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Abstrak :
Latar Belakang: Sepsis neonatorum diagnosisnya sulit ditegakkan karena gejala klinis dan laboratorium yang tidak spesifik. Pengobatan utama sepsis neonatorum adalah antibotik untuk menurunkan mortalitas, namun penggunaan antibiotik sering berlebihan, sehingga menyebabkan resistensi bahkan meningkatkan mortalitas. Objektif: Mengetahui tingkat kepatuhan dokter penanggung jawab pasien DPJP terhadap pedoman antibiotika pada tata laksana sepsis neonatorum, faktor-faktor yang mempengaruhi keputusan DPJP untuk memulai pemberian antibiotik, proses evaluasi pemberian dan penghentian antibiotik, kepatuhan pemilihan antibiotik empirik serta mengetahui faktor-faktor risiko apa saja yang dipakai dalam menegakkan diagnosis sepsis neonatorum awitan dini (SNAD) maupun sepsis neonatorum awitan lambat (SNAL). Metode: Studi dengan uji potong lintang menggunakan kuesioner wawancara pada subyek, data sekunder rekam medik serta melakukan Indepth Interview pada DPJP. Sampel penelitian adalah semua bayi baru lahir baik di RSCM maupun dari luar, diputuskan mendapat terapi antibiotik empirik lalu diberi stempel antibiotik periode bulan Desember 2017-Februari 2018 di divisi Neonatologi RSCM. Sebanyak 113 subyek dengan 167 kejadian dilakukan analisis. Hasil: Terdapat keragaman pemeriksaan septic screening awal yaitu 1-6 jam setelah lahir dan pemeriksaan ulangan rerata 56,45 37,40 jam pada SNAD dan pada SNAL 72,00 50,91 jam, antibiotik yang dilanjutkan sesuai antara klinis dan laboratorium pada SNAD 43 52,43 dari 82 subyek, dan SNAL 7 50 dari 14 subyek, namun 100 patuh pada regimen antibiotik empirik ampisilin dan gentamisin untuk tatalaksana SNAD ringan pada 86 51,49 kasus, rerata hari konsul ke divisi Infeksi adalah 9,53 5,39 pada SNAD dan 9,63 3,89 pada SNAL. Dan tidak didapatkannya hubungan antara faktor risiko dengan kesesuaian laboratorium dan klinis sepsis p=0.869. Kesimpulan: Terdapat perbedaan pertimbangan para DPJP dalam mendiagnosis sepsis, sehingga menyebabkan ketidak patuhan terhadap pedoman antibiotik yang ada.

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Background: Establishing diagnosis of neonatal sepsis is difficult due to non-specific clinical symptoms and laboratorial results. The key management for neonatal sepsis is antibiotic administration, decreasing mortality rate. However, over administration of antibiotic may lead to resistance and even increasing the mortality rate. Objectives: To evaluate the adherence of attending physicians to the neonatal sepsis guideline; To know factors that influence the attending physicians 39; decision in administrating the antibiotics; And to know risk factors that are considered by attending physicians to diagnose both early-onset neonatal sepsis EOS and late-onset neonatal sepsis (LOS). Methods: Cross-sectional study was performed using questionnaire taken from the subjects, secondary data in form of medical records, and in-depth interview on the attending physicians. Data collection was done in December 2017-February 2018, in Cipto Mangunkusumo Hospital Neonatologi Division. Total subjects of the research was 113, with 167 cases recorded, were then analyzed. Results: Various results were found regarding the early screening 1-6 hours after birth and follow-up screening for EOS 56,45 37,40 hours and LOS 72,00 50,91 hours. Appropriate administration of antibiotic, based on clinical and laboratorial data, are found in 43 52,43 from 82 case of EOS and 7 50 from 14 cases of LOS. All of attending physicians followed the guidelines regarding empirical antibiotic regiments for mild EOS, which is Ampicillin and Gentamicin on 86 cases 51.49. Average management time before attending physicians started to ask for consultation for EOS and LOS are 9,53 5,39 days and 9,63 3,89 days respectively. No relation were found between risk factors with laboratorial results and clinical sepsis p=0.869. Conclusion: Low level of adherence toward the antibiotic guideline is due to different considerations of attending physicians in diagnosing neonatal sepsis.

