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Korelasi Neutrofil-Limfosit Rasio dengan Kadar C-Reaktif Protein sebagai Biomarker Sepsis Neonatus pada Bayi Prematur di Rumah Sakit Wangaya Denpasar Sriwaningsi, Lina; Bikin Suryawan, I Wayan; Suarca, I Kadek
Sari Pediatri Vol 27, No 2 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp27.2.2025.89-95

Latar belakang. Sepsis neonatus merupakan kondisi yang mengancam jiwa dengan angka kematian yang tinggi pada bayi prematur. Bayi prematur memiliki sistem kekebalan tubuh yang belum matang. Sampai saat ini, kultur darah masih menjadi pemeriksaan standar emas untuk mendiagnosis sepsis neonatus. Neutrofil-limfosit Rasio (NLR) diusulkan sebagai penanda inflamasi, mendeteksi, dan menentukan tingkat keparahan sepsis, sedangkan C-Reaktif Protein (CRP) paling banyak digunakan pada fase akut, tetapi parameter ini dibatasi oleh sensitivitas, spesifisitas, ketersediaan, dan biaya. Kami mencoba menganalisis NLR sebagai alternatif pada sepsis neonatus.Tujuan. Mengetahui nilai cut-off point Neutrofil-limfosit Rasio yang optimal sebagai prediktor sepsis neonatus pada bayi prematur di Rumah Sakit Umum Daerah Wangaya.Metode. Penelitian ini merupakan penelitian analitik observasional cross-sectional menggunakan data sekunder dari rekam medis bayi yang dirawat di perinatologi dan NICU/neonatal intensive care unit Rumah Sakit Umum Daerah Wangaya. Total 94 bayi yang memenuhi kriteria inklusi dan ekslusi. Data yang terkumpul disajikan secara deskriptif, dengan analisis bivariat dan analisis cut-off point menggunakan kurva ROC.Hasil. Berdasarkan sosiodemografi, bayi sepsis dengan berat badan lahir rendah sebanyak 81%, sebagian besar mengalami sepsis neonatorum awitan dini (SNAD) 73 bayi (77%). Nilai cut-off point NLR 3,52 dengan nilai AUC 85%, sensitivitas 81%, dan spesifisitas 81%. Sedangkan nilai cut-off point CRP dengan nilai AUC 71%, sensitivitas 68%, dan spesifisitas 67%. Terdapat hubungan nilai NLR dengan CRP pada sepsis neonatus bayi prematur p-value 0,00 (p=<0,05).Kesimpulan. Nilai cut-off point NLR dapat digunakan sebagai prediktor deteksi dini sepsis neonatus. Deteksi sepsis neonatus menjadi lebih baik bila dikombinasikan dengan CRP.

Analisis Faktor-Faktor yang Memengaruhi Kematian Neonatus: Studi Retrospektif di Rumah Sakit Wangaya Denpasar Predani, Ni Luh Putu Diaswari; Bikin Suryawan, I Wayan; Suryaningsih, Putu Siska
Sari Pediatri Vol 25, No 5 (2024)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp25.5.2024.322-7

