8 research outputs found
The Mosaic of Risk in Neonatal Asphyxia: A Systematic Review of Clinical, Placental, and Systemic Predictors
No full textBackground: Neonatal asphyxia, a critical failure of gas exchange during the perinatal period, remains a primary cause of neonatal mortality and long-term neurodevelopmental disability worldwide, including hypoxic-ischemic encephalopathy (HIE). Its etiology is a complex mosaic of interconnected factors. Understanding this intricate risk profile is essential for developing effective prevention and intervention strategies. The aim of this study is to systematically review and synthesize recent evidence (published 2019–2025) on the spectrum of maternal, fetal, intrapartum, placental, and systemic risk factors associated with neonatal asphyxia.
Methods: This systematic review was conducted following the PRISMA guidelines. A comprehensive literature search was performed in PubMed, ScienceDirect, and Google Scholar for observational studies published between January 1st, 2019, and April 1st, 2025. Dual reviewers independently conducted study selection, data extraction, and risk of bias assessment using the Newcastle-Ottawa Scale (NOS). Due to significant clinical and methodological heterogeneity, a narrative synthesis was performed.
Results: The search yielded 870 articles, from which 13 observational studies met the inclusion criteria. The synthesis of these studies revealed a consistent and powerful link between neonatal asphyxia and a wide array of predictors. Key factors included maternal comorbidities (hypertensive disorders), prenatal maternal psychological stress, intrapartum complications (prolonged labor, meconium-stained amniotic fluid), placental pathology (maternal vascular malperfusion, meconium-associated changes), fetal characteristics (low birth weight), and crucial systemic factors, such as maternal immigrant status and sociodemographic disparities. Predictive models developed in two of the included studies demonstrated good discriminative performance in identifying high-risk pregnancies, offering potential for clinical application.
Conclusion: Neonatal asphyxia arises from a complex interplay of risk factors that span the entire perinatal continuum, from pre-conceptual maternal health and systemic inequities to acute intrapartum events. Effective mitigation requires a multi-pronged approach encompassing comprehensive antenatal care that addresses both physical and mental health, vigilant intrapartum monitoring, and systemic efforts to ensure equitable access to high-quality perinatal care. The integration of validated risk prediction tools into clinical practice holds significant promise for reducing the global burden of this devastating condition
Case Report: Exercise-Induced Supraventricular Tachycardia in a 16-Year-Old Boy with Tricuspid Regurgitation
No full textTakikardia supraventrikel (SVT) adalah takidisritmia yang sering ditemukan pada pasien anak yang membutuhkan pengobatan. Berbeda dengan takikardia sinus, SVT bukan merupakan respon kompensatorik normal terhadap stres fisiologis. Artikel ini membahas tentang kasus takikardi supraventrikel pada anak laki-laki berusia 16 tahun yang muncul ketika berolahraga berat. Dalam kasus ini turut disajikan panduan dalam mengidentifikasi gambaran SVT, mengesklusi diagnosis banding untuk takikardia kompleks sempit, diikuti dengan panduan untuk tatalaksana takikardia pediatrik berdasarkan algoritme Pediatric Advanced Life Support.Supraventricular tachycardia (SVT) is a tachydysrhythmia that is often found in pediatric patients which requires treatment. In contrast to sinus tachycardia, SVT is not a normal compensatory response to physiologi-cal stress. This article discusses the case of supraventricular tachycardia in a 16-year-old boy, which appear during strenuous exercise. In this case a guide was also provided in identifying SVT, excluding the differential diagnosis for narrow complex tachycardia, followed by guidelines for the management of pediatric tachycardia based on the Pediatric Advanced Life Support algorithm
Navigating Diagnostic Constraints in Pediatric Herpes Simplex Encephalitis: Successful Empirical Acyclovir Therapy without PCR Confirmation
No full textBackground: Herpes simplex encephalitis is an acute or subacute disease associated with focal or global cerebral dysfunction caused by herpes simplex virus type 1 or type 2. Without adequate antiviral administration, the mortality rate reaches 70 percent, with only 9 percent of survivors returning to normal function. While cerebrospinal fluid polymerase chain reaction testing is the gold standard for diagnosis, its availability is severely restricted in resource-limited clinical environments.