Abstrak :
[ABSTRAK
Latar belakang. Sepsis neonatorum awitan dini (SNAD) adalah sindrom klinis akibat respon sistemik terhadap infeksi pada awal kehidupan. Diagnosis SNAD seringkali sulit karena gejala klinisnya tidak spesifik. Tujuan. Mengetahui sensitivitas dan spesifisitas biakan usap telinga dalam diagnosis SNAD. Metode. Subjek penelitian adalah neonatus yang lahir di RSCM Jakarta dan RSU Tangerang Selatan dengan diagnosis SNAD. Dilakukan pengambilan biakan dari usapan telinga dan darah bayi. Hasil. Diantara 50 subjek, terdapat 2 neonatus dengan biakan darah positif, dan 32 neonatus dengan biakan usap telinga positif. Hanya 1 subjek yang memiliki kesesuaian jenis kuman yang tumbuh dari biakan darah dan biakan usap telinga. Bakteri yang tumbuh pada biakan usap telinga sebagian besar adalah Gram postif (62%). Biakan usap telinga mempunyai sensitivitas 64,7%, spesifisitas 36,4%, nilai duga positif 34,3%, nilai duga negatif 66,6%, rasio kemungkinan positif 1,02, rasio kemungkinan negatif 0,97, dan, akurasi 46% untuk mendeteksi SNAD. Simpulan. Ditemukan hasil biakan darah positif pada 2 subjek. Biakan usap telinga memiliki sensitivitas 64,7%, spesifisitas 36,4%, nilai duga positif 34,3%, nilai duga negatif 66,6%, rasio kemungkinan positif 1,02, rasio kemungkinan negatif 0,97, dan akurasi 46% untuk mendeteksi SNAD.

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ABSTRACT
Background. Early-onset neonatal sepsis (EOS) is a clinical syndrome due to systemic response to infection in early life. EOS is often difficult to diagnosed because the clinical symptoms are not specific. Objective. The study aim to determine sensitivity and specificity of ear swabs culture in the diagnosis of EOS. Methods. Neonates born in the CMH Jakarta and Tangerang Selatan Hospital who developed sepsis were studied. Swabs were collected for culture from baby’s ear. Bacterias isolated from ear swabs cultured were correlated with those from blood culture. Results. Among 50 neonates studied, 2 neonates had positive blood cultured and 32 neonates had positive ear swabs cultured. Only one subject had suitability types of bacterias that grew from blood and ear swabs. Bacteria grew from ear swab cultured were predominantly Gram-positive (62%). Ear swabs cultured had sensitivity 64.7%, specificity 36.4%, positive predictive value (PPV) 34.3%, negative predictive value (NPV) 66.6%, positive likelihood ratio (PLR) 1.02, negative likelihood ratio (NLR) 0.97, and accuracy 46% to detect EOS. Conclusions. This study showed positive blood culture results were found in two subjects. Ear swabs cultured had a sensitivity 64.7%, specificity 36.4%, PPV 34.3%, NPV 66.6%, PLR 1.02, NLR 0.97, and accuracy 46% to detect EOS, Background. Early-onset neonatal sepsis (EOS) is a clinical syndrome due to systemic response to infection in early life. EOS is often difficult to diagnosed because the clinical symptoms are not specific. Objective. The study aim to determine sensitivity and specificity of ear swabs culture in the diagnosis of EOS. Methods. Neonates born in the CMH Jakarta and Tangerang Selatan Hospital who developed sepsis were studied. Swabs were collected for culture from baby’s ear. Bacterias isolated from ear swabs cultured were correlated with those from blood culture. Results. Among 50 neonates studied, 2 neonates had positive blood cultured and 32 neonates had positive ear swabs cultured. Only one subject had suitability types of bacterias that grew from blood and ear swabs. Bacteria grew from ear swab cultured were predominantly Gram-positive (62%). Ear swabs cultured had sensitivity 64.7%, specificity 36.4%, positive predictive value (PPV) 34.3%, negative predictive value (NPV) 66.6%, positive likelihood ratio (PLR) 1.02, negative likelihood ratio (NLR) 0.97, and accuracy 46% to detect EOS. Conclusions. This study showed positive blood culture results were found in two subjects. Ear swabs cultured had a sensitivity 64.7%, specificity 36.4%, PPV 34.3%, NPV 66.6%, PLR 1.02, NLR 0.97, and accuracy 46% to detect EOS]

Abstrak :
