KEGAWATAN PADA NEONATUS

DISKUSI KASUS

dr. Defa Rahmatun Nisaa, SpA, MKes.

FK UNSWAGATI CIREBON

Kasus 1
Seorang bayi lahir dari ibu G2P1Ao letak kepala
spontan, kehamilan 39-40 minggu
Bayi lahir menangis lemah, tonus otot baik, warna kulit
kemerahan, akrosianosis (+), ketuban jernih
HR 130 x/m, RR 40 x/m, Sp02 70%
BBL 3000 gram, PBL 49 cm
Selama hamil ibu sehat

APGAR Scores
Sign
Score = 0
Score = 1
Score = 2
---------------------------------------------------------------------------------------------------APPEARANCaE
Blue all over,
Acrocyanosis
Pink all over
(color)
or pale
PULSE
(heart rate)

Absent

Below 100

Above 100

GRIMACE
No response
(reflex irritability)

Grimace or
weak cry

Good cry

ACTIVITY

Some flexion of

Well flexed, or active

extremities

movements of extremities

Flaccid

(muscle tone)
RESPIRATIONS

Absent

Weak, irregular,
or gasping

Good crying

============================================
The APGAR score should be assigned at one minute and five minutes, finding the
total score (0-10) at each time by adding up points from the table above. Continue
to assign scores every five minutes thereafter as long as the APGAR score is less
than 7.

APGAR SKOR 18 dan 510

Kesan:
TI, AGA (39-40 mgg), letak kepala spontan
Terapi:
Vit K
Salep mata
ASI ad lib
Rawat gabung

Kasus 2
Seorang bayi lahir dari ibu G1PoAo letak kepala sc a.i.
Gawat janin + ibu PEB + perdarahan antepartum e.c
placenta previa, kehamilan 36-37 minggu
Bayi lahir tidak menangis, flaccid, warna kulit kebiruan,
ketuban jernih
HR 50 x/m, RR 5x/m gasping, Sp02 40%
BBL 1800 gram, PBL 42 cm
Selama hamil ibu menderita hipertensi, kontrol tidak
teratur

APGAR Scores
Sign
Score = 0
Score = 1
Score = 2
---------------------------------------------------------------------------------------------------APPEARANCaE
Blue all over,
Acrocyanosis
Pink all over
(color)
or pale
PULSE
(heart rate)

Absent

Below 100

Above 100

GRIMACE
No response
(reflex irritability)

Grimace or
weak cry

Good cry

ACTIVITY

Some flexion of

Well flexed, or active

extremities

movements of extremities

Flaccid

(muscle tone)
RESPIRATIONS

Absent

Weak, irregular,
or gasping

Good crying

============================================
The APGAR score should be assigned at one minute and five minutes, finding the
total score (0-10) at each time by adding up points from the table above. Continue
to assign scores every five minutes thereafter as long as the APGAR score is less
than 7.

APGAR skor : 2
Kesan:
Asfiksia Berat
Terapi:
Tahapan resusitasi dilanjutkan hingga stabil
Nutrisi parenteral, sementara puasa
pemantauan komplikasi

Setelah resusitasi 3 menit

HR <60x/m, pengembangan dada adekuat dengan VTP
(pasien telah ter-intubasi)
Didapatkan akral yang dingin, CRT memanjang >3 detik
Kesan : syok

Tatalaksana syok pada bayi

Pemberian cairan kristaloid (NaCl 0,9%) 10-20 cc/kg
selama 30 menit (vena umbilikus)
Apabila belum memberikan respon (curiga karena
perdarahan antepartum) : pemberian PRC 5-10 cc/kgBB
selama 30 menit
Pantau tanda2 overload dan diuresis (minimal 0,5
cc/kg/jam)

Pasien Stabil

Pemantauan 24 jam
Didapatkan kejang berupa mata mendelik ke atas,
mulut mencucu, kaki tangan kaku selama 3 menit
Kesan : Neonatal seizure e.c DD/

Hipoglikemia
HIE
Perdarahan intrakranial
Infeksi

Tatalaksana Kejang pada Neonatus

Hipoglikemia
GDS <60 mg/dL
Bolus D10% 2-4 mL/kBB, dilanjutkan GIR 6-8

mg/kg/menit

Hipokalsemia
Ca <8,0 mg/dL
Bolus Ca Glukonas 10% 100-200 mg/kg
20 menit

dalam 15-

Obat antikonvulsant
Fenobarbital
loading dose 15-20 mg/kgBB bolus lambat dalam
20 menit
rumatan 3-4 mg/kg/hari po/iv 1x

Segera Rujuk
Ke RS yang mempunyai NICU

Terima Kasih