Background.National Immunization Technical Advisory Groups (NITAGs) are established by national authorities to provide them with independent, bias-free, objective, and evidence-based advice on vaccines and immunization challenges. As of December 2015, 125 countries have reported having set up an NITAG. The Health Policy and Institutional Development Center at the Agence de Médecine Préventive, a World Health Organization (WHO) Collaborative Center for evidence-informed immunization, through its Supporting Independent Immunization and Vaccine Advisory Committees (SIVAC) Initiative project, provides assistance to low- and middle-income countries in the establishment and strengthening of their NITAGs. The Indonesian NITAG (ITAGI) was formed in December 2006 and Uganda’s (UNITAG) was formed in November 2014. Both Uganda and Indonesia have introduced inactivated polio vaccine (IPV) as part of the Global Polio Eradication and Endgame Strategic Plan (the Endgame plan). The authors reflect on the process and the role played by NITAGs in the introduction of IPV in the routine immunization program and the lessons learned.Methods.This commentary is a reflection of the authors’ experience on NITAG’s role as observed in 2 particular local settings and applied to a global public health issue, the polio eradication Endgame plan. The reflection is backed up by the relevant (policy and technical) documents on polio eradication, along with minutes and reports from countries’ ministries of health, immunization programs, WHO, and NITAGs.Results.NITAGs are valuable tools for ministries of health to ensure sustainable, evidence-informed immunization policies that are trusted and accepted by their communities. Early engagement with NITAGs also ensures that the adoption of strategies addressing global public health threats at the country level reinforces the national immunization programs. On the other end, when NITAGs are proactive and forward-thinking, they can contribute to a smooth and effective introduction of the above-mentioned strategies. Time and resources are key factors to ensure optimal performance of NITAGs.

AbstrakIkatan Dokter Anak Indonesia melalui Satuan Tugas Imunisasi mengeluarkan rekomendasi Imunisasi IDAI tahun 2017 untuk menggantikan jadwal imunisasi sebelumnya. Jadwal imunisasi 2017 ini bertujuan menyeragamkan jadwal imunisasi rekomendasi IDAI dengan jadwal imunisasi Kementerian Kesehatan RI khususnya untuk imunisasi rutin. Jadwal imunisasi 2017 juga dibuat berdasarkan ketersediaan kombinasi vaksin DTP dengan hepatitis B seperti DTPw-HB-Hib, DTPa-HB-Hib-IPV, dan dalam situasi keterbatasan atau kelangkaan vaksin tertentu seperti vaksin DTPa atau DTPw tanpa kombinasi dengan vaksin lainnya. Hal baru yang terdapat pada jadwal 2017 antara lain: vaksin hepatitis B monovalen tidak perlu diberikan pada usia 1 bulan apabila anak akan mendapat vaksin DTP-Hib kombinasi dengan hepatitis B; bayi paling sedikit harus mendapat satu dosis vaksin IPV (inactivated polio vaccine) bersamaan (simultan) dengan OPV-3 saat pemberian DTP-3; vaksin DTPw direkomendasikan untuk diberikan pada usia 2,3 dan 4 bulan. Hal baru yang lain adalah untuk vaksin influenza dapat diberikan vaksin inaktif trivalen atau quadrivalen, vaksin MMR dapat diberikan pada usia 12 bulan apabila anak belum mendapat vaksin campak pada usia 9 bulan. Vaksin HPV apabila diberikan pada remaja usia 10-13 tahun, pemberian cukup 2 dosis dengan interval 6-12 bulan; respons antibodi setara dengan 3 dosis. Vaksin Japanese Encephalitis direkomendasikan untuk diberikan mulai usia 12 bulan pada daerah endemis atau pada turis yang akan bepergian ke daerah endemis. Vaksin dengue direkomendasikan untuk diberikan pada anak usia 9-16 tahun dengan jadwal 0, 6, dan 12 bulan. Dengan pemberian imunisasi sesuai rekomendasi, diharapkan anak-anak Indonesia terlindungi dari penyakit infeksi yang dapat dicegah dengan imunisasi. Sari Pediatri 2017;18 (5) In the new recommendation, monovalent hepatitis B vaccine need not to be given in the first month of age if the infant will be given combination vaccine containing hepatitis B and DTP; infants should have at least one dose IPV (inactivated polio vaccine) simultaneously with bOPV-3 and DTP-3; DTwP is recommended to be administered at age of 2, 3 and 4 months. Influenza immunization could be given in the form of either trivalent or quadrivalent inactive influenza vaccine. MMR vaccine can be administered at age of 12 months if measles vaccine has not been given in age 9 months. Two doses of HPV vaccine is sufficient for female adolescents age 10-13 years; antibody respons after two doses is not inferior to the three dose regiment. Japanese Encephalitis vaccine is recommended to be given to infants aged 12 months who live in endemic area or for tourist traveling to endemic area. Dengue vaccine is recommended to children age 9-16 years with 0, 6 dan 12 month schedule. Timely immunization according to recommendation will protect Indonesian children from vaccine-preventable diseases. Sari Pediatri 2017;18(5):

