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Background Sepsis remains one of the causes of child morbidity and mortality worldwide. The reference standard diagnosis of sepsis is blood culture, but its false negative is relatively high. Therefore, a validated triage tool is needed for rapid diagnosis. In Indonesia, diagnosis and management of pediatric sepsis are based on Indonesian Sepsis National Guidelines 2021. Objective To evaluate the performance of Indonesian Sepsis National Guidelines 2021 in diagnosing pediatric bacterial sepsis in PICU. Methods This cross-sectional study was conducted in the PICU unit of Dr. Sardjito Hospital, Yogyakarta, using subject’s the medical records. All patients with suspected bacterial infection who were admitted to the PICU, had complete evaluation of PELOD-2 score, and the blood culture results were included in this study. Sepsis was assessed with Indonesian Sepsis National Guidelines 2021. Performance analysis of the guidelines was conducted with SPSS version 25, by assessing sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and likelihood ratio. Results Two hundred subjects were enrolled in this study, of whom 52.5% were males. Most subjects aged under one year (40.5%), and the most common infection was respiratory system (49%). A total of 63.5% were referral cases, with the length of stay in the previous hospital more than 48 hours (69.7%). There were 77% of subjects had antibiotics treatment at the previous hospital. As for outcomes, 63.5% survived and 36.5% died. The positivity rate of blood culture in this study was 19%. Performance evaluation of Sepsis Indonesian Sepsis National Guidelines 2021 revealed sensitivity 28.95%, specificity 87.65%, accuracy 76.5%, positive predictive value 35.48%, negative predictive value 84.02%, positive likelihood ratio 2.34 (95%CI 1.28 to 4.32) and negative likelihood ratio 0.81 (95%CI 0.7 to 0.94). Conclusion Indonesian Sepsis National Guidelines 2021 (PNPK Sepsis 2021) has low sensitivity and high specificity in diagnosing bacterial sepsis.

Introduction Reducing neonatal deaths in premature infants in low- and middle-income countries is key to reducing global neonatal mortality. International neonatal networks, along with patient registries of premature infants, have contributed to improving the quality of neonatal care; however, the involvement of low-to-middle-income countries was limited. This project aims to form an international collaboration among neonatal networks in Asia (AsianNeo), including low-, middle- and high-income countries (or regions). Specifically, it aims to determine outcomes in sick newborn infants, especially very low birth weight (VLBW) infants or very preterm infants, with a view to improving the quality of care for such infants.Methods and analysis Currently, AsianNeo comprises nine neonatal networks from Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan and Thailand. AsianNeo will undertake the following four studies: (1) institutional questionnaire surveys investigating neonatal intensive care unit resources and the clinical management of sick newborn infants, with a focus on VLBW infants (nine countries/regions); (2) a retrospective cohort study to describe and compare the outcomes of VLBW infants among Asian countries and regions (four countries/regions); (3) a prospective cohort study to develop the AsianNeo registry of VLBW infants (six countries/regions); and (4) implementation and evaluation of educational and quality improvement projects in AsianNeo countries and regions (nine countries/regions).Ethics and dissemination The study protocol was approved by the Research Ethics Board of the National Center for Child Health and Development, Tokyo, Japan (reference number 2020–244, 2022–156). The study findings will be disseminated through educational programmes, quality improvement activities, conference presentations and medical journal publications.

Latar belakang. Air susu ibu (ASI) merupakan nutrisi yang penting untuk bayi kurang bulan. Pemberian ASI pada bayi kurang bulan mempunyai banyak kendala yang akan memengaruhi keberhasilan pemberian ASI. Tujuan. Mengetahui durasi pemberian ASI pada bayi yang lahir kurang bulan dan faktor-faktor yang memengaruhi Metode. Rancang bangun penelitian adalah potong lintang. Data diambil dari registri bayi kurang bulan yang dirawat di bangsal Perinatologi RSUP Dr. Sardjito, yang lahir antara 1 Januari 2018 – Desember 2018. Bayi yang tidak mendapatkan ASI karena alasan medis, misal ibu menderita HIV, ibu mendapatkan kemoterapi atau karena ibu meninggal dunia dikeluarkan dari penelitian ini. Analisis simple dan multiple linear regression dilakukan untuk mengetahui hubungan variabel bebas terhadap lama pemberian ASI. Hasil. Sebanyak 79 bayi kurang bulan yang memenuhi kriteria inklusi dan eksklusi direkrut ke dalam penelitian. Rerata ± SD lama pemberian ASI pada bayi kurang bulan adalah 10,8±8,1 bulan dengan median 7 bulan. Bayi yang mendapatkan ASI sampai usia 2 bulan adalah 96,2%, usia 4 bulan 89,9%, 6 bulan 81%, 8 bulan 45,6 %, 10 bulan 34,2%. Hasil analisis regresi linear berganda menunjukkan bahwa variabel yang secara independent terbukti bermakna memengaruhi lama menyusui adalah usia pertama kali bayi diberikan susu formula (?=0,66; p=

