Latar belakang. Duktus arteriosus persisten (DAP) pada bayi kurang bulan (BKB) dapat menimbulkan gangguan hemodinamika sehingga perlu segera ditutup. Salah satu cara penutupan adalah dengan obat penghambat siklooksigenase (COX), khususnya ibuprofen. Mengingat efek samping yang ditimbulkan ibuprofen, parasetamol yang bekerja menghambat peroksidase mulai diperkenalkan sebagai alternatif dengan efektifitas setara dan efek samping yang minimal. Tujuan. Membandingkan efektifitas dan keamanan antara parasetamol intravena dan ibuprofen oral untuk penutupan DAP pada BKB. Metode. Uji klinis terbuka, acak terkontrol pada bayi dengan usia gestasi ≤37 minggu yang dikonfirmasi DAP dengan menggunakan ekokardiografi. Dilakukan randomisasi blok untuk menerima parasetamol intravena atau ibuprofen oral. Hasil utama yang dinilai adalah respon terapi penutupan duktus arteriosus (DA), efek samping yang timbul, dan kejadian reopening. Hasil. Penutupan DAP terjadi pada 33 dari 36 (91,6%) BKB yang mendapat parasetamol intravena dan 29 dari 40 (72,5%) yang mendapat ibuprofen oral (p=0,03). Pada kelompok ibuprofen, efek samping yang timbul berupa trombositopenia (28,5%) dan perdarahan saluran cerna (25,7%), sedangkan pada kelompok parasetamol intravena tidak dijumpai efek samping. Reopening terjadi hanya pada satu bayi di kelompok ibuprofen oral. Kesimpulan. Parasetamol intravena lebih efektif dan lebih aman dibandingkan ibuprofen oral untuk penutupan DAP pada BKB. Sari Pediatri 2015;17(4):279-84. Kata kunci: duktus arteriosus persisten, bayi kurang bulan, parasetamol intravena, ibuprofen oral The Comparison of Effectiveness and Safety between Intravenous Paracetamol and Oral Ibuprofen for Persistent Ductus Arteriosus in Preterm InfantsOktaviliana Sari,* Ria Nova,* Herman Bermawi,* Erial Bahar** Background. Persistent ductus arteriosus (PDA) in preterm infants can cause hemodynamic disturbances, that it must be closed immediately. PDA can be closed using cyclooxygenase inhibitor agents (COX), mainly ibuprofen. Because the side effects, intravenous paracetamol, a peroxidase inhibitor was recently introduced as an alternative terapy for ductal closure with similar effectiveness and minimal side effects. Objectives. To compare the effectiveness and safety of intravenous paracetamol and oral ibuprofen for PDA closure in preterm infants.Methods. An open label randomized controlled study was done in seventy six preterm infants (gestational age ≤37 weeks) with echocardiographically confirmed PDA. Infant were randomly assigned to received either intravenous paracetamol or oral ibuprofen. The main outcome was the success of ductal closure and secondary outcomes were adverse effects and reopening. Results. PDA closure was achieved in 33 of 36 (91.6%) infants receiving intravenous paracetamol and in 29 of 40 (72.5%) infants receiving oral ibuprofen (p=0.03). In the ibuprofen group, thrombocytopenia and gastrointestinal bleeding were found in 28.5% and 25.7% infants respectively, while in the paracetamol group, no adverse effect was observed. There ...
Background The gold standard for diagnosis of neonatal jaundice is total serum bilirubin (TSB) measurement. This method, however, is invasive, painful, and costly in terms of workload, time, and money. Moreover, repeated blood sampling may lead to significant blood loss, which is of particular concern in preterm infants. To overcome these drawbacks, non-invasive methods of bilirubin measurement have been proposed. Transcutaneous bilirubinometry (TcB) determines the yellowness of the subcutaneous tissue of a newborn infant by measuring the difference between optical densities for light in the blue and green wavelength regions. Objective To evaluate the accuracy of transcutaneous bilirubinometry for estimating TSB levels in neonatal jaundice. Methods Subjects were infants aged < 28 days with jaundice who had never been treated with phototherapy or exchange transfusion. The study was done from February to July 2016 in Mohammad Hoesin Hospital. Subjects underwent transcutaneous bilirubin (TcB) and TSB assays, with a maximum interval of 15 minutes between tests. Results One hundred fifty patients were included in this study. The TcB values > 5 mg/dL were correlated to TSB > 5 mg/dL, with 100% sensitivity and 83.3% specificity. This cut-off point was obtained from a receiver-operator characteristic (ROC) curve with AUC 99.3% (95%CI 97.9 to 100%; P< 0.001).The correlation coefficients (r) for TSB and TcB measurements on the forehead were 0.897 (P<0.001). Conclusion Transcutaneous bilirubinometry can be used to accurately estimate TSB levels in neonatal jaundice, and may be useful in clinical practice as a non-invasive method to reduce blood sampling. [Paediatr Indones.
