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Thrombocytopenia is a condition in which platelet count below 150 x 109/L. Neonatal thrombocytopenia (NT) accounts up to 35% of all patients admitted to neonatal intensive care unit (NICU). The underlying cause of NT can often be predicted by the onset time of thrombocytopenia and course of disease. The purpose of this study was to determine the risk factors of thrombocytopenia in term infants undergoing treatment at Prof. Dr. I.G.N.G. Hospital. Method:An observational analytical study using case-control design was conducted in 50 term infants from March 2021 to October 2021 in Prof. Dr. I.G.N.G. Hospital Denpasar Bali. Result:Total 25 infants with thrombocytopenia in case group and 25 infants without thrombocytopenia in control group. Most of the infants were dominated by female gender (54%), mean gestational age was 38 (± 1) weeks, birth weight 2,940 (± 445) gram, cesarean section (56%). In addition, 48% of patients were vigorous babies. Early-onset neonatal sepsis (EOS) was 76% and late-onset neonatal sepsis (LOS) was 14%, most infants had neonatal pneumonia 58% and necrotizing enterocolitis (NEC) 48%. Mothers with preeclampsia were 26%. Multivariate analysis showed EOS was risk factor for NT (OR 4.69; 95% CI 0.9 – 22.0) and NEC (OR 4.17; 95% CI 1.2 – 14.4). Conclusion:Early onset neonatal sepsis (EOS) and necrotizing enterocolitis (NEC) are risk factors for thrombocytopenia in term infants.

Background: Obesity is defined as a medical condition characterized by excessive accumulation of body fat and is associated with an increased prevalence of dyslipidemia. Probiotics are living microorganisms, which upon consumption in sufficient numbers, exert health benefits. One of the benefits that has been studied is improving blood lipid profile. The aim of this study was to determine the efficacy of probiotics supplementation on obese adolescents’ lipid profiles. Methods: A randomized, double-blind, controlled clinical trial involving 58 obese adolescents aged 12-15 years in Denpasar City was performed. After the physical activity, nutritional intake, and lipid profile were assessed, subjects were randomized with random block into two groups: the treatment group who received sachet containing probiotics with five strains bacteria (Streptococcus thermophilus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium longum, Bifidobacterium bifidum) and the control group who received placebo for eight weeks. During the study, there were six drop out subjects, and the final analysis was performed on 52 subjects. The data was analyzed using MANCOVA test, with p value of

Background:Speech delay was one among the most prevalent and most often developmental disorders found in children. The use of screen media was suspected to be associated with speech delay, especially related to screen time. Urgent study related with identifying the association between speech delay and screen time was needed especially among younger children. Objective:This study aimed to prove the association between speech delay and screen time in 1-2-year-old children. Methods:This is a cross-sectional study, subjected at children aged 1-2-year-old in Denpasar, Bali, Indonesia Primary Health Care working area. Outcome was speech delay which diagnosed using Capute scales. Results:This study included 167 subjects with average age introduced to screen media was 9,84+4,04 months. This study subjects were mostly male (55%) with average age was 19.2+3.5 months. Children with screen time more than 2 hours per day were associated with speech delay [OR 6.15 (CI95% 2.84-13.30; p= Conclusion:Screen time more than two hours daily increase the risk of speech delay 6.2 times in children aged 1-2-year old. Male and low parental education also acted as risk factors for speech delay.Keywords: critical congenital heart disease, early screening

Background: Obesity in children has the potential to increase the risk of morbidity and even death in the future. One of the diseases that are at risk due to obesity is hypertension and also impaired kidney function. Glomerular filtration rate differences in obese and normal-weight children are somehow contradictory. This study aims to prove the difference in blood pressure and kidney function in adolescents with obese and non-obese.Methods: A cross-sectional study was conducted among high school children in Denpasar. Subjects were classified as obese and non-obese. The Mann-Whitney test was used to assess the mean difference of blood pressure, whereas the Independent t-test was used to determine the mean difference of GFR. Multivariate analysis was performed with logistic regression and ANCOVA. Data were analyzed using SPSS version 20 for Windows.Results: A total of 68 subjects with obese and 52 subjects with non-obese were included in this study. Systolic and diastolic blood pressure in the obese group was higher than in a non-obese group, with the mean difference in systolic and diastolic blood pressure was 29 mmHg (P

Neonatal appendicitis (NA) is an extremely rare acute abdomen condition, moreover, if it is a chronic suppurative one. The definite risk factor of NA is barely unknown. The signs and symptoms are often nonspecific and appear after perforation occurs. Most of the cases were found unexpectedly during surgery suspected as other diagnoses. A 7-day-old male neonate presenting lethargic and hypoglycemia since 1 st day of life. Patient drunk breast milk right after since he was born. Meconium was produced

