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All Journal The Indonesian Biomedical Journal Paediatrica Indonesiana ISM (Intisari Sains Medis) : Jurnal Kedokteran
Made Sukmawati
Departement Of Pediatrics, Faculty Of Medicine, Udayana University, Sanglah Hospital, Denpasar, Bali
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Public Health

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Juvenile rheumatoid arthritis associated with uveitis in a 4-year-old girl Made Sukmawati; Hendra Santoso; Niti Susila
Paediatrica Indonesiana Vol 46 No 2 (2006): March 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.2.2006.87-92

Abstract

The variability of the disease may explain mis-conceptions that JRA is usually a benign disease. Acohort study in which 506 subjects during the periodof 1970-1999 found that approximately one-third ofJRA patients achieve disease remission. The visualcomplications are also important in determining theoutcome. Functional disability is common and can belong-lasting. Recognizing JRA symptoms earlier areimportant to prevent mortality, disability, and long-term complications. Although JRA is the most com-mon rheumatic disease in children, many doctors arenot familiar with this disease. The purpose of thispaper is to report a case of juvenile rheumatoid ar-thritis associated with uveitis in a 4-year, 8-month-old girl.
Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants Made Sukmawati; Rinawati Rohsiswatmo; Rulina Suradi; Pramita Gayatri
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (117.76 KB) | DOI: 10.14238/pi57.3.2017.154-9

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Background Feeding intolerance is a common condition that affects preterm infants. Erythromycin is a prokinetic agent used to treat feeding intolerance, but its efficacy remains inconclusive.Objective To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in preterm infants.Methods This prospective, randomized controlled trial in preterm infants was conducted at Sanglah Hospital, Denpasar, Bali, from June 2015 to January 2016. Eligible infants were randomized to receive either 12.5 mg/kg/dose oral erythromycin or a placebo, every 8 hours. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were body weight at full enteral feeding and length of hospital stay.Results Of 62 initial subjects, 3 infants dropped out of the study. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline characteristics of the two groups were similar, with mean of gestational ages of 31.4 (SD 1.7) weeks in the erythromycin group and 32.4 (SD 2.2) weeks in the placebo group. The median times to reach full enteral feeding did not significantly differ between the two groups, with 10 (SD 5.3) days in the erythromycin group vs. 8 (SD 6.5) days in the placebo group (P=0.345). Also, median body weights at full enteral feeding and lengths of hospital stay were not significantly different between the two groups.Conclusion Erythromycin of 12.5 mg/kg/dose every 8 hours as prophylactic treatment does not significantly enhance feeding tolerance in preterm infants. Median body weights at full enteral feeding and length of hospital stay are not significantly different between the erythromycin and placebo groups.
Full outline of unresponsiveness score as a predictor of outcomes in critically ill pediatric patients Novita Purnamasari Assa; Dyah Kanya Wati; Ida Bagus Subanada; Soetjiningsih Soetjiningsih; Made Kardana; Made Sukmawati
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (222.985 KB) | DOI: 10.14238/pi60.2.2020.77-82

