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ASFIKSIA & HIE

Kelompok Kerja Perinatologi
RSAB Harapan Kita
Jakarta

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newly born
newborn
infant

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KEMATIAN BAYI
( < 1 tahun )
8 juta

KEMATIAN NEONATUS
( 28 hari )
5 juta

KEMATIAN NEONATUS DINI

( 7 hari )
3,4 juta

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KEMATIAN NEONATUS DI INDONESIA

ANGKA KEMATIAN BAYI ( IMR )

45,7 / 1000 lahir hidup

47 %
neonatus

50 %
Neonatus dini

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PENYEBAB KEMATIAN NEONATUS

Kongenital
10%

Lain-lain
5%
Infeksi
32%

Prematur
24%

Asfiksia + trauma
lahir
29%

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BAYI BARU LAHIR

masa transisi
Intra uterin

ekstra uterin
respirasi
kardiovaskuler

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Definisi asfiksia
keadaan bayi baru lahir yang gagal
bernapas spontan dan teratur segera
setelah lahir
Hutchinson 1967

disertai hipoksia, hiperkapnia dan asidosis

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KESULITAN TRANSISI
Bayi tidak bernapas dengan kuatparu
tak terisi udara dan oksigen tak masuk
darah
Kehilangan darah dan bradikardia karena
hipoksia menyebabkan hipotensi sistemik
Konstriksi arteriol karena hipoksia akan
menyebabkan hipertensi pulmonal
persisten

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POLA KLINIS ASFIKSIA

APNOE PRIMER: setelah pernapasan
awal yg cepat,disertai penurunan
frekuensi jantung, tekanan darah normal
dan perangsangan dapat memulai
pernapasan

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POLA KLINIS ASFIKSIA

APNOE SEKUNDER:setelah napas
megap2, disertai penurunan frekuensi
jantung dan tekanan darah; rangsangan
saja tak cukup untuk memulai pernapasan
Dawes 1968

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TANDA KLINIS BAHAYA

SIANOSIS : karena kekurangan oksigen
darah
BRADIKARDIA: karena kekurangan
oksigen di otot jantung dan otak
Tekanan darah yang rendah karena
kekurangan oksigen dan kehilangan darah

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Perubahan penting
pada asfiksia

Hipoksia
Hiperkapnia
Asidosis respiratorik dan metabolik
Glikogenolisis untuk metabolisme anaerob
Perubahan sistem kardiovaskular

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BAYI LAHIR DENGAN ASFIKSIA

menunjukkan satu / > tanda klinis :

Sianosis
Bradikardi
Hipotensi
Depresi pernapasan
Hipotoni

Apnoe primer dan apnoe sekunder

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tatalaksana
RESUSITASI
Adekuat
Jangan tunda

PENCEGAHAN
antisipasi
oksigen antenatal pada ibu
persalinan emergensi
konseling

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prognosis
Tergantung lamanya bayi tidak bernafas
Organ yg dipengaruhi
Otak
Hati
Ginjal
Paru
Usus

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HYPOXIC-ISCHAEMIC
ENCEPHALOPATHY

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sinonim

HIE
Newborn encephalopathy
Neonatal encephalopathy
NE
HIE-NE
Birth asphyxiation
Hypoxic-ischaemic brain injury
BILIRUBIN ENCEPHALOPATHY mirip NE

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NCB
cortex cerebri
nuclei cerebri

NKB
substantia alba
IVH

Terjadi fetal,antental,intranatal

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National Colaborative Perinatal

Project

Aktifitas yg kurang setelah hari pertama

Perlu inkubator lebih dari 3 hari
Problem minum
Refleks isap buruk
Gangguan pernapasan

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patologi
perfusi dan oksigenisasi otak dibawah
batas kritis
hipoksemia dan hiperkarbia
gangguan miokard
iskemia neuron

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patofisiologi
Hiposemia perinatal primer
Iskemi perinatal
diperburuk oleh hipoglikemia & hipertermia

Gangguan autoregulasi sirkulasi otak

Excitotoxicity
glutamat

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riwayat

problem persalinan dan melahirkan

kesulitan resusitasi
gangguan kesadaran
gangguan ventilasi
kejang

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NKB (terutama KMK)

PVL
hipotensi ibu
kehamilan kembar
aritmia ibu/janin
gangguan kardiorespirasi; TD< 30
asidosis
gagal jantung

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klasifikasi
SARNAT n SARNAT
Stage1: kurang tidur, simpatis yg aktif, reaksi
berlebih thd stimuli, refleks isap kurang walau
tonus otot baik, kelainan EEG (1 hari)
Stage 2: hipotonia,letargi, kejang,
parasimpatis aktif, FJ < 120,peristaltik naik,
kelainan EEG (2-14 hari)
Stage 3: stupor, posisi deserebrasi, hipotonia,
refleks menghilang, refleks primitif jelas

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klasifikasi..
MILLER
Dgn sistem skor. Makin besar makin buruk
Yg dinilai: minum, kesadaran, tonus, status
pernafasan, refleks dan kejang
Skor pada hari 3 dipakai sebagai faktor
prognostik

Lipper postasphyxiation index: usia 48 jam

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tatalaksana

mencegah asfiksia, hipoperfusi

tatalaksana cairan: hindari overload
bantuan respirasi
atasi kejang
atasi hipokalsemia dan hipoglikemia