Latar belakang. Kematian pada masa neonatal masih menjadi penyebab kematian tertinggi pada bayi dan balita di Indonesia pada tahun 2021 dengan angka kematian bayi di Indonesia 12 dari 1000 bayi lahir hidup. Upaya untuk menurunkan angka kematian neonatus di Indonesia terus dilakukan dengan target 9 per 1000 kelahiran pada tahun 2025. Berat badan lahir rendah, asfiksia, prematuritas, kelainan kongenital serta sepsis menjadi faktor risiko tertinggi kejadian kematian neonatus. Tujuan. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kematian neonatus di Rumah Sakit Umum Daerah Wangaya, Denpasar.Metode. Penelitian ini menggunakan metode analitik observasional cross-sectional dengan data sekunder menggunakan rekam medis. Teknik pengambilan sampel adalah dengan consecutive sampling dengan total sampel 114 neonatus yang memenuhi kriteria inklusi dan eksklusi. Variabel yang diteliti adalah berat badan lahir rendah, asfiksia, prematuritas, kelainan kongenital dan infeksi. Data dianalisis dengan SPSS versi 23 mengunakan uji Chi-square. Hubungan antar variabel dikatakan signifikan apabila nilai p<0,05 dengan interval kepercayaan 95%.Hasil. Faktor yang berhubungan dengan kematian neonatus adalah berat badan lahir rendah (p=0,001 dan RP 2,02 dengan IK 95%: 1,18-3,07), asfiksia (p=0,000 dan RP 2,56 dengan IK 95%: 1,7-3,85) dan usia kehamilan kurang bulan (p=0,000 dan RP 2,52 dengan IK 95%: 1,68-3,89). Sedangkan kelainan kongenital dan infeksi tidak berhubungan secara bermakna dengan kejadian kematian neonatus (p=0,1 RP 1,6; 95%; IK 95%: 1,09-2,44 dan p=0,5 RP 1,14; IK 95%: 0,7-1,68)Kesimpulan. Disimpulkan bahwa ada hubungan yang bermakna antara berat badan lahir rendah, asfiksia dan usia kehamilan kurang bulan dengan kematian neonatus di Rumah Sakit Umum Daerah Wangaya, Denpasar.

Pengaruh Status Gizi terhadap Nilai CD4 pada Anak dengan Sindrom Imunodefisiensi Akuisita di Rumah Sakit Wangaya Kota Denpasar Paramerta, Ni Putu Gladys Arys; Suryawan, I Wayan Bikin; Dewi, Made Ratna
Sari Pediatri Vol 26, No 2 (2024)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp26.2.2024.80-4

Latar belakang. Human immunodeficiency virus / Acquired Immune Deficiency Syndrome pada anak merupakan masalah kesehatan global yang serius. Penurunan sistem imun yang diukur melalui nilai CD4 seringkali diperparah oleh status gizi yang buruk, yang dapat memengaruhi perkembangan penyakit dan kualitas hidup pasien. Studi tentang hubungan antara status gizi dan nilai CD4 pada anak dengan HIV/AIDS masih terbatas.Tujuan. Tujuan penelitian ini untuk mengetahui hubungan antara status gizi dengan nilai CD4 pada pasien anak dengan Sindrom Imunodefisiensi Akuisita.Metode. Penelitian ini menggunakan rancangan penelitian analitik observasional dengan penegakan potong lintang. Penelitian ini dilakukan pada bulan Maret 2023 – Juni 2023.Hasil. Sebanyak 36 pasien anak dengan Sindrom Imunodefisiensi Akuisita dilibatkan dalam penelitian ini. Berdasarkan analisis deskriptif, rerata usia pasien sebesar 9,25±2,99 tahun. Selain itu, sebagian besar pasien merupakan perempuan, yakni sebanyak 19 pasien (52,8%) sedangkan untuk pasien laki-laki sebanyak17 pasien (47,2%). Sebagian besar pasien memiliki nilai CD4 normal, yakni sebesar 27 pasien (75,0%), sedangkan pasien yang memiliki nilai CD4 rendah, yakni sebesar 9 pasien (25,0%). Hasil analisis Chi-square menunjukkan bahwa tidak terdapat hubungan yang signifikan antara status gizi dengan nilai CD4 pada pasien anak dengan Sindrom Imunodefisiensi Akuisita (p=0,079; two-tailed).Kesimpulan. Tidak terdapat hubungan yang signifikan antara status gizi dengan nilai CD4 pada pasien anak dengan Sindrom Imunodefisiensi Akuisita

Risk Factors Affecting Length of Stay in Preterm Infants at Wangaya Regional General Hospital, Indonesia Putri Prashanti, Nyoman Ananda; Kanthi Soraca Widiatmika; Putu Siska Suryaningsih; I Wayan Bikin Suryawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 1 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i1.907

