Congenital neurosyphilis presenting as neonatal sepsis.

INTRODUCTION: Congenital syphilis involves any organs with various symptoms, including neurological signs. Neurosyphilis is a severe syphilis complication that can develop at any stage of illness. CASE PRESENTATION: A 2,520 g male infant was spontaneously born at term from an untreated syphilis mother. Physical examination revealed decreased consciousness, respiratory distress, seizure, but without neurologic abnormality sign. The serum and cerebrospinal fluid Venereal Disease Research Laboratory and Treponemal Pallidum Hemagglutination Assay TPHA tests titters were 1:16 and 1:1,280, respectively. The diagnosis at admission was respiratory failure and neonatal sepsis. The infant was mechanically ventilated and treated with early management of sepsis. Blood culture was sterile later on. Then, the infant was administered intramuscular benzathine penicillin G (50,000 units/kg/dose) for a total of three weeks. The infant's condition was improved during the treatment. CONCLUSIONS: There are many challenges associated with screening and monitoring neurosyphilis in congenital syphilis. Congenital syphilis presenting as sepsis is easily misdiagnosed as bacterial sepsis.

Corrigendum to "The knowledge of Indonesian pediatric residents on hyperbilirubinemia management" [Heliyon 7 (4) (2021) e06661].

[This corrects the article DOI: 10.1016/j.heliyon.2021.e06661.].

The knowledge of Indonesian pediatric residents on hyperbilirubinemia management.

Hyperbilirubinemia in the newborn occurs more frequently in Indonesia. Therefore, it is important that pediatric residents in Indonesia acquire adequate knowledge of hyperbilirubinemia management. This study aims to determine the pediatric residents' knowledge on hyperbilirubinemia management, whether they follow recommended guidelines, and whether differences exist between five large Indonesian teaching hospitals. We handed out a 25-question questionnaire on hyperbilirubinemia management to pediatric residents at five teaching hospitals. A total of 250 questionnaires were filled in completely, ranging from 14 to 113 respondents per hospital. Approximately 76% of the respondents used the Kramer score to recognize neonatal jaundice. Twenty-four percent correctly plotted the total serum bilirubin levels (TSB) on the phototherapy (PT) nomograms provided by the American Academy of Pediatrics (AAP) and the National Institute for Health and Care Excellence (NICE) for full-term and nearly full-term infants. Regarding preterm infants <35 weeks' gestational age, 66% of the respondents plotted TSB levels on the AAP nomogram, although this nomogram doesn't apply to this category of infants. Seventy percent of residents knew when to perform an exchange transfusion whereas 27% used a fixed bilirubin cut-off value of 20 mg/dL. Besides PT, 25% reported using additional pharmaceutical treatments, included albumin, phenobarbitone, ursodeoxycholic acid and immunoglobulins, while 47% of the respondents used sunlight therapy, as alternative treatment. The limited knowledge of the pediatric residents could be one factor for the higher incidence of severe hyperbilirubinemia and its sequelae. The limited knowledge of the residents raises doubts about the knowledge of the supervisors and the training of the residents since pediatric residents receive training from their supervisors.

Newborn screening in Indonesia.

In Indonesia, newborn screening is not yet a policy, and the incidence of preventable causes of mental retardation detected by newborn screening is not known. Congenital hypothyroidism (CH) is not infrequent. Without a screening program, unrecognized CH patients were neglected for years. Since May 1999, the International Atomic Energy Agency (IAEA) has assisted in starting a CH Newborn Screening Project to estimate the local incidence of CH and to evaluate the problems associated with the screening. In June 2000, a pilot study was conducted using primary TSH measurement, supplemented by T4 in infants with elevated TSH. The target was to screen 12,000 newborn infants, using cord blood serum taken at birth, or a heel prick between 2 to 6 days of age. Between June 2000 and February 2001, 3,534 neonates born in 4 hospitals were screened using cord blood serum taken at birth (recall rate 3.3%). From March 2001 onwards, the heel prick method was used and participating hospitals increased from 4 to 7. Using this approach, until August 2001, 3,309 samples were analysed and the recall rate was much lower (0.64%). The number of unsatisfactory samples was relatively high due to an unstable process of blood collection. Parental refusal and low acceptance of screening among policy makers resulted from lack of awareness of the dangers of CH, and the screening program was not considered a health priority. Recall of patients after screening was a major barrier, with problems in tracking patients arising from urbanization and a high rate of relocation. To advance the CH screening program nationwide, infrastructure must be improved along with the recall system, and education as well as information campaigns for parents and medical professionals must be intensified. The Department of Health must be persuaded to give a national mandate.