December, 24th 2012 S Active movement (+); seizure (-). O Sens: CM, Temp: 36.8oC.

HR: 140bpm, RR: 42tpm A Meningitis ec Staphylococcus epidermidis + Staphylococci scalded syndrome + WCBSMK P Management: Meropenem injection 120 mg / 8 hours/ iv (D12) Vancomycin injection 44 mg/ 8 hours/ iv (D18) Phenobarbital injection 7mg/ 12 hours/ iv Total fluid needed 580cc/ day Diet ASI/PASI 48cc/ 2 hours/ oral

December 25th 2012 S Active movement (+); seizure (-). O Sens: CM, Temp: 36,8oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 138 bpm, reguler; murmur (-). RR: 36 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 138 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded syndrome + WCBSMK Management: Meropenem injection 120 mg / 8 hours/ iv (D13) Vancomycin injection 44 mg/ 8 hours/ iv (D19) Phenobarbital injection 7mg/ 12 hours/ iv Total fluid needed 500cc/ day Diet ASI/PASI 48cc/ 2 hours/ oral December 26th 2012

S Active movement (+); seizure (-). O Sens: CM, Temp: 37,1oC Thorax Simetris fusiformis. Retraction (-) HR: 142 bpm, reguler; murmur (-). RR: 40 tpm, regular, rales (-) A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome + WCB-SMK Management: Meropenem injection 120 mg / 8 hours/ iv (D14) Vancomycin injection 44 mg/ 8 hours/ iv (D20) Phenobarbital injection 7mg/ 12 hours/ iv Total fluid needed 564cc/ day

Diet ASI/PASI 47cc/ 2 hours/ oral December 27th 2012 S Active movement (+); seizure (-). O Sens: CM, Temp: 36,4oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 136 bpm, reguler; murmur (-). RR: 40 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 136 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome + WCB-SMK Management: Meropenem injection 120 mg / 8 hours/ iv (AFF) Vancomycin injection 44 mg/ 8 hours/ iv (D21) Phenobarbital injection 7mg/ 12 hours/ iv Total fluid needed 548cc/ day Diet ASI/PASI 46cc/ 2 hours/ oral Chloval hidrat 135mg da in 10cc aquabidest Transfuse PRC 28cc (Hb 9.5g/dl)

Diagnostic Planning EEG December 28th 2012 S Active movement (+); seizure (-); cry loudly O Sens: CM, Temp: 36,8oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 136 bpm, reguler; murmur (-). RR: 38 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 136 bpm, regular, adequate p/v, warm, CRT < 3. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome + WCB-SMK Management: Meropenem injection 120 mg / 8 hours/ iv (D14) Phenobarbital 2x7mg (pulvis) Nystatin 2 x 0.5cc Total fluid needed 564cc/ day Diet ASI/PASI 47cc/ 2 hours/ oral

Hb post transfusion 10.7g/dl December 29th 2012 S Active movement (+); seizure (-); cry loudly (+) O Sens: CM, Temp: 36,6oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 140 bpm, reguler; murmur (-). RR: 36 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 140 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome + Sepsis ec Staphylococcus aureus Management:

Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Total fluid needed 564cc/ day Diet ASI/PASI 47cc/ 2 hours/ oral CRP: positive ; Procalcitonin: 2.92

Hb/Ht/L/PLT: 11.40/34.20/7960/288.000 December 30th 2012 S Active movement (+); seizure (-); poor rooting reflex O Sens: CM, Temp: 37oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 142 bpm, reguler; murmur (-). RR: 36 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 142 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome + Sepsis ec Staphylococcus aureus Management: Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Total fluid needed 564cc/ day

Diet ASI/PASI 47cc/ 2 hours/ oral December 31th 2012 S Active movement (+); seizure (-); cry loudly (+) O Sens: CM, Temp: 36,8oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 144 bpm, reguler; murmur (-). RR: 40 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 144 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit.

A P

Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome + Sepsis ec Staphylococcus aureus Management: Meropenem injection 120 mg / 8 hours/ iv (D14) Vancomycin injection 44 mg/ 8 hours/ iv (D20) Phenobarbital injection 7mg/ 12 hours/ iv Total fluid needed 564cc/ day Diet ASI/PASI 47cc/ 2 hours/ oral

January, 1st 2013 S seizure (-); cry loudly (+) O Sens: CM, Temp: 37.1oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 110 bpm, reguler; murmur (-). RR: 40 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 144 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Total fluid needed 564cc/ day

Diet ASI/PASI 47cc/ 2 hours/ oral January, 2nd 2013 S seizure (-); cry loudly (+) O Sens: CM, Temp: 36.6oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 126 bpm, reguler; murmur (-).

