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.

Background In Indonesia, the burden of severe hyperbilirubinemia is higher compared to other countries. Whether this is related to ineffective phototherapy (PT) is unknown. The aim of this study is to investigate the performance of phototherapy devices in hospitals on Java, Indonesia. Methods In 17 hospitals we measured 77 combinations of 20 different phototherapy devices, with and without curtains drawn around the incubator/crib. With a model to mimic the silhouette of an infant, we measured the irradiance levels with an Ohmeda BiliBlanket Meter II, recorded the distance between device and model, and compared these to manufacturers’ specifications. Results In nine hospitals the irradiance levels were less than required for standard PT: < 10 μW/cm 2 /nm and in eight hospitals irradiance failed to reach the levels for intensive phototherapy: 30 μW/cm 2 /nm. Three hospitals provided very high irradiance levels: > 50 μW/cm 2 /nm. Half of the distances between device and model were greater than recommended. Distance was inversely correlated with irradiance levels (R 2 = 0.1838; P < 0.05). The effect of curtains on irradiance levels was highly variable, ranging from − 6.15 to + 15.4 μW/cm2/nm, with a mean difference (SD) of 1.82 (3.81) μW/cm2/nm ( P = 0.486). Conclusions In half of the hospitals that we studied on Java the levels of irradiance are too low and, in some cases, too high. Given the risks of insufficient phototherapy or adverse effects, we recommend that manufacturers provide radiometers so hospitals can optimize the performance of their phototherapy devices. Electronic supplementary material The online version of this article (10.1186/s12887-019-1552-1) contains supplementary material, which is available to authorized users.

ABSTRAKKasus kekerasan anak di Indonesia terus meningkat dari tahun ke tahun. Salah satu faktor mendasar yang dianggap sebagai penyebab utama adalah kesiapan orang tua dalam mengasuh, mendidik, dan membesarkan anak. Penelitian ini bertujuan untuk mengetahui dan mengidentifikasi parenting stress, pengasuhan dan penyesuaian dalam keluarga terhadap perilaku kekerasan anak dalam rumah tangga. Penelitian ini berupa observasional dengan pendekatan survey. Subyek penelitian berjumlah 18 orang yang terdiri dari 6 orang sampel positif kasus,berasal dari nara pidana Rumah Tahanan Negara Klas I Surabaya dengan riwayat kasus kekerasan anak dalam rumah tangga. Sedangkan 12 orang merupakan sampel negatif kasus yang diteliti berdasarkan kelurahan tempat tinggal responden kasus. Variabel independen penelitian adalah parenting stress dan pengasuhan dan penyesuaian dalam keluarga. Hasil pengujian chi-square dengan tabel 2x3 menunjukkan bahwa variabel parenting stress (p = 0,001), pengasuhan dan penyesuaian dalam keluarga (p = 0,001) memiliki hubungan terhadap perilaku kekerasan anak dalam rumah tangga (p < 0,05). Analisis tersebut membuktikan bahwa parenting stress dan pengasuhan dan penyesuaian dalam keluarga memiliki hubungan perilaku kekerasan anak dalam rumah tangga sehingga perlu adanya pendidikan sebelum menikah mengenai kesehatan reproduksi untuk orang tua terutama pada ibu dan anak, serta pendidikan tentang kewajiban orang tua dalam mendidik, merawat, dan membesarkan anak agar calon orang tua lebih siap untuk menghadapi berbagai persoalan dalam rumah tangga.

Background: In some hospitals in low/middle-income countries, methods to determine the bilirubin level in newborn infants are unavailable and based on a clinical evaluation, namely a clinical score designed by Kramer. In this study, we evaluated if this score can be used to identify those infants that need phototherapy. Method: Infants admitted between November 2018 and June 2019 to three hospitals in Surabaya, Indonesia were included. The jaundice intensity was scored using the Kramer score. Blood was sampled for total serum bilirubin (TSB) measurement. The infants were categorized into Treatment Needed (TN) group when treatment with phototherapy was indicated and the No Treatment Needed (NTN) group when phototherapy was not indicated, based on the Indonesian Guideline for hyperbilirubinemia. Result: A total of 280 infants with a mean birth weight of 2744.6 ± 685.8 g and a gestational age of 37.3 ± 2.3 weeks were included. Twenty-seven of 113 (24%) infants with Kramer score 2 needed phototherapy, compared with 41 of 90 (46%) infants with score 3 and 20 of 28 (71%) of infants with score 4. The percentage of infants that needed phototherapy was higher with decreasing gestational age. Conclusion: The Kramer score is an invalid method to distinguish between those infants needing phototherapy and those infants where this treatment is not indicated.

Introduction A range of phototherapy devices are commercially available. The American Academy of Pediatrics (2004) recommends routine intensity measurement of phototherapy devices to ensure that babies affected by hyperbilirubinemia receive effective phototherapy. Objective The aims of this study were to calculate the irradiance decay velocity of phototherapy devices used in a tertiary care hospital to evaluate whether current maintenance procedures for phototherapy devices are effective, and to contribute to the improvement of a standardized maintenance procedure in daily practice, thus helping to ensure that all babies affected by hyperbilirubinemia receive prompt treatment. Methods This research represents a prospective observational study conducted at Dr. Soetomo Academic Teaching Hospital in Surabaya, Indonesia from February 2019–July 2019. The intensities of 11 phototherapy devices were measured at specific times using a Bili Blanket Meter II. We calculated the Δ irradiance differences in μW/cm 2 /nm and calculated them as velocity μW/cm 2 /nm/hour of use. Results Among the 11 phototherapy devices included in this study, nine were fluorescent and two were light-emitting diode (LED) machines. The mean (standard deviation) irradiance decay velocity of the fluorescent lamps was 0.02 (±0.03) μW/cm 2 /nm/hour of use, while that of the LED lamps was 0.015 (±0.007) μW/cm 2 /nm/hour of use. The fastest irradiance decay velocity was 0.08 μW/cm 2 /nm/hour of use, while the slowest irradiance decay velocity was <0.01 μW/cm 2 /nm/hour of use, both of which were from fluorescent-based devices. There was one fluorescent-based device that provided an intensity lower than the therapeutic level. Conclusion Irradiance decay occurred in all phototherapy device lamps. It is important to perform routinely intensity measurements, regardless of manufacturer recommendations, to avoid ineffective phototherapy resulting from intensities lower than the required therapeutic levels.