DIAGNOSIS DAN

TATALAKSANA
BATUK PILEK
PADA BAYI <3 BULAN
Khadijah Rizky Sumitro
Batuk? Pilek?
• A cough is your body's way of responding when something irritates
your throat or airways
• A runny nose = rhinorrhea involves a thin, mostly clear fluid
running from the nose

Grok-grok?
Nafasnya bunyi?
Reanamnesis keluhan yg dimaksud dg
BATUK dan PILEK!
Bersin?
Hidung buntu?
Meler?
Case 1
• A 2 months old, male, 4 kg
• Cough and fever since 3 days ago
• Since this morning, the baby has refused to breastfeed and looks weak

Physical examination:
• Weak baby, HR 170 bpm regular, t 38.50C, RR 66 tpm, SpO2 90%
• Nasal flaring (+), head bobbing (+)
• Intercostal and subcostal retraction, fine rhales in both lungs,
no wheezing
• Otherwise no remarkable findings
Pneumonia
• Pneumonia is defined as a lower
respiratory tract infection (LRTI)
typically associated with fever,
respiratory symptoms, and
evidence of parenchymal
involvement (alveoli) by either
physical examination or the
presence of infiltrates on chest
radiography
 Birth Cohort Study in Indonesian Children
• 422 infants
• 12-month period of observation

Oktaria V, Danchin M, Triasih R, Soenarto Y, Bines JE, Ponsonby A-L, et al. (2021) The incidence of acute respiratory infection in Indonesian infants and association with vitamin D deficiency. PLoS ONE 16(3): e0248722
Case 1 PNEUMONIA
• A 2 months old, male, 4 kg
• Cough and fever since 3 days ago
• Since this morning, the baby has refused to breastfeed and looks weak

Physical examination:
• Weak baby, HR 170 bpm regular, t 38.50C, RR 66 tpm, SpO2 95%
• Nasal flaring (+), head bobbing (+)
• Intercostal and subcostal retraction, fine rhales in both lungs,
no wheezing
• Otherwise no remarkable findings
Bagaimana menghitung laju napas?
JANGAN LUPA BUKA PAKAIAN ANAK PADA SAAT PEMERIKSAAN FISIK!
Head bobbing

Nasal flaring

Chest Indrawing
Case 1 PNEUMONIA
• A 2 months old, male, 4 kg Management?
• Cough and fever since 3 days ago
• Hospitalized
• Since this morning, the baby has
refused to breastfeed • Primary Survey – ABC
• Weak baby
(Oxygenation)
• HR 170 bpm, t 38.50C, RR 66 tpm, • Antibiotic – Ampicilline and
SpO2 95% Gentamycine iv
• Nasal flaring (+), head bobbing (+) • Risk factor? Brestfeeding,
Immumization, etc
• Intercostal and subcostal retraction
• Fine rhales in both lungs
WHO, 2014
Jika bayi berusia<2 bulan
Jika bayi berusia<2 bulan
Case 1 PNEUMONIA
• A 2 months old, male, 4 kg
• Cough and fever since 3 days ago
• Since this morning, the baby has Laboratory
refused to breastfeed examination??
• Weak baby
• HR 170 bpm, t 38.50C, RR 66 tpm,
SpO2 95% Chest X-Ray??
• Nasal flaring (+), head bobbing (+)
• Intercostal and subcostal retraction
• Fine rhales in both lungs
Case 1 PNEUMONIA
• A 2 months old, male, 4 kg • Natal history: born spontaneously,
• Cough and fever since 3 days ago midwife, 3000 grams
• Since this morning, the baby has • Immunization history: Hepatitis 0,
refused to breastfeed Polio 1, BCG
• Weak baby
• HR 170 bpm, t 38.50C, RR 66 tpm,
SpO2 95%
• Nasal flaring (+), head bobbing (+)
• Intercostal and subcostal retraction
• Fine rhales in both lungs
Case 2
A 10 weeks, male, 5 kg
• Cough and sneezing since 3 days ago
• Fever since 3 days ago
• Increased of breathing was oserved by the mother since this morning,
and he has refused to breastfeed

• Natal history: born spontaneously, term, midwife, 3300 grams

• Immunization history: Hepatitis 0, Polio 1 & 2, BCG, DPT-Hib-HepB 1
Case 2
A 10 weeks, male, 5 kg

Physical examination:
• Alert baby, HR 168 bpm regular, t 37.80C, RR 60 tpm, SpO2 96%
• Prolonged expiration (+), minimal subcostal retraction, wheezing
in both lungs, minimal fine rhales in 1/3 distal both lungs,
• Otherwise no remarkable findings
 Bronchiolitis
• Bronchiolitis is a common acute lower respiratory tract infectious
(ALRTI) disease in infants and children that mainly occurs in children
aged under 3 years old, especially those under 2 years old
• The peak age of onset is 2–6 months
• Bronchiolitis is often associated with infectious wheezing in infants
• This disease is primarily caused by respiratory syncytial virus (RSV)
infection, followed by rhinovirus

Tian J, Wang XY, Zhang LL, Liu MJ, Ai JH, Feng GS, Zeng YP, Wang R, Xie ZD. Clinical epidemiology and disease burden of bronchiolitis in hospitalized children in China: a national cross-sectional study. World J Pediatr. 2023
Sep;19(9):851-863.
www.openpediatrics.org
Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics in Review, 40(11), 568–576. doi:10.1542/pir.2018-0260
www.openpediatrics.org
 Diagnosis based on H&P!

Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics in Review, 40(11), 568–576. doi:10.1542/pir.2018-0260
Rahels and Wheezing Sound

Prolonged Expiration
Case 2 BRONCHIOLITIS
• A 10 weeks, male, 5 kg
Management?
• Cough, sneezing, fever since 3 days ago
• Hospitalized
• Increased of breathing since morning
• Refused to breastfeed • Primary Survey – ABC
(Oxygenation)
• Alert baby
• HR 168 bpm, t 37.80C, RR 60 tpm, • Antibiotic ?
SpO2 92%
• Prolonged expiration (+)
• Minimal subcostal retraction
• Wheezing in both lungs
• Min fine rhales in 1/3 distal both lungs
 Management
• Supportive treatment
• The mainstay of therapy begins with an assessment of need for
supportive care by assessing hydration status and oxygenation
• Antibiotic – If identified concomitant bacterial infection (such as acute
otitis media or urinary tract infection) is confirmed or suspected

• Despite numerous trials of various medical therapeutic interventions,

no clear single therapy has been found to be significantly beneficial

Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics in Review, 40(11), 568–576. doi:10.1542/pir.2018-0260
Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics in Review, 40(11), 568–576. doi:10.1542/pir.2018-0260
 Indication for Hospitalization
• Poor oral intake – Dehydration
• Hypoxia
• Apnea
• Moderate – Severe Respiratory Distress
• High risk factor

Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics in Review, 40(11), 568–576. doi:10.1542/pir.2018-0260
www.openpediatrics.org
 Prognosis
• By nature, bronchiolitis is a self-limited disease with a relatively
good prognosis

Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics in Review, 40(11), 568–576. doi:10.1542/pir.2018-0260
Case 2 BRONCHIOLITIS
• A 10 weeks, male, 5 kg
• Cough, sneezing, fever since 3 days ago
• Increased of breathing since morning Laboratory
• Refused to breastfeed examination??
• Alert baby
• HR 168 bpm, t 37.80C, RR 60 tpm,
SpO2 92%
Chest X-Ray??
• Prolonged expiration (+)
• Minimal subcostal retraction
• Wheezing in both lungs
• Min fine rhales in 1/3 distal both lungs
 AAP guidelines recommend against the routine use of
laboratory or radiographic testing.

Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics in Review, 40(11), 568–576. doi:10.1542/pir.2018-0260
www.openpediatrics.org
Case 2 BRONCHIOLITIS
• A 10 weeks, male, 5 kg
• Cough, sneezing, fever since 3 days ago
• Increased of breathing since morning
• Refused to breastfeed
• Alert baby
• HR 168 bpm, t 37.80C, RR 60 tpm, How to prevent?
SpO2 92%
• Prolonged expiration (+)
• Minimal subcostal retraction
• Wheezing in both lungs
• Min fine rhales in 1/3 distal both lungs
?
Case 3
• A 1 month baby, female, 3.5 kg
• Sneezing and runny nose since 4 days ago, along with fever for 2 days
• She looks active and is breastfeeding well
• One week ago, mother has experienced the same complaint

Physical examination:
• Alert baby, HR 136 bpm regular, t 36.70C, RR 48 tpm, SpO2 98%
• No remarkable findings
Rhinopharyngitis = Nasopharyngitis = Common
Cold = Selesma
• An infectious disorder of the nasal (rhino-) and pharyngeal (pharynx-)
mucosa
• NICE : “a mild, self-limiting, upper respiratory tract infection (URTI)
characterized by nasal stuffiness and discharge, sneezing, sore throat,
and cough”
• Mostly caused by respiratory viruses
 Birth Cohort Study in Indonesian Children
95% infants have experienced the common cold at least once during
the first year of life

64% infants suffered 3-6 periods of common cold during 1 year of life

Oktaria V, Danchin M, Triasih R, Soenarto Y, Bines JE, Ponsonby A-L, et al. (2021) The incidence of acute respiratory infection in Indonesian infants and association with vitamin D deficiency. PLoS ONE 16(3): e0248722
 Epidemiology

The incidence of common

cold is inversely
related to age with
infants having 6–8 colds/y
compared to
adults having 2–4 colds/y

Heikkinen, T., & Järvinen, A. (2003). The common cold. The Lancet, 361(9351), 51–59. doi:10.1016/s0140-6736(03)12162-9
Eclles, Ronald. (2023). Common Cold. Front. Allergy:4. https://doi.org/10.3389/falgy.2023.1224988
 Etiology

