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Background Early onset neonatal sepsis is a potential life-threatening problem for preterm infant. Diagnosing early onset neonatal sepsis is challenging. Difficulties in establishing diagnosis might cause delay definitive treatment. Objective To analyze for potential associations between early onset neonatal sepsis (EONS) risk and mean platelet volume (MPV) as well as immature platelet fraction (IPF) in neonates of 28-36 weeks gestational age. Methods A prospective cohort study was conducted at Dr. Hasan Sadikin General Hospital, Bandung, West Java. Mean platelet volume (MPV) and IPF were evaluated in the first ?6 hours of life and during the 48-72 hours after the first examination. This examination was followed by observation for sepsis development. Double logistic regression analysis was used. Results Of 115 subjects, 45 preterm infants (39.1%) developed early onset neonatal sepsis. The increase in both mean MPV and mean IPF were significantly different (P

Introduction: Congenital syphilis involves any organs with various symptoms, including neurological signs. Neurosyphilis is a severe syphilis complication that can develop at any stage of illness. Case presentation: A 2,520 g male infant was spontaneously born at term from an untreated syphilis mother. Physical examination revealed decreased consciousness, respiratory distress, seizure, but without neurologic abnormality sign. The serum and cerebrospinal fluid Venereal Disease Research Laboratory and Treponemal Pallidum Hemagglutination Assay TPHA tests titters were 1:16 and 1:1,280, respectively. The diagnosis at admission was respiratory failure and neonatal sepsis. The infant was mechanically ventilated and treated with early management of sepsis. Blood culture was sterile later on. Then, the infant was administered intramuscular benzathine penicillin G (50,000 units/kg/dose) for a total of three weeks. The infant's condition was improved during the treatment. Conclusions: There are many challenges associated with screening and monitoring neurosyphilis in congenital syphilis. Congenital syphilis presenting as sepsis is easily misdiagnosed as bacterial sepsis.

Latar belakang. Demam neutropenia pada leukemia limfoblastik akut (LLA) termasuk kegawatan onkologi yang harus mendapatkan tatalaksana segera berupa pemberian antibiotik tanpa menunggu hasil kultur. Saat ini, seftazidim dan sefepim digunakan sebagai monoterapi empiris demam neutropenia di Divisi Hemato-Onkologi Rumah Sakit Hasan Sadikin. Namun, hingga saat ini, efektifitas kedua antibiotik tersebut tidak pernah dinilai.Tujuan. Studi ini bermaksud untuk membandingkan efektifitas seftazidim dan sefepim sebagai monoterapi empiris pada pasien demam neutropenia anak dengan LLA.Metode. Uji acak terkendali dilakukan terhadap pasien LLA anak dengan demam neutropenia pada bulan Maret 2017 hingga Maret 2018 di Rumah sakit Dr Hasan Sadikin Bandung. Seftazidim dan sefepim diberikan secara konsekutif sebagai monoterapi empiris. Turunnya demam, peningkatan absolute neutophyl count (ANC) dan penurunan C-reactive protein (CRP) pada hari ke-3,5, dan 7 digunakan sebagai parameter efektivitas terapi.Hasil. Sebanyak 48 pasien mengikuti penelitian hingga selesai. Seftazidim dan sefepim diberikan masing-masing pada 28 dan 20 pasien. Tidak didapatkan perbedaan bermakna secara statistik pada usia, jenis kelamin dan keparahan penyakit pada kedua grup (p=0,908, p=0,251, p=0,507). Pada kelompok seftazidim terjadi penurunan demam pada hari ke-2, 3-4, 5-6 and >7 ditemukan sebanyak 15 (53,6%), 4 (14,3%), 1 (3,6%), 8 (28,6%) pasien, sedangkan pada kelompok sefepim masing-masing ditemukan pada 12 (60%), 4 (20%), 0, dan 4 (20%) pasien (p=0,638, p=0,442, p=0,583 p=0,449). Nilai rata-rata ANC pada awal 315,4 (154,2) pada grup seftazidim dan 276,2 (292,3) pada grup sefepim (p=0,778). Sebagian besar pasien pada kedua grup mencapai ANC>500 pada hari 5 (x=773 (1603,8) dan x=840 (979,8), (p=0,664). Nilai CRP awal mengalami sedikit peningkatan dari nilai normal, tidak berbeda signifikan secara statistik (x=8,80 (6,28) CI 0,3−28,1 dan 13,62 (10,57) CI 0,5−35,3; p=0,193). Nilai CRP menurun pada kedua grup pada hari ke-7 (x=7,84 (6,82), CI 0,5−25 dan 8,15 (9,39) CI 0,1−36,7; p=0,618)Kesimpulan. Penelitian ini menunjukan bahwa seftazidim dan sefepim memiliki efektifitas yang sama sebagai monoterapi empiris pada pasien LLA anak dengan demam neutropenia. Pemilihan antibiotik dengan mempertimbangkan ketersediaan obat, biaya, dan efek samping.

