Background Neonatal sepsis is one of the major causes of mortality and long term morbidity in neonates, particularly in premature and low birth weight infants. The incidence of neonatal sepsis varies from 1 to 4 in 1000 live births in developed countries and 10 to 50 in 1000 live births in developing countries. The mortality rate of neonatal sepsis remains high, especially in developing countries.Objective To describe the incidence, mortality rate, and factors associated 'With mortality in neonatal sepsis in Sanglah Hospital, Denpasar.Methods A retrospective, cohort study was conducted in the Perinatology Ward, Department of Child Health, Sanglah Hospital, Denpasar, Bali from January to December 2008. One hundred thirty􀁄eight patients 'With neonatal sepsis were enrolled in this study. Patients' characteristic data were collected including sex, mode of delivery (spontaneous, non􀁄spontaneous), condition at birth (vigorous, asphyxic), gestational age (premature, full tenn), birth weight «2500 grams, > 2500 grams), and sepsis classifica􀁄tion (early onset sepsis, late onset sepsis). Outcomes were grouped into alive and dead.Results A total of 138 cases of neonatal sepsis were reviewed, 59.4% of whom were boys, 63.0% spontaneously delivered,39.1 % asphyxic, 53.6% 'With low birth weight, 50.7% premature, and84.8% with early onset sepsis. The incidence of neonatal sepsis was 5% of babies admitted, 'With a mortality rate of 28.3%. Low birth weight and prematurity were significantly associated withmortality in neonatal sepsis (RR8.4, 95% CI 2.4 to 29.0, P = 0.001 and RR3.4, 95% ClI.O to 11.0, P 􀀂 0.042, respectively). Conclusion The incidence of neonatal sepsis in Sanglah Hospital was 5% of babies admitted, with a mortality rate of 28.3%. Low birth weight and prematurity were significantly associated with mortality in neonatal sepsis. 2011;51:144-8].

Background In Indonesia, the infant mortality rate in 2001 was 50 per 1000 live births, with 34.7% due to perinatal death. This perinatal death was associated with low birth weight (LBW) newborn, which was caused by prematurity, infection, birth asphyxia, hypothermia, and inadequate breast feeding. In developing countries, lack of facilities of LBW infant care leads to the utilization of kangaroo method as care to prevent hypothermia in LBW newborn.Objective To evaluate the differences of hypothermia event andduration of birth weight regain in LBW newborns between earlykangaroo care (EKC) and conventional care (CC).Methods This was an open label randomized controlled trial. The1500-2250 g LBW newborns who were born in Sanglah Hospitalwere randomized to EKC and CC groups.Results Hypothermia events were found more often in CC groupthan EKC group (RR=0.645, 90% CI 0.45 to 0.92, P=0.05). Thisdifference was influenced by breast feeding frequency. Duration of birth weight regain in EKC group (median 5 days (SE=0.31, 90% CI 4.49 to 5.51) was shorter than CC group (median 6 days (SE=0.52, 90% CI 5.15 to 6.85), but this difference wasn't statistically significant (P=0.40). Percentage of birth weight decrease, breastfeeding frequency, and hyperbilirubinemia events that needed phototheraphy were associated with the duration of birth weight increase.Conclusion EKC helps to decrease the incidence of hypothermiaevents, but fails to shorten duration of birth weight increase.Percentage of birth weight decrease, breast-feeding frequency, and hyperbilirunemia events that need phototheraphy are associated with the duration of birth weight increase in LBW newborn.

Background: Neonatal sepsis is a common occurrence in our part of the world, characterized by signs and symptoms of bacterial infection during first 28 days of life. Diagnosis of neonatal sepsis may be difficult as the early signs of sepsis may be subtle and not specific. Objective: This study was to determine the accuracy of a simple and cost effective hematological scoring system (HSS) in the early diagnosis of neonatal sepsis using blood culture as a gold standard. Methods: The cross-sectional study enrolled 62 neonates who were clinically suspected of sepsis. The neonatal hematological parameter was measured in all cases. All subjects were analyzed according to HSS. Blood culture was taken for the gold standard of proven sepsis. Results: Proven sepsis confirmed by blood culture was found in 34% of neonates. The HSS was found to have a sensitivity of 80.9%, specificity of 92.7%, positive predictive value of 85%, negative predictive value of 90.5%, positive likelihood ratio of 11.1, negative likelihood ratio of 0.2, and accuracy of 88.7%. Conclusion:The HSS is a simple cost effective tool that can be used to early diagnose of neonatal sepsis.

Background Neonatal mortality, which is largely caused by severe illness, is the biggest contributor to overall infant mortality. The World Health Organization (WHO) estimated that 4 million neonates die yearly worldwide, often due to severe infection and organ system immaturity. Neonates with severe illness require treatment in the neonatal intensive care unit (NICU), in which a reliable assessment tool for illness severity is needed to guide intensive care requirements and prognosis. Neonatal disease severity scoring systems have been developed, including Score for Neonatal Acute Physiology and Perinatal Extension II (SNAppE II), but it has never been validated in our setting. Objective To study the prognostic value of SNAppE II as a predictor of neonatal mortality in Sanglah Hospital, Denpasar, Indonesia. Methods This prospective cohort study was conducted in the NICU of Sanglah Hospital, Denpasar from November 2014 to February 2015. All neonates, except those with congenital anomaly, were observed during the first 12 hours of admission and their outcomes upon discharge from the NICU was recorded. We assessed the SNAppE II cut-off point to predict neonatal mortality. The calibration of SNAppE II was done using the HosmerLemeshow goodness-of-fit test, and discrimination of SNAppE II was determined from the receiver-operator characteristic (ROC) curve and area under the curve (AUC) value calculation. Results During the period of study, 63 children were eligible, but 5 were excluded because of major congenital abnormalities. The SNAppE II optimum cut-off point of 37 gave a high probability of mortality and the ROC showed an AUC of 0.92 (95%CI 0.85 to 0.99). The Hosmer-Lemeshow goodness-of-fit test showed a good calibration with p=1.0 Conclusion The SNAppE II has a good predictive ability for neonatal mortality in Sanglah Hospital, Denpasar, Indonesia.[Paediatr Indones. 2016;56:257-61.

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