Oleh : Dr. Abdurachman Sukadi, dr.

,SpAK

INTRODUCTION DEFINITIONS LIVE BIRTH STILLBIRTH STILLBIRTH RATE : TILL BIRTH STILLBIRTH + LIVE BIRTH INTERMEDIATE FETAL DEATH

X 1000

EARLY NEONATAL MORTALITY EARLY NEOTATAL MORTALITY RATE : EARLY NEONATAL DEATH LIVE BIRTH PERINATAL MORTALITY PERINATAL MORTALITY RATE : STILLBORN + EARLY NEONATAL DEATH STILL BIRTH + LIVE BIRTH X 1000 X 1000

RISK PREGNANCIES FACTOR ASSOCIATED WITH HIGH RISK PREGNACIES GENETIC FACTORS MATERIAL FACTORS POLYHYDRAMNIONS & OLIGOHYDRAMNIONS .HIGH .

neutropenia . eclampsia Hyperthyroidism Intra uterine growth retardation Fetal death Thrombocytopena.TABLE : MATERNAL DISEASE EFFECTING THE FETUS AND NEONATE DISORDER HYPERTENSION Diabetes Mellitus : Mild EFFECTS OF FETUS / NEONATE Intra uterine growth retardation Fetal Death Large for gestational age Hypoglycemia Severe Hearth Disease Intra uterine growth retardation Intra uterine growth retardation Endemic Goiter Pre-eclampsia.

fetal death Congenital rubella Congenital CMV Congenital AIDS Congenital HSV PERASITES : Toxoplasmosis Etc.DISORDER Infection : EFFECTS OF FETUS / NEONATUS Bacteria : TBC VIRUS : Rubella Cytomegalovirus Human immunodef Herpes simplex II Prematurity. Congenitaltoxoplasmosis / asymptomaic .

heary Abdomen Genitalia Anus Skin Extremities * Neurologic examination . Neck & mouth Lungs.PHYSICAL EXAMINATION OF NEWBORN INFANT * General Appearance Head.

HIGH RISK INFANT Prematurity Post term infant Asphyxia Birth weight Small for gestational age Large for gestational age Tachypnea Cyanosis Congenital disorder Pale Ptechyae .

FETAL CIRCULATION .

TRANSITION CIRCULATION GAMBAR HAL 7 .

NEONATAL CIRCULATION GAMBAR HAL 8 .

Transport 2. Excretion CLASSIFICATION : Physiologic hyperbilirubinemia Non physiologic hyperbilirubenia .NEONATAL HYPERBILIRUBINEMIA BILIRUBIN METABOLISM : 1. Conjugation 4. Uptake 3.

Defective conjugation d. Hemolytic anemia b. Increased enterohepatic circulation . Polycythemia d.ETIOLOGY OF PHYSIOLOGIC HYPERBILIRUBINEMIA a. Increased ilirubin production b. Decreased hepatic excretion ETIOLOGY OF NON PHYSIOLOGIC a. Defective uptake c. Blood extravasation c.

Figure : DIAGNOSIS OF THE ETIOLOGY OF HYPERBILIRUBINEMIA CLINICAL JAUDICE MEASURE BILIRUBIN BILIRUBIN > 12 mg/dl AND INFANT <24 HOURS OLD BILIRUBIN < 12 mg/dl AND INFANT > 24 HOURS OLD COOMBS' TEST FOLLOW BILIRUBIN POSITIVE COOMBS' NEGATIVE COOMBS' IDENTIFY ANTIBODY * Rh. DIRECT BILIRUBIN .etc. * ABO * KELL.

CONSIDER * HEPATITIS * INTRAUTERINE. DIRECT BILIRUBIN < 2 HEMATOCRIT NORMAL OR LOW HIGH (polycythemia) RBC MORPJOLOGY RETICULOCYTE COUNT ABNORMAL * SPHEROCYTOSIS * ELLIPTOCYTOSIS * etc.Figure : DIAGNOSIS OF THE ETIOLOGY OF HYPERBILIRUBINEMIA DIRECT BILIRUBIN DIRECT BILIRUBIN >2 . . VIRAL * etc. NORMAL : * ENCLOSED HEMORRHAGE * INCREASED ENTEROHEPATIC CIRCULATON * etc.

