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Dimas Wiantadiguna
BAYI BERAT BADAN LAHIRRENDAH / BBLR
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Riwayat Kehamilan
I(u (ayi men"a-u ini a,alah -ehamilannya yan" -e &2 I(u(ayi (iasa AN4 ,i pus-esmas yan" ,iperi-sa /leh (i,an )-ali2 I(u (ayi men"a-u usia -ehamilannya 5 min""u2se(elum melahir-an3 i(u men"alami riaya' -eluar airmerem(es3 0ernih3 ,an 'i,a- (au3 ,iser'ai ,en"an peru' yan"mules2 Se(elum melahir-an i(u men"a-u mela-u-anhu(un"an se-sual ,en"an suaminya2 i(u (ayi 'i,a- pernahsa-i' a'au pun minum /(a'$/(a'an2 Ana- per'ama i(umen"alami -e"u"uran3 ana- -e i(u lahir pre 'erm 6 (ulan(era' lahir 7!! "ram3 ana- -e ,uanya menin""al ,ua (ulanse'elah ,ilahir-an3 se(elum lahir i(u 0u"a men"a-umela-u-an hu(un"an se-sual ,en"an suaminya
Riwayat Persalinan
Bayi lahir sp/n'an 'an""al & sep'em(er !1) pu-ul 1&2&)BBL 1!! "ram2 Ap"ar s-/r 1 $ % $ 62 Air -e'u(an 0ernih
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PE+ERIKSAAN 8ISIK
Keadaan umum: Lemah +erin'ih Tanda Vital: Na,i: 6! 9meni'3 Suhu: &63% /43
RR: &6 9meni'
Pertumbuhan :Bera' Ba,an : 1!! "ram
Pan0an" Ba,an : &% m
Lin"-ar Kepala : 6 m
Lin"-ar Da,a : m Penilaian Umum :
A-'i;i'as : menurun
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Kepala
Ben'u- -epala : sime'ris3 l/n0/n"3 anemis =$>3 I-'eri- =$>3apu' suen,aneum =$>3 ,an ephal hema'/m =$>3 sian/sis ?(i(ir
ThoraksInspe-si : ,in,in" ,a,a sime'ris3 re'ra-si ,in,in" ,a,a =?>
su(/s'al2
Palpasi: "era-an ,in,in" ,a,a sime'ris
Per-usi: s/n/r ,i-e,ua lapan" paru
Aus-ul'asi : ;esi-uler ??3 rh $$3 h $$
Penilaian pernapasan : napas 'era'ur =?>3 'ahypnea =$>3 s'ri,/r=$>3 'ari-an ,in,in" ,a,a =??> su(/s'al2
Jantung
S1S 'un""al re"ular3 mur # mur =$>3 "all/p =$>2
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bdomen
Inspe-si : ,is'ensi =$>3 /r"an/me"ali =$>3 -elainan/n"eni'al =$>
Aus-ul'asi : (isin" usus N/rmal
Palpasi : massa =$>3 supel =?>3 hepar$lien 'i,a- 'era(a2
Per-usi : 'impani =?> ,iseluruh lapan" a(,/men
umbili!us
Um(ili-us (ersih3 arna -unin" -ehi0auan =$>3 e,ema =$>3-emerahan =$> pa,a pan"-al um(ilius2
"enitalia
N/rmal2 @ip/spa,ia =$>3 epispa,ia =$>3 hi,r/-el =$>3 ru"ae'es'is =?> halus2
nus dan rektum
Anus =?>3 me-/ninum =$> % 0am per'ama2 #kstremitas
N/rmal2 Syn,a'yli =$>3 p/li,a'yli =$>3 'alipes euin/;arus=$$>3 hema'/m =$$> Akral hangat
$ $
? ?
$ $
? ?
