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PRESENTASI KASUS

NEONATUS
Disusun Oleh :
Resha Ardianto
20131040101101
Pe!"i!"in# :
Dr$ E%%end&' S($A
)A*+ S,- I),U PEN.AKIT ANAK
*APE)KES RSUD /O,*AN0
2014
1
KASUS NEONATUS
ANA,NESA
IDENTITAS BAYI
No. Register : 221716
Nama : By Ny. Istiqoma
TT! : "om#a$g% 2& mei 2'1( % )12 : 1*+
"e$is Ke,ami$ : !a-i.,a-i
A,amat : /0,o ,or gg (% "om#a$g
IDENTITAS ORAN1 TUA
I#0
Nama : Ny. istiqoma
Um0r : 23 Ta0$
4e-er5aa$ : I#0 r0ma ta$gga
4e$6i6i-a$ : S74
Agama : Is,am
S0-0 : "a8a
Ba$gsa : I$6o$esia
A,amat : /0,o ,or gg (% "om#a$g
Aya
Aya : T$. A$a$g setia8a$
Um0r : (& Ta0$
4e-er5aa$ : sa8stas
4e$6i6i-a$ : sma
Agama : Is,am
S0-0 : "a8a
Ba$gsa : I$6o$esia
A,amat : /0,o ,or gg (% "om#a$g
2
RI9AYAT KE:A7I!AN
12 4''' A'1'
A$a- /ertama se,ama -eami,a$ ,air se;ara KET saat i#0 #er0sia 26 t
6i,a-0-a$ o/erasi o,e 6o-ter S/.O1
Se,ama -eami,a$ r0ti$ me,a-0-a$ AN< 6i #i6a$ setia/ #0,a$ 2 -a,i%
te-a$a$ 6ara tia/ -a,i -o$tro, $orma, yait0 12'=&' 6a$ 6i#eri o#at ta#,et
>e 6a$ ?itami$.
I#0 memi,i-i ri8ayat Dia#etes 7e,it0s se5a- 0sia 2* t s06a 6i,a-0-a$
/emeri-saa$ g0,a 6ara /0asa 6a$ i#0 ti6a- r0ti$ mi$0m OAD. Biasa$ya
mi$0m g,i#e$;,ami6
Saat -eami,a$ i#0 me$ya$g-at me$ga,ami sa-it se/erti 6emam% #at0-%
ata0 sa-it ya$g ,ai$. Saat ami, 50ga ti6a- ter,a,0 seri$g me$g-o$s0msi
o#at OAD. I#0 saat memeri-asa-a$ 10,a 6ara$ya me$ga$gga/ s06a
$orma, 6a$ #ar0 me$ge$ti-a$ /e$go#ata$ OAD
Ri8ayat -e/0tia$ se,ama ami, )@+% 8ar$a /0ti -e$ta,% Ba0 )@+% gata, ).+
6emam )@+ta/i s06a -o$tro, -e #i6a$ 6a$ 6i#eri a$ti#ioti- 6a$ ti6a- ta0
5e$is$ya a/a.
Berat #a6a$ i#0 $ai- & -g se,ama -eami,a$ 6ari *' -g me$5a6i *& -g
RI9AYAT 4ERSA!INAN
4asie$ 6ata$g 6ari OK U1D 12 41''1 A''' K4D A 1 5am TB A2*''%
o,igoi6ram$io$ ,air se;ara S<
4er-iraa$ 0sia -eami,a$ 2(=2* mgg #er6asar-a$ :4:T -eami,a$
t0$gga,% ,eta- #050r 6e$ga$ /rese$tasi -e/a,a.
4roses /ersa,i$a$ #er,a$gs0$g 6i Kamar #ersa,i$ RSUD "om#a$g 6e$ga$
/roses /ersa,i$a$ s/o$ta$.
Bayi ,air ari Sa#t0 ta$gga, 2& mei 2'1(% 4-.12.1* 9IB 5e$is -e,ami$
,a-i.,a-i
Bayi ti6a- ,a$gs0$g me$a$gis% meri$ti% A/gar S;ore 2.*.6.6% Do8$ s;ore
6% #erat #a6a$ 22*' gram 6a$ sisa -et0#a$ me-o$ea, #a0 )@+.
3
Bayi 6i-irim -e r0a$g a$ggre- -are$a K0ra$g #0,a$% Berat ,air re$6a
6e$ga$ A/gar s;ore 2.*
PE,ERIKSAAN -ISIK 1 tan##al 22 ,aret 2014' P3$ 13$14 5
Keadaan Umum
A-tiBitas ,ema% meri$ti% :i/ersa,iCasi )@+% to$0s otot ,ema% -0,it
#er8ar$a -emeraa$% sesa- )@+% % /osisi semi eDte$si
Vital Sign
S00 )
O
<+ aDi,,a : 26%7
O
<
:R ):eart Rate+ : 1(& D = me$it% reg0,er
RR ) Res/iratory Rate + : 6' D = me$it% terat0r
<RT ) <a//i,ary ReBi,, time + : E2 6eti-
Anthropometri
BB !air : 22*' gram
BB 7as0- : 22*' gram
4a$5a$g Ba6a$ : *' ;m
!i$g-ar Ke/a,a )>O+ : 27 ;m
!i$g-ar Da6a : 2( ;m
!i$g-ar A#6ome$ : 22 ;m
Sistem Pernafasan :
RR: 6' D=me$it% terat0r
9ar$a K0,it : mera m06a% e-stremitas aga- -e#ir0aa$
Di$6i$g Da6a : /ergera-a$ simetris% retra-si I<S )@+% retra-si
s0/raster$a, )@+% retra-si e/igastria, ).+
4er$aBasa$ : s/o$ta$% /er$aBasa$ ;0/i$g i60$g )@+% gr0$ti$g )@+
S0ara NaBas : Cesi-0,er% ti6a- a6a ro$;i ma0/0$ 8eeFi$g
Sistem Cardivaskular
:R : 1(& D = me$it% reg0,ar
4
B0$yi 5a$t0$g : S1.S2 t0$gga,% reg0,er% t6- 6i6a/at-a$ m0rm0r
ma0/0$ ga,,o/
4re;or6ia, /0,sasi )@+
E/igastri0m /0,sasi ).+
Sistem Neurologis :
A-tiCitas : #a$g0$=sa6ar
Ti$g-at Kesa6ara$ : <om/os 7e$tis
>o$ta$e, : 6atar% S0t0ra : ter/isa
4ergera-a$ :s/o$ta$
7e$a$gis : gera- ta$gis ,ema% gr0$ti$g )@+
To$0s :,ema
40/i, : /0/i, #0,at iso-or% 6iameter 2 mm
7em#0-a 7ata : s/o$ta$
Ti6a- Ke5a$g
ReB,e-s :% rooti$g% 6a$ isa/ )@+ ,ema
Sistem Gastrointestinal
Bisi$g Us0s : )@+ $orma,
Di$6i$g 4er0t : -emeraa$% s0/e,% :e/ar=!ie$ ti6a- tera#a% t6-
6i6a/at-a$ 6arm ;o0$t0r ti6a- meteorism0s% T0rgor -0,it #ai-
S06a BAB me;o$ia,
Sistem Genitourinaria
Testis s06a t0r0$
10rata$ s-rot0m a6a
Be,0m BAK
Kepala dan leher
<e/a, ematoma ).+% <a/0t s0;;a6e$0m ).+
S0t0ra : 6a,am #atas $orma,
7ata : t6- A$emis% t6- I;ter0s% S0#;o$50$gtiCa #,ee6i$g ).+
Te,i$ga : $orma,
70,0t : $orma,
5
4em#esara$ Ke,e$5ar 1eta Be$i$g ti6a- a6a
Ekstremitas
A-ra, 6i$gi$
T6- a6a E6ema
<ya$osis
T6- a6a >ra-t0r
PE,ERIKSAAN ,ATURITAS -ISIK
K0,it : 7era 5am#0 ,em#0t % tam/a- gam#ara$ Ce$a
ses6i-it )2+
!a$0go : 6aera -e#ota-a$ )2+
1aris te,a/a- -a-i : 1aris -a-i a$ya 6i se,0r0 te,a/a- )(+
4ay06ara : Areo,a me$o$5o, )(+
7ata 6a$ Te,i$ga : #e$t0- 6a$ -e-erasa$ ter#e$t0- #ai-% ta/i re;oi,
;e/at )2+
1e$ita, : Testis s06a t0r0$ 6a$ s-rot0m 6a,am )2+
Tota,: 2'
PE,ERIKSAAN ,ATURITAS NEURO,US6U)AR
4ost0re : Semi B,esi )2+
Sq0are 8i$6o8 : 2'
'
)2+
Arm re;oi, : 3'
'
.1''
'
)2+
4o/,itea, a$g,e : E3'
'
)*+
S;arB sig$ : taa$a$ tari-a$ #ai- )(+
:ee, to ear : #ias 6i te$ga2 )2+
Tota,: 21
"0m,a S;ore G 21 Berarti 0sia -eami,a$ se-itar 26.27 mi$gg0
RESU,E
By. Ny. Istiqoma
12 4''' A'1'
6
Se,ama -eami,a$ r0ti$ me,a-0-a$ AN<
I#0 memi,i-i ri8ayat Dia#etes 7e,it0s se5a- 0sia 2* t OAD g,i#e$;,ami6
. Berat #a6a$ i#0 $ai- & -g se,ama -eami,a$ 6ari *' -g me$5a6i *& -g
Bayi ,air s/o$ta$% ti6a- ,a$gs0$g me$a$gis% meri$ti% A/gar S;ore 2.*.6.
