You are on page 1of 15


Objective: In this case report to determine the success of resuscitation in severe conditions afiksia
preenterm neonates and low birth weight infants

Research Design: Case report

Methods: Observations made during the day in the emergency unit at the hospital PR

Discussion: lack of oxygen and increasing carbon dioxide will cause death in organ tubuh.bayi born
premature and low birth weight have a life expectancy <80% due to dysfunction organ.resusitasi to do if
a baby is born not breathing adequately, pulse heart rate <60 beats / min , do not cry, baby negative
tone then quickly perform resuscitation on the baby

Conclusion: Resuscitation done as quickly as possible when seen babies have respiratory and pulse rate
<60 beats / min.

Keywords: Afiksia, predisposing factors for preterm , resuscitation

Infant mortality is when the baby is born until the age of 1 tahun.kematian infants divided into two
endogenous and eksogen.kematian endogenous or neonatal death is the death of infants during the first
month after birth, and is generally caused by factors that brought children from birth , which was
obtained from the parents at the time of conception or acquired during kehamilan.kematian exogenous
or post neonatal death is infant deaths that occur after the age of one month until the age of one year
are caused by factors relating to external environmental influences (Agusyanti 2012 ).

Neonatal asphyxia is a condition in which a newborn baby can not breathe spontaneously soon after
birth and regular. This is caused by hypoxia and hypoxia fetus in utero is associated with factors that
arises in pregnancy, childbirth or soon after birth. Clinically state of asphyxia often called anoxia or
hypoxia (Amir, 2008).

According to the results of basic medical research in 2007, the three main causes of perinatal mortality
in Indonesia is disordered breathing / respiratory disorders (35.9%), prematurity (32.4%) and neonatal
sepsis (12.0%). (Ministry of Health, 2009)

In Indonesia of the infant deaths, 57% of dead newborns (aged under 1 month) and every 6 minutes
there is one newborn who died, the cause of neonatal deaths in Indonesia are low birth weight babies
(29%) , asphyxia (27%) and others 44% (JNPK-KR, 2008)

Results IDHS (Indonesian Demographic and Health Survey) in 2012 and found that the infant mortality
rate in Indonesia is currently experiencing a decline from 43 per 1,000 to 32 per 1,000 live births. Among
this number, 19 per 1,000 occur in the neonatal period from birth to the age of 28 days. But the MDG
target by 2015, the figure should drop to 23 per 1,000 live births. The biggest cause of the mortality rate
of newborns is a respiratory disorder that is equal to 37%, as well as premature as much as 34% and 12%
.In sepsis West Java asphyxia numbers are 25, 2%. In Cirebon District of death from asphyxia increased
from the year 2012 the number of deaths due to asphyxia 62 infants (27%), while in 2013 data from the
Department of Health Cirebon shows the number of deaths due to asphyxia as many as 75 babies out of
227 infant deaths (30%) and the number of births 46 657 live babies. (IDHS, 2012)

Patient referrals from hospitals PS with preterm neonates born according gestation 03.00, indirect
menangis.berat 1100 grams birth, babies born from 28 weeks gestation, height 32 cm, negative tone in
infants, cyanosis in positive baby, awareness on baby somnolence, blood pressure 50 / palpitations, 30-
40x minute pulse, respiration rate 3 times / minute, temperature 35.8 Celsius, random blood glucose
581 mg / dl.

Doctors diagnose a patient comes to the circumstances afiksia berat.dokter and midwifery team set up
equipment to support the patient's life such as infant warmer, oxygen mask, NTT 2.5, balloons, cloth
kering.statu patients with Free Airway, birthing apneu symmetrical lobes, Circulation> 3 seconds
cyanosis ,

Handling is carried out systematically by a doctor and nurse midwifery

14:27 history-taking, check vital signs (respiration rate 3 times per minute, temperature 35.8 Celsius,
pulse 30-40 times per minute)

