Introduction: Necrotizing enterocolitis (NEC) poses a significant threat to preterm infants, with nonspecific early manifestations complicating timely diagnosis. Therefore, this study aimed to develop a novel scoring system for early diagnosis of NEC, incorporating clinical and laboratory data...

Background Congenital cytomegalovirus (CCMV) infection is the leading cause of congenital infections worldwide. Clinical manifestations of CCMV are highly variable and make the clinical diagnosis difficult, especially in settings where advanced diagnostic tools are not available. Objective To identify a cluster of clinical manifestations indicative of CCMV and analyze for correlations with PCR-confirmed diagnoses. Methods This case-control study was conducted at a tertiary care hospital in Malang, East Java, and included 40 neonates clinically suspected to have CCMV. PCR specimens from urine or saliva were collected and analyzed to evaluate clinical manifestations of suspected CCMV. Demographic and clinical data were organized and analyzed using SPSS. Results Of neonates with suspected CCMV, 32.5% (n=13) had PCR-confirmed CCMV. The median age for PCR testing post-suspected CCMV was 8.50 (range 3.75 to 24.25) days. Significant correlations emerged between PCR-confirmed CCMV and symptoms such as microcephaly, jaundice, purpura, thrombocytopenia, acute liver injury, hepatomegaly, feeding difficulties, and anemia. However, seizures, low birth weight, ventriculomegaly, and intrauterine growth restriction did not show significant associations, indicating their limited utility as solitary markers for CCMV. The clinical symptoms associated with CCMV were confirmed by PCR, emphasizing the significance of certain sign and symptom clusters, such as microcephaly with thrombocytopenia (OR 41.60; P<0.001), or the traditional triad of jaundice, purpura, and hepatosplenomegaly/acute liver injury (OR 41.60; P<0.001). Conclusion Several clinical manifestations are significantly associated with PCR-confirmed CCMV infection, underscoring the diagnostic value of specific symptom combinations in identifying CCMV infection. These combinations are microcephaly and thrombocytopenia and the classic triad of jaundice, purpura, and hepatosplenomegaly/acute liver injury.

Background The outcomes of neonatal surgical cases has steadily improved in the last decade. However, limited local data are available in Indonesia regarding the contributing factors and outcomes of surgical procedures in neonates. Objective To determine the incidence of infection and mortality in neonatal surgical cases in Saiful Anwar Hospital, Malang, East Java, Indonesia. Methods This retrospective cohort study included neonates who underwent abdominal surgery over a period of 20 months from January 2021 to August 2022. Data collected included subjects’ basic demographics, primary surgical diagnoses, associated congenital anomalies, pre-operative conditions, and referral status. These parameters were analyzed in relation to the incidence of infection and mortality in the 30 days after surgical procedure. Results Of fifty-four neonates in this study, the most common neonatal surgical conditions were anorectal malformation, followed by necrotizing enterocolitis and Hirschsprung’s disease. The mortality rate at 30 days was 48%. The most common associated factors were sepsis (OR 0.778; 95%CI 0.233 to -1.167; P=0.041), pre-operative respiratory failure/hemodynamic instability (OR 2.129; 95%CI 1.039 to 3.126; P<0.001), and delayed referral (OR 0.295; 95%CI 0.074 to 1.177; P=0.048). Other factors such as age at presentation, gender, gestational age, birth weight, referral patient vs. those born in our hospital, associated congenital anomalies, and emergency procedures were not associated with mortality. The survival time in the sepsis group [17.30 (1.68-13.98) days] was significantly lower than in the non-sepsis group [25.95 (1.63-22.76) days] (P< 0.001). Conclusion Sepsis, pre-operative respiratory failure/hemodynamic instability, and delayed referral are risk factors for mortality in neonates following abdominal surgery. Identification of these risk factors and early intervention are important to improve outcomes.

This case report details a newborn in Ende, Indonesia, diagnosed with primary congenital lymphoedema, evidenced by bilateral lower limb swelling. This rare condition is characterised by developmental defects in the lymphatic system, leading to a fluid balance disruption. Diagnosis was primarily clinical, relying on thorough patient history and physical examination, given the limited resources for advanced diagnostic tools. The report emphasises the importance of supportive care, including meticulous skin care and manual lymph drainage, to improve life quality and minimise infection risks. It highlights the diagnostic and management challenges faced in low-resource settings and stresses the need for awareness and early intervention to manage such congenital conditions effectively.

Objective: Rare diseaseBackground: Hereditary spherocytosis (HS) is an autosomal dominant inherited disorder that causes severe hyperbilirubine-mia in neonates. There is no factual data about the prevalence in Indonesia. It is common that neonates with suspected hereditary spherocytosis are not diagnosed or treated adequately in developing countries such as Indonesia.Case Report: A 6-day-old baby was referred from a secondary public hospital to our tertiary hospital in Malang, East Java with severe hyperbilirubinemia unresponsive to the 2 days of conventional phototherapy. Initial laboratory ex-amination showed total serum bilirubin level 28.83 mg/dL and indirect bilirubin level 25 mg/dL. Complete blood count showed hemoglobin level of 10.3 g/dL with high MCHC 36.9 g/dL and increased RDW 18.7%. The HS ratio (MCHC per MCV) was 0.41. The blood smear showed spherocytes with positive family history from the mother and grandmother. There were no specific tests such as EMA binding, cryohemolysis, or analysis of erythrocyte membrane protein available in our hospital. The patient was then treated with 2 sessions of intensive photo -therapy with phototherapy unit bilisphere 360 LED. The total serum bilirubin level dropped to 12.19 mg/dL. In this case, we decided to perform intensive phototherapy first, not only because of facility-based constraints to do timely exchange transfusion, but also due to the low socio-economic and educational background of the parents. Conclusions: There are some challenges in diagnosing and treating HS adequately in Indonesia. Limitations of specific tests, inadequacy of conventional phototherapy, lack of awareness of and adherence to guidelines, and facility-based inability to perform timely exchange transfusion all can contribute to severe hyperbilirubinemia and its sequelae.

Caring for preterm infants in the intensive care unit can lead to a variety of conditions that increase stress and pain during routine care procedures. One of the intensive care unit procedures is diapers usage and change. The immature anatomical and physiological growth and development, especially the musculoskeletal system, neurological system, and integumentary system, is a challenge in the care of premature infants. Inappropriate diapers in premature infants can result in neurodevelopment problems, diaper dermatitis, and long-term postural disorders. Supportive care in the intensive care unit should include maintaining sleep cycles, creating a comfortable environment, periodic stress and pain measurement, practicing infants’ skincare, and care involving parents.