Abstract Background Screening of critical congenital heart disease (CCHD) using pulse oximetry is a routine procedure in many countries, but not in Indonesia. This study aimed to evaluate the feasibility of implementing CCHD screening with pulse oximetry for newborns in Yogyakarta, Indonesia. Methods A cross-sectional study was conducted at four hospitals in Yogyakarta, Indonesia. Newborns aged 24–48 hours who met the inclusion criteria were screened on the right hand and left or right foot using a pulse oximeter. Positive results were indicated by: either (1) SpO2 level 3% between the upper and lower extremity on three measurements conducted 1 hour apart. Positive findings were confirmed by echocardiography. Results Of 1452 newborns eligible for screening, 10 had positive results and were referred for echocardiographic evaluation. Of those, 8 (6 per 1000 live birth, 8/1452) had CCHD. Barriers found during screening processes were associated with hospital procedures, equipment, healthcare personnel, and condition of the newborn. Conclusion Pulse oximetry screening might be feasible to be implemented within the routine newborn care setting for CCHD in Indonesia. In order to successfully implement pulse oximetry screening to identify CCHD in Indonesia, the barriers will need to be addressed.

Caring for extremely low birth weight (ELBW) infants remains a challenge in developing countries due to high morbidity and mortality rates. In Dr. Sardjito Hospital, Yogyakarta, the ELBW survival rate was 39.3%.1 Expected outcomes of these ELBW survivors are increased risk of mortality during the infant period and short term as well as long term complications.2 Osteopenia of prematurity is a comorbidity that can interfere with longterm growth and neurodevelopment.3 Osteopenia of prematurity is found in approximately 55% of babies with ELBW.4 Antenatal demineralization is aggravated by improper nutritional interventions during perinatal care and post-discharge care. This comorbidity is asymptomatic in the infant’s early life, but later contributes to linear growth failure, delayed teeth eruption, respiratory problems, and bone fractures in ELBW babies.3 Early detection and prompt management of osteopenia of prematurity are needed for all ELBW infants. Here we present a case of an ELBW infant with osteopenia of prematurity who we observed for 18 months. The child underwent multidisciplinary interventions for modifiable prognostic factors to support optimal achievement of growth and neurodevelopment.

Latar belakang. Anorectal malformation (ARM) atau imperforate anus atau malformasi anorektal (MAR) atau atresia ani merupakan kelainan bawaan yang sering ditemui. Kematian neonatus MAR yang tidak segera terdiagnosis masih terjadi. Kesakitan neonatus MAR pasca operasi dikaitkan dengan infeksi saluran kencing dan gangguan pertumbuhan, serta dapat terjadi perforasi usus serta septikemia yang dapat menyebabkan kematian. Tujuan. Penelitian ini bertujuan untuk mengidentifikasi faktor prediktor yang memengaruhi kematian neonatus dengan MAR pasca operasi. Metode. Dilakukan penelitian kohort retrospektif pada data neonatus malformasi anorektal pasca operasi di RSUP dr. Sardjito Yogyakarta antara Januari 2013 - Desember 2019. Data karakteristik berupa jenis kelamin, usia kehamilan, berat lahir, usia operasi, fistula, VACTERL, penyakit jantung bawaan, sepsis, dan usia ibu. Hasil. Diperoleh 188 neonatus MAR dari 9736 neonatus yang dirawat di bangsal perinatal dan NICU pada periode Januari 2013- Desember 2019. Analisis bivariat diperoleh variabel: usia kehamilan, berat lahir, penyakit jantung bawaan, dan sepsis merupakan faktor prediktor kematian pada neonatus MAR. Dari analisis multivariat didapatkan variabel yang dapat menjadi faktor prediktor kematian neonatus MAR pasca operasi adalah penyakit jantung bawaan (OR:3,91;CI 95% :1,52-10,03) dan sepsis (OR:3,16; CI 95% :1,45-6,89). Kesimpulan. Penyakit jantung bawaan dan sepsis merupakan faktor prediktor kematian pada neonatus malformasi anorektal.

