Bayi Baru Lahir Abnormal-BANYUMAS
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Bayi Baru Lahir Abnormal
Bayi Baru Lahir Abnormal
Afrilia Intan Pratiwi12176Noor Adibah Hanum Che Hashim12299Meita Ucche 12122Zamrina Adilafatma 12159
RSUD Banyumas Minggu VI
KasusBayi 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 6/8Riwayat Perkembangan Penyakit2 jam setelah lahir:DiagnosisTTN memiliki gejala yang mirip dengan gangguanpernapasan lain yang berat pada bayipneumonia hipertensi pembuluh darah paru-paru
foto rontgen untuk menegakkan diagnosis.
Infiltrate difus di lapang paruPerihilar streaking retensi cairan paru Over inflatedDefinisigangguan pernapasan pada bayi baru lahir yang berlangsung singkatPenyebabwet lungsataurespiratory distress syndrometipe II tidak dapat didiagnosis sebelum lahir. faktor risiko :
PatophysiologiRespiratory Distress Syndromeclinical Dx, interchanged terms Hyaline Membrane Disease (pathological diagnosis) and Surfactant Deficiency (typical appearances on radiographs of infants with RDS)typical radiological features of Surfactant Deficiency:
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.
Meconium Aspiration Syndromeoccurs in about 12% of deliveriesdefined by meconium aspirated from below the vocal cordspresents as respiratory distress and cyanosispulmonary hypertension is common.
*Because the symptoms and radiological features are non specific, infection should be included on the differential diagnosis.Radiographic Features
bilateral patch opacity with hyperinflation (although not severe).
air leak with a prominent mediastinal lucency free air at the bases patchy opacity of the lung fields
Pulmonary Haemorrhagerelatively common in neonatesdramatic in its onset, with a catastrophic collapse, or it can be more subtle with blood-tinged endotracheal secretionsin preterm infants, it is most commonly associated with apatent ductus arteriosuscausing haemorrhagic pulmonary oedemaother 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
non-specific in appearance commonly demonstrate patchy infiltrates, although appearances can be normalNeonatal Chronic Lung Diseasea sequel of significant lung disease in the immediate newborn periodfour stages :Stage 1 was the homogenous appearance ofRDSStage 2 was a generalised opacity, frequently seen towards the end of the first week of lifeStage 3 marked the onset of chronic changes, with a bubbly appearanceStage 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 Aspirationchest radiographs not specific but frequently demonstrate pleural effusions and patchy alveolar infiltrateinfection must be considered in the DDx, and antibiotics should be given at least until cultures are proven negative.
pleural effusions and patchy alveolar infiltrateHydropsfluid 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.