Sianosis
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DIANCSA
Ne/na'us Pre'erm
BBLSRAs-sia (era'
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Ballar, S/re
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TERAPII8D D1!F 1!!% 0amPyin 96! m"
ASI 59&
PuasaPasan" NT
C lpm
Therm/re"ulasi
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8CLLC< UP
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Pendahuluan
Bayi berat badan lahir rendah (BBLR mau!unbayi "urang bulan (B#B meru!a"an masalahutama sehubungan dg tingginya m$rtalitas danm$rbiditas !arinatal/ne$natal
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De%inisi
Bayi (era' (a,an lahir ren,ah =BBLR> Bayi (aru lahir =BBL> ,en"an BB G )!! "ram2
Bera' lahir =BL> Bir'h ei"h' BB yan" ,i 'im(an" se0a- !$% 0am se'elah lahir2
Bayi (era' lahir san"a' ren,ah =BBLSR> ery l/Bir'h
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Eur/pean Perina'al +e,iine II ,i L/n,/n=1H7!> 'elah ,iusul-an ,e.enisi (eri-u' :%ayi kurang bulan a,alah (ayi ,en"an
masa -ehamilan -uran" ,ari &7 min""u2
%ayi imatur a,alah BBL ,en"an usia-ehamilan G 5 min""u
%ayi !ukup bulan a,alah (ayi ,en"an masa-ehamilan mulai ,ari &7 min""u sampai %
min""u2%ayi lebih bulan a,alah (ayi ,en"an masa
-ehamilan mulai % min""u a'au le(ih
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"R&IK
'U%
()#
*(+
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PEN&EL'P'#AN BBLR
BBLR
BKB
BCB
BLB
KMK
BMK
KMK
SMK
KMK
BBLR ) BERAT BADAN LAHIR RENDAHB#B ) BAYI #*RAN& B*LANB+B ) BAYI +*#*P B*LANBLB ) BAYI LEBIH B*LAN## ) #E+IL A,A #EHAILAN
,# ) ,E,*AI A,A #EHAILANB# ) BE,AR A,A #EHAILAN
asing-masing "el$m!$" BBLR tersebut di atas a"anberdam!a" terhada! m$rbiditas dan m$rtalitas yangberbeda
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Den"an pen"er'ian seper'i yan" 'elah,i'eran"-an ,ia'as3 (ayi BBLR ,apa' ,i(a"imen0a,i ,ua "/l/n"an3 yai'u :
Prematuritas murni+asa "es'asinya G&7 min""u ,an (era' (a,annya sesuai,en"an (era' (a,an un'u- masa "es'asi i'u a'au (iasa,ise(u' (ayi -uran" (ulan$sesuai masa -ehamilan =BKB$S+K>2
,ismaturitasBayi lahir ,en"an (era' (a,an -uran" ,ari (era' (a,anseharusnya un'u- masa "es'asi i'u2 Berar'i (ayimen"alami re'ar,asi per'um(uhan in'rau'erine ,an
merupa-an (ayi yan" -eil un'u- masa -ehamilan =K+K>2
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ETI'L'&I
Belum di"etahuiBerhubungan dengan "$ndisi sbb)
Ibu menderita !enya"itIbu menderita !enya"ita"ut/"r$nis -- lahira"ut/"r$nis -- lahir!rematur!rematur
#ehamilan multi!el#ehamilan multi!el #ehamilan sebelumnya#ehamilan sebelumnya
.ele".ele"
a"t$r-%a"t$r "ebidanana"t$r-%a"t$r "ebidanan %a"t$r .anin%a"t$r .anin ,ebab lain,ebab lain
,tatus s$sial e"$n$mi,tatus s$sial e"$n$miyang rendahyang rendah Ras ( "ulit hitam 0Ras ( "ulit hitam 0
lebih tinggi 12lebih tinggi 12 *sia Ibu 3 45 tahun /*sia Ibu 3 45 tahun /
6 78 tahun6 78 tahun A"ti%itasA"ti%itas
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#E9ADIAN BBLR
Di negara ber"embang 1:; (Ibrahim? ) BBL,R ?
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e0ala Klinis
Prematuritas murniBera' -uran" ,ari )!! "r
PB -uran" a'au sama ,en"an %) m
LD -uran" ,ari &! m
LK -uran" ,ari && m
+asa "es'asi -uran" ,ari &7 min""u2
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Disma'uri'asDapa' 'er0a,i pre$'erm3 a'erm3 ,an p/s'$'erm2
Pa,a pre$'erm a-an 'erliha' "e0ala si- (ayiprema'ur murni ,i'am(ah ,en"an "e0ala
,isma'uri'as2 Dalam hal ini (era'nya -uran",ari )!! "r2 Kara-'eris'i- sama ,en"an (ayiprema'ur ,an mun"-in ,i'am(ah ,en"anre'ar,asi per'um(uhan ,an "e0ala
-wasting.
