Prematuritas

Erny, Harison
FK-UWKS
2012
 Standart kompetensi
Setelah mengikuti kuliah ini mahasiswa
diharapkan memahami dan mampu
mengenali bayi prematuritas dan tatalaksana
yang harus dilakukan
Mampu melakukan rujukan
Mampu memberi edukasi pada orang tua
Mampu menentukan prognosis
 Pendahuluan
Definisi prematuritas :
Bayi lahir dengan usia kehamilan <37 minggu
tanpa memandang berat lahir

Diagnosis banding :
Bayi aterm (cukup bulan - usia gestasi 37-42
minggu) dengan berat lahir rendah (BBLR)
(<2500 gram)
 BBLR
<2500 gram

ATERM PREMATURE
(37-42 minggu) (<37 minggu)

Masalah kompleks :
Imaturitas fungsi multiorgan
Risiko kematian & kecacatan tinggi
Membutuhkan penanganan spesifik
 Epidemiologi
Secara umum : angka kejadian 12% dari total kelahiran
Mortalitas : TINGGI dinegara yang sedang berkembang
Africa : 45/1000 bayi lahir hidup

Saat ini angka harapan hidup (survival rate) meningkat

karena peningkatan tehnologi kedokteran
Bayi prematur <1000gram : SR : 74,9%

Penyebab kematian terbesar : gagal nafas, infeksi &

malformasi kongenital (CHD)
 Pemeriksaan fisik
Menentukan usia kehamilan (gestasional age)
1. DUBOWITZ score
2. BALLARD score

Menentukan masalah kesehatan secara umum : persistem

organ :
1. Sistem kardiovaskuler
2. Sistem respirasi
3. Sistem saraf
4. Sistem gastrointestinal
5. Sistem urogenital
6. Sistem hematologi

Menentukan kelainan kongenital yang menyertai

 LANUGO

Preterm infant Full term infant

Lanugo on Baby's face Lanugo on Baby's shoulder
 PLANTAR CREASES

28 weeks' gestation. 33 weeks' gestation. Term gestation.

Note the flat sole Note the presence of only Note the multiple creases
an anterior crease
 BREAST TISSUE

28 weeks' gestation. 33 weeks' gestation.

No breast tissue is present, and the areolae are The breast tissue is less than 1 cm, and the
barely visible. areolae are raised and/or pigmented
Premature skin. This premature infant
demonstrates translucent, paper-thin skin
with a prominent venous pattern

Full term infant. The skin normal

without venous pattern and cracking

Post-term skin. Peeling and cracking of

the skin are characteristics of the infant
delivered after 42 weeks' gestation.
 EAR FORMATION

26 weeks ; Ear cartilage. 28 weeks' gestation. 33 weeks' gestation. A term infant has well-
The lack of cartilage and Note the small amount Note the increased developed cartilage with
the easy foldability (lack of ear cartilage and/or cartilage, recoil, and instant recoil.
of recoil) flattened pinna outer ridge curving
inward
Neuromuscular maturity

General posture. The typical, marked flexor Preterm posture : ekstensi

posture of the term infant tungkai
 Tests for flexion angles

Knee flexion. The position for assessing knee

flexion is shown. Note the decreased knee
flexibility of this term infant (A) compared with
preterm infant of 29 weeks' gestation (B).
Scarf sign.
The elbow cannot be drawn,
with gentle traction on the
upper extremity, across this
term infant's chest (A). This is
in contrast to the marked
flexibility of a preterm infant
of 29 weeks' gestation (B).
Heel-to-ear maneuver.
The position for assessing the heel-to-ear maneuver is
demonstrated. The degree of extension seen is
consistent with a 28- to 30-week infant
 Pemeriksaan penunjang
Darah lengkap :
1. anemia/polisitemia
2. Lekopenia/lekosistosis
3. Golongan darah/rhesus
Analisis serum elektrolit :
1. Magnesium pada ibu dengan Tx sulfas
magnesium
2. Calcium
Glukosa serum : hipoglikemia atau hiperglikemia

Radiologi : thorax foto (RDS), UGS kepala (ICH)

 Masalah bayi prematur
Lemak subcutan relatif tipis & lemak coklat menurun : risiko
hipotermi
Kulit imatur, /(-) stratum corneum, kerapatan antar
lapisan kulit, retensi air, edema jaringan : kulit mudah
cedera, absorpsi obat/material kontak & risiko infeksi
transdermal water loss, fungsi ginjal imatur, pengaruh
lingkungan : imbalans air & elektrolit
Surfactan belum terbentuk : RDS
Fungsi SSP : belum optimal : fungsi pengaturan sistim saraf
tidak optimal
 Prognosis
22-27 minggu: kelainan neurodevelopmental
pada usia 8 tahun
Risiko : buta, tuli, CP, gangguan intelektual dan
kecacatan fisik
23-25 minggu: dengan pemberian
korticosteroid antenatal : mortalitas dan
morbiditas relatif lebih rendah