Respiratory distress syndrome (RDS) remains a major cause of mortality and morbidity among preterm infants, especially in developing countries. Up to 40% of those infants who do survive RDS may develop bronchopulmonary dysplasia (BPD). The aim of this study is to find out the relationship between serum IL-6 levels and BPD in preterm infants at 28–34 weeks’ gestation with RDS. A cross sectional study was carried out in Department of Child Health Hasan Sadikin General Hospital Bandung in June–September 2018. Serum samples collected within 6–12 hours after birth. Respiratory distress syndrome was diagnosed on the basis of radiographic findings, respiratory distress, and an increasing oxygen requirement. Bronchopulmonary dysplasia was diagnosed based on the requirement of supplemented oxygen by at least 28 days at 36 weeks of post menstrual age (PMA). Serum IL-6 levels were measured using enzyme‑linked immunosorbent assay (ELISA). Data was analyzed using logistic regression. Sixty-eight neonates were studied. Ten developed BPD and 58 were not. Based on logistic regression showed that an increase of 1 pg/mL of serum IL-6 levels from the normal values examined at 6–12 hours after birth in preterm infants at 28–34 weeks’ gestation with RDS would increase log odds of BDP by 0.005 (p = 0.031) after adjustment for confounding factors of birth weight and gestational age. Increased in serum IL-6 levels within 6–12 hours after birth in preterm infants at 28–34 weeks’ gestation with RDS was associated with an increased risk of BPD.

Background The main parameter used to determine renal function in newborns is serum creatinine. Fetal growth restriction during pregnancy can cause the baby to be born small-for-gestational age. Serum creatinine levels in newborns are affected by muscle mass, gestational age, as well as the number of nephrons and kidney development. Objective To determine the usefulness of serum creatinine levels as an estimate of glomerular filtration rate in small-for-gestational age and appropriate-for-gestational age newborns. Methods This cross-sectional study was conducted in May-June 2018. The subjects were full term newborn infants consisting of small-for-gestational age and appropriate-for-gestational age groups (16 subjects each), born in Bandung City Regional Public Hospital. Serum creatinine level was tested by the Jaffe method. The estimated glomerular filtration rate was calculated based on serum creatinine, infant height, and a proportionality constant using the original Schwartz method, eGFR = [k * height]/SCr. Results Of 32 subjects, there were 17 spontaneous deliveries, 14 males, and 18 females. Mean serum creatinine levels in the small-for-gestational age and appropriate-for-gestational age groups were 0.94 (SD 0.36; 95%CI 0.75 to 1.14) mg/dL and 0.69 (SD 0.18; 95%CI 0.60 to 0.79) mg/dL (mean difference 0.25; 95%CI 0.05 to 0.46; P=0.009), respectively. The median estimated glomerular filtration rates (eGFR) in the small-for-gestational age and appropriate-for-gestational age groups were 25.69 mL/min/1.73m2 and 30.10 mL/min/1.73m2 (median difference 4.42; 95%CI 2.04 to 15.8; P=0.008), respectively. There was a weak negative correlation between serum creatinine and birth weight (r=–0.344; P=0.027). Conclusion Serum creatinine levels in small-for-gestational age newborns are significantly higher than in appropriate-for-gestational age newborns.

