LAPORAN KASUS DARI RS PANTI RAPIH YOGYAKARTA

BAYI LAHIR
DARI IBU HEPATITIS B
fx. wikan indrarto
WEBINAR IDAI CABANG DIY
MINGGU, 20 DESEMBER 2020
LAPORAN KASUS RSPR

1. Bayi lahir dari ibu berpenyakit infeksi.

2. Risiko penularan pada bayi dan
tindakan medis segara
3. Skrining pemeriksaan antenatal
4. PMS, Hepatitis B, HIV dan COVID-19
 LAPORAN KASUS RSPR

Skrining pemeriksaan antenatal 2020 :

1. PMS (TPHA) : 0 bayi

2. Hepatitis B (HBsAg) : 8 bayi.
3. HIV (serologi) : 1 bayi.
4. COVID-19 (skrining, rapid test, RT
PCR) : 10 bayi.
LAPORAN KASUS RSPR
1. By. AF (RM : 1176290), ibu HBsAg
(+), lahir spontan, 16 Oktober 2020,
pk. 1
2. Bayi bugar, tidak asfiksia A/S : 7/8.
3. Pemeriksaan jasmani : dbn
4. Diagnosis :
1. BAYI LAHIR (NORMAL) (P00.9)
2. LAHIR DG RIWAYAT IBU HEPATITIS
(P00.8)
5. Terapi : RG, ASI eksklusif, injeksi vit K
(Rp. 2.134), HBIG (Rp. 2.692.000),
HB 0 (Rp. 107.355)
 LAPORAN KASUS

16 Oktober 2020, pk. 10.36, usia 1 hari

1. Muntah 2x, tidak ada keluhan lain, mulai
menetek.
2. Pemeriksaan fisik : dbn
3. Diagnosis :
1. BAYI LAHIR (NORMAL) (P00.9)
2. LAHIR DG RIWAYAT IBU HEPATITIS
(P00.8)
3. VOMITUS NEWBORN (P92.0)
4. Terapi : Observasi, RG, ASI eksklusif
 LAPORAN KASUS

17 Oktober 2020, pk. 10.14, usia 2 hari

1. Tidak muntah, tidak ada keluhan lain,
mulai lancar menetek.
2. Pemeriksaan fisik : dbn
3. Diagnosis :
1. BAYI LAHIR (NORMAL) (P00.9)
2. LAHIR DG RIWAYAT IBU HEPATITIS
(P00.8)
4. Terapi : Boleh pulang sesuai ibu, ASI
eksklusif
 LAPORAN KASUS
Kontrol 22 Oktober 2020 (4 hari), pk. 09.45
1. Keluhan Utama : Kontrol bbl lahir spontan bb lahir
3655 gr, Tali pusat belum puput dan agak berdarah,
ASI, Sudah imunisasi hep b1, demam sepulang dari
RS suhu 38,7 dan rewel, selama 2 hari, hari ketiga
sudah turun jadi 37 naik menjadi 38,0, kembali
turun.
2. Pemeriksaan jasmani : dbn, ikterik K2
3. Diagnosis :
1. JAUNDICE NEONATAL (P59.9)
2. BAYI LAHIR DG RIWAYAT IBU HEPATITIS (P00.8)
4. Terapi : edukasi dan motivasi ASI eksklusif, kontrol 1
 DISKUSI 1
WHO (July 2020) :

1. Elimination of HBV infection as a public health

threat requires a reduction in the prevalence of
hepatitis B surface antigen (HBsAg) to below Prevention of
0.1% in children 5 years of age. mother-to-child
transmission of
hepatitis B virus:
2. This can be achieved through universal Guidelines on
immunization of newborns against hepatitis B and antiviral prophylaxis
in pregnancy,
other interventions to prevent mother-to-child 27 July 2020
transmission of HBV
https://www.who.int/publications/i/item/978-92-4-000270-8
 DISKUSI 2
Preventing perinatal HBV transmission in the United States :
1. Screening of pregnant women for HBsAg during each pregnancy.
2. Screening all HBsAg-positive pregnant women for HBV DNA to use of
maternal antiviral therapy during pregnancy (DNA is >200 IU/mL).
3. Case management of HBsAg-positive mothers and their infants.
4. Provision of immunoprophylaxis for infants born to infected mothers,
including hepatitis B vaccine and hepatitis B immune globulin within 12
hours of birth
5. Routine vaccination of all infants with the hepatitis B vaccine series,
with the first dose administered within 24 hours of birth

https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm
 DISKUSI 3
1. Due to very low to low quality evidence found in this review, we are
uncertain of the effect of benefit of antenatal HBIG administration to
the HBV-infected mothers on newborn outcomes, such as HBsAg,
HBV-DNA, and HBeAg compared with no intervention.
2. The results of the effects of HBIG on HBsAg and HBeAg are surrogate
outcomes (raising risk of indirectness), and we need to be critical
while interpreting the findings.
3. Well-designed randomised clinical trials are needed to determine the
benefits and harms of HBIG versus placebo in prevention of MTCT of
HBV.
Eke AC, Eleje GU, Eke UA, Xia Y, Liu J, 2017, Hepatitis B immunoglobulin (HBIG) during pregnancy
for MTCT of hepatitis B virus (HBV), https://www.cochrane.org/CD008545/
 DISKUSI 4
Hepatitis B and breastfeeding (WHO, 1996) :

1. There is no evidence that breastfeeding from an

HBV infected mother poses an additional risk of
HBV infection to her infant, even without
immunization.
2. Thus, even where HBV infection is highly endemic
and immunization against HBV is not available,
breastfeeding remains the recommended method of
infant feeding.
https://www.who.int/maternal_child_adolescent/documents/pdfs/hepatitis_b_and_
breastfeeding.pdf
 DISKUSI 5
Neonatal jaundice and HBV mother :

1. Neonatal jaundice was seen in 50% neonates, but

majority were mild and physiological and did not
require NICU admission in most of the cases.
2. None of the neonates developed sepsis in the
present study.

Sujatha, A, et al, 2019, Study on Hepatitis B Virus Infection in Pregnant Women

and its RiskFactors, International Journal of Contemporary Medical Research,
Volume 6, pp. 2454-7379
 DISKUSI 6

Neonatal fever and HBV mother :

Symptoms of acute HBV infection in neonates are

indistinguishable from those of other types of
hepatitis, including nausea, vomiting, anorexia, low-
grade fever, myalgias, and fatigue.

Nelson, N, Jamieson, D., and Murphy, T, 2014, Prevention of Perinatal Hepatitis B

Virus Transmission, J Pediatric Infect Dis Soc. 2014 Sep; 3(Suppl 1): S7–S12.
 EVALUASI
Pertanyaan :

1. Hubungan demam dan ikterik pada BBL dengan ibu Hepatitis B?

2. Membedakan ikterik fisiologis dengan hepatitis pada BBL?
3. Bagaimana kalau HBIG tidak tersedia?
4. Kapan pemeriksaan serologi hepatitis B diperlukan?
1. HbsAg (Rp. 176.500)
2. HBeAg (Rp. 403.500)
3. Anti HBs (Rp 387.500)
 MATUR NUWUN

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