Severe hyperbilirubinemia, which may result in kernicterus, is seen more frequently in low and middle-income countries, such as Indonesia, than in high-income countries. In Indonesia midwives, general practitioners (GPs), and pediatricians are involved in the care of jaundiced newborn infants. It is unknown whether the high incidence of severe hyperbilirubinemia in this country is related to a lack of awareness of existing hyperbilirubinemia guidelines issued by, for example, the World Health Organization, the American Academy of Pediatrics, or the Indonesian Health Ministry, or to a lack of adherence to such guidelines. The aim of this questionnaire study was to assess health professionals’ awareness of existing guidelines and their adherence to these guidelines in daily practice. We handed out a ten-question questionnaire to midwives, GPs, and pediatricians that included questions about the professionals themselves as well as clinical questions. The midwives completed 291 questionnaires, the GPs 206, and the pediatricians 154, all of which we used for our analysis. Almost 30% of the midwives and 23% of the GPs were either unaware of any existing guidelines or they did not adhere to them. Only 54% of the midwives recognized the warning signs of severe hyperbilirubinemia correctly, compared to 68% of the GPs and 89% of the pediatricians. Twenty-eight percent of the midwives and 31% of the GPs indicated that their first follow-up visit was after 72 hours, while 90% of them discharged infants after less than 48 hours after birth. The awareness of and adherence to guidelines for preventing and treating hyperbilirubinemia is low amongst the midwives and GPs in Indonesia. This may be an important contributing factor in the high incidence of severe hyperbilirubinemia in Indonesia.

Objective Determining neonatal and maternal factors that are associated with the incidence of OFP. Methods This study employed a cross-sectional design, in which the participants were identified for clinical variables (sex, gestational age, birth weight, etc.), neonatal morbidity (sepsis, necrotizing enterocolitis (NEC), etc.), and maternal risk factors (premature rupture of membranes, preeclampsia, etc.). The data were analyzed using Chi-square test, independent t -test, and logistic regression test with p < 0.05. Results The birth weight ranged from 800 to 1495 g (1219 ± 225 g), of which 5 newborns (17%) were <1000 g. The gestational age ranged from 27 to 32 weeks, with a mean of 29 ± 1.5 weeks. The signs of OFP were observed in 13 (43%) infants, of which 2 (15%) OFP infants had a birth weight <1000 g. There was significant difference in parenteral nutrition duration ( p = 0.018), onset of vitamin D supplementation ( p = 0.019), and ALP level ( p = 0.012) of infants between the OFP group and the non-OFP group. The variables associated with the incidence of OFP were parenteral nutrition duration >15 days (OR = 5.4; 95% CI 1.120–26.044; p = 0.036), ALP level >500 U/L (OR = 2.889; 95% CI 1.703–4.900; p = 0.014), and PROM (OR = 5.4; 95% CI 1.039–28.533; p = 0.045). Conclusion The lack of phosphate intake, prolonged parenteral nutrition, ALP level >500 U/L, onset of vitamin D supplementation, and premature rupture of membranes are associated with the incidence of OFP.

Background and Objectives: Neonatal sepsis is the third leading cause of neonatal death in the world. The patterns of pathogens causing neonatal sepsis varies in many countries. This study was aimed to identify hematological and microbiological profile of culture-proven neonatal sepsis in Indonesian tertiary neonatal intensive care unit (NICU). Materials and Methods: Hospital based cross-sectional study was conducted in all inborn neonates that were suspected sepsis neonatal over a period of six months from April to September 2019. Complete blood count, c-reactive protein (CRP) and blood culture were examined before antibiotic administration. Statistical analysis were calculated based on Chi-Square’s Test and Mann-Whitney U test and p <0.05 considered significant. Results: One hundred four inborn neonates admitted to NICU and diagnosed with suspected neonatal sepsis were recruited. Culture-proven neonatal sepsis were confirmed in 52 (50%) neonates, 13 (25%) in early-onset neonatal sepsis (EONS) and 39 (75%) in late-onset neonatal sepsis (LONS). The most common abnormal hematological profile were anemia and thrombocytopenia, with amount of 61.5% and 75%, respectively. High CRP only detected in 36.4% and only 18.5% experienced leukopenia. Gram negative bacteria responsible in 75% from total isolated pathogens. Klebsiella pneumoniae accounted for 48.1% followed by coagulase negative staphylococci (CONS) for 17.3% and Enterobacter cloacae for 11.5%. Conclusion: Anemia and thrombocytopenia were the top two hematological profile of culture-proven neonatal sepsis. Most causes of culture-proven neonatal sepsis were Gram negative bacteria and the dominant pathogen was K. pneumoniae.