Abstract Background Compared to their appropriate-for-gestational-age (AGA) peers, small-for-gestational-age (SGA) infants are prone to growth deficits. As the first 6 months of exclusive breastfeeding is generally recommended, it is essential to understand how this intervention might impact SGA infants’ growth. This study aims to assess growth of exclusively breastfed SGA term infants in the first 6 months of life. Methods A prospective cohort study was conducted on term infants born in Dr. Sardjito General Hospital and two private hospitals in Yogyakarta, Indonesia. SGA was defined as birth weight less than the 10th percentile according to Fenton criteria. Weight, length, and head circumference (HC) were measured at birth and monthly until 6 months old. Results A total of 39 AGA and 17 SGA term infants who were exclusively breastfed in their first 6 months were included and followed. In SGA compared to AGA, birth weight, length, and HC (mean ± SD) were significantly lower (p

Child with left renal agenesis fulfill the diagnostic criteria for chronic kidney disease due to its structural abnormalities that lasted for more than three months. It is important to monitored the disease progression and also growth, development and quality of life in children with chronic disease. Management of other risk factors that can accelerate disease progression must be carried out comprehensively. The patient's was 9 months old girl with stage I chronic kidney disease and also having recurrent complex urinary tract infections with left renal agenesis. The interventions was to identify other abnormalities of the urinary tract and syndromic disorders, prevention of urinary tract infection (UTI) recurrence, prevention of renal injury, renal scaring and dietary education. After 18 months of observation there was no urinary tract abnormality in imaging results, there was one episode of mild recurrent UTI, no renal injury and there was no sign of renal scaring. The final outcome was no significant decrease in glomerular filtration rate (GFR), growth and development was good and good quality of life. The immunizations was given as scheduled. Monitoring and multidisciplinary intervention of prognostic variables such as urinary tract and syndromic disorders, recurrence UTI, renal injury, renal scaring and diet in children with chronic kidney disease are important for optimal outcome. No decrease of GFR, good growth, development and optimal quality of life and also knowing the progression of chronic kidney disease was the final outcomes of the intervention.

Background Diabetic ketoacidosis (DKA) is an acute complication in type 1 diabetes mellitus (DM) and a significant cause of morbidity and mortality in developing countries. Diabetic ketoacidosis can be prevented by good management of the disease. Risk factors from previous studies that increase the DKA incidence were peripubertal age, female gender, low socio-economic status, low parental education status, DKA at the first diagnosis of type 1 DM, infection, psychological problems, poor metabolic control, and non-compliance with insulin treatment. Objective To determine whether sex, age, socio-economic status, parental education level, DKA at the initial diagnosis of type 1 DM, infection, psychological problems, poor metabolic control, and failing to take insulin as needed were predictive of DKA in type 1 DM patients. Methods We conducted a retrospective cohort study using medical records from type 1 DM patients aged 0-20 years, at the Department of Child Health, Dr. Sardjito Hospital, Yogyakarta, from January 2011 to May 2017. We assessed for the incidence and predictors of DKA. Logistic regression analysis was done to determine which factors increased DKA incidence. Results A total of 57 type 1 DM patients were recruited, with DKA incidence of 37 (65%). Five (8.8%) DKA patients died. Multivariate analysis revealed that infection (OR 5.23; 95%CI 1.47 to 19.68; P=0.014) and DKA at the first diagnosis of type 1 DM (OR 5.37; 95%CI 1.40 to 19.52; P=0.011) were significant risk factors for DKA. Conclusion Infection and DKA at the first diagnosis of type 1 DM are significant predictors of increased DKA incidence.

