Lily Rundjan

Diagnostic Performance Analysis of the Point-of-Care Bilistick System in Identifying Severe Neonatal Hyperbilirubinemia by a Multi-Country Approach

Importance The real prevalence and clinical burden of severe neonatal jaundice are undefined due to difficulties in measuring total serum bilirubin (TSB) outside secondary and tertiary clinical centers. Objective To assess the diagnostic performance of the point-of care Bilistick System (BS) in identifying neonatal jaundice patients requiring treatment. Design Between April 2015 and November 2016, 1911 neonates, were recruited to participate in the study. Blood samples were simultaneously collected for the TSB determination by BS and by hospital laboratory (Lab). Data were collected and sent to the Bilimetrix headquarter in Trieste where statistical analysis was performed. Newborns with neonatal jaundice were treated with phototherapy according to each centers guidelines. Setting 17 hospitals from Nigeria, Egypt, Indonesia, and Viet Nam. Participants 1911 newborns were included, of which 1458 (76·3%) fulfilled the inclusion criteria. Results TSB level measured by BS agreed (p < .0001) with the lab result in all four countries. The diagnostic performance of BS showed a positive predictive value (PPV) of 92·5% and a negative predictive value (NPV) of 92·8%. Conclusions and Relevance BS is a reliable system to detect neonatal jaundice over a wide range of bilirubin levels. Since Bilistick is a point-of-care test, its use may provide appropriate and timely identification of jaundiced newborns requiring treatment.

Closed Catheter Access System Implementation in Reducing the Bloodstream Infection Rate in Low Birth Weight Preterm Infants

Background: Bloodstream infection (BSI) is one of the significant causes of morbidity and mortality encountered in a neonatal intensive care unit, especially in developing countries. Despite the implementation of infection control practices, such as strict hand hygiene, the BSI rate in our hospital is still high. The use of a closed catheter access system to reduce BSI related to intravascular catheter has hitherto never been evaluated in our hospital. Objective: To determine the effects of closed catheter access system implementation in reducing the BSI rate in preterm neonates with low birth weight. Methods: Randomized clinical trial was conducted on 60 low birth weight preterm infants hospitalized in the neonatal unit at Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to September 2013. Randomized subjects either received a closed or non-closed catheter access system. Subjects were monitored for 2 weeks for the development of BSI based on clinical signs, abnormal infection parameters, and blood culture. Results: Closed catheter access system implementation gave a protective effect toward the occurrence of culture-proven BSI (relative risk 0.095, 95% CI 0.011–0.85, p = 0.026). Risk of culture-proven BSI in the control group was 10.545 (95% CI 1.227–90.662, p = 0.026). BSI occurred in 75% of neonates without risk factors of infection in the control group compared to none in the study group. Conclusion: The use of a closed catheter access system reduced the BSI in low birth weight preterm infants. Choosing the right device design, proper disinfection of device, and appropriate frequency of connector change should be done simultaneously.

Nistatin Oral Sebagai Terapi Profilaksis Infeksi Jamur Sistemik pada Neonatus Kurang Bulan

Infeksi jamur sistemik merupakan salah satu penyebab utama sepsis dan kematian pada neonatus. Neonatus kurang bulan memiliki risiko lebih tinggi terkena infeksi jamur sistemik dibandingkan dengan neonatus cukup bulan. Terdapat beberapa faktor risiko terjadi infeksi jamur sistemik pada neonatus diantaranya adalah kolonisasi jamur. Tindakan pencegahan terhadap infeksi jamur pada neonatus pada prinsipnya sama dengan tindakan pencegahan infeksi lainnya. Penting dilakukan tindakan untuk memodifikasi faktor risiko dalam hal ini. Pencegahan khusus dapat dilakukan dengan memberikan antijamur seperti nistatin untuk mencegah kolonisasi. Pemberian terapi profilaksis antijamur terbukti menurunkan angka kejadian infeksi jamur sistemik. Efek samping, toksisitas, biaya, dan kemungkinan terbentuknya galur (strain) yang resisten menjadi hal utama yang harus dipertimbangkan dalam pemberian terapi profilaksis. Disajikan beberapa penelitian mengenai pemakaian nistatin sebagai terapi profilaksis yang telah dilakukan di berbagai negara untuk menilai efektifitas nistatin oral sebagai terapi profilaksis infeksi jamur sistemik pada neonatus kurang bulan disertai contoh kasus