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All Journal The International Journal of Medical Science and Health Research The Indonesian Journal of General Medicine
Ririn Azhari
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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The Comprehensive Literature Review of Surgical Management of Omphalocele Yosie Yulanda Putra; Ririn Azhari
The Indonesian Journal of General Medicine Vol. 7 No. 2 (2024): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/a42kkh91

Abstract

Background: The surgical management of omphalocele has undergone significant evolution over the past decade, with various studies contributing to a deeper understanding of treatment modalities and outcomes.  Literature Review: In developing countries, challenges persist, particularly in managing ruptured omphaloceles where resources are limited. The adaptation of surgical techniques, such as employing simple suture methods in the absence of advanced materials, underscores the need for flexibility in surgical management (Komlatsè Akakpo-Numado et al., 2012). Furthermore, innovative conservative management approaches have shown promise, with gentian violet yielding satisfactory survival rates and reduced hospital stays, emphasizing the role of a multidisciplinary team in optimizing care (Rahman Mitul & Ferdous, 2012). The importance of individualized treatment plans is reinforced by findings from a tertiary care center, which advocate for conservative approaches in cases of giant omphalocele, utilizing staged management strategies that prioritize patient safety . Moreover, systemic inflammation's role in pulmonary hypertension related to isolated giant omphalocele further emphasizes the need for prenatal diagnosis and careful postnatal management, suggesting that a "paint-and-wait" approach can be beneficial (Teillet et al., 2022). Conclusion: In conclusion, the surgical management of omphalocele encompasses a variety of strategies that reflect the complexity of the condition and the necessity for individualized care. The literature collectively emphasizes the importance of adapting surgical techniques to specific patient needs, the benefits of conservative management in certain contexts, and the critical role of multidisciplinary teams in improving patient outcomes.
The Comprehensive Literature Review of Surgical Management of Gastroschisis Yosie Yulanda Putra; Ririn Azhari
The Indonesian Journal of General Medicine Vol. 7 No. 2 (2024): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/pzcy0v35

Abstract

Background: The surgical management of gastroschisis has evolved significantly over the years, reflecting advancements in both surgical techniques and neonatal care. The literature indicates a marked increase in the birth prevalence of gastroschisis, with a notable reduction in mortality rates from 60% in the 1960s to 3-10% by the mid-1990s, although recent studies suggest that mortality rates have plateaued (J Bradnock et al., 2011). Literature Review: Innovative approaches, such as the use of composite mesh, have emerged to address cases where traditional fascial closure is not feasible, thus highlighting the adaptability of surgical methods to meet patient-specific needs (K. Dikshit et al., 2015). Moreover, the focus on low- and middle-income countries (LMICs) emphasizes the need for accessible and practical surgical strategies, particularly the application of preformed silos that can be managed by trained healthcare personnel in resource-limited settings (J Wright et al., 2018). Emerging research on fetal surgical interventions highlights the potential for proactive management strategies that could improve outcomes by addressing the defect before birth (Durmaz et al., 2022). This shift towards minimally invasive techniques reflects a broader trend in surgical management, emphasizing the importance of careful patient selection and timing of intervention. Finally, the implications of umbilical cord graft closure and its association with umbilical hernia development underscore the need for meticulous postoperative assessment and management, highlighting the complexities involved in the long-term care of these patients (Taher et al., 2022). Conclusion: In conclusion, the literature on the surgical management of gastroschisis reveals a dynamic and evolving landscape characterized by innovation and adaptability in surgical techniques. The advancements in surgical care, particularly the integration of minimally invasive approaches and the focus on practical solutions for resource-limited settings, are pivotal in enhancing patient outcomes. However, ongoing research is essential to address existing gaps in knowledge and to refine management strategies further.
The Analysis Study of Surgical Management of Intussusception : A Pediatric Surgery Systematic Review Yosie Yulanda Putra; Ririn Azhari
The International Journal of Medical Science and Health Research Vol. 7 No. 4 (2024): 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/gn96nt49

Abstract

Background: Intussusception, a common abdominal emergency in children under three years of age, can lead to serious complications due to abnormal bowel movements, anatomical abnormalities, and infection. Surgical management is required if non-surgical reduction fails. Methods: This systematic review adheres to the PRISMA 2020 principles, focusing on full-text papers published in English between 2014 and 2024. Editorial and review articles without DOIs were removed to ensure that only high-quality sources were included. A comprehensive literature search was performed using major databases such as ScienceDirect, PubMed, and SagePub to uncover studies related to this research issue. Results: The database search identified over 1000 relevant publications, and eight were selected for in-depth analysis. Each study underwent rigorous critical appraisal to ensure quality and relevance, which formed the basis for a comprehensive review of the role of surgical management in the management of pediatric intussusception. Conclusions: Intussusception is a common condition in children under three years of age, with 85% of cases occurring during infancy. Surgical management is critical to the clinical outcome, with ultrasonography being the preferred diagnostic method. Secondary intussusception occurs in 1.5 to 15% of cases. In developing countries, surgical management is more common due to late diagnosis and limited access to radiological reduction methods.
The Analysis Study of Surgical Management of Hernia Inguinalis in Children : A Pediatric Surgery Systematic Review Yosie Yulanda Putra; Ririn Azhari
The International Journal of Medical Science and Health Research Vol. 7 No. 4 (2024): 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: 10.70070/7wq40m73

Abstract

Background: Inguinal hernia is a type of abdominal wall hernia, accounting for 7% of surgical consultations and 12% of total surgical procedures globally. Inguinal hernia can occur at any age, and premature infants have the highest incidence. Surgical treatment for inguinal hernia in children is necessary to avoid severe complications. Methods: This systematic review followed the PRISMA 2020 guidelines, focusing on full-text articles published in English between 2014 and 2024. Editorial and review articles without DOI were removed to ensure only high-quality sources were used. A comprehensive literature search process was performed through leading databases such as ScienceDirect, PubMed, and SagePub to identify studies relevant to this research topic. Results: An initial database search revealed more than 1000 publications relevant to this topic. After a thorough three-stage screening process, eight studies were selected based on pre-defined inclusion criteria and deemed eligible for further in-depth analysis. Each selected study underwent a thorough critical appraisal to ensure its quality and relevance, thus providing a solid foundation for a comprehensive study on the role of surgical management in the management of pediatric inguinal hernia. Conclusion: Laparoscopy is a minimally invasive procedure that requires specialized equipment that may not be available at all centers. Laparoscopic repair is gaining popularity due to its advantages over open surgery. Laparoscopic surgery is a viable option, but it has not shown significant advantages in terms of recurrence or short-term outcomes when compared to open surgery.
Long-Term Neurodevelopmental Outcome Measures in Preterm Infants: A Systematic Review Nurul Purnamasari; Ririn Azhari
The International Journal of Medical Science and Health Research Vol. 16 No. 3 (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/jtxw1843

Abstract

Introduction: Advances in neonatal care have significantly increased the survival of preterm infants, shifting the focus to long-term neurodevelopmental outcomes. Infants born before 37 weeks of gestation are at an elevated risk for a wide spectrum of impairments due to the interruption of critical in-utero brain development. This systematic review synthesizes the current evidence on long-term neurodevelopmental outcomes in preterm infants and the measures used for their assessment. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, and the Cochrane Library was performed to identify observational studies and randomized controlled trials that reported neurodevelopmental outcomes in preterm infants assessed at or after 12 months of age, compared to term-born controls or other preterm subgroups. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. A narrative synthesis was conducted, with results grouped by neurodevelopmental domain. Results: The search yielded 4,720 unique records, from which 8 studies met the inclusion criteria, encompassing a total of 72,974 preterm-born children. The evidence confirms a clear gradient of risk, with the prevalence and severity of impairment increasing with decreasing gestational age. Preterm infants demonstrate significantly higher rates of adverse outcomes across all major domains. Key findings include a pooled prevalence of overall neurodevelopmental impairment of 16% and cerebral palsy of 5% in low- and middle-income countries. Cognitive delays were the most frequently reported outcome, with preterm children scoring, on average, 11-13 points lower on IQ scales than their term-born peers. Increased risks were also consistently found for motor impairments, language delays, academic difficulties, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and internalizing and externalizing behavioral problems. A wide array of assessment tools was identified, with the Bayley Scales of Infant and Toddler Development and Wechsler Intelligence Scales being the most common. Discussion: The findings underscore the substantial and persistent burden of neurodevelopmental morbidity following preterm birth. The heterogeneity of assessment tools across studies presents a significant challenge for synthesizing evidence and comparing outcomes. The data suggest a developmental cascade, where early motor and language deficits may contribute to later cognitive and behavioral challenges. The necessity for long-term surveillance is highlighted by "sleeper effects," where some impairments only manifest later in childhood as academic and social demands increase. Conclusion: Preterm birth is a major risk factor for a wide spectrum of long-term neurodevelopmental impairments. Comprehensive, multidisciplinary follow-up programs using validated and context-appropriate assessment tools are essential for early identification and intervention to optimize the developmental potential of this vulnerable population.
Responsive versus Scheduled Interval Feeding for Preterm and Low Birth Weight Infants: A Systematic Review Nurul Purnamasari; Ririn Azhari
The International Journal of Medical Science and Health Research Vol. 16 No. 3 (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/ev8p0z60

Abstract

Introduction: Optimal feeding for preterm and low birth weight (LBW) infants is critical for growth and development, yet the ideal feeding strategy remains debated. This systematic review evaluates the effects of responsive (cue-based) feeding compared with traditional scheduled interval feeding on a comprehensive range of outcomes in this vulnerable population. Methods: Following PRISMA guidelines, we conducted a systematic search of CENTRAL, MEDLINE, EMBASE, and CINAHL for randomized controlled trials (RCTs) comparing responsive versus scheduled feeding in preterm (<37 weeks' gestation) or LBW (<2500 g) infants. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2 tool. Data were synthesized using random-effects meta-analysis for homogeneous outcomes, with results reported as mean difference (MD) or risk ratio (RR) with 95% confidence intervals (CI). A narrative synthesis was performed for heterogeneous data. The certainty of evidence was assessed using the GRADE framework. Results: Nine RCTs involving over 650 infants were included. Meta-analysis revealed that responsive feeding resulted in a slower rate of weight gain compared to scheduled feeding (MD −1.36 g/kg/day, 95% CI −2.44 to −0.29; low certainty) but significantly reduced the time to achieve full oral feeding (MD −5.53 days, 95% CI −6.80 to −4.25; low certainty). There was no consistent or statistically significant effect on the overall duration of hospital admission (MD −1.42 days, 95% CI −5.43 to 2.59; very low certainty). Data on critical outcomes, including long-term neurodevelopment, parental satisfaction, breastfeeding duration, and specific adverse events like necrotizing enterocolitis, were systematically absent across the included trials. Most included studies were small and possessed methodological limitations, primarily a high risk of bias due to lack of blinding. Discussion: The evidence highlights a central clinical trade-off: responsive feeding appears to accelerate the acquisition of oral feeding skills at the potential cost of slower short-term weight gain. The lack of a corresponding reduction in hospital stay suggests that other discharge criteria, such as achieving a specific weight, may negate the benefits of earlier feeding proficiency. A profound misalignment exists between the developmental philosophy of responsive feeding and the predominantly biomedical outcomes measured in existing trials. Conclusion: The current evidence, which is of low to very low certainty, is insufficient to recommend the universal adoption of responsive feeding over scheduled feeding to improve growth or shorten hospitalization for preterm and LBW infants. Responsive feeding appears to be a safe alternative that may hasten the transition to full oral feeding. High-quality, large-scale RCTs that measure patient- and family-centered outcomes are urgently needed.
The Relation Between 25-Hydroxyvitamin D Levels and Sepsis in Neonatal Intensive Care Unit Infants: A Comprehensive Systematic Review Nurul Purnamasari; Ririn Azhari
The International Journal of Medical Science and Health Research Vol. 16 No. 4 (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/zhjype47

Abstract

Introduction: Neonatal sepsis is a leading cause of morbidity and mortality worldwide, characterized by a dysregulated host immune response to infection. Vitamin D, recognized for its potent immunomodulatory functions, has been implicated as a potential modifiable risk factor. This systematic review aims to comprehensively evaluate the association between 25-hydroxyvitamin D levels and the incidence and severity of sepsis in infants admitted to the Neonatal Intensive Care Unit (NICU). Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted to identify observational (case-control and cohort) studies assessing maternal, cord, or neonatal 25(OH)D levels in NICU infants with and without sepsis. Data on study characteristics, participant demographics, vitamin D status, and a minimum of 15 clinical and laboratory outcomes were extracted. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). Results: The review included a robust selection of observational studies. A consistent and statistically significant association was found between lower 25(OH)D levels and the presence of neonatal sepsis. Neonates with sepsis had markedly lower mean 25(OH)D concentrations compared to non-septic controls across multiple studies. Furthermore, low maternal and cord blood 25(OH)D levels were identified as significant independent risk factors for developing neonatal sepsis, with neonates born to vitamin D-deficient mothers having substantially increased odds of infection. Vitamin D deficiency was also significantly associated with increased sepsis severity, longer hospital and NICU stays, greater need for mechanical ventilation and inotropic support, and adverse laboratory profiles, including elevated C-reactive protein (CRP) and lower platelet counts. Discussion: The evidence strongly suggests that pre-existing vitamin D deficiency is a critical predisposing factor for neonatal sepsis, rather than merely a consequence of the acute illness. The immunomodulatory role of vitamin D—enhancing innate antimicrobial defenses while tempering excessive inflammation—provides a strong biological rationale for these clinical findings. Low vitamin D status appears to impair the neonate's ability to mount an effective yet controlled immune response, thereby increasing susceptibility to infection and the risk of progression to severe sepsis and organ dysfunction. Methodological challenges, including variability in 25(OH)D assays and the unmeasured influence of Vitamin D Binding Protein (VDBP), are important limitations in the current literature. Conclusion: There is a robust association between vitamin D deficiency and an increased risk and severity of neonatal sepsis. Optimizing perinatal vitamin D status represents a promising preventative strategy. High-quality, large-scale randomized controlled trials are urgently needed to establish causality and to formulate evidence-based guidelines for vitamin D supplementation in pregnant women and high-risk neonates for the prevention of sepsis.
Co-Authors Nurul Purnamasari Yosie Yulanda Putra