR = 1.46 (1.30-1.66), p <0.001]., Conclusion: We identified several factors affecting parental perception on school reopening during COVID-19 pandemic that should be addressed. This study can be used for policy-maker to make further recommendations and health educations prior to school reopening in Indonesia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Pudjiadi, Putri, Sjakti, Yanuarso, Gunardi, Roeslani, Pasaribu, Nurmalia, Sambo, Habibah, Utami, Prawira, Kaswandani, Alam, Kadafi, Hanafi, Tjahjadi, Aprianti, Salma, Wijaya, Alatas and Pulungan.)

Preterm neonates are born with fewer functional nephrons, rendering them vulnerable to secondary insult. These insults are associated with acute kidney injury (AKI); thus, structural damage must be detected as early as possible. Urinary L-type fatty acid-binding protein (u-LFABP) has been proposed as a highly suitable kidney injury biomarker during prematurity. We aimed to analyze the use of POC u-LFABP in critically ill, very preterm neonates. This study was conducted at the neonatal intensive care unit (NICU), Dr. Cipto Mangunkusumo General Hospital, from November to December 2020. Baseline characteristics were recorded from electronic medical records. u-LFABP examination utilized stored urine samples from a previous study and was performed using a LFABP POC test kit. The proportion of abnormal u-LFABP (83.3%) was highest at 72 hours. Neonates with older gestational age (0-48 hours; p =0.017) and higher birth weight (0-48 hours; p =0.022, 72 hours; p =0.013) had normal u-LFABP levels. Neonates exposed to nephrotoxic agents showed higher proportion of abnormal u-LFABP (0-48 hours; p =0.006). Longer invasive mechanical ventilation (IMV) period was observed in neonates with abnormal u-LFABP levels at 0-48 hours (7.44 ± 7.9 vs. 1.50 ± 2.9 days; p =0.011). We found an association between complication rates and poorer disease outcome trends with abnormal u-LFABP; however, this relationship was not supported statistically. In conclusion, this study demonstrated that u-LFABP can be detected using bedside POC kit in critically ill very preterm neonates and those exposed to nephrotoxic agents may be at risk for kidney injury, confirmed by abnormal u-LFABP levels., Competing Interests: The authors declare no competing financial interests., (Copyright © 2022 Henny Adriani Puspitasari et al.)