6% #erat #a6a$ 22*' gram 6a$ sisa -et0#a$ me;o$ea,
Kea6aa$ Um0m : A-tiBitas ;0-0/% ta$gisa$ ,ema% meri$ti% to$0s otot
,ema% -0,it #er8ar$a -emeraa$ sia$osis /a6a a-ra,% tam/a- sesa-% ti6a-
tam/a- e6ema% /osisi semi eDte$si
?ita, sig$ : S00 : 26%7
'
<% :R : 1(& D= me$it% reg0,ar% RR: 6' D = me$it%
terat0r% <RT: E 2 6eti-
4er$aBasa$ : S/o$ta$% 4er$aBasa$ ;0/i$g i60$g )@+% retra-si )@+% gr0$ti$g
)@+
Ba,,ar6 s;ore 26.27 mgg
DIA0NOSIS
. Bayi ;0-0/ B0,a$= Ses0ai 7assa Keami,a$
. S0s/ i/og,i-emi-
. S0s/ I$Be-si 4eri$ata,
. As/yDia #erat
P)ANNIN0 DIA0NOSIS
D!
:#
!e0-osit
:;t
Eritrosit
Trom#osit
1DA
<R4 -0a$titatiB
K0,t0r 6ara
1o,6a R
P)ANNIN0 T7ERAP.
Termoreg0,asi
7
4era8ata$ Bayi 6a$ ta,i /0sat
4asa$g sat0rasi o-sige$ O
2
<4A4 #ias 6e$ga$ $eo/0BB
I$5e-si Citami$ K '%1 mg I7
Tetes 7ata ge$tami;i$ 2 tetes ODS
O1TRete$si40asa
I$B0s D1' 21* m,=2( 5am
I$5 <a 1,0;o$as 1' m,
I$5 Am/i;i,,i$.s0,#a;tam 2 D 1'' mg
P)ANNIN0 ,ONITOR
Kea6aa$ 0m0m #ayi )sesa-% sia$osis+
4e$0r0$a$=/e$i$g-ata$ Berat Ba6a$
Sat0rasi o-sige$
?ita, sig$ )t
o
<% :R% RR% <RT+
Ba,a$;e ;aira$ );aira$ i$B0s.0ri$e+
Rete$si ;aira$ ,am#0$g
PRO0NOSIS : "e,e-
8
PRO0RESS NOTE
289492014
1+1+1
229492014
2+2+2
309492014
3+3+3
S
Sesa- )@+% gr0$ti$g )@+
:i/ersa,iCasi )@+% a-ra,
sem#a#% Be#ris ).+%
gera- ta$gis ,ema%
to$0s ,ema.
Sesa- )@+% gr0$ti$g )@+
:i/ersa,iCasi )@+% a-ra,
sem#a#% Be#ris ).+%
gera- ta$gis ,ema%
to$0s ,ema.
Sesa- )@+% gr0$ti$g )@+
:i/ersa,iCasi ).+% a-ra,
sem#a#% Be#ris )@+%
gera- ta$gis ,ema%
to$0s ,ema.
O
BB 22*'gr
:RG 1*'D RRG62D
TG26%*
o
< <RTE26t-
.K=!: a=i=;=6G.=.=@=@
/; )@+%
.T: Simetris% retra-si
i$ter;ostae )@+
s0/rater$a, )@+% S0ara
$aBas Cesi-0,er
i$s/irasiAe-s/irasi% r
.=.% 8 .=.% s1.s2 t0$gga,
reg0,er m0rm0r ).+
.A#6: S0/e,% BU )@+
$orma,% :=! ta- tera#a
.E-s: A: @@=@@ e6 ..=..
1DA (2
BB 22''gr
:RG 16'D RRG*&D
TG26%&
o
< <RTE26t-
.K=!: a=i=;=6G.=.=@=@
/; )@+%
.T: Simetris% retra-si
i$ter;ostae )@+
s0/rater$a, )@+% S0ara
$aBas Cesi-0,er
i$s/irasiAe-s/irasi% r
.=.% 8 .=.% s1.s2 t0$gga,
reg0,er m0rm0r ).+
.A#6: S0/e,% BU )@+
$orma,% :=! ta- tera#a
.E-s: A: @@=@@ e6 ..=..
!a#:
:#: 13 :;t: *6
!e0:6''' Eri: *%* 5t
Trom#osit: 1''.'''
1DA (2
1o, '
Sat0rasi o-sige$ 3& H
BB 21*'gr
:RG 16&D RRG67D
TG2&%6
o
< <RTE26t-
.K=!: a=i=;=6G.=.=@=@
/; )@+%
.T: Simetris% retra-si
i$ter;ostae )@+
s0/rater$a, )@+% S0ara
$aBas Cesi-0,er
i$s/irasiAe-s/irasi% r
.=.% 8 .=.% s1.s2 t0$gga,
reg0,er m0rm0r ).+
.A#6: S0/e,% BU )@+
$orma,% :=! ta- tera#a
.E-s: A: @@=@@ e6 ..=..
1DA 7(
A
. B<B=S7K
. :i/og,i-emi-
. S0s/ /eri$ata, i$Be-si
. B<B=S7K
. i/og,i-emi
. S0s/ /eri$ata, i$Be-si
. B<B=S7K
. S0s/ /eri$ata, i$Be-si
P 4,a$$i$g DD:
D!@1o,o$ga$ 6ara
4,a$$i$g TD:
. Nasa, <a$0, <4A4
4,a$$i$g TD:
. Nasa, <a$0, <4A4
9
4,a$$i$g TD:
. Nasa, <a$0, <4A4
>iO
2
('H% mo$itor
sat0rasi
. O1T
. I$B D1' 21* ;;=2( 5am
. ;a g,0-o$as 1';;
. I$5 ?i;;i,i$ sD 2D1''
mg
. D1'H 2m,=-g 6%*
m, -e;e/at$ 1m,=me$it
1 5am 6i ;e- ,agi 1DA
**mg=6,
./0asa
>iO
2
('H% mo$itor
sat0rasi
. O1T
. I$B D1' 2*' ;;=2( 5am
. ;a g,0-o$as 1';;
. ami$oB0si$ /e6 6';;
. I$5 ?i;;i,i$ sD 2D1''
mg
D1'H 2m,=-g 6%* m,
-e;e/at$ 1m,=me$it
1 5am 6i ;e- ,agi 1DA
*3 mg=6,
Asi=/asi 2%* ;;
>iO
2
('H% mo$itor
sat0rasi
. O1T
. I$B D1' 2*' ;;=2( 5am
. ;a g,0-o$as 1';;
. ami$oB0si$ /e6 &';;
. I$5 ?i;;i,i$ sD 2D1''
mg
Asi=/asi 2%* ;;
19492014
3+4+4
29492014
4+4+4
39492014
4+:+:
S Sesa- )@+% gr0$ti$g )@+
:i/ersa,iCasi ).+% a-ra,
sem#a# ).+% Be#ris )@+%
gera- ta$gis ,ema%
to$0s ,ema.
Sesa- )@+% gr0$ti$g )@+
:i/ersa,iCasi ).+% a-ra,
sem#a# ).+% Be#ris )@+%
gera- ta$gis ).+% to$0s
ma-i$ ,ema..