Aim: Glutamine is needed for optimal cell growth and for the immune system, especially in the enterocytes of gut mucosal immune responses. Low birth weight makes infants susceptible to glutamine depletion because nutrition is limited in the first week of life. To determine the effect of enteral glutamine supplementation on weight gain patterns and fecal secretory immunoglobulin A. Material and Methods:This study is a double-blind, randomized controlled trial. Infants were randomly assigned to the glutamine group and placebo group. The glutamine group was supplemented with glutamine 400 mg/kg/day for 14 days, and placebo group received glucose 400 mg/kg/day for 14 days. The infants were observed for 30 days. Return-to-birth-weight, weight gain velocity, and fecal secretory immunoglobulin A levels were monitored during the study. Results: Thirty-seven low-birth-weight infants were randomly assigned to the glutamine and placebo groups. The glutamine group had a shorter return-to-birth-weight time than the placebo group (8.1±0.9 vs. 11.0±1.6 days) and faster weight gain velocity (20.0±1.8 vs. 15.5±2.2 g/ kg/day) (p<0.001). Secretory immunoglobulin A levels after glutamine supplementation were higher than in the placebo group (0.456±0.057 vs. 0.376±0.035 mg/g) (p<0.001). Levels of secretory immunoglobulin A after treatment in each group were increased. However, there was a significant difference before and after supplementation between the glutamine and placebo groups (0.247±0.024 vs. 0.140±0.016 mg/g) (p<0.001). Conclusion: Enteral glutamine supplementation in low-birth-weight infants accelerates return to birth weight, increases the weight gain velocity, and the levels of fecal secretory immunoglobulin A.

To meet their requirements for bone mineralization, it is recommended that preterm infants receive nutritional support containing calcium and phosphate. There are no clear data on the incidence of osteopenia of prematurity (OFP) in preterm infants without phosphate supplementation. This study aimed to investigate the incidence of OFP in preterm infants without phosphate supplementation and its relationship with the duration of parenteral nutrition (PN). This was a prospective and observational study. This study included 30 infants aged <32 gestational weeks and weighed <1500 g at birth. All infants received PN according to a standard protocol, beginning on day 1 with calcium, without phosphate. Starting from the first day of life, all infants received human milk without fortifiers. Oral vitamin D (400 IU/d) was administered when enteral nutrition reached 100 mL/kg/d. The diagnosis of OFP was based on radiographs that were taken of both wrists. Serum alkaline phosphatase (ALP) was measured 3 times: at the start of PN (ALP 1), at the end of PN (ALP 2), and at discharge or the expected due date (ALP 3). Radiographs were obtained on the same day as ALP 3. The duration of PN was analyzed in the presence of OFP using receiver operating characteristic curve analysis. Among the 30 infants, 13 (43%) were diagnosed with OFP. The duration of PN was significantly longer in the OFP group than in the group without OFP (16 vs 12 days; P < .05). The provision of PN for >15 days significantly increased the risk of OFP (odds ratio, 5.40; 95% confidence interval, 1.12–26.04; P = .035). We found a high incidence of OFP in preterm infants without phosphate supplementation. An association was found between the duration of PN and the incidence of OFP. Further research is needed to prevent the development of osteopenia in preterm infants.

ABSTRAKPendahuluan: Ikterus neonatorum merupakan manifestasi klinis pada neonatus yang ditandai dengan warna kuning pada kulit dan sklera akibat dari akumulasi produksi bilirubin tak terkonjugasi yang berlebih dalam jaringan. Berdasarkan data di RSUD Dr. Soetomo, tepatnya di ruang NICU dari 844 neonatus (46,8%) mengalami ikterus neonatorum. Tujuan penelitian ini adalah untuk menganalisis faktor risiko yang berhubungan dengan kejadian ikterus neonatorum.Metode: Desain penelitian menggunakan analitik observasional dengan pendekatan case control. Sampel yang digunakan sebanyak 84 neonatus. Teknik pengambilan sampel menggunakan sequential sampling. Variabel independen yaitu inkompatibilitas ABO, prematuritas, BBLR, asfiksia, dan riwayat ibu DM, sedangkan variabel dependen adalah ikterus neonatorum. Pengumpulan data berupa data sekunder dari neonatus dan ibu. Analisis data menggunakan Contingency coefficient dengan α=0,05.Hasil: Hasil penelitian menunjukkan 85,7% neonatus yang inkompatibilitas ABO mengalami ikterus neonatorum dan didapatkan nilai p=0,048, OR=6.833. Terdapat 57,4% neonatus yang prematur mengalami ikterus neonatorum dan didapatkan nilai p=0,028, OR=3,077. Terdapat 42,4% BBLR yang mengalami ikterus neonatorum dan didapatkan nilai p=0,032, OR=0,346. Terdapat 60% neonatus yang asfiksia mengalami ikterus neonatorum dan didapatkan nilai p=0,500. Terdapat 85,7% riwayat Ibu DM yang mengalami ikterus neonatorum dan didapatkan nilai p=0,048, OR=6,833.Kesimpulan: Kesimpulan penelitian ini, terdapat hubungan antara inkompatibilitas ABO, prematuritas, BBLR, dan riwayat Ibu DM dan tidak ada hubungan antara asfiksia dengan kejadian ikterus neonatorum di RSUD Dr. Soetomo.

