Compliance in maintaining hand cleaning on health care workers in neonatology unit in tertiary referral hospital Indonesia: The usage of CCTV for supervision

Background Compliance in maintaining hand cleaning on health care workers in neonatology unit in tertiary referral hospital Indonesia: The usage of CCTV for supervision. Aim Compliance in maintaining hand cleaning on health care workers in neonatology unit in tertiary referral hospital Indonesia: The usage of CCTV for supervision. Method Compliance in maintaining hand cleaning on health care workers in neonatology unit in tertiary referral hospital Indonesia: The usage of CCTV for supervision. Result Compliance in maintaining hand cleaning on health care workers in neonatology unit in tertiary referral hospital Indonesia: The usage of CCTV for supervision. Conclusion Compliance in maintaining hand cleaning on health care workers in neonatology unit in tertiary referral hospital Indonesia: The usage of CCTV for supervision

Transcutaneous bilirubin level to predict hyperbilirubinemia in preterm neonates

Background: Hyperbilirubinemia is common in neonates, with higher prevalence among preterm neonates, which can lead to severe hyperbilirubinemia. Assessment of total serum bilirubin (TSB) and the use of a transcutaneous bilirubinometry (TcB) are existing methods that identify and predict hyperbilirubinemia. This study aimed to determine TcB cut-off values during the first day for preterm neonates to predict hyperbilirubinemia at 48 and 72 hours. Methods: This cohort study was conducted at Dr. Soetomo General Hospital from September 2018 to January 2019 a total of 90 neonates born ≤35 weeks. They were divided into two groups (Group I: 1000-1500 grams; Group II: 1501-2000 grams). The bilirubin levels were measured on the sternum using TcB at the ages of 12, 24, and 72 hours. TSB measurements were taken on the third day or if the TcB level reached phototherapy threshold ± 1.24 mg/dL and if TcB showed abnormal results (Group I: 5.76-8.24 mg/dL; Group II: 8.76-11.24 mg/dL). Hyperbilirubinemia was defined as TSB ≥7 mg/dL for Group I and >10 mg/dL for Group II. Results: In total, 38 Group I neonates and 48 Group II neonates were observed. Almost half of the neonates in Group I (45%) suffered from hyperbilirubinemia at the age of 48 hours, along with 46% of Group II at 72 hours. The best 24-hour-old TcB cut-off values to predict hyperbilirubinemia at 48 hours were calculated to be 4.5 mg/dL for Group I and 5.8 mg/dL for Group II. The determined 24-hour-old TcB value to predict hyperbilirubinemia at 72 hours was 5.15 mg/dL for Group II. Conclusion: TcB values in the early days of life can be used as hyperbilirubinemia predictors on the following days for preterm neonates. Close monitoring should be managed for those with TcB values higher than the calculated cut-off values

Performance of fecal S100A12 as a novel non-invasive diagnostic biomarker for pediatric inflammatory bowel disease:a systematic review and meta-analysis

Objective: The incidence and prevalence of inflammatory bowel disease (IBD) in pediatric patients are increasing. Currently, the diagnostic method for IBD is inconvenient, expensive, and difficult. S100A12, a type of calcium-binding protein, detected in the feces of patients with IBD has recently been suggested as a promising diagnostic tool. Hence, the authors aimed to evaluate the accuracy of fecal S100A12 in diagnosing IBD in pediatric patients by performing a meta-analysis. Methods: The authors performed a systematic literature search in five electronic databases for eligible studies up to July 15, 2021. Pooled diagnostic accuracies of fecal S100A12 were analyzed as the primary outcomes. Secondary outcomes were standardized mean difference (SMD) of fecal S100A12 levels between IBD and non-IBD groups and a comparison of diagnostic accuracies between fecal S100A12 and fecal calprotectin. Results: Seven studies comprising 712 children and adolescents (474 non-IBD controls and 238 IBD cases) were included. Fecal S100A12 levels were higher in the IBD group than in the non-IBD group (SMD = 1.88; 95% confidence interval [CI] = 1.19–2.58; p &lt; 0.0001). Fecal S100A12 could diagnose IBD in pediatric patients with a pooled sensitivity of 95% (95% CI = 88%–98%), specificity of 97% (95% CI = 95%–98%), and area under the receiver operating summary characteristics (AUSROC) curve of 0.99 (95% CI = 0.97–0.99). Fecal S100A12 specificity and AUSROC curve values were higher than those of fecal calprotectin (p &lt; 0.05). Conclusion: Fecal S100A12 may serve as an accurate and non-invasive tool for diagnosing pediatric IBD.</p

Infection in Neonates and Infants: Epidemiology Aspects

Neonatal infection is a one of the major cause of death and morbidity, especially in the first week of their life. So it is important to know about epidemiology aspects of neonatal infection and prevent neonatal sepsis by early diagnosis of Early Onset Sepsis (EOS) and managed this condition, as the first golden hours in neonatal infection. The challenges for clinicians are three fold: (1) identifiying neonates with a high likelihood of sepsis promptly and initiating antimicrobial therapy; (2) distinguishing "high risk" healthy-appearing infants of infants with clnical signs who do not require treatment; and (3) discontinuing antimicrobial therapy once sepsis is deemed unlikely. The optimal treatment of infants with suspected EOS is broad-spectrum antimicrobial agents (ampicillin and aminoglycoside). Once the pathogen is identified, antimicrobial therapy should be naarowed (unless synergism is needed). Antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low

Diagnostic Properties of a Portable Point-of-Care Method to Measure Bilirubin and a Transcutaneous Bilirubinometer

Background: Recently, the Bilistick®, a point-of-care instrument to measure bilirubin levels, has been developed. It is fast and cheaper than transcutaneous bilirubin (TCB)-measuring devices, but data on diagnostic properties are scarce.Objective: This study aimed to compare the performance of the Bilistick® (BM-BS 1.0 - FW version 2.0.1) and the JM-105 bilirubinometer for measuring bilirubin.Method: This is a prospective study in infants born after ≥32 weeks' gestation, and/or a birth weight of ≥1,500 g, and a postnatal age ≤14 days in Surabaya, Indonesia. Bilirubin was measured with the Bilistick® System (BM-BS 1.0 - FW version 2.0.1), transcutaneously (TCB) with the JM-105 bilirubinometer, and in serum (TSB) with a routine laboratory technique. Mean differences and 95% limits of agreement (LOA) and correlations were calculated.Result: We enrolled 149 neonates and 126 had paired measurements of Bilistick® bilirubin, TCB, and TSB. Bilistick® failed in 16 (10.7%) infants. Mean Bilistick® bilirubin-TSB difference was -11 μmol/L (95% LOA: -101 to 79 μmol/L) and r = 0.738 (p &lt; 0.001). Mean TCB-TSB difference was 26 μmol/L (95% LOA: -33 to 88) and r = 0.785 (p &lt; 0.001). The sensitivity, specificity, PPV, and NPV for Bilistick® bilirubin for a TSB above treatment thresholds were 0.74, 0.84, 0.67, and 0.88, respectively, and for TCB 0.92, 0.64, 0.54, and 0.95, respectively.Conclusion: The Bilistick® System (BM-BS 1.0 - FW version 2.0.1) underestimates TSB, whereas TCB overestimates TSB in jaundiced Indonesian infants. Further improvement of Bilistick®'s diagnostic accuracy with less false-negative readings is essential to increase its use. </p

Introduction of a neonatal pain and agitation protocol at neonatal intensive care unit Dr Soetomo Hospital Surabaya

Background : Neonate especially preterm are the most likely to be exposed with pain stimuli in the NICU. Repeated number of painful exposure have the potential for deleterious consequences alter vital sign and later neurodevelopmental outcome. Dr Soetomo Hospital not implemented neonatal pain and agitation protocol yet. Objective: To analyze the implementation of a neonatal pain management based on Neonatal Infant Pain Scale (NIPS) score Methods : Location in NICU from January to May 2016. The protocol of neonatal pain and agitation management was implemented. Staff behavior in neonatal pain management before introduction vs after implementation were evaluated. Results : There were 72 patients before introduction had gestational age (GA) 34.8 (SD 2.6) weeks, birth weight 2023.8 (SD 437) gram and 30 nurse were include. Forty two patients, GA 35.8 (SD 2.58) week, birth weight 1988 (SD 571) gram, and 15 nurses after implementation of pain management were included. Vein puncture was the most procedure that frequently performed (62.09%) followed by ROP screening examination (21.56%), heel prick (13.07%). Compliance of staff in assessment of pain was seen from increasing number of pain assessment from 62.78% (SD 22.19) to 90.49% (SD 14.07). There was a significant increase of sucrose (00.00 vs 80.62%) and lidocain cream (00.00 vs 78.97%) used. Inter-observer agreement between nurse to evaluate pain using NIPS score, kappa 0.88, p = 0.00. Conclusion: Compliance of pain assessment and management were increased after pain protocol implementation

A review of existing neonatal hyperbilirubinemia guidelines in Indonesia [version 2; peer review: 2 approved]

Background Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. Methods Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. Results The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. Conclusions The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required

A review of existing neonatal hyperbilirubinemia guidelines in Indonesia

Background: Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. Methods: Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. Results: The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. Conclusions: The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required