RR: 42 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 126 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Total fluid needed 580cc/ day Diet ASI/PASI 24cc/ 2 hours/ oral Hasil kultur darah: Bakteri: t.a.p Jamur: t.a.p January, 3th 2013 S Active movement (+); seizure (-). O Sens: CM, Temp: 37oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 116 bpm, reguler; murmur (-). RR: 38 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 116 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Total fluid needed 348cc/ day

Diet ASI/PASI 24cc/ 2 hours/ oral January, 4th 2013 S Active movement (+); seizure (-); cry loudly(+) O Sens: CM, Temp: 36,1oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-)

HR: 126 bpm, reguler; murmur (-). RR: 38 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 126 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Total fluid needed 348cc/ day

Diet ASI/PASI 24cc/ 2 hours/ oral January, 5th 2013 S Active movement (+); seizure (-); cry loudly (+) O Sens: CM, Temp: 37oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 128 bpm, reguler; murmur (-). RR: 38 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 128 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Cefadroxil 2 x 30mg Total fluid needed 464cc/ day

Diet ASI/PASI 38cc/ 2 hours/ oral January, 6th 2013 S Active movement (+); seizure (-); cry loudly (+) O Sens: CM, Temp: 36,7oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 126 bpm, reguler; murmur (-).

RR: 36 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 126 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Cefadroxil 2 x 30mg Total fluid needed 493cc/ day

Diet ASI/PASI 41cc/ 2 hours/ oral January, 7th 2013 S Active movement (+); seizure (-). O Sens: CM, Temp: 36,9oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 140 bpm, reguler; murmur (-). RR: 43 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 140 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Cefadroxil 2 x 30mg Total fluid needed 580cc/ day

Diet ASI/PASI 48cc/ 2 hours/ oral January, 8th 2013 S Active movement (+); seizure (-); cry loudly (+); poor rooting reflex O Sens: CM, Temp: 36,1oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 142 bpm, reguler; murmur (-).

RR: 40 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 142 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Cefadroxil 2 x 30mg Total fluid needed 580cc/ day Diet ASI/PASI 48cc/ 2 hours/ oral January, 9th 2013 S seizure (-) O Sens: CM, Temp: 36.8oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 144 bpm, reguler; murmur (-). RR: 42 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 144 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Cefadroxil 2 x 30mg Total fluid needed 580cc/ day

Diet ASI/PASI 48cc/ 2 hours/ oral January, 10th 2013 S seizure (+) O Sens: CM, Temp: 36.6oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-)

HR: 140 bpm, reguler; murmur (-). RR: 40 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 140 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenitoin injection 15mg/12jam/iv Piridoxin injection 100mg/iv/day Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Total fluid needed 435cc/ day

Diet ASI/PASI 24cc/ 2 hours/ oral January, 11th 2013 S seizure (-); spastic (+) O Sens: CM, Temp: 37oC Head Thorax Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 135 bpm, reguler; murmur (-). RR: 40 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 135 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenitoin injection 15mg/12jam/iv Piridoxin injection 100mg/iv/day Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Total fluid needed 435cc/ day

Diet ASI/PASI 24cc/ 2 hours/ oral January, 12th 2013 S seizure (-); cry loudly(+) O Sens: CM, Temp: 36,7oC

Head Thorax

Flat open crown. Conjunctiva palpebra inferior anemic (-). Light reflex (+)/(+). Isochoric pupil. Simetris fusiformis. Retraction (-) HR: 145 bpm, reguler; murmur (-).

RR: 40 tpm, regular, rales (-) Abdomen Soepel peristaltic; normoperistaltic. Liver and spleen unpalpable. Extremities Pulse 145 bpm, regular, adequate p/v, warm, CRT < 3. Genital Male; anus (+); within normal limit. A P Meningitis ec Staphylococcus epidermidis + Staphylococci scalded skin syndrome Management: Phenitoin injection 15mg/12jam/iv Piridoxin injection 100mg/iv/day Phenobarbital 2 x 7mg (pulvis) Nystatin 2 x 0.5cc Total fluid needed 406cc/ day Diet ASI/PASI 27cc/ 2 hours/ oral