Sesa- )@+% gr0$ti$g )@+
:i/ersa,iCasi ).+% a-ra,
sem#a# ).+% Be#ris )@+%
gera- ta$gis ).+% to$0s
,ema. Sema-i$ ,ema
6ari /a6a ari
se#e,0m$ya
O BB 22('gr
:RG 167D RRG62D
TG2&%1
o
< <RTE26t-
.K=!: a=i=;=6G.=.=@=@
/; )@+%
.T: Simetris% retra-si
i$ter;ostae )@+
s0/rater$a, ).+% S0ara
$aBas Cesi-0,er
i$s/irasiAe-s/irasi% r
.=.% 8 .=.% s1.s2 t0$gga,
reg0,er m0rm0r ).+
.A#6: S0/e,% BU )@+
$orma,% :=! ta- tera#a
.E-s: A: @@=@@ e6 ..=..
1DA 6*
BB 222' gr
:RG 163D RRG66D
TG27%&
o
< <RTE26t-
..K=!: a=i=;=6G.=.=@=@
/; )@+%
.T: Simetris% retra-si
i$ter;ostae )@+
s0/rater$a, ).+% S0ara
$aBas Cesi-0,er
i$s/irasiAe-s/irasi% r
.=.% 8 .=.% s1.s2 t0$gga,
reg0,er m0rm0r ).+
.A#6: S0/e,% BU )@+
$orma,% :=! ta- tera#a
.E-s: A: @@=@@ e6 ..=..
1DA 77
!a# :#: 12%6 :;t: 2*%6
!e0:2''' Eri: 2%2& 5t
Trom#osit: 1'.'''
BB 126'gr
:RG 1('D RRG*6D
TG2&%6
o
< <RTE26t-
...K=!: a=i=;=6G.=.=@=@
/; )@+%
.T: Simetris% retra-si
i$ter;ostae )@+
s0/rater$a, ).+% S0ara
$aBas Cesi-0,er
i$s/irasiAe-s/irasi% r
.=.% 8 .=.% s1.s2 t0$gga,
reg0,er m0rm0r ).+
.A#6: S0/e,% BU )@+
$orma,% :=! ta- tera#a
.E-s: A: @@=@@ e6 ..=..
1DA 72
A . B<B=S7K
. S0s/ /eri$ata, i$Be-si
. BKB=BB!R=S7K
. Se/sis
. BKB=BB!R=S7K
. Se/sis
P 4,a$$i$g TD:
. Nasa, <a$0, <4A4
>iO
2
('H% mo$itor
sat0rasi
4,a$$i$g TD:
. Nasa, <a$0, <4A4
>iO
2
('H% mo$itor
sat0rasi
4,a$$i$g TD:
. Nasa, <a$0, <4A4
>iO
2
('H% mo$itor
sat0rasi
10
. Nasa, <a$0, O
2
. O1T
. I$B D1' 2&' ;;=2( 5am
. ;a g,0-o$as 1';;
. ami$oB0si$ /e6 1'';;
. I$5 ?i;;i,i$ sD 2D1''
mg
Asi=/asi 2 ;;
. Nasa, <a$0, O
2
. O1T
. I$B D1' 26' ;;=2( 5am
. ;a g,0-o$as 1';;
. ami$oB0si$ /e6 12';;
. I$5 ?i;;i,i$ sD 2D1''
mg
Asi=/asi * ;;
. Nasa, <a$0, O
2
. O1T
. I$B D1' 26' ;;=2( 5am
. ;a g,0-o$as 1';;
. ami$oB0si$ /e6 12';;
. I$5 ?i;;i,i$ sD 2D1''
mg
Asi=/asi 7 ;;
49492014
:++
S me$i$gga,
O me$i$gga,
A . .
P
11
TIN/AUAN PUSTAKA
7IPO0)IKE,I
De%inisi
<or$#,at 6a$ Reis$er )136*+ /ertama -a,i ya$g mem/0#,i-asi-a$
-a6ar g0,a 6ara /a6a #ayi $orma,% mere-a me$6a/at-a$ 3*H #ayi ;0-0/ #0,a$
,e#i 6ari 2' mg=6! 6a$ 3&%(H #ayi /remat0r ,e#i 6ari 2' mg=6!. 7ere-a
me$6eBi$isi-a$ i/og,i-emia 0$t0- #ayi ;0-0/ #0,a$ #i,a -a6ar g0,a 6ara$ya
-0ra$g 6ari 2' mg=6! 6a,am (& 5am /ertama 6a$ ('.*' mg=6! sete,a 0sia (& 5am
sete,a ,air. Bayi -e;i, masa -eami,a$ ti6a- termas0- 6a,am -e,om/o- i$i.
U$t0- #ayi #erat #a6a$ ,air re$6a% 6i6eBi$isi-a$ i/og,i-emia #i,a -a6ar g0,a
6ara E 2' mg=6!.4e$e,itia$ ,ai$ me$0$50--a$ #a8a -e;0a,i /a6a 5am /ertama
-ei60/a$% #ai- /a6a #ayi /remat0r ma0/0$ ge$a/ #0,a$ ya$g 6i#eri-a$ mi$0m
s0s0 sea8a, m0$g-i$ sa$gat 5ara$g -a6ar g0,a 6ara$ya -0ra$g 6ari (' mg=6!
)9or,6 :ea,t Orga$iFatio$% 1337+.
Ber6asar-a$ /e$6a/at 6ari #e#era/a a,i 6a/at 6i-em0-a-a$ a$g-a.
a$g-a $i,ai -a6arg,0-osa 6ara=/,asma ata0 ser0m 0$t0- 6iag$osis i/og,i-emia
/a6a #er#agai -e,om/o- a$a- se/erti ter,iat /a6a ta#,e ):ay% 2''3+
12
Ber6asar-a$ ta#e, 6i atas% se#agai #atasa$ i/og,i-emia /a6a #ayi aterm
6e$ga$ #erat#a6a$ 2*'' gram ata0 ,e#i% -a6ar g,0-osa /,asma 6ara ,e#i
re$6a 6ari 2' mg=6, 6a,am 72 5am /ertama 6a$ (' g=6, /a6a ari #eri-0t$ya%
se6a$g-a$ /a6a #erat #a6a$ ,air re$6a 6i #a8a2* mg=6,. )9or,6 :ea,t
Orga$iFatio$% 1337+
Ba$ya- /e$0,is me$ga$50r-a$ -riteria i/og,i-emia 0$t0- #ayi 6a$
a$a- #i,a -a6ar g0,a 6ara -0ra$g 6ari (' mg=6!% #e#era/a /e$0,is 6e$ga$ -riteria
ya$g ,e#i ti$ggi% (7 mg=6!.Sei$gga /e$6e-ata$ ya$g ama$ /a6a #ayi 6a$ a$a-
6e$ga$ -a6ar g,0-osa -0ra$g 6ari *' mg=6! ar0s 6i/a$ta0 6e$ga$ #ai-% #i,a
-a6ar g,0-osa -0ra$g 6ari (' mg=6!% ma-a ar0s 6im0,ai ti$6a-a$ 0$t0-
me$ega--a$ 6iag$osis 6a$ m0,ai 6i#eri-a$ tera/i. Bi,a /e$g0-0ra$ -a6arg,0-osa
6ig0$a-a$ g,0-ometer% ma-a ar0s 6i-o$Birmasi 6e$ga$ /emeri-saa$ ya$g ,e#i
a-0rat%-are$a -a6ar g,0-osa /a6a 8o,e #,oo6 ,e#i re$6a 1*H #i,a
6i#a$6i$g-a$ -a6ar 6a,am ser0mata0 /,asma ):ay% 2''3+
Klasi%i3asi
:i/og,i-emia 6a/at 6i#agi me$0r0t 0sia yait0 i/og,i-emia $eo$at0s 6a$
i/og,i-emia /a6a #a,ita ata0 a$a- ya$g ,e#i #esar ):ay% 2''3+
13
1. :i/og,i-emia /a6a $eo$ates BersiBat seme$tara. Biasa$ya ter5a6i /a6a #ayi
#ar0 ,air% misa,$ya -are$a mas0-a$ g,0-osa ya$g -0ra$g ) starCasi% -e,a/ara$+%
i/otermia% syo-% 6a$ /a6a #ayi 6ari i#0 6ia#etes.
