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Beyond Microcephaly: Semilobar Holoprosencephaly with Marked Macrocephaly due to Severe Congenital Hydrocephalus, Brachycephaly, and Hyponatremia – A Case Report Cynthia Cynthia; Edbert Wielim; Regina Suriadi; Putu Siska Suryaningsih
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.v5i5.768

Holoprosencephaly (HPE) is a rare, complex brain malformation arising from incomplete prosencephalon cleavage, typically associated with microcephaly and facial dysmorphism. Coexisting severe hydrocephalus leading to macrocephaly in HPE, particularly the semilobar type, presents a distinct clinical picture. Hyponatremia often complicates neurological conditions involving increased intracranial pressure, potentially worsening prognosis. The aim of this case report is to meticulously describe the clinical presentation, diagnostic evaluation, management approach, and early outcomes of this rare and complex neonatal neurological disorder. A male neonate, born at 35+3 weeks gestation to a mother with severe preeclampsia, presented with marked macrocephaly (head circumference 50 cm), a prominent fontanel, and bilateral sunset eyes. Initial CT scan confirmed hydrocephalus. Subsequent evaluation and a repeat CT scan at one month revealed brachycephaly (cephalic index 98) and semilobar holoprosencephaly. Head circumference progressed to 64 cm by the time of ventriculoperitoneal (VP) shunt surgery at approximately 5 weeks of age. Laboratory investigations showed hyponatremia (120 mEq/L), hyperkalemia, and hypochloremia. At three months, the patient exhibited significant growth and developmental delays and malnutrition. In conclusion, this case highlights an unusual presentation of semilobar HPE characterized by severe congenital hydrocephalus causing marked macrocephaly, rather than microcephaly, complicated by brachycephaly and significant hyponatremia. Early, comprehensive diagnostic evaluation and multidisciplinary management are crucial in such complex neurodevelopmental disorders to address multifaceted challenges and attempt to optimize outcomes.

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.

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.

Packed red cell transfusions in preterm neonates: a retrospective study Sulistio, Ivena Clairine; Delicia Rudy; Putu Siska Suryaningsih; I Wayan Bikin Suryawan
Pediatric Sciences Journal Vol. 6 No. 2 (2025): In Press Online : December 2025
Publisher : Medical Faculty of Brawijaya University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/pedscij.v6i2.142

Introduction: Preterm neonates are highly vulnerable to anemia. Packed red cell (PRC) transfusions are often necessary but must be carefully considered due to associated risks. This study aims to assess the characteristics of preterm infants who received PRC transfusions to guide safer and effective transfusion practices. Methods: This study was conducted using a retrospective descriptive approach. It included preterm neonates who received PRC transfusions, as documented in the medical records from July 2022 to March 2025. Patient characteristics, hemoglobin level, transfusion profile, and comorbidities in preterm neonates receiving PRC transfusions were evaluated. Results: The sample consisted of 52 neonates, 37 boys, and 15 girls. The gestational age of infants was mainly between 28 and <32 weeks (64,5%). Most neonates were very low birth weight, which is 53,8%. The mode of delivery was relatively similar between spontaneously and cesarean section. The average length of hospital stay was 35.27 ± 16.62 days. The initial hemoglobin level of preterm infants receiving PRC transfusions averaged 10.88 ± 1.33 g/dL. The first transfusion was typically administered at 18.10 ± 9.69 days of life. Notably, most infants (59.6%) required three or fewer transfusions. The most common comorbidity among preterm infants receiving PRC transfusions was respiratory distress syndrome (RDS) at 78.8%, followed by neonatal jaundice (53.8%) and asphyxia (40.4%). Most RDS cases (69.2%) were caused by hyaline membrane disease (HMD). Conclusion: Preterm neonates receiving PRC transfusions had a high-risk profile, underscoring the importance of individualized transfusion thresholds and close post-transfusion monitoring to improve clinical outcomes.