Background The macronutrients in human milk change dynamically and vary among mothers. Evaluation of macronutrient content in human milk is needed to improve nutritional management in preterm infants. Objective To measure the macronutrient content in preterm and full term human milk during three lactation periods in the first three weeks after delivery. Methods We conducted a prospective study among 80 mothers of infants who were hospitalized in the Department of Perinatology/NICU at Sardjito Hospital, Yogyakarta. Carbohydrate, fat, protein, and caloric content were measured using a MIRIS human milk analyzer, once per week for three consecutive weeks after delivery. A single, daytime human milk specimen was collected in the morning by directly expressing from the breast. Results Median protein, fat, carbohydrate, and caloric contents of mature milk in the preterm group were 1.40 (IQR 0.38), 3.25 (IQR 1.00), 5.70 (IQR 0.80) g/dL, and 60 kcal/dL, respectively. Median protein, fat, carbohydrate, and caloric contents of mature milk in the full term group were 1.40 (IQR 0.35), 3.30 (IQR 0.77), 5.80 (IQR 0.75) g/dL, and 62 kcal/dL, respectively, at the third week after delivery. In both groups, protein content in the first week was significantly higher than in the third week (P

Background: Interactions between the genome and intrauterine environment can affect bone mineralization in newborns and even in adult life. Several studies show that intrauterine fetal bone mineralization or early postnatal bone condition influences the risk of osteoporosis in later life.Objectives: To determine whole body bone mineral content (WB BMC) and factors that influence neonatal WB BMC in Indonesian term newborns.Subjects/Methods: A cross-sectional study was conducted in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. A total of 45 term, appropriate for gestational age (AGA) newborns were included in this study. BMC was assessed by dual-energy x-ray absorptiometry (DXA) in the first week of life. Weight (g), length (cm) and head circumference (cm) were measured at birth. Data on maternal characteristics were obtained from the maternal health records or reported by the mothers.Results: WB BMC measured in the present study (mean ± SD: 33.2 ± 9.3 g) was lower than WB BMC of similar populations in developed countries. Multiple linear regression showed that birth weight, birth length, and gestational age had a positive association with WB BMC (p = 0.048, 0.017, and

Latar belakang. Bayi yang lahir dari ibu diabetes melitus (IDM) memiliki risiko lebih tinggi mengalami berbagai morbiditas pada masa neonatus. Metabolisme bilirubin merupakan salah satu sistem yang mungkin terganggu. Tujuan. Mengetahui faktor risiko hiperbilirubinemia pada bayi IDM dan hubungannya dengan faktor risiko hiperbilirubinemia yang lain. Metode. Studi kohort retrospektif pada 71 IDM dan 71 bayi ibu tidak diabetes melitus (ITDM) yang lahir di RSUP Dr.Sardjito antara Januari 2007 - Desember 2014. Data diperoleh dari register neonatal-perinatal WHO-SEARO. Hasil. Risiko hiperbilirubinemia lebih tinggi pada bayi IDM dibandingkan ITDM (42% vs 17%) (RR 2,5 IK95%: 1,4-4,5). Analisis stratifikasi menunjukkan bahwa risiko dipengaruhi oleh usia kehamilan, berat lahir, polisitemia, dan inisiasi menyusu dini. Sepsis meningkatkan risiko pada IDM (RR 11,5 IK95%: 3,7-36,0), sedangkan inisiasi menyusu dini merupakan faktor pencegah (RR 0,6, IK95%: 0,3-0,9). Kesimpulan. Ibu diabetes melitus meningkatkan risiko hiperbilirubinemia pada masa neonatus. Risiko ini dipengaruhi oleh berat lahir, usia kehamilan, kondisi sepsis, dan inisiasi menyusu dini.

Latar belakang. Bayi berat lahir sangat rendah (BBLSR) masih merupakan tantangan dalam upaya menurunkan angka kematian neonatal. Beberapa faktor risiko telah terbukti meningkatkan risiko kematian BBLSR, seperti berat lahir dan umur kehamilan. Besarnya variasi tingkat perawatan di neonatal intensive care unit(NICU) juga akan berkontribusi terhadap risiko kematian. Tujuan. Melakukan pengaruh beberapa faktor maternal, fetal, kondisi bayi dan parameter pemeriksaan pendukung terhadap kematian BBLSR. Metode. Penelitian kohort prospektif dilakukan di bangsal Perinatologi RSUP Dr. Sardjito Yogyakarta dari tanggal 1 Februari 2007 sampai Agustus 2010. Semua bayi yang dirawat dengan berat lahir lebih dari 500 g, tanpa kelainan kongenital yang lethal dan dapat diikuti sampai diijinkan pulang dimasukkan sebagai subjek penelitian. Data faktor prognostik kematian dikumpulkan dengan formulir yang sudah terkode. Dilakukan analisis dengan logistik regresi untuk mengetahui pengaruh faktor prognosis terhadap kejadian kematian BBLSR. Hasil. Didapatkan 394 bayi lahir BBLSR yang diikutsertakan ke dalam penelitian, 33 (8%) bayi dikeluarkan karena pulang sebelum diijinkan. Angka kematian BBLSR 62,3%. Dari hasil analisis multivariat didapatkan variabel yang dapat menjadi faktor prognostik kematian BBLSR adalah berat lahir