2. BersiBat me$e$ta/ ata0 #er0,a$g. Ter5a6i a-i#at 6eBisie$si ormo$%
i/eri$s0,i$isme% serta -e,ai$a$ meta#o,ism -ar#oi6rat 6a$ asam ami$o%
ga$gg0a$ meta#o,isme ya$g #ersiBat er6iter )misa,$ya g,y;oge$storage 6iseases%
6isor6ers oB g,0;o$eoge$esis% Batty a;i6 oDi6atio$ 6isor6ers+. :i/og,i-emia /a6a
#a,ita ata0 a$a- ya$g ,e#i #esar. :i/og,i-emia 6a/at ter5a6i -are$a a-i#at
starCasi ter0tama #i,a ;a6a$ga$ g,i-oge$ re$6a% /re 6ia#etes% o#at.o#ata$
misa,$ya i$s0,i$ /a6a /asie$ 6ia#etes me,,it0s ti/e 1% /e$ya-it sistemi- #erat% 6a$
/a6a ga$gg0a$ e$6o-ri$ 6a$ meta#o,isme. ):ay% 2''3+
Ta#e, 2. K,asiBi-asi :i/og,i-emia 4a6a Bayi 6a$ A$a-
14
Epidemiologi
>re-0e$si i/og,i-emia /a6a #ayi=a$a- #e,0m 6i-eta0i /asti. Di Ameri-a
6i,a/or-a$ se-itar 1(''' #ayi me$6erita :i/og,i-emia. 10t#er,et 6a$ <or$#,at
me,a/or-a$ Bre-0e$si i/og,i-emia (%( /er 1''' -e,aira$ i60/ 6a$ 1*%* /er
1''' BB!R. :a$ya 2''I2(' /e$6erita i/og,i-emia /ersiste$ ma0/0$
i$termitte$ setia/ ta0$$ya ya$g mas0- r0ma sa-it. A$g-a i$i #er6asar-a$
o#serCasi #a8a /e$6erita i/og,i-emia #er50m,a 2 I 2 /er 1''' a$a- ya$g
mas0- r0ma sa-it% se6a$g-a$ a$a- ya$g 6ira8at #er50m,a &'.''' /erta0$ 1 .
Se6a$g-a$ 6i I$6o$esiamasi #e,0m a6a 6ata )<or$#,at% 2'''+
15
4er-iraa$ i$si6e$si i/og,i-emia /a6a $eo$at0s #erga$t0$g /a6a 6eBi$isi
o/erasio$a, 6a$ meto6e /emeri-saa$ g,0-osa 6ara ya$g 6i,a-0-a$. I$si6e$s
se;ara 0m0m 6i/er-ira-a$ a$tara 1.* /er 1''' -e,aira$ i60/% $am0$ a$g-a
terse#0t me$i$g-at /a6a /o/0,asi 6e$ga$ risi-o ti$ggi. )<or$#,at% 2'''+
:i/og,i-emia ,e#i seri$g ter5a6i /a6a $eo$at0s ya$g ,air /a6a -0ra$g
6ari 27 mi$gg0 6a$ ,e#i 6ari (' mi$gg0 0sia -eami,a$% 6e$ga$ ti$g-at -e5a6ia$
2%(H /a6a $eo$at0s ,air /a6a 27 mi$gg0 0sia -eami,a$% '%7H /a6a $eo$at0s
,air /a6a 2&.(' mi$gg0 6ari 0sia -eami,a$. Se,ai$ it0% 1%6H 6a$ 1%&H /a6a
$eo$at0s ya$g ,air /a6a 0sia -eami,a$ (1 6a$ (2mi$gg0 )<or$#,at% 2'''+
Etiolo#i
Se;ara garis #esar% etio,ogi i/og,i-emia 6i#agi me$5a6i 60a #agia$
#esar% yait0 -e,ai$a$ ya$g me$ye#a#-a$ /ema-aia$ g,0-osa #er,e#ia$ 6a$
/ro60-si g,0-osa -0ra$g )9i,,iams% 2''*+
Ke,ai$a$ ya$g me$ye#a#-a$ /ema-aia$ g,0-osa #er,e#ia$
1. :i/eri$s0,i$isme )#ayi 6ari i#0 /e$6erita 6ia#etes% i/og,i-emia
i/eri$s0,i$isme me$eta/ /a6a #ayi% t0mor ya$g mem/ro60-si i$s0,i$ 6a$ ;i,6
a#0se+. :i/eri$s0,i$isme me$ye#a#-a$ /ema-aia$ g,0-osa ya$g #er,e#ia$
ter0tama a-i#at ra$gsa$g am#i,a$ g,0-osa o,e otot. 4a6a #ayi% i/eri$s0,i$emia
6a/at ter5a6i -are$a 6eBe- ge$eti- ya$g me$ye#a#-a$ a-tiCasi rese/tor
s0,Bo$y,0rea a-i#at se-resi i$s0,i$ ya$g me$eta/. Ke,ai$a$ i$i 6i-eta0i se#agai
i/og,i-emia i/eri$s0,i$ e$6oge$ me$eta/ /a6a #ayi ya$g se#e,0m$ya 6ise#0t
se#agai $esi6io#,astosis. Bayi 6ari /e$6erita 6ia#etes 50ga mem/0$yai -a6ar
i$s0,i$ ya$g ti$ggi sete,a ,air -are$a ti$ggi$ya /a/ara$ g,0-osa i$0tero a-i#at
16
5e,e-$ya -o$tro, g,0-osa se,ama -eami,a$% a, i$i ya$g me$ye#a#-a$
i/eri$s0,i$emia /a6a #ayi. 4a6a a$a-% i/eri$s0,i$emia 5ara$g ter5a6i%
/e$ye#a#$ya t0mor ya$g mem/ro60-si i$s0,i$. 4e$gg0$aa$ i$s0,i$ e-soge$ ata0
/em#eria$ o#at ya$g me$ye#a#-a$ i/og,i-emia -a6a$g 6a/at ter5a6i -are$a
-e;e,a-aa$ ata0 sa,a /e$gg0$aa$% sei$gga a, i$i /a6a a$a- ar0s
6i/ertim#a$g-a$. Ditem0-a$ se#a$ya- *'H 6ari sem0a -as0s i/og,i-emia /a6a
#ayi. Diag$osis i/og,i-emia 6i;0rigai #i,a sera$ga$ ;e$6er0$g #er0,a$g.
Diag$osis i/eri$s0,i$isme 6itega--a$ #i,a 6i6a/at-a$ s0at0 -ea6aa$
i/og,i-emia ya$g 6iserta0 -a6ar i$s0,i$ ya$g ti$ggi. 4a6a -ea6aa$ $orma,%
/e$0r0$a$ -a6ar g0,a 6ara 6isertai 6e$ga$ /e$0r0$a$ -a6ar i$s0,i$ ya$g ses0ai.
Ka6ar i$s0,i$ A1' JU=m, /a6a -ea6aa$ i/og,i-emia a6a,a a#$orma,% #a-a$
/a6a #e#era/a -as0s -a6ar ya$g ,e#i -e;i, m0$g-i$ ti6a- ses0ai 6e$ga$ -ea6aa$
i/og,i-emia ya$g a6a 6a$ me$0$50-a$ a6a$ya se-resi oto$om. Ba$ya- /asie$
ya$g /a6a saat #ayi 6i-e$a, me$ga,ami i/og,i-emia i6io/ati- ter$yata
me$ga,ami i/eri$s0,i$isme. :i/eri$s0,i$isme se#agai /e$ye#a# i/og,i-emia
#erat% /a6a 0m0m$ya m0$;0, /a6a #ayi #ar0 ,air sam/ai 0sia 2 #0,a$. A6a$ya
i/eri$s0,i$isme% i/og,i-emia sim/tomati- tim#0, sete,a /0asa 26 5am 6a$
6isertai 6e$ga$ re$6a$ya -a6ar #eta.i6ro-si#0tirat )#e$6a.#e$6a -eto$+% >>A
6a$ i/eri$s0,i$emia re,atiB )A 12 mi-ro 0$it=m,+. Res/o$s i/erg,i-emia tera6a/
g,0;ago$ me$i$g-at. U5i to,era$si to,#0tami6 mem#eri-a$ asi, rea-si ya$g
e#at.:i/eri$s0,i$isme% a6a 60a )9i,,iams% 2''*+
a. :i/eri$s0,i$isme $eo$ata, tra$sie$
:i/eri$s0,i$isme seri$g 6i6a/at-a$ /a6a $eo$at0s. :a, i$i m0$g-i$
mer0/a-a$gam#ara$ 6ari imat0ritas reg0,asi se-resi i$s0,i$. Kea6aa$ i$i 6a/at
17
ter5a6i /a6a #ayisa-it% teta/i ,e#i 5e,as /a6a #ayi ya$g asBi-sia 8a-t0 ,air 6a$
#ayi.#ayi -e;i, 0$t0- masa -eami,a$ -are$a ;a6a$ga$ g,i-oge$$ya ,e#i
ter#atas. 9a,a0/0$ i/eri$s0,i$ i$ia$ya #er,a$gs0$g seme$tara% $am0$
/e$a$ga$a$ ya$g ;e/at 6a$ te/at ar0s segera6i#eri-a$ agar ti6a- me$im#0,-a$
;a;at ota- ya$g me$eta/. 7asa,a i$i seri$g ter5a6isei$gga /ema$ta0a$ -a6ar
g,0-osa 6ara /a6a 5am.5am /ertama ar0s se,a,0 6i,a-0-a$0$t0- sem0a #ayi
6e$ga$ resi-o.4em#eria$ mi$0m ar0s segera 6im0,ai% #i,a /er,0 6e$ga$ g,0-osa
i$traCe$a.4a6a saat /em0,ia$% /em#eria$ g,0-osa i$traCe$a 6i-0ra$gi se;ara
#ertaa/. 9a,a0/0$ 5ara$g% /er,0 6i-eta0i i/eri$s0,i$isme /ersiste$ ya$g
memer,0-a$ /e$a$ga$a$ ya$gi$te$siB.
