Garuda - Garba Rujukan Digital

The Protective Paradox of Operative Delivery: A Case-Control Analysis of Maternal and Neonatal Risk Factors for Asphyxia in a Balinese Hospital Ida Ayu Sintya Pratiwi; I Wayan Dharma Artana
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.773

Neonatal asphyxia constitutes a primary driver of neonatal morbidity and mortality worldwide, with a disproportionate burden in developing nations like Indonesia. The identification of localized, modifiable risk factors is a critical prerequisite for the development of targeted and effective preventive healthcare strategies. This study was designed to meticulously identify the significant maternal, intrapartum, and neonatal risk factors associated with neonatal asphyxia within a tertiary care hospital setting in Bali, Indonesia. We executed a retrospective matched case-control study at a specialized Maternal and Child Hospital in Denpasar, Bali. The study included all neonates diagnosed with asphyxia (cases, n=103) born between January 1st and December 31st, 2023, and 103 randomly selected neonates without asphyxia (controls), also born within the same period. To control for potential confounding, cases and controls were matched by gender and month of birth. An exhaustive review of maternal and neonatal medical records was conducted. The data were analyzed using Chi-square tests for bivariate analysis and a multivariate logistic regression model to isolate the independent predictors of asphyxia. The multivariate analysis identified prematurity as the most profound risk factor for neonatal asphyxia, conferring a more than tenfold increase in risk (Adjusted Odds Ratio [aOR] = 10.33, 95% CI: 4.50-23.71, p<0.001). Significant maternal risk factors included anaemia during pregnancy (aOR = 6.56, 95% CI: 2.36-18.20, p<0.001), maternal age outside the optimal range of 20-35 years (aOR = 3.93, 95% CI: 1.50-10.32, p=0.005), and maternal obesity (aOR = 2.92, 95% CI: 1.20-7.11, p=0.018). Premature rupture of membranes (PROM) was identified as a significant intrapartum risk factor (aOR = 3.16, 95% CI: 1.30-7.72, p=0.011). Notably, delivery by caesarean section or instrumental assistance appeared to be a significant protective factor (aOR = 0.22, 95% CI: 0.08-0.59, p=0.003). In conclusion, prematurity, maternal anaemia, age extremes, maternal obesity, and PROM are confirmed as critical, independent risk factors for neonatal asphyxia in this Balinese population. The striking protective association of operative delivery likely represents a "protective paradox," a statistical artifact arising from confounding by indication, wherein timely and decisive obstetric intervention for high-risk pregnancies successfully mitigates adverse outcomes. Preventive strategies must therefore be multifaceted, prioritizing the public health imperatives of preterm birth prevention and the rigorous clinical management of maternal anaemia and obesity throughout the continuum of antenatal care.

The Price of Delay and the Uncoupling of Severity: A Penalized Multivariate Analysis of Treatment Adequacy Versus Timing as Determinants of Congenital Syphilis Ida Ayu Sintya Pratiwi; I Wayan Dharma Artana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1536

Background: Despite global elimination targets, congenital syphilis (CS) remains a critical cause of preventable neonatal morbidity. While the importance of antenatal screening is established, the relative impact of treatment adequacy (dosage/adherence) versus timing on neonatal severity—specifically the uncoupling phenomenon where severe visceral damage occurs despite normal birth biometrics—remains under-characterized in resource-limited settings. Methods: A retrospective cross-sectional study analyzed 101 syphilis-exposed mother-infant pairs at a tertiary referral center in Indonesia (2021–2025). We evaluated maternal serologic testing time, treatment timing, and treatment adequacy (defined strictly per CDC guidelines; inadequate defined as <30 days pre-delivery, non-penicillin, or missed doses). To address sparse data bias and quasi-complete separation in the dataset, Firth’s Penalized Likelihood Logistic Regression was utilized to calculate adjusted odds ratios (aOR) for severe clinical manifestations. Results: The prevalence of proven/possible CS was 58.4%. High-fidelity analysis revealed that inadequate maternal treatment was the dominant predictor of adverse outcomes (aOR = 85.40; 95% CI: 14.2–512.5; p<0.001), significantly outpacing delayed serologic testing (aOR = 4.8; p=0.012). A distinct uncoupling profile was identified: neonates born to inadequately treated mothers had high odds of severe visceral manifestations (hepatosplenomegaly, hematological failure) (aOR = 11.05), yet traditional biometrics (low birth weight, prematurity) showed no significant association (p>0.05). Conclusion: Treatment adequacy is the single most critical determinant of neonatal prognosis. The dissociation between normal birth weight and severe organ damage suggests that anthropometry is a poor triage tool for syphilis. A zero-tolerance policy for therapeutic deviations is imperative.