Latar belakang. Epilepsi pascaensefalitis merupakan salah satu komplikasi ensefalitis yang sering terjadi serta memerlukan tata laksana jangka panjang dan menurunkan kualitas hidup pasien. Kejang berulang dan status epileptikus pada ensefalitis dicurigai dapat meningkatkan risiko terjadi epilepsi pascaensefalitis. Tujuan. Mengetahui apakah risiko epilepsi pascaensefalitis lebih tinggi pada pasien yang mengalami kejang berulang dan status epileptikus pada ensefalitis. Metode. Penelitian kasus kontrol pada pasien pascaensefalitis usia 6 bulan-18 tahun dilakukan di bangsal anak RSUP Dr. Sardjito, Yogyakarta. Kelompok kasus terdiri dari 26 pasien dengan diagnosis epilepsi pascaensefalitis, 27 pasien pascaensefalitis dengan gejala sisa selain epilepsi atau tanpa gejala sisa sebagai kelompok kontrol. Data klinis subyek selama episode ensefalitis akut didapatkan dari rekam medis pasien saat dirawat. Kekuatan hubungan antara variabel independen dengan variabel dependen diketahui berdasarkan analisis bivariat dan analisis multivariat. Hasil. Kejang berulang ensefalitis akut meningkatkan risiko terjadinya epilepsi pascaensefalitis (OR 3,6;95 % CI 1,0-12,7; p0,05). Kesimpulan. Kejang berulang ensefalitis meningkatkan risiko terjadinya epilepsi pascaensefalitis. Status epileptikus pada ensefalitis secara klinis meningkatkan risiko terjadinya epilepsi pascaensefalitis, tetapi secara statistik tidak bermakna.

Latar belakang. Prevalensi rinitis alergi di dunia semakin meningkat termasuk di Indonesia. Rinitis alergi menyebabkan penurunan kualitas hidup sehingga sedini mungkin dicegah agar proses tumbuh kembang anak optimal. Faktor pencegah di antaranya dengan pemberian air susu ibu (ASI) secara eksklusif. Tujuan. Mengetahui apakah pemberian ASI eksklusif merupakan faktor protektif terhadap rinitis alergi pada anak di Provinsi Daerah Istimewa Yogyakarta. Metode. Rancang penelitian berupa kasus kontrol berpasangan, analisis Mc.Nemar, dan conditional logistic regression. Populasi target murid sekolah dasar di Yogyakarta dengan rinitis alergi sebagai kasus (diagnosis berdasarkan kriteria AIRA, kuesioner ISAAC, uji tusuk kulit). Matching berdasarkan umur dan jenis kelamin. Informasi pemberian ASI dengan wawancara dan kuesioner. Hasil. Subjek penelitian adalah 55 kasus dan 55 kontrol. Alergen terbanyak menimbulkan alergi adalah kutu rumah. Pemberian ASI eksklusif terhadap rinitis alergi mempunyai rasio odds 0,23; IK95% 0,08-061; p=0,23. Paparan asap rokok terhadap alergi mempunyai rasio odds 3,07; IK95% 1,23-7,68; p=0,016. Kesimpulan. ASI eksklusif merupakan faktor protektif terhadap rinitis alergi pada anak.

