Background Early diagnosis and prompt antibiotic treatment are crucial to reducing morbidity and mortality of early-onset sepsis (EOS) in neonates. However, this strategy remains challenging due to non-specific clinical findings and limited facilities. Inappropriate antibiotics use is associated with ineffective therapy and adverse outcomes. This study aims to determine the characteristics of EOS and use of antibiotics in the neonatal-intensive care units (NICUs) in Indonesia, informing efforts to drive improvements in the prevention, diagnosis, and treatment of EOS. Methods A descriptive study was conducted based on pre-intervention data of the South East Asia-Using Research for Change in Hospital-acquired Infection in Neonates project. Our study population consisted of neonates admitted within 72 h of life to the three participating NICUs. Neonates who presented with three or more clinical signs or laboratory results consistent with sepsis and who received antibiotics for 5 consecutive days were considered to have EOS. Culture-proven EOS was defined as positive blood or cerebrospinal fluid culture. Type and duration of antibiotics used were also documented. Results Of 2,509 neonates, 242 cases were suspected of having EOS (9.6%) with culture-proven sepsis in 83 cases (5.0% of neonatal admissions in hospitals with culture facilities). The causative organisms were mostly gram-negative bacteria (85/94; 90.4%). Ampicillin / amoxicillin and amikacin were the most frequently prescribed antibiotics in hospitals with culture facilities, while a third-generation cephalosporin was mostly administered in hospital without culture facilities. The median durations of antibiotic therapy were 19 and 9 days in culture-proven and culture-negative EOS groups, respectively. Conclusions The overall incidence of EOS and culture-proven EOS was high in Indonesia, with diverse and prolonged use of antibiotics. Prospective antibiotic surveillance and stewardship interventions are required.

Background Several modifications of the Kimura procedure for congenital duodenal obstruction (CDO) have been reported, however, their effects on the outcomes show conflicting results. Methods We compared the CDO outcomes following the Kimura procedure with and without post-anastomosis jejunostomy feeding tube (JFT). Results A total of 52 CDO neonates were involved (JFT: 13 males and 2 females vs. non-JFT: 14 males and 23 females, p = 0.0019). Time to full oral feeding was significantly earlier in the JFT than non-JFT group (14 [interquartile range (IQR), 12–15] vs. 17 [IQR, 14–22.5] days; p = 0.04). Duration of parenteral nutrition given to infants with CDO after surgery was significantly shorter in the JFT than non-JFT group (12 [IQR, 10–15] vs. 17 [IQR, 13–23] days; p = 0.031). Moreover, enteral feeding was significantly earlier in the JFT than non-JFT group (2 [IQR, 1–3.5] vs. 5 [IQR, 4–6] days; p = < 0.0001). However, the length of stay following surgery was not significantly different between groups (16 [IQR, 14–22] vs. 20 [IQR, 17–28] days; p = 0.22). Also, overall patient survival did not significantly differ between JFT (66.7%) and non-JFT patients (59.5%) (p = 0.61). Conclusion Jejunostomy feeding tube shows a beneficial effect on the time to full oral feeding, duration of parenteral nutrition and early enteral feeding in neonates with congenital duodenal obstruction after Kimura procedure.

dari ibu diabetes mellitus (IDM) memiliki risiko lebih tinggi mengalami berbagai morbiditas pada masa neonatus. Metabolisme bilirubin merupakan salah satu sistem yang mungkin terganggu. Tujuan. Mengetahui faktor risiko hiperbilirubinemia pada bayi IDM dan hubungannya dengan faktor risiko hiperbilirubinemia yang lain. Metode. Studi kohort retrospektif pada 71 IDM dan 71 bayi ibu tidak diabetes melitus (ITDM) yang lahir di RSUP Dr.Sardjito antara Januari 2007 -Desember 2014. Data diperoleh dari register neonatal-perinatal WHO-SEARO. Hasil. Risiko hiperbilirubinemia lebih tinggi pada bayi IDM dibandingkan ITDM (42% vs 17%) (RR=2,5 IK95% 1,4-4,5). Analisis stratifikasi menunjukkan bahwa risiko dipengaruhi oleh usia kehamilan, berat lahir, polisitemia, dan inisiasi menyusu dini. Sepsis meningkatkan risiko pada IDM (RR=11,5 IK95% 3,7-36,0), sedangkan inisiasi menyusu dini merupakan faktor pencegah (RR=0,6, KI 95% 0,3-0,9). Kesimpulan. Ibu diabetes melitus meningkatkan risiko hiperbilirubinemia pada masa neonatus. Risiko ini dipengaruhi oleh berat lahir, usia kehamilan, kondisi sepsis, dan inisiasi menyusu dini. Sari Pediatri 2016;18(1):6-11Kata kunci: bayi baru lahir, ibu diabetes melitus, hiperbilirubinemia Risk Factors for Hyperbilirubinemia in Infants of Diabetic MothersDio R.Biade, Tunjung Wibowo, Setya Wandita, Ekawaty L. Haksari, Madarina Julia Background. Infants of diabetic mothers (IDM) have higher risk for morbidities in neonatal period, including problems due to bilirubin metabolism. Objective. To assess the risk for hyperbilirubinemia in IDM and its associations with other risk factors for hyperbilirubinemia. Methods. Retrospective cohort study on 71 IDM and 71 infants of non-diabetic mother (NIDM) who were born at Dr. Sardjito hospital between January 2007 and December 2014. Data were collected from the WHO-SEARO Neonatal -Perinatal Database. Results. Hyperbilirubinemia was more common in IDM than in NIDM (42% vs 17%), RR=2.5, 95%CI 1.4 to 4.5. Further stratification showed that risk for hyperbilirubinemia was modified by birth weight, gestational age, sepsis, polycythemia and initial breastfeeding. Sepsis increased risk for hyperbilirubinemia, i.e. combined RR (95%CI) of 11.5 (3.7-36.0). Initial breastfeeding protected IDM from hyperbilirubinemia (RR= 0.6, 95%CI 0.3 to 0.9). Conclusion. Infants of diabetic mothers has increased risk for hyperbilirubinemia. The risk is modified by birth weight, gestational age, sepsis and initial breast feeding. Sari Pediatri 2016;18(1):6-11

Background Infants who are breastfed receive natural protection