Case presentation: We report the case of a 4-year-old girl who presented with a profoundly decreased level of consciousness following a five-day history of fluctuating fever. Physical examination revealed a soporific state with a Glasgow Coma Scale of E4V1M1. Initial non-contrast computed tomography of the head was unremarkable. Cerebrospinal fluid analysis demonstrated a mononuclear pleocytosis. Despite the lack of polymerase chain reaction confirmation and the absence of advanced electrophysiological monitoring, the patient was empirically diagnosed with herpes simplex encephalitis based on clinical deterioration and cerebrospinal fluid findings. Immediate management included intravenous acyclovir, dexamethasone, phenobarbital, and supportive care. The patient demonstrated significant clinical improvement and was discharged on day 24 without severe immediate neurological deficits.
Conclusion: The absence of molecular diagnostics and advanced neuro-monitoring must not delay the administration of intravenous acyclovir in pediatric patients exhibiting fever and altered mental status. Empirical antiviral intervention remains the most critical determinant of survival and neurological recovery
Neonatal dengue: a case report and literature review
No full textDengue fever is a viral infectious disease that remains a health problem worldwide. Neonates mortality and morbidity have been linked to vertical transmission of the dengue virus. Infants born to mothers with dengue infection before the days of delivery require suspicion and tracing of dengue infection, particularly in dengue-endemic areas. This case report describes the possibility of vertical transmission of dengue in an infant with a dengue-infected mother near delivery. The baby had clinical improvement during treatment and was discharged at 11 days of life. Prompt diagnosis, appropriate treatment, and close monitoring are needed to improve neonatal dengue outcomes
Alcohol-Induced Hyperosmolar Hyperglycemic State in Type 1 Diabetes Mellitus: A Case Report
No full textBackground: Adolescents with diabetes mellitus who consume alcohol increase the risk of developing diabetic ketoacidosis (DKA) and HHS. In addition, alcohol consumption has long-term adverse effects on the glycemic control of type 1 diabetes mellitus. This study aimed to describe cases of alcohol-induced hyperosmolar hyperglycemic state in adolescents with type 1 diabetes mellitus.
Case presentation: A teenage boy, aged 15 years, came with his family to the ER with complaints of weakness. The patient also complained of persistent tingling in the legs for the last two weeks. Three days before entering the hospital, the patient also felt blurred vision that disturbed him while studying at school. The results of the physical examination stated that the general condition was weak, compos mentis, pulse 80x/minute, blood pressure 110/70 mmHg, respiratory rate 20x/minute, axillary temperature 36ºC, weight 65 kg, and height 165 cm. Examination of the extremities showed a slow return of skin turgor. Laboratory evaluation showed an increased leukocyte count (10.45x103/μL), and blood gas analysis showed mild acidosis (HCO3 24.3 mmol/L, PCO2 38.6 mmHg, PO2 82 mmHg, tCO2 26 mmol/L, pH 7.4, and SaO2 96%), HbA1c 14.2%, glucose at 621 mg/dL (hyperglycemia), C-peptide 0.87 ηg/dL. The patient was diagnosed with hyperglycemia, hyperosmolar state, type 1 diabetes mellitus, and mild dehydration.
Conclusion: The main management of alcohol-induced hyperosmolar hyperglycemic state in type 1 diabetes mellitus is fluid resuscitation to achieve hemodynamic stability, correction of electrolyte abnormalities, gradual reduction of blood sugar levels, and hyperosmolality. Insulin administration to lower blood sugar levels is done after stable hemodynamics
Relationship between Febrile Seizures and the Incidence of Microcytic Hypochromic Anemia in Children at Sanjiwani General Hospital, Gianyar, Indonesia
No full textBackground: Febrile seizures are the most common seizures in children. As many as 2% to 5% of children aged less than 5 years have had seizures accompanied by fever, and most occurrences are at the age of 17-23 months. Microcytic hypochromic anemia causes hypoxic conditions and neuronal instability due to iron depletion. This study aimed to explore the relationship between febrile seizures and the incidence of microcytic hypochromic anemia in children at Sanjiwani General Hospital, Gianyar, Indonesia.