Peningkatan permintaan pelayanan kesehatan di seluruh Indonesia menuntut rumah sakit pemerintah berbenah untuk mampu memberikan pelayanan terbaik pada masyarakat termasuk di RSUP Sanglah Denpasar, Bali. Penelitian ini bertujuan untuk mengetahui tingkat kepuasan orangtua pasien BPJS terhadap pelayanan di bangsal anak RSUP Sanglah Denpasar. Penelitian ini merupakan penelitian deskriptif analitik dengan pengambilan data dilakukan dengan cara menyebar kuesioner dengan metode SERVQUAL. Model SERVQUAL yang digunakan terdiri dari lima dimensi yaitu: 1) Tangibles, 2) Reliability, 3) Responsiveness, 4) Assurance, dan 5) Empathy. Kuesioner telah melewati uji reliabilitas dan vailiditas. Penelitian ini mengambil sampel secara consecutive sampling yaitu salah satu orangtua dari seluruh pasien anak yang dirawat di Ruang Cempaka 3 pada bulan April sampai September 2020. Analisis gap dan kuadran menggunakan analisis Importance Performance Analysis dengan diagram Cartesian. Dari 151 sampel yang terkumpul, didapatkan perbandingan lelaki banding perempuan 1,25:1. Rata-rata usia pasien adalah 5,75 tahun dengan rata-rata lama perawatan 8,8 hari. Berdasarkan analisis Importance Performance, tidak ada satupun atribut dengan nilai kenyataan lebih tinggi daripada harapan. Dimensi SERVQUAL dengan jumlah gap tertinggi adalah Reliability/keandalan. Pada analisis kuadran didapatkan bahwa seluruh dimensi kecuali dimensi tangibles (nyata) perlu meningkatkan performa. Secara umum, orangtua pasien belum puas terhadap pelayanan di RSUP Sanglah Denpasar khususnya di bangsal Cempaka 3. Kata kunci: kepuasan pasien, pelayanan rumah sakit, pediatri, SERVQUAL Abstract Increasing demand of health care in Indonesia require government hospital to compete in giving the best care. The objective of this study is to determine satisfaction level of BPJS patient parents in Sanglah General Hospital Denpasar. This is an analytical descriptive study using valid and reliable SERVQUAL questionnaire to collect samples. SERVQUAL model consists of 5 dimensions: 1) tangibles, 2) reliability, 3) responsiveness, 4) assurance, and 5) empathy. The questionnaire passed reliability and validity test. Samples were parents of all children admitted to Cempaka 3 Ward from April to September 2020 and were taken consecutively. Gap and quadrant analysis using Importance Performance Analysis and Cartesian Diagram were done. From 151 collected samples, the ratio of boys and girls were 1.25:1. Mean age of samples was 5.75 years old and mean hospital stay was 8.8 days. Based on Importance Performance Analysis, all of the reality value fell below expectation value. SERVQUAL dimension with the highest gap was reliability. In quadrant analysis, all of the dimensions except tangible need improvement. In general, parents of patients was not satisfied with health care in Cempaka 3 ward, Sanglah General Hospital Denpasar. Keywords: patient satisfaction, hospital care, paediatrics, SERVQUAL

BACKGROUND: Left ventricular end-diastolic volume (LVEDV) on echocardiography is one of the tests performed on heart failure. This refers to the volume of the left ventricle at the end of the diastolic phase, which would be increased when there is a disturbance in preload, afterload, and contractility factors. Matrix metalloproteinase-2 (MMP2) is a marker of congestive heart failure that can be examined through laboratory examinations. AIM: The objective of the study was to provide evidence of the association between MMP and inflammatory process as well as its correlation with LVEDV in children with heart failure. METHODS: This was a cross-sectional study conducted on children aged 3 months–12 years old with heart failure, who visited Sanglah Hospital, Denpasar, Indonesia from May 2017 to March 2018. Echocardiographic examination (LVEDV) and blood samples were taken to measure the serum level of MMP2 on day 1 after the subjects were diagnosed with heart failure. RESULTS: A total of 32 subjects with heart failure were analyzed in this study. Acyanotic congenital heart defect (CHD) was the most common cause of heart failure, as observed in 23 subjects (71.9%). Characteristics data revealed that 24 subjects (75%) were underweight, 23 (71.9%) had cardiomegaly, and 22 (68.8%) had mild heart failure. Data analysis showed a moderate positive correlation between MMP2 levels with LVEDV after controlling for the influence of age (p = 0.02; r = 0.425). CONCLUSION: There was a moderate positive correlation between MMP2 level and LVEDV after controlling for the age factor.