Background The World Health Organization has asked for a spe- cial attention to the relation between pneumonia and indoor air pollution, i.e., household biomass fuel smoke, cigarette smoke, and mosquito coil smoke, especially in developing countries. Objective To analyze the role of indoor air pollution and other factors as risk factors for pneumonia in under-five-year children. Methods This case-control study was carried out from August un- til December 2000 at Public Health Centers in Banjarnegara, Kebumen, Jepara, and Pekalongan districts. All children qualify- ing pneumonia classification as recommended by WHO in IMCI (Integrated Management of Childhood Illness) were defined as cases and without pneumonia as controls. Severe pneumonia and no pneumonia (as classified in IMCI) were excluded. Statistical analysis was done using bivariate and logistic regression. Results There were three hundreds and five children with pneu- monia and 289 children without pneumonia. By bivariate analysis, biomass fuel smoke (OR=3.25; 95%CI 1.50;7.07) and cigarette smoke exposure from other family members (OR=1.63; 95%CI 1.11;2.38) were risk factors for pneumonia, while mosquito coil smoke (OR=1.13; 95%CI 0.79;1.69) was not. History of wheezing (OR=2.60; 95%CI 2.7;8.55), malnutrition (OR=2.60; 95%CI 1.33;5.07), and male sex (OR=1.47; 95%CI 1.06;2.04) were other risk factors. Conclusions Household biomass fuel smoke and cigarette smoke were risk factors for pneumonia. Other variables as risk factors were history of wheezing, male sex, and malnutrition

Background Neonatal sepsis remains the leading cause of neonatal deaths. Therefore, efforts should be made to reduce its mortality. Lactate clearance can be used as a marker of onset of hypoxia and microcirculation disorders, as well as to predict patient outcomes. Objective To assess the use of lactate clearance to predict mortality from neonatal sepsis. Methods We conducted a prospective cohort study in the levels 2 and 3 of neonatal care unit, Department of Child Health, Dr. Sardjito General Hospital, Yogyakarta, from October to November 2011. We enrolled 40 neonatal sepsis patients, who were divided into either the high or low lactate clearance groups. All neonates were followed up until they were discharged from the hospital, as to whether they survived or died. We performed blood lactate measurements early on following their diagnosis of sepsis, and after the subsequent six hours following the first antibiotic administration. Logistic regression for the multivariate analysis and ROC curves for the accurate analysis of predictive outcome factors were performed. Results More deaths occurred in neonates with low lactate clearance at six hours (48%) than in those in the high lactate clearance group (7%). Low lactate clearance at six hours was a significant predictor of mortality (RR 15.1; 95%CI 1.7 to 133), whereas the ROC analysis showed moderate accuracy. Conclusion Lactate clearance at six hours may be used as a predictor of mortality in infants with neonatal sepsis.

Background: Body mass index (BMI) and skinfold thickness are widely used to evaluate body composition. Information on patterns of skinfold thickness may help to understand changes in body composition during growth. The objectives of this study were to observe patterns of BMI, percentage body fat (%BF), and skinfold thicknesses of Indonesian children and adolescents aged 7–18 years. Methods: Weight, height, and four skinfold thicknesses were measured in 2104 school children (924 boys, 1,180 girls) aged 7–18 years from Yogyakarta between 2015 and 2018. BMI and ratios between central and peripheral skinfold thicknesses were determined. %BF was predicted using the equation of Slaughter et al. Data were analyzed using analysis variance (ANOVA), independent sample t-test, and partial correlation (SPSS version 20.0). Results: At 7–18 years, boys and girls showed a comparable gain in BMI. The comparable gain in %BF between boys and girls only occurred till age 10 and total skinfolds till age 11 years. While, %BF and skinfold thicknesses were higher in girls at 12–17 years, central to peripheral skinfold ratio were higher in boys. Partial correlation analyses showed that all skinfold thickness parameters and %BF were significantly correlated with BMI (P < 0.001; r = 0.19–0.87). Conclusions: The gain in BMI and skinfold thickness between the ages of 7 and 18 years occurred in age- and sex-specific patterns. Instead of comparable BMI, girls showed higher means of total skinfold thickness from age 12 years, while boys had higher central to peripheral adiposity ratio.

