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All Journal Medicina Sari Pediatri Paediatrica Indonesiana ISM (Intisari Sains Medis) : Jurnal Kedokteran

Putu Junara Putra

Bagian Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Udayana/RSUP Sanglah,

Author-ID : 351475

Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology

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The characteristic of neonatal hyperbilirubinemia before and after phototherapy at Sanglah Hospital, Denpasar, Bali in 2017 Wayan Sulaksmana Sandhi Parwata; Putu Junara Putra; Made Kardana; Wayan Dharma Artana; Made Sukmawati
Intisari Sains Medis Vol. 10 No. 2 (2019): (Available online: 1 August 2019)
Publisher : DiscoverSys Inc.

Background: Hyperbilirubinemia is the most clinical problem in newborn babies.Â Hyperbilirubinemia occurs 60% in aterm babies and 80% in premature babies. This study aims to know the incidence of hyperbilirubinemia, characteristics of hyperbilirubinemia and effect of phototherapies to bilirubin levels.Methods: A cross-sectional retrospective study was conducted using medical records among 94 neonates with hyperbilirubinemia who treated with phototherapies at Sanglah hospital during 2017. Data regarding gender, gestational weeks, type of delivery, size for gestational age, the onset of hyperbilirubinemia, etiology, birth weight, maternal gravid status, and bilirubin levels were collected and analyzed using SPSS version 20 software descriptively.Results: From 94 neonatal hyperbilirubinemia that meet the inclusion criteria, 51 (54.3%) Â males and 43 (45.7%) females based on gender. Mean gestational ages were 36.35Â±2.921 weeks. The major etiology of neonatal hyperbilirubinemia were breastfeeding jaundice 33 (25.8%), Prematurity 23 (18.7%), ABO incompatibility 13 (10.6%), Breast milk jaundice 11 (8.9%), gastrointestinal malformation 6 (4.9%), G6PD deficiency 5 (4.1%), and sepsis 3 (2.4%). The mean total bilirubin prior to phototherapy was 15.6Â±4.11 mg/dL whereas the indirect bilirubin was 14.56Â± 3.55 mg/dL. The duration of phototherapy in this study was 2.8Â±0.65 days.Conclusions: The incidence of neonatal hyperbilirubinemia during 2017 at Sanglah Hospital were predominantly caused by breastfeeding jaundice, prematurity, and ABO incompatibility. There were decreased bilirubin levels following phototherapies.

The characteristics of neonatal sepsis in Low Birth Weight (LBW) infants at Sanglah General Hospital, Bali, Indonesia Novita Purnamasari Assa; I Wayan Dharma Artana; I Made Kardana; Putu Junara Putra; Made Sukmawati
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Backgrounds: Neonatal sepsis is a significant cause of mortality and long-term morbidity. The preterm infant has high-risk sepsis and its sequelae. Low birth weight infants were more susceptible to sepsis. Initial infections in neonates may not be identified due to non-specific symptoms and sign with the limited laboratory criteria. This study aims to describe the characteristics of neonatal sepsis in low birth weight infants in the neonatology intensive care unit of Sanglah Hospital.Methods: A retrospective cross-sectional study was conducted among 168 infants aged zero to 28 days with birth weights <2,500 grams from May 2017 â€“ April 2018 at Sanglah General Hospital, Bali, Indonesia using a purposive sampling technique. The inclusion criteria were sepsis infants who were hospitalized in neonatology care rooms during the study period at Sanglah General Hospital. Variables assessed in this study were sex, location and mode of delivery, birth weight, gestational age, number of parity, length of stay, the onset of sepsis, as well as the outcome. Data were analysed using SPSS version 17 for Windows.Results: The mortality rate of sepsis in low birth weight infants was 29.8%. Most of the subjects were male (53%), location of delivery at Sanglah Hospital (60.7%), born spontaneously (51.2%), birth weight were 1500-2499 grams (58,3%) and the most gestational ages were 32-36 weeks (44,6%). Early-onset neonatal sepsis (EONS) dominates patients with neonatal sepsis, with a mean length of stay was 23.27Â±20.32 days. The major infection risk factor was premature rupture membrane (PRM) >24 hours (14.9%), and minor infection risk factor was gestational age <37 weeks (78%), very low birth weight (44.6%) and asphyxia (41.1%). The total blood culture positivity was 38 (22.6%) cases, and Enterococcus faecalis was the most common organism in this study.Conclusion: The incidence and mortality of neonatal sepsis in LBW infants were still high. The importance of knowledge and awareness of pregnant women about danger signs and the risk of infection can reduce the incidence of early-onset neonatal sepsis. Prevention of healthcare-associated infections can reduce the incidence of late-onset neonatal sepsis.