Background: Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. Methods:  Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and  World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. Results: The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. Conclusions: The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required.

Latar belakang. Tantangan tatalaksana bayi prematur adalah terjadinya pertumbuhan ekstra uteri terhambat karena kecukupan nutrisi tidak sesuai dengan kebutuhan pertumbuhannya. Tujuan. Mengetahui distribusi terjadinya PEUT menurut asupan jenis nutrisinya. Metode. Penelitian deskriptif retrospektif dari rekam medik bayi prematur dirawat di Rumah Sakit Anak Bunda Harapan Kita pada Juli 2018 – Juli 2019. Hasil. Penelitian ini melibatkan 128 bayi prematur. Jenis asupan nutrisi yang diterima adalah ASI, ASI dengan fortifikasi human milk fortifier, ASI dengan susu formula prematur dan susu formula prematur saja. Bayi prematur yang mengalami PEUT berjumlah 55 (43%). Risiko terjadinya PEUT 1,08 dan 1,78 berturut-turut pada ASI dibandingkan dengan susu formula serta ASI dibandingkan dengan ASI ditambah HMF. Percepatan pertumbuhan tertinggi pada kelompok PEUT yang mendapat ASI dengan fortifikasi HMF (14 gram/kgBB/hari), terendah pada kelompok susu formula prematur (4,6 gram/kgBB/hari). Percepatan kenaikan berat badan hampir sama pada semua bayi prematur dalam kelompok pertumbuhan normal (11,5 – 13,7 gram/kgBB/hari). Kesimpulan. Air susu ibu adalah pilihan terbaik dalam pemberian introduksi nutrisi enteral pada periode kritis perawatan bayi prematur. Jenis nutrisi enteral pada periode pertumbuhan disesuaikan dengan kecukupan kebutuhan masing-masing bayi prematur.

Background Prematurity is still the leading cause of mortality and morbidity in neonates. The premature change of the environment causes stress, which leads to hemodynamic instability. Music therapy may have a positive impact on hemodynamic parameters of preterm infants in the NICU. Objective To evaluate preterm infants’ physiological responses to music therapy in NICU setting. Methods A systematic review was performed in 12 electronic databases from March 2000–April 2018. Our review included all English language publications on parallel or crossover RCTs of music therapy versus standard care or placebo in preterm infants. The outcomes were physiological indicators [heart rate (HR), respiratory rate (RR), and oxygen saturation (SaO2)]. Risk of bias was assessed using the Revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Results The search yielded 20 articles on 1,148 preterm infants of gestational age 28 and 37 weeks, who received recorded music, recorded maternal/male voice or lullaby, or live music interventions in the NICU with intensity of 30–76 dB. Recorded music improved all outcomes in 6, 6, and 4 of 16 studies for HR, RR, and SaO2, respectively. Seven studies used classical music as melodic elements. However, eight studies showed no significant results on all outcomes. Conclusion Despite the finding that music interventions demonstrate promising results in some studies, the variation in quality of the studies, age groups, outcome measures, as well as type and timing of the interventions across the studies make it difficult to draw overall conclusions about the effects of music in preterm infants.