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14 - 120218213815. Pneumonia Neonatal PDF
14 - 120218213815. Pneumonia Neonatal PDF
ROCKY WILAR
UKK NEONATOLOGI
IKATAN DOKTER ANAK INDONESIA
1
PNEUMONIA NEONATAL
Penyebab penting infeksi pada neonatus
Angka kematian yang tinggi di negara berkembang
Sepertiga kematian pada anak dalam 28 hari pertama
kehidupan
PNEUMONIA NEONATAL
Terjadi saat : Infeksi transplasental/intrauterine, proses
persalinan, infeksi nosokomial
Onset Dini Gejala klinis timbul dalam 48 jam I sampai
1 minggu
Onset Lanjut Gejala klinis timbul > 1 minggu
Nissen MD. Congenital and Neonatal Pneumonia. Pediatrics Resp Reviews. 2007;
8: 185-203.
3
ETIOLOGI
Streptokokus grup B
CMV
Treponema pallidum
Toxoplasma gondii
RSV
Stoll BJ, Hansen NI, Higgins RD, dkk. Very low birth weight preterm infants with
early onset neonatal sepsis: the predominance of gram-negative infections
continues in the National Institute of Child Health and Human Development
Neonatal Research Network, 2002-2003. Pediatr Infect Dis J. 2005 Jul; 24(7):635-
9.
ETIOLOGI 4
Michael ND Congenital and neonatal pneumonia. Ped Resp Rev (2007) 8, 195-203
5
PATOGENESIS
TRANS Cairan amnion, infeksi
intrauteri
PLASENTAL
Patel SJ, Saiman L. Antibiotic Resistance in Neonatal Intensive Care Unit Pathogens: Mechanism, Clinical
Impact, and Prevention Including Antibiotic Stewardship. Clinical Perinatology. 2010; 37: 547-563.
6
PATOGENESIS
INDUKSI DISFUNGSI
PELEPASAN
SITOKIN SURFAKTAN
INFLAMASI
PARU
CEDERA EPITEL
SALURAN
PERNAFASAN
Stoll BJ, Hansen NI, Higgins RD, dkk. Very low birth weight preterm infants with early onset neonatal sepsis:
the predominance of gram-negative infections continues in the National Institute of Child Health and Human
Development Neonatal Research Network, 2002-2003. Pediatr Infect Dis J. 2005 Jul; 24(7):635-9.
PATOGENESIS 7
Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J
Med 2000;342(20):1500-7
8
DIAGNOSIS
PNEUMONIA NEONATAL
ANAMNESIS
(FAKTOR RESIKO DAN
PREDISPOSISI DARI IBU DAN BAYI)
PEMERIKSAAN
FISIK
PEMERIKSAAN PENUNJANG
(LABORATORIUM DAN
PENCITRAAN)
Dear PRF, FIFE A. Pneumonia. Dalam: Greenough A, Milner AD, penyunting. Neonatal Respiratory
Disorders. 2003; London: Arnold: 21: 278-310.
9
FAKTOR PREDISPOSISI
PNEUMONIA NEONATAL
IMATURITAS
KORIOAMNIONITIS
Stoll BJ. Infections of the neonatal infant. Dalam: Behrman R, Kliegman R, Jenson H, penyunting.
Nelson textbook of paediatrics. Edisi ke-18. Philadelphia: Saunders; 2007. h.794-815
10
GEJALA KLINIS
PNEUMONIA NEONATAL
TIDAK GANGGUAN PEMERIKSAAN
SPESIFIK NAFAS FISIK
• MALAS MINUM • GRUNTING • PEKAK PADA
• LETARGI • TAKIPNEA PERKUSI
• IRITABILITAS • RETRAKSI • PERUBAHAN
• TIDAK AKTIF • SIANOSIS SUARA NAFAS
• TEMPERATUR • APNEA • RONKHI
TIDAK STABIL • GAGAL NAFAS
Stoll BJ. Infections of the neonatal infant. Dalam: Behrman R, Kliegman R, Jenson H, penyunting.
Nelson textbook of paediatrics. Edisi ke-18. Philadelphia: Saunders; 2007. h.794-815
11
PEMERIKSAAN PENUNJANG
PNEUMONIA NEONATAL
PENCITRAAN
RADIOGRAFI DADA
PEMERIKSAAN BIOKIMIA
DARAH
PEMERIKSAAN
HEMATOLOGI
Nissen MD. Congenital and Neonatal Pneumonia. Pediatrics Resp Reviews. 2007; 8: 185-203.
12
PEMERIKSAAN PENUNJANG
HEMATOLOGI
Bender L, Thaarup J, Varming K, dkk. Early and late markers for the detection of early onset
neonatal sepsis. Med Bull. 2008; 55:219-23
13
PEMERIKSAAN PENUNJANG
KULTUR
Nissen MD. Congenital and Neonatal Pneumonia. Pediatrics Resp Reviews. 2007; 8: 185-203.
14
PEMERIKSAAN PENUNJANG
RADIOLOGIS
PERSELUBUNGAN DIFUS ATAU GRANULER
AIR BRONCHOGRAM DISERTAI KONSOLIDASI LUAS BAIK
SEGMENTAL ATAU LOBAR
INFILTRAT PATCHY KASAR ATAU NODULAR DI KEDUA
LAPANGAN PARU
PNEUMATOKEL BERHUBUNGAN DENGAN EFUSI PLEURA
Ostapchuk M, Roberts MD, Haddy R. Community-Acquired Pneumonia in Infants and Children. Am
Fam Physician. Sep 2004; 1(7):899-908
Haney PJ, Bohlman M, Sun CC. Radiographic findings in neonatal pneumonia. AJR Am J Roentgenol.
1984 Jul. 143(1):23-6.
15
PERBANDINGAN TEMUAN RADIOGRAFI
PADA NEONATAL RESPIRATORY DISTRESS
RFLLS (Retained Fetal Lung Liquid Syndrome) , RDS (Respiratory Distress Syndrome), MAS
(Meconium Aspiration Syndrome)
Penggunaan oksigen
Deteksi dan pengobatan hipoksemia
Atasi apnea
Termoregulasi
Deteksi dan cegah hipoglikemia
Perhatikan pemberian nutrisi untuk
intake adekuat
Bradley JS, Byington CL, Shah SS, dkk. The management of community-acquired pneumonia in infants and
children older than 3 months of age: clinical practice guidelines by the pediatric infectious diseases society and
the infectious diseases society of america. Clin Infect Dis. 2011 Oct. 53(7):e25-76.
18
DIAGNOSIS BANDING
OBSTRUKSI
PENYAKIT PENYAKIT
JALAN NAFAS
PULMONAL KARDIAK
ATAS
• Atresia Choana • Respiratory Distress • Kelainan jantung
• Stenosis nasal Syndrome bawaaan sianotik
• Pierre-Robin • Aspirasi • Kelainan jantung
Syndrome • Trakeoesofageal bawaan asianotik
• Stenosis Laring fistula • Gagal jantung
• Hemangioma • Agenesis pulmonal • Pneumopericard
• Trakeomalasia • Efusi pleura • Kardiomiopati
• Celah bibir • Sekuestrasi bronkus
• Paralisis pita suara • Emfisema paru
Stack C, Dobbs P. Pneumonia. In: Essentials of Pediatrics Intensive Care. New York. Greenwich.
2003. p11.80-81
19
DIAGNOSIS BANDING
Stack C, Dobbs P. Pneumonia. In: Essentials of Pediatrics Intensive Care. New York. Greenwich.
2003. p11.80-81
PENDEKATAN DIAGNOSIS KELAINAN 20
JANTUNG ATAU PARU
Menjaga
Perawatan hygiene staf Rasional dan
Lama di RS medis yang efektif
Ketuban bertugas
Pecah Memperhatik
an Tepat sasaran
Dini Perawatan
baik untuk
Lama di kebersihan
alat-alat onset dini
Ruang maupun
Intensif medis lambat
Kirkwood BR, Gove S, Rogers S et al. Potential intervention for the prevention of childhood
pneumonia in developing countries a systematic review. Bull World Health Organ. 1995; 73: 793-798.