Neonatal appendicitis (NA) is an extremely rare acute abdomen condition, moreover, if it is a chronic suppurative one. The definite risk factor of NA is barely unknown. The signs and symptoms are often nonspecific and appear after perforation occurs. Most of the cases were found unexpectedly during surgery suspected as other diagnoses. A 7-day-old male neonate presenting lethargic and hypoglycemia since 1 st day of life. Patient drunk breast milk right after since he was born. Meconium was produced <24 h. On the 3 rd day of hospitalization, he experienced bilious vomiting and abdominal distension, so nasogastric tube was installed. Physical examination revealed decreased bowel sound. Investigation showed leucocytosis, slightly increased procalcitonin and abdominal X-ray showed that gas distribution lasted until third part of duodenum followed by minimal gas distribution in the distal part of duodenum. The patient was suspected as distal duodenum stenosis or proximal jejunum. Intraoperatively, it was found that there was second part duodenum malrotation and open Ladd’s procedure was done. During Ladd’s procedure, a perforated appendix was also found. The histopathology result revealed that it was a chronic suppurative appendicitis. Patient was discharged in good condition 20 days after surgery. NA is a rare condition with nonspecific signs and symptoms which was usually found accidentally during surgery suspected as other diagnoses.

Introduction: Bacterial meningitis is a severe acute infection of the central nervous system that caused by bacteria.The antibiotic should be given immediately. An appropriate antibiotic may reduce the morbidity and mortality caused by bacterial meningitis. This study aims to evaluate the bacterial pattern and antibiotic sensitivity in children bacterial meningitis at tertiary hospital in Denpasar. Material and methods: This retrospective descriptive study was using a cross-sectional design that involved pediatric patients aged 1 month-18 years old with suspected bacterial meningitis who underwent a lumbar puncture at Sanglah Hospital from January 2019 to December 2020. The diagnosis of bacterial meningitis was made based on cerebrospinal fluid culture and antibiotic sensitivity test. Samples were taken by consecutive sampling method and would be excluded if the medical record was incomplete. Results: There were ninety five pediatric patients treated with suspected meningitis. Thirty-three subjects had positive cerebrospinal fluid culture results with eight of them were contaminants. The proportion of bacterial meningitis was 26.3%. Bacterial meningitis was more common in children younger less than two years old (72%) compare with older children. The most gram-positive bacteria were Staphylococcus sp. while for gram-negative was Acinetobacter sp. and Sphingomonas paucimobilis. Vancomycin had a high sensitivity (92.8%) for gram-positive therapy, while for gram-negative it was cephalosporin drug which is ceftriaxone and cefepime (63.6%). Conclusion: Ceftriaxone as the main choice of empiric therapy still has high sensitivity to gram-negative bacteria but low sensitivity to gram-positive bacteria.