The purpose of this study was to determine the nutritional status of preterm neonates when discharged from the hospital. A descriptive study was reviewed from the register of preterm neonate after hospitalization in neonatal ward Sanglah Hospital Denpasar. The number of total samples in this study was 190 patients. Most of the preterm neonates in this study were low birth weight (59.47%). At the beginning of the hospitalization, there were 83.86% preterm neonates with good nutritional status, decreased to 54.73% at discharge from the hospital. The group of neonates that had the highest number of decreases in the good nutritional status at discharge was found in 28-32 weeks gestational age. Most of the samples used breast milk for enteral feeding (68,42%). In preterm neonates with sepsis, only 42.52% neonates discharge with good nutritional status. Low birth weight preterm neonates with kangaroo method care were found increased weight gain in 78.57% neonates. The nutritional status of preterm neonates following hospitalization at Sanglah hospital is still not good. The preterm neonates with good nutritional status were decreased at discharge from the hospital.

The purpose of this study was to investigate the number of referral neonates that came with an unstable condition (according to a S.T.A.B.L.E program) and characteristic of unstable conditions of the referred neonates. An observational prospective study was conducted for two years from 1st January 2018 to 31st December 2019 in the Emergency Department of Sanglah Hospital, Bali, Indonesia. Referred neonates were assessed in terms of gender, gestational age, referral characteristic, and condition on arrival at the hospital according to S.T.A.B.L.E criteria. According to S.T.A.B.L.E criteria, 283 neonates (54.8%) came on unstable condition. Prematurity (42.6%) was the main reason for referral, 37.9% of them were very low birth weight. Most of them were referred from Denpasar (33.9%), the equipment of transportation was incubator transport (41.8%). T-piece resuscitator was used in 30.4% of referred neonates. Characteristics of unstable conditions were mostly hypoglycemia (33%) and 36% of unstable neonates had more than one condition of instability. This study revealed 283 neonates were unstable and the main reason of transfer neonates is prematurity. Most of them come with unstable conditions that could lead to higher mortality. This study could be a reference for improvement in the neonatal transportation system in Bali.

Background: Sepsis is one of the most common causes of mortality and long terms morbidity among infants. It is known to be related to Low Birth Weight (LBW) due to the lack of immunity function to resist the infection. This study aims to identify the characteristics of neonatal sepsis in LBW infants in Sanglah General Hospital.Method: A retrospective cross-sectional study was conducted in the Neonatal Care Unit, Sanglah General Hospital, during January-December 2018 period among 135 neonates. Samples were taken using total sampling for neonates who had LBW and diagnosed with sepsis. Uncompleted data and voluntarily discharge patients were excluded from the study. Data regarding baseline characteristics of respondents, major and minor risk factors, laboratory results of sepsis, as well as blood culture, were analyzed using SPSS version 23 for Windows.Result: Most of respondents were male (54.1%), followed by bodyweight 1,500-2,499 grams (58.5%), and preterm labor (

Background: Obesity is a state of Body Mass Index (BMI) above or equal to 25 kg/m2. In obesity, dyslipidaemia can occur alone or together with other comorbid. This situation could affect pro-inflammatory and anti-inflammatory cytokines that lead to health problems. Several parameters assessed in dyslipidaemia conditions include High-Density Lipoprotein (HDL) and adiponectin. This study aims to evaluate the correlation between HDL and adiponectin levels in obese adolescents. Methods: A cross-sectional observational study was conducted among 33 obese adolescence (0-18 years) who met the inclusion criteria at Junior and Senior High School in Denpasar during August 2018-January 2019 period. Variables evaluated in this study were age, sex, weight, height, BMI, HDL, and adiponectin. The correlation assessment of HDL and adiponectin levels was conducted by Partial Correlation test after controlling age and sex using SPSS version 23 for Windows. Results: Males (66.70%) were predominant than females (33.30%) with a ratio of 2:1. The average age of respondents was 15.51±0.70 years old. The mean body weight was 91.04±15.40 kilograms, followed by height (163.09±7.40 cm), BMI (34.08±3.90 kg/m2), HDL (43.40±8.00 mg/dl), and adiponectin (4.55±2.1 µg/ml). There was a very weak and not significant correlation by Partial correlation test (r=0.143; p=0.444) between HDL and adiponectin levels.Conclusion: Our study found There was a very weak and not significant correlation between HDL and adiponectin levels among obese adolescent in Denpasar, Bali, Indonesia

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

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 24 hours (14.9%), and minor infection risk factor was gestational age