Prematurity and low birth weight are some of the causes of neonatal death and significant health problem. This study aimed to determine the influence of gestational age and birth weight on neonatal mortality at the Al Islam Hospital Bandung in 2015–2019. It was a case-control retrospective observational analysis using medical records of the Al Islam Bandung Hospital from January 1, 2015, to December 31, 2019. The inclusion criteria for infants were born alive. Exclusion criteria had severe congenital abnormalities and gestational age

Background : Appropriate treatment on neonatal bacterial sepsis is important based on the exact etiology to prevent bacterial resistance, but bacterial identification using blood cultures requires a considerable time. The newest data of various bacteria and their sensitivity can be used to assist empirical antibiotics usage. This study was conducted to identify bacterial profile that caused neonatal sepsis and their sensitivity to antibiotics at Dr. Hasan Sadikin General Hospital Bandung.. Methods : A total of 275 neonatal sepsis cases and 288 blood cultures results were collected from a database provided by Dr. Hasan Sadikin General Hospital Bandung during the period of July 2011 toDecember 2012 (three semesters). Etiology of the bacteria and antimicrobial sensitivity profile data were taken from positive bacteria results. Then, these variables were processed using the descriptive method and classified by semester Result : The most common bacteria that caused neonatal sepsis in the second semester 2011 is Serratia marescens, the first semester 2012 was Enterobacter aerogenes and in the second semester 2012 was Burkholderia cepacia. The most sensitive antibiotics were piperacillin tazobactam, cefepime, meropenem and amikacin in all three semesters, gentamycin in the second semester 2011 and 2012, and amoxicillin clavulanic in the second semester 2012. Conclusions : Bacterial and antimicrobial sensitivity profile is varied in every semester. Keywords : Antimicrobial sensitivity profile, bacterial profile, neonatal sepsis DOI: 10.15850/amj.v4n2.1072

Hyperbilirubinemia in the newborn occurs more frequently in Indonesia. Therefore, it is important that pediatric residents in Indonesia acquire adequate knowledge of hyperbilirubinemia management. This study aims to determine the pediatric residents' knowledge on hyperbilirubinemia management, whether they follow recommended guidelines, and whether differences exist between five large Indonesian teaching hospitals. We handed out a 25-question questionnaire on hyperbilirubinemia management to pediatric residents at five teaching hospitals. A total of 250 questionnaires were filled in completely, ranging from 14 to 113 respondents per hospital. Approximately 76% of the respondents used the Kramer score to recognize neonatal jaundice. Twenty-four percent correctly plotted the total serum bilirubin levels (TSB) on the phototherapy (PT) nomograms provided by the American Academy of Pediatrics (AAP) and the National Institute for Health and Care Excellence (NICE) for full-term and nearly full-term infants. Regarding preterm infants, Hyperbilirubinemia, newborn infants, knowledge, residents, guidelines.

Hyperbilirubinemia in the newborn occurs more frequently in Indonesia. Therefore, it is important that pediatric residents in Indonesia acquire adequate knowledge of hyperbilirubinemia management. This study aims to determine the pediatric residents' knowledge on hyperbilirubinemia management, whether they follow recommended guidelines, and whether differences exist between five large Indonesian teaching hospitals. We handed out a 25-question questionnaire on hyperbilirubinemia management to pediatric residents at five teaching hospitals. A total of 250 questionnaires were filled in completely, ranging from 14 to 113 respondents per hospital. Approximately 76% of the respondents used the Kramer score to recognize neonatal jaundice. Twenty-four percent correctly plotted the total serum bilirubin levels (TSB) on the phototherapy (PT) nomograms provided by the American Academy of Pediatrics (AAP) and the National Institute for Health and Care Excellence (NICE) for full-term and nearly full-term infants. Regarding preterm infants35 weeks' gestational age, 66% of the respondents plotted TSB levels on the AAP nomogram, although this nomogram doesn't apply to this category of infants. Seventy percent of residents knew when to perform an exchange transfusion whereas 27% used a fixed bilirubin cut-off value of 20 mg/dL. Besides PT, 25% reported using additional pharmaceutical treatments, included albumin, phenobarbitone, ursodeoxycholic acid and immunoglobulins, while 47% of the respondents used sunlight therapy, as alternative treatment. The limited knowledge of the pediatric residents could be one factor for the higher incidence of severe hyperbilirubinemia and its sequelae. The limited knowledge of the residents raises doubts about the knowledge of the supervisors and the training of the residents since pediatric residents receive training from their supervisors.