Jejunal atresia in the newborn: three cases after resection and end-to-end anastomoses Ni Made Sukewanti; I Wayan Dharma Artana; Putu Junara Putra; I Made Kardana; Made Sukmawati; Kadek Deddy Ariyanta
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background:Â Intestinal atresia is a common cause of neonatal intestinal obstruction. Jejunal atresia occurs more frequent than duodenal or colonic atresias while single atresias are most commonly encountered. Jejunal atresia is classified into 4 types: Type I (a mucosal/septal), Type II (a fibrous cord/band), Type III (blind ends are entirely separated without a fibrous cord between them and a large mesenteric defect), and Type IV (combination of atresia type I to III). This study aims to elaborate jejunal atresia in the newborn after resection and end-to-end anastomoses.Case Description:Â We report three cases of jejunal atresia consists of different types: type IV (first case), type IIIa (second case) and type I (third case). Cases were neonates born with signs of upper gut obstruction. Bile-stained vomiting was reported a few hours after birth and failed to pass meconium in the first 24 hours. Postnatal abdominal X-ray showed dilatation of the gaster and no gas present in the pelvic floor. In the third case, it showed a triple bubble sign on abdominal x-ray and a laparotomy revealed the type of jejuno-ileal atresia. Also, the resection on the atresias and end to end anastomosis were performed. Cases were admitted to neonatal intensive care unit with total parenteral nutrition. The first two cases died due to sepsis, while the third case survived.Conclusion:Â Jejunal atresia is a rare disease among newborn. All of the patients have provided resection and end-to-end anastomoses, although 2 of them did not survive.Â

Hubungan Rasio Neutrofil Limfosit (RNL) terhadap kejadian relaps pada anak dengan sindrom nefrotik di RSUP Sanglah, Bali, Indonesia Wega Upendra Sindhughosa; Gusti Ayu Putu Nilawati; Ni Putu Siadi Purniti; Bagus Ngurah Putu Arhana; Ketut Ariawati; Putu Junara Putra
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Nephrotic Syndrome is a disease whose cause is not fully known and has a high relapse rate. The lymphocyte neutrophil ratio is a marker of inflammation in patients with malignancy, infection, and coronary heart disease. This study aims to determine the relationship between Neutrophil Lymphocyte Ratio (NLR) and the occurrence of relapse nephrotic syndrome.Methods: This study was a retrospective analytic observational study with a cross-sectional approach to finding the relationship between increased NLR and the incidence of relapse in patients with nephrotic syndrome at SMF Children's Health Sciences Faculty of Medicine Universitas Udayana/Sanglah General Hospital. Data were taken from medical records of 45 respondents with episodes of relapse or remission from January 2018-January 2019. Data were analyzed using SPSS version 20 for Windows.Results: The results showed that most of the subjects were male (71.1%), aged 1-5 years (51.2%), and aged 4.00 Â± 8.50 years in both the relapse and remission groups. However, the infection rate (66.7%) and medication adherence (75.0%) tended to be higher in the relapse group. The analysis of the ROC curve shows the cut-off point of NLR was 2.36 (AUC: 0.521), with a sensitivity of 71.1% and a specificity of 73.3%. There was a significant relationship between the NLR value and the incidence of relapsed nephrotic syndrome in multivariate analysis (adjusted OR: 4.53; 95% CI: 1.68 - 12.22; p = 0.003).Conclusion: This study shows that there is a relationship between an increase in RNL and the incidence of relapse in pediatric nephrotic syndrome patients at Sanglah General Hospital, Bali, Indonesia.Â Latar belakang: Sindrom Nefrotik merupakan salah satu penyakit yang penyebabnya belum sepenuhnya diketahui dan memiliki angka relaps yang tinggi. rasio neutrofil limfosit merupakan suatu pertanda inflamasi pada pasien yang mengalami keganasan, infeksi dan penyakit jantung koroner. Penelitian ini bertujuan untuk mengetahui hubungan Rasio Neutrofil Limfosit (RNL) dengan terjadinya sindrom nefrotik relaps.Metode: Penelitian ini merupakan penelitian retrospektig observasional analitik dengan pendekatan potong lintang untuk mencari hubungan peningkatan RNL terhadap kejadian relaps pada pasien sindrom nefrotik di SMF Ilmu Kesehatan Anak FK UNUD/Rumah Sakit Umum Pusat Sanglah. Data diambil dari rekam medik terhadap 45 responden dengan episode relaps maupun remisi dari Januari 2018-Januari 2019. Data dianalisis dengan SPSS versi 20 untuk Windows.Hasil: Hasil penelitian menunjukkan bahwa sebagian besar subyek adalah laki-laki (71,1%), berusia 1-5 tahun (51,2%), maupun berusia 4,00Â±8,50 tahun baik pada kelompok relaps maupun remisi. Akan tetapi angka infeksi (66,7%) maupun ketidak patuhan pengobatan (75,0%) cenderung lebih tinggi pada kelompok relaps. Analisa kurva ROC menunjukkan titik potong RNL sebesar 2,36 (AUC: 0,521) dengan sensitivitas 71,1% dan spesifisitas 73,3%. Terdapat hubungan bermakna antara nilai RNL dengan kejadian sindrom nefrotik relaps pada analisis multivariat (adjusted OR: 4,53; 95%IK: 1,68 â€“ 12,22; p=0,003).Simpulan: Penelitian ini menunjukkan bahwa terdapat hubungan antara peningkatan RNL terhadap kejadian relaps pada penderita sindrom nefrotik anak di RSUP Sanglah, Bali, Indonesia

