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LAPORAN KASUS:

INFEKSI DENGUE NEONATAL

A Case Report: Neonatal Dengue Infection

Yudi Rakhmadi, Yulia Iriani, Herman Bermawi, Julniar M.Tasli,


Afifa Ramadanti, Indrayady
Divisi Infeksi, Departemen Kesehatan Anak
Universitas Sriwijaya / RSUP Dr. Mohammad Hoesin Palembang

Abstrak
Latar Belakang: Infeksi dengue dapat terjadi pada seluruh trimester kehamilan dan dikaitkan dengan berbagai
komplikasi neonatal seperti kematian perinatal, keguguran, berat lahir rendah dan kelahiran prematur. Ini adalah
laporan kasus penularan dengue perinatal pada bayi yang dilahirkan melalui operasi caesar darurat

Kasus: Bayi perempuan dari ibu usia 21 tahun G1P0A0 hamil 33 minggu dengan anhidramnion tanpa
pecah ketuban dan demam berdarah dengue (NS1+) lahir secara SC atas indikasi anhidramnion dan
trombositopenia (trombosit 39.000u/L). Ibu riwayat demam 5 hari prepartum dan tidak memiliki
riwayat penyakit lain.

Investigasi: Bayi lahir memiliki Apgar 8/9, BBL 2.000gram, PL 45cm, lingkar kepala 30cm,
meconeum (-), urin (-). Gerak aktif, refleks isap dan tangis kuat, tanda vital dan reflek primitif normal.
Kesan: pertumbuhan dan perkembangan sesuai usia gestasi (Ballard 20). Demam muncul pada hari ke-
4 dan terdiagnosis sepsis neonatorum dengan CRP 12mg/L, LED 17mm/jam, sementara pemeriksaan
LP normal. Diagnosis infeksi dengue tegak hari ke-7 dengan NS1Ag(+) dan Dengue IgG(+) hari ke-8.
Kadar trombosit menurun hingga 52.000/uL pada hari ke-8 dan meningkat mencapai kadar normal pada
hari ke-10.

Tatalaksana dan luaran: Sejak lahir, bayi diinjeksi Vitamin K dan diberi ASI/2 jam lamanya 45-
60menit, diteruskan ASI on demand. Bayi menerima IVFD D10%1/5NS kecepatan 10cc/jam hingga 6
hari dan injeksi Ceftazidim 3x120 mg selama 14 hari sejak terdiagnosis sepsis neonatorum. Kondisi
bayi menurun postpartum hingga mencapai kovalesens pada hari ke 6 untuk seterusnya membaik dan
dipulangkan pada hari ke-14.

Kesimpulan: Tatalaksana bayi dengue neonatal serupa dengue anak. Pasien diberi cairan adekuat dan
dimonitor tiap 1-4 jam sampai melewati fase kritis, lalu cairan diperlambat dan distop saat tanda vital
stabil. Sepsis dapat disebabkan karena infeksi nosokomial, sehingga bayi diberi antibiotik maksimal 14
hari.

Kata kunci:.dengue neonatal, diagnosis, tatalaksana

A CASE REPORT:
NEONATAL DENGUE INFECTION

Laporan Kasus: Infeksi Dengue Neonatal

Yudi Rakhmadi, Yulia Iriani, Herman Bermawi, Julniar M.Tasli,


Afifa Ramadanti, Indrayady
Division of Infection, Departement of Child Health
University of Sriwijata / Dr. Mohammad. Hoesin Hospital, Palembang

Abstract
Background: Dengue infection is possible in all three trimesters of pregnancy. It is associated with several
neonatal complications such as perinatal death, miscarriage, low birth weight and preterm delivery. This is a case
report of perinatal transmission of dengue in a baby who was born by an emergency caesarean section

Case: A female baby was born by cesarean section from 21-year-old mother G1P0A0 33 weeks
gestational age with anhydramnios, thrombocytopenia (platelets 39,000u/L), and diagnosed with
dengue hemorrhagic fever (NS1+). Mother had history of 5 days prepartum fever and no other diseases
history.

Investigation: Newborn baby had Apgar 8/9, BW 2000gram, BL 45cm, and head circumference of
30cm, meconeum (-), urine (-). Active motion, strong suction reflex and cries, normal vital signs and
primitive reflexes. Impression: growth and development were according to gestational age (Ballard 20).
Fever appeared on day-4 and diagnosed with neonatal sepsis by CRP 12mg/L, LED 17mm/hours, while
normal LP examination. Dengue infection was diagnosed on day-7 by NS1Ag(+) and Dengue IgG(+).
Platelet levels decreased to 52000u/L on day-8 and increased to normal levels on day-10.

Management and outcome: Immediately after birth, infants injected with Vitamin K and given breast
milk/2 hours of 45-60 minutes. Babies receive IVFD D10% 1/5NS at speeds of 10cc/hour for 6 days
and injection of Ceftazidim 3x120mg for 14 days since the diagnosis of neonatal sepsis. Baby condition
were decreases postpartum until it reaches convalescence on the 6th day and discharged on day-14.

Conclusion: Management of neonatal dengue similar to children dengue. Babies are given adequate
fluids and monitored every 1-4 hours until pass the critical phase, then the fluid is slowed and stopped
when vital signs are stable. Sepsis can be caused due to nosocomial infections, so babies best given
antibiotics up to 14 days.

Keywords: neonatal dengue, diagnosis, treatment