Background The prevalence of autistic spectrum disorder (ASD) has increased in recent decades. The definitive causes of ASD have yet to be recognized. Howevei; it is believed that both genetic and non-genetic, as well as perinatal and post natal factors influence ASD. Previous studies have shown inconsistent findings. Objectives To assess for prematurity, birth weight, asphyxia, mode of delivery, bleeding during pregnancy, parental age and education, as prognostic factors for ASD. Methods We conducted a cross sectional study at schools for autistic children in Yogyakarta between February 2011 to October 2012. The inclusion criteria were children with and without ASD, whose parents consented to participate in this study. Children with genetic abnormalities or who planned to move away during the study period were excluded. A total of 48 subjects with ASD and 96 subjects without ASD were involved in this study. Data were obtained by direct interview using questionnaires. Logistic regression analysis was performed to examine the hypoth esis. Results Multivariate analysis showed that prematurity was not a significant prognostic factor (RR 2.73; 95%CI 0.3 to 15.7) for ASD. Howevei; children born by Caesarean section were 5.4 times more likely to have ASD (RR 5.4; 95%CI 1.3 to 22.8) compared to those who were delivered vaginally or by vacuum extraction. Moreovet; asphyxia was also a significant prognostic factor for ASD (RR 8.7; 95%CI 1.9 to 38.6) . Conclusion Prematurity is not a risk factor for ASD. Asphyxia and Caesarean birth should be considered as potential confounders in this study.

Background Seizures in neonates are often associated with neurological disorders in early life, including epilepsy. Several possible prognostic factors may influence the development of epilepsy in these patients. Objective To evaluate prognostic factors that may influence the occurrence of epilepsy in the first two years of life in patients with a history of neonatal seizures. Methods We performed a cohort retrospective study on patients with neonatal se izures in Sardjito Hospital during 2004-2009. Prognostic factors observed were gender, family history of epilepsy, neonatal hypoglycemia, assisted labor, hypoxic ischemic encephalopathy, preterm infant delivery, and epileptic state. Results Hypoxic ischemic encephalopathy and epileptic state increased the risk of epilepsy (HR 5.8; 95%CI 1.63 to 20.43 and HR 6.3; 95%CI 2 .0 to 19. 70, respectively). Assisted labor, preterm delivery, neonatal hypoglycemia, family history of epilepsy, and gender did not increase the risk of epilepsy in the first two years of life. Conclusion Hypoxic ischemic encephalopathy and epileptic state in neonates presenting with seizures are the prognostic factors to be epileptic children during the first two years of life.

Background Neonatal sepsis is a leading cause of neonatal morbidity and mortality. There are no pathognomonic signs or symptoms to diagnose neonatal sepsis. Blood culture is the standard tool for sepsis diagnosis, but it is not available in most district hospitals. In 2004, the Indonesian Pediatric Society (IPS) developed a medical standard of care to diagnose neonatal sepsis, but its accuracy has not been adequately verified. Objective To evaluate the diagnostic accuracy of the IPS medical standard of care 2004 to diagnose neonatal sepsis. Methods We conducted diagnostic testing at the Perinatal Ward, Dr. Sardjito Hospital, Yogyakarta, from June to November 2010. Inclusion criteria were neonates with signs and symptoms of infection. We excluded neonates with congenital anomalies, blood disorders, or whose mothers received peripartum antibiotic treatment. All neonates were assessed by the 2004 IPS medical standard of care for neonatal sepsis and by blood culture examinations. Results A total of 193 neonates with signs and symptoms of infection were evaluated. The IPS medical standard had a sensitivity of 88% (95% CI 81 to 94), specificity of 17% (95% CI 2 to 25), positive predictive value of 53% (95% CI 45 to 60), negative predictive value of 57% (95% CI 39 to 75), positive likelihood ratio of 1.06 (95% CI 0.94 to 1.19), and negative likelihood ratio of0.71 (95% CI 0.36 to 1.42). Conclusion The 2004 IPS medical standard of care showed adequate sensitivity for diagnosing neonatal sepsis, but its low specificity limits its use as a diagnostic tool. [Paediatr lndones. 2012;52:86-90].

Background: Low birth weigth babies (LBW) are most likely a cause of the infant mortality and morbidity. Many factors causes LBW babies as maternal health, behavior during pregnancy, environmental as well as fetal and placental factors. Negative behavior during pregnancy such as exposure of cigarette smoke can affect the body’s supply of oxygen from mother to fetus and placenta. Exposure to cigarette smoke may also reduce maternal folic acid level which causes disruption of fetal growth inside the womb. Objective: This study was aimed to fnd out the risk of low birth weight baby in the passive smoker pregnant woman. Method: The study used a case control design. The subject consisted of mothers who delivered at RSU dr. Zainoel Abidin in Banda Aceh municipality. The case group were mothers who delivered babies of less than 2,500 grams and the control group were those who delivered babies of 2,500 grams or more. Each group consisted of 105 mothers (1:1). Sample were taken using non probability with consecutive sampling method. Data analysis used univariable method with frequency distribution, bivariable with chi square and multivariable with logistic regression. Results: Passive smoker pregnant woman exposed the 1-10 cigarettes a day had risk 2,4 times greater of getting low birth weight baby (OR=2,42; 95%CI 1,24-4,71). Pregnant mother exposed to ≥11 cigarettes a day had the risk 3,1 times greates in having LBW infants than those not exposed (OR=3,1; 95%CI 1,50-6,70). Conclusion: Passive smoker of pregnant mother increased the risk of low birth weight babies.