The Price of Delay and the Uncoupling of Severity: A Penalized Multivariate Analysis of Treatment Adequacy Versus Timing as Determinants of Congenital Syphilis Ida Ayu Sintya Pratiwi; I Wayan Dharma Artana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1536

Background: Despite global elimination targets, congenital syphilis (CS) remains a critical cause of preventable neonatal morbidity. While the importance of antenatal screening is established, the relative impact of treatment adequacy (dosage/adherence) versus timing on neonatal severity—specifically the uncoupling phenomenon where severe visceral damage occurs despite normal birth biometrics—remains under-characterized in resource-limited settings. Methods: A retrospective cross-sectional study analyzed 101 syphilis-exposed mother-infant pairs at a tertiary referral center in Indonesia (2021–2025). We evaluated maternal serologic testing time, treatment timing, and treatment adequacy (defined strictly per CDC guidelines; inadequate defined as <30 days pre-delivery, non-penicillin, or missed doses). To address sparse data bias and quasi-complete separation in the dataset, Firth’s Penalized Likelihood Logistic Regression was utilized to calculate adjusted odds ratios (aOR) for severe clinical manifestations. Results: The prevalence of proven/possible CS was 58.4%. High-fidelity analysis revealed that inadequate maternal treatment was the dominant predictor of adverse outcomes (aOR = 85.40; 95% CI: 14.2–512.5; p<0.001), significantly outpacing delayed serologic testing (aOR = 4.8; p=0.012). A distinct uncoupling profile was identified: neonates born to inadequately treated mothers had high odds of severe visceral manifestations (hepatosplenomegaly, hematological failure) (aOR = 11.05), yet traditional biometrics (low birth weight, prematurity) showed no significant association (p>0.05). Conclusion: Treatment adequacy is the single most critical determinant of neonatal prognosis. The dissociation between normal birth weight and severe organ damage suggests that anthropometry is a poor triage tool for syphilis. A zero-tolerance policy for therapeutic deviations is imperative.

To Intubate or Not: A Comprehensive Clinical Analysis of Airway Management and Stabilization Strategies for Neonatal Congenital Diaphragmatic Hernia in Resource-Limited Facilities Ida Ayu Sintya Pratiwi; I Wayan Dharma Artana
The International Journal of Medical Science and Health Research Vol. 24 No. 1 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/498zkw58

Introduction: Congenital Diaphragmatic Hernia (CDH) remains a formidable challenge in neonatal medicine, particularly in low- and middle-income countries (LMICs) where diagnostic resources and advanced life support modalities, such as extracorporeal membrane oxygenation (ECMO), are often unavailable.1 This condition, characterized by the herniation of abdominal viscera into the thoracic cavity through a diaphragmatic defect, leads to a critical triad of pulmonary hypoplasia, persistent pulmonary hypertension of the newborn (PPHN), and cardiac dysfunction.3 The immediate postnatal management, specifically the decision to initiate invasive mechanical ventilation versus non-invasive support, is a pivotal determinant of survival.3 Case Illustration: This report details two distinct cases of postnatally diagnosed CDH at a Type C hospital in Bali, Indonesia. Case 1 involves a full-term female neonate (2,900g) presenting with moderate respiratory distress (Apgar 4/5/6), who was successfully stabilized using non-invasive continuous positive airway pressure (CPAP) and orogastric decompression before being referred at 20 hours of life. Case 2 involves a full-term low-birth-weight female neonate (2,325g) with prenatally suspected dextrocardia and severe hypoxemia (SpO2 40%), necessitating prompt endotracheal intubation and pressure-controlled ventilation to achieve physiological stability prior to tertiary referral. Discussion: The analysis explores the embryological origins of the diaphragmatic defect, occurring between the 4th and 12th weeks of gestation, and the physiological impact on lung development.3 It highlights the utility of the Downes score for clinical monitoring in settings where arterial blood gas analysis may be limited.6 Furthermore, the discussion contrasts the "gentle ventilation" strategy with historical hyperventilation approaches and examines the systemic challenges of neonatal transport within the Indonesian healthcare framework.7 Conclusion: Individualized airway management is essential in resource-limited settings. While immediate intubation is mandatory for severe hypoxemia, non-invasive stabilization may be appropriate for clinically stable phenotypes, provided meticulous orogastric decompression is maintained.3 Early recognition and standardized referral pathways are critical to improving survival outcomes in these complex cases.9

Title

Found 4 Documents
Search

Abstract

Abstract

Abstract

Abstract

Title Search

Found 4 Documents Search

Abstract

Abstract

Abstract

Abstract

Title

Found 4 Documents
Search