KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN

UNIVERSITAS SRIWIJAYA
FAKULTAS KEDOKTERAN
UNIT PENDIDIKAN KEDOKTERAN (UPK)

Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 580061
atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 352342, Fax. 0711 373438,

Skenario C Blok 23 Tahun 2014

A female baby was born at Moh.Hoesin Hospital from a 19 years old woman. Her
mother, Mrs. Solehah was hospitalized at Moh.Hoesin Hospital due to contraction. It was
her first pregnancy. She forgot when her first day of last period, but she thought that her
pregnancy was about 8 months. She said that she never had hypertension or other illness
during her pregnancy. Six hours after admitted, she delivered her baby spontaneously.
The labor process was 30 minutes, and rupture of membrane happened one hour before
delivery. The baby didnt cry spontaneously after birth, and resuscitation was done.
APGAR score at 1 minute was 1, at 5 minute was 3, and at 10 minutes was 7. One hour
later the baby still had grunting and cyanosis.
On physical examination:
Body weight was 1400 gr, body length was 40 cm, and head circumference was 30 cm.
The muscle tone decreased, she poorly flexed at the limbs, she had thin skin, more lanugo
over the body and plantar creased at 1/3 anterior. At 10 minutes of age, she still had
grunting and cyanosis on the whole body. The respiratory rate was 70 x/min, heart rate
was 150 bpm, the temperature was 36oC. There was chest indrawing. Other physical
examinations were within normal limit.
As a general practitioner please analyze the problem and the management.
-----------------------------------------------------------------------------------------------------------For Tutors Only
Learning Objectives:
Students must be able to:
1. Explain the definition and classification of low birth weight infant.
2. Explain risk factors which predispose of low birth weight infant
3. Diagnose low birth weight infant
4. Manage low birth weight infant
5. Explain the definition, risk factor, diagnosis and management of asphyxia
neonatorum
6. Explain the definition, risk factor, diagnosis and management of respiratory
distress
Klarifikasi Istilah
1 Contraction (perut mules)
2 Rupture of membrane (pecah ketuban)
3 First day of last period (HPHT)
4 Apgar score
5 Lanugo
6 Plantar creased
7 Grunting (merintih)
8 Cyanosis (biru)
9 Chest indrawing (retraksi dinding dada)

Identifikasi Masalah
1. Bayi Ny. Solehah, perempuan, berat badan lahir 1400 gram
2. HPHT lupa dan usia kehamilan kira-kira 8 bulan.
3. Bayi lahir tidak langsung menangis, APGAR skor 1/3/7
4. Bayi merintih dan biru.
Analisis Masalah
1. Berat badan 1400 gram, berdasarkan berat badan lahir bayi ini diklasifikasikan
sebagai apa?
2. HPHT lupa dan ibu mengatakan usia kehamilannya kira-kira 8 bulan. Dengan
menggunakan apa kita dapat menentukan berapa minggu masa gestasinya?
3. Berdasarkan masa gestasi dan berat badan lahir bayi ini diklasifikasikan sebagai
apa? Apa yang digunakan untuk mengklasifikasikan bayi baru lahir berdasarkan
berat lahir dan masa gestasi baru baru lahir?
4. Bayi tidak langsung menangis setelah lahir, Apgar score rendah, apa
diagnosisnya?
5. Bayi merintih dan biru, apa yang diderita bayi ini?
6. Apa diagnosis bandingnya?
7. Apa kemungkinan diagnosisnya?
8. Pemeriksaan apa yang diperlukan pada penderita ini?
9. Bagaimana tatalaksana penderita ini?
Hipotesis
Bayi Ny. Solehah, preterm, SGA (sesuai dengan usia kehamilan), BBLSR lahir spontan
dengan asfiksia perinatal dan respiratory distress. Kemungkinan penyebabnya
(diagnosisnya) adalah penyakit membran hialin.
Sintesis
1. Berat badan 1400 gram. Berdasarkan berat badan lahir, bayi ini diklasifikasikan
sebagai BBLSR
2. HPHT tidak diketahui. Pada penderita ini kita dapati kulit tipis, banyak lanugo
dan plantar creased hanya didapati 1/3 bagian depan telapak kaki, dari sini kita
dapat memperkirakan bahwa bayi termasuk bayi preterm. Lalu lakukan penentuan
masa gestasi dengan menggunakan Ballards score. Faktor risiko pencetus
kehamilan prematur pada skenario ini adalah faktor usia ibu yang muda (<20
tahun)
3. Berdasarkan masa gestasi kira-kira 8 bulan dan berat badan lahir 1400, dengan
menggunakan kurve Lubchenco bayi ini diklasifikasikan sebagai AGA.
4. Bayi merintih dan biru, apa yang diderita bayi ini dengan menggunakan
Downes score maka bayi ini mengalami respiratory distress.
5. Diagnosis bandingnya adalah penyakit membran hialin dan transient tachypnea of
the newborn (TTN).
6. Kemungkinan diagnosisnya adalah penyakit membran hyalin.
7. Pemeriksaan yang diperlukan pada penderita ini:
a. Rontgen dada
b. Pemeriksaan darah (Hb, leukosit, hitung jenis, trombosit, CRP)
c. Kadar gula darah
d. Kultur darah
8. Tata laksana penderita ini:
a. Pertahankan suhu tubuh dalam batas normal (rawat dalam inkubator)
b. Beri vitamin K1 0,5 mg intramuskuler
c. Parenteral feeding
d. Beri oksigen
e. Beri antibiotika sampai kemungkinan infeksi dapat disingkirkan
f. Monitoring

KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN

UNIVERSITAS SRIWIJAYA
FAKULTAS KEDOKTERAN
UNIT PENDIDIKAN KEDOKTERAN (UPK)

Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 580061
atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 352342, Fax. 0711 373438,

Skenario C Blok 23 Tahun 2014

A female baby was born at Moh.Hoesin Hospital from a 19 years old woman. Her
mother, Mrs. Solehah was hospitalized at Moh.Hoesin Hospital due to contraction. It was her first
pregnancy. She forgot when her first day of last period, but she thought that her pregnancy was
about 8 months. She said that she never had hypertension or other illness during her pregnancy.
Six hours after admitted, she delivered her baby spontaneously. The labor process was 30
minutes, and rupture of membrane happened one hour before delivery. The baby didnt cry
spontaneously after birth, and resuscitation was done. APGAR score at 1 minute was 1, at 5
minute was 3, and at 10 minutes was 7. One hour later the baby still had grunting and cyanosis.
On physical examination:
Body weight was 1400 gr, body length was 40 cm, and head circumference was 30 cm. The
muscle tone decreased, she poorly flexed at the limbs, she had thin skin, more lanugo over the
body and plantar creased at 1/3 anterior. At 10 minutes of age, she still had grunting and cyanosis
on the whole body. The respiratory rate was 70 x/min, heart rate was 150 bpm, the temperature
was 36oC. There was chest indrawing. Other physical examinations were within normal limit.
As a general practitioner please analyze the problem and the management.

KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN

UNIVERSITAS SRIWIJAYA
FAKULTAS KEDOKTERAN
UNIT PENDIDIKAN KEDOKTERAN (UPK)

Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 580061
atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 352342, Fax. 0711 373438,

Skenario C Blok 23 Tahun 2014

A female baby was born at Moh.Hoesin Hospital from a 19 years old woman. Her
mother, Mrs. Solehah was hospitalized at Moh.Hoesin Hospital due to contraction. It was her first
pregnancy. She forgot when her first day of last period, but she thought that her pregnancy was
about 8 months. She said that she never had hypertension or other illness during her pregnancy.
Six hours after admitted, she delivered her baby spontaneously. The labor process was 30
minutes, and rupture of membrane happened one hour before delivery. The baby didnt cry
spontaneously after birth, and resuscitation was done. APGAR score at 1 minute was 1, at 5
minute was 3, and at 10 minutes was 7. One hour later the baby still had grunting and cyanosis.
On physical examination:
Body weight was 1400 gr, body length was 40 cm, and head circumference was 30 cm. The
muscle tone decreased, she poorly flexed at the limbs, she had thin skin, more lanugo over the
body and plantar creased at 1/3 anterior. At 10 minutes of age, she still had grunting and cyanosis
on the whole body. The respiratory rate was 70 x/min, heart rate was 150 bpm, the temperature
was 36oC. There was chest indrawing. Other physical examinations were within normal limit.
As a general practitioner please analyze the problem and the management.