Latar belakang. Upaya menurunkan angka kematian neonatus belum optimal sesuai dengan yang ditargetkan MDG's 2015, yaitu menurunkan angka kematian neonatus menjadi 23/1000 kelahiran hidup. Tujuan. Mengetahui profil kematian neonatus berdasarkan faktor maternal, faktor neonatal, sosio-demografi, keadaan klinis neonatus lahir hidup, usia ≤ 7 hari, sampai 28 hari serta mengetahui penyebab kematian neonatus dini dan neonatus lanjut. Metode. Penelitian deskriptif dilakukan di ruang Intensif Instalasi Rawat Darurat, Gedung Bedah Pusat Terpadu dan ruang Intermediate Neonatal SMF Ilmu Kesehatan Anak RSUD dr. Soetomo. Penelitian dimulai 1 September 2014 sampai 28 Februari 2015. Pengumpulan data menggunakan Lembar Pengumpul Data Perinasia Pusat, setiap neonatus yang dirawat kemudian meninggal dimasukkan kematian neonatus dini maupun lanjut, dicatat keadaan klinis, serta faktor risiko dari ibu dan neonatus. Hasil. Dari 807 kelahiran neonatus didapatkan 101 (12,5%) kematian neonatus terdiri dari 63 (7,8%) kematian neonatus dini dan 38 (4,7%) kematian neonatus lanjut. Kematian neonatus dini dan lanjut ditemukan paling banyak pada neonatus BBL ≥2500 g (34,9% dan 50%) , laki-laki (61,9% dan 71,1%), tunggal (95,2% dan 199%) dan sesuai masa kehamilan (79,4% dan 84,2%) serta usia ibu 20-25 tahun (82,5% dan 71,1%). Sesak (95,2% dan 86,8%) dan sepsis (66,7% dan 63,2%) merupakan keadaaan klinis neonatus pada usia ≤ 7 hari sementara keadaan klinis kematian neonatus lanjut sampai usia 28 hari terutama sesak (100%), sepsis (84,2%), dan pneumonia (52,6%). Kesimpulan. Profil penyebab kematian neonatus yang sering ditemukan adalah sepsis, prematuritas, asfiksia, dan kelainan bawaan. Results. Of the 807 neonatal births, 101 (12.5%) of neonatal deaths were found to be 63 (7.8%) of early neonatal death and 38 (4.7%) of advanced neonatal deaths. Early and advanced neonatal deaths were found to be highest in neonate BBL ≥2500 g (34.9% and 50%), men (61.9% and 71.1%), single (95.2% and 199%) and According to gestation (79.4% and 84.2%) and maternal age 20-25 years (82.5% and 71.1%). Shortness (95.2% and 86.8%) and sepsis (66.7% and 63.2%) were clinical neonates at age ≤7 days while clinical neonatal death to 28 days was mainly congested (100%) , Sepsis (84.2%) and pneumonia (52.6%). Conclusion. Common neonatal death profiles are sepsis, premature, asphyxia, and congenital abnormalities. Sari Pediatri 2017;18(6):

Background: Preeclampsia has been a major problem for obstetric care in Indonesia due to risks of preterm birth and lower Apgar score.Objective: This study is to examine relationships of preeclampsia, preterm births, and Apgar Score. Methods: This used an analytic study with retrospective case-control design in Dr. Soetomo Academic Hospital. A case group was taken by total sampling from medical records of all patients who had preterm delivery in 2017, and a control group of term deliveries was taken by random sampling. Then the data were analysed by using Chi-square test and Fisher's Exact Test. Results: There were 80 samples for each group. 63.75% of patients by age of 20-35 years were who delivered preterm birth, 40.00% had normal BMI, 40.00% were nulliparous, 92.50% did not have history of preterm labour, 50.00% had preeclampsia with severe features, and 46.25% had spontaneous vaginal delivery. Around 47.14% neonates from preeclamptic women were born at 32-<37 weeks gestation, 50.00% were born with low birth weight, 52.86% had the first minute Apgar score <7, and 72.86% had the fifth minutes Apgar score ≥7. The statistical analysis showed a significant relationship between the preeclampsia and the preterm birth (p<0.007; OR=2.54, 95% CI 1.34-4.83). The preeclampsia was also related to lower Apgar score at 1 st minute (p<0.042; OR=2.03, 95% CI 1.07-3.85) and 5 th minute (p<0.046; OR=2.42, 95% CI 1.08-5.41). Preterm neonates born from preeclamptic mothers were related to lower Apgar score at 1 st minute (p<0.002; OR=5.82, 95% CI 1.99-17.02) and 5 th minute (p<0.001; OR 17.31, 95% CI 2.15-139.54). Conclusion: Preeclampsia could make pregnant women at risks of delivering preterm birth and neonates with low Apgar score.