Background Hypothermia in neonates increases the risk of mortality and morbidity such as infection, coagulation disorders, acidosis and hyaline membrane disease. Mercury thermometer is commonly used to detect hypothermia in newborns, but it has it is not ecological acceptable, difficult to be sterilized, easily broken, difficult to find in some developing countries and needs some training before use. A simple, effective and easily used tool for detection of hypothermia in newborns is needed. Objective To evaluate the ability of liquid crystal thermometry (LCT) in early detection of newborn hypothermia. Methods This study was conducted in the neonatology ward, Sardjito Hospital. The LCT was placed on the abdominal wall. Digital thermometer measurement and LCT observation were conducted three times in each patient. LCT’s color and body temperature were documented by using a pre-coded questionnaire. Results A total of 268 newborns met the inclusion and exclusion criteria. The pilot study showed that the inter-observer agreement of LCT was 0.75. Positive likelihood ratio during three measurements were 22.9 (95%CI 11.47;45.78), 18.97 (95%CI 9.43;38.16) and 22.8 (95%CI 11.34;45.83) respectively. Conclusion LCT exhibits good accuracy and is safe to diagnose hypothermia in newborn.

Latar belakang. Kemajuan di bidang pelayanan obstetri berhasil menurunkan kejadian trauma lahir. Namun, trauma lahir masih merupakan salah satu penyebab morbiditas dan mortalitas pada neonatal. Banyak faktor risiko yang berperan dalam trauma lahir. Tujuan. Mengetahui faktor risiko trauma lahir. Metode. Penelitian kasus-kontrol di bangsal Perinatal Rumah Sakit Dr Sardjito, Yogyakarta, mulai Januari 2004 sampai Desember 2008. Kriteria inklusi adalah semua neonatus dengan trauma lahir dan kriteria eksklusi adalah jika ada anomali kongenital dan data medis tidak lengkap. Kontrol adalah neonatus tanpa trauma lahir. Kasus adalah semua neonatus dengan trauma lahir, dan keduanya memenuhi kriteria inklusi dan eksklusi. Data dikumpulkan dari rekam medis yang berkaitan dengan data ibu, bayi, dan faktor risiko yang diduga berhubungan dengan trauma lahir. Hasil. Di antara 6678 neonatus, 47 mengalami trauma lahir, yaitu trauma kepala 27 (57%), trauma tulang 13(28%), saraf perifer 10(21,3%), saraf pusat 7(14,8%), dan 3 lainnya (6%). Faktor risiko trauma lahir adalah paritas (OR 1,3;CI95%=0,5-3,4; p=0,625), umur kehamilan (OR 1,5;95%CI=0,2-9,6; p=1,00), berat lahir (OR 1,4;95%CI=0,3-6,5; p=0,100), lingkar kepala (OR 1,5;95%CI=0,4-5,0; p=0,76), malpresentasi (OR 3,6;95%CI=0,4-30,3;p=0,244), presentasi bokong (OR 3,9;95%CI=1,0-14,8; p=0,049), presentasi muka (OR 2,0;95%CI=1,7-2,5; p=1,00), vakum ekstraksi (OR 10,1;95%CI=1,2-88,3; p=0,037), versi ekstraksi (OR 3,1;95%CI=0,3-31,3; p=0,62), penyulit persalinan (OR 11,4;95%CI=2,2-60,2; p=0,004), letak lintang (OR 1,0;95%CI=0,2-5,2; p=1,000), dan seksio kaisaria (OR 0,4;95%CI=0,1-0,8; p=0,017). Kesimpulan. Faktor risiko trauma lahir adalah presentasi bokong, persalinan dengan penyulit dan vakum ekstraksi, sedangkan kelainan presentasi tidak berhubungan dengan trauma lahir. Seksio kaisaria merupakan faktor protektif terhadap terjadinya trauma lahir.