ABSTRAKKejadian ikterus pada bayi aterm di beberapa rumah sakit di Indonesia bervariasi antara 13,7-85%. Jenis ikterus patologis dapat menyebabkan hiperbilirubinemia. Penelitian ini dilakukan untuk mengetahui pengaruh karakter demografi, usia klinis dan laboratorium terhadap bayi hiperbilirubinemia yang dirawat di rumah sakit umum Dr. Saiful Anwar, Malang. Penelitian ini merupakan penelitian observasional retrospektif. Data-data diambil dari rekam medis sejak Januari 2010-Oktober 2010. Dari analisis regresi multiple dengan confident interval 95% (CI 95%) dan p<0,05, ada empat faktor signifikan yang mempengaruhi tingkat bilirubin. Faktor-faktor yang berpengaruh adalah instrumen persalinan (p=0,006), asfiksia (p=0,013), kadar hemoglobin (p=0,047), dan ASI eksklusif (p=0,049). Asfiksia, persalinan dengan instrumen, ASI eksklusif, dan tingkat hemoglobin merupakan faktor penting yang mempengaruhi tingkat bilirubin pada neonatus

Background Severe hyperbilirubinemia is more frequent in low- and middle-income countries such as Indonesia than in high-income countries. One of the contributing factors might be the lack of adherence to existing guidelines on the diagnosis and treatment of hyperbilirubinemia. We developed a new national guideline for hyperbilirubinemia management in Indonesia. To help healthcare workers use this guideline, a web-based decision support tool application may improve both the adherence to the guideline and the care for infants with hyperbilirubinemia. Methods We developed a web-based application (BiliNorm) to be used on a smartphone that displays the bilirubin level of the patient on the nomogram and advises about the treatment that should be started. Healthcare workers of two teaching hospitals in East Java, Indonesia, were trained on the use of BiliNorm. At 6 months after the introduction, a questionnaire was sent to those who worked with the application enquiring about their experiences. An observational study was conducted in two time epochs. A chart review of infants with hyperbilirubinemia in the two hospitals was sent. The appropriateness of hyperbilirubinemia management during a 6-month period before BiliNorm introduction was compared to that during a 7-month period after its introduction. Results A total of 43 participants filled in the questionnaire, the majority (72%) of them indicated that BiliNorm was well received and easy to use. Moreover, 84% indicated that BiliNorm was helpful for the decision to start phototherapy. Chart review of 255 infants before BiliNorm introduction and that of 181 infants after its introduction indicated that significantly more infants had received treatment according to the guideline (38% vs 51%, p = 0.006). Few infants received phototherapy, but bilirubin level was not measured (14% vs 7%, p = 0.024). There was no difference in the proportion of infants who were over- and under-treated (34% vs 32% and 14% vs 10%, respectively). Conclusions The web-based decision tool BiliNorm appears to be a valuable application. It is easy to use for healthcare workers and helps them adhere to the guideline. It improves the care for infants with hyperbilirubinemia and may help reduce the incidence of severe hyperbilirubinemia in Indonesia.

Background The outcomes of neonatal surgical cases has steadily improved in the last decade. However, limited local data are available in Indonesia regarding the contributing factors and outcomes of surgical procedures in neonates. Objective To determine the incidence of infection and mortality in neonatal surgical cases in Saiful Anwar Hospital, Malang, East Java, Indonesia. Methods This retrospective cohort study included neonates who underwent abdominal surgery over a period of 20 months from January 2021 to August 2022. Data collected included subjects’ basic demographics, primary surgical diagnoses, associated congenital anomalies, pre-operative conditions, and referral status. These parameters were analyzed in relation to the incidence of infection and mortality in the 30 days after surgical procedure. Results Of fifty-four neonates in this study, the most common neonatal surgical conditions were anorectal malformation, followed by necrotizing enterocolitis and Hirschsprung’s disease. The mortality rate at 30 days was 48%. The most common associated factors were sepsis (OR 0.778; 95%CI 0.233 to -1.167; P=0.041), pre-operative respiratory failure/hemodynamic instability (OR 2.129; 95%CI 1.039 to 3.126; P<0.001), and delayed referral (OR 0.295; 95%CI 0.074 to 1.177; P=0.048). Other factors such as age at presentation, gender, gestational age, birth weight, referral patient vs. those born in our hospital, associated congenital anomalies, and emergency procedures were not associated with mortality. The survival time in the sepsis group [17.30 (1.68-13.98) days] was significantly lower than in the non-sepsis group [25.95 (1.63-22.76) days] (P< 0.001). Conclusion Sepsis, pre-operative respiratory failure/hemodynamic instability, and delayed referral are risk factors for mortality in neonates following abdominal surgery. Identification of these risk factors and early intervention are important to improve outcomes.

Patient: Male, 6-day-old Final Diagnosis: Hereditary spherocytosis Symptoms: Severe hyperbilirubinemia Medication:— Clinical Procedure: Intensive phototherapy Specialty: Hematology • Pediatrics and Neonatology Objective: Rare disease Background: Hereditary spherocytosis (HS) is an autosomal dominant inherited disorder that causes severe hyperbilirubinemia in neonates. There is no factual data about the prevalence in Indonesia. It is common that neonates with suspected hereditary spherocytosis are not diagnosed or treated adequately in developing countries such as Indonesia. Case Report: A 6-day-old baby was referred from a secondary public hospital to our tertiary hospital in Malang, East Java with severe hyperbilirubinemia unresponsive to the 2 days of conventional phototherapy. Initial laboratory examination showed total serum bilirubin level 28.83 mg/dL and indirect bilirubin level 25 mg/dL. Complete blood count showed hemoglobin level of 10.3 g/dL with high MCHC 36.9 g/dL and increased RDW 18.7%. The HS ratio (MCHC per MCV) was 0.41. The blood smear showed spherocytes with positive family history from the mother and grandmother. There were no specific tests such as EMA binding, cryohemolysis, or analysis of erythrocyte membrane protein available in our hospital. The patient was then treated with 2 sessions of intensive photo-therapy with phototherapy unit bilisphere 360 LED. The total serum bilirubin level dropped to 12.19 mg/dL. In this case, we decided to perform intensive phototherapy first, not only because of facility-based constraints to do timely exchange transfusion, but also due to the low socio-economic and educational background of the parents. Conclusions: There are some challenges in diagnosing and treating HS adequately in Indonesia. Limitations of specific tests, inadequacy of conventional phototherapy, lack of awareness of and adherence to guidelines, and facility-based inability to perform timely exchange transfusion all can contribute to severe hyperbilirubinemia and its sequelae.

Caring for preterm infants in the intensive care unit can lead to a variety of conditions that increase stress and pain during routine care procedures. One of the intensive care unit procedures is diapers usage and change. The immature anatomical and physiological growth and development, especially the musculoskeletal system, neurological system, and integumentary system, is a challenge in the care of premature infants. Inappropriate diapers in premature infants can result in neurodevelopment problems, diaper dermatitis, and long-term postural disorders. Supportive care in the intensive care unit should include maintaining sleep cycles, creating a comfortable environment, periodic stress and pain measurement, practicing infants’ skincare, and care involving parents.