Secara global, sebanyak 15 juta bayi lahir secara prematur setiap tahunnya. Indonesia menempati peringkat kelima negara dengan angka kelahiran prematuritas tertinggi di dunia. Salah satu komplikasi utama pada bayi prematur adalah sepsis neonatorum. Sepsis neonatorum adalah respon inflamasi sistemik yang dapat terjadi pada neonatus diakibatkan oleh transmisi infeksi secara vertikal maupun melalui lingkungan. Dikarenakan oleh temuan klinis sepsis yang variatif, menyebabkan upaya mendiagnosis sepsis menjadi sullit dilakukan. Oleh karena itu, perlu diberlakukan profilaksis sepsis neonatorum pada bayi prematur, sehingga muncul prosedur oral care. Pemahaman mengenai kebermanfaatan dan keamanan prosedur oral care masih diperlukan untuk dapat menggunakan prosedur ini secara optimal. Tujuan. (1) Mengetahui karakteristik subjek penelitian berdasarkan karakteristik jenis kelamin, usia gestasi, berat lahir, usia ibu, dan jenis persalinan. (2) Mengetahui angka kejadian sepsis neonatorum pada bayi prematur yang mendapat dan tidak mendapat oral care. (3) Mengetahui hubungan antara pemberian oral care dengan kejadian sepsis neonatorum pada bayi prematur. Metode penelitian. Sebuah studi cross-sectional dilakukan pada populasi bayi prematur yang lahir di RSCM pada tahun 2015-2017. Sebanyak 42 sampel yang dipilih secara simple random sampling. Pengambilan data dilakukan pada bulan Januari hingga Agustus 2018 dengan melihat rekam medis subjek penelitian yang dilanjutkan dengan analisis bivariat. Hasil penelitian. Jumlah total subjek yang memenuhi kriteria inklusi dan eksklusi pada penelitian ini adalah 42 bayi prematur. Karakteristik penelitian ini adalah jenis kelamin laki-laki sebesar 52,4%, rerata usia gestasi 33 (24-36) minggu, rerata berat lahir 1569,24±493,3 gram, rerata usia ibu 30,5238±6,67 tahun, dan jenis persalinan sectio caesaria sebesar 85,7%. Didapatkan hubungan bermakna antara pemberian oral care dengan kejadian sepsis neonatorum (P=0,030 ; RR=0,533 ; IK 95%=0,290-0,980). Didapatkan hubungan bermakna antara usia gestasi dengan kejadian sepsis neonatorum pada subjek yang mendapat oral care (UG: 32-37 minggu = 91,7% subjek tidak sepsis ; P=0,003), serta hubungan bermakna antara berat lahir dengan kejadian sepsis neonatorum pada subjek yang mendapat oral care (BL: 1500-2499 gram = 100% subjek tidak sepsis ; P=0,002). Kesimpulan. Terdapat hubungan yang signifikan antara pemberian oral care dengan kejadian sepsis neonatorum pada bayi prematur di RSCM, terdapat penurunan kemungkinan terkena sepsis neonatorum sebesar 0,533 kali lipat.

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Introduction. Globally, it is estimated that there are 15 million premature infants born every year. Indonesia ranks fifth in the incidence of prematurity worldwide. One of the major complications of premature infants is neonatal sepsis. Neonatal sepsis is a systemic inflammatory response on infants caused by infections acquired vertically and enviromentally. Sepsis has a wide range of clinical findings, therefore it is hard to diagnose precisely. Therefore, profilactic measures to prevent neonatal sepsis is needed, and oral care rises as one of the solution. The understanding in regards of efficacy and safety of oral care is needed in order to be able to optimally utilize this procedure. Objectives. (1) To determine the subject characteristic based on gender, gestational age, birth weight, maternal age, and mode of delivery. (2) To determine the incidence of neonatal sepsis in premature infants with or without the administration of oral care. (3) To determine the association between oral care administration and the incidence of neonatal sepsis in premature infants. Methods. A cross-sectional study is done to premature infants born in RSCM in 2015-2017. 42 samples are chosen by simple random sampling. Data is collected from January to August 2018 by observing the medical records of the subject, and then continued to be analyzed using bivariate analysis. Results. There are 42 subjects that met the inclusion and exclusion criteria. The characteristics of this study are, 52,4% subject is male, mean gestational age is 33 (24-36) weeks, mean birth weight is 1569,24±493,3 gram, mean maternal age is 30,5238±6,67 years, and 85,7% subject delivered by sectio caesaria mode. There is a significant association between oral care administration and the incidence of neonatal sepsis (P=0,030 ; RR=0,533 ; CI 95%=0,290-0,980). There is a significant association between gestational age and the incidence of neonatal sepsis in subjects receiving oral care (GA: 32-37 weeks = 91,7% subjects without neonatal sepsis ; P = 0,003), and a significant association between birth weight and the incidence of neonatal sepsis in subjects receiving oral care (BW: 1500-2499 gram = 100% subjects without neonatal sepsis ; P = 0,002). Conclusion. There is a significant association between oral care administration and the incidence of neonatal sepsis in premature infants in RSCM, with the reduction of probability of the incidence of neonatal sepsis as much as 0,533 times higher.

