5 research outputs found
A Case Study on Neurological Outcome in Persistent Neonatal Hypoglycemia in Upper Middle-Income Country
No full textIn Indonesia, comprehensive management and monitoring of persistent neonatal hypoglycemia, is rarely reported. Despite the fact that there are studies highlighting the risk of neurodevelopmental disorders in neonates with hypoglycemia, there seems to be limited comprehensive case reports detailing both the early diagnosis and the long-term growth and development monitoring in these neonates. A unique case report of a 10-day-old male baby, born at a term weeks gestation via caesarean section, diagnosed with persistent hypoglycemia and suspect of hyperinsulinemia is presented in this study. At birth, the neonate exhibited hypoglycemia with a blood glucose level of 25 mg/dL, accompanied by a one-minute seizure characterized by upward gaze and stiffening of the extremities. The neonate cried after seizure and there was no loss of consciousness and was admitted to the NICU due to worsening respiratory distress. Based on the thoracic X-ray examination, he was diagnosed with transient tachypnea of newborn (TTN). Blood glucose levels were monitored every four hours, and tests for cortisol, thyroid and growth hormone and routine urinalysis were planned. Total parenteral nutrition (TPN) were given with intravenous antibiotics. At 6months of age, the infant was diagnosed with intellectual disability by the growth and development social pediatric unit. At 7 months, the infant began undergoing physiotherapy. This case was followed for 7 months in total and the findings highlight the challenges in managing neonatal persistent hypoglycemia and the potential long-term developmental implications in neonates with early-life hypoglycemia, emphasizing the need for continual growth and development monitoring
Managing Neonatal Varicella: A Case Series Highlighting the Effectiveness of Antiviral Therapy Without IVIG
No full textBackground: Chicken pox is a rare but serious condition in neonates—often regarded as a common childhood illness with mild symptoms—yet it can lead to severe complications, especially in the perinatal period. Neonatal varicella may present with fever occurring within the first 5–10 days of life, followed by a generalized vesicular eruption. The syndrome is uncommon, largely due to the widespread immunity in women of childbearing age, acquired through prior chicken pox infection or varicella immunization. However in Indonesia, a developing country without a national mandatory varicella vaccination program, the disease burden remains significant, and cases of neonatal varicella are still encountered. Neonates are at high risk of severe varicella infection, which, if untreated, has a reported mortality rate of up to 30%. Although varicella is rare in neonates, there are limited studies that have reported it. This study highlights the clinical presentations upon admission, diagnostic investigations, therapeutic management strategies, and potential complications of neonatal varicella. Methods: This study presents two cases of neonatal varicella that were managed at Hasan Sadikin General Hospital in West Java, Indonesia. Each patient underwent a clinical assessment and diagnostic evaluation upon arrival, followed by therapeutic management strategies, including the management of any complications that emerged during treatment. Results: The two cases of neonates presented with classic clinical features of neonatal varicella, including a generalized vesicular rash followed by fever within the first 10 to 12 days of life, without dermatological lesions or congenital malformations at birth. In both cases, maternal chicken pox developed within the first few days postpartum, suggesting postnatal transmission as the likely source of infection. Complications observed included respiratory failure and pneumonia, requiring respiratory support. However, both neonates recovered successfully without the administration of IVIG. Conclusions: Early initiation of antiviral therapy, timely administration of antibiotics, comprehensive supportive care, and monitoring for potential complications play a crucial role in managing neonatal varicella, even in the absence of IVIG
Umbilical Venous Catheter Position Evaluation in Hasan Sadikin General Hospital : Overview of the Time Required
No full textBackground: An umbilical venous catheter (UVC) is one of the most frequently used access in neonates. In developed countries, bedside ultrasonography (USG) is used in assessing the position of the UVC catheter’s tip. However, this is difficult to be implemented in developing countries. In Indonesia, which categorized as a middle- income developing country, the evaluation of UVC mainly used chest radiographs. However, this procedure would take time. The delay in ascertaining UVC positioning through chest radiography among neonatologists in Indonesia remains unstudied, despite its potential on the clinical efficacy. Therefore, this study aimed to determine the time required for the installation of the UVC and the interval from the completion of UVC insertion until the release of the chest radiography result.
Method: In this prospective observational cohort study, neonates requiring UVC access were examined in Dr. Hasan Sadikin Hospital in Bandung, West Java. Patients underwent anthropometric measurements and UVC installation. Duration required for UVC installation and the interval between the completion of UVC insertion and the release of the chest radiography result were documented. Descriptive data were shown in percentage, mean and standard deviation.
Result: 127 neonates were studied. The average time taken for UVC insertion was 31 minutes and the average time taken from the completion of UVC insertion until the release of chest radiography results was 6 hours.
Conclusion: The long wait for chest radiography results significantly delayed the administration of fluids, medications, and parenteral nutrition in this study. Therefore, we need alternative tools to evaluate the UVC location that can be used bedside right after the installation
Unusual Lifespan of Edwards' Syndrome in COVID-19 Era
No full textEdwards' syndrome is caused by an extra chromosome on the 18th chromosome. Patients with this diagnosis have median survival of only 3-14.5 days, with the majority of infants with full trisomy 18 type die before or shortly after they are born. There is only supportive treatment available for Edwards’ syndrome. During the COVID-19 pandemic, providing health services was challenging, leading to less than optimum treatments added by patients’ reluctance to visit healthcare facilities due to the fear of COVID-19 transmission. This case study presented an infant with Edwards’ syndrome with major malformation. The patient had several organ problems, was admitted to the NICU, and continued with home care for monitoring for 6 months. Patient then died at 9 months of age. Maintaining the best quality of life for this patient was very challenging for parents and healthcare providers. Since the management for this type of sydnome is more palliative, good education, information, and psychosocial supports for the parents are needed to prepare them with the worst conditions, which was especially more challenging during the COVID-19 pandemic
Predicting Postoperative Mortality in Neonates with Congenital Gastrointestinal Anomalies: Development of a Prognostic Scoring System
No full textBackground: Congenital gastrointestinal anomalies (CGIAs) are the third most common congenital malformation globally, with a mortality rate reaching 39.8% in developing countries. Surgical intervention is often necessary for life-saving or corrective purposes. However, postoperative mortality in resource-limited settings can reach up to 50%. Identifying prognostic factors is essential to improve clinical management and inform family counseling regarding potential outcomes. Objectives: We aimed to develop a prognostic scoring system to predict postoperative mortality in neonates with CGIAs. Methods: This retrospective study analyzed medical records of neonates who underwent surgery for CGIAs between 2020 and 2024. Prognostic factors were identified using logistic regression analysis. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff points for mortality prediction. Results: A total of 282 neonates were included; 121 (42.9%) died and 161 (57.1%) survived. Multivariate logistic regression identified sepsis, mechanical ventilation, prematurity, and upper gastrointestinal anomalies as independent predictors of mortality. A scoring system was developed, with a score > 3 yielding a sensitivity of 83.5% and specificity of 72.0%. The area under the ROC curve (AUC) was 0.840 (p < 0.001). Conclusions: We developed a simple and reliable scoring system to predict postoperative mortality in neonates with CGIAs, which may support clinical decision-making and family counseling
