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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

Author-ID : 5390250

Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Public Health

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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.

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.

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)Â 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.

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 (Â± 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 (Â± 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.

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

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 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

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