Abstrak :
Sepsis neonatorum masih merupakan penyebab utama morbiditas dan mortalitas neonatus di seluruh dunia, terutama di negara berkembang seperti Indonesia. Klebsiella pneumoniae dalam beberapa tahun terakhir tidak hanya muncul sebagai patogen terbanyak penyebab sepsis, namun juga menimbulkan masalah lain berupa resistensi antibiotik. Klebsiella pneumonia merupakan mikroorganisme penyebab infeksi terbanyak di ruang perinatologi RS Cipto Mangukusumo (RSCM) selama tahun 2018 yaitu sebesar 16,2%. Penelitian ini bertujuan untuk mengetahui faktor risiko yang memengaruhi mortalitas pada pasien sepsis neonatorum yang terinfeksi K. pneumoniae. Studi kohort retrospektif dilakukan terhadap 174 pasien di unit perinatologi RSCM dengan diagnosis sepsis neonatorum dengan hasil kultur positif terhadap isolat K. pneumoniae sejak Januari 2017 - Oktober 2020. Karakteristik demografi, riwayat tata laksana, serta antibiogram diambil dari rekam medis. Penelitian ini mendapatkan proporsi mortalitas pada neonatus yang terinfeksi K. pneumoniae di RSCM sebesar 71,8%. Karakteristik neonatus yang terinfeksi K. pneumonia pada kelompok yang meninggal mayoritas memiliki usia gestasi kurang bulan, berat lahir rendah, dan dirawat lebih dari tujuh hari. Tindakan medis yang diperoleh antara lain mendapatkan nutrisi parenteral total, ventilasi mekanis dan kateter vena sentral lebih dari 14 hari, memiliki riwayat penggunaan vasopressor dan antibiotik karbapenem sebelumnya. Analisis pola sensitivitas antibiotik menunjukkan bahwa antibiotik yang paling sensitif terhadap K. pneumoniae adalah kolistin (90,9%), fosfomisin (75%), dan doripenem (65,7%). Dari analisis bivariat, hanya riwayat penggunaan vasopressor yang secara statistik bermakna terhadap mortalitas pada neonatus yang terinfeksi oleh K. pneumoniae (p<0,001; OR=5,0; IK95%=2,2-11,3). Analisis multivariat menunjukkan faktor risiko independen terhadap mortalitas pada neonatus yang terinfeksi oleh K. pneumoniae adalah berat lahir rendah (p=0,008; OR=3,6; IK95%=1,4-9,1). ......Neonatal sepsis remains the leading cause of neonatal morbidity and mortality worldwide, especially in developing countries including Indonesia. Klebsiella pneumoniae in recent years has emerged not only as the most common pathogen causing sepsis but also causing a drug resistance problem. In 2018, Klebsiella pneumoniae caused 16.2% infection in perinatology unit Cipto Mangunkusumo Hospital (CMH). This study is aimed to determine the risk factors that affect mortality in neonatal sepsis due to K. pneumoniae infection. A retrospective cohort study was done to 174 patients in perinatology unit of CMH with diagnosis of neonatal sepsis with positive culture result to K. pneumonia isolates during January 2017 - October 2020. Demographic characteristics, history of treatment, and antibiograms were obtained from medical records. This study found the proportion of mortality in neonates infected by K. pneumoniae at CMH was 71.8%. The majority of subjects who died to K. pneumoniae infection were born premature, had low birth weight, and were treated for more than seven days. They also received total parenteral nutrition, mechanical ventilation, and central venous catheter for more than 14 days, had history of using vasopressors and a recent carbapenem antibiotic. Analysis of antibiotic sensitivity patterns showed that the antibiotics most sensitive to K. pneumoniae were colistin (90.9%), fosfomycin (75%) and doripenem (65.7%). However, bivariate analysis showed that only history of vasopressor administration is statistically significant related to mortality due to K. pneumonia infection (p<0.001; OR=5.0; 95%CI=2.2-11.3). Multivariate analysis showed that the independent risk factor for mortality in infected neonates was the low birth weight group (p=0.008; OR=3,6; 95% CI=1.4-9.1).