Background The prognosis of neonatal sepsis can be influenced by various risk factors, one of which is a deficiency of zinc micronutrient substances. Objective To assess for a potential association between serum zinc level and prognosis of infants with early-onset neonatal sepsis (EONS). Methods This prospective cohort study was done in neonates with clinical EONS from September 2017 until December 2018. Serum zinc level was measured on the first day of diagnosis and prognosis was assessed on the fourth day. The association between serum zinc levels and prognosis of EONS was analyzed by Chi-square test and logistic regression with adjustment for confounding variables. Results A total of 70 subjects were divided into two groups based on their serum zinc levels. A cut-off point of 75 ug/dL was used based on area under the curve (sensitivity 91.2% and specificity 93.7%), with accuracy 97.8% (95%CI 0.943 to 1.000; P=0.0001). Subjects with lowzinc level had a 16.8 times greater risk compared to subjects with high serum zinc (RR=16.81; 95% CI 4.35 to 65.02; P 0.05). Conclusion Serum zinc level is associated with prognosis of early onset neonatal sepsis, with a cut-off of 75 μg/dL. The high level of serum zinc associates with a better prognosis.

Hypoxic ischemic encephalopathy (HIE) is a worldwide problem. It is a type of brain injury that occurs when the brain doesn’t receive enough oxygen or blood flow occurring during pregnancy, labor and delivery or in the postnatal period. We aimed to investigate the characteristics of HIE among neonates admitted to Sanglah General Hospital. This observational retrospective study was conducted from January 2018 to December 2020 in Neonatology Ward of Sanglah General Hospital. This study was dominated by male subject, mild HIE (65.4%) with caesarian section (65.4%) and referred from other hospital (60.6%). Moreover the cases of seizure, neonatal sepsis and neonatal pneumonia accounted for 20.2%, 73.1%, and 34.6%, respectively. Mortality occurred in 28.8% neonates, but only 17.6% moderate HIE and 47.4% severe HIE got cooling therapy. Maternal characteristics were severe preeclampsia, placenta previa, previous abortion, hypertension, asthma and diabetes mellitus. This study demonstrated that HIE characteristics in neonates of Sanglah General Hospital mostly were mild stages, male gender, caesarean section as mode of delivery and majority was referred from other hospital.

Neonatal mortality is topic of concern for many medical faculties. Recently Score for Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE-II) is used to predict the mortality and morbidity of neonates in neonatal intensive care unit (NICU). This study aimed to find the association of mortality and morbidity among neonates using SNAPPE-II score in NICU of Sanglah Hospital with cross-sectional design. All newborns admitted in NICU within 48 hours of birth since January - December 2020 were recruited as sample and assessed by using SNAPPE-II. Statistical analysis was performed by using Chi-square test and Mann–Whitney U test. Eighty-three newborns fulfilled inclusion criteria. In the mortality group, 75.6% had SNAPPE score ≥ 37 and 24% had SNAPPE score 37 is associated with neonatal mortality. The high SNAPPE-II score in the survived group also affects length of stay in NICU, ventilator and antibiotic usage. These findings imply that SNAPPE-II can be applied routinely in NICU to know the most critical newborn for prioritizing the management of care and for counselling the parents.&nbsp

Background Amikacin is the antibiotic of choice for eradicating bacteria in neonatal sepsis because of its effectiveness against Gram-negative bacteria. However, this drug has nephrotoxic effects. Monitoring kidney function in neonates is very important because amikacin can interfere with development of the kidney. Several studies have shown that serum cystatin C levels were closer to glomerular filtration rate (GFR) values ​​compared to serum creatinine levels. Objective To evaluate cystatin C levels before and after administration of amikacin in neonates with sepsis. Methods This prospective cohort study was conducted in one group with a pretest and posttest design. Thirty neonatal sepsis patients who received amikacin therapy at Sanglah General Hospital, Denpasar, Bali, were included by consecutive sampling. Their cystatin C levels were measured before and after receiving amikacin therapy. Data were normally distributed and analyzed by paired T-test, with a value of P

Neonatal Late-Onset Sepsis (LOS) is a leading cause of mortality in the Neonatal Intensive Care Unit (NICU). The microbial characteristics of LOS are of primary importance in guiding clinical antisepsis practice, and strategies to prevent and treat neonatal LOS, in turn, influence the pattern of LOS pathogens. This study is a retrospective descriptive study with a cross-sectional approach conducted between 2016 until 2020 in the neonatal ward (level II-III) of the Sanglah General Hospital, Bali. Data collected consists of demography, clinical characteristics, laboratory results, and outcomes. Subjects in this study dominated by male (64%), gestational age > 37 weeks (56%), born ≥ 2.500 grams (54%), last mother education mostly in Senior High School (56%), spontaneous delivery method (54%) and 31 (62%) subjects were referral from other hospital and primary health care. Most of the subjects were lethargic (68%) and 15 (30%) subjects were died. Laboratory finding normal leukocyte, neutrophil, lymphocyte, hemoglobin, thrombocyte and IT ratio but have higher procalcitonin result. Poor outcome group were dominated by male, smaller gestational age, VLBW, and neonates who experience lethargy, temperature instability, respiratory distress and got positive blood culture.

