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TUGAS KEGAWATDARURATAN

MATERNAL DAN NEONATAL

KELAS C1 :
Zakiah Kurniasari – 173112540120475
Rochmawati – 173112540120456
Fitri Apriyanti – 173112540120202
Linda Kada – 173112540120221
Intan Mauludd – 173112540120382
Hidayati – 173112540120170
Monalisa – 173112540120270

FAKULTAS ILMU KESEHATAN – DIV KEBIDANAN


UNIVERSITAS NASIONAL
2018
Format Resume Jurnal I

Judul Jurnal :
Neonatal hipertermia dan stres termal di negara-negara
berpenghasilan rendah dan menengah: penyebab
tersembunyi kematian pada neonatus dengan berat
badan sangat rendah.
Amadi HO, Olateju EK, Alabi P, Kawuwa MB, Ibadin
MO, Osibogun AO.
(2015 Aug;35(3):273-81.Epub 2015 May 2.)

Latar Belakang : Lebih dari 70% kematian neonatal di Nigeria terjadi


dalam 7 hari pertama kehidupan dan, meskipun tujuan
pembangunan milenium, tidak ada pengurangan yang
signifikan dari angka ini.

Tujuan : Untuk menyelidiki bagaimana perubahan suhu yang


cepat di luar rentang yang diijinkan secara fisiologis
pada bayi berat badan lahir sangat rendah dikaitkan
dengan peningkatan mortalitas.

Metodologi : Sembilan puluh delapan kasus neonatal di tiga rumah


sakit perawatan tersier Nigeria direkrut secara
retrospektif; atas dasar berat lahir <1500 g, jumlah ini
dikurangi menjadi 41 untuk analisis dua tahap. Pada
tahap pertama, 34 kasus yang direkrut selama 24 bulan
dianalisis. Pada tahap kedua, tujuh kasus yang direkrut
selama 6 bulan dianalisis; ini adalah neonatus yang
dikelola dengan teknik kontrol suhu baru ('pendekatan
praktis') untuk memungkinkan perbandingan hasil.
Mean (SD) berat lahir bayi yang dianalisis adalah 991
g (251), dan 28 di antaranya adalah berat lahir sangat
rendah [mean (SD) 846 g (128)]. Sebuah plot suhu
seumur hidup dengan zona referensi yang terlihat jelas
dikembangkan, dari mana semua tekanan termal dan
durasi mereka terkait dengan kematian diidentifikasi
dan ditentukan berdasarkan karakteristik mereka.
Metode mengukur besarnya dan durasi tekanan termal
ini dirancang untuk memungkinkan definisi nilai-nilai
kritis. Ini kemudian diterapkan untuk menghitung
ukuran berbagai tekanan termal yang mungkin telah
berkontribusi terhadap kematian neonatal.

Hasil : Peristiwa hipotermik sangat umum pada semua bayi


dalam periode penelitian, tetapi tidak terkait secara
bermakna dengan mortalitas. Namun, kejadian
hipertermik terjadi pada 35% bayi dan lebih mungkin
dikaitkan dengan kematian. Kebanyakan neonatus
dengan hipotermia berkepanjangan memuncak pada
hipertermia cepat yang bertahan. Namun, semua
neonatus berat lahir sangat rendah yang mengalami
hipertermia berkepanjangan yang berpuncak pada
hipotermia cepat meninggal dalam 8 jam setelah
kejadian. Ada kelangsungan hidup berat lahir sangat
rendah yang lebih besar (6/6) pada tahap kedua
menggunakan 'pendekatan praktis' daripada di tahap
pertama (2/22).

Kesimpulan : Hipertermia adalah kejadian berisiko tinggi pada bayi


berat lahir sangat rendah dan metode pendinginan suhu
tinggi dan berkepanjangan harus ditinjau.
Kelebihan : 1. Kejadian hipertermi rentan terjadi pada berat
bayi lahir sangat rendah, berat bayi lahir
normal tidak terlalu berisiko.
Kekurangan : 1. Berat bayi sangat rendah berisiko terjadi
hipertermi.
2. Angka kejadian mortalitas tinggi pada berat
bayi lahir sangat rendah yang mengalami
hipertermi.
FORMAT RESUME JURNAL II