Background: Advances in neonatology have led to many preterm infants being saved. Prolonged length of stay (LOS) increases the incidence of neonatal complications and even mortality, placing a significant economic burden on families and strain on healthcare systems. This study aims to determine the factors associated with LOS in preterm infants. Methods: This cross-sectional study involved 60 preterm babies treated at Wangaya Hospital from May 2022 to May 2023. Infants with congenital anomalies, referred from other hospitals and did not receive appropriate treatment were excluded from the study. Data were taken from the electronic medical record after obtaining ethical clearance and then analyzed using descriptive statistics and linear regression in SPSS 25. Statistical significance was considered at 0.05. Results: As many as 46 out of 60 preterm infants were born at moderate to late preterm gestational age. The majority of 81.7% of infants were born with a body weight of 1500-2499 grams. The median number of LOS was 7.5 days (IQR 15). Multivariate analysis of numerical independent variables obtained an equation log [LOS] = 2.902-0.066*gestational age+ 0.022*duration of parenteral nutrition (R2 = 78.1%). Meanwhile, in the categorical independent variables obtained, an equation log [LOS] = 0.398 + 0.223*very preterm + 0.144* RDS + 0.178*NEC + 0.206*prolonged antibiotics administration + 0.278*late enteral feeding + 0.148*abdominal distension + 0.144*vomiting (R2 = 87.4%). Conclusion: Factors influencing LOS of preterm infants are gestational age, duration of parenteral nutrition, the presence of RDS, NEC, vomiting, abdominal distension, late enteral feeding, and prolonged use of antibiotics. It is essential to carry out antenatal care for pregnant women to prevent premature birth.

Postoperative Craniopharyngioma in a 10-Year-Old Girl Presenting with Central Precocious Puberty, Central Diabetes Insipidus, and Growth Hormone Deficiency Putri Prashanti, Nyoman Ananda; Putu Wahyu Dyatmika Tanaya; I Wayan Bikin Suryawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 3 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i3.936

Background: Hypopituitarism is the most common endocrinology complication of postoperative craniopharyngioma. However, we found a 10-year-old girl with a history of postoperative craniopharyngioma presenting with central precocious puberty (CPP), central diabetes insipidus (CDI), and growth hormone deficiency (GHD). Case presentation: A 5-year-old girl experienced breast growth followed by menstruation six months later. The patient's weight was 19 kg (weight-for-age: P25-P50), height was 109 cm (height-for-age: P10-P25), and good nutritional status (Waterlow 90%). The stage of pubertal development was M2P2. There was a history of craniopharyngioma, and it was resected at the age of 2 years. After surgery, the patient developed CDI and has received desmopressin. No new tumour growth was found from evaluation with periodic MRIs every three years. After CPP was established, with increased serum levels of LH, FSH, and estradiol, GnRH agonist therapy was given at 100 mcg/kg BW every month. During five years of follow-up, the patient experienced clinical and laboratory improvement. However, the growth is only 3-4 cm/year (<P3) with short stature (height-for-age: <P3) and overweight. Low levels of IGF1 and GH were found in the stimulation test results, so the diagnosis of GHD was confirmed. The patient will receive growth hormone therapy and is expected to reach her potential genetic height (148.5 - 165.5 cm). Conclusion: Even though the craniopharyngioma tumour has been resected and no recurrence has occurred, it is crucial to evaluate the hormones produced by the pituitary thoroughly.

Neonatal hypoglycemia and associated factors at Wangaya General Hospital Putri, Asterisa Retno; Arumndari, Runi; Liman, Claudia Natasha; Suarca, Kadek; Suryawan, I Wayan Bikin
Indonesian Journal of Multidisciplinary Science Vol. 3 No. 1 (2023): Indonesian Journal of Multidisciplinary Science
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/ijoms.v3i1.709