Rhinoviruses (RVs) are

the most common cause
of the common cold as
they are found in more
than half of upper
respiratory tract
infections and can be
considered as the most
common infection of
humans world-wide
Heikkinen, T., & Järvinen, A. (2003). The common cold. The Lancet, 361(9351), 51–59. doi:10.1016/s0140-6736(03)12162-9
Eclles, Ronald. (2023). Common Cold. Front. Allergy:4. https://doi.org/10.3389/falgy.2023.1224988
 Risk Factors

Eclles, Ronald. (2023). Common Cold. Front. Allergy:4. https://doi.org/10.3389/falgy.2023.1224988

Case 3 COMMON COLD
• A 1 month baby, female, 3.5 kg Management?
• Sneezing and runny nose since 4 days
ago, along with fever for 2 days • Supportive treatment
• She looks active and is breastfeeding • Continue breastfeeding
well
• One week ago, mother has experienced
the same complaint
• Alert baby, HR 136 bpm regular,
t 36.70C, RR 48 tpm, SpO2 98%
• No remarkable findings
DeGeorge KC, Ring DJ, Dalrymple SN. Treatment of the Common Cold. Am Fam Physician. 2019 Sep 1;100(5):281-289.
DeGeorge KC, Ring DJ, Dalrymple SN. Treatment of the Common Cold. Am Fam Physician. 2019 Sep 1;100(5):281-289.
Case 3 COMMON COLD
• A 1 month baby, female, 3.5 kg
• Sneezing and runny nose since 4 days
ago, along with fever for 2 days
• She looks active and is breastfeeding
well
• One week ago, mother has experienced
the same complaint How to prevent?
• Alert baby, HR 136 bpm regular,
t 36.70C, RR 48 tpm, SpO2 98%
• No remarkable findings
Case 4
• A six-week-old girl, 4 kg
• Cough since 2 weeks ago
Case 4
• A nine-week-old girl, 5 kg • Natal history : born
• Cough since 3 weeks ago spontaneously, term, doctor,
3200 grams
• Cough description:
• Paroxysms cough • Immunization history:
• Cyanosis after cough Hepatitis 0, Polio 1&2
• Otherwise look normal beetwen
cough
• No fever
• No dyspnea
• Breastfeeding 10 times/day
Case 4
• A six-week-old girl, 4 kg
• Cough since 2 weeks ago

Physical examination:
• Alert baby
• HR 140 bpm regular, t 36.50C, RR 52 tpm, SpO2 98%
• No chest retraction, no rhales, no wheezing
• Otherwise no remarkable findings
Whats’s next?
Case 4
• A six-week-old girl, 4 kg
• Cough since 2 weeks ago

Lab Result
Hb 13.7 g/dL
WBC 22.89x103/L
Lymphocyte 17.79x10103/L (77.7%) Normal Chest X-Ray
Platelet 22.89x103/L
ESR 4mm/hour

Clinical Diagnosis
 Pertussis
• Batuk rejan, batuk 100 hari
• Bordetella pertussis
• Humans are the only known reservoir for B. pertussis
• Very contagious respiratory illness that spreads from
person to person through the air (direct transmission)
Gram-negative, aerobic, pathogenic,
encapsulated cocc obacillus
Sizaire V, Garrido-Estepa M, Masa-Calles J, Martinez de Aragon MV. Increase of pertussis incidence in 2010 to 2012 after 12 years of low circulation in Spain. EuroSurveill. 2014;19(32):pii=20875.
Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20875
Case 4
• A six-week-old girl, 4 kg
• Cough since 2 weeks ago

Lab Result
Hb 13.7 g/dL
WBC 22.89x103/L
Lymphocyte 17.79x10103/L (77.7%)
Platelet 22.89x103/L
ESR 4mm/hour
Gold Standard
Case 4
• A six-week-old girl, 4 kg
• Cough since 2 weeks ago

Suspicion of Pertussis

Management
Management
• Hospitalization (especially infants <6 months)
• Isolation Room
• Oxygenation
• Antibiotic
Management
 Complications & Prognosis
• Of those infants younger than 12 months with pertussis who need
treatment in a hospital approximately
• 68% will have apnea
• 22% will get pneumonia
• 2.2% will have seizures/convulsions
• 1% will die
• 0.6% will have encephalopathy (as a result of hypoxia from coughing or possibly
from toxin)
• Prognosis for full recovery from pertussis is excellent in children older than
3 months of age
• In those younger than 3 months, the mortality is 1-3%
https://www.cdc.gov/pertussis/clinical/complications.html
https://emedicine.medscape.com/article/967268-overview#a6
Case 4
• A six-week-old girl, 4 kg
• Cough since 2 weeks ago

Suspicion of Pertussis

How to prevent
Take Home Messages
• History taking and physical examination are very important to
determining the diagnosis and etiology of cough & runny nose
• Use antibiotic properly!
Not all cough & runny nose need to be treated with antibiotic
• A good diagnosis will lead to good management

THANK YOU
Normal?
• Bunyi grok-grok normal
• Laryngomalacia