#. :i/eri$s0,i$isme /ersiste$
:i/eri$s0,i$isme /ersiste$ /a6a 0m0m$ya 6ise#a#-a$ o,e a6a$ya 6eBe-
6a,am/er-em#a$ga$ se, #eta ya$g me$ye#a#-a$ tim#0,$ya ga$gg0a$ B0$gsi 6a$
a#$orma,itas str0-t0r i$s0,i$.
2. DeBe- /a6a /e,e/asa$ g,0-osa )6eBe- si-,0s Kre#s% 6eBe- res/iratory ;ai$ +.
Ke,ai$a$ i$isa$gat 5ara$g% me$gga$gg0 /em#e$t0-a$ AT4 6ari o-si6asi g,0-osa%
6isi$i -a6ar ,a-tatsa$gat ti$ggi.
2. DeBe- /a6a /ro60-si e$ergi a,ter$atiCe )6eBisie$si ;ar$iti$e a;y, tra$sBerase%
6eBisie$si :71 <oA% 6eBisie$si ra$tai /a$5a$g 6a$ me6i0m a;y,.<oA
6ey6roge$ase% 6eBisie$si ra$tai /e$6e- a;y,.<oA 6eyroge$ase+. Ke,ai$a$ i$i
me$gga$gg0 /e$gg0$aa$ ,ema- se#agai e$ergi% sei$gga t0#0 sa$gat terga$t0$g
a$ya /a6a g,0-osa. I$i a-a$me$ye#a#-a$ masa,a #i,a /0asa 6a,am 5a$g-a ,ama
ya$g seri$g-a,i #er0#0$ga$6e$ga$ /e$ya-it gastroi$testi$a,.
(. Se/sis ata0 /e$ya-it 6e$ga$ i/ermeta#o,i-% termas0- i/ertiroi6isme.
18
Ke,ai$a$ ya$g me$ye#a#-a$ -0ra$g$ya /ro60-si g,0-osa )9i,,iams% 2''*+
1. Sim/a$a$ g,0-osa ti6a- a-0at )/remat0r% #ayi -e;i, masa -eami,a$%
6isam/i$g i/og,i-emia a-i#at /em#eria$ i$s0,i$ /a6a 6ia#etes. :a, i$i 6a/at
6i#e6a-a$ 6e$ga$ me,iat -ea6aa$ -,i$is 6a$ a6a$ya i/og,i-emia -etoti-%
#iasa$ya ter5a6i a-i#at /a6a a$a- ya$g -0r0s% 0sia a$tara 1& #0,a$ sam/ai 6 ta0$.
mas0-a$ ma-a$a$ ya$g terga$gg0 -are$a #erma;am se#a#. 4e$e,itia$ tera-ir
me-a$isme ya$g me$6asari i/og,i-emia -etoti- a6a,a gaga,$ya
g,0-o$eoge$esis.
2. Ke,ai$a$ /a6a /ro60-si g,0-osa e/ar a$tara ,ai$ 6eBisie$si g,0;ose.6.
/os/atase) g,y;oge$ storage 6isease ty/e I +% 6eBisie$si 6e#ra$;er ) g,y;oge$
storage 6isease ty/e III +% 6eBisie$si /os/atase e/ar ) g,y;oge$ storage 6isease
ty/e ?I% 6eBisie$si g,y;oge$sy$tase% 6eBisie$si Br0;tose 1%6 6i/os/atase%
6eBisie$si /os/o.e$o, /yr0Cate% 6eBisie$si /yr0Cate ;ar#oDy,ase% ga,a;tosemia%
i$to,era$si Br0;tose ere6iter% /e$ya-it ma/,e 0ri$e syr0/ +. Ke,ai$a$ i$i
me$0r0$-a$ /ro60-si g,0-osa me,a,0i #er#agai 6eBe- termas0- #,o-a6e /a6a
/e,e/asa$ 6a$ si$tesis g,0-osa ata0 am#ata$ /a6a g,0-o$eoge$esis. A$a- ya$g
me$6erita /e$ya-it i$i a-a$ 6a/at #era6a/tasi tera6a/ i/og,i-emia -are$a
/e$ya-it$ya #ersiBat -ro$i-.
2. Ke,ai$a$ ormo$a, ) /a$y/o/it0itarisme % 6eBisie$si ormo$ /ert0m#0a$%
6eBisie$si-ortiso, 6a/at /rimer ata0 se-0$6er. :a, i$i -are$a ormo$ /ert0m#0a$
6a$ -ortiso,#er/era$ /e$ti$g /a6a /em#e$t0-a$ e$ergi a,ter$atiCe 6a$
mera$gsa$g /ro60-si g,0-osa.Ke,ai$a$ i$i m06a 6io#ati $am0$ ya$g sa$gat
/e$ti$g a6a,a 6iag$osis 6i$i.
19
(. To-si$ 6a$ /e$ya-it ,ai$ )eta$o,% sa,isi,at% /ro/a$o,o,% ma,aria+. Eta$o,
me$gam#atg,0-o$eoge$esis me,a,0i e/ar sei$gga 6a/at me$ye#a#-a$
i/og,i-emia. :a, i$i-0s0s$ya /a6a /asie$ 6e$ga$ 6ia#etes ya$g 6io#ati i$s0,i$
ya$g ti6a- 6a/at me$g0ra$gise-resi i$s0,i$ se#agai res/o$ #i,a ter5a6i
i/og,i-emia. I$to-si-asi sa,isi,at 6a/atme$ye#a#-a$ i/og,i-emia ata0/0$
i/erg,i-emia. :i/og,i-emia -are$a #ertam#a$yase-resi i$s0,i$ 6a$ am#ata$
/a6a g,0-o$eoge$esis.
Pato#enesis
:i/og,i-emi seri$g ter5a6i /a6a BB!R% -are$a ;a6a$ga$ g,0-osa
re$6a. 4a6a i#0 D7 ter5a6i tra$sBer g,0-osa ya$g #er,e#ia$ /a6a 5a$i$ sei$gga
res/o$ i$s0,i$ 50ga me$i$g-at /a6a 5a$i$. Saat ,air 6i ma$a 5a,0r /,ase$ta
ter/0t0s ma-a tra$sBer g,0-osa #ere$ti se6a$g-a$ res/o$ i$s0,i$ masi ti$ggi
)tra$sie$t i/eri$s0,i$ism+ sei$gga ter5a6i i/og,i-emi. :i/og,i-emi a6a,a
masa,a seri0s /a6a #ayi #ar0 ,air% -are$a 6a/at me$im#0,-a$ -e5a$g ya$g
#era-i#at ter5a6i$ya i/o-si ota-. Bi,a ti6a- 6i-e,o,a 6e$ga$ #ai- a-a$
me$im#0,-a$ -er0sa-a$ /a6a s0s0$a$ saraB /0sat #a-a$ sam/ai -ematia$.