Abstract

Background Mortality predictions are very important for improving service quality in the pediatric intensive care unit (PICU). The full outline of unresponsiveness (FOUR) is a new coma scale and is considered capable of predicting mortality and outcome. Objective To assess the ability of FOUR scores to predict outcomes of critically ill patients in the PICU. Methods This prospective cohort study included children aged 1 months - 18 years who were admitted to the PICU. Subjects were assessed by FOUR, grouped into score < 9 or score >9, and followed until outcomes were obtained. Bivariate analysis to assess the risk of death was made by cross-tabulation and the strength of the association in the form of risk ratio by Chi-square test. Multivariate analysis was done by logistic regression test. Results Of 94 subjects, 47 had FOUR scores <=9 and 47 subjects had FOUR >9. Bivariate analysis revealed that PICU patients with FOUR score <=9 had a higher risk of death than those with FOUR score >9 (RR 12.5; 95%CI 3.1 to 49.8; P<0.0001). Multivariate analysis revealed that FOUR score, length of stay <=7 days, and non-surgical disease significantly increased the risk of mortality in PICU patients (by 42.8 times, 8.9 times, and 5.9 times, respectively). Conclusion The FOUR scores have good ability to predict the outcomes of critically ill pediatric patients. A FOUR score <=9 at the beginning of treatment is significantly associated with the outcome of mortality during treatment in the PICU.
Pediatric Index of Mortality 3 score as a predictor for the outcomes of critically ill patients Gusti Ayu Nyoman Yulia Sitta Dewi; Dyah Kanya Wati; Made Gede Dwi Lingga Utama; Ketut Suarta Suarta; I Wayan Darma Artana; Made Sukmawati
Paediatrica Indonesiana Vol 60 No 6 (2020): November 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.6.2020.328-33

Abstract

Background The ability to predict mortality in critically ill patients is important for assessing patient prognosis, evaluating therapy, and assessing intensive care unit quality. The Pediatric Index of Mortality (PIM) 3 is a scoring system to predict outcomes in order to assist clinical decision-making. Objective To assess the ability of PIM 3 to predict outcomes of critically ill PICU patients.Methods This prospective cohort study included 150 children aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU), Sanglah Hospital, Denpasar, Bali. Subjects were grouped into two based on ROC curve PIM score ≥48 and <48. The PIM 3 score was consisted of 10 variables, with a re-diagnosis classification of the PIM 2 score. Bivariate analysis was conducted to both groups to find the distribution of mortality in both groups, followed by homogenity test on variables gender, age, nutritional status, lenght of stay and mechanical ventilation. Variables which made the cut on bivariate test were included in multivariate analysis.Results The optimal PIM 3 score limit in predicting mortality was ≥48, with area under the curve (AUC) 76% (95%CI 0.69 to 0.85). Multivariate analysis revealed a 2.48 times increased risk to mortality in patients with PIM 3 score ≥48 (95%CI 1.6 to 3.7). In addition, PICU length of stay ≤7 days was a significant risk factor for mortality. Conclusion The PIM 3 has a good ability to predict the outcome of critically ill PICU patients. Critically ill patients with PIM 3 score ≥48 have a higher risk of mortality compared to those with PIM 3 < 48.
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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (223.866 KB) | DOI: 10.15562/ism.v10i2.312

Abstract

Background: Hyperbilirubinemia is the most clinical problem in newborn babies.  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%)  males and 43 (45.7%) females based on gender. Mean gestational ages were 36.35±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 15.6±4.11 mg/dL whereas the indirect bilirubin was 14.56± 3.55 mg/dL. The duration of phototherapy in this study was 2.8±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.
Hubungan ASI eksklusif terhadap terjadinya diare akut di Puskesmas III Denpasar Utara periode 2018 I Putu Gede Danika Adikarya; Ni Nyoman Metriani Nesa; Made Sukmawati
Intisari Sains Medis Vol. 10 No. 3 (2019): (Available online: 1 December 2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (238.532 KB) | DOI: 10.15562/ism.v10i3.434