Diagnostic Value of Platelet-to-Lymphocyte Ratio Versus Neutrophil-to-Lymphocyte Ratio in Early-Onset Neonatal Sepsis: A Retrospective Analysis in a Limited-Resource Setting Delicia Rudy; Nova Damayanti; Putu Siska Suryaningsih; I Wayan Bikin Suryawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (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.v10i2.1507

Background: Early-onset neonatal sepsis remains a critical cause of mortality in developing nations. Blood culture, the gold standard, suffers from delay and low sensitivity. While hematologic indices such as neutrophil-to-lymphocyte ratio (NLR) are used in adults, their utility in the first 72 hours of life is confounded by physiological instability. This study evaluates the diagnostic accuracy of the platelet-to-lymphocyte ratio (PLR) compared to NLR, mean platelet volume (MPV), and red cell distribution width (RDW) in early-onset neonatal sepsis. Methods: A retrospective observational study was conducted on 55 neonates (25 septic, 30 symptomatic non-septic controls) at a tertiary center in Indonesia. Sepsis was defined by clinical criteria and C-reactive protein positivity, independent of complete blood count parameters, to avoid incorporation bias. Diagnostic performance was assessed using Mann-Whitney U tests, receiver operating characteristic curve analysis, and multivariable logistic regression to control for confounders, including asphyxia. Results: The median PLR was significantly lower in the sepsis group compared to controls (32.6 [IQR 3.4–100.4] versus 71.1 [IQR 45.3–82.9]; p = 0.016). Conversely, NLR (p = 0.80), MPV (p = 0.163), and RDW (p = 0.422) showed no significant discrimination. PLR yielded an area under the curve of 0.724. At a cut-off of equal to or less than 40.5, determined by the Youden Index, PLR demonstrated a sensitivity of 68.0%, specificity of 73.3%, positive likelihood ratio of 2.55, and negative likelihood ratio of 0.44. Multivariable regression confirmed PLR as an independent predictor (Adjusted Odds Ratio 0.96; 95% CI 0.93–0.99; p = 0.038) after adjusting for birth asphyxia. Conclusion: PLR demonstrates superior discriminative ability over NLR for early-onset sepsis in this cohort. The distinct inverse PLR phenomenon reflects sepsis-induced thrombocytopenia and bone marrow suppression. While not a standalone diagnostic tool, PLR serves as a valuable, zero-cost adjunctive marker for risk stratification in resource-limited settings.

Diagnostic Value of Platelet-to-Lymphocyte Ratio Versus Neutrophil-to-Lymphocyte Ratio in Early-Onset Neonatal Sepsis: A Retrospective Analysis in a Limited-Resource Setting Delicia Rudy; Nova Damayanti; Putu Siska Suryaningsih; I Wayan Bikin Suryawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (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.v10i2.1507

Background: Early-onset neonatal sepsis remains a critical cause of mortality in developing nations. Blood culture, the gold standard, suffers from delay and low sensitivity. While hematologic indices such as neutrophil-to-lymphocyte ratio (NLR) are used in adults, their utility in the first 72 hours of life is confounded by physiological instability. This study evaluates the diagnostic accuracy of the platelet-to-lymphocyte ratio (PLR) compared to NLR, mean platelet volume (MPV), and red cell distribution width (RDW) in early-onset neonatal sepsis. Methods: A retrospective observational study was conducted on 55 neonates (25 septic, 30 symptomatic non-septic controls) at a tertiary center in Indonesia. Sepsis was defined by clinical criteria and C-reactive protein positivity, independent of complete blood count parameters, to avoid incorporation bias. Diagnostic performance was assessed using Mann-Whitney U tests, receiver operating characteristic curve analysis, and multivariable logistic regression to control for confounders, including asphyxia. Results: The median PLR was significantly lower in the sepsis group compared to controls (32.6 [IQR 3.4–100.4] versus 71.1 [IQR 45.3–82.9]; p = 0.016). Conversely, NLR (p = 0.80), MPV (p = 0.163), and RDW (p = 0.422) showed no significant discrimination. PLR yielded an area under the curve of 0.724. At a cut-off of equal to or less than 40.5, determined by the Youden Index, PLR demonstrated a sensitivity of 68.0%, specificity of 73.3%, positive likelihood ratio of 2.55, and negative likelihood ratio of 0.44. Multivariable regression confirmed PLR as an independent predictor (Adjusted Odds Ratio 0.96; 95% CI 0.93–0.99; p = 0.038) after adjusting for birth asphyxia. Conclusion: PLR demonstrates superior discriminative ability over NLR for early-onset sepsis in this cohort. The distinct inverse PLR phenomenon reflects sepsis-induced thrombocytopenia and bone marrow suppression. While not a standalone diagnostic tool, PLR serves as a valuable, zero-cost adjunctive marker for risk stratification in resource-limited settings.

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