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PNEUMONIA ASPIRASI

PADA NEONATUS

Definisi
Teraspirasinya cairan amnion yang mengandung verniks

kaseosa, sel epitel, mekonium, atau benda-benda dari


saluran lahir, serta bakteri patogen yg dpt memblokade
jalan napas dan mengganggu pertukaran oksigen dan
karbondioksida

Etiologi
Intubated infants
Gastroesophageal reflux
Anestesi
Swallowing dysfunction

Agen infeksi
Virus : Herpes simplex, cytomegalovirus, rubella
Bakteri : T. palidum, Listeria monocytogenes,
streptococcus Grup B, E. coli, B. fragilis, Prevotella,
Porphyromonas, Bacteriodes spp.
Jamur : Candida

Epidemiologi
Angka mortalitas sangat tinggi di negara maju, yaitu 20-

50%. Angka mortalitas di Indonesia diduga lebih tinggi


Insiden pneumonia neonatal pada bayi cukup bulan
(1%), bayi kurang bulan (10%)

Klasifikasi
P23 Congenital pneumonia
Incl.: infective pneumonia acquired in utero or during birth Excl.: neonatal
pneumonia resulting from aspiration (P24.-)
P23.0 Congenital pneumonia due to viral agent Excl.: congenital rubella
pneumonitis (P35.0)
P23.1 Congenital pneumonia due to Chlamydia
P23.2 Congenital pneumonia due to staphylococcus
P23.3 Congenital pneumonia due to streptococcus, group B
P23.4 Congenital pneumonia due to Escherichia coli
P23.5 Congenital pneumonia due to Pseudomonas
P23.6 Congenital pneumonia due to other bacterial agents Haemophilus
influenzae Klebsiella pneumoniae Mycoplasma Streptococcus, except
group B
P23.8 Congenital pneumonia due to other organisms
P23.9 Congenital pneumonia, unspecified

Klasifikasi
P24 Neonatal aspiration syndromes
Incl.: neonatal pneumonia resulting from aspiration
P24.0 Neonatal aspiration of meconium
P24.1 Neonatal aspiration of amniotic fluid and mucus
Aspiration of liquor (amnii)
P24.2 Neonatal aspiration of blood
P24.3 Neonatal aspiration of milk and regurgitated food
P24.8 Other neonatal aspiration syndromes
P24.9 Neonatal aspiration syndrome, unspecified
Neonatal aspiration pneumonia NOS

Manifestasi Klinis
Gejala tidak khas berupa: serangan apnea, sianosis,

merintih, napas cuping hidung, takipnea, letargi, muntah,


tidak mau minum, takikardi atau bradikardi, retraksi
subkosta, demam. Pada bayi BBLR sering terjadi
hipotermi

Diagnosis
Cultures of tracheal aspirate, pleural fluids, needle

aspirate of the lungs, blood cultures


Bacterial infection tend to be more alveolar and viral
infections more interstisial for this reason:
- Radiating parahilar streakingness and diffuse, hazzy, or
reticulonodular lungs favor viral disease
- Coarse, patchy parenchymal infiltrates and
consolidatins (rare in neonates) favor bacterial disease
Pleural effusions are relatively common with bacterial
infections but quite rare with viral infections
Rarely, viral infections can produce calsifications later in
life

Diagnosis
Pada bayi berusia di bawah 2 bulan
Pneumonia
- Bila ada napas cepat (>60 x/menit) atau sesak napas
- Harus dirawat & diberikan antibiotik
Bukan pneumonia
- Tidak ada napas cepat atau sesak napas
- Tidak perlu dirawat, cukup diberikan pengobatan
simptomatis

Penatalaksanaan
Pengobatan kausal
Terapi antibiotik 10-14 hari dan diperpanjang sampai 21 hari (kasus
jarang)
Chlamydia trachomatis eritromisin, sulfisoxazole
Pneumonia rawat jalan:
Antibiotik oral lini pertama: amoksisilin (dosis: 25 mg/kgBB) atau
kotrimoksazol (dosis: 4 mg/kgBB)
Pneumonia rawat inap:
Antibiotik golongan beta-laktam atau kloramfenikol, getamisin,
amikasin, sefalosporin diteruskan selama 7-10 hari
Antibiotik yg direkomendasikan antibiotik intravena spektrum luas
spt kombinasi beta-laktam/klavulanat dengan aminoglikosid, atau
sefalosporin generasi ketiga. Bila keadaan sudah stabil ganti
antibiotik oral selama 10 hari

Prognosis
Angka mortalitas tinggi
Prognosis akhir bergantung pada luasnya jejas sistem

saraf pusat akibat asfiksia

REFERENSI
Nelson-Ilmu Kesehatan Anak
Respirologi Anak-IDAI
Clinical Infectious Disease-David Schlossberg
Anaerobic Infections: Diagnosis and Management-Itzhak

Brook