Background The morbidity and mortality of hyaline membrane dis- ease (HMD) are quite high due to delayed diagnosis and intervention. Commonly, HMD occurs in preterm infants with surfactant deficiency because of lung immaturity. Lung maturity test could be performed using biochemical, biophysical, and amniotic fluid turbidity test. Objective To find out HMD prevalence and the value of shake test and lamellar body concentration in diagnosing HMD in preterm infants. Methods This was a cross-sectional study carried out at Hasan Sadikin Hospital Bandung on preterm infants born during October- December 2001. The shake test was performed using gastric fluid and amniotic fluid while the lamellar body concentration was per- formed using amniotic fluid. Results During the 3-month period, 571 infants were born, of 64 (11.2%) preterm infants, only 41 (64%) fulfilled the inclusion crite- ria; among those preterm infants, 14 (34%) suffered from respira- tory distress and 7 suffered from HMD (prevalence 17%). All HMD cases occurred in infants less than 32 weeks for gestational age. In 7 preterm infants with HMD, the shake test of gastric fluid ob- tained by lavage showed negative results in 3 and +1 in 4 infants; while the shake test of amniotic fluid revealed negative result in 5 and +1 in 2 infants. Lamellar body concentration of amniotic fluid was ≤18,000/ml in all HMD infants. Among three infants less than 32 weeks for gestational age who did not suffer from HMD, +1 shake test of gastric fluid was found in 2 infants and +2 in 1 infant; while shake test of amniotic fluid showed negative result in 1 infant and +1 in 2; the lamellar body concentration of amniotic fluid was ≤18,000/ml in 2 infants and >18,000/ml in 1 infant. Conclusions We concluded that HMD occurred in 17% of preterm infants. The shake test of gastric and amniotic fluids revealed nega- tive or +1 results whereas lamellar body concentration had value of less than or equal to 18,000/mL. More extensive studies are warranted to assess the validity (sensitivity, specificity and predic- tive values) of these measurements

Background : Gestational age is required to determine diagnosis and optimal management of newborns. The gold standard for gestational age determination is the first day of last menstrual period (LMP). However, not all mothers remember their LMP. Another method for gestational age determination after birth is the New Ballard Score (NBS). This method measures gestational age using two main components, namely neorumuscular and physical maturity. In premature infants, surfactant deficiency leads to hypoxia which eventually leads to neuromuscular disorders. This situation may cause younger gestational age estimation when using NBS. The objective of this study was to analyze the conformity between NBS and LMP in determining gestational age in newborns with respiratory distress syndrome (RDS). Methods : A cross-sectional study was conducted on 35 newborns with RDS that were recorded in 2012 database in Dr. Hasan Sadikin General Hospital Bandung. Data on the date of birth, LMP, NBS soon after birth, sex, birth weight, type of delivery and diagnosis were collected and analyzed statistically using Wilcoxon test. Results : The study showed that there was a significant difference (p

In Indonesia, newborn screening is not yet a policy, and the incidence of preventable causes of mental retardation detected by newborn screening is not known. Congenital hypothyroidism (CH) is not infrequent. Without a screening program, unrecognized CH patients were neglected for years. Since May 1999, the International Atomic Energy Agency (IAEA) has assisted in starting a CH Newborn Screening Project to estimate the local incidence of CH and to evaluate the problems associated with the screening. In June 2000, a pilot study was conducted using primary TSH measurement, supplemented by T4 in infants with elevated TSH. The target was to screen 12,000 newborn infants, using cord blood serum taken at birth, or a heel prick between 2 to 6 days of age. Between June 2000 and February 2001, 3,534 neonates born in 4 hospitals were screened using cord blood serum taken at birth (recall rate 3.3%). From March 2001 onwards, the heel prick method was used and participating hospitals increased from 4 to 7. Using this approach, until August 2001, 3,309 samples were analysed and the recall rate was much lower (0.64%). The number of unsatisfactory samples was relatively high due to an unstable process of blood collection. Parental refusal and low acceptance of screening among policy makers resulted from lack of awareness of the dangers of CH, and the screening program was not considered a health priority. Recall of patients after screening was a major barrier, with problems in tracking patients arising from urbanization and a high rate of relocation. To advance the CH screening program nationwide, infrastructure must be improved along with the recall system, and education as well as information campaigns for parents and medical professionals must be intensified. The Department of Health must be persuaded to give a national mandate.