BACKGROUND: Cognitive, motoric, and language development in a human immunodeficiency virus (HIV)-infected child is an important issue that affects developmental milestone and quality of life. The effect of HIV infection on cognitive function must be detected early to prevent delayed cognitive, motoric, and language function. AIM: This study aimed to assess the correlation of cognitive scores with CD4 count among HIV-infected children in pediatrics polyclinic Sanglah Hospital, Bali. METHODS: This cross-sectional study recruited 68 HIV-infected children age 0–36 months old as participants. Cognitive score was assessed using Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) scores and HIV status, and CD4 count was obtained from the medical record. RESULTS: The result showed that mean of CD4 count among subject was 29.85 cells/mm3, there was positive correlation between CAT scores with CD4 count (r = 0.33, p = 0.006) and also between CLAMS scores with CD4 count (r = 0.307, p = 0.01). CONCLUSION: It can be concluded that CD4 count correlated with Capute scores on HIV-infected children.

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

Cognitive development is the result of the relationship between nervous system and individual experiences to adapt to its environment. A thorough social and demographic changes lead to increased number of children receiving non-parental care. Some mothers entrust their child care in daycare. The impact of daycare service to the child's development depends on several interrelated factors, including the personality of the child, stimulation, care setting, and family condition. In daycare facilites, the children were cared non-parental or non-familial settings. Factors that may affect the child's development in a daycare are duration of care, caregiver-to-child ratio, the level of caregiver education, and child stimulation during the daycare. The aim of this study is to confirm association between the care duration, caregiver-to-child ratio, caregiver education, and daycare stimulation on child’s cognitive in daycare. This was an observational analytical study with a cross-sectional design. This study was conducted at the daycare in Denpasar since July 2018 to July 2019. The child’s cognitive was measured with Mullen score. A total of 80 children in 6 daycares were included. The mean Mullen score was 91.71 (SD 10.4). The bivariate analysis of caregiver education, caregiver-to-child ratio, and stimulation using independent T test showed significant differences. The level of caregiver education showed a mean difference of 6.3 with a p-value of 0.045 (95% CI 0.129-12.411). The caregiver-to-child ratio showed a mean difference difference of 10.1 with a p-value of

Background An estimated 6 of 1,000 children with live births suffer from permanent hearing loss at birth or the neonatal period. At least 90% of cases occur in developing countries. Hearing loss should be diagnosed as early as possible so that intervention can be done before the age of 6 months. Objective To determine risk factors for hearing loss in neonates. Methods We performed a case-control study involving 100 neonates with and without hearing loss who were born at Sanglah Hospital, Denpasar from November 2012 to February 2013. Subjects were consisted of 2 groups, those with hearing loss (case group of 50 subjects) and without hearing loss (control group of 50 subjects). The groups were matched for gender and birth weight. We assessed the following risk factors for hearing loss: severe neonatal asphyxia, hyperbilirubinemia, meningitis, history of aminoglycoside therapy, and mechanical ventilation by Chi-square analysis. The results were presented as odds ratio and its corresponding 95% confidence intervals. Results Seventy percent of neonates with hearing loss had history of aminoglycoside therapy. Multivariable analysis revealed that aminoglycoside therapy of 14 days or more was a significant risk factor for hearing loss (OR 2.7; 95%CI 1.1 to 6.8; P=0.040). There were no statistically significant associations between hearing loss and severe asphyxia, hyperbilirubinemia, meningitis, or mechanical ventilation. Conclusion 􀀤􀁐􀁌􀁑􀁒􀁊􀁏􀁜􀁆􀁒􀁖􀁌􀁇􀁈􀀃􀁗􀁋􀁈􀁕􀁄􀁓􀁜􀀃􀁉􀁒􀁕􀀃􀂕􀀃􀀔􀀗􀀃􀁇􀁄􀁜􀁖􀀃􀁚􀁄􀁖􀀃􀁌􀁇􀁈􀁑􀁗􀁌􀁉􀁌􀁈􀁇􀀃 as a risk factor for hearing loss in neonates. [