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Tan,a -wasting:Stadium pertama
Bayi 'ampa- -urus ,an rela'i. le(ih pan0an"3 -uli' l/n""ar3-erin" seper'i per-amen3 'e'api (elum 'er,apa' me-/nium
Stadium keduaDi,apa'-an 'an,a s'a,ium per'ama ,en"an arna -uli'3plasen'a ,an um(ili-us -ehi0auan2 @al ini -arena me-/nium'erampur ,en"an plasen'a ,an men"en,ap ,i-uli'2Se(a"ai an/-sia in'rau'erin
Stadium ketigaDi'emu-an 'an,a s'a,ium -e,ua ,i'am(ah ,en"an -uli'(erarna -unin"2 A-i(a' an/-sia in'rau'erin yan"(erla"sun" lama2
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#'PLI#A,I BBLR
LR, K :As%i"sia !erinatalCHi!$"sia ante/intra!artum resusitasi intra uterinCAs%i"sia !$stnatal resusitasiC
,usunan ,yarat Pusat CRe%le" batu" lemah terseda" as!irasi !nCRe!le"s !rimiti% (men$leh
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,aluran !erna!asan )
Penya"it membran hyalin (PH/HD/RD, IDe%isiensi ,ur%a"tan ale$li "$la!s atele"tasis se"uder
yang "eFil-"eFil (gambaran bayangan reti"ul$granuler di%us
A!nea re"uren (!ada B#B
A"ibat belum sem!urna/matangnya susunan syara% !usatdan !aru- !aru !erlu !emantauan !erna!asan selama 4-7minggu sam!ai bebas serangan a!nea
Wils$! dd"(4=>4 ) te$%ilin da!at meFegah/menguragiserangan a!nea 5:G=:;C
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,indr$ma "eb$F$ran udaraPada !enggunaan entilat$r berte"anan besar
!eum$t$ra" 5 ) ang"a "e.adian 4;
Br$nFh$!ulm$nary Dys!lasia (BPD#$m!li"asi dari !ema"aian etilat$r yang terlalu lama (6 1
mgg atau a"ibat !ema"aian "$nsetrasi '1 65:->:; dalam.ang"a lama#eraFunan '1
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Therm$legulasi dan sumber !anasPusat therm$regulat$r belum sem!urnamudah
hi!$/hi!ertermiaLema" sub"utan masih sedi"it dan br$n%at belum
terbentu" sehingga mudah hi!$termi
#ardi$as"ulerHi!ertensi a"ibat dari adanya hi!$$lemia "arena
!erdarahan ante/intra !artum dis%ungsi.antung/as$dilatasi "arena adanya in%e"sisistemi"/se!sis
PDA sering ter.adi (berbanding terbali" dengan usia"ehamilan dan lebih sering !ada bayi-bayi denganPH
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,aluran !enFernaanEnter$"$litis Ne"r$ti"an (E#N47; "asus B#B/BBL,RPenyebab bersi%at multi%a"t$rial (maturitas< trauma
hi!$"si" is"emi" saluran Ferna yang masih imatur< "$l$nisasiba"teri !at$gen serta substrat !r$tein dalam lumen usus
etab$lismeI"terus Ne$nat$rum (a"ibat enJim glu"$r$nil
tras%erase sel-sel hati belum sem!urnaHi!$gli"emia dan hi!$"alsemia dini !ada yg
mengalami as%i"sia !erinatal
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Hemat$l$gis
Anemia !rematuritas (Anemia $% !rematuritya"ibat)Eritr$sit a"tu lahir menurun#adar Hb terendah lebih Fe!at "arena ),urial eritr$sit B#B 6 !ende"
Pertumbuhan B#B relati% 6 Fe!at d! B+BDe%isiensi it E (tu .i"a inta"e !-$ "urang
Anemia "arena !erdarahan intra"ranial (a"ibat!rematuritas< sungsang< lahir terlalu Fe!at
,en"an ?7 $& ?1
+a'uri'as si- ,an neur/l/"is =S-/r Du(/i'3Ballar, maupun simplie, Du(/i'>
