Infections are responsible for significant mortality and long-term morbidity for infants in the neonatal intensive care unit (NICU). We are reporting an outbreak of neonatal cellulites and sepsis caused by a unique species of Salmonella (Salmonella worthington). We also provide the steps that were initiated in order to control such an unusual epidemic. Our aim is to increase awareness of the community to this rare but serious infection with its unique presentation, and re-emphasize the importance of hand hygiene in the control of infections. This is a retrospective observational study. Data on septicemia and cellulites were collected during January-October 2002 and January-October 2003 in the NICU at Dr. Soetomo hospital. A total of 24 infants with cellulites-septicemia were identified during the period of January-October 2002. Of them 12 cases died. Blood culture of all cases grew S. worthington. All infections occurred during the first 3 days of life. Only one case was identified in the period of January-October 2003; this infant survived. All of the isolates recovered were sensitive to amikacin, chloramphenicol, and meropenem, while resistant to ampicillin. Two third of the cases were sensitive to cefopime 66% Environmental cultures recovered S. worthington from hands of healthcare providers. Outbreaks of S. worthington in NICU have high case-fatality rate, but can be efficiently controlled with hand washing or hand spraying. Cellulites in the newborn are a warning sign for infection with S. worthington.
Background Scoring systems which quantify initial risks have animportant role in aiding execution of optimum health services by pre-dicting morbidity and mortality. One of these is the score for neonatalacute physiology perinatal extention (SNAPPE), developed byRichardson in 1993 and simplified in 2001. It is derived of 6 variablesfrom the physical and laboratory observation within the first 12 hoursof admission, and 3 variables of perinatal risks of mortality.Objectives To assess the validity of SNAPPE II in predicting mor-tality at neonatal intensive care unit (NICU), Soetomo Hospital,Surabaya. The study was also undertaken to evolve the best cut-offscore for predicting mortality.Methods Eighty newborns were admitted during a four-month periodand were evaluated with the investigations as required for the specifi-cations of SNAPPE II. Neonates admitted >48 hours of age or afterhaving been discharged, who were moved to lower newborn care <24hours and those who were discharged on request were excluded. Re-ceiver operating characteristic curve (ROC) were constructed to derivethe best cut-off score with Kappa and McNemar Test.Results Twenty eight (35%) neonates died during the study, 22(82%) of them died within the first six days. The mean SNAPPE IIscore was 26.3+19.84 (range 0-81). SNAPPE II score of thenonsurvivors was significantly higher than the survivors(42.75+18.59 vs 17.4+14.05; P=0.0001). SNAPPE II had a goodperformance in predicting overall mortality and the first-6-daysmortality, with area under the ROC 0.863 and 0.889. The best cut-off score for predicting mortality was 30 with sensitivity 81.8%,specificity 76.9%, positive predictive value 60.0% and negativepredictive value 90.0%.Conclusions SNAPPE II is a measurement of illness severity whichcorrelates well with neonatal mortality at NICU, Soetomo Hospital.The score of more than 30 is associated with higher mortality
Latar belakang. Kelahiran kurang bulan dan preeklamsia berat merupakan faktor risiko penyimpangan perkembangan. Deteksi dini perkembangan sangat penting. Hal tersebut memberi peluang intervensi awal dengan hasil optimal. Pemeriksaan ultrasonografi kepala mempunyai keterbatasan dalam memprediksi outcome perkembangan bayi kurang bulan. Pemeriksaan general movementslebih murah dan dapat digunakan di negara berkembang dengan sarana diagnostik yang terbatas. Penambahan pemeriksaan kualitas general movementsdapat meningkatkan nilai prediksi dibandingkan dengan pemeriksaan ultrasonografi kepala saja. Tujuan. Melakukan analisis nilai prediksi ultrasonografi kepala, pemeriksaan general movements,dan kombinasi keduanya untuk memprediksi status perkembangan bayi kurang bulan.Metode. Studi longitudinal diagnostik, dilakukan di RS Dr Soetomo Surabaya pada bulan Desember 2009 sampai Juni 2010. Pemeriksaan ultrasonografi kepala dilakukan pada usia 2 minggu pertama, general movementspada usia 52 minggu gestasi, dan status perkembangan dievaluasi dengan Denver II pada usia 4 bulan usia koreksi. Data dianalisis menggunakan SPSS 12.0. Persetujuan kelaikan etik dikeluarkan oleh RS Dr Soetomo, Surabaya. Hasil.Delapan belas bayi kurang bulan (<37 minggu gestasi) mengikuti penelitian.mempunyai nilai sensitivitas (SN), spesivisitas (SP), nilai prediksi positif (NPP), nilai prediksi negatif (NPN), dan likelyhood ratio(LR) ultrasonografi kepala (0,2;1,0;1,0;1;0,50;5,0), sedangkan general movements (0,90;0,75;0,82;0,86;3,60). Kombinasi kedua pemeriksaan tersebut mempunyai nilai prediksi (0,80;0,50;0,67;0,67;1,60). Kesimpulan.Penambahan pemeriksaan kualitas general movementsdapat meningkatkan sensitivitas outcomeperkembangan bayi kurang bulan dibandingkan hanya pemeriksaan ultrasonografi kepala saja.
Kata kunci: gangguan perkembangan, gerakan spontan, metode Prechtl
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