ASSOCIATION BETWEEN DIRECT BILIRUBIN LEVELS TO THE OUTCOME OF NEONATAL SEPSIS WITH CHOLESTASIS
Isna Panca Bayu Karuniasari,Ninung Rose Diana
FK UNDIPRSUP dr Kariadi Semarang Department of Pediatrics, Faculty of Medicine, Diponegoro University, Dr Kariadi Hospital, Semarang, Indonesia
Background : Neonatal sepsis was known as one of the leading cause of neonatal morbidity and mortality in developing country. Neonatal sepsis can lead to cholestasis due to immaturity of immune system and bile formation especially in the first weeks of life. Previous research reported that the prevalence of cholestasis in neonatal sepsis was 65.9% with 52.8% mortality. Another study showed that elevated serum bilirubin levels were associated with an increased risk of mortality in patients with severe sepsis. The objective of this study was to determine association between direct bilirubin levels to the outcome (mortality) of neonatal sepsis with cholestasis.
Material : This was a prospective study. Subjects were neonates with sepsis and cholestasis in neonatology ward of Kariadi Hospital, Semarang from January 2016 - July 2017. Levels of direct bilirubin were taken on day-7 (first examination) and day-10 (second examination) after diagnosed sepsis. The analysis was performed by Chi-square test and Receiver Operating Characteristics (ROC) curve.
Results : There were 43 neonates with sepsis and cholestasis, 39.6% were died. The majority of the subjects were male (60.5 %) and preterm (60.5 %). ROC analysis revealed that cut off the direct bilirubin level was 3.45 mg/dL. There was no significant correlation between direct bilirubin cut off point ? 3.45 mg/dL according to mortality on first examination (RR 1.32; 95% CI=0.600 - 2.905; p = 0.697) and second examination (RR 1.18; 95% CI=0.562 - 2.473; p = 0.902).
Conclusions : There was no association between direct bilirubin levels to the outcome (mortality) of neonatal sepsis with cholestasis