BKB : Usia -ehamilan G &7 min""u =G)H hari >,ise(u' (ayi -uran" (ulan =BKB>2
BBLR3 (ila BL =(era' lahir> G)!! "ram G%HH
"ram>
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TATALAKSANABeri /-si"en 0i-a 'er,apa' salah sa'u 'an,a hip/-semiaSU@UPeraa'an -uli' -e -uli' ,ian'ara -e,ua payu,ara i(u a'au
pa-aian ,iruan"an han"a' a'au humi,iri(2Ji-a 'i,a- a,a pen"han"a' (er'ena"a lis'ri-3 "una-an
(/'/l air panas y" ,i(un"-us han,u-2
Per'ahan-an suhu in'i 'u(uh se-i'ar &63) # &73) /44airan ,an Pem(erian +inum4airan I 6! mL-"hari selama hari per'ama -ehi,upan2
una-an pe,ia'ri =1!! mL> in'ra;en/us (ure''e ," 6! ''s 1 mL3 sehin""a 1 'pm 1 mL0am2
Ji-a (ayi seha' $% ml ASI perah se'iap 0am melalui
NT2+ulai (eri minum 0i-a -/n,isi (ayi s'a(il2 Pem(erian
minum ,imulai 0i-a peru' 'i,a- ,is'ensi ,an lem(u'3'er,apa' BU3 'elah -eluar me-/nium M ',- 'er,apa'apneu2
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4airan ,an Pem(erian +inum
Pem(erian susu ,imulai $% ml1$ 0am melaluiNT ,apa' ,i'erima 'anpa mun'ah3 ;/lume,apa' ,i'in"-a'-an 1$ ml perminum se'iap hari2
Ji-a 'er,apa' 'an,a '/leransi (uru- hen'i-an-uran"i2
+inum ,apa' ,i'in"-a'-an selama m"" per'amahin""a 1)!$15! ml-"hari =1H$& ml&0am un'u-(ayi 1 -" M 5$&% ml un'u- (ayi 12)-">
A'au menuru' D/yle =1HH7> men"an0ur-an-e(u'uhan airan-"BBhari p, :hari -e$1 : 6!3hari -e$ : H!3hari -e$& : 1!3hari -e$% : 1)!3hari -e$) ,s' : 1)!
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Ke(u'uhan Ele-'r/li' Se'elah 1$% 0am -ehi,upan3 al2 Na3 K3 4a
Pem(erian i'aminKe(u'uhan ener"i-al/ri
lu-/sa =hari per'ama : %$6 m"-"BBmn'> Pr/'ein =mulai hari -e$&> Lema- =mulai hari -e$&> Nu'risi En'eral
+eneh"ah ,an +en"a'asi In.e-si +ene"ah In.e-si +en"a'asi In.e-si
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+ene"ah In.e-si Pen""unaan (ara- (ila masu- -amar (ayi 4ui 'an"an se(elumsesu,ah peri-sa Semua 'in,a-an seara a ,an an'isep'i- Pen""unaan mas-er (a"i pe'u"as y" sa-i' S/n,e ,i"an'i 'iap $& hr M in.us se' 'iap % 0am Raa' ,i ruan" is/lasi u peny2 +enular
+ene"ah peraa'an 'erlalu lama+enin"-a'-an pen"e'ahuan pe'u"as ''" in.e-siN/s/-/mial
Rasi/ peraa' ,an pasien i,eal+en"a'ur -un0un"an pasen
+en"a'asi In.e-si : Pem(erian An'i(i/'i- y" 'epa'
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Pemulan"an ,an Peman'auanBBLR
BBLR ,apa' ,ipulan"-an apa(ila :Ti,a- 'er,apa' 'an,a (ahaya a'au 'an,a
in.e-si (era'
Bera' (a,an (er'am(ah hanya ," ASI
Suhu 'u(uh (er'ahan p, -isaran n/rmal =&6$&7/4> ," pa-aian 'er(u-a
I(u ya-in ,an mampu meraa'nya
BBLR harus ,i(eri semua ;a-sin yan"
,i0a,al-an p, saa' lahir
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Pr/"n/sis
Pr/"n/sis BBLR ini 'er"an'un" ,ari (era'rin"annya masa perina'al3 misalnya masa"es'asi =ma-in mu,a masa "es'asima-inren,ah (era' (a,an3 ma-in 'in"""i an"-a
-ema'ian>Pr/"n/sis ini 0u"a 'er"an'un" ,ari -ea,aan
s/sial e-/n/mi3 pen,i,i-an /ran" 'ua ,anperaa'an pa,a saa' -ehamilan3 persalinan
,an p/s'na'al2