The Multidisciplinary Perioperative Management of Conjoined Twin Separation Surgery During the Pandemic.

Background: Conjoined twin management, especially separation surgery, is a complex procedure which requires multidisciplinary work in the perioperative period. This complexity further increased with the COVID-19 pandemic, where social distancing protocols and the general reduction in non-COVID-19-related health-care services added a new dimension to the modern form of teamwork. Methods: This study focused on the process of preparation for conjoined twin separation surgery during the pandemic from March 2020 to May 2022 with pre-pandemic era comparison. We described the decision-making process and the available facilities in terms of equipment, human resources, and the inclusion of information and technology. Results: Among the essential requirements for separation surgery are doctors from various disciplines, pediatric anesthesiologists, nurses from different specialties, radiologists, rehabilitation specialists, nutritionists, pharmacists, psychologists, social workers, public relations, and information and technology staff. The team composition may change depending on the patient's clinical characteristics and social needs. Surgery preparation consists of a prognostication period, preoperative management, surgery, and discharge. Conclusion: Complex surgery such as conjoined twin separation can be managed effectively by a team of multidisciplinary experts. The application of information technology, to manage changes in multidisciplinary work pre- and post-pandemic, can reduce pandemic-related social restrictions while maintaining effectiveness and increasing efficiency.

C-reactive protein and haemoglobin level in acute kidney injury among preterm newborns.

Aim To explore the possibility of C-reactive protein (CRP) and haemoglobin (Hb) in prediction and risk assessment of acute kidney injury (AKI) among preterm newborns. This is believed to be closely related to the incidences of AKI, and could be the most affordable in early detection of AKI. Methods A case control study was carried out at Dr Hasan Sadikin Hospital in Bandung with a total of 112 preterms divided into two groups: with and without AKI based on the neonatal KDIGO (Kidney Disease: Improving Global Outcomes). CRP and creatinine serum were measured within 6 hours and at 72-96 hours after birth. The routine blood count included haemoglobin, haematocrit, leucocyte, and thrombocyte in the first 24 hours of life. Results CRP increase was the most influential factor for AKI with sensitivity of 80.6% and specificity of 60.2%. An increase in CRP >0.04 had an aOR (95% CI) of 5.64 (1.89-16.84). Haemoglobin <14.5 g/dL had slightly increased aOR (95% CI) of 1.65 (1.05- 8.63) Conclusion CRP increases >0.04 and level Hb <14.5 g/dL showed acceptable as an early warning for AKI in preterm newborns.

The association of rs187238, rs19465518 and rs1946519 IL-8 polymorphisms with acute kidney injury in preterm infants.

BACKGROUND: Interleukin 18 (IL-18) promoter polymorphisms (-656G > T, -607C > A, and -137G > C) affect serum IL- 18 (sIL-18) levels and are associated with renal injury. PURPOSE: This study aimed to determine the diagnostic utility of sIL-18 and urine IL-18 (uIL-18) as biomarkers for acute kidney injury (AKI) and analyse the association of IL-18 polymorphisms to AKI in preterm infants. METHODS: Blood and urine samples were collected from 56 preterm infants with AKI and 56 without AKI to measure serum creatinine (SCr), sIL-18, and uIL-18. Genotyping of polymorphisms was performed and analysed, with AUC-ROCs analysis used to evaluate the diagnostic utility of s-/uIL-18 levels. RESULTS: The median sIL-18 and uIL-18 levels were significantly higher than those without AKI. For a cutoff of >132 pg/mL, the sIL-18 expression had sensitivity and specificity of 80.36% and 60.71%, respectively, while for uIL-18, a cutoff of >900.7 pg/mL had sensitivity and specificity of 51.79% and 78.57%, respectively. The odds ratio of sIL-18 and uIL-18 to predict AKI in preterm infants was 5.89 (95%CI:2.31-15.02) and 4.15 (95%CI:1.58-10.89), respectively. The polymorphisms -137G > C and -656G > T were significantly associated with sIL-18 expression. CONCLUSION: Serum and urine IL-18 levels are risk factors for and a moderate predictor of AKI in preterm infants.