Judul Jurnal : Fetal and neonatal hyperthermia

Latar Belakang : Modest therapeutic hypothermia (TH) (core temperature of


33e34

C) in neonates with moderate to severe
hypoxiceischaemic en- cephalopathy (HIE) is now
regarded as a standard of care. It im- proves outcomes,
reducing the risk of death and neurodisability. However,
when newborns with hypoxiceischaemic encephalop- athy
were stratified by the severity of the initial amplitude inte-
grated EEG (aEEG), the neuroprotective effect was
statistically
significant only in the group of infants with moderately
abnormal initial aEEG. This suggests that the therapeutic
effect is partly limited by the extent and severity of the
initial brain injury. Even in the select group of neonates
with moderate HIE, where TH has proven benefits, the
effect is best described as modest. The short
therapeutic window (3e6 hours) to achieve target temperature
for optimum neuroprotection and the decremental
neuroprotective effect of TH over time poses significant
logistic challenge in managing infants born outside the
cooling centre.
Tujuan : This article explores the concerns related to adverse
neurological out- comes associated with fetal and neonatal
hyperthermia

Metodologi :
Hasil : This article explores the concerns related to adverse
neurological out- comes associated with fetal and neonatal
hyperthermia. Maternal temper- ature is the most important
determinant of fetal temperature; here we draw attention to
the changing epidemiology of intrapartum maternal py-
rexia and consequent fetal hyperthermia, particularly its
association with labour epidural analgesia. The
implications of potential adverse neonatal outcomes
demand a greater understanding of the pathophysiology of
intrapartum maternal fever and exploration of monitoring,
preventative and therapeutic options encompassing the
modern obstetric, anaesthetic and neonatal practice.

Kesimpulan :
There is a need for heightened awareness among perinatal
cli- nicians about the potential harmful effects of
intrapartum maternal pyrexia on the fetus and the newborn
infant, including its association with epidural use. Epidural
analgesia is now so integral to pain relief in labour that it
will be unkind and impractical to suggest universal
limitation of its use. However, patients should be informed
of this adverse effect and its im- plications so that they are
able make an informed choice of the different available
modes of analgesia in labour. A greater vig- ilance of
maternal temperature in labour must be adopted and
traditionally available means of reducing temperature
instituted promptly until a more specific preventative or
therapeutic strategy is available. This may include a
prompt measurement of neonatal temperature at birth and
adoption of intentional passive cooling for the
hyperthermic newborns. Ongoing research in this area is
vital to resolve many of the unanswered
questions.

Kelebihan : - Jurnal tersebut banyak membahas


pengetahuan/pengalaman peneliti
- Di jelaskan secara detail penelitian tersebut

Kekurangan : - Bahasa yang digunakan sulit dimengerti


- Tidak dibahas detail metode apa yang digunakan pada
saat penelitian
Format Resume Jurnal III

Judul Jurnal : Hyperthermia, Inflammation, and Perinatal Brain Injury

Latar Belakang : There are numerous studies that have assessed the
effect of hyperthermia on cerebral damage during a
period of ischemia, with or without hypoxia. It has
been repeatedly demonstrated that hyperthermia
exacerbates ischemic and/ or hypoxic-ischemic damage
and that avoidance of hyper- thermia in a patient at risk
for neurologic injury is imper- ative. Potential
mechanisms of injury include an increase in metabolic
demand, alterations in cerebral blood flow, and/ or an
increase in enzymes such as caspase-3, which is
important in the pathway leading to apoptosis [8,9,18].
Additionally, alteration of the blood-brain barrier may
occur with hypoxia and/or ischemia. A study of rats
exposed to 1, 2, and 7 days of hypobaric hypoxia
demonstrated a signifi- cant increase in sodium
fluorescein leak, which was used as a proxy for altered
blood-brain barrier permeability, into brain
parenchyma. There was also an associated reduction in
the expression of endothelial barrier antigen, a blood-
brain barriereassociated protein. When hypoxia was