Checks GDS 581

Doing VTP 3 cycles -> heart rate 110-120 times / menit.saturasi oxygen 50-60% -> ETT number 2.5 (does
not fit, terkeci number 2.5) -> post nasal single pronge -> oxygen saturation of 50-55%, Heart rate is 110
beats per minute

15:06 Check Heart reat 30-40 times / min

oxygen saturation of 40%

VTP 5 cycles of negative response -> 0 Heart rate, oxygen saturation 10%, Pupil mydriasis -> ECG


15:07-positive patients declared dead by doctors


The ideal birth is 9 months or 36 minggu.pada 36 weeks of gestation the fetus has a mature organ for
fetal life when lahir.kelahiran menunjan premature ie at 28 weeks gestation the fetus in the womb have
immature organ making it less able to support fetal life when already born.

Premature birth have a life expectancy <80% () because the organ for organ organ dysfunction in babies
born prematurely masi conditions immature.sesuai case when a field visit in the hospital obtained PR
status of the patient, who was born to the age of 28 weeks gestation, low birth weight 1100 grams and
Respiration rate 3 times per .datang with somnoleh state of consciousness, doctors diagnose severe
Neonatal asphyxia is a condition in which a newborn baby can not breathe spontaneously soon after
birth and regular. This is caused by hypoxia and hypoxia fetus in utero is associated with factors that
arises in pregnancy, childbirth or soon after birth (Wiknjosastro, 1999)

asphyxia can be caused by the following (Medical Forensic Science, 1997). Natural causes, such as
respiratory diseases such as laryngitis clog diphtheria or cause movement disorders such as pulmonary
fibrosis lung. 2. Trauma mechanical asphyxia mechanical causes, such as trauma resulting in venous air
embolism, fat embolism, bilateral pneumothorax; blockage or obstruction of the airways and so forth. 3.
Poisoning materials that cause depression of the respiratory center, such as barbiturates and
narkotika.4 commonest cause asphyxia in a forensic context is a type of mechanical asphyxia, compared
to other causes such as natural causes or poisoning (Knight, 1996)

From the view of pathology, death from asphyxia can be divided into 2 groups (Amir, 2008), namely:

1. Primary (direct result of asphyxia) Lack of oxygen is found throughout the body, does not depend on
the type of asphyxia. Brain cells are very sensitive to lack of oxygen. Certain parts of the brain requires
more oxygen, so that part is more susceptible to oxygen deprivation. The changes seen in the
characteristics of the cells of the cerebrum, cerebellum and basal ganglia. Here the brain cells that die
are replaced by glial tissue, while in other organs the heart, lungs, liver, kidneys and other changes due
to lack of oxygen directly or primer is not clear.

2. Secondary (dealing with the causes and compensation effort from the body) Heart seeks to
compensate the state of low oxygen pressures by raising its output, consequently arterial and venous
pressure rises. Because oxygen in the blood decreases continuously and not enough for the work of the
heart, then the heart failure and death take place quickly. This situation is found in:

The closure of the mouth and nose (pembekapan).

- Airway obstruction as in dead hanging, entrapment, strangulation

and corpus alienum the airway or the sinking due

blocking fluid intake air into the lungs.

- Impaired breathing movement for oppressed or jostle

(Traumatic asphyxia).

- Primary Termination of respiratory failure at the center

respiratory, such as wounds electricity and some form of poisoning.

In people who asphyxiated will be symptoms that can be distinguished

in 4 stages (Amir, 2008), namely:

1. Stage Dyspnea

Occurs due to lack of O2 with increased levels of CO2 will

stimulate the respiratory center, respiratory movements (inspiration and expiration)

increases in and quickly with the operation of the respiratory muscles

additional. Anxious face, lips started to bluish, protruding eyes, pulse

and increased blood pressure. If this situation continues, then go to

stadium seizures.

2. Stage Seizures

Clonic movements strong form in almost all muscles of the body,

lost consciousness quickly, spinkter experience the relaxation that

faeces and urine can come out spontaneously. Pulse and blood pressure are still

high, cyanosis more clearly. If deficiencies O2ini continues, then

patients will enter the stadium apnoe.