Beberapa penelitian terakhir melaporkan bahwa sensitifitas kuman terhadap ampisilin dan gentamisin yang lazim digunakan sebagai terapi sepsis neonatorum telah menurun sehingga digunakan sefalosporin generasi ketiga sebagai alternatif. Dilakukan penelitian uji klinik acak tersamar ganda terhadap 50 kasus tersangka sepsis neonatorum dengan tujuan untuk menilai perbandingan efektivitas kombinasi ampisilin dan gentamisin dengan seftazidim. Subyek penelitian adalah seluruh pasien yang dicurigai sepsis neonatorum dan memenuhi persyaratan penelitian. Data diperoleh dari anamnesis, pemeriksaan fisis dan laboratorium. Analisa statistik menggunakan t-test, chi square test dan Kruskal_Wallis, berdasarkan jenis data yang akan diolah. Dari hasil penelitian kelompok yang mendapat kombinasi ampisilin dan gentamisin 8,3% memberikan respons klinis baik (dengan 95% confidence limit: 1-27%) dan 91,7% gagal. Sedangkan pada kelompok seftazidim 88,5% memberikan respons baik (dengan 95% confidence limit: 69,8-97,6%) dan 11,5% gagal. Terdapat perbedaan yang sangat bermakna antara hasil pengobatan kombinasi ampisilin dan gentamisin dengan seftazidim. Hasil pengobatan seftazidim jauh lebih baik dibanding dengan kombinasi ampisilin dan gentamisin, RR 7,9 artinya risiko gagal kelompok kombinasi ampisilin dan gentamisin 7,9 kali lebih besar daripada kelompok seftazidim.Kata kunci: sepsis neonatorum, seftazidim.
Background Given the high rates of mortality and morbidity in neonatal sepsis, rapid, easy-to-use, and inexpensive biomarkers with high sensitivity and specificity are needed to diagnose neonatal sepsis. Procalcitonin is often used as a predictor in identifying neonatal sepsis, but C-reactive protein (CRP) and micro-erythrocte sedimentation rate (m-ESR) may also be valid biomarkers of neonatal sepsis. Objective To compare the accuracy of procalcitonin to the combination of CRP and m-ESR, as well as to find cut-off points for the three tests, in diagnosing bacterial neonatal sepsis. Methods Subjects were neonates hospitalized from July to October 2016 in Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, with sepsis at clinical presentation and healthy neonates with sepsis risk factors. All subjects underwent complete blood counts, CRP, m-ESR, blood cultures, and procalcitonin examinations. Results Ninety-four infants were included, of whom 26 had proven sepsis. The combined values of m-ESR and CRP had 85% sensitivity, 59% specificity, and 66% accuracy. A procalcitonin (PCT) cut-off point of 9.7 ng/mL showed 100% sensitivity, 96% specificity, and 97% accuracy level, which were significantly higher than the combined values of m-ESR and CRP. ConclusionThe combined values of m-ESR (13 mm/hour) -CRP (17 mg/dL) and procalcitonin alone (2 ng/mL) are both valid for the diagnosis of bacterial neonatal sepsis, but the accuracy of procalcitonin at 9.7 ng/mL is significantly greater.
Latar belakang. Kuman penyebab sepsis neonatorum makin banyak resisten terhadap seftazidim, yangmerupakan monoterapi pilihan. Sefepim dapat menjadi alternatif atau lini kedua karena spektrum lebihluas dan potensi resistensi lebih rendah.Tujuan. Membandingkan efektifitas sefepim dan seftazidim dalam pengobatan sepsis neonatorum.Metode. Dilakukan uji klinis acak tersamar tunggal terhadap 53 neonatus dengan kemungkinanbesar sepsis. Dibandingkan kesembuhan klinis antara neonatus yang mendapat sefepim dan seftazidimserta sensitivitas in-vitro obat. Analisis terpisah dilakukan terhadap 36 subkelompok subjek biakanpositif.Hasil. Angka kesembuhan kelompok sefepim adalah 84% (21/25), sedangkan pada kelompok seftazidim78,6% (22/28) (p=0,441). Pada subkelompok biakan positif ditemukan proporsi kesembuhan sama,yaitu masing-masing 14 dari 18 (77,8%; p=0,655). Pada uji sensitivitas in-vitro terhadap 36 isolat, yangsensitif terhadap sefepim dan seftazidim masing-masing 69,4% dan 50% (p=0,016).Kesimpulan. Meski pola sensitivitas kuman terhadap sefepim lebih baik, angka kesembuhan klinis tidakberbeda. Sefepim belum dapat direkomendasikan di atas seftazidim dalam pengobatan sepsis neonatorum.
Background Given the high rates of mortality and morbidity in neonatal sepsis, rapid, easy-to-use, and inexpensive biomarkers with high sensitivity and specificity are needed to diagnose neonatal sepsis. Procalcitonin is often used as a predictor in identifying neonatal sepsis, but C-reactive protein (CRP) and micro-erythrocte sedimentation rate (m-ESR) may also be valid biomarkers of neonatal sepsis. Objective To compare the accuracy of procalcitonin to the combination of CRP and m-ESR, as well as to find cut-off points for the three tests, in diagnosing bacterial neonatal sepsis. Methods Subjects were neonates hospitalized from July to October 2016 in Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, with sepsis at clinical presentation and healthy neonates with sepsis risk factors. All subjects underwent complete blood counts, CRP, m-ESR, blood cultures, and procalcitonin examinations. Results Ninety-four infants were included, of whom 26 had proven sepsis. The combined values of m-ESR and CRP had 85% sensitivity, 59% specificity, and 66% accuracy. A procalcitonin (PCT) cut-off point of 9.7 ng/mL showed 100% sensitivity, 96% specificity, and 97% accuracy level, which were significantly higher than the combined values of m-ESR and CRP. ConclusionThe combined values of m-ESR (13 mm/hour) -CRP (17 mg/dL) and procalcitonin alone (2 ng/mL) are both valid for the diagnosis of bacterial neonatal sepsis, but the accuracy of procalcitonin at 9.7 ng/mL is significantly greater.
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