combined with hyperthermia, there was an even further


decrease in the expression of this protein [11]. In another
study of rats subjected to focal embolic stroke, there was
a loss of neuroprotection with tissue plasminogen activator
seen in those rats exposed to hyperthermia. It has been
speculated that hyperthermia may greatly diminish the
effects of tissue plasminogen activator by increasing blood-
brain barrier permeability, leading to subsequent cerebral
edema [12]. Though the previously mentioned study clearly
exposes the rat to longer periods (i.e., 1, 2, and 7 days) of
hypoxia-ischemia than is commonly encountered in the
neonatal population, there is strong evidence to suggest an
increased risk for adverse outcome with hyperthermia
following intrapartum hypoxia-ischemia. Another potential
mechanism of injury may occur via hyperthermia induced
edema in the ischemic brain, resulting in downstream
microvasculature compression thereby preventing restora-
tion of blood flow [12].
Other studies have sought to determine whether pre-
venting hyperthermia could potentially decrease cerebral
damage associated with seizures during the course of
neonatal hypoxia-ischemia. Thus, in one study, rat pups
were subjected to unilateral carotid artery ligation and
hypoxia-ischemia followed by 30 minutes of recovery, and
finally kainic acideinduced seizures following recovery
[19]. Importantly, in a previous study by the same investi-
gators, it was found that the core temperature in rats
undergoing kainic-acid induced seizures was elevated to
a mean of 1.47○C above controls throughout the duration of
seizures [20]. It was found that maintaining the rats at a
normothermic temperature and avoiding hyperthermia
immediately following hypoxia-ischemia or before seizure
onset significantly decreased the degree of brain damage and
necrosis. It is important to also note that the mainte- nance of
normothermia was time-sensitive; that is, there was a greater
reduction in extent of brain damage if hyperthermia was
avoided immediately following hypoxia- ischemia as opposed
to at the time of seizure onset

Tujuan : . Moreover, an elevation in temperature during labor has


been associated with a variety of other adverse neurologic
sequelae such as neonatal seizures, encephalopathy, stroke,
and cerebral palsy. These outcomes may be secondary to a
number of deleterious effects of hyperthermia including an
increase in cellular metabolic rate and cerebral blood flow
alteration, release of excitotoxic products such as free
radicals and glutamate, and hemostatic changes. There is
also an association between cho- rioamnionitis at the time
of delivery and cerebral palsy, which is thought to be
secondary to cytokine-mediated injury.

Metodologi : Review Experimental

Hasil : A similar result was also found in an observational


secondary study of whole-body cooling. Thus, control
infants in the highest quartile for mean esophageal
temperature over the 72-hour study period were noted to
have a fourfold increase
in risk for death or disability at 18 to 22 months of age
(OR 4 per 1○C increase in temperature), albeit with a
wide confi- dence interval (95% CI: 1.5-11.2) [53].
These studies empha- size that we must not only
efficiently identify those infants who are candidates for
therapeutic hypothermia, but that we
must also avoid hyperthermia in this population.
Addition- ally, one may consider not actively warming an
infant who is being transferred to a tertiary care center for
therapeutic hypothermia, although studies are needed on
this.
Kesimpulan : In summary, the association between perinatal inflam-
mation and the risk for neurologic injury, most
specifically cerebral palsy, has been well-studied. This is
thought to be modulated mainly through cytokine, free
radical, and excitatory amino acid release as well as
through an overall systemic inflammatory response.
There is increasing evidence that intrapartum maternal
fever may predispose an infant toward neurologic
morbidities such as neonatal encephalopathy or seizures.
This may be secondary to the previously discussed
release of detrimental modulators of inflammation and/or
alterations in cerebral blood flow as well as blood-brain
barrier permeability. Hyperthermia in the setting of
hypoxia-ischemia or ischemic stroke has also been
associated with adverse neurodevelopmental outcome.
Again, this likely is related to one event com- pounding
the other as both may lead to release of cytokines, free
radicals, excitatory amino acids and overall energy
depletion (Fig 1).
It is clear that the effect of hyperthermia in the setting of
neonatal and pediatric stroke needs to be studied further. In
addition, the effect of aggressively addressing maternal
intrapartum fever (i.e., administering antipyretics/anti-
inflammatory agents to these mothers) has never been studied
and could be of potential benefit. Large prospective studies
would be needed to study this effect. Additionally, in the
future, studies may be warranted assessing placental
pathology for inflammation immediately following delivery
to more closely monitor infants born in an inflammatory
environment as they may be at risk for neurologic injury

Kelebihan : - Jurnal tersebut memuat banyak pihak peneliti


mempublikasikan hasil penelitiannya sehingga banyak
pengetahuan
- Di jelaskan secara Detail hasil penelitian tersebut
Kekurangan : - Bahasa yang digunakan sulit dipahami