Desiana Dharmayani

 BL < 2500 gram

 Klasifikasi:
 NKB SMK
 NKB KMK
 NCB KMK
 BBLSR (<1500 g)
 BBLASR (<1000 g)
NKB (PREMATUR)
 UG < 37 mgg
 Etiologi: ?
 Sosio-ekonomi rendah
 Kulit hitam > kulit putih
 Usia ibu: <16 thn atau >35 thn
 Aktivitas ibu, stress psikis
 Penyakit ibu (akut / kronik)
 Kehamilan multipel
 Riwayat prematur
 Faktor obstetri: malformasi uterus, trauma, PP, KPD, PJT
 Kondisi janin: gawat janin, eritroblastosis, PJT
MASALAH PADA PREMATUR
 Kesulitan adaptasi dengan kehidupan ekstrauterin
karena sisitem organ imatur

 Masalah:
 Respirasi: HMD, Apnu, BPD
 Neurologi: perdarahan intraventrikel, LPV
 Kardiovaskuler: hipotensi, PDA
 Hematologi: anemia, hiperbilirubinemia
 Nutrisi: refleks hisap dan menelan –
 Saluran cerna: NEC
 Metabolik: hipoglikemi
 Ginjal: gangguan elektrolit
 Pengaturan suhu: hipo/hipertermi
 Imunologi: Ig rendah, neutrofil dan limfosit belum
sempurna
 Optalmologi: ROP ( NKB <1500g atau UG 28 mgg atau
1500-2000g dgn kondisi khusus  skrining UG 31-33
mgg atau umur 4-6mgg
 Pendengaran: terganggu  skrining <3 bulan
TATA LAKSANA
 Postnatal:
 Peralatan dan SDM
 Resusitasi stabilisasi
 Neonatal:
 Suhu
 Oksigenasi – ventilator
 Cairan dan elektrolit
 Nutrisi parenteral
 Nutrisi enteral:
 >1500g  (32 mgg) ASI 1-3 jam setelah lahir interval 2-3 jam 60
ml/kg/hr, naikkan 30 ml/kg/hr (max 160-180 ml/kg/h), OGT
PJT
 BL di bawah persentil 10 dari kurva BL normal
 Etiologi:
 Faktor ibu: genetik, umur, ras, tidak kawin, malnutrisi,
penyakit kronik, ggn aliran plasenta, infertilitas, riwayat
abortus spontan, radiasi, bekerja berat.
 Faktor plasenta: penyakit vaskular, kehamilan multipel,
malformasi, tumor
 Faktor janin:konstitusional, kromosom abnormal,
malformasi, infeksi kongenital, multipel
TATA LAKSANA
 Saat Kehamilan:
 Identifikasi
 Kelahiran dini jika perlu
 Saat Kelahiran
 Lahir di RS rujukan Risti
Fluids and feeding for
LBW
Weight < 1200 g; Gestation < 30 wks*
 Start initial intravaneous fluids
 Introduce gavage feeds once stable
 Shift to katori-spoon feeds over next few
days. Later on breast feeds.
* Mary try gavage feeds, if no sick
Fluids and feeding for LBW
Weight 1200-1800 g; Gestation 30-34 wks*
 Start initial gavage feeds.
 Katori-spoon feeding after 1-3 days.
 Shift to breast feeds as soon as baby is able
to suck.

* May need intravenous fluids, if sick

Fluids and feeding for LBW
Weight 1200-1800 g; Gestation 30-34 wks*
 Start initial gavage feeds.
 Katori-spoon feeding after 1-3 days.
 Shift to breast feeds as soon as baby is able
to suck.

* May need intravenous fluids, if sick

Fluids and feeding for LBW
Weight > 1800 g; Gestation > 34 weeks*
 Breast feeding.
 Katori-spoon feeding, if sucking not
satisfactory on breast.
 Shift to breast feeds as soon as possible.
Feeding schedule

 Begin at 60 to 80 ml / kg / day
increase by 15 ml / kg every day
maximum of 180-200 ml / kg /day
 First feed at 2 hrs of age then every 2
hourly.
Gavage feeding
Guidelines for fluid
requirements

 First day 60-80 ml / kg / day.

 Daily increment 15 ml / kg till day 7.
 Add extra 20 – 30 ml / kg for infants
under radiant warmer and 15 ml / kg
for those receiving phototherapy.
Fluid requirements (ml / kg)
Birth Weight
Day of life
> 1500 g 1000 to 1500 g
1 60 80
2 75 95
3 90 110
4 105 125
5 120 140
6 135 155
7 onwards 150 170
 Adequacy of nutrition
Weight pattern*
 Loses 1 to 2% weight every day.
 Cumulative weight loss 10%; more in
preterm.
 Regains birth weight by 10-14 days.
 Daily weight gain 1 to 1.5% of birth weight.
Excessive loos or inadequate weight gain
 Cold stress, anemia, poor intake, sepsis
* LBW term baby does not lose weight
 Supplements
 Vitamins : IM vit K 1.0 mg at birth
Vit A* 1000 I.U. per day
Vit D* 400 I.U. per day
 Iron : Oral 2 mg / kg per day
from 8 weeks of age
* From 2 weeks of age
Danger signals
(Early detection and referral)

 Lethargy, refusal to feed

 Hypothermia
 Tachypnea, grunt, gasping, apnea
 Seizures, vacant stare
 Abdominal distension
 Bleeding, icterus over palms / soles
 Perawatan:
 Mencari penyebab PJT jika belum jelas
 Evaluasi komplikasi
 Tatalaksana khusus:
 Nutrisi
 Kadar GD
 Kadar kalsium
 Kehamilan berikutnya