)9or,6 :ea,t Orga$iFatio$% 1337+. Ke5a6ia$ i/og,i-emi ,e#i seri$g 6i6a/at
/a6a #ayi 6ari i#0 6e$ga$ 6ia#etes me,it0s. 1,0-osa mer0/a-a$ s0m#er -a,ori
ya$g /e$ti$g 0$t0- -etaa$a$ i60/ se,ama /roses /ersa,i$a$ 6a$ ari.ari
/ertama /as;a ,air. Setia/ stress ya$g ter5a6i me$g0ra$gi ;a6a$ga$ g,0-osa ya$g
a6a -are$a me$i$g-at-a$ /e$gg0$aa$ ;a6a$ga$ g,0-osa% misa,$ya /a6a asBi-sia%
i/otermi% i/ertermi% ga$gg0a$ /er$a/asa$. )DaCies% 2''&+
Tanda dan 0e;ala
20
Ta$6a 6a$ 1e5a,a :i/og,i-emi: Jitteriness% Sia$osis% Ke5a$g ata0 tremor. !etargi
6a$ me$y0s0i ya$g #0r0-. A/$ea. Ta$gisa$ ya$g ,ema ata0 #er$a6a ti$ggi.
:i/otermia. RDS. )9or,6 :ea,t Orga$iFatio$% 1337+
Dia#nosis
A$am$esis
Ri8ayat #ayi me$6erita asBi-sia% i/otermi% ga$gg0a$ /er$aBasa$
Ri8ayat #ayi /remat0r
Ri8ayat #esar 0$t0- masa -eami,a$ )B7K+
Ri8ayat #ayi -e;i, 0$t0- masa -eami,a$ )K7K+
Ri8ayat #ayi 6e$ga$ i#0 Dia#etes 7e,,it0s
Ri8ayat #ayi 6e$ga$ /e$ya-it 5a$t0$g #a8aa$
Bayi ya$g #eresi-o ter-e$a i/og,i-emia
Bayi 6ari i#0 6ia#etes me,,it0s )ID7+
Bayi ya$g #esar 0$t0- masa -eami,a$% !arge Bor 1estatio$a, Age )!1A+
Bayi ya$g -e;i, 0$t0- masa -eami,a$% Sma,, Bor 1estatio$a, Age )S1A+
Bayi /remat0r 6a$ ,e8at #0,a$
Bayi sa-it ata0 stress )Res/iratory Distress Sy$6rome)RDS+% i/otermia+
Bayi /0asa
Bayi 6e$ga$ /o,isitemia
Bayi 6e$ga$ eritro#,astosis
21
O#at.o#at ya$g 6i-o$s0msi i#0% misa,$ya steroi6% #eta I sim/atomimeti-
6a$ #eta #,o;-er
Dia#nosis "andin#
I$s0Bisie$si a6re$a,% -e,ai$a$ 5a$t0$g% gaga, gi$5a,% /e$ya-it SS4% se/sis%
asBi-sia% a#$orma,itas meta#o,i- )i/o-a,semia% i/o$atremia% i/er$atremia%
i/omag$esemia% 6eBisie$si /iri6o-si$+. 4e$y0,it :i/o-sia ota-. Ker0sa-a$ sistem
saraB /0sat. )9or,6 :ea,t Orga$iFatio$% 1337+
Penatala3sanaan
a. Monitor Pada bayi yang beresiko (BBLR, BMK, bayi dengan ibu DM)
perlu dimonitor dalam 3 hari pertama :
Periksa kadar glukosa saat bayi datang / umur 3 jam Ulangi tiap
6 jam selama 24 jam atau sampai pemeriksaan glukosa normal
dalam 2 kali pemeriksaan
Kadar glukosa 45 mg/dl atau gejala positif tangani hipoglikemia
Pemeriksaan kadar glukosa baik, pulangkan setelah 3 hari
penganganan hipoglikemia selesai )9or,6 :ea,t Orga$iFatio$%
1337+
b. Penanganan hipoglikemia dengan gejala
Bolus glukosa 10% 2 ml/kg pelan-pelan dengan kecepatan 1
ml/menit
Pasang jalur IV D 10% sesuai kebutuhan (kebutuhan infus glukosa
6-8 mg/kg/menit) Contoh : BB 3 kg, kebutuhan glukosa 3 kg X 6
mg/kg/menit = 18 mg/menit =25920 mg/hari Bila dipakai D 10%
22
artinya 10 gr/100 cc, bila perlu 25920 mg/hari atau 25,9 gr/hari
berarti perlu 25,9 gr/10 gr X 100 cc = 259 cc D 10%/hari Atau cara
lain dengan Glucosa Infution Rate (GIR) Konsentrasi glukosa
tertinggi untuk infus perifer adalah 12,5%, bila lebih dari 12,5%
digunakan vena sentral. Untuk mencari kecepatan infus glukosa
pada neonatus dinyatakan dengan GIR Kecepatan infus (GIR) =
glucosa infus rate GIR (mg/kg/menit) = kecepatan cairan (cc/jam)
X konsentrasi Dextrose (%) 6 X berat (kg)
Contoh : berat bayi 3 kg umur 1 hari Kebutuhan 80 cc/jam/hari =
80 X 3 = 240 cc/hari = 10 cc/ jam GIR = 10 X 10 (Dextrose 10 %)
= 100 = 6 mg/kg/menit 6 X 3 18
Periksa glukosa darah pada : 1 jam setelah bolus dan tiap 3 jam
Bila kadar glukosa masih < 25 mg/dl, dengan atau tanpa gejala,
ulangi seperti di atas
Bila kadar glukosa 25-45 mg/dl, tanpa gejala klinis : -Infus D 10%
diteruskan -Periksa kadar glukosa tiap 3 jam -ASI diberikan bila
bayi dapat minum
Bila kadar glukosa 45 mg/dl dalam 2 kali pemeriksaan -Ikuti
petunjuk bila kadar glukosa sudah normal (lihat ad b) -ASI
diberikan bila bayi dapat minum dan jumlah infus diturunkan
pelan-pelan -Jangan menghentikan infus secara tiba-tiba )9or,6
:ea,t Orga$iFatio$% 1337+
c. Kadar glukosa darah < 45 mg/dl tanpa GEJALA
23
ASI teruskan
Pantau, bila ada gejala manajemen seperti diatas Periksa kadar
glukosa tiap 3 jam atau sebelum minum, bila : - Kadar < 25 mg/dl,
dengan atau tanpa gejala tangani hipoglikemi (lihat ad b). Kadar
25-45 mg/dl naikkan frekwensi minum. Kadar 45 mg/dl
manajemen sebagai kadar glukosa normal )9or,6 :ea,t
Orga$iFatio$% 1337+
DA-TAR PUSTAKA
24
UNI<E>% UK Ba#y >rie$6,y I$itiatiCe. 2'11. 10i6a$;e o$ te 6eCe,o/me$t oB
/o,i;ies a$6 g0i6e,i$es Bor te /reCe$tio$ a$6 ma$ageme$t oB
y/og,y;aemia oB te $e8#or$. K;ite6 2'12 A/ri, '2L. ACai,a#,e Brom:
tt/:==888.0$i;eB.org.0-=Ba#y>rie$6,y=Reso0r;es=10i6a$;e.Bor.:ea,t.
4roBessio$a,s=9riti$g. /o,i;ies.a$6.g0i6e,i$es=Best./ra;ti;e.sta$6ar6s.Bor.
$eo$ata,.0$its=.
:ay 99% Ra50 TN% :iggi$s RD% Ka,a$ S<% DeCas-ar SU. 2''3. K$o8,e6ge
ga/s a$6 resear; $ee6s Bor 0$6ersta$6i$g a$6 treati$g $eo$ata,
y/og,y;emia: 8or-so/ re/ort Brom E0$i;e Ke$$e6y SriCer Natio$a,
I$stit0te oB <i,6 :ea,t a$6 :0ma$ DeCe,o/me$t. Te "o0r$a, oB
4e6iatri;s. 2''3M 1**)*+:612. 7.
<or$#,at 7% :a86o$ "7% 9i,,iams A>% Ay$s,ey.1ree$ A% 9ar6.4,att 74%
S;8artF R% et a,. <o$troCersies regar6i$g 6eBi$itio$ oB $eo$ata,
y/og,y;emia: s0ggeste6 o/eratio$a, treso,6s. 4e6iatri;s. 2'''M
1'*)*+:11(1.*..
