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  • Antithrombine III Replacement Therapy in Neonatal Sepsis - Rinawati

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    Bayu Kurniawan
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    1) The document discusses neonatal sepsis at a national tertiary referral hospital in Indonesia. It provides data on birth rates, preterm rates, NICU capacity and survival rates based on weight and gestational age from 2017-2018. 2) It describes the hospital's experience with late onset sepsis in babies under 32 weeks gestation from 2015-2018. Supportive treatment included fresh frozen plasma, platelet concentrate, and antithrombin III replacement therapy. 3) Problems with antithrombin III testing and treatment are that it is not universally available, is costly, and requires further research through a randomized controlled trial.

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    1) The document discusses neonatal sepsis at a national tertiary referral hospital in Indonesia. It provides data on birth rates, preterm rates, NICU capacity and survival rates based on weight and gestational age from 2017-2018. 2) It describes the hospital's experience with late onset sepsis in babies under 32 weeks gestation from 2015-2018. Supportive treatment included fresh frozen plasma, platelet concentrate, and antithrombin III replacement therapy. 3) Problems with antithrombin III testing and treatment are that it is not universally available, is costly, and requires further research through a randomized controlled trial.

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    © All Rights Reserved
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    7 views10 pages

    Antithrombine III Replacement Therapy in Neonatal Sepsis - Rinawati

    Uploaded by

    Bayu Kurniawan
    1) The document discusses neonatal sepsis at a national tertiary referral hospital in Indonesia. It provides data on birth rates, preterm rates, NICU capacity and survival rates based on weight and gestational age from 2017-2018. 2) It describes the hospital's experience with late onset sepsis in babies under 32 weeks gestation from 2015-2018. Supportive treatment included fresh frozen plasma, platelet concentrate, and antithrombin III replacement therapy. 3) Problems with antithrombin III testing and treatment are that it is not universally available, is costly, and requires further research through a randomized controlled trial.

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    © All Rights Reserved
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    of 10

    Antithrombin III Replacement Therapy in

    Neonatal Sepsis; Experienced Based


    Dr. dr. Rinawati Rohsiswatmo Sp.A(K)
    dr. Audesia Alvianita
    CMH Profile
    National Tertiary Referral Hospital in Indonesia
    and as the Oldest Medical School in Indonesia
    Birth rate : 2125 birth(2017)/1148 birth (2018)/548
    birth(June 2019)
    Preterm rate : 47.9% (2017)/47% (2018)/51% (June 2019)

    Small-for-gestation (SGA+IUGR??): + 30%


    NICU bed capacity : 28 beds

    Special care nursery : 50 beds

    Koletzko B, Poindexter B, Uauy R (eds): Nutritional Care of Preterm Infants: Scientific Basis3and Practical Guidelines. World Rev Nutr Diet. Basel, Karger, 2014, vol 110, pp 177–
    7/3/2019
    189
    100%
    120%

    20%
    40%
    60%
    80%

    0%
    <700 gr
    700 - 999 gr
    1000 - 1499 gr
    1500 - 1999 gr
    2000 - 2499 gr
    2500 - 2999 gr
    3000 - 3499 gr
    3500 - 3999 gr
    Survival Rate Based on Weight

    ≥4000
    Survival rate
    100%
    120%

    20%
    40%
    60%
    80%

    0%

    <26 weeks
    26-27 weeks
    28-30 weeks
    31-32 weeks
    33-34 weeks
    35-36 weeks
    37-41 weeks
    ≥42 weeks
    Survival Rate Based on Gestational Age
    Survival Rate Data 2018 in CMH

    Survival Rate
    Neonatal Sepsis in CMH
    July – Desember 2018

    Neonates
    (776)

    Outborn
    Inborn (656)
    (120)

    Medical Medical
    problem Surgical (13) problem Surgical (22)
    (325) (89)

    EOS (158) LOS (63) EOS (8) LOS (2) EOS (5) LOS (6) EOS (5) LOS (7)

    Proven 1 Proven Proven Proven 1 Proven Proven 2 Proven 7


    Proven 1
    (+1) 17 (+5) (1) (+1) (0) (+1) (+2)
    CLINICAL EXPERIENCE
    January 2015 – Desember 2018
    Late onset sepsis

    <28 Clinically sepsis


    • 5 babies
    weeks Early bleeding sign

    Shock

    Hematological indices:
    28-32 WBC count/ Leucocyte
    • 25 babies
    •
    weeks •
    •
    (<5,000 / >25,000)
    Platelets count (<100,000)
    • IT-ratio (>0,02)
    32 babies
    Inflamatory mediators indices:
    • CRP
    Pro-calcitonin
    >32 •
    • 2 babies
    weeks Coagulation profile:
    • AT-III/ PT, APTT
    CLINICAL EXPERIENCE
    6 x 100% =
    18%
    <28 Positive only
    • 5 babies culture 32
    3 babies - Klebsiella pneumonia (2)
    weeks - Serratia marcescens

    Positive
    28-32 culture - E. Coli
    • 25 babies 2 babies - Acinetobacter
    weeks baumanii
    32 babies

    Positive
    >32 culture
    • 2 babies 1 babies - Acinetobacter
    weeks baumanii
    Suportive Treatment
     Fresh Frozen Plasma (10-20 cc/kgBW)
    <28
    weeks  Platelet Concentrate (10 cc/kgBW)

     Anti-trombin III

    28-32 Loading dose: 100 IU/kgBW


    weeks
    Maintenance dose: 50 IU/kgBW/8 hr
    32 babies

     Protrombin Complex 50 IU/kgBW/day


    >32
    weeks
    Outcome
    Death
    <28
    • 5 babies 2 babies
    Due to early onset of
    weeks sepsis

    28-32
    Survival: 93,75%
    • 25 babies
    weeks
    32 babies

    >32
    • 2 babies
    weeks
    Problem
     AT-III testing is not available in
    every places
    - CMH: Monday-Friday
    - Private Hospital: referred to other
    hospital (eg. Cikini Hospital)

     AT-III testing is costly


     Need further research (Double-
    blind Randomized Controlled Trial)
    Q&A Session

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