Gastroschisis: five cases after primary closure at Sanglah General Hospital, Bali, Indonesia Nyoman Gina Henny Kristianti; I Wayan Darma Artana; I Made Kardana; Putu Junara Putra; Made Sukmawati; Kadek Deddy Ariyanta; Made Darmajaya
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Gastroschisis is a congenital anterior abdominal wall defect characterized by intra-abdominal organs evisceration without covering the membrane. Several risk factors affect the outcome of a gastroschisis patient. Considering these risk factors might also increase the chance of better prognosis and survival. We report five neonates with gastroschisis after primary closure in Sanglah General Hospital, Denpasar, Bali, in 2017. This case series aims to describe the clinical characteristics and outcome of different babies with gastroschisis managed by primary closure surgery.Case Presentation: Four of our cases were detected during pregnancy with fetal gastroschisis at the age of 32, 19, 23, 25 weeks of gestation, respectively. We reserve cesarean delivery for the patient who did antenatal care in our hospital, but one of our patients was born by spontaneous labor due to lack of antenatal care. Four cases had the primary closure of less than 2 hours and one of them after 10 hours. Good outcome was found in three cases that started enteral feeding on the 7th day after post closure. Other cases started oral feeding on the 3rd day and 12th day—both of them shown poor outcomes. Three cases survive, but two others died because of sepsis.Conclusion: We found poor outcomes in both cases, which neonatal sepsis as a significant cause. One of our cases with poor outcome was referred from another hospital without antenatal care and had a long duration of entering the operating room. Diagnosing these babies in their early prenatal period and transferring them to an experienced medical centre containing multidisciplinary working facilities will contribute to both the mother and the baby's health.

Co-Authors Ayu Setyorini Mestika Mayangsari Bagus Ngurah Putu Arhana Franky Luhulima Gusti Ayu Putu Nilawati I Gusti Agung Trisna Windiani I Komang Kari I Made Kardana I Wayan Darma Artana I Wayan Dharma Artana I Wayan Gustawan Ida Bagus Subanda IK. Suandi IM Dharmajaya Julitasari S Kadek Deddy Ariyanta Kadek Deddy Ariyanta Kadek Hartini Ketut Ariawati Made Darmajaya Made Sukmawati Ni Made Sukewanti Ni Putu Siadi Purniti Novilia Sjafri Bachtiar Novita Purnamasari Assa Nyoman Gina Henny Kristianti Pustika Amalia Wahidiyat Rinawati Rohsiswatmo Rini Mulia Sari Sudaryat S Wayan Sulaksmana Sandhi Parwata Wega Upendra Sindhughosa Yoga Putra

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Journal : ISM (Intisari Sains Medis) : Jurnal Kedokteran