3650 11776

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\slmult0 \par\pard\ql\li1912\sb0\sl-414\slmult0 \par\pard\ql\li1912\sb0\sl-414\s
lmult0 \par\pard\ql\li1912\sb0\sl-414\slmult0 \par\pard\ql\li1912\ri1724\sb273\s
l-414\slmult0\tx4640 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 D
IAGNOSIS DAN TATALAKSANA PENYAKIT JANTUNG BAWAAN YANG \line\tab \up0 \expndtw3\charscalex100 KRITIS PADA NEONATUS \par\pard\ql \li4132\sb114\sl-276\slmult0 \
up0 \expndtw-3\charscalex100 ( DIAGNOSIS AND MANAGEMENT OF \par\pard\ql \li2550\
sb138\sl-276\slmult0 \up0 \expndtw-3\charscalex100 CRITICAL CONGENITAL HEART DIS
EASE IN THE NEWBORN) \par\pard\ql \li5276\sb0\sl-276\slmult0 \par\pard\ql\li5276
\sb276\sl-276\slmult0 \up0 \expndtw-3\charscalex100 Teddy Ontoseno \par\pard\ql
\li3695\ri3505\sb24\sl-414\slmult0\tx4060 \up0 \expndtw-3\charscalex100 Divisi K
ardiologi Bagian Ilmu Kesehatan Anak \line\tab \up0 \expndtw-3\charscalex100 FK
Unair - RSU Dr. Soetomo Surabaya \par\pard\ql \li1800\sb0\sl-276\slmult0 \par\p
ard\ql\li1800\sb0\sl-276\slmult0 \par\pard\ql\li1800\sb0\sl-276\slmult0 \par\par
d\ql\li1800\sb0\sl-276\slmult0 \par\pard\ql\li1800\sb252\sl-276\slmult0 \up0 \ex
pndtw-3\charscalex100 Korespondensi : \par\pard\ql \li1800\sb138\sl-276\slmult0
\up0 \expndtw-3\charscalex100 Dr. dr.H.Teddy Ontoseno Dr. SpAK., SpJP \par\pard\
qj \li1800\ri5501\sb26\sl-412\slmult0 \up0 \expndtw-3\charscalex100 Telp. : 031
550 1693, 031 5942439, 0818322205 \up0 \expndtw-3\charscalex100 No. Faximile : 0
31 5938735 \par\pard\ql \li1800\ri3636\sb1\sl-414\slmult0\tx3540 \up0 \expndtw-3
\charscalex100 Alamat Kantor : Divisi Kardiologi Bagian Ilmu Kesehatan Anak \lin
e\tab \up0 \expndtw-2\charscalex100 FK. Unair - RSU dr. Soetomo \par\pard\qj \l
i1800\ri4862\sb0\sl-414\slmult0\fi1740 \up0 \expndtw-3\charscalex100 Jl. Prof Dr
. Moestopo 6-8 Surabaya \up0 \expndtw-3\charscalex100 Alamat e-mail : teddy_on
toseno@yahoo.com \par\pard\ql \li10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\s
b0\sl-276\slmult0 \par\pard\ql\li10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\s
b0\sl-276\slmult0 \par\pard\ql\li10320\sb132\sl-276\slmult0 \up0 \expndtw-3\char
scalex100 \ul0\nosupersub\cf2\f3\fs24 1 \par\pard\sect\sectd\fs24\paperw12240\pa
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lmult0 \par\pard\ql\li1800\sb0\sl-207\slmult0 \par\pard\ql\li1800\sb0\sl-207\slm
ult0 \par\pard\ql\li1800\sb182\sl-207\slmult0 \up0 \expndtw-2\charscalex100 \ul0
\nosupersub\cf3\f4\fs18 ABSTRAK : \par\pard\qj \li1799\ri1655\sb13\sl-310\slmult
0\fi0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf4\f5\fs18 Neonatus dengan p
enyakit jantung bawaan (PJB) yang kompleks pada beberapa jam atau beberapa hari
setelah lahir \up0 \expndtw-1\charscalex100 sering tanpa disertai gejala klinis
yang jelas, tetapi sebagian neonatus dengan kelainan yang sama sudah memberikan
\up0 \expndtw0\charscalex100 gejala kritis. Perubahan sirkulasi fetal ke n
eonatal berlangsung dalam satu bulan pertama kehidupan, hal ini \up0 \expnd
tw-1\charscalex100 memberikan pola pikir rasional bahwa selama dalam periode ter
sebut, terutama pada saat keluar rumah sakit, sangat \up0 \expndtw0\charscalex10
2 perlu re-evaluasi cermat. Tujuannya untuk memantau perubahan sirkulasi fetal k
e neonatal sehingga kemungkinan \up0 \expndtw0\charscalex100 menderita PJB dapat
terdeteksi secara dini. Pola pikir ini memerlukan pemahaman dasar tentang sirku
lasi fetal dan \up0 \expndtw0\charscalex106 segala perubahan yang terjadi secara
fisiologis pada saat setelah lahir agar dapat melakukan evaluasi secara \up0 \e
xpndtw0\charscalex102 sistematis dan cermat. Deteksi dini terhadap PJB kritis pa
da neonatus mutlak diperlukan untuk memberikan terapi \up0 \expndtw0\charscalex1
05 awal sehingga kematian dini dapat dihindari serta dapat merencanakan tatalaks
ana lanjutan yang rasional dan \up0 \expndtw-1\charscalex100 adekuat. Perhatian
utama ditujukan terhadap gejala klinis gangguan sistem kardiovaskuler pada masa
neonatus, yaitu \up0 \expndtw0\charscalex100 : \ul0\nosupersub\cf3\f4\fs18 siano
sis sentral, penurunan perfusi perifer \ul0\nosupersub\cf4\f5\fs18 dan\ul0\nosup
ersub\cf3\f4\fs18 takipnea\ul0\nosupersub\cf4\f5\fs18 . Tatalaksana dini dan la
njutan yang optimal memerlukan \up0 \expndtw0\charscalex102 kesepakatan dan kerj
asama tim yang baik dari berbagai disiplin ilmu dan profesi, yaitu dokter umum,
dokter anak, \up0 \expndtw-1\charscalex100 neonatologi, kardiologi, bedah kardio
vaskuler dan anastesi serta perawat. \par\pard\ql \li1799\sb87\sl-207\slmult0 \u
p0 \expndtw-2\charscalex100 Kata kunci : PJB kritis, neonatus, gejala klinis \pa
r\pard\ql \li1799\sb0\sl-207\slmult0 \par\pard\ql\li1799\sb0\sl-207\slmult0 \par
\pard\ql\li1799\sb6\sl-207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub
\cf3\f4\fs18 ABSTRACT \par\pard\qj \li1799\sb0\sl-310\slmult0 \par\pard\qj\li179

9\ri1656\sb13\sl-310\slmult0\fi0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf
4\f5\fs18 The newborn with very complex heart disease is rarely symptomatic, ye
t many newborn infants with same defects are \up0 \expndtw-1\charscalex100 criti
cally ill within hours or days after birth. The transition from the fetal to a m
ore mature circulation occurs over the \up0 \expndtw0\charscalex100 first few we
eks of life so serial evaluations are necessary during this time, so it is extre
mely important for every infant \up0 \expndtw-1\charscalex100 to be carefully as
sessed at the time of discharge and at subsequent visits during the first month
of life. A comprehensive \up0 \expndtw0\charscalex103 understanding of fetal car
diovascular physiology and the changes that occur at birth is essential for deve
loping a \up0 \expndtw0\charscalex102 systematic approach to the diagnosis and t
reatment of a newborn with congenital cardiovascular disease. At birth, \up0 \ex
pndtw0\charscalex100 there are rapid dramatic changes in cardiovascular function
and blood flow patterns as the newborn adapts to a new \up0 \expndtw-1\charscal
ex100 circulation in which oxygen exchange occurs in the lungs, the placenta is
removed from the circulation. \par\pard\qj \li1799\ri1657\sb2\sl-310\slmult0 \up
0 \expndtw0\charscalex100 Early identification of the newborn with serious or li
fe-threatening heart disease is essential for optimal outcome. The \up0 \expndtw
0\charscalex100 evaluation should focus on the three cardinal signs of neonatal
cardiovascular distress: \ul0\nosupersub\cf3\f4\fs18 cyanosis, decrease systemic
\up0 \expndtw0\charscalex102 perfusion\ul0\nosupersub\cf4\f5\fs18 , and \ul0\no
supersub\cf3\f4\fs18 tachypnea.\ul0\nosupersub\cf4\f5\fs18 A thoughtful and rat
ional approach to the differential diagnosis is important for prompt \up0 \expnd
tw0\charscalex100 recognition and appropriate management. It is imperative
that a concerted team approach involving general \up0 \expndtw0\charscal
ex100 practitioner, pediatrician, neonatologist, cardiologist, nurse, surgeon, a
nd anesthesiologist are utilized. Effective and \up0 \expndtw0\charscalex100 ong
oing communication is essential for optimizing care and for providing a uniform
approach to the management of \up0 \expndtw-2\charscalex100 these complex medica
l patients. \par\pard\ql \li1800\sb86\sl-207\slmult0 \up0 \expndtw-2\charscalex1
00 Key words : Critical CHD, Neonate and clinical manifestation \par\pard\ql \li
10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\sb0\sl-276\slmult0 \par\pard\ql\li
10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\sb56\sl-276\slmult0 \up0 \expndtw3\charscalex100 \ul0\nosupersub\cf2\f3\fs24 2 \par\pard\sect\sectd\fs24\paperw12
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lmult0 \par\pard\ql\li1800\sb0\sl-253\slmult0 \par\pard\ql\li1800\sb112\sl-253\s
lmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf6\f7\fs22 PENDAHULUAN \pa
r\pard\qj \li1799\sb0\sl-379\slmult0 \par\pard\qj\li1799\ri1621\sb21\sl-379\slmu
lt0\fi720 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf7\f8\fs22 Penyakit jan
tung bawaan merupakan kelainan bawaan yang sering ditemukan, yaitu 10% \up0 \exp
ndtw0\charscalex103 dari seluruh kelainan bawaan dan sebagai penyebab uta
ma kematian pada masa neonatus. \up0 \expndtw-1\charscalex100 Perkembangan di bi
dang diagnostik, tatalaksana medikamentosa dan tehnik intervensi non bedah \up0
\expndtw0\charscalex103 maupun bedah jantung dalam 40 tahun terakhir memberikan
harapan hidup sangat besar pada \up0 \expndtw-1\charscalex100 neonatus dengan P
JB yang kritis. Bahkan dengan perkembangan ekokardiografi fetal, telah dapat \up
0 \expndtw0\charscalex102 dideteksi defek anatomi jantung, disritmia serta disfu
ngsi miokard pada masa janin.\ul0\super\cf8\f9\fs21 1\ul0\nosupersub\cf7\f8\fs22
Di bidang \up0 \expndtw-1\charscalex100 pencegahan terhadap timbulnya gangguan
organogenesis jantung pada masa janin, sampai saat ini \up0 \expndtw0\charscale
x102 masih belum memuaskan, walaupun sudah dapat diidentifikasi adanya multifakt
or yang saling \up0 \expndtw-3\charscalex100 berinteraksi yaitu faktor genetik d
an lingkungan. \ul0\super\cf8\f9\fs21 2,3 \par\pard\qj \li1799\ri1623\sb0\sl-379
\slmult0\fi720 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf7\f8\fs22 Kita sa
dari walaupun cara diagnostik canggih dan akurat telah berkembang dengan pesat,
\line \up0 \expndtw-1\charscalex100 namun hal ini tidak bisa dilakukan oleh seti
ap dokter terutama di daerah dengan sarana diagnostik \line \up0 \expndtw-1\char
scalex100 yang belum memadai. Hal ini tidak menjadi alasan bahwa seorang dokter
tidak mampu membuat \line \up0 \expndtw0\charscalex100 diagnosis dini dan sekali
gus terapi awal, yang dilanjutkan dengan rujukan untuk terapi definitif \line
\up0 \expndtw0\charscalex105 yaitu bedah korektif di pusat pelayanan jantung. Ol
eh karena itu, perlu dipahami perubahan-\line \up0 \expndtw0\charscalex100 perub
ahan sirkulasi fetal ke neonatal dan berbagai penyimpangannya dalam periode mi
nimal 1 \line \up0 \expndtw-1\charscalex100 bulan pertama. Keberhasilan deteksi
dini merupakan awal keberhasilan tatalaksana lanjutan PJB \line \up0 \expndtw3\charscalex100 kritis pada neonatus. \ul0\super\cf8\f9\fs21 2,4 \par\pard\ql \l
i1800\sb0\sl-253\slmult0 \par\pard\ql\li1800\sb232\sl-253\slmult0 \up0 \expndtw3\charscalex100 \ul0\nosupersub\cf6\f7\fs22 PERUBAHAN SISTEM SIRKULASI PADA SAAT
LAHIR \par\pard\qj \li1800\ri1621\sb23\sl-379\slmult0\fi900 \up0 \expndtw0\char
scalex100 Tangisan pertama\ul0\nosupersub\cf7\f8\fs22 merupakan proses masuknya
oksigen yang pertama kali ke dalam \up0 \expndtw-1\charscalex100 paru. Peristiw
a ini membuka alveoli, pengembangan paru serta penurunan tahanan ekstravaskular
\up0 \expndtw0\charscalex102 paru dan peningkatan tekanan oksigen sehingga terja
di vasodilatasi disertai penurunan tahanan \up0 \expndtw0\charscalex104 dan peni
pisan dinding arteri pulmonalis. Hal ini mengakibatkan penurunan tekanan ventrik
el \up0 \expndtw0\charscalex103 kanan serta peningkatan saturasi oksigen sistemi
k. Perubahan selanjutnya terjadi peningkatan \up0 \expndtw-2\charscalex100 alira
n darah ke paru secara progresif, sehingga mengakibatkan peningkatan tekanan di
atrium kiri \up0 \expndtw-1\charscalex100 sampai melebihi tekanan atrium kanan.
Kondisi ini mengakibatkan penutupan \ul0\nosupersub\cf10\f11\fs22 foramen ovale
\ul0\nosupersub\cf7\f8\fs22 juga \up0 \expndtw0\charscalex102 peningkatan tekan
an ventrikel kiri disertai peningkatan tekanan serta penebalan sistem arteri
\up0 \expndtw0\charscalex100 sistemik. Peningkatan tekanan oksigen sistemik dan
perubahan sintesis serta metabolisme bahan \up0 \expndtw0\charscalex100 vasoakt
if prostaglandin mengakibatkan kontraksi awal dan penutupan fungsional dari

duktus \up0 \expndtw-1\charscalex100 arteriosus yang mengakibatkan berlanjutnya
penurunan tahanan arteri pulmonalis. Pada neonatus \up0 \expndtw0\charscalex100
aterm normal, konstriksi awal dari duktus arteriosus terjadi pada 10-15 jam pert
ama kehidupan, \par\pard\ql \li10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\sb0
\sl-276\slmult0 \par\pard\ql\li10320\sb21\sl-276\slmult0 \up0 \expndtw-3\charsca
lex100 \ul0\nosupersub\cf2\f3\fs24 3 \par\pard\sect\sectd\fs24\paperw12240\paper
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0028a28a0028a28a0028a28a00ffd9}}}}}\pard\sb0\sl-240\par\pard\qj \li1800\sb0\sl-3
79\slmult0 \par\pard\qj\li1800\sb0\sl-379\slmult0 \par\pard\qj\li1800\ri1624\sb3
53\sl-379\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf7\f8\fs22 lalu
terjadi penutupan duktus arteriosus secara fungsional setelah 72 jam postnatal.
Kemudian \up0 \expndtw0\charscalex104 disusul proses trombosis, proliferasi inti
mal dan fibrosis setelah \up0 \expndtw0\charscalex104 3-4 minggu postnatal yang
\up0 \expndtw0\charscalex105 akhirnya terjadi penutupan secara anatomis. Pada ne
onatus prematur, mekanisme penutupan \up0 \expndtw-2\charscalex100 duktus arteri
osus ini terjadi lebih lambat, bahkan bisa sampai usia 4-12 bulan. \par\pard\qj
\li1800\ri1622\sb1\sl-379\slmult0\fi719 \up0 \expndtw0\charscalex105 \ul0\nosupe
rsub\cf6\f7\fs22 Pemotongan tali pusat\ul0\nosupersub\cf7\f8\fs22 mengakibat
kan peningkatan tahanan vaskuler sistemik, \up0 \expndtw0\charscalex104 terh
entinya aliran darah dan penurunan tekanan darah di vena cava inferior serta p
enutupan \up0 \expndtw-1\charscalex100 duktus venosus, sehingga tekanan di atriu
m kanan juga menurun sampai dibawah tekanan atrium \up0 \expndtw0\charscalex102
kiri. Hal ini mengakibatkan penutupan \ul0\nosupersub\cf10\f11\fs22 foramen ova
le\ul0\nosupersub\cf7\f8\fs22 , dengan demikian ventrikel kanan hanya \up0 \expn
dtw-1\charscalex100 mengalirkan darahnya ke arteri pulmonalis. Peristiwa ini dis
usul penebalan dinding ventrikel kiri \up0 \expndtw0\charscalex105 oleh karena m
enerima beban tekanan lebih besar untuk menghadapi tekanan arteri sistemik. \up0
\expndtw0\charscalex103 Sebaliknya ventrikel kanan mengalami penipisan aki
bat penurunan beban tekanan untuk \up0 \expndtw-2\charscalex100 menghadapi t
ekanan arteri pulmonalis yang mengalami penurunan ke angka normal. \par\pard\qj
\li1800\ri1624\sb2\sl-379\slmult0\fi719 \up0 \expndtw-2\charscalex100 Penutupan

duktus venosus, duktus arteriosus dan \ul0\nosupersub\cf10\f11\fs22 foramen oval
e\ul0\nosupersub\cf7\f8\fs22 diawali penutupan secara \up0 \expndtw0\charscalex
102 fungsional kemudian disusul adanya proses proliferasi endotel dan ja
ringan \ul0\nosupersub\cf10\f11\fs22 fibrous\ul0\nosupersub\cf7\f8\fs22 yang
\up0 \expndtw-2\charscalex100 mengakibatkan penutupan secara anatomis (permanen)
. \par\pard\qj \li1800\ri1624\sb0\sl-379\slmult0\fi719 \up0 \expndtw0\charscalex
100 Tetap terbukanya duktus venosus pada waktu lahir mengakibatkan \ul0\n
osupersub\cf10\f11\fs22 masking effect \line \up0 \expndtw0\charscalex103 \ul0
\nosupersub\cf7\f8\fs22 terhadap \ul0\nosupersub\cf10\f11\fs22 total anomalous p
ulmonary venous connection\ul0\nosupersub\cf7\f8\fs22 dibawah difragma. Tetap t
erbukanya \line \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf10\f11\fs22 foram
en ovale\ul0\nosupersub\cf7\f8\fs22 pada waktu lahir mengakibatkan \ul0\nosuper
sub\cf10\f11\fs22 masking effect \ul0\nosupersub\cf7\f8\fs22 terhadap kelainan
obstruksi \line \up0 \expndtw-1\charscalex100 jantung kanan. \up0 \expndtw0\cha
rscalex100 Tetap terbukanya duktus arteriosus pada waktu lahir mengakibatkan \ul
0\nosupersub\cf10\f11\fs22 masking \line \up0 \expndtw0\charscalex100 effect \ul
0\nosupersub\cf7\f8\fs22 terhadap semua PJB dengan \ul0\nosupersub\cf10\f11\fs
22 ductus dependent sistemic\ul0\nosupersub\cf7\f8\fs22 dan \ul0\nosupersub\cf1
0\f11\fs22 ductus dependent pulmonary \line \up0 \expndtw-3\charscalex100 circul
ation.\ul0\super\cf8\f9\fs21 5,6 \par\pard\qj \li1800\sb0\sl-379\slmult0 \par\pa
rd\qj\li1800\ri1627\sb3\sl-379\slmult0 \up0 \expndtw0\charscalex110 \ul0\nosuper
sub\cf6\f7\fs22 FAKTOR YANG MEMBUAT KECURIGAAN TERHADAP PJB KRITIS PADA \up0 \ex
pndtw-3\charscalex100 NEONATUS \par\pard\ql \li2159\sb106\sl-253\slmult0 \up0 \e
xpndtw-1\charscalex100 1.\ul0\nosupersub\cf11\f12\fs22 \ul0\nosupersub\cf6\f7\f
s22 Riwayat : \par\pard\ql \li2879\sb141\sl-253\slmult0 \up0 \expndtw-2\charsc
alex100 \ul0\nosupersub\cf12\f13\fs22 \u8226?\ul0\nosupersub\cf13\f14\fs22 \ul0
\nosupersub\cf7\f8\fs22 Famili dengan penyakit herediter, saudaranya dengan PJ
B \par\pard\ql \li2879\ri1625\sb38\sl-379\slmult0\tx3239 \up0 \expndtw0\charscal
ex104 \ul0\nosupersub\cf12\f13\fs22 \u8226?\ul0\nosupersub\cf13\f14\fs22 \ul0\n
osupersub\cf7\f8\fs22 Kehamilan dan perinatal : infeksi virus, obat yang dikon
sumsi si ibu terutama \line\tab \up0 \expndtw-3\charscalex100 saat kehamilan tri
mester I. \par\pard\ql \li2879\sb122\sl-253\slmult0 \up0 \expndtw-1\charscalex10
0 \ul0\nosupersub\cf12\f13\fs22 \u8226?\ul0\nosupersub\cf13\f14\fs22 \ul0\nosup
ersub\cf7\f8\fs22 Postnatal : kesulitan minum, sianosis sentral. \par\pard\ql
\li2159\sb128\sl-253\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf6\f
7\fs22 2.\ul0\nosupersub\cf11\f12\fs22 \ul0\nosupersub\cf6\f7\fs22 Pemeriksan
Fisik : \par\pard\ql \li2879\sb140\sl-253\slmult0 \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf12\f13\fs22 \u8226?\ul0\nosupersub\cf13\f14\fs22 \ul0\nosupe
rsub\cf7\f8\fs22 Auskultasi : harus dilakukan pertama kali sebelum bayi menang
is \par\pard\ql \li3211\ri2282\sb24\sl-379\slmult0 \up0 \expndtw-2\charscalex100
Frekuensi meningkat dan irama denyut jantung tidak teratur, suara jantung \up0
\expndtw-3\charscalex100 II mengeras atau tidak terdengar, terdengar bising jant
ung (kualitas, \line \up0 \expndtw-3\charscalex100 intensitas, \ul0\nosupersub\c
f10\f11\fs22 timing\ul0\nosupersub\cf7\f8\fs22 , lokasi), \ul0\nosupersub\cf10\
f11\fs22 gallop. \ul0\nosupersub\cf7\f8\fs22 Tidak semua bising jantung pada \p
ar\pard\ql \li10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\sb268\sl-276\slmult0
\up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf2\f3\fs24 4 \par\pard\sect\sect
d\fs24\paperw12240\paperh15840{\shp
z-10000\shplid4
ffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
00110803e7030403012200021101031101ffc4001f00000105010101010101000000000000000001
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2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
53\sl-379\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf7\f8\fs22 neon
atus adalah PJB dan tidak semua neonatus dengan PJB terdengar \up0 \expndtw-3\c
harscalex100 bising jantung. \par\pard\ql \li2880\ri1623\sb16\sl-379\slmult0\tx3
240\tx3240 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf12\f13\fs22 \u8226?\ul
0\nosupersub\cf13\f14\fs22 \ul0\nosupersub\cf7\f8\fs22 Sianosis sentral, penu
runan perfusi perifer, hiperaktivitas prekordial, \ul0\nosupersub\cf10\f11\fs22
thrill,\ul0\nosupersub\cf7\f8\fs22 pulse \line\tab \up0 \expndtw0\charscalex105
dan tekanan darah ke 4 ekstremitas berbeda bermakna, takipnea, takikardia, \li
ne \tab \up0 \expndtw-3\charscalex100 edema. \par\pard\qj \li2340\ri1624\sb0\sl379\slmult0 \up0 \expndtw0\charscalex100 Tidak semua gejala tersebut timbul pada
masa neonatus dan tidak semua neonatus dengan \up0 \expndtw0\charscalex103 geja
la tersebut memerlukan tindakan spesifik yang harus segera dilaksanakan
tapi \up0 \expndtw-3\charscalex100 memerlukan pemeriksaan tambahan, yaitu : \pa
r\pard\ql \li2159\sb105\sl-253\slmult0 \up0 \expndtw-3\charscalex100 3. \ul0\nos
upersub\cf6\f7\fs22 Pemeriksaan tambahan : \par\pard\ql \li2879\ri1625\sb38\sl-3
80\slmult0\tx3239 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf12\f13\fs22 \u
8226?\ul0\nosupersub\cf13\f14\fs22 \ul0\nosupersub\cf7\f8\fs22 Foto polos dad
a : adanya kelainan letak, ukuran dan bentuk jantung, vaskularisasi \line\tab \u
p0 \expndtw-3\charscalex100 paru, edema paru, parenkim paru, letak gaster dan he
par. \par\pard\ql \li2879\ri1624\sb16\sl-379\slmult0\tx3239 \up0 \expndtw0\chars
calex104 \ul0\nosupersub\cf12\f13\fs22 \u8226?\ul0\nosupersub\cf13\f14\fs22 \ul
0\nosupersub\cf7\f8\fs22 Elektrokardiografi : adanya kelainan frekuensi, irama
, aksis gelombang P dan \line\tab \up0 \expndtw-3\charscalex100 QRS, voltase di
sandapan prekordial. \par\pard\ql \li2131\sb106\sl-253\slmult0 \up0 \expndtw-3\c
harscalex100 \ul0\nosupersub\cf6\f7\fs22 4. Pada monitoring\ul0\nosupersub\cf7\f
8\fs22 , ditemukan kelainan berupa : \par\pard\ql \li2879\ri1615\sb39\sl-379\sl
mult0\tx3240 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf12\f13\fs22 \u8226?\
ul0\nosupersub\cf13\f14\fs22 \ul0\nosupersub\cf7\f8\fs22
Perbedaan saturasi
O\ul0\sub\cf8\f9\fs21 2\ul0\nosupersub\cf7\f8\fs22 arteri dengan \ul0\nosuper
sub\cf10\f11\fs22 pulse\ul0\nosupersub\cf7\f8\fs22 oksimetri pada preduktal (ta
ngan \line\tab \up0 \expndtw-4\charscalex100 kanan) dan
postduktal (kaki). \p
ar\pard\ql \li2880\ri1625\sb16\sl-380\slmult0\tx3240 \up0 \expndtw0\charscalex10
0 \ul0\nosupersub\cf12\f13\fs22 \u8226?\ul0\nosupersub\cf13\f14\fs22 \ul0\nosup
ersub\cf7\f8\fs22 pH arteri, dan analis gas darah terhadap hipoksemia dan asid
osis metabolik (pada \line\tab \up0 \expndtw-3\charscalex100 neonatus dengan gag
al jantung ada peningkatan CO\ul0\sub\cf8\f9\fs21 2\ul0\nosupersub\cf7\f8\fs22 )
.\ul0\super\cf8\f9\fs21 7-9 \par\pard\qj \li1799\ri1621\sb0\sl-379\slmult0\fi720
\up0 \expndtw0\charscalex103 \ul0\nosupersub\cf7\f8\fs22 Berdasarkan riwayat pr
enatal, natal dan postnatal yang cermat serta pemeriksaan fisis \up0 \expndtw0\c
harscalex106 yang sistematis dan teliti serta pemeriksaan tambahan dan monitorin
g, maka gejala sianosis \up0 \expndtw0\charscalex100 sentral, penurunan perfusi

perifer dan takipnea akibat PJB kritis pada neonatus bisa ditegakkan. \up0 \expn
dtw-1\charscalex100 Dengan demikian dapat segera diberikan terapi awal untuk men
cegah kematian dini dan sekaligus \up0 \expndtw0\charscalex105 dapat direncanaka
n tatalaksana lanjutan yang tepat, rasional dan adekuat. Bilamana fasilitas \up0
\expndtw0\charscalex105 kesehatan yang memadai tidak tersedia dan neonatus suda
h dalam kondisi yang relatif stabil \up0 \expndtw-2\charscalex100 maka dapat dip
ersiapkan pelaksanaan rujukan ke pusat pelayanan jantung yang terjangkau. \par\p
ard\qj \li1799\ri1624\sb0\sl-379\slmult0\fi720 \up0 \expndtw0\charscalex106 Peni
ngkatan impuls parasternal dan subxyphoid sering dijumpai pada PJB sianosis, \li
ne \up0 \expndtw0\charscalex103 terabanya impuls ventrikel kiri menunjukkan adan
ya dilatasi ventrikel kiri akibat peningkatan \line \up0 \expndtw0\charscalex103
beban volume. Bising jantung sering ditemukan pada neonatus normal dan
sering tidak \line \up0 \expndtw0\charscalex100 ditemukan pada neontus dengan
PJB. Bising jantung yang bersifat sistolik ejeksi yang menjalar \line \up0 \exp
ndtw0\charscalex100 ke leher akibat lesi obstruksi jantung kiri atau bila terd
engar penjalarannya ke punggung maka \line \up0 \expndtw0\charscalex106 curiga a
danya lesi obstruksi jantung kanan. Pembesaran dan lokasi hepar sangat membantu
\line \up0 \expndtw0\charscalex103 adanya peningkatan volume darah dan tekanan a
trium kanan, aliran darah ke paru dan adanya \line \up0 \expndtw-3\charscalex100
situs inversus. \par\pard\ql \li10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\s
b79\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf2\f3\fs24 5 \
par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
z-10000\shplid5
ffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
00110803e7030403012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
53\sl-379\slmult0\fi720 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf6\f7\fs22
Gejala sianosis\ul0\nosupersub\cf7\f8\fs22 \ul0\nosupersub\cf6\f7\fs22 sentral
\ul0\nosupersub\cf7\f8\fs22 pada penyakit jantung bawaan biru (\ul0\nosupersub\
cf10\f11\fs22 Cardiac cyanosis\ul0\nosupersub\cf7\f8\fs22 ) sering \up0 \expndtw
0\charscalex102 belum terdeteksi pada saat neonatus keluar rumah sakit. Terdapat
beberapa keadaan yang juga \up0 \expndtw0\charscalex107 memberikan gejala hampi

r sama yaitu : penyakit parenkhim paru, sirkulasi fetal persisten, \up0 \expndt
w0\charscalex102 kelainan sisitem saraf sentral dan kelainan hematologi. Penyaki
t parenkhim paru selalu disertai \up0 \expndtw0\charscalex100 distres nafas yang
segera memerlukan ventilator dan ditemukan kelainan pada pemeriksaan foto \up0
\expndtw0\charscalex100 polos dada. Sirkulasi fetal yang persisten akibat f
aktor intrauterin sehingga dinding arteria \up0 \expndtw0\charscalex103 pulm
onalis tetap menebal dan tekanannya tetap tinggi yang sering ditandai distres na
fas yang \up0 \expndtw0\charscalex100 ringan atau sedang, riwayat asfiksia, sind
roma aspirasi mekonium dan prematuritas serta riwayat \up0 \expndtw-3\charscalex
100 ibu mengkonsumsi steroid pada bulan terakhir kehamilan. \par\pard\qj \li1799
\ri1624\sb0\sl-379\slmult0\fi720 \up0 \expndtw-1\charscalex100 Tetap terbukanya
duktus pada beberapa jam atau hari setelah lahir akan mempertahankan \up0 \expnd
tw0\charscalex100 pasokan darah ke sistem sirkulasi paru tetap normal (\ul0\nosu
persub\cf14\f15\fs22 ductus dependent pulmonary circulation\ul0\nosupersub\cf7\f
8\fs22 ). \up0 \expndtw0\charscalex100 Kondisi ini meniadakan gejala sianosis se
ntral (\ul0\nosupersub\cf10\f11\fs22 masking effect\ul0\nosupersub\cf7\f8\fs22 )
sehingga tidak ada persangkaan \up0 \expndtw0\charscalex103 adanya PJB biru pad
a neonatus yang sedang kita hadapi. Peningkatan kebutuhan oksigen oleh \up0 \exp
ndtw0\charscalex106 tangisan atau aktivitas minum serta peningkatan satura
si oksigen kearah nilai normal \up0 \expndtw0\charscalex102 mengakibatkan ra
ngsangan penutupan duktus. Pada saat ini baru timbul gejala sianosis sentral \up
0 \expndtw0\charscalex106 walaupun kadang masih bersifat transient, yaitu teruta
ma pada saat menangis atau aktivitas \up0 \expndtw0\charscalex100 minum. Penutup
an duktus masih terjadi secara anatomis tetapi secara fungsionil masih terbuka.
\up0 \expndtw0\charscalex102 Pada kondisi seperti ini pemeriksaan saturasi oksig
en secara serial dengan cara \ul0\nosupersub\cf10\f11\fs22 pulse oxymetri \up0 \
expndtw0\charscalex102 \ul0\nosupersub\cf7\f8\fs22 memang diperlukan. \ul0\nosup
ersub\cf10\f11\fs22 Hyperoxic-test,\ul0\nosupersub\cf7\f8\fs22 pemberian oksige
n 100 % dengan kecepatan 1 liter/menit \up0 \expndtw-1\charscalex100 selama 10 m
enit, bila saturasi O2 >98% bukan PJB sianosis, bila saturasi O2 >90% kemungkina
n \up0 \expndtw-2\charscalex100 suatu PJB sianosis, tapi bila saturasi O2 tetap
dibawah 90% hampir dipastikan suatu PJB sianosis. \par\pard\qj \li1799\ri1621\sb
2\sl-379\slmult0\fi720 \up0 \expndtw-1\charscalex100 Kondisi hipoksemia ini mera
ngsang kemoreseptor sehingga menimbulkan gejala takipnea \up0 \expndtw0\charscal
ex104 ringan dengan ventilasi yang tetap normal. Dengan demikian tidak disertai
gejala pernafasan \up0 \expndtw0\charscalex100 cuping hidung, retraksi ruang iga
maupun suara pernafasan \ul0\nosupersub\cf10\f11\fs22 grunting.\ul0\nosupersub\
cf7\f8\fs22 Hipoksemia akan berjalan \up0 \expndtw0\charscalex103 progresif dal
am beberapa hari dengan terjadinya penutupan duktus yang sudah persisten yaitu \
up0 \expndtw0\charscalex100 secara anatomis maupun fungsional. Gejala sianosis s
entral semakin nyata dan tampak menetap, \up0 \expndtw-2\charscalex100 yaitu wal
aupun pada saat tidur maupun beraktivitas. \par\pard\qj \li1799\ri1621\sb0\sl-37
9\slmult0\fi720 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf6\f7\fs22 Gejala
penurunan perfusi perifer\ul0\nosupersub\cf7\f8\fs22 akibat terganggunya aliran
darah ke perifer karena \up0 \expndtw0\charscalex100 tidak terbentuknya struktu
r jantung kiri, obstruksi di tingkat aorta atau disfungsi miokard akibat \up0 \e
xpndtw0\charscalex100 sepsis, hipoglikemia, hipokalsemia, asidosis metabolik, an
emia dan polisitemia. Dalam beberapa \up0 \expndtw0\charscalex104 jam pertama se
telah lahir, oleh pengaruh duktus yang masih terbuka akan meniadakan gejala \up0
\expndtw0\charscalex100 (\ul0\nosupersub\cf10\f11\fs22 masking effect\ul0\nosup
ersub\cf7\f8\fs22 ) penurunan perfusi perifer (\ul0\nosupersub\cf14\f15\fs22 duc
tus dependent systemic circulation\ul0\nosupersub\cf7\f8\fs22 ). Penutupan \up0
\expndtw-1\charscalex100 duktus akan menimbulkan penurunan aliran darah ke siste
m arteri perifer, hal ini mengakibatkan \par\pard\ql \li10320\sb0\sl-276\slmul
t0 \par\pard\ql\li10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\sb0\sl-276\slmul
t0 \par\pard\ql\li10320\sb159\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\
nosupersub\cf2\f3\fs24 6 \par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
z-10000\shplid6

ffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
00110803e7030403012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
53\sl-379\slmult0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf7\f8\fs22 penur
unan perfusi perifer dengan gejala berupa tidak mau minum, pucat dan berkeringat
disertai \up0 \expndtw-3\charscalex100 distres nafas. \par\pard\qj \li1800\ri16
23\sb0\sl-379\slmult0\fi720 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf6\f7\
fs22 Gejala takipnea \ul0\nosupersub\cf7\f8\fs22 pada neonatus dengan PJB non
sianotik\ul0\nosupersub\cf6\f7\fs22 \ul0\nosupersub\cf7\f8\fs22 (terdapat pirau
kiri ke kanan) \up0 \expndtw0\charscalex100 baru terjadi beberapa hari atau
minggu kehidupan, yaitu setelah terjadi penurunan tahanan \up0 \expndtw0\ch
arscalex100 pembuluh darah paru dan penurunan hemoglobin kearah normal. Oleh kar
ena itu, takipnea yang \up0 \expndtw0\charscalex104 timbul segera setelah lahir
tanpa disertai gejala sianosis sentral dan penurunan perfusi perifer \up0 \expnd
tw0\charscalex100 menunjukkan suatu kelainan paru, bukan PJB !. Neonatus normal
bernafas lebih cepat daripada \up0 \expndtw-2\charscalex100 bayi, namun tidak le
bih dari 60 kali per menit untuk periode waktu yang lama. \par\pard\qj \li1800\s
b0\sl-379\slmult0 \par\pard\qj\li1800\ri1625\sb2\sl-379\slmult0 \up0 \expndtw0\c
harscalex102 \ul0\nosupersub\cf6\f7\fs22 PENDEKATAN KLINIS UNTUK PENYAKIT JANTUN
G BAWAAN SIANOSI YANG \up0 \expndtw0\charscalex101 DISERTAI PENURUNAN ALIRAN DAR
AH KE PARU (\ul0\nosupersub\cf14\f15\fs22 CARDIAC CYANOSIS\ul0\nosupersub\cf6\f7
\fs22 ) PADA \up0 \expndtw-3\charscalex100 NEONATUS \par\pard\qj \li1800\sb0\sl379\slmult0 \par\pard\qj\li1800\ri1623\sb1\sl-379\slmult0\fi720 \up0 \expndtw-1\
charscalex100 \ul0\nosupersub\cf7\f8\fs22 Sianosis adalah manifestasi klinis ter
sering dari PJB simptomatik pada neonatus. Sianosis \up0 \expndtw0\charscalex107
tanpa disertai gejala distres nafas yang jelas hampir selalu akibat PJB, sebab
pada kelainan \up0 \expndtw0\charscalex100 parenkhim paru yang sudah sangat bera
t saja yang baru bisa memberikan gejala sianosis dengan \up0 \expndtw-3\charscal
ex100 demikian selalu disertai gejala distres nafas yang berat. \par\pard\qj \li
1799\ri1624\sb0\sl-379\slmult0\fi720 \up0 \expndtw0\charscalex104 Pada neonatus
normal, pelepasan oksigen ke jaringan harus sesuai dengan kebutuhan \up0 \expndt
w0\charscalex103 metabolismenya. Jumlah oksigen yang dilepaskan ke jaringan berg
antung kepada aliran darah \up0 \expndtw0\charscalex105 sistemik, kadar hemoglo
bin dan saturasi oksigen arteri sistemik. Pada saat lahir, kebutuhan \up0 \expnd
tw0\charscalex102 oksigen meningkat sampai \up0 \expndtw0\charscalex105 3 kal

i lipat untuk memenuhi kebutuhan metabolisme agar \up0 \expndtw0\charscale
x100 menghasilkan enersi untuk bernafas dan termoregulasi. Untuk ini diperlukan
peningkatan aliran \up0 \expndtw0\charscalex100 darah sistemik 2 kali lipat dan
saturasi oksigen 25% sehingga pelepasan dan pengikatan oksigen \up0 \expndtw-2\c
harscalex100 di jaringan juga meningkat sesuai kebutuhan. sianosis perifer (\ul0
\nosupersub\cf10\f11\fs22 acrocyanosis\ul0\nosupersub\cf7\f8\fs22 ) sering dijum
pai pada \up0 \expndtw-1\charscalex100 neonatus , hal ini akibat tonus vasomotor
perifer yang belum stabil. Tampak warna kebiruan pada \up0 \expndtw0\charscalex
104 ujung jari tangan dan kaki serta daerah sekitar mulut, disertai suhu yang di
bawah normal dan \up0 \expndtw-3\charscalex100 hiperoksia tes menunjukkan hasil
yang negatip. \par\pard\qj \li1799\ri1624\sb0\sl-379\slmult0\fi720 \up0 \expndtw
0\charscalex100 Pada neonatus dengan PJB sianosis, tidak mampu meningkatkan satu
rasi oksigen arteri \up0 \expndtw0\charscalex100 sistemik, justru sangat menurun
drastis saat lahir, sehingga pelepasan dan pengikatan oksigen di \up0 \expndtw0
\charscalex103 jaringan menurun. Kondisi ini bila tidak segera diatasi mengakiba
tkan metabolisme anaerobik \up0 \expndtw-2\charscalex100 dengan akibat selanjutn
ya berupa asidosis metabolik, hipoglikemi, hipotermia dan kematian. \par\pard\qj
\li1799\ri1625\sb0\sl-379\slmult0\fi720\tx7307 \up0 \expndtw0\charscalex101 Sia
nosis sentral akibat penyakit jantung bawaan \tab \up0 \expndtw0\charscalex
100 (\ul0\nosupersub\cf14\f15\fs22 Cardiac cyanosis\ul0\nosupersub\cf7\f8\fs22
) yang disertai \up0 \expndtw0\charscalex105 penurunan aliran darah ke paru ol
eh karena ada hambatan pada jantung kanan, yaitu katup \up0 \expndtw-1\charsca
lex100 trikuspid atau arteri pulmonalis. Kondisi ini mengakibatkan kegagalan pro
ses oksigenasi darah di \par\pard\ql \li10320\sb0\sl-276\slmult0 \par\pard\ql\li
10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\sb55\sl-276\slmult0 \up0 \expndtw3\charscalex100 \ul0\nosupersub\cf2\f3\fs24 7 \par\pard\sect\sectd\fs24\paperw12
240\paperh15840{\shp
z-10000\shplid7
ffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
00110803e7030403012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
53\sl-379\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf7\f8\fs22 paru
sehingga darah dengan kadar oksigen yang rendah (\ul0\nosupersub\cf14\f15\fs22

unoxygenated\ul0\nosupersub\cf7\f8\fs22 ) akan beredar ke sirkulasi \line \up0 \
expndtw0\charscalex102 arteri sistemik melalui \ul0\nosupersub\cf10\f11\fs22 for
amen ovale\ul0\nosupersub\cf7\f8\fs22 atau VSD (pada tetralogy Fallot). Seluruh
jaringan tubuh \line \up0 \expndtw0\charscalex104 akan mengalami hipoksia dan m
enimbulkan gejala klinis berupa sianosis sentral tanpa gejala \line \up0 \expndt
w-1\charscalex100 gangguan pernafasan. Kesulitan akan timbul, bila sianosis dise
rtai tanda-tanda distres pernafasan. \line \up0 \expndtw0\charscalex100 Terdapat
nya anemia berat mengakibatkan jumlah Hb yang tereduksi tidak cukup menimbulkan
\line \up0 \expndtw0\charscalex100 gejala sianosis. Adanya pigmen yang gelap ser
ing mengganggu sianosis sentral yang berderajat \line \up0 \expndtw0\charscalex1
02 ringan akibat PJB. Sianosis perifer bila disertai bising \ul0\nosupersub\c
f10\f11\fs22 inoccent\ul0\nosupersub\cf7\f8\fs22 dapat menyesatkan dugaan \
line \up0 \expndtw-2\charscalex100 adanya PJB sianotik. \par\pard\qj \li1800\ri1
624\sb1\sl-379\slmult0\fi720 \up0 \expndtw0\charscalex104 Beberapa kondisi klini
s yang memberikan dugaan \ul0\nosupersub\cf10\f11\fs22 cardiac cynosis\ul0\nosup
ersub\cf7\f8\fs22 pada neonatus dan \up0 \expndtw0\charscalex100 sudah merupaka
n alasan yang cukup untuk merujuk ke rumah sakit yang lebih lengkap, didasari \u
p0 \expndtw-3\charscalex100 beberapa alasan tambahan sebagai berikut : \par\par
d\ql \li2160\sb105\sl-253\slmult0 \up0 \expndtw-2\charscalex100 1.\ul0\nosupersu
b\cf13\f14\fs22 \ul0\nosupersub\cf7\f8\fs22 Hipoksemia sistemik menimbulkan g
ejala sianosis sentral \par\pard\ql \li2160\sb128\sl-253\slmult0 \up0 \expndtw-2
\charscalex100 2.\ul0\nosupersub\cf13\f14\fs22 \ul0\nosupersub\cf7\f8\fs22 Si
anosis sentral akibat PJB tidak timbul segera setelah lahir \par\pard\ql \li216
0\sb126\sl-253\slmult0 \up0 \expndtw-1\charscalex100 3.\ul0\nosupersub\cf13\f14\
fs22 \ul0\nosupersub\cf7\f8\fs22 Sianosis sentral tidak tampak selama saturas
i oksigen arteri masih diatas 85% \par\pard\qj \li2160\ri1625\sb22\sl-379\slmult
0\tx2519 \up0 \expndtw0\charscalex103 4.\ul0\nosupersub\cf13\f14\fs22 \ul0\nosu
persub\cf7\f8\fs22 Sianosis sentral dengan frekuensi pernafasan yang cepat (hi
perventilasi) tanpa disertai \line\tab \up0 \expndtw-2\charscalex100 pernafasan
cuping hidung dan retraksi ruang iga serta kadar CO2 yang rendah. \par\pard\ql \
li2159\sb107\sl-253\slmult0 \up0 \expndtw-2\charscalex100 5.\ul0\nosupersub\cf13
\f14\fs22 \ul0\nosupersub\cf7\f8\fs22 Sianosis sentral dengan tes hiperoksia
positip. \par\pard\ql \li2159\ri1569\sb22\sl-379\slmult0\tx2519\tx2519\tx2519 \u
p0 \expndtw0\charscalex102 6.\ul0\nosupersub\cf13\f14\fs22 \ul0\nosupersub\cf7\
f8\fs22 Harus dicari apakah aliran darah sistemik berasal dari ventrikel kanan
atau kiri, adanya \line\tab \up0 \expndtw0\charscalex106 duktus yang masih terb
uka mengakibatkan aliran darah aorta asenden dan disenden \line \tab \up0 \expnd
tw0\charscalex103 berasal dari ventrikel yang tidak sama. Pada kondisi ini diper
lukan pemasangan \ul0\nosupersub\cf10\f11\fs22 pulse \line \tab \up0 \expndtw-9\
charscalex100 oxymetri\ul0\nosupersub\cf7\f8\fs22 pada tangan kanan dan kaki.\
ul0\super\cf15\f16\fs21 1\ul0\nosupersub\cf8\f9\fs14 1\ul0\nosupersub\cf15\f16\f
s14 ,\ul0\nosupersub\cf8\f9\fs14 ,\ul0\nosupersub\cf15\f16\fs14 5\ul0\nosupersub
\cf8\f9\fs14 5\ul0\nosupersub\cf15\f16\fs14 ,\ul0\nosupersub\cf8\f9\fs14 ,\ul0\n
osupersub\cf15\f16\fs14 6\ul0\nosupersub\cf8\f9\fs14 6 \par\pard\qj \li1800\sb0\
sl-379\slmult0 \par\pard\qj\li1800\ri1627\sb3\sl-379\slmult0 \up0 \expndtw0\char
scalex100 \ul0\nosupersub\cf6\f7\fs22 PENDEKATAN KLINIS UNTUK PENYAKIT JANTUNG B
AWAAN YANG DISERTAI \up0 \expndtw-3\charscalex100 PENINGKATAN ALIRAN DARAH KE PA
RU (NON SIANOSIS) PADA NEONATUS \par\pard\qj \li1800\sb0\sl-379\slmult0 \par\par
d\qj\li1800\ri1621\sb1\sl-379\slmult0\fi719 \up0 \expndtw0\charscalex100 \ul0\no
supersub\cf7\f8\fs22 Pada neonatus neonatus normal, saat lahir masih disertai ta
hanan arteri pulmonalis yang \up0 \expndtw0\charscalex103 tinggi. Setelah 4-12
minggu terjadi penurunan tahanan arteri pulmonalis sampai menuju nilai \up0 \exp
ndtw0\charscalex100 normal. Pada neonatus dengan PJB non sianotik, selama tahana
n arteri pulmonalis masih tinggi, \up0 \expndtw-2\charscalex100 defek jantung ya
ng ada belum menimbulkan perubahan aliran darah dari sistemik ke paru. Setelah \
up0 \expndtw-2\charscalex100 4-12 minggu postnatal, pada saat terjadi penurunan
tahanan arteri pulmonalis sampai menuju nilai \up0 \expndtw0\charscalex100 norma
l, defek jantun yang dan akan menimbulkan perubahan aliran darah yaitu yang seha
rusnya \up0 \expndtw0\charscalex104 ke sistemik berubah menuju ke paru. Pada saa
t inilah baru terjadi pirau kiri ke kanan disertai \up0 \expndtw0\charscalex104

gejala klinis berupa mulai terdengarnya bising sampai
gagal jantung dengan
gejala utama \par\pard\ql \li1800\sb107\sl-253\slmult0 \up0 \expndtw-2\charscal
ex100 \ul0\nosupersub\cf6\f7\fs22 takipnea. \par\pard\ql \li10320\sb0\sl-276\slm
ult0 \par\pard\ql\li10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\sb75\sl-276\sl
mult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf2\f3\fs24 8 \par\pard\sect
\sectd\fs24\paperw12240\paperh15840{\shp
z-10000\shplid8
ffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
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31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
53\sl-379\slmult0\fi0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf7\f8\fs22 H
arus dibedakan takipnea akibat PJB dan akibat kelainan parenkhim paru, Takipnea
akibat PJB \up0 \expndtw0\charscalex102 non sianosis pada neonatus baru timbul b
ila peningkatan aliran darah ke paru sampai lebih dari \up0 \expndtw0\charscalex
105 2,5 kali aliran normal. Takipnea akibat penyakit paru pada neonatus sudah ti
mbul walaupun \up0 \expndtw0\charscalex105 peningkatan aliran darah ke paru masi
h ringan-ringan saja. Adanya penyakit pada paru akan \up0 \expndtw-3\charscalex1
00 memperjelas gejala takipnea pada PJB usia neonatus. \par\pard\qj \li1800\ri16
23\sb0\sl-379\slmult0 \up0 \expndtw0\charscalex104 Peningkatan aliran darah ke p
aru mengakibatkan peningkatan tekanan prekapiler di paru dan \up0 \expndtw0\char
scalex100 aliran limfatik sehingga terjadi peningkatan cairan intersisial di par
enkhim paru dan terutama di \up0 \expndtw0\charscalex100 peribronkhial. Hal ini
mengakibatkan penurunan fungsi bronkhioli dan terjadi penurunan aliran \up0 \e
xpndtw0\charscalex102 udara serta peningkatan tekanan udara, kondisi ini
meningkatkan \ul0\nosupersub\cf10\f11\fs22 work of breathing\ul0\nosupersub\c
f7\f8\fs22 dan \up0 \expndtw-3\charscalex100 terdengarnya \ul0\nosupersub\cf10
\f11\fs22 wheezing expiratoir\ul0\nosupersub\cf7\f8\fs22 . \ul0\super\cf8\f9\fs2
1 1,8,9 \par\pard\qj \li1800\ri1627\sb380\sl-380\slmult0 \up0 \expndtw0\charscal
ex100 \ul0\nosupersub\cf6\f7\fs22 PENDEKATAN KLINIS UNTUK PENYAKIT JANTUNG BAWAA
N YANG DISERTAI \up0 \expndtw-3\charscalex100 PENURUNAN ALIRAN DARAH KE SISTEMIK
PADA NEONATUS \par\pard\qj \li1799\ri1624\sb378\sl-379\slmult0\fi720 \up0 \expn
dtw-1\charscalex100 \ul0\nosupersub\cf7\f8\fs22 Penurunan aliran darah ke sistem
ik akibat PJB pada neonatus berupa a) hambatan aliran \up0 \expndtw0\charscale

x100 darah dari paru atau atrium kiri ke ventrikel kiri, b) ventrikel kiri tidak
adekuat memompa darah \up0 \expndtw0\charscalex100 ke aorta. Kedua kondisi ini
mengakibatkan peningkatan tekanan vena paru dan edema paru serta \up0 \expndtw0\
charscalex100 penurunan perfusi organ-organ vital. Gejala klinis tampak segera
setelah lahir dan berat, berupa \up0 \expndtw0\charscalex103 penurunan suhu kul
it dan perubahan warna kulit yang pucat, penurunan tekanan darah sampai \up0 \ex
pndtw0\charscalex105 tidak terukur, sulit atau tidak terabanya denyut nadi perif
er, hiperaktif RV,
dan penurunan \up0 \expndtw-2\charscalex100 \ul0\nosupersu
b\cf10\f11\fs22 capillary refile\ul0\nosupersub\cf7\f8\fs22 , metabolik asidosis
berat\ul0\nosupersub\cf10\f11\fs22 \ul0\nosupersub\cf7\f8\fs22 serta distres n
afas sedang sampai berat. \par\pard\qj \li1800\ri1623\sb2\sl-379\slmult0\fi720 \
up0 \expndtw0\charscalex104 Denyut nadi dan tekanan darah harus diukur pada ektr
emitas atas dan bawah, normal \up0 \expndtw0\charscalex106 tekanan darah ekstrem
itas bawa lebih tinggi. Bila ada perbedaan denyut nadi tanpa disertai \up0 \expn
dtw0\charscalex105 perbedaan tekanan darah, harus diraba pulsasi arteri karotis.
Perbedaan pulsasi arteri karotis \up0 \expndtw0\charscalex100 dengan pulsasi ek
stremitas bawah dan ekstremitas bawah menunjukkan kemungkinan koartasio \up0 \ex
pndtw0\charscalex103 aorta, \ul0\nosupersub\cf10\f11\fs22 interrupted\ul0\nosupe
rsub\cf7\f8\fs22 aorta atau arteri subklavia berasal dari aorta d Ada 2 keadaan
pada neonatus \up0 \expndtw-2\charscalex100 yang baru lahir dengan penrunan per
fusi perifer disertai gejala distres nafas derajat sedang sampai \up0 \expndtw-2
\charscalex100 berat yang disertai retraksi ruang iga, subkosta, nafas cuping hi
dung dan \ul0\nosupersub\cf10\f11\fs22 grunting\ul0\nosupersub\cf7\f8\fs22 , yai
tu \ul0\nosupersub\cf10\f11\fs22 persistent \up0 \expndtw0\charscalex100 pulmona
ry hypertension\ul0\nosupersub\cf7\f8\fs22 dan \ul0\nosupersub\cf10\f11\fs22 to
tal anomalous pulmonary venous return\ul0\nosupersub\cf7\f8\fs22 . Kedua kondisi
ini sulit \up0 \expndtw0\charscalex104 dibedakan !, pada\ul0\nosupersub\cf10\f1
1\fs22 persistent pulmonary hypertension \ul0\nosupersub\cf7\f8\fs22 sering d
isertai riwayat prenatal berupa \up0 \expndtw-2\charscalex100 ketuban pecah dini
, sindroma aspirasi mekonium atau asfiksia berat.\ul0\super\cf8\f9\fs21 1,8,9 \p
ar\pard\ql \li10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\sb0\sl-276\slmult0 \
par\pard\ql\li10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\sb0\sl-276\slmult0 \
par\pard\ql\li10320\sb0\sl-276\slmult0 \par\pard\ql\li10320\sb0\sl-276\slmult0 \
par\pard\ql\li10320\sb89\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosup
ersub\cf2\f3\fs24 9 \par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
z-10000\shplid9
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01010101010101010101010101010101010101010101010101010101010101010101010101010101
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ffd9}}}}}\pard\sb0\sl-240\par\pard\qj \li1800\sb0\sl-380\slmult0 \par\pard\qj\li
1800\sb0\sl-380\slmult0 \par\pard\qj\li1800\sb0\sl-380\slmult0 \par\pard\qj\li18
00\sb0\sl-380\slmult0 \par\pard\qj\li1800\ri1633\sb350\sl-380\slmult0\tx2700 \up
0 \expndtw-2\charscalex100 \ul0\nosupersub\cf6\f7\fs22 Tabel 1 : Kelainan jantun
g yang memberikan gejala DALAM 2 minggu pertama kehidupan \line\tab \up0 \expndt
w-2\charscalex100 postnatal \par\pard\li2074\sb0\sl-230\slmult0\par\pard\li2074\
sb0\sl-230\slmult0\par\pard\li2074\sb121\sl-230\slmult0\fi1336\tx7339\tx9288 \up
0 \expndtw-3\charscalex100 \ul0\nosupersub\cf18\f19\fs20 Obstruksi Jantung\tab \
up0 \expndtw-3\charscalex100 Obstruksi Jantung\tab \up0 \expndtw-2\charscalex100
Pirau kiri\par\pard\li2074\sl-180\tx5282 \up0 \expndtw-2\charscalex100 \ul0\nos
upersub\cf17\f18\fs20 Hari ke\tab \up0 \expndtw-2\charscalex100 \ul0\nosupersub\
cf18\f19\fs20 Malposisi Arteri Besar\par\pard\li2074\sl-180\tx3897\tx7903\tx9304
\tab \up0 \expndtw-2\charscalex100 kanan\tab \up0 \expndtw-2\charscalex100 Kiri
\tab \up0 \expndtw-2\charscalex100 ke kanan\par\pard\li2074\sb126\sl-230\slmult0
\fi274\tx3958\tx6161\tx8031\tx9630 \up0 \expndtw-2\charscalex100 1\tab \up0 \exp
ndtw-2\charscalex100 PFC\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2
\charscalex100 -\tab \up0 \expndtw-2\charscalex100 -\par\pard\li2074\sb125\sl-23
0\slmult0\fi274\tx3542\tx6160\tx8030\tx9629 \up0 \expndtw-2\charscalex100 2\tab

\up0 \expndtw-2\charscalex100 PA tanpa VSD\tab \up0 \expndtw-2\charscalex100 -\t
ab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2\charscalex100 -\par\pard\
li2074\sb0\sl-230\slmult0\par\pard\li2074\sb10\sl-230\slmult0\fi274\tx3799\tx552
1\tx8031\tx9630 \up0 \expndtw-2\charscalex100 3\tab \up0 \expndtw-2\charscalex10
0 PS berat\tab \up0 \expndtw-2\charscalex100 TGA tanpa VSD\tab \up0 \expndtw-2\c
harscalex100 -\tab \up0 \expndtw-2\charscalex100 -\par\pard\li2074\sb0\sl-230\sl
mult0\par\pard\li2074\sb12\sl-230\slmult0\fi274\tx4103\tx5681\tx7802\tx9630 \up0
\expndtw-2\charscalex100 4\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndt
w-3\charscalex100 TGA + VSD\tab \up0 \expndtw-2\charscalex100 HLHS\tab \up0 \exp
ndtw-2\charscalex100 -\par\pard\li2074\sb0\sl-230\slmult0\par\pard\li2074\sb44\s
l-230\slmult0\fi274\tx4104\tx5276\tx7886\tx9630 \up0 \expndtw-2\charscalex100 5\
tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-3\charscalex100 Ventrikel
tunggal \ul0\nosupersub\cf19\f20\fs20 \ul0\nosupersub\cf18\f19\fs20 PS\tab \up0
\expndtw-3\charscalex100 IAA\tab \up0 \expndtw-2\charscalex100 -\par\pard\li2074
\sb0\sl-230\slmult0\par\pard\li2074\sb44\sl-230\slmult0\fi274\tx4103\tx6160\tx80
30\tx9629 \up0 \expndtw-2\charscalex100 6\tab \up0 \expndtw-2\charscalex100 -\ta
b \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \
expndtw-2\charscalex100 -\par\pard\li2074\sb125\sl-230\slmult0\fi274\tx4103\tx61
60\tx8030\tx9629 \up0 \expndtw-2\charscalex100 7\tab \up0 \expndtw-2\charscalex1
00 -\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2\charscalex100 -\tab
\up0 \expndtw-2\charscalex100 -\par\pard\li2074\sb125\sl-230\slmult0\fi274\tx37
95\tx6161\tx7639\tx9630 \up0 \expndtw-2\charscalex100 8\tab \up0 \expndtw-2\char
scalex100 TF berat\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2\chars
calex100 AVS berat\tab \up0 \expndtw-2\charscalex100 -\par\pard\li2074\sb126\sl230\slmult0\fi274\tx3461\tx6161\tx7650\tx9630 \up0 \expndtw-2\charscalex100 9\ta
b \up0 \expndtw-3\charscalex100 Anomali Ebstein\tab \up0 \expndtw-2\charscalex10
0 -\tab \up0 \expndtw-2\charscalex100 CoA berat\tab \up0 \expndtw-2\charscalex10
0 -\par\pard\li2074\sb125\sl-230\slmult0\fi224\tx4103\tx6160\tx8029\tx9226 \up0
\expndtw-2\charscalex100 10\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndt
w-2\charscalex100 -\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2\char
scalex100 PDA besar\par\pard\li2074\sb124\sl-230\slmult0\fi224\tx4103\tx6160\tx8
029\tx9226 \up0 \expndtw-2\charscalex100 11\tab \up0 \expndtw-2\charscalex100 -\
tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2\charscalex100 -\tab \up0
\expndtw-2\charscalex100 VSD besar\par\pard\li2074\sb125\sl-230\slmult0\fi224\t
x4103\tx6160\tx8030\tx9629 \up0 \expndtw-2\charscalex100 12\tab \up0 \expndtw-2\
charscalex100 -\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2\charscal
ex100 -\tab \up0 \expndtw-2\charscalex100 -\par\pard\li2074\sb125\sl-230\slmult0
\fi224\tx4103\tx6160\tx8029\tx9450 \up0 \expndtw-2\charscalex100 13\tab \up0 \ex
pndtw-2\charscalex100 -\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndtw-2\
charscalex100 -\tab \up0 \expndtw-2\charscalex100 AVC\par\pard\ql \li7417\sb222\
sl-230\slmult0 \up0 \expndtw-3\charscalex100 TAPVD dengan \par\pard\li2299\sb0\s
l-180\slmult0\fi0\tx4103\tx6160\tx9495 \up0 \expndtw-2\charscalex100 14\tab \up0
\expndtw-2\charscalex100 -\tab \up0 \expndtw-2\charscalex100 -\tab \up0 \expndt
w-2\charscalex100 TrA\par\pard\ql \li7696\sb0\sl-180\slmult0 \up0 \expndtw-2\cha
rscalex100 obstruksi \par\pard\ql \li1800\sb209\sl-230\slmult0 \up0 \expndtw-3\c
harscalex100 Umur rara-rata \par\pard\li3933\sb0\sl-180\slmult0\fi0\tx5990\tx786
1\tx9409 \up0 \expndtw-3\charscalex100 3 \ul0\nosupersub\cf19\f20\fs20 \ul0\nosu
persub\cf18\f19\fs20 1\tab \up0 \expndtw-3\charscalex100 4 \ul0\nosupersub\cf19\
f20\fs20 \ul0\nosupersub\cf18\f19\fs20 1\tab \up0 \expndtw-3\charscalex100 8 \ul
0\nosupersub\cf19\f20\fs20 \ul0\nosupersub\cf18\f19\fs20 1\tab \up0 \expndtw-2\c
harscalex100 12 \ul0\nosupersub\cf19\f20\fs20 \ul0\nosupersub\cf18\f19\fs20 1\pa
r\pard\ql \li1800\sb0\sl-180\slmult0 \up0 \expndtw-2\charscalex100 saat Dx (hari
) \par\pard\qj \li1800\ri1655\sb28\sl-309\slmult0 \up0 \expndtw0\charscalex100 \
ul0\nosupersub\cf16\f17\fs18 (Dikutip dari Sastroasmoro S dalam Penatalaksanaan
awal penyakit jantung bawaan sianotik. Penidikan Kedokteran \up0 \expndtw-2\char
scalex100 Berkelanjutan Ilmu Kesehatan Anak XX FKUI 1989) \par\pard\ql \li10200\
sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\

sb123\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf2\f3\fs24 1
0 \par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
z-10000\shplid10
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14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145
1400514514005145140051451400514514005145140051451401ffd9}}}}}\pard\sb0\sl-240\pa
r\pard\qj \li1800\sb0\sl-380\slmult0 \par\pard\qj\li1800\sb0\sl-380\slmult0 \par
\pard\qj\li1800\sb0\sl-380\slmult0 \par\pard\qj\li1800\sb0\sl-380\slmult0 \par\p
ard\qj\li1800\ri2448\sb350\sl-380\slmult0\tx2700 \up0 \expndtw-2\charscalex100 \
ul0\nosupersub\cf6\f7\fs22 Tabel 2 : Kelainan Jantung yang memberikan gejala SET
ELAH 2 minggu pertama \line\tab \up0 \expndtw-3\charscalex100 kehidupan postnata
l \par\pard\li1800\sb0\sl-230\slmult0\par\pard\li1800\sb0\sl-230\slmult0\par\par
d\li1800\sb11\sl-230\slmult0\fi0\tx3599\tx5579\tx7559\tx9719 \up0 \expndtw-2\cha
rscalex100 \ul0\nosupersub\cf17\f18\fs20 Umur\tab \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf18\f19\fs20 Obstruksi Jantung\tab \up0 \expndtw-3\charscalex10
0 Malposisi Arteri\tab \up0 \expndtw-3\charscalex100 Obstruksi Jantung Kiri\tab
\up0 \expndtw-2\charscalex100 Pirau Kiri ke Kanan\par\pard\li1800\sb112\sl-230\s
lmult0\fi1799\tx5579 \up0 \expndtw-2\charscalex100 Kanan\tab \up0 \expndtw-2\cha
rscalex100 Besar\par\pard\li1800\sb0\sl-230\slmult0\par\pard\li1800\sb23\sl-230\
slmult0\fi0\tx3601\tx5579\tx7559 \up0 \expndtw-2\charscalex100 Bulan I\tab \up0
\expndtw-3\charscalex100 PGA VSD\tab \up0 \expndtw-3\charscalex100 TGS VSD\tab \
up0 \expndtw-2\charscalex100 HLHS\par\pard\li1800\sb115\sl-230\slmult0\fi1799\tx
7559 \up0 \expndtw-3\charscalex100 PS berat\tab \up0 \expndtw-2\charscalex100 IA
A\par\pard\li1800\sb115\sl-230\slmult0\fi1799\tx7559 \up0 \expndtw-2\charscalex1
00 PA + TA\tab \up0 \expndtw-3\charscalex100 AVS berat\par\pard\li1800\sb115\sl230\slmult0\fi5759 \up0 \expndtw-3\charscalex100 CoA berat\par\pard\li1800\sb115
\sl-230\slmult0\fi5759 \up0 \expndtw-3\charscalex100 TAPVD + obstruksi\par\pard\
li1800\sb124\sl-230\slmult0\fi0\tx3599\tx5579\tx9719 \up0 \expndtw0\charscalex10
0 Bulan I - V\tab \up0 \expndtw-2\charscalex100 TA + VS\tab \up0 \expndtw-2\char
scalex100 SV tanpa PS DORV\tab \up0 \expndtw-2\charscalex100 PDA Besar\par\pard\
li1800\sb116\sl-230\slmult0\fi1799\tx5579\tx9719 \up0 \expndtw-3\charscalex100 T
F dengan serangan\tab \up0 \expndtw-2\charscalex100 tanpa PS\tab \up0 \expndtw-2
\charscalex100 VSD Besar\par\pard\li1800\sb114\sl-230\slmult0\fi1799\tx9719 \up0
\expndtw-2\charscalex100 sianotik\tab \up0 \expndtw-2\charscalex100 CAVC\par\pa
rd\ql \li9719\sb116\sl-230\slmult0 \up0 \expndtw-2\charscalex100 TrA \par\pard\q
j \li9719\ri1211\sb19\sl-345\slmult0 \up0 \expndtw-2\charscalex100 TA tanpa PS \
line \up0 \expndtw-3\charscalex100 TAPVD tanpa \line \up0 \expndtw-2\charscalex1
00 obstruksi \par\pard\li1800\sb106\sl-230\slmult0\fi0\tx3600\tx9719 \up0 \expnd
tw0\charscalex100 Bulan VI - XII\tab \up0 \expndtw-3\charscalex100 TF tanpa sera
ngan\tab \up0 \expndtw-2\charscalex100 ASD Besar\par\pard\ql \li3599\sb115\sl-23
0\slmult0 \up0 \expndtw-2\charscalex100 sianotik \par\pard\ql \li3599\ri3665\sb2
0\sl-344\slmult0 \up0 \expndtw-3\charscalex100 TA + PS sedang \line \up0 \expndt
w-3\charscalex100 DORV + PS \line \up0 \expndtw-2\charscalex100 Ebstein \par\par
d\li1800\sb107\sl-230\slmult0\fi0\tx3600\tx7560\tx9719 \up0 \expndtw-2\charscale
x100 Tahun II - VI\tab \up0 \expndtw-3\charscalex100 TF ringan\tab \up0 \expndtw
-2\charscalex100 CoA\tab \up0 \expndtw-3\charscalex100 AVS\par\pard\li1800\sb114
\sl-230\slmult0\fi5759\tx9719 \up0 \expndtw-3\charscalex100 ASD\tab \up0 \expndt
w-3\charscalex100 VSD sedang\par\pard\ql \li9719\sb116\sl-230\slmult0 \up0 \expn
dtw-3\charscalex100 PDA kecil \par\pard\ql \li1800\sb0\sl-253\slmult0 \par\pard\
ql\li1800\sb0\sl-253\slmult0 \par\pard\ql\li1800\sb1\sl-253\slmult0 \up0 \expndt
w-3\charscalex100 \ul0\nosupersub\cf6\f7\fs22 Keterangan : \par\pard\qj \li1799\
ri1646\sb32\sl-341\slmult0\fi0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf18
\f19\fs20 PFC = sirkulasi janin yang menetap; PA= atresia pulmonal; PS= stenosis
pulmonal; TGA= transposisi \line \up0 \expndtw0\charscalex100 arteri besar; H
LHS=sindrom hipoplasia jantung kiri; IAA=arkus aorta terputus; TF=tetralo
gi Fallot; \line \up0 \expndtw0\charscalex100 AVS=stenosis katub aorta; CoA=koa
rtasio aorta; PDA=duktus arterisosus persisten; VSD=defek septum \line \up0 \exp
ndtw0\charscalex100 ventrikel; AVC=kanalis atrioventrikular; TAPVD=anomali total
drainase vena pulmonalis; TrA=trunkus \line \up0 \expndtw0\charscalex102 arteri

osus; DORV=\ul0\nosupersub\cf20\f21\fs20 double outlet right ventricle\ul0\nosup
ersub\cf18\f19\fs20 ; SV=ventrikel tunggal\ul0\nosupersub\cf7\f8\fs22 . \ul0\nos
upersub\cf16\f17\fs18 (Dikutip dari Sastroasmoro S dalam \line \up0 \expndtw0\ch
arscalex100 Penatalaksanaan awal penyakit jantung bawaan sianotik. Penidikan Ked
okteran Berkelanjutan Ilmu Kesehatan Anak \line \up0 \expndtw-2\charscalex100 XX
FKUI 1989) \par\pard\ql \li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\sl
-276\slmult0 \par\pard\ql\li10200\sb143\sl-276\slmult0 \up0 \expndtw-3\charscale
x100 \ul0\nosupersub\cf2\f3\fs24 11 \par\pard\sect\sectd\fs24\paperw12240\paperh
15840{\shp
z-10000\shplid11
ffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
00110803e7030403012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
80\slmult0 \par\pard\qj\li1800\sb0\sl-380\slmult0 \par\pard\qj\li1800\sb0\sl-380
\slmult0 \par\pard\qj\li1800\sb0\sl-380\slmult0 \par\pard\qj\li1800\ri1628\sb350
\sl-380\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf6\f7\fs22 PEMERI
KSAAN TAMBAHAN LAINNYA YANG DIPERLUKAN UNTUK PJB KRITIS \up0 \expndtw-3\charscal
ex100 PADA NEONATUS \par\pard\qj \li1799\ri1623\sb379\sl-379\slmult0\fi720 \up0
\expndtw0\charscalex102 \ul0\nosupersub\cf7\f8\fs22 Selain pemeriksaan elektro
kardiogram untuk melihat kemungkinan adanya disritmia, \up0 \expndtw0\charscalex
102 aksis dan potensial listrik dari ventrikel, juga pemeriksaan foto polos dada
untuk melihat besar \up0 \expndtw0\charscalex100 dan bentuk jantung serta paren
khim paru serta letak organ diluar jantung (\ul0\nosupersub\cf10\f11\fs22 invers
us\ul0\nosupersub\cf7\f8\fs22 atau \ul0\nosupersub\cf10\f11\fs22 solitus\ul0\no
supersub\cf7\f8\fs22 ). \up0 \expndtw0\charscalex102 Pemeriksaan ekokardiografi
sangat penting untuk menetapkan/konfirmasi diagnosis defek \up0 \expndtw0
\charscalex100 anatomis pada setiap neonatus dengan dugaan PJB. Fetal ekokardiog
rafi dapat mendeteksi \ul0\nosupersub\cf10\f11\fs22 fetal \up0 \expndtw-2\charsc
alex100 heart failure\ul0\nosupersub\cf7\f8\fs22 bila ditemukan edema scalp, as
ites, efusi perikard atau gerakan fetus yang melemah. \up0 \expndtw0\charscalex1
04 Pemeriksaan kateterisasi dan angiokardiografi yang dilanjutkan dengan interve
nsi non bedah \up0 \expndtw0\charscalex104 (\ul0\nosupersub\cf10\f11\fs22 balloo
n atrial septostomy, balloon valvuloplasty, intraductal stent\ul0\nosupersub\cf7
\f8\fs22 dan \ul0\nosupersub\cf10\f11\fs22 balloon angioplasty\ul0\nosupersub\c

f7\f8\fs22 ) \up0 \expndtw0\charscalex104 sering merupakan tindakan yang harus s
egera dilakukan untuk menyelamatkan kematian dini \up0 \expndtw0\charscalex102 s
erta untuk optimalisasi kondisi klinis dalam rangka persiapan operasi jantung te
rbuka sebagai \up0 \expndtw-3\charscalex100 pengobatan definitif untuk neonatus
dengan PJB kritis. \par\pard\qj \li1799\ri1625\sb2\sl-379\slmult0\fi719\tx6791 \
up0 \expndtw0\charscalex103 Pemeriksaan \ul0\nosupersub\cf10\f11\fs22 mean c
orpuscular volume \tab \up0 \expndtw0\charscalex112 \ul0\nosupersub\cf7\f8\fs2
2 (MCV) dan serum ferritin sangat \up0 \expndtw0\charscalex100 menggambarka
n status besi pada setiap neonatus dengan PJB sianosis. Pada kondisi ini bila ad
a \up0 \expndtw-2\charscalex100 defisiensi besi merupakan risiko untuk terjadiny
a trombosis dan perdarahan otak.\ul0\super\cf8\f9\fs21 1,12,13 \par\pard\ql \li1
800\sb0\sl-253\slmult0 \par\pard\ql\li1800\sb232\sl-253\slmult0 \up0 \expndtw-3\
charscalex100 \ul0\nosupersub\cf6\f7\fs22 PENATALAKSANAAN AWAL NEONATUS DENGAN P
JB KRITIS \par\pard\qj \li1800\sb0\sl-379\slmult0 \par\pard\qj\li1800\ri1623\sb2
3\sl-379\slmult0\fi719 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf7\f8\fs22
Penatalaksanaan neonatus dengan dugaan PJB kritis tidak jauh berbeda dengan kond
isi \line \up0 \expndtw0\charscalex103 kritis pada neonatus akibat penyakit dilu
ar jantung. Faktanya, ada kecenderungan para dokter \line \up0 \expndtw0\charsca
lex100 untuk melepaskan tanggung jawab dan menyerahkan ke dokter konsultan jantu
ng. Hal ini tidak \line \up0 \expndtw0\charscalex103 boleh terjadi dan alur pena
talaksanaannya menjadi tidak efektif sehingga akhirnya merugikan \line \up0 \exp
ndtw-3\charscalex100 pasien. \par\pard\qj \li1800\ri1623\sb0\sl-379\slmult0\fi72
0 \up0 \expndtw0\charscalex105 Penatalaksanaan awal pada setiap neonatus dengan
PJB kritis sangat berperan dalam \up0 \expndtw0\charscalex100 mencegah memburukn
ya kondisi klinis bahkan kematian dini. Diawali dengan penatalaksanaan \up0 \exp
ndtw-1\charscalex100 kegawatan secara umum kemudian dilanjutkan penatalaksanaan
kegawatan jantung secara khusus \up0 \expndtw-1\charscalex100 sesuai dengan masa
lah kritis yang sedang dihadapi \ul0\nosupersub\cf6\f7\fs22 (sianosis sentral\ul
0\nosupersub\cf7\f8\fs22 , \ul0\nosupersub\cf6\f7\fs22 peningkatan aliran darah
\up0 \expndtw-3\charscalex100 ke paru\ul0\nosupersub\cf7\f8\fs22 atau \ul0\nosu
persub\cf6\f7\fs22 penurunan aliran darah ke sistemik)\ul0\nosupersub\cf7\f8\fs2
2 sebagai berikut : \par\pard\li1800\sb105\sl-253\slmult0\fi0\tx8289\tx8928 \up
0 \expndtw0\charscalex101 \ul0\nosupersub\cf6\f7\fs22 1.\ul0\nosupersub\cf11\f12
\fs22 \ul0\nosupersub\cf6\f7\fs22 Penempatan pada lingkungan yang nyaman
dan fisiologis\tab \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf7\f8\fs22 (
suhu\tab \up0 \expndtw0\charscalex103 36,5-37\ul0\super\cf8\f9\fs21 o\ul0\nosupe
rsub\cf7\f8\fs22 C dan\par\pard\li1800\sb127\sl-253\slmult0\fi359 \up0 \expnd
tw-3\charscalex100 kelembaban sekitar 50%).\par\pard\ql \li10200\sb0\sl-276\slmu
lt0 \par\pard\ql\li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb76\sl-276\slm
ult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf2\f3\fs24 12 \par\pard\sect
\sectd\fs24\paperw12240\paperh15840{\shp
z-10000\shplid12
ffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
00110803e7030403012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
\slmult0 \par\pard\ql\li1800\sb0\sl-253\slmult0 \par\pard\ql\li1800\sb204\sl-253
\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf6\f7\fs22 2.\ul0\nosupe
rsub\cf11\f12\fs22 \ul0\nosupersub\cf6\f7\fs22 Pemberian oksigen \par\pard\qj
\li2159\ri1623\sb21\sl-379\slmult0\fi0 \up0 \expndtw0\charscalex106 \ul0\nosupe
rsub\cf7\f8\fs22 Oksigen sering diberikan pada neonatus yang dicuriga
i menderita PJB tanpa \line \up0 \expndtw0\charscalex102 mempertimbangkan
tujuan dan dampak negatifnya. Pemberian oksigen pada neonatus \line \up0
\expndtw0\charscalex104 mengakibatkan vasokonstriksi arteria sistemik dan vasod
ilatasi arteria pulmonalis, hal ini \line \up0 \expndtw0\charscalex105 memperbur
uk PJB dengan pirau kiri ke kanan. Pemberian oksigen pada neonatus \ul0\nosupers
ub\cf10\f11\fs22 ductus \line \up0 \expndtw0\charscalex102 dependent sistemic
circulation\ul0\nosupersub\cf7\f8\fs22 atau \ul0\nosupersub\cf10\f11\fs22 duc
tus dependent pulmonary
circulation \ul0\nosupersub\cf7\f8\fs22
malah \l
ine \up0 \expndtw0\charscalex104 mempercepat penutupan duktus dan memperburuk ke
adaan. Pada kedua kondisi tersebut \line \up0 \expndtw0\charscalex105 lebih baik
mempertahankan saturasi oksigen tidal lebih dari 85% dengan
udara kamar \li
ne \up0 \expndtw-3\charscalex100 (0,21% O2). \par\pard\qj \li2131\ri1622\sb0\sl379\slmult0\fi28 \up0 \expndtw0\charscalex113 Saturasi oksigen neonatus denga
n PJB sianotik selalu rendah dan tidak akan \line \up0 \expndtw0\charscale
x115 meningkat secara nyata dengan pemberian oksigen . Namun demikian , pa
da \line \up0 \expndtw0\charscalex115 neonatus yang mengalami distres , akan men
gganggu ventilasinya dan gangguan \line \up0 \expndtw0\charscalex114 ini dapat
akan berkurang dengan pemberian oksigen yang dilembabkan dengan \line \up0 \ex
pndtw0\charscalex112 kecepatan 2 - 4 liter per menit dengan masker atau kat
eter nasofaringeal . Pada \line \up0 \expndtw0\charscalex115 neonatus dengan di
stres nafas yang berat maka bantuan ventilasi mekanik sangat \line \up0 \expndtw
-2\charscalex100 diperlukan. \par\pard\ql \li1799\sb108\sl-253\slmult0 \up0 \exp
ndtw-2\charscalex100 \ul0\nosupersub\cf6\f7\fs22 3.\ul0\nosupersub\cf11\f12\fs22
\ul0\nosupersub\cf6\f7\fs22 Pemberian cairan dan nutrisi \par\pard\ql \li21
59\ri1622\sb21\sl-379\slmult0 \up0 \expndtw0\charscalex117 \ul0\nosupersub\cf7\f
8\fs22 Harus dipertahankan dalam status normovolemik sesuai umur dan berat badan
. \up0 \expndtw0\charscalex121 Pada neonatus yang dengan distres ringan dengan
pertimbangan masih dapat \up0 \expndtw-2\charscalex100 diberikan masukan oral su
su formula dengan porsi kecil tapi sering. Perlu \line \up0 \expndtw0\charscalex
116 perhatian khusus pada PJB kritis terhadap gangguan reflex menghisap
dan \up0 \expndtw0\charscalex119 pengosongan lambung serta risiko aspirasi .
Pemberian melalui sonde akan \up0 \expndtw-1\charscalex100 menambah distres n
afas dan merangsang reflex vagal. Pada kondisi shock, pemberian cairan \up0 \exp
ndtw0\charscalex104 10 - 15 ml/kgBB dalam 1-2 jam, kemudian dilihat respons terh
adap peningkatan tekanan \up0 \expndtw-1\charscalex100 darah, peingkatan produks
i urine dan tanda vital yang lain. Disfungsi miokard akibat asfiksia \up0 \expnd
tw-3\charscalex100 berat memerlukan pemberian dopamin dan dobutamin. \par\pard\q
l \li1799\sb106\sl-253\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf6
\f7\fs22 4.\ul0\nosupersub\cf11\f12\fs22 \ul0\nosupersub\cf6\f7\fs22 Pemberia
n prostaglandin E1 \par\pard\qj \li2131\ri1622\sb21\sl-379\slmult0 \up0 \expndtw
-1\charscalex100 \ul0\nosupersub\cf7\f8\fs22 Merupakan tindakan awal yang harus
diberikan, sebagai \ul0\nosupersub\cf10\f11\fs22 life-saving\ul0\nosupersub\cf7\
f8\fs22 dan sementara menunggu \up0 \expndtw0\charscalex100 kepastian diagnosi

s, evaluasi dan menyusun terapi rasional selanjutnya, prostaglandin E1 \up0
\expndtw-3\charscalex100 diberikan pada : \par\pard\ql \li2159\ri1625\sb1\sl-379
\slmult0\tx2519\tx2519 \up0 \expndtw0\charscalex106 a.\ul0\nosupersub\cf13\f14\f
s22 \ul0\nosupersub\cf7\f8\fs22 Setiap bayi umur kurang dari 2 minggu yang d
icurigai dengan PJB sianosis (\ul0\nosupersub\cf10\f11\fs22 ductus \line\tab \up
0 \expndtw0\charscalex100 dependent pulmonary circulation\ul0\nosupersub\cf7\f8\
fs22 ). Tujuan : meningkatkan aliran darah ke paru (Atresia \line \tab \up0 \exp
ndtw0\charscalex103 pulmonal, pulmonal stenosis yang berat, atresia trikuspid) a
tau meningkatkan tekanan \par\pard\ql \li10200\sb0\sl-276\slmult0 \par\pard\ql\l
i10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\slmult0 \par\pard\ql\l
i10200\sb159\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf2\f3
\fs24 13 \par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
z-10000\shplid13
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01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
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2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
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6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
53\sl-379\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf7\f8\fs22 atriu
m kiri agar terjadi pirau kiri ke kanan sehingga oksigenasi sistemik menjadi leb
ih \up0 \expndtw-3\charscalex100 baik (transposisi pembuluh darah besar). \par\p
ard\ql \li2160\ri1622\sb0\sl-379\slmult0\tx2520\tx2520\tx2520\tx2520\tx2520\tx25
20\tx2520\tx2520\tx2520\tx2520\tx2520\tx2520\tx2520\tx2520\tx2520\tx2520\tx2520\
tx2520\tx2520\tx2520\tx2520 \up0 \expndtw-2\charscalex100 b. \tab \up0 \expndtw0
\charscalex100 Setiap bayi umur kurang dari 2 minggu yang disertai syok, pulsasi
perifer lemah atau tak \line\tab \up0 \expndtw0\charscalex100 teraba, kardiomeg
li dan hepatomegali (\ul0\nosupersub\cf10\f11\fs22 ductus dependent systemic cir
culation\ul0\nosupersub\cf7\f8\fs22 ). Tujuan : \line \tab \up0 \expndtw0\charsc
alex100 meningkatkan aliran darah ke arteri sistemik (aorta stenosis yang kritis
, koartasio aorta, \line \tab \up0 \expndtw-2\charscalex100 transposisi pembuluh
darah besar, \ul0\nosupersub\cf10\f11\fs22 interrupted\ul0\nosupersub\cf7\f8\fs
22 arkus aorta atau hipoplastik jantung kiri). \line \tab \up0 \expndtw0\charsc
alex105 Dosis awal \up0 \expndtw0\charscalex105 0,05 mikrogram/kgBB/menit sec
ara intravena atau melalui kateter \line \tab \up0 \expndtw-1\charscalex100
umbilikalis, dosis bisa dinaikkan sampai 0,1 sampai 0,15 mikrogram/kgBB/menit se

lama \line \tab \up0 \expndtw0\charscalex105 belum timbul efek samping dan sampa
i tercapai efek yang optimal. Bila terjadi efek \line \tab \up0 \expndtw0\charsc
alex102 samping berupa hipotensi atau apnea maka pemberian prostaglandin segera
diturunkan \line \tab \up0 \expndtw0\charscalex101 dosisnya dan diberikan bolus
cairan \up0 \expndtw0\charscalex101 5-10 ml/kgBB intravena. Bila terjadi apnea m
aka \line \tab \up0 \expndtw0\charscalex102 selain menurunkan dosis prostagla
ndin E1, segera dipasang intubasi dan ventilasi \line \tab \up0 \expndtw-2
\charscalex100 mekanik dengan O2 rendah, dipertahankan minimal saturasi oksigen
mencapai 65 %. \line \tab \up0 \expndtw0\charscalex100 Bila keadaan sudah stabil
kembali maka dapat dimulai lagi dosis awal, bila tidak terjadi \line \tab \up0
\expndtw0\charscalex102 efek samping pada pemberian dosis 0,05 mikrogram/kgBB/me
nit tersebut, maka dosis \line \tab \up0 \expndtw0\charscalex101 dapat diturunk
an sampai \up0 \expndtw0\charscalex101 0,01 mikrogram/kgBB/menit atau lebih
rendah sehingga \line \tab \up0 \expndtw0\charscalex100 tercapai dosis minimal
yang efektif dan aman. Selama pemberian prostaglandin E1 perlu \line \tab \up0
\expndtw-1\charscalex100 disiapkan ventilator dan pada sistem \ul0\nosupersub\cf
10\f11\fs22 infusion pump\ul0\nosupersub\cf7\f8\fs22 tidak boleh dilakukan \ul
0\nosupersub\cf10\f11\fs22 flushed.\ul0\nosupersub\cf7\f8\fs22 Harus \line \ta
b \up0 \expndtw0\charscalex106 dipantau ketat terhadap efek samping lainnya
yaitu \up0 \expndtw-1\charscalex100 : disritmia, diare, apnea, \line \ta
b \up0 \expndtw0\charscalex100 hipoglikemia, NEC, hiperbilirubinemia, trombos
itopenia dan koagulasi intravaskular \line \tab \up0 \expndtw-1\charscalex100
diseminata, perlu juga diingat kontraindikasi bila ada sindroma distres nafas d
an sirkulasi \line \tab \up0 \expndtw0\charscalex104 fetal yang persisten. Bila
ternyata hasil konfirmasi diagnosis tidak menunjukkan PJB \line \tab \up0 \expnd
tw-2\charscalex100 maka pemberian prostaglandin E1 segera dihentikan. \par\pard\
qj \li2491\ri1623\sb0\sl-379\slmult0 \up0 \expndtw0\charscalex102 Telah dicoba p
emakaian prostaglandin E2 per oral, mempunyai efek yang hampir sama \up0 \expndt
w0\charscalex102 dengan prostaglandin E1, lebih praktis dan harganya lebi
h murah. Pada awalnya \up0 \expndtw0\charscalex106 diberikan setiap jam, namu
n bila efek terapinya sudah tercapai, maka obat ini dapat \par\pard\ql \li1800\r
i1621\sb0\sl-379\slmult0\fi720\tx2520\tx2491\tx2520\tx2520\tx2520 \up0 \expndtw0
\charscalex102 diberikan tiap 3-4 jam sampai 6 jam. Dapat mempertahankan terbuka
nya duktus dalam \line\tab \up0 \expndtw-2\charscalex100 beberapa bulan, namun d
uktus akan menutup bila pemberiannya dihentikan. \line \tab \up0 \expndtw0\chars
calex100 Untuk neonatus usia 2-4 minggu, walaupun angka kesuksesan rendah , masi
h dianjurkan \line \tab \up0 \expndtw0\charscalex103 pemberian prostaglandin E1
. Bila dalam 1-2 jam setelah pemberian dosis maksimum \line \tab \up0 \expndtw0\
charscalex100 (0,10 mikrogram/kgBB/menit) ternyata tidak terjadi reopen duktus,
maka pemberiannya \line \tab \up0 \expndtw-2\charscalex100 harus segera distop d
an direncanakan untuk \ul0\nosupersub\cf10\f11\fs22 urgent surrgical interventio
n. \line \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf6\f7\fs22 5. \up0 \exp
ndtw-3\charscalex100 Koreksi terhadap gagal jantung dan disritmia \par\pard\ql \
li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\slmult0 \par\pard\ql\
li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb157\sl-276\slmult0 \up0 \expnd
tw-3\charscalex100 \ul0\nosupersub\cf2\f3\fs24 14 \par\pard\sect\sectd\fs24\pape
rw12240\paperh15840{\shp
z-10000\shplid14
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5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
53\sl-379\slmult0 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf7\f8\fs22 Bila
gagal jantung telah dapat ditegakkan, maka obat pertama yang harus diberikan ada
lah \up0 \expndtw0\charscalex104 diuretik dan pembatasan cairan, biasanya furose
mid dengan dosis awal 1 mg/kgBB yang \up0 \expndtw-3\charscalex100 dapat diberik
an intravena atau per oral, 1 sampai 3 kali sehari. \par\pard\qj \li2160\ri1620\
sb1\sl-379\slmult0 \up0 \expndtw-1\charscalex100 Cedilanid dapat ditambahkan unt
uk memperkuat kontraksi jantung (inotropik dan vasopresor) \line \up0 \expndtw0\
charscalex102 dengan dosis digitalisasi total untuk neonatus preterm 10 mikrogra
m/kgBB per oral, untuk \line \up0 \expndtw0\charscalex103 neonatus aterm 10 - 20
mikrogramkgBB per oral. Diberikan \ul0\nosupersub\cf10\f11\fs22 loading dose \u
l0\nosupersub\cf7\f8\fs22 sebesar 1/2 dari \line \up0 \expndtw0\charscalex102 do
sis digitalisasi total, disusul 1/4 dosis digitalisasi total 6 -12 jam kemudian
dan 1/4 dosis \line \up0 \expndtw0\charscalex103 sisanya diberikan 12-24 jam kem
udian. Disusul dosis rumatan 5-10 mikrogram/kgBB per \line \up0 \expndtw0\charsc
alex100 oral. Pemberian intravena dilakukan bila per oral tidak memungkinkan, do
sis 80% dari dosis \line \up0 \expndtw0\charscalex103 per oral. Dosis per oral m
aupun intravena diturunkan sampai 60% nya bila ada penurunan \line \up0 \expndtw
-2\charscalex100 funsi ginjal. \par\pard\qj \li2160\ri1623\sb0\sl-379\slmult0\tx
3891\tx7659 \up0 \expndtw0\charscalex103 Dopamin
dosis \tab \up0 \expndtw0\ch
arscalex101 2-20 mikrogram/kgBB/menit per drip \tab \up0 \expndtw0\charscalex
102 (dilatasi \ul0\nosupersub\cf10\f11\fs22 renal vascular bed\ul0\nosupersub
\cf7\f8\fs22 ) \up0 \expndtw0\charscalex100 dikombinasi dengan Dobutamin dosis 2
-20 mikrogram/kgBB/menit per drip (meningkatkan \up0 \expndtw0\charscalex104 kon
traktilitas miokard) merupakan kombinasi yang sangat baik untuk meningka
tkan \up0 \expndtw-3\charscalex100 penampilan jantung dengan dosis yang minimal.
\par\pard\ql \li2160\ri1622\sb0\sl-379\slmult0\tx4973 \up0 \expndtw0\charscalex
102 Captopril sebagai vasodilator \tab \up0 \expndtw0\charscalex103 (menurunkan
tahanan vaskuler sistemik dan meningkatkan \line \up0 \expndtw-1\charscalex100 k
apasitas sistem vena) ) sangat berperan pada neonatus dengan gagal jantung konge
stif. Dosis \line \up0 \expndtw0\charscalex104 1 mg/kgBB per oral dosis tunggal
disusul dosis yang sama untuk rumatan. Sangat efektif \line \up0 \expndtw0\chars
calex104 pada kondisi neonatus dengan: a) penurunan fungsi ventrikel, b) pirau k
iri ke kanan yang \line \up0 \expndtw-2\charscalex100 masif, c) regurgitasi katu
p, c) hipertensi sistemik, d) hipertensi pulmonal. \line \up0 \expndtw0\charscal
ex104 Dengan meningkatkan kontraktilitas miokard, menurunkan \ul0\nosupersub\cf1
0\f11\fs22 sinoatrial node rate\ul0\nosupersub\cf7\f8\fs22 , dilatasi \line \u
p0 \expndtw0\charscalex106 \ul0\nosupersub\cf10\f11\fs22 renal vascular bed\ul0\
nosupersub\cf7\f8\fs22 , dan menurunkan tahanan sistemik, maka penampilan jantun
g dapat \line \up0 \expndtw0\charscalex103 ditingkatkan sehingga dapat mening
katkan sirkulasi perifer dan mengurangi hipoksia \line \up0 \expndtw-2\char
scalex100 jaringan. \par\pard\qj \li2160\ri1622\sb0\sl-379\slmult0 \up0 \expndtw
0\charscalex100 Disritmia jantung sering menyertai hipoksemia berat, bila hipoks

emia berat telah dikurangi \up0 \expndtw0\charscalex105 dan kelainan metabolik l
ainnya dikoreksi, maka disritmianya biasanya akan menghilang \up0 \expndtw0\char
scalex105 dengan sendirinya. Tidak dianjurkan memberikan obat anti disritmia tan
pa memperbaiki \up0 \expndtw0\charscalex104 hipoksemia dan kelainan metabolik la
innya yang menyertai, selain tidak bermanfaat juga \up0 \expndtw-3\charscalex100
malah menimbulkan disritmia jenis lain yang lebih membahayakan. \par\pard\ql \l
i1800\sb0\sl-253\slmult0 \par\pard\ql\li1800\sb0\sl-253\slmult0 \par\pard\ql\li1
800\sb0\sl-253\slmult0 \par\pard\ql\li1800\sb107\sl-253\slmult0 \up0 \expndtw-2\
charscalex100 \ul0\nosupersub\cf6\f7\fs22 6.\ul0\nosupersub\cf11\f12\fs22 \ul0\
nosupersub\cf6\f7\fs22 Koreksi terhadap kelainan metabolik \par\pard\ql \li102
00\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\slmult0 \par\pard\ql\li102
00\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\slmult0 \par\pard\ql\li102
00\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb6\sl-276\slmult0 \up0 \expndtw-3\ch
arscalex100 \ul0\nosupersub\cf2\f3\fs24 15 \par\pard\sect\sectd\fs24\paperw12240
\paperh15840{\shp
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53\sl-379\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf7\f8\fs22 Hipok
sia jaringan akan menyebabkan asidosis metabolik yang seringkali sukar dikoreksi
. \up0 \expndtw0\charscalex104 Untuk kondisi ini harus diberikan Na-bikarbonat,
dosis 1-2 ml/kgBB intravena perlahan\up0 \expndtw-3\charscalex100 lahan atau dis
esuaikan dengan hasil analisis gas darah. \par\pard\qj \li2160\ri1632\sb1\sl-379
\slmult0 \up0 \expndtw0\charscalex100 Hipoglokemia dan gangguan keseimbangan ele
ktrolit yaitu kalium, natrium, magnesium dan \up0 \expndtw-1\charscalex100 kalsi
um sering menyertaikondisi hipoksemia, koreksi secepatnya bila pada pemantauan k
linis \up0 \expndtw-2\charscalex100 ditemukan hal-hal tersebut.\ul0\super\cf8\f9
\fs21 1,13,14 \par\pard\ql \li1800\sb0\sl-253\slmult0 \par\pard\ql\li1800\sb234\
sl-253\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf6\f7\fs22 PENATAL
AKSANAAN SPESIFIK NEONATUS DENGAN PJB KRITIS \par\pard\qj \li1800\ri1622\sb20\s
l-379\slmult0\fi720 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf7\f8\fs22 Set
elah tindakan umum awal tersebut diatas dikerjakan, seorang dokter harus dapat \
up0 \expndtw0\charscalex106 mengukur kemampuan menangani neonatus dengan PJB yan
g kritis sesuai dengan fasilitas \up0 \expndtw0\charscalex102 setempat dengan me
lakukan evaluasi terhadap segala yang telah dikerjakan. Bila hasil evaluasi \up0
\expndtw0\charscalex104 tidak ada perbaikan atau bahkan memburuk dan tindakan
lebih lanjut tidak dapat dilakukan, \up0 \expndtw0\charscalex104 maka harus dip
ikirkan untuk merujuk penderita sesegera mungkin ke rumah sakit yang lebih \up0
\expndtw0\charscalex102 lengkap. Bila kondisi memungkinkan langsung dirujuk
ke pusat pelayanan jantung yang \up0 \expndtw0\charscalex104 terjangkau. D
isini setelah diagnosis spesifik ditegakkan maka harus bisa dijawab (1) apakah
\up0 \expndtw0\charscalex105 kelainan yang ada dapat ditolong dengan operasi \u
p0 \expndtw-1\charscalex100 ?, dan \up0 \expndtw0\charscalex104 (2) apakah tin
dakan bedah harus \up0 \expndtw-2\charscalex100 dilakukan segera atau dapat ditu
nda?. \par\pard\qj \li1799\ri1624\sb0\sl-379\slmult0\fi720 \up0 \expndtw0\charsc
alex104 Tindakan di pusat pelayanan jantung yang perlu dilakukan untuk mengurang
i derajat \up0 \expndtw0\charscalex103 hipoksemia sesuai dengan kelainan anatomi
k jantung, berupa (a) meneruskan dan melengkapi \up0 \expndtw0\charscalex104 ter
api medik yang telah diberikan, (b) intervensi non bedah yaitu : septostomi atri
um dengan \up0 \expndtw0\charscalex102 balon, valvuloplasti katup dengan balon a
tau pemasangan stent untuk mempertahankan duktus \up0 \expndtw0\charscalex103 te
tap terbuka, dan (c) tindakan bedah, bila memungkinkan langsung dilakukan kor
eksi total \up0 \expndtw-2\charscalex100 sebagai tindakan definitip atau dapat d
itunda. \par\pard\ql \li2159\sb106\sl-253\slmult0 \up0 \expndtw-1\charscalex100
\ul0\nosupersub\cf6\f7\fs22 a.\ul0\nosupersub\cf11\f12\fs22 \ul0\nosupersub\cf6
\f7\fs22 Terapi medik \par\pard\qj \li2519\ri1624\sb21\sl-379\slmult0 \up0 \ex
pndtw0\charscalex105 \ul0\nosupersub\cf7\f8\fs22 Bila yang dihadapi adalah PJB k
ritis akibat \ul0\nosupersub\cf10\f11\fs22 decompensated PDA\ul0\nosupersub\cf7\
f8\fs22 , ditandai hiperaktif \up0 \expndtw0\charscalex106 prekordium, bising ko
ntinyu pada \ul0\nosupersub\cf10\f11\fs22 ICS\ul0\nosupersub\cf7\f8\fs22 2 kiri
, \ul0\nosupersub\cf10\f11\fs22 wide pulse pressure, bounding pulses\ul0\nosuper
sub\cf7\f8\fs22 , \up0 \expndtw0\charscalex103 kardiomegali dan peningkatan vask
ularisasi pada foto polos dada, maka pembatasan \up0 \expndtw-1\charscalex100
cairan dan pemberian diuretika diteruskan. Bila tidak ada respons maka segera
diberikan \up0 \expndtw0\charscalex102 Indomethasin 0,2 - 0,3 mg/kg/BB/dosis
intravena diulang setiap \up0 \expndtw0\charscalex106 8-12 jam sampai \up0 \expn
dtw-1\charscalex100 maksimal 3 kali/hari. Bila belum juga ada respon, program b
isa dulang sampai 2 -3 hari, \up0 \expndtw-2\charscalex100 kalau tetap tidak ad
a respons maka segera dilakukan operasi ligasi duktus. \par\pard\qj \li2519\ri16
26\sb0\sl-379\slmult0 \up0 \expndtw-1\charscalex100 Bila yang dihadapi adalah PJ
B kritis yang bergantung kepada terbukanya duktus (\ul0\nosupersub\cf10\f11\fs2
2 ductus \up0 \expndtw0\charscalex105 dependent systemic circulation \ul0\nosupe
rsub\cf7\f8\fs22 atau\ul0\nosupersub\cf10\f11\fs22 ductus dependent pulmonary c
irculation\ul0\nosupersub\cf7\f8\fs22 ), maka \up0 \expndtw-2\charscalex100 mene
ruskan pemberian prostaglandin E1 dengan dosis minimal yang optimal. \par\pard\q
l \li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\slmult0 \par\pard\
ql\li10200\sb55\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf2
\f3\fs24 16 \par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
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05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
0028a28a0028a28a0028a28a00ffd9}}}}}\pard\sb0\sl-240\par\pard\li2160\sb0\sl-253\s
lmult0\par\pard\li2160\sb0\sl-253\slmult0\par\pard\li2160\sb0\sl-253\slmult0\par
\pard\li2160\sb0\sl-253\slmult0\par\pard\li2160\sb204\sl-253\slmult0\fi0\tx2519
\up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf6\f7\fs22 b.\tab \up0 \expndtw-3
\charscalex100 Intervensi non bedah\par\pard\ql \li2519\ri1624\sb21\sl-379\slmul
t0 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf7\f8\fs22 Septostomi septum in
ter atrial dengan balon dapat memperbaiki hipoksemia secara \up0 \expndtw0
\charscalex104 dramatis terutama pada transposisi pembuluh darah besar dengan pe
rcampuran darah \up0 \expndtw0\charscalex100 sistemik dan pulmonal yang tidak ad
ekuat. Dilatasi katup pada \ul0\nosupersub\cf10\f11\fs22 critical pulmonal/aorti
c \up0 \expndtw-2\charscalex100 stenosis\ul0\nosupersub\cf7\f8\fs22 dengan \ul0
\nosupersub\cf10\f11\fs22 balloon valvuloplasty\ul0\nosupersub\cf7\f8\fs22 memb
erikan hasil yang cukup dramatis. \line \up0 \expndtw0\charscalex103 Pemasangan
stent didalam duktus telah dicoba di beberapa pusat pelayanan jantung di \up0 \e
xpndtw0\charscalex103 luar negeri, tapi masih dipertimbangkan keuntungan dan
kekurangannya serta masih \up0 \expndtw-3\charscalex100 perlu studi jangka panja
ng. \par\pard\li2160\sb107\sl-253\slmult0\fi0\tx2520 \up0 \expndtw-3\charscalex1
00 \ul0\nosupersub\cf6\f7\fs22 c.\tab \up0 \expndtw-3\charscalex100 Tindakan bed
ah\par\pard\qj \li2520\ri1623\sb21\sl-379\slmult0\fi0 \up0 \expndtw-1\charscalex
100 \ul0\nosupersub\cf7\f8\fs22 Di negara yang sudah maju, telah dilakukan opera
si koreksi jantung pada masa neonatus, \up0 \expndtw0\charscalex103 sehingga tin
dakan bedah ini merupakan tindakan rutin dari penatalaksanaan awal PJB \up0 \exp
ndtw0\charscalex100 sianotik. Di Indonesia hal ii belum dapat dilaksanakan, sein
gga tindakan bedah biasanya \up0 \expndtw-2\charscalex100 merupakan langkah lanj
utan dari penatalaksanaan PJB sianotik. \par\pard\qj \li2520\ri1623\sb1\sl-379\s
lmult0 \up0 \expndtw0\charscalex103 Tindakan bedah tersebut berupa (a) bedah pal
iatif untuk meningkatkan aliran darah ke \up0 \expndtw0\charscalex100 paru denga
n pintasan Blalock-Taussig atau modifikasinya, atau tindakan mengikat arteri \up
0 \expndtw0\charscalex101 pulmonalis untuk mengurang aliran darah ke paru,
dan \up0 \expndtw0\charscalex101 (b) bedah definitif untuk \up0 \expndtw-3\
charscalex100 menjamin fisiologi yang normal dengan melakukan koreksi anatomik.\
ul0\super\cf8\f9\fs21 16-19 \par\pard\ql \li1800\sb0\sl-253\slmult0 \par\pard\ql
\li1800\sb232\sl-253\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf6\f
7\fs22 KONSULTASI, RUJUKAN dan TRANSPOTASI \par\pard\qj \li1800\ri1622\sb21\sl-3
79\slmult0\fi720 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf7\f8\fs22 Dengan
mencermati langkah-langkah yang telah diuraikan diatas, seorang dokter dapat \u
p0 \expndtw0\charscalex106 mengukur kemampuan menangani neonatus dengan PJB yang
kritis sesuai dengan fasilitas \up0 \expndtw0\charscalex100 setempat. Bila tind
akan lebih lanjut tidak dapat dilakukan, maka harus dipikirkan untuk merujuk \up
0 \expndtw-2\charscalex100 penderita ke rumah sakit yang lebih lengkap atau bila
kondisi memungkinkan langsung dirujuk ke \up0 \expndtw-2\charscalex100 pusat pe
layanan jantung yang terjangkau. \par\pard\qj \li1799\ri1624\sb0\sl-379\slmult0\
fi720 \up0 \expndtw0\charscalex100 Di negara maju, rujukan dini sudah merupakan
kesepakatan di antara para dokter umum, \up0 \expndtw0\charscalex107 dokter anak
, dokter ahli jantung, dokter ahli perawatan intensif dan ahli bedah jantung. Di
\up0 \expndtw0\charscalex100 Indonesia, berbagai kendala meliputi lokasi, komun
ikasi, transportasi, biaya dan pengertian atau \up0 \expndtw-2\charscalex100 per
setujuan pihak keluarga penderita. \par\pard\qj \li1799\ri1624\sb0\sl-379\slmul
t0\fi720 \up0 \expndtw0\charscalex100 Bilamana segala aspek telah dipertimbangka
n dan diputuskan untuk melakukan rujukan \up0 \expndtw0\charscalex100 segera, ma
ka tindakan yang harus dilakukan adalah mengamankan neonatus selama transportasi
, \up0 \expndtw0\charscalex105 berupa : (a) bahaya hipotermia, neonatus harus
dibawa dalam inkubator, dengan tambahan \up0 \expndtw0\charscalex105 selimut kat
un serta kertas aluminium untuk mencegah kehilangan panas, (b) asidosis, harus
\up0 \expndtw0\charscalex100 dikoreksi sebelum neonatus dibawa, mungkin koreksi
perlu diulang dalam perjalanan yang jauh, \up0 \expndtw0\charscalex103 tentunya
hanya berdasarkan penilaian klinis saja, (c) kelainan metabolik berupa hipoglike
mia, \par\pard\ql \li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\sl
mult0 \par\pard\ql\li10200\sb55\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul
0\nosupersub\cf2\f3\fs24 17 \par\pard\sect\sectd\fs24\paperw12240\paperh15840{\s
hp
z-10000\shplid17
ffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
00110803e7030403012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
53\sl-379\slmult0 \up0 \expndtw0\charscalex104 \ul0\nosupersub\cf7\f8\fs22 hipok
alsemia, hipokalemia dan hipovolemia atau anemia harus dicegah dan sedapat mungk
in \up0 \expndtw-1\charscalex100 diatasi sebelum neonatus dibawa, (d) hipoksia b
erat, harus dikurangi dengan ventilasi yang harus \up0 \expndtw0\charscalex105 d
ilakukan sebelum bayi dibawa. Pemberian prostaglandin E1 sudah harus dimulai wal
aupun \up0 \expndtw0\charscalex100 diagnosa definitif belum bisa ditegakkan. Bil
a mungkin didampingi dokter atau dokter anak dan \up0 \expndtw0\charscalex100 pe
rawat, tidak boleh dilupakan \ul0\nosupersub\cf10\f11\fs22 informed concent\ul0\
nosupersub\cf7\f8\fs22 dan lembar observasi mencatat waktu, kejadian \up0 \expn
dtw-3\charscalex100 klinis, semua obat dan tindakan yang telah dikerjakan.\ul0\s
uper\cf8\f9\fs21 13,20 \par\pard\qj \li1800\sb0\sl-379\slmult0 \par\pard\qj\li18
00\ri1627\sb3\sl-379\slmult0 \up0 \expndtw0\charscalex101 \ul0\nosupersub\cf6\f7
\fs22 TUGAS PERAWAT PADA NEONATUS DENGAN PENYAKIT JANTUNG BAWAAN \up0 \expndtw-3
\charscalex100 KRITIS \par\pard\qj \li1799\ri1622\sb0\sl-379\slmult0\fi720 \up0
\expndtw0\charscalex103 \ul0\nosupersub\cf7\f8\fs22 Diagnosis PJB kritis pada ne
onatus selalu menimbulkan beban moril maupun materiil \line \up0 \expndtw0\chars
calex102 dan rasa bersalah, putus asa, bingung, marah pada orang tua, kakek nene
k, saudara-saudaranya \line \up0 \expndtw0\charscalex105 dan seluruh keluarga pe
nderita. Pada kondisi seperti ini, peran perawat sangat penting untuk \line \up0
\expndtw0\charscalex100 membantu tim dokter dalam memberikan suasana tenang ser
ta membantu memberikan informasi \line \up0 \expndtw0\charscalex100 tentang kond
isi penderita, keadaan klinis yang menggambarkan kegawatan jantung (peningkatan
\line \up0 \expndtw0\charscalex100 frekuensi nafas, bertambah jelasnya siano
sis sentral, menurunnya kemampuan minum dan \line \up0 \expndtw0\charscalex
105 produksi kencing, muntah atau melemahnya tangisan) dan rencana pemer
iksaan untuk \line \up0 \expndtw0\charscalex100 menegakkan diagnosis maupun tin
dakan yang akan dikerjakan untuk menyelamatkan penderita \line \up0 \expndtw-1\c
harscalex100 dari kematian dini. Peran perawat juga sangat diperlukan dalam kard
iologi pencegahan, yaitu ikut \line \up0 \expndtw0\charscalex100 membantu mengid
entifikasi faktor risiko yang kemungkinan terjadi pada penderita selama masa \li
ne \up0 \expndtw-3\charscalex100 prenatal. \par\pard\ql \li1800\sb0\sl-207\slmul
t0 \par\pard\ql\li1800\sb0\sl-207\slmult0 \par\pard\ql\li1800\sb72\sl-207\slmult
0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf21\f22\fs18 KEPUSTAKAAN \par\p
ard\qj \li2160\ri1654\sb0\sl-207\slmult0\tx2520 \up0 \expndtw0\charscalex100 \ul
0\nosupersub\cf16\f17\fs18 1.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf21
\f22\fs18
Artman M, Mahony L, Teitel DF. \ul0\nosupersub\cf16\f17\fs18 Neonat
al Cardiology. The McGraw-Hill Companies Medical Publishing \line\tab \up0 \expn
dtw-2\charscalex100 Division. 2002 \par\pard\qj \li2160\ri1655\sb0\sl-207\slmult
0\tx2520 \up0 \expndtw-1\charscalex100 2.\ul0\nosupersub\cf22\f23\fs18 \ul0\nos
upersub\cf21\f22\fs18
Ontoseno T. \ul0\nosupersub\cf16\f17\fs18 Kelainan jant
ung bawaan dan etiologinya masa kini. Buletin Toraks Kardiovaskuler Indonesia.
\line\tab \up0 \expndtw-2\charscalex100 1996 : IV (4) : 30-34. \par\pard\ql \li2
160\ri1652\sb0\sl-207\slmult0\tx2520\tx2520 \up0 \expndtw0\charscalex104 3.\ul0\
nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18
Saenz RB, Diane KB, L
aramie C\ul0\nosupersub\cf16\f17\fs18 . Triplett, M.D. Caring for Infants with C
ongenital Heart Disease and \line\tab \up0 \expndtw-1\charscalex100 Their Famili
es. University of Mississippi Medical Center Jackson, Mississippi American acad
emy of Family \line \tab \up0 \expndtw-2\charscalex100 Physician. 2003 \par\pard
\ql \li2160\ri1654\sb0\sl-207\slmult0\tx2520\tx2520 \up0 \expndtw0\charscalex102
4.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18
Madiyono B. \
ul0\nosupersub\cf16\f17\fs18 Kardiologi anak masa lampau, kini, dan masa mendata
ng : Perannya dalam pencegahan dan \line\tab \up0 \expndtw0\charscalex100 penang
gulangan penyakit kardiovaskuler. Pidato pada upacara pengukuhan sebagai guru be
sar tetap dalam \line \tab \up0 \expndtw-1\charscalex100 ilmu kardiologi anak pa
da Fakultas Kedokteran Universitas Indonesia. Jakarta, 1997: 11 Juni. \par\pard\
ql \li2160\ri1647\sb0\sl-207\slmult0\tx2520\tx2520 \up0 \expndtw0\charscalex102
5.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18
Anderson RH, M
acartney FJ, Shinebourne EA, Tynan M.\ul0\nosupersub\cf16\f17\fs18 Fetal circul
ation and circulatory changes at \line\tab \up0 \expndtw0\charscalex102 birth. I
n : Anderson RH, Macartney FJ, Shinebourne EA and Tynan M, eds. Paediatric Cardi
ology. Vol.2 \line \tab \up0 \expndtw-3\charscalex100 Churchill Livingstone, 198
7: 109. \par\pard\qj \li2160\ri1654\sb0\sl-207\slmult0\tx2520 \up0 \expndtw0\c
harscalex100 6.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18
W
ren C, Richmond S, Donaldson L : \ul0\nosupersub\cf16\f17\fs18 Presentation of c
ongenital heart disease in infancy : implications for \line\tab \up0 \expndtw-1\
charscalex100 routine examination. Arch Dis Child Fetal Neonatal Ed 1999 : 80 :
F49-F53. \par\pard\ql \li2160\sb1\sl-198\slmult0 \up0 \expndtw0\charscalex100 \u
l0\nosupersub\cf21\f22\fs18 7.\ul0\nosupersub\cf23\f24\fs18 \ul0\nosupersub\cf2
1\f22\fs18
Dinarevic S, Kurtagic S, Maksic H : \ul0\nosupersub\cf16\f17\fs18
Use of prostaglandins in neonatal Cardiology. Med Arh. 2000 :54(5-\par\pard\ql \
li2520\sb2\sl-207\slmult0 \up0 \expndtw-2\charscalex100 6):279-82 \par\pard\li21
60\sb0\sl-207\slmult0\fi0 \up0 \expndtw0\charscalex100 8.\ul0\nosupersub\cf22\f2
3\fs18 \ul0\nosupersub\cf21\f22\fs18
Westmoreland D : \ul0\nosupersub\cf16\f
17\fs18 Critical congenital cardiac defects in the newborn. J. Perinat Neonatal
Nurs. 1999 : Mar\par\pard\li2160\sb0\sl-207\slmult0\fi359 \up0 \expndtw-2\charsc
alex100 12\t \up0 \expndtw-2\charscalex100 (4):67-87.\par\pard\ql \li2159\ri1657
\sb1\sl-206\slmult0\tx2519\tx2519 \up0 \expndtw0\charscalex105 9.\ul0\nosupersub
\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18
Friedman WF, Silverman N.\ul0\n
osupersub\cf16\f17\fs18 Congenital Heart Disease in Infancy and Childhood. In H
eart Disease A \line\tab \up0 \expndtw0\charscalex104 Textbook of Cardiovascular
Medicine..6\ul0\super\cf24\f25\fs18 th\ul0\nosupersub\cf16\f17\fs18 ed. Ed By
Braunwald, Zipes, Libby. WB Saunders Company \line \tab \up0 \expndtw-1\charscal
ex100 Philadelphia London New York St Louis Sydney Toronto. 2001: pp 1505-1591.
\par\pard\ql \li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\slmult0
\par\pard\ql\li10200\sb126\sl-276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\no
supersub\cf2\f3\fs24 18 \par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
z-10000\shplid18
ffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
00110803e7030403012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
lmult0 \par\pard\ql\li2160\sb177\sl-207\slmult0 \up0 \expndtw0\charscalex100 \ul
0\nosupersub\cf16\f17\fs18 10.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf2
1\f22\fs18 Korones SB, Bada-Ellzey HS : \ul0\nosupersub\cf16\f17\fs18 Shock. In
:\ul0\nosupersub\cf21\f22\fs18 \ul0\nosupersub\cf16\f17\fs18 Korones SB, BadaEllzey HS,eds. Neonatal Decision Making. \par\pard\ql \li2520\sb0\sl-206\slmul
t0 \up0 \expndtw-2\charscalex100 B.C Decker An Imprint of Mosby-Year Book, Inc.
1993 : 158-160. \par\pard\ql \li2160\ri1654\sb2\sl-207\slmult0\tx2520\tx2520 \u
p0 \expndtw0\charscalex100 11.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf2
1\f22\fs18 Sastroasmoro S. \ul0\nosupersub\cf16\f17\fs18 Penatalaksanaan awa
l penyakit jantung bawaan sianotik. Dalam: Sastroasmoro dan \line\tab \up
0 \expndtw0\charscalex103 Madiyono B ed. Penatalaksanaan kedaruratan kerdiovas
kular pada anak Naskah lengkap Pendidikan \line \tab \up0 \expndtw-1\charsc
alex100 Kedokteran Berkelanjutan Ilmu Kesehatan Anak XX FKUI. Desember 1989:1-20
\par\pard\qj \li2160\ri1656\sb0\sl-207\slmult0\tx2520 \up0 \expndtw0\charscalex
100 12.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18 Hsia C.C.W.

\ul0\nosupersub\cf16\f17\fs18 Respiratory Function of Hemoglobin. The New Engla
nd Journal of Medicine. 1998: 338 (4) : \line\tab \up0 \expndtw-2\charscalex100
239-47 \par\pard\qj \li2160\ri1655\sb0\sl-207\slmult0\tx2520 \up0 \expndtw0\char
scalex100 13.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18 Wilki
nson JL.\ul0\nosupersub\cf16\f17\fs18 Initial management and referral for surgi
cal intervention of neonates with critical congenital \line\tab \up0 \expndtw2\charscalex100 heartd disease. Indones J Pediatr Cardiol 2002:1: 4-6 \par\pard\
ql \li2160\sb0\sl-204\slmult0 \up0 \expndtw0\charscalex100 14.\ul0\nosupersub\cf
22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18 Dinarevic S, Kurtagic S, Maksic H :
\ul0\nosupersub\cf16\f17\fs18 Use of prostaglandins in neonatal cardiology.\ul0\
nosupersub\cf21\f22\fs18 \ul0\nosupersub\cf16\f17\fs18 Med Arh. 2000 : 54(5-\pa
r\pard\ql \li2520\sb2\sl-207\slmult0 \up0 \expndtw-2\charscalex100 6):279-82 \pa
r\pard\ql \li2160\ri1655\sb5\sl-205\slmult0\tx2520\tx2520 \up0 \expndtw0\charsca
lex103 \ul0\nosupersub\cf21\f22\fs18 15.\ul0\nosupersub\cf23\f24\fs18 \ul0\nosu
persub\cf21\f22\fs18 Mulyadi M Djer, Bambang Madyono, Sudigdo Sastroasmoro, Suk
man T Putra, Ismet N Oesman, \line\tab \up0 \expndtw0\charscalex103 Najib Adva
ni, Mazeni Alwi :\ul0\nosupersub\cf16\f17\fs18 Stent implantation into ductus
arteriosus: a new alternative of palliative \line \tab \up0 \expndtw-1\charsc
alex100 treatment of duct-dependent pulmonary circulation. Paediatrica Indonesi
ana. 2004 : 44 (1-2): 30-36. \par\pard\qj \li2160\ri1656\sb3\sl-206\slmult0\tx25
20 \up0 \expndtw0\charscalex100 16.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersu
b\cf21\f22\fs18 Korones SB, Bada-Ellzey HS : \ul0\nosupersub\cf16\f17\fs18 Pate
nt Ductus Arteriosus. In :\ul0\nosupersub\cf21\f22\fs18 \ul0\nosupersub\cf16\f1
7\fs18 Korones SB, Bada- Ellzey HS,eds. Neonatal \line\tab \up0 \expndtw-1\chars
calex100 Decision Making. B.C Decker An Imprint of Mosby- Year Book, Inc. 1993
: 162-163. \par\pard\qj \li2160\ri1655\sb3\sl-206\slmult0\tx2520 \up0 \expndtw-1
\charscalex100 17.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18
Rao PS.\ul0\nosupersub\cf16\f17\fs18 Interventional pediatric cardiology: state
of art and future directions. Pediatr Cardiol 1998 : 19: 107-\line \tab \up0 \e
xpndtw-2\charscalex100 24 \par\pard\qj \li2160\ri1656\sb3\sl-206\slmult0\tx2520
\up0 \expndtw0\charscalex100 18.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\c
f21\f22\fs18 Ontoseno T. \ul0\nosupersub\cf16\f17\fs18 Perjalanan hidup penderi
ta dengan Penyakit Jantung Bawaan. Jurnal
Kardiologi Indonesia. \line\tab \u
p0 \expndtw-2\charscalex100 1996 : XXI : 329-334. \par\pard\qj \li2160\ri1655\sb
3\sl-206\slmult0\tx2520 \up0 \expndtw0\charscalex102 19.\ul0\nosupersub\cf22\f23
\fs18 \ul0\nosupersub\cf21\f22\fs18 Lewis\ul0\nosupersub\cf16\f17\fs18 \ul0\n
osupersub\cf21\f22\fs18 AB, Freed MD, Heyman MA, Roehl SL, Kensey RC\ul0\nosup
ersub\cf16\f17\fs18 . Side effect of prostaglandin E1 in infants \line\tab \up0
\expndtw-2\charscalex100 with critical congenital heart disease. Circulation 198
1: 64: 893-8. \par\pard\ql \li2160\sb2\sl-207\slmult0 \up0 \expndtw0\charscalex1
00 20.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18 Sao Paulo SP
:\ul0\nosupersub\cf16\f17\fs18 Critical Analysis of Diagnostic Methods in Pedi
atric Cardiology. Arq Bras Cardiol 2001: 76 \par\pard\ql \li2520\sb0\sl-206\slmu
lt0 \up0 \expndtw-2\charscalex100 (1), 4-6. \par\pard\qj \li2160\ri1656\sb3\sl-2
06\slmult0\tx2520 \up0 \expndtw0\charscalex103 21.\ul0\nosupersub\cf22\f23\fs18
\ul0\nosupersub\cf21\f22\fs18 Sullivan ID\ul0\nosupersub\cf16\f17\fs18 : Pren
atal diagnosis of structural heart disease : doe it make a difference to survi
val ? Heart \line\tab \up0 \expndtw-2\charscalex100 2002 : 87: 405-406. \par\par
d\ql \li2160\sb2\sl-207\slmult0 \up0 \expndtw-1\charscalex100 22.\ul0\nosupersub
\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18 Eronen M\ul0\nosupersub\cf16\f17\
fs18 : Outcome of fetuses with heart disease diagnosed in utero. Arch Dis \par\
pard\li2880\sb1\sl-205\slmult0\fi0\tx3240 \up0 \expndtw-2\charscalex100 a.\tab \
up0 \expndtw-2\charscalex100 Child 1997 : 77 : F41-F46\par\pard\ql \li10200\sb0\
sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\

sl-276\slmult0 \par\pard\ql\li10200\sb160\sl-276\slmult0 \up0 \expndtw-3\charsca
lex100 \ul0\nosupersub\cf2\f3\fs24 19 \par\pard\sect\sectd\fs24}

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{\rtf1{\fonttbl

{\f2 Times New Roman Bold;}

{\sp{\sn fBehindDocument}{\sv 1}}

\cf3\f4\fs18 ABSTRACT \par\pard\qj \li1799\sb0\sl-310\slmult0 \par\pard\qj\li179

if prostaglandin mengakibatkan kontraksi awal dan penutupan fungsional dari

\li1800\ri1624\sb2\sl-379\slmult0\fi719 \up0 \expndtw-2\charscalex100 Penutupan

g, maka gejala sianosis \up0 \expndtw0\charscalex100 sentral, penurunan perfusi

beberapa keadaan yang juga \up0 \expndtw0\charscalex107 memberikan gejala hampi

{\sp{\sn shapeType}{\sv 75}}

tw0\charscalex102 oksigen meningkat sampai \up0 \expndtw0\charscalex105 3 kal

sehingga darah dengan kadar oksigen yang rendah (\ul0\nosupersub\cf14\f15\fs22

t inilah baru terjadi pirau kiri ke kanan disertai \up0 \expndtw0\charscalex104

ik akibat PJB pada neonatus berupa a) hambatan aliran \up0 \expndtw0\charscale

0\slmult0\fi274\tx3542\tx6160\tx8030\tx9629 \up0 \expndtw-2\charscalex100 2\tab

sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\

drainase vena pulmonalis; TrA=trunkus \line \up0 \expndtw0\charscalex102 arteri

\f8\fs22 dan \ul0\nosupersub\cf10\f11\fs22 balloon angioplasty\ul0\nosupersub\c

f8\fs22 dan sementara menunggu \up0 \expndtw0\charscalex100 kepastian diagnosi

umbilikalis, dosis bisa dinaikkan sampai 0,1 sampai 0,15 mikrogram/kgBB/menit se

0\charscalex100 Disritmia jantung sering menyertai hipoksemia berat, bila hipoks

100 12.\ul0\nosupersub\cf22\f23\fs18 \ul0\nosupersub\cf21\f22\fs18 Hsia C.C.W.

sl-276\slmult0 \par\pard\ql\li10200\sb0\sl-276\slmult0 \par\pard\ql\li10200\sb0\

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