DaCies 79% <art8rigt D. :y/og,y;aemia. I$: DaCies 79% <art8rigt D% I$g,iss
1DT% e6itors. 4o;-et Notes o$ Neo$ato,ogy. 2$6 e6. 7arri;-Ci,,e:
<0r;i,, !iCi$gsto$eM 2''&.
Des/a$6e S% 4,att 79. Te i$Cestigatio$ a$6 ma$ageme$t oB $eo$ata,
y/og,y;aemia. Semi$ars i$ >eta, a$6 Neo$ata, 7e6i;i$e. 2''*M
1')(+:2*1.61.
9i,,iams A>. Neo$ata, y/og,y;aemia: ;,i$i;a, a$6 ,ega, as/e;ts. Semi$ars i$
>eta, a$6 Neo$ata, 7e6i;i$e. 2''*M 1')(+:262.&.
9or,6 :ea,t Orga$iFatio$% 1337. 9i,,iams A>. :y/og,y;aemia oB te $e8#or$:
reCie8 oB te ,iterat0re. 1e$eCa: 9or,6 :ea,t Orga$iFatio$M 1337.
25
TIN/AUAN PUSTAKA
IN-EKSI PERINATA)
De%inisi
I$Be-si /a6a $eo$at0s ya$g ter5a6i /a6a masa $eo$ata,% i$tra$ata, 6a$
/ost$ata,. I$Be-si /a6a #ayi #ar0 ,air ,e#i seri$g 6item0-a$ /a6a BB!R. I$Be-si
50ga ,e#i seri$g 6item0-a$ /a6a #ayi ya$g ,air 6i r0ma sa-it 6i#a$6i$g 6e$ga$
#ayi ya$g ,air 6i ,0ar r0ma sa-it. Bayi #ar0 ,air me$6a/at -e-e#a,a$
)im0$itas+ tra$s/,ase$ta tera6a/ -0ma$ ya$g #erasa, 6ari i#0$ya. Ses06a ,air%
#ayi ter/a/ar 6e$ga$ -0ma$ ya$g 50ga #erasa, 6ari ora$g ,ai$. Tera6a/ -0ma$
ya$g #erasa, 6ari ora$g ,ai$ i$i #ayi ti6a- memi,i-i im0$itas )Bar#ara% 2''2+.
Etiolo#i dan -a3tor Predis(osisi
Etio,ogi I$Be-si /eri$ata, 6a/at 6ise#a#-a$ o,e #er#agai #a-teri se/erti
Escherichia coli, Pseudomonas pyocyaneus, Klebsielia, Staphylococcus aureus%
6a$ Coccus gonococcus. >a-tor ya$g mem/e$gar0i ter5a6i$ya i$Be-si
/eri$ato,ogi 6a/at 6i#agi me$5a6i 2 ya-$i% Ba-tor mater$a,% Ba-tor ,i$g-0$ga$% 6a$
Ba-tor /e$5am0.
>a-tor mater$a, ter6iri 6ari r0/t0r se,a/0t -et0#a$ ya$g ,ama%
/ersa,i$a$ /remat0r% am$io$itis -,i$is% 6emam mater$a,% ma$i/0,asi #er,e#ia$
se,ama /roses /ersa,i$a$% 6a$ /ersa,i$a$ ya$g ,ama. 4e$gar0 ,i$g-0$ga$ ya$g
6a/at me$5a6i /re6is/osisi #ayi ya$g ter-e$a se/sis% teta/i ti6a- ter#atas /a6a
#0r0-$ya /ra-te- ;0;i ta$ga$ 6a$ te-$i- /era8ata$% -ateter 0m#i,i-0s arteri 6a$
Ce$a% se,a$g se$tra,% #er#agai /emasa$ga$ -ateter se,a$g tra-eae-$o,ogi i$CasiCe%
6a$ /em#eria$ s0s0 Borm0,a. >a-tor /e$5am0 me,i/0ti 5e$is -e,ami$ ,a-i.,a-i%
#ayi /remat0r% #erat #a6a$ ,air re$6a% 6a$ -er0sa-a$ me-a$isme /ertaa$a$
6ari /e$5am0.
26
4e$ya-it ya$g 6i 6erita i#0 se,ama -eami,a$ 6a/at /0,a me$5a6i Ba-tor
/re6is/osisi ter5a6i$ya i$Be-si /eri$ata,% /era8ata$ a$te$ata, ya$g ti6a- mema6aiM
I#0 me$6erita e-,amsia% 6ia#etes me,,it0s. 4erto,o$ga$ /ersa,i$a$ ya$g ti6a-
igie$e% /art0s ,ama% /art0s 6e$ga$ ti$6a-a$% -e,aira$ -0ra$g #0,a$% BB!R%
;a;at #a8aa$. A6a$ya tra0ma ,air% asBi-sia $eo$at0s% ti$6a-a$ i$CasiB /a6a
$eo$at0s. Ti6a- me$era/-a$ ra8at ga#0$g. Sara$a /era8ata$ ya$g ti6a- #ai-%
#a$gsa, ya$g /e$0 sesa-. Ket0#a$ /e;a 6i$i% am$io$ -e$ta, 6a$ #er#a0M
4em#eria$ mi$0m me,a,0i #oto,% 6a$ /em#eria$ mi$0m #0ata$ )Bar#ara% 2''2+.
Pato%isiolo#i
7i-roorga$isme ata0 -0ma$ /e$ye#a# i$Be-si 6a/at me$;a/ai $eo$at0s
me,a,0i #e#era/a ;ara ya-$i /a6a saat /a6a saat a$te$ata,% i$tra$ata,% 6a$
/ost$ata,.
4a6a masa a$te$ata, -0ma$ 6ari i#0 sete,a me,e8ati /,ase$ta 6a$
0m#i,i-0s mas0- -e 6a,am t0#0 #ayi me,a,0i sir-0,asi 6ara 5a$i$. 4e$ye#a#
i$Be-si a6a,a Cir0s ya$g 6a/at me$em#0s /,ase$ta a$tara ,ai$: Cir0s r0#e,,a%
er/es% sitomega,o% -o-sa-i% i$B,0e$Fa% /arotitis. Ba-teri ya$g me,a,0i 5a,0r i$i
a$tara ,ai$: ma,aria% si/i,is% 6a$ to-so/,asma. Ri8ayat -eami,a$ ya$g
me$i$g-at-a$ resi-o #ayi teri$Be-si% 6ia$tara$ya a6a,a i$Be-si /a6a i#0 se,ama
-eami,a$ se/erti TOR<:% e-s,am/sia% 6ia#etes me,it0s% /e$ya-it #a8aa$ /a6a
i#0.
4a6a masa i$tra$ata, ata0 saat /ersa,i$a$ I$Be-si saat /ersa,i$a$ ter5a6i
-are$a -0ma$ ya$g a6a /a6a Cagi$a 6a$ serCi-s $ai- me$;a/ai -orio$ 6a$
am$io$. A-i#at$ya ter5a6i am$io$itis 6a$ -orio$itis% se,a$50t$ya -0ma$ me,a,0i
0m#i,i-0s mas0- -et0#0 #ayi. I$Be-si i$i seri$g ter5a6i -eti-a mi-roorga$isme
27
mas0- 6ari Cagi$a% ,a,0 $ai- 6a$ -em06ia$ mas0- -e 6a,am ro$gga am$io$%
#iasa$ya sete,a se,a/0t -et0#a$ /e;a. Ket0#a$ ya$g /e;a ,e#i 6ari 12 5am
a-a$ me$5a6i /e$ye#a# tim#0,$ya /,ase$titis 6a$ am$io$itis. I$Be-si 6a/at ter5a6i
/0,a 8a,a0/0$ air -et0#a$ #e,0m /e;a% yait0 /a6a /art0s ,ama ya$g seri$g
6i,a-0-a$ ma$i/0,asi Cagi$a% termas0- /eri-sa 6a,am 6a$ -romi,age )me,e#ar-a$
5a,a$ ,air 6e$ga$ 5ari /e$o,o$g+. I$Be-si 6a/at /0,a ter5a6i me,a,0i -o$ta-
,a$gs0$g 6e$ga$ -0ma$ ya$g #erasa, 6ari Cagi$a% misa,$ya /a6a B,e$$oroe.
<ara ,ai$ yait0 /a6a saat /ersa,i$a$% -em06ia$ me$ye#a#-a$ i$Be-si /a6a 5a$i$
6a/at ter5a6i me,a,0i -0,it #ayi ata0 port de entre% saat #ayi me,e8ati 5a,a$ ,air
ya$g ter-o$tami$asi o,e -0ma$ )misa,$ya: er/es ge$eta,ia% ;a$6i6a a,#i;a$s%
go$orrea+.