6 mg% : 14.umbilicus Kramer 3 : Umbilical .PATHOPHYSIOLOGY Increased production ( Pre-hepatic ) Decreased secretion Mixed ( Post-hepatic ) EXAMINATION : Clinical : Icterometer Bilirubinmeter Kramer 1 : Head and neck Kramer 2 : Chest .wrist : 7.knee Kramer 4 : Knee .4 mg% : 10.1 mg% : 17.ankle shoulder.2 mg% .

MANAGEMENT : * Healthy term infants : Age (hours) Consider Photo -therapy Phototerapy Exchange tranfusion if intensive phototerapy fails > 20 > 25 > 25 Exchange tranfusion & photo therapy 25-48 49-72 > 72 > 12 > 15 > 17 > 15 > 18 > 20 > 25 > 30 > 30 .

12 mg/dl Exchange tranfusion at 15 .18 mg/dl Phototerapy at 13 .Premature infants Birth weight (g) Therapy < 1000 Start phototerapy during firt 24 hours of life Exchange tranfusion at 10 .1500 1500 .15 mg/dl Exchange tranfusion at 18 .9 mg/dl Exchange tranfusion at 12 .15 mg/dl Phototerapy at 10 .12 mg/dl Phototerapy at 7 .2000 2000 .20 mg/dl 1000 .2500 .

* Infants with Hemolytic disease COMPLICATION Kern icterus .

SKOLIOSIS .TULANG BELAKANG .LORDOSIS. OPISTOTONUS .KAKU KUDUK. KIFOSIS.

GAMBAR 49 PERABAAN LUBANG HERNIA .

EPISPADIA. FEMINISASI TESTIS.GENITALIA DILAKUKAN DENGAN INSPEKSI DAN PALPASI . TESTIS. KLITORIS.GENITALIA LAKI-LAKI : UKURAN DAN BENTUK PENIS.GENITALIA WANITA : GENITALIA EKSTERNA. SEKRET. SINDROM. HIPOSPADIA. PIMOSIS . BENDA ASING . TANDA SEKS SEKUNDER.

KANDUNG KENCING .DAERAH PERIANAL .KETEGANGAN DINDING PERUT DAN NYERI TEKAN .PALPASI .PALPASI GINJAL : BALLOTEMENT .MASSA INTRAABDOMINAL ANUS DAN REKTUM .PALPASI HATI : 2 PATOKAN GARIS .PEMERIKSAAN COLOK DUBUR .PALPASI LIMPA : CARA SCHUFFENER .DAERAH ANUS .

NORMAL BUNYI TIMPANI .MENENTUKAN BATAS HATI .NORMAL PERISTALTIK SETIAP 10-30 DETIK .AUSKULTASI .MENCARI ASITESIS * PERKUSI SISTEMATIK * SHIFTING DULLNES * FLUID WAVE * PUDDLE SIGN .VENOUS HUM .MENENTUKAN BATAS MASSA .BISING ( 'BRUAT' ) .BOOMING ATAU PISTOL SHOT PERKUSI .

GAMBAR 46. SKEMA PENGUKURAN PEMBESARAN LIMPA TAMPAK LIMPA TERABA SI .

GAMBAR 48 PALPASI PADA STENOSIS PILORUS DILAKUKAN DENGAN BAYI SAMBIL MINUM BOTOL .

1/2 . CARA MENGUKUR BESANYA HATI PADA CONTOH INI BESARNYA HATI DAPAT DINYATAKAN DENGAN 1/3 .GAMBAR 44.

GAMBAR 39 PERKUSIS UNTUK MENDETEKSI ASITES .

GAMBAR 38 SISTEMATIKA PERKUSI ABDOMEN .

GAMBAR 36 PEMBAGIAN DAERAH ABDOMEN DAN TOPOGRAFI ORGAN DALAM ABDOMEN .

GERAKAN DINDING PERUT .UKURAN DAN BENTUK PERUT .MELIPUTI 4 TAHAP : INSPEKSI AUSKULTASI PALPASI PERKUSI INSPEKSI .DINDING PERUT .HARUS DIDAHULUKAN .ABDOMEN .HARUS BERTAHAP .

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