In the early hours to early days of life, managing low blood glucose levels and screening infants at risk are common problems in the care of newborns. Still missing, though, is a precise definition of newborn hypoglycemia. The purpose of this study is knowing that pregnancy hypertension/preeclampsia/eclampsia, prematurity, small-gestational-weight (SGA), large-gestational-weight (LGA), asphyxia, and sepsis are risk factors associated with neonatal hypoglycemia. The type of research conducted was a cross-sectional retrospective analytic study on infants in the perinatology room at Wangaya Hospital in 2022. The sample in this study consisted of 18 hypoglycemia babies and 18 normoglycemia babies taken by purposive sampling with matching hypertension/preeclampsia/eclampsia pregnancy, prematurity, SGA, LGA, asphyxia and sepsis. Data collection used medical record data and perinatology register data. Statistical tests used were Chi-Square and logistic regression with a 95% confidence interval. The results showed that prematurity was an associated risk factor (OR=2.78; 95% CI=1.437-5.379), asphyxia and sepsis also showed statistical significance (OR=2.07; 95% CI=1.221-3.513) (OR=2.27; 95% CI=1.257-4.109). In multivariate analysis, there was no statistical significance among other factors (p-value 0.019). Prematurity, asphyxia, and sepsis were risk factors associated with the incidence of neonatal hypoglycemia with odds of 2.78 times, 2.07 times and 2.27 times respectively compared to the control population. However, in the multivariate analysis, there was no relationship between one factor to another factor that influenced each other in being a risk factor associated with hypoglycemia at Wangaya Hospital.

Faktor-Faktor yang Mempengaruhi Keberhasilan ASI Eksklusif pada Anak di RSUD Wangaya Kurnia, Bella; Suryawan, I Wayan Bikin
Majalah Kedokteran Indonesia Vol 69 No 10 (2019): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, V
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.69.10-2020-178

Background: Breastmilk is the best natural food for babies. Human milk consists of nutrients, such as proteins, lipid, carbohydrate, minerals, vitamins, and trace elements that are important for babies to ensure optimum growth and development. There is still low percentage of breastfeeding coverage in Indonesia. This study was designed to determine the factors that associated with the success of exclusive breastfeeding of children at Wangaya General Hospital. Methods: This study uses case-control method. Data was collected from medical record and interviews in Wangaya Regional General Hospital between April to May 2019. This study uses consecutive sampling. Data analysis uses chi square for bivariate and logistic regression for multivariate. Results: Factors associated with the success of exclusive breastfeeding were multipara (p=1,000; OR=1.214), labor method (p=1,000; OR=1.214), information availability (p less than 0,001; OR=46.000), occupation (p=0,148; OR=2.778), and educational level (p=0,240; OR=2.364). From multivariate analysis, information availability (p=0,001) was significant. Conclusion: Factor associated with successful breastfeeding in children at Wangaya General Hospital was information availability about breastfeeding to the mother.

Hubungan Antara Status Nutrisi dan Respons Imunologis pada Anak dengan HIV/AIDS di RSUD Wangaya Kota Denpasar: Hasil Penelitian Arumndari, Runi; Retno Putri, Asterisa; Liman, Claudia Natasha; Made Ratna Dewi; Suryawan, I Wayan Bikin
Cermin Dunia Kedokteran Vol 51 No 10 (2024): Infeksi
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v51i10.1097

Introduction: HIV infection and malnutrition are strongly linked and correlated. Although the exact mechanism is unknown, malnutrition is suspected to disrupt antiretroviral (ART) drug absorption. This research is aimed at determining the relationship between nutritional status and immunological response in children with HIV/AIDS taking ART. Methods: A cross-sectional retrospective analytic study was conducted on 30 children with HIV/AIDS in the pediatric clinic at Wangaya Hospital, using medical record data. The sample was taken with purposive sampling. Nutritional status was defined as poor (weight per height [WHZ] < -2 for children <5 years old and BMI for age [BAZ] <-2 for children ≥5 years old) and good nutrition (WHZ ≥-2 and <+1 for <5 years old children and BAZ ≥-2 and <+1 for ≥5 years old). Immunological response was seen by the increase in CD4 level through a certain time span and categorized into poor (did not increase or increase below the average) and good response (increase above the average). The data was analyzed using Chi-Square. Results: There is no significant relationship between nutritional status and immunological response in children with HIV/AIDS (p = 0.660). There was an almost equal amount of each immunological response category for both good and poor nutritional status. Conclusion: This study showed no difference in immunological response among children with either good or poor nutritional status. Further research on other confounding factors that may affect immunological responses is needed.