Methods: This study was an analytic observational study with a cross-sectional approach. A total of 59 subjects participated in this study. Data analysis was carried out with the help of SPSS software in univariate and bivariate to determine the relationship between febrile seizures and microcytic hypochromic anemia.
Results: There is a relationship between the incidence of febrile seizures and the incidence of microcytic hypochromic anemia, with p<0.05. This study also showed that the risk of febrile seizures increased 1.7 times higher in individuals with microcytic hypochromic anemia.
Conclusion: There is a relationship between the incidence of febrile seizures and the incidence of microcytic hypochromic anemia in pediatric patients at Sanjiwani General Hospital, Gianyar, Indonesia
Recurrent pneumonia in malnourished children
No full textRecurrent pneumonia was defined as two episodes of pneumonia per year or three episodes of pneumonia at any time of life. The causes of recurrent pneumonia are multifactorial. Additional diagnostic should be considered because most cases are associated with an underlying illness. We reported a case recurrent pneumonia of a 3 months old malnourished male patient. Chest radiograph show infiltrate in both lung with history hospitalized for pneumonia one month before admission. Recurrent pneumonia occurs in 7.7-9% of children with community-acquired pneumonia. Several related conditions such as malnutrition, anatomic defect, immunodeficiency and other underlying illness can cause recurrent pneumonia
Mortalitas Asidosis Metabolik Laktat dan Non-laktat di Unit Perawatan Intensif Pediatrik RSUP Sanglah
No full textLatar belakang. Hiperlaktasemia terjadi pada pasien sakit berat disebabkan karena peningkatan produksi
laktat dan hambatan pengeluaran laktat. Konsentrasi laktat serum >5 mmol/L disertai pH darah <7,35
disebut asidosis laktat. Prognosis asidosis metabolik laktat lebih buruk dibandingkan asidosis metabolik
non-laktat meskipun kadar asidosis lebih ringan.
Tujuan. Membandingkan angka mortalitas pasien asidosis metabolik laktat dan non-laktat yang dirawat di Unit
Perawatan Intensif Pediatrik RSUP Sanglah, serta mengetahui peran beberapa parameter laboratotium.
Metode. Rancangan penelitian kohort prospektif dengan pembanding internal. Pasien yang mengalami
asidosis metabolik, dianalisis dan angka mortalitas dibandingkan antara asidosis metabolik laktat dan
asidosis metabolik non-laktat. Risiko relatif dihitung untuk mencari hubungan antara asidosis metabolik
laktat dengan mortalitas. Hubungan antara beberapa variabel independen terhadap variabel dependen
dilakukan analisis multivariat regresi logistik.
Hasil. Di antara 80 pasien, terdapat perbedaan bermakna mortalitas kelompok asidosis metabolik laktat
(p= 0,025; RR= 2,81; IK 95% 1,129-6,991). Kadar laktat (p: 0.007; IK 95% 0.037-0.121) dan pH darah
(p: 0.013; IK 95% -2.264- -0.361) menunjukkan hubungan yang bermakna terhadap mortalitas. Kadar
laktat >10 mmol/L dan pH darah <7,1 memperlihatkan mortalitas 100%
Kesimpulan. Asidosis metabolik laktat memiliki risiko relatif 2,81 terhadap mortalitas, kadar laktat dan
pH darah memiliki hubungan dengan kejadian mortalitas. Terdapat perbedaan proporsi mortalitas pada
kadar laktat >10 mmol/L dan pH darah <7,1