Abstrak :
Latar Belakang:. Sepsis neonatorum awitan dini masih menjadi penyebab kesakitan dan kematian yang utama pada neonatus, dengan angka lebih tinggi terjadi pada bayi kurang bulan. Berbagai faktor diketahui berhubungan dengan kejadian sepsis neonatorum awitan dini, namun penelitian yang dilakukan pada bayi prematur masih terbatas. Tujuan:. Mengetahui faktor-faktor risiko yang berhubungan dengan kejadian sepsis neonatorum awitan ini pada bayi kurang bulan di RSCM. Metode:. Penelitian desain case-control dengan mengambil data dari rekam medis bayi lahir kurang bulan di RSCM pada rentang waktu Januari 2016-Desember 2017 sebanyak 186 sampel (93 untuk masing-masing kelompok). Data dianalisis secara bivariat dan multivariat. Hasil: Terdapat perbedaan bermakna dari karakteristik bayi kurang bulan antara kelompok kasus dan kontrol yaitu usia gestasi, jenis kelamin laki-laki, dan berat lahir. Gejala klinis tersering ditemukan adalah sesak napas. Dari 7 faktor yang dianalisis, infeksi intrauterin, nilai APGAR 1 menit pertama, dan nilai APGAR 5 menit pertama pada analisis bivariat dimasukkan ke analisis multivariat (p<0,25) sementara pada faktor lainnya tidak ditemukan hubungan yang bermakna. Pada analisis multivariat, ditemukan bahwa jenis kelamin laki-laki, usia gestasi, infeksi intrauterin, dan nilai APGAR 1 menit pertama memiliki hasil yang bermakna secara statistik. Kesimpulan: Jenis kelamin laki-laki, usia gestasi, infeksi intrauterin, dan nilai APGAR 1 menit pertama merupakan faktor risiko independen sepsis neonatorum awitan dini pada bayi kurang bulan. Penelitian lebih lanjut dibutuhkan untuk mengetahui pengaruh faktor-faktor tersebut terhadap kejadian sepsis neonatorum awitan dini pada bayi kurang bulan. ...... Background: Early onset neonatal sepsis is still considered as a common cause of morbidity and mortality in neonates, with a higher prevalence found in preterm infants. Many factors are known to be correlating to the cases of early onset neonatal sepsis, but research done specifically in preterm infants is limited. Objective: To determine the factors associated with early onset neonatal sepsis in preterm infants. Method: This research was done using a case-control design, where the data is taken from the medical record of preterm patients born in RSCM within January 2016-December 2017. The total sample is 186 (93 for each group). Data was then analyzed using bivariate and multivariate analysis. Result: A significant result was found in characteristic such as gestational age, gender, and birth weight. Out of 7 factors that were analysed, the factors that were analysed using multivariate analysis were intrauterine infection, low APGAR score in the first minute, and low APGAR score in the fifth minute. From multivariate analysis, gender, gestational age, intrauterine inflammation, and low APGAR score in the first minute were stastically significant. Conclusion: gender, gestational age, intrauterine inflammation, and low APGAR score in the first minute are independent risk factors for early onset neonatal sepsis. Further study is needed to understand the correlation between those factors and early onset neonatal sepsis in preterm infants.