Abstract

Introduction: Diarrhea is still a public health problem in developing countries, including Indonesia, because of its high morbidity and mortality. Breast milk is one of the important factors to reduce mortality and morbidity due to diarrhea. The aim of this study was to determine the relationship of exclusive breastfeeding to the occurrence of acute diarrhea. This research is analytic research with cross sectional method.Method: The study was carried out in Community Health Centre III Subdistrict of North Denpasar from October to November 2018. The research subjects were taken by consecutive sampling. Data analysis used the prevalence ratio calculation and chi square test to determine the relationship between exclusive breastfeeding and the incidence of diarrhea.Result: In this study the results of acute diarrhea patients in the exclusive breastfeeding group were 17 children and non-exclusive breastfeeding as many as 31 children. Subjects who did not experience acute diarrhea in the excluded breastfeeding group were 28 children and in the non-exclusive breastfeeding group as many as 14 children. The results of statistical analysis showed the value of p=0.003 (p<0.05)  PR=0.514 CI 95% (0.115-0.656).Conclusion: Exclusive breastfeeding has a significant relationship with the incidence of acute diarrhea and is a protective factor for the incidence of diarrhea.
Korelasi kadar laktat dengan Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE II) pada neonatus yang dirawat di NICU RSUP Sanglah, Bali, Indonesia I Gede Deden Susma Sugara; I Wayan Dharma Artana; Ketut Suarta; Soetjiningsih Soetjiningsih; Ni Putu Siadi Purniti; Dyah Kanya Wati; Made Sukmawati; Made Kardana
Intisari Sains Medis Vol. 10 No. 2 (2019): (Available online: 1 August 2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (423.462 KB) | DOI: 10.15562/ism.v10i2.505

Abstract

Background: Infant mortality rate is one of the indicators of public health degree that determines the human development index. Various attempts were made to early detect the problems, one of which was by assessing the severity of neonatal disease using Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPE II) which was associated with lactate levels as a metabolic response and organ dysfunction due to critical illness that were suffered at the Neonatal Intensive Care Unit (NICU).Methods: A cross-sectional analytic study was conducted among 48 critically ill neonates treated at the Sanglah Hospital Denpasar NICU. Samples were selected from affordable populations by consecutive sampling. Data analysis was performed by Saphiro-Wilk data normality test, correlation analysis using the Pearson correlation coefficient, significant results if the value of p <0.05. Data were analyzed using SPSS version 17 for Windows.Results: Most of the respondents were males (67%), the mean of neonatal gestational age was 33 (± 3,2) weeks with the median neonatal age at lactate sampling being 24 (24-48) hours. The average age of the mother at delivery was 24 (21-40) years. The mean lactate level in critically ill neonatal patients admitted to the NICU was 3.2 (± 0,5) mmol / L. The mean SNAPPE II score on the subject was 32 (20-42). There was a significant positive correlation between the levels of lactate and the severity of the disease in critically ill neonates in the NICU assessed by SNAPPE II (r = 0.45; p = 0.004).Conclusion: Lactate levels has a moderate positive correlation with the severity of the disease in critically ill neonates in the NICU assessed by SNAPPE II
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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (308.125 KB) | DOI: 10.15562/ism.v11i1.522

Abstract

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 – 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 23.27±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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1204.964 KB) | DOI: 10.15562/ism.v11i1.538

Abstract

Background: 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: 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: 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. 
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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (324.96 KB) | DOI: 10.15562/ism.v11i3.730

Abstract

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 Anak Agung Ngurah Subawa Anak Agung Wiradewi Lestari Dyah Kanya Wati Gusti Ayu Nyoman Yulia Sitta Dewi Hendra Santoso I Gede Deden Susma Sugara I Made Kardana I Nyoman Wande I Putu Gede Danika Adikarya I Wayan Darma Artana I Wayan Darma Artana I Wayan Dharma Artana I Wayan Gede Artawan Eka Putra Ida Bagus Subanada Kadek Deddy Ariyanta Kadek Deddy Ariyanta Ketut Suarta Ketut Suarta Suarta Made Darmajaya Made Gede Dwi Lingga Utama N. K. Niti Susila, N. K. Ni Kadek Mulyantari Ni Made Sukewanti Ni Nyoman Mahartini Ni Nyoman Metriani Nesa Ni Putu Siadi Purniti Ni Putu Sukma Sumantri Prabandari Novita Purnamasari Assa Novita Purnamasari Assa Nyoman Gina Henny Kristianti Pramita Gayatri Putu Junara Putra Rinawati Rohsiswatmo Rulina Suradi Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Wayan Sulaksmana Sandhi Parwata