Risk Factors Affecting Length of Stay in Preterm Infants at Wangaya Regional General Hospital, Indonesia Putri Prashanti, Nyoman Ananda; Kanthi Soraca Widiatmika; Putu Siska Suryaningsih; I Wayan Bikin Suryawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 1 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i1.907

Background: Advances in neonatology have led to many preterm infants being saved. Prolonged length of stay (LOS) increases the incidence of neonatal complications and even mortality, placing a significant economic burden on families and strain on healthcare systems. This study aims to determine the factors associated with LOS in preterm infants. Methods: This cross-sectional study involved 60 preterm babies treated at Wangaya Hospital from May 2022 to May 2023. Infants with congenital anomalies, referred from other hospitals and did not receive appropriate treatment were excluded from the study. Data were taken from the electronic medical record after obtaining ethical clearance and then analyzed using descriptive statistics and linear regression in SPSS 25. Statistical significance was considered at 0.05. Results: As many as 46 out of 60 preterm infants were born at moderate to late preterm gestational age. The majority of 81.7% of infants were born with a body weight of 1500-2499 grams. The median number of LOS was 7.5 days (IQR 15). Multivariate analysis of numerical independent variables obtained an equation log [LOS] = 2.902-0.066*gestational age+ 0.022*duration of parenteral nutrition (R2 = 78.1%). Meanwhile, in the categorical independent variables obtained, an equation log [LOS] = 0.398 + 0.223*very preterm + 0.144* RDS + 0.178*NEC + 0.206*prolonged antibiotics administration + 0.278*late enteral feeding + 0.148*abdominal distension + 0.144*vomiting (R2 = 87.4%). Conclusion: Factors influencing LOS of preterm infants are gestational age, duration of parenteral nutrition, the presence of RDS, NEC, vomiting, abdominal distension, late enteral feeding, and prolonged use of antibiotics. It is essential to carry out antenatal care for pregnant women to prevent premature birth.

Postoperative Craniopharyngioma in a 10-Year-Old Girl Presenting with Central Precocious Puberty, Central Diabetes Insipidus, and Growth Hormone Deficiency Putri Prashanti, Nyoman Ananda; Putu Wahyu Dyatmika Tanaya; I Wayan Bikin Suryawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 3 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i3.936

Background: Hypopituitarism is the most common endocrinology complication of postoperative craniopharyngioma. However, we found a 10-year-old girl with a history of postoperative craniopharyngioma presenting with central precocious puberty (CPP), central diabetes insipidus (CDI), and growth hormone deficiency (GHD). Case presentation: A 5-year-old girl experienced breast growth followed by menstruation six months later. The patient's weight was 19 kg (weight-for-age: P25-P50), height was 109 cm (height-for-age: P10-P25), and good nutritional status (Waterlow 90%). The stage of pubertal development was M2P2. There was a history of craniopharyngioma, and it was resected at the age of 2 years. After surgery, the patient developed CDI and has received desmopressin. No new tumour growth was found from evaluation with periodic MRIs every three years. After CPP was established, with increased serum levels of LH, FSH, and estradiol, GnRH agonist therapy was given at 100 mcg/kg BW every month. During five years of follow-up, the patient experienced clinical and laboratory improvement. However, the growth is only 3-4 cm/year (<P3) with short stature (height-for-age: <P3) and overweight. Low levels of IGF1 and GH were found in the stimulation test results, so the diagnosis of GHD was confirmed. The patient will receive growth hormone therapy and is expected to reach her potential genetic height (148.5 - 165.5 cm). Conclusion: Even though the craniopharyngioma tumour has been resected and no recurrence has occurred, it is crucial to evaluate the hormones produced by the pituitary thoroughly.

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