Abstrak :
Latar belakang: Menurut data WHO, sebanyak 15 juta bayi di dunia dilahirkan kurang bulan setiap tahunnya, dan Indonesia menduduki peringkat ke-5 di dunia. Salah satu komplikasi pada bayi kurang bulan yang sering terjadi adalah sepsis. Sepsis Neonatorum Awitan Dini (SNAD) merupakan infeksi sistemik pada bayi pada usia kurang dari 72 jam yang seringkali disebabkan oleh transmisi patogen secara vertikal sebelum atau saat proses kelahiran. Strategi utama dalam penanggulangan kejadian SNAD bergantung pada identifikasi faktor risiko, termasuk ketuban pecah berkepanjangan. Namun, sampai saat ini masih belum ada kesepakatan terkait ambang batas waktu ketuban pecah yang meningkatkan risiko kejadian SNAD secara signifikan pada populasi bayi kurang bulan. Tujuan: (1) Mengetahui sebaran subjek penelitian berdasarkan karakteristik jenis kelamin, usia gestasi, usia ibu, berat lahir dan metode persalinan. (2) Mengetahui sebaran subjek penelitian berdasaran gejala klinis dan hasil pemeriksaan kultur. (3) Mengetahui hubungan antara waktu ketuban pecah dengan kejadian SNAD pada ambang batas waktu 24 jam, 18 jam dan 12 jam di RSCM. Metode penelitian: Sebuah studi kasus-kontrol dilakukan pada populasi bayi kurang bulan yang lahir di RSCM dari tahun 2016-2017. Subjek dibagi menjadi 2 kelompok: (1) kelompok kasus yang mengalami SNAD; dan (2) kelompok kontrol yang tidak mengalami SNAD; dipilih secara simple random sampling. Jumlah total subjek pada penelitian ini adalah 154 bayi kurang bulan (77 kasus dan 77 kontrol). Pengambilan data dilakukan pada Januari-Agustus 2018 dengan melihat rekam medis subjek penelitian, dilanjutkan dengan analisis bivariat menggunakan uji Chi Squared dan analisis multivariat menggunakan regresi logistik. Hasil penelitian: Semua karakteristik tidak memiliki perbedaan yang bermakna, kecuali usia gestasi (p=0,012) dan berat lahir (p=0,02). Gejala klinis yang paling sering ditemukan dan memiliki hubungan yang bermakna adalah sesak napas (63,0%; p<0,001) dan instabilitas suhu (40,9%; p<0,001). Kesimpulan: Terdapat hubungan yang signifikan antara waktu ketuban pecah dengan kejadian SNAD pada bayi kurang bulan di RSCM pada ambang batas waktu 12 jam, 18 jam dan 24 jam. Ketuban pecah lebih dari 12, 18 dan 24 jam meningkatkan risiko SNAD pada bayi kurang bulan 2,3 kali lipat, dan ketuban pecah lebih dari  12 jam meningkatkan risiko 2,9 kali lipat setelah adjustment.

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Introduction: According to WHO, 15 million babies are born premature annually, and  Indonesia ranks 5th worldwide. One of the most frequent complications in preterm infants is sepsis. Early onset neonatal sepsis (EONS) is defined as the systemic infection in infants less than 72 hours old which is often caused by vertical transmission of pathogens before or during labour. With the current lack of consensus in the definition of neonatal sepsis, identification risk factors, including prolonged premature preterm rupture of membranes (ROM), becomes the main strategy. Unfortunately, there is also currently lack of worldwide agreement in the threshold of duration of ROM which significantly increases the risk of EONS in preterm infants. Objectives: (1) To determine the distribution of subjects based on selected characteristics: gender, gestational age, maternal age, birth weight and mode of delivery. (2) To determine the distribution of subjects based on clinical symptoms and bacterial culture examination. (3) To determine the association between the duration of ROM and the incidence of EONS in preterm infants, at the thresholds of 24 hours, 18 hours and 12 hours, in RSCM. Methods: A case-control study was done on preterm infants born in RSCM in 2016-2017. The subjects were divided into 2 groups: (1) the case group for preterm infants who had EONS; and (2) the control group for preterm infants who did not have EONS; each selected by simple random sampling. The total number of subjects in the study was 154 preterm infants (77 in the case group and 77 in the control group). Data collection from the medical records of the subjects was performed in January-August 2018, followed by bivariate analysis using Chi Square Test and  multivariate analysis using logistic regression. Result: Characteristics had insignificant differences, except gestational age (p=0,012) and birth weight (p=0,02). The clinical symptoms which were most frequent and had significant associations with EONS were respiratory instability (63,0%, p<0,001) and temperature instability (40,9%, p<0,001). Conclusion. There is a significant association between the duration of ROM at 12, 18 and 24 hours, and the incidence of EONS in preterm infants, especially at duration of more than 12 hours. Prolonged PPROM for 12, 18, and 24 hours increases the risk of EONS in preterm infants 2.3 times (unadjusted) and PPROM for 12 hours increases the risk of EONS in preterm infants 2.9 times after adjustment for other factors.