3. Stage Apnea

Victim out of breath because of the depression of the respiratory center, the muscles become

weakness, loss of reflexes, dilated pupils, decreased blood pressure, respiration

shallow and more elongated, eventually stopping in conjunction with

ratings for babies born using Skol APGAR

Tanda 0 1 2
Frekuensi Menurun Kurang dari Lebih dari
jantung 100/menit 100/menit

Usaha bernafas Lambat Lambat, tidak Menangis lemah


Tonus otot Baik Ekstremitas fleksi Gerakan kurang

sedikit aktif

Refleks Ada Gerakan sedikit Menangis

Warna Biru/pucat Tubuh kemerahan, Tubuh dan ekstre-

ekstremitas biru mitas kemerahan

If the Apgar score in infants <3 can be considered to perform resuscitation on infants. Handling post-
resuscitation of the newborn who suffered perinatal asphyxia is very complex and requires close
monitoring and anticipatory actions quickly, because the baby is at risk of multiorgan dysfunction and
changes in the ability to maintain physiological homeostasis (Sarwono, 2014). Early detection and
intervention against organ function impairment greatly affects output and must be done in an intensive
care unit for treatment support, monitoring, and diagnostic evaluation lanjut.Prinsip more common than
post-neonatal resuscitation handling of them continue to support kardiorespiratorik, correction of
hypoglycemia, metabolic acidosis, electrolyte abnormalities, as well as the handling of hypotension.
(Sarwono, 2014).

Neonatal resuscitation equipment and supplies

• Bulb syringe

• suction catheters (size 5 or 6.8 and 10 Fr)

• Meconium Aspirator

• Pipe gastric ukutan 8 Fr and 20 cc syringe

Balloons and containment equipment Resuscitation

• Balloon neonatal resuscitation are able to provide oxygen 90-100% and has a pressure-relief valve /
pressure gauge

• Oxygen with a flow meter and hose

• Lid / face mask with a rim size bearings untun term infants and premature
• Catheter nasal

• Oral airway, the size of term infants and premature

intubation equipment

• laryngoscopes with straight leaves, size 00 (very premature), 0 (premature) and 1 (neonates at term)

• The bulb and batrai backup to a laryngoscope

• Pipe ET (size 2.5, 3, 3.5 and 4.0)


•Gloves Etc

• Separate Incubator to resuscitate neonates with radiant heating and a towel or blanket


• Plaster

• Spuit

• Tray

• Antiseptic

• Tools cardiac monitor and pulse oximeter and electrodes or probes

• Sponges alcohol

• Clamps umbilkus

• Needles (25.21 and 18)

• umbilical catheters (3.5 and 5 Fr)

The initial steps of resuscitation

• Place the baby under a radiant heater / infant warmer

• Place the baby lying at the half gaze upward position to open the airway, a rolled towel placed under
your shoulders to help prevent neck flexion and blockage of the airway.

• Clean the upper airway by sucking mouth first, then the nose, using a bulb syringe, sucker lenders, or
catheter pengisap.perhatikan to keep the baby from heat loss at any time
• Aspiration is restricted kontiyu 3-5 seconds at pengisapan.mulut smoked beforehand to prevent

• more aggressive suctioning is only done when there is meconium in meconium napas.bila road and the
baby does not fit, do tracheal suctioning

• Dry, stimulation, replace the cloth wet with a dry cloth, and repositioning of the head

• Actions taken at birth to repositioning the head no longer than 30 seconds

• Assess breathing

• If the baby started breathing regularly and marking, check your heart rate, if a heart rate> 100 beats /
min and the baby is not cyanotic hetikan resusitasi.akan but, if cyanosis encountered, give oxygen free

Positive pressure ventilation

• If there is no pernapas or Why is the Why is the baby, starting with the positive pressure ventilation
using a balloon resuscitation and hoods, sengan frequency of 40-60 times / min

• If the pulse rate <100 beats / min, even with adequate breathing, VTP should start at a speed of 40-60
beats / min

• Endotracheal intubation is required if the baby does not respond to VTP by using balloons and VTP and be prepared to move the baby to the NICU

chest compressions
• If the heart rate is <60 beats / min after 30 seconds VTP adequate chest compressions should be

• Compression is done on the sternum in proximal processes sifoideus, do not press / above sifoid.kedua
thumb meresusitasi officers used to suppress the sternum, while the other fingers around the chest or
daru index and middle fingers of one hand can be used for compression while the other hand hold back
as deep as 1/3 thick compressed bayi.sternum antero-posterior chest.

• Chest compressions interspersed ventilation synchronously coordinated by a ratio of 3: 1, the speed of

the combination of these activities touched 120 / min (ie 90 compression and 30 ventilation). After 30
seconds, the evaluation respons.jika heart rate> 60 beats / min chest compressions may be stopped and
VTP continued until the heart rate reaches 100 beats / minute and the baby to breathe effectively

Loveliest child is a gift given to the almighty to the servants who siap.salah a charity that never end until
the grave is prayer to entrust a child sholeh.allah ihsani to be treated with great affection as god loves
his slave.

And know that your possessions and your children is just as true in the trials and Allah is a great reward.
"(Q.S. Al-Anfal: 27)

When the Messenger was awarded the offspring of his other wife, Maria Al Qibthiyah namely, the boy
named Ibrahim. But Abraham was not old age, he died in the year 10 H at age 17 or 18 months.
Rasulullah very saddened by the departure of his son who became his conditioning this. When Ibrahim
died, the Prophet said,

"Indeed, these eyes shed tears and the heart is sad, but we can not say anything that is not blessed our
Rab. Indeed, we are saddened by the departure O Ibrahim. "(HR. Bukhari).

We need to know the secret of death of children before the age of puberty, among others:

1. The child straight into heaven without reckoning

"Each child of Muslims who die before puberty will be entered into heaven by the grace of God." (HR.
Bukhari and Muslim)

2. Children will deliver her parents to enter also into heaven

According to the Hadith Qudsi:

Allah says in harui Judgment to children:

"Go you into heaven!"

The children said: "Ya Rabbi (we wait) until our mom and dad

sign. "

Then they approached the door of heaven! but do not want to enter into it. God

said again: "Why, I see they are reluctant to enter? Come on guys

into heaven! "

They said: "But (how) our parents?" Allah also says:

"Go you into heaven along with your parents."

(Hadith Qudsi history of Syurahbil bin Ahmad Syua'ah sourced from

Companions of the Prophet SAW)

It was narrated from Anas: "The Messenger of Allah said, is not a Muslim deaths of three children who
have baligh, except, God will enter him into Paradise due to his affection to his children that," (Reported
by Bukhari, Muslim).

3. God never encumber anything beyond his level of ability servant

"Allah does not burden a person but according to his ability. He gets the reward of (virtue) were earned,
and he got the punishment (of the crime) was doing. (They say), `Our Lord, Thou our laws if we forget or
make mistakes. ''

4. God will give the dressing better, if the parents be patient

Have heard the story of the death of the child Umm Sulaym? Here's her story:

Told that the sick child whimpered Talha, while Abu Talha was out of the house. Then the boy died.
When Abu Talha came home, he asked, "How's my son?"

Umm Sulaym boy- mum replied, "He was calm as usual (in question is dead, while Abu Talha thought
that his son was in good health)."

Then Umm Sulaym provide dinner for Abu Talha. After that he decorated himself, more beautiful than
usual, until Abu Talha menggaulinya.

Once she saw that her husband had let go of longing and satisfaction, Umm Sulaym said to him, "O Abu
Talha, what do you think, if a people lent a loan, whether the borrowing is entitled to reject them if
asked for it back?"

Abu Talha replied, "Of course not!" Then Umm Sulaym said, "Similarