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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.

Fatal Disseminated Tuberculosis in Vaccinated Children with Failed BCG Scar Formation: A Clinical-Pathological Correlation and Immunological Review Delicia Rudy; Prisillia Brigitta; I Kadek Suarca
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.v10i2.1510

Background: The Bacillus Calmette-Guérin (BCG) vaccine remains the cornerstone of preventative strategies against severe pediatric tuberculosis (TB), specifically disseminated forms such as miliary TB and tuberculous meningitis (TBM). While the formation of a cutaneous scar is historically viewed as a surrogate marker for successful vaccine uptake and delayed-type hypersensitivity (DTH), its absence is often clinically overlooked. This study investigates the correlation between the lack of BCG scarring, immunological anergy, and fatal disseminated disease outcomes. Case presentation: We report a clinical-pathological analysis of two pediatric patients admitted to a tertiary care center in Indonesia. Case 1, an 11-month-old male vaccinated at birth, presented with status epilepticus and was diagnosed with Probable TBM Stage III. Despite vaccination, he lacked a BCG scar and exhibited Tuberculin Skin Test (TST) anergy (0 mm). Case 2, a 2-year-8-month-old female vaccinated at birth, presented with Type 1 respiratory failure due to severe miliary TB. She demonstrated profound wasting and TST anergy (0 mm). Both patients succumbed to the disease (Day 9 and Day 14, respectively) despite aggressive management. Conclusion: The absence of a BCG scar in vaccinated children serves as a critical clinical indicator of "immunological silence." It correlates with a failure to mount the Th1-mediated granulomatous response necessary for containing lymphohematogenous spread. We recommend that scar failure be treated as a risk factor requiring enhanced surveillance and a lower threshold for preventative therapy.

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.

Fatal Disseminated Tuberculosis in Vaccinated Children with Failed BCG Scar Formation: A Clinical-Pathological Correlation and Immunological Review Delicia Rudy; Prisillia Brigitta; I Kadek Suarca
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.v10i2.1510

Background: The Bacillus Calmette-Guérin (BCG) vaccine remains the cornerstone of preventative strategies against severe pediatric tuberculosis (TB), specifically disseminated forms such as miliary TB and tuberculous meningitis (TBM). While the formation of a cutaneous scar is historically viewed as a surrogate marker for successful vaccine uptake and delayed-type hypersensitivity (DTH), its absence is often clinically overlooked. This study investigates the correlation between the lack of BCG scarring, immunological anergy, and fatal disseminated disease outcomes. Case presentation: We report a clinical-pathological analysis of two pediatric patients admitted to a tertiary care center in Indonesia. Case 1, an 11-month-old male vaccinated at birth, presented with status epilepticus and was diagnosed with Probable TBM Stage III. Despite vaccination, he lacked a BCG scar and exhibited Tuberculin Skin Test (TST) anergy (0 mm). Case 2, a 2-year-8-month-old female vaccinated at birth, presented with Type 1 respiratory failure due to severe miliary TB. She demonstrated profound wasting and TST anergy (0 mm). Both patients succumbed to the disease (Day 9 and Day 14, respectively) despite aggressive management. Conclusion: The absence of a BCG scar in vaccinated children serves as a critical clinical indicator of "immunological silence." It correlates with a failure to mount the Th1-mediated granulomatous response necessary for containing lymphohematogenous spread. We recommend that scar failure be treated as a risk factor requiring enhanced surveillance and a lower threshold for preventative therapy.

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