I$Be-si /as;a$ata, ata0 ses06a me,air-a$ I$Be-si ya$g ter5a6i ses06a
-e,aira$ 0m0m$ya ter5a6i ses06a -e,aira$% ter5a6i a-i#at i$Be-si $aso-omia,
6ari ,i$g-0$ga$ 6i ,0ar raim )misa,$ya me,a,0i a,at.a,at /e$gisa/ ,e$6ir% se,a$g
e$6otra-ea% i$B0s% se,a$g $asogastri-% #oto, mi$0ma$ ata0 6ot+. 4era8at ata0
/roBesi ,ai$ ya$g i-0t me$a$ga$i #ayi% 6a/at me$ye#a#-a$ ter5a6i$ya i$Be-si
$aso-omia,. I$Be-si 50ga 6a/at me,a,0i ,0-a 0m#i,i-0s )Bar#ara% 2''2+.
Dia#nosis
Diag$osis i$Be-si ti6a- m06a -are$a ta$6a -as se/erti ya$g ter6a/at
/a6a #ayi ,e#i t0a seri$g -a,i ti6a- 6item0-a$% 6iag$osis 6a/at 6i#0at 6e$ga$
/e$gamata$ ya$g ;ermat. Diag$osis 6i$i 6a/at 6i#0at a/a#i,a ter6a/at -e,ai$a$
ti$g-a ,a-0 #ayi 6a/at mer0/a-a$ ta$6a.ta$6a /erm0,aa$ i$Be-si 0m0m.
Ta$6a 6a$ 1e5a,a 1e5a,a i$Be-si ya$g 0m0m$ya ter5a6i /a6a #ayi ya$g
me$ga,ami i$Be-si /eri$ata, a6a,a se#agai #eri-0t: #ayi ma,as mi$0m% ge,isa.
28
,etargi% Bre-0e$si /er$a/asa$ me$i$g-at% #erat #a6a$ t0r0$% /ergera-a$ -0ra$g%
m0$ta% 6iare% s-,erema 6a$ oe6ema% /er6araa$% i-ter0s 6a$ -e5a$g% s00 t0#0
6a/at $orma,% i/otermia% ata0 i/ertermi ):aria$to% 2''&+.
Klasi%i3asi
"e$is I$Be-si -are$a #a-teri /a6a #ayi #ar0 ,air 6a/at 6i-,asiBi-asi-a$
me$5a6i tiga yait0 se#agai #eri-0t :
1. I$Be-si #a-teri sistemi-
Bayi tam/a- me$ga$t0-=,etargi ata0 ti6a- sa6ar% -e5a$g 6isertai sat0
ta$6a i$Be-si% ga$gg0a$ $aBas% ma,as mi$0m ata0 ti6a- #isa mi$0m
6e$ga$ ata0 ta$/a m0$ta% #agia$ t0#0 mera 6a$ me$geras%0#0$.
0#0$ ;em#0$g% s00 #isa /a$as ata0 6i$gi$.
2. I$Be-si #a-teri ,o-a, #erat
4a6a #ayi 6item0-a$ $a$a 6i6aera mata% te,i$ga% ta,i /0sat ata0
0m#i,i-0s -emeraa$ 6a$ me,0as sam/ai -e-0,it /er0t%#er$a$a
serta a6a -er0sa-a$ -0,it.
2. I$Be-si #a-teri ,o-a,
4a6a #ayi ter6a/at $a$a -e,0ar 6ari mata 6a,am 50m,a se6i-it%
6aera ta,i /0sat 6a$ 0m#i,i-0s -emeraa$% #er#a0 #0s0- 6a$
ter5a6i se6i-it -er0sa-a$ -0,it )SaiB06i$% 2''&+.
Penatala3sanaan
4e$a$ga$a$ se;ara 0m0m #ayi ya$g me$ga,ami i$Be-si% 6ia$tara$ya
a6a,a :
1. 7em/ertaa$-a$ t0#0 #ayi teta/ a$gat
29
2. ASI teta/ 6i#eri-a$ ata0 6i#eri air g0,a
2. I$5e-si a$ti#ioti- #ers/e-tr0m ,0as ses0ai 6osis 6a$ terara
(. 4era8ata$ s0m#er i$Be-si.
4em#eria$ a$ti#ioti- ya$g #er,e#ia$ 6a$ ti6a- terara 6a/at
me$ye#a#-a$ t0m#0$ya mi-roorga$isme ya$g taa$ tera6a/ a$ti#ioti- serta
t0m#0$ya 5am0r ya$g #er,e#ia$ se/erti Candida albicans )SaiB06i$% 2''&+.
4em#eria$ a$ti#ioti- e$6a-$ya 6ises0ai-a$ 6e$ga$ /o,a -0ma$ ya$g
a6a /a6a masi$g.masi$g 0$it /era8ata$ $eo$at0s. Ti6a- a6a$ya /o,a -0ma$ ya$g
-as ya$g 6a/at 6ig0$a-a$ se#agai /e6oma$ tera/i seme$tara me$0$gg0 asi,
-0,t0r se,esai ya$g mema-a$ 8a-t0 tiga sam/ai ,ima ari mer0/a-a$ sa,a sat0
/e$ye#a# resiste$si ):a6i$egoro% 2''2+. O,e -are$a it0 05i mi-ro#io,ogi 6a$ 05i
resiste$si ar0s 6i,a-0-a$ se;ara r0ti$ 0$t0- mem06a-a$ /ara 6o-ter 6a,am a,
memi,i a$ti#ioti-.
4emi,ia$ a$ti#ioti- i$isia, /a6a $eo$at0s ya$g 6i;0rigai #a-teremia
6i6asar-a$ /a6a -o$6isi -,i$i-. "i-a ti6a- 6i#eri-a$% $eo$at0s ya$g me$ga,ami
#a-teremia #erisi-o #er-em#a$g me$5a6i -om/,i-asi se/erti me$i$gitis ata0
/$e0mo$ia sei$gga ar0s 6i#eri-a$ se;ara te/at 6a$ rasio$a,. Begit0 asi, -0,t0r
6ara a6a% tera/i ar0s 6ises0ai-a$ 6e$ga$ asi, 05i se$sitiBitas. Bi,a asi, -0,t0r
ti6a- me$0$50--a$ /ert0m#0a$ #a-teri 6a,am 60a sam/ai tiga ari 6a$ #ayi
se;ara -,i$is #ai-% ma-a a$ti#ioti- ar0s 6ie$ti-a$. Da,am a, i$i 6o-ter /er,0
me$g0asai #e$ar me$ge$ai ta$6a.ta$6a -,i$is /asie$ 0$t0- me$e$t0-a$ /asie$
ma$a ya$g #0t0 a$ti#ioti- segera 6a$ ya$g ti6a- 0$t0- me$gi$6ari /e$gg0$aa$
a$ti#ioti- ya$g #er,e#ia$ )Amir% 2''*+.
30
DA-TAR PUSTAKA
Amir I% R0$65a$ !. 4em#eria$ a$ti#ioti- se;ara rasio$a, /a6a se/sis $eo$ator0m.
Di 6a,am : U/6ate i$$eo$ata, i$Be;tio$. Ba,ai 4e$er#it >KUIM 2''* : 1.1'
31
Bar#ara "S% 2''2% Infection of the neonatal infant% Ne,so$ TeDt#oo- oB 4e6iatri;s
17t e6itio$ )7ay 2''2+.
:a6i$egoro SR. 4ema-aia$ a$ti#ioti- 6i #i6a$g /e6iatri. Di 6a,am : Soe6armo S4%
1ar$a :% :a6i$egoro SR%e6itor. B0-0 a5ar i,m0 -eseata$ a$a- i$Be-si
6a$ /e$ya-it tro/is% e6sisi /ertama. "a-arta : Ba,ai 4e$er#it>KUIM 2''2 :
72.&(
:aria$to A. 2''&. Se/sis Neo$ator0m. Pedoman Diagnosis dan Terapi B!"S#$
Ilmu Kesehatan na% Edisi &% S0ra#aya: RSU 6r Soetomo.
SaiB06i$% 6--. 2''&. B0-0 4a$60a$ 4ra-tis 4e,aya$a$ Keseata$ 7ater$a, 6a$
Neo$ata,
32