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BAYI BARU LAHIR

ABNORMAL
Afrilia Intan Pratiwi
12176
Noor Adibah Hanum Che Hashim12299
Meita Ucche
12122
Zamrina Adilafatma
12159

Kasus

Bayi laki-laki lahir dari ibu P1A0 dengan


UK 36+1 minggu, spontan, tidak
langsung menangis, air ketuban jernih,
resusitasi sehingga langkah awal,
dengan berat badan lahir 2550 gram,
Apgar Score 6/8

Riwayat Perkembangan
Penyakit
2 jam setelah lahir:
Bernapas cepat & dalam (takipnea) >
60 x/menit
Napas cuping hidung/nasal flare
Retraksi interkostal
Mulut dan hidung sianosis
Grunting

Diagnosis
TTN memiliki gejala yang mirip dengan
gangguan
pernapasan lain yang berat pada bayi
pneumonia
hipertensi pembuluh darah paru-paru

foto rontgen untuk menegakkan


diagnosis.

Infiltrate
difus di
lapang paru

Over inflated

Perihilar
streaking
retensi cairan
paru

Definisi

gangguan pernapasan pada bayi baru


lahir yang berlangsung singkat

short-lived(<
24 jam)

self-limited

terjadi sesaat
setelah /
beberapa jam
setelah
kelahiran

prematur &
matur

Penyebab

wet lungsataurespiratory distress


syndrometipe II
tidak dapat didiagnosis sebelum lahir.
faktor risiko :
Lahir secara secar
Lahir dari ibu
dengan diabetes
Lahir dari ibu
dengan asma
Small for
gestational age

Patophysiologi
sisa
cairan
yang
masih
terdapat
di paruparu

pengeluar
an cairan
dari paruparu
terlalu
lambat

bernapa
s lebih
cepat
dan
lebih
dalam

Respiratory Distress Syndrome

clinical Dx, interchanged terms Hyaline


Membrane Disease (pathological
diagnosis) and Surfactant Deficiency
(typical appearances on radiographs of
infants with RDS)
Small
typical radiological featuresvolume lungs
of Surfactant Deficiency:
Homogenous
Air
"ground
bronchogram
glass"
s
opacity

heart is all but


obscured by the
diffuse,
homogenous lung
fields
intubated
umbilical catheters
in situ

Transient Tachypnoea of the


Newborn (TTN)

also called Retained Fetal Lung Fluid or


Wet Lung is a diagnosis of exclusion

*Because the symptoms and radiological


features are non-specific, infection should
be considered in the differential
diagnosis. Typically, respiratory
symptoms resolve within the first 24-hours
of life, but occasionally can persist longer.

Typical radiologic features are illdefined but include


Increase
d central
Evidence
vascular
of
Prominen
markings Hyper- interstitia
t
("staraeration
l and
interloba
burst"
pleural r fissures
appearan
fluid
ce)

Cardiomegaly

Meconium Aspiration Syndrome

occurs in about 12% of deliveries


defined by meconium aspirated from below
the vocal cords
presents as respiratory distress and cyanosis
pulmonary hypertension is common.
*Because the symptoms and radiological
features are non specific, infection should be
included on the differential diagnosis.

Radiographic Features

Coarse
infiltrates

Widespread
consolidation

Pleural
effusions

Hyperinflation

Pneumothorax
and
pneumomedias
tinum

bilateral
patch
opacity with
hyperinflatio
n (although
not severe).

air leak
with a
prominent
mediastinal
lucency
free air at
the bases
patchy
opacity of
the lung
fields

Pulmonary Haemorrhage

relatively common in neonates


dramatic in its onset, with a catastrophic collapse, or it can be more
subtle with blood-tinged endotracheal secretions
in preterm infants, it is most commonly associated with apatent
ductus arteriosuscausing haemorrhagic pulmonary oedema
other causes include :

surfactant administration (perhaps from a rapid change in compliance


resulting in an increase in the size of the left-to-right shunt, and
haemorrhagic oedema)
airway haemangiomata (rare)
any cause of pulmonary congestion (for example, severely reduced left
ventricular function in an asphyxiated or septic term infant)

Babies frequently require a significant increase in their ventilatory


support. The PEEP should generally be increased in an attempt to
maintain high mean airway pressures so that oedema is forced back
into the pulmonary vascular bed

nonspecific in
appearanc
e

commonly
demonstra
te patchy
infiltrates,
although
appearanc
es can be
normal

Neonatal Chronic Lung Disease

a sequel of significant lung disease in the


immediate newborn period
four stages :

Stage 1 was the homogenous appearance ofRDS


Stage 2 was a generalised opacity, frequently seen
towards the end of the first week of life
Stage 3 marked the onset of chronic changes, with
a bubbly appearance
Stage 4 consisted of a inhomogenous appearance
with hyperinflation, bleb formation, irregular fibrous
streaks, and cardiomegaly (from cor pulmonale)

8 and 12 days in a baby born at 25 weeks


lung fields show a coarse bubbly appearance,
initially more marked on the right but then more
widespread a few days later

advanced Stage 4 CLD - lung fields are generally


"bubbly" and "streaky" with localised areas of
hyperaeration in the right lower lobe and left lower
lobe

Water Aspiration

chest radiographs not specific but


frequently demonstrate pleural effusions
and patchy alveolar infiltrate
infection must be considered in the DDx,
and antibiotics should be given at least
until cultures are proven negative

pleural
effusions
and patchy
alveolar
infiltrate

Hydrops

fluid in at least two body cavities

with hydrops - in this case, bilateral pleural


effusions, ascites, and oedema

cause congenital chylothorax

appearance after
birth
generalised
oedema
bilateral huge
pleural effusions
right lung is seen
as the (small) lucent
area slightly crossing
the midline
appearance of
central gas in the
abdomen,
suggesting the
presence of ascites

appearance 3
days after
birth
dramatic
reduction in
the
subcutaneous
oedema
bilateral
pleural
effusions
remain.