A risk scoring model to predict progression of retinopathy of prematurity for Indonesia

Introduction: Retinopathy of prematurity (ROP) is a serious eye disease in preterm infants. Generally, the progression of this disease can be detected by screening infants regularly. In case of progression, treatment can be instituted to stop the progression. In Indonesia, however, not all infants are screened because the number of pediatric ophthalmologists trained to screen for ROP and provide treatment is limited. Therefore, other methods are required to identify infants at risk of developing severe ROP.Objective: To assess a scoring model’s internal and external validity to predict ROP progression in Indonesia.Method: To develop a scoring model and determine its internal validity, we used data on 98 preterm infants with ROP who had undergone one or more serial eye examinations between 2009 and 2014. For external validation, we analyzed data on 62 infants diagnosed with ROP irrespective of the stage between 2017 and 2020. Patients stemmed from one neonatal unit and three eye clinics in Jakarta, Indonesia.Results: We identified the duration of oxygen supplementation, gestational age, socio-economic status, place of birth, and oxygen saturation monitor setting as risk factors for developing ROP. We developed two models—one based on the duration of supplemental oxygen and one on the setting of the oxygen saturation monitor. The ROP risk and probabilistic models obtained the same sensitivity and specificity for progression to Type 1 ROP. The agreement, determined with the Kappa statistic, between the ROP risk model’s suitability and the probabilistic model was excellent. The external validity of the ROP risk model showed 100% sensitivity, 73% specificity, 76% positive predictive value, 100% negative predictive value, positive LR +3.7, negative LR 0, 47% pre-test probability, and 77% post-test probability.Conclusion: The ROP risk scoring model can help to predict which infants with first-stage ROP might show progression to severe ROP and may identify infants who require referral to a pediatric ophthalmologist for treatment.</p

Awareness of Neonatal Danger Signs and Timely Healthcare-Seeking Behaviour in Mothers of 0–12-Month-Old Infants

Introduction: Neonatal mortality is a critical issue in Indonesia, with a staggering 63% of infant deaths occurring during this period. Early detection of neonatal danger signs is vital in encouraging mothers to seek healthcare services promptly. Further research is necessary to evaluate the level of knowledge among mothers regarding neonatal danger signs and their healthcare-seeking behaviour in primary healthcare facilities within Tangerang District, which has the highest neonatal mortality rate. Methods: A cross-sectional study assessed the knowledge of neonatal danger signs in mothers with infants aged 0-12 months. Data was collected through interviews and questionnaires and analyzed using SPSS-25 and the Pearson Chi-Square test (p &lt; 0.05). Results: Two factors were significantly associated with healthcare-seeking behaviour: knowledge of neonatal danger signs (p=0.000, AOR=13.374, 95% CI) and maternal education (p=0.019, AOR=14.939, 95% CI). Conclusions: Educating mothers of infants about neonatal danger signs increases their likelihood of seeking healthcare for their babies. Health education campaigns and initiatives are crucial to promoting awareness of neonatal health among caregivers

Prevalens dan Faktor Risiko Terjadinya Hipozincemia Bayi Berat Lahir Rendah pada Usia Koreksi Mendekati Cukup Bulan atau Cukup Bulan

Latar belakang. Deposit Seng (Zn) berperan terhadap fungsi metabolik tubuh. Bayi kurang bulan mempunyai cadangan Zn yang rendah pada masa fetus, kebutuhan Zn yang tinggi setelah lahir, kapasitas untuk mengabsorbsi dan retensi zat makanan terbatas. Gambaran klinis dari defisiensi Zn yang berat yaitu dermatitis, iritabel, kandidiasis oral, diare, mineralisasi tulang yang buruk, gangguan fungsi motorik dan kognitif, meningkatnya risiko terkena infeksi, dan retardasi pertumbuhan. Tujuan. Untuk menentukan prevalens dan faktor risiko hipozincemia pada bayi berat lahir rendah. Metode.Penelitian prospektif, desain penelitian potong lintang. Data dikumpulkan dari 3 rumah sakit di Jakarta. Informasi faktor risiko dicatat dan kadar Zn diperiksa pada bayi dengan berat lahir <2000 g dan usia gestasi <34 minggu, pada usia koreksi mendekati cukup bulan atau cukup bulan. Hasil dianalisis dengan (T-test, dan Mann-Whitney) (regresi logistik). Defisiensi Zn didiagnosis apabila kadar Zn <55mg/ dl (8,4 μmol/L). Hasil. Dari 63 bayi yang diteliti terdapat 18 bayi yang hipozincemia sehingga didapatkan prevalens hipozincemia 28%. Dari 18 bayi hipozincemia, 67% disertai dengan gejala yang paling banyak dijumpai adalah gangguan pertumbuhan. Peningkatan usia gestasi, peningkatan kadar kalsium dan pemberian suplemen besi berhubungan dengan penurunan risiko hipozincemia (OR 0,622; 95% CI: 0,42-0,92), (OR 0,376; 95% CI: 0,16 – 0,88) dan (OR 0,062; 95 % CI: 0,008-0,46). Sedangkan jenis kelamin laki laki berhubungan dengan peningkatan risiko hipozincemia(OR 4,764; 95% CI: 0,06-21,40). Kesimpulan.Prevalens hipozincemia pada bayi usia gestasi <34 minggu dan berat lahir <2000 gram, yang diperiksa pada usia koreksi >35 minggu, didapatkan 28% dengan gejala. Gangguan pertumbuhan merupakan gejala yang paling banyak dijumpai. Faktor risiko hipozincemia ditemukan pada bayi laki-laki, usia gestasi yang lebih rendah, penurunan kadar kalsium dan tanpa pemberian suplementasi besi

Multicentre survey of retinopathy of prematurity in Indonesia

Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants.Objective To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia.Setting Data were collected from 34 hospitals with different levels of care: national referral centres, university-based hospitals, and public and private hospitals.Methods A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016–2017 in relation to gestational age and birth weight.Results We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28–32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%–5%. Both mortality and the incidence of ROP were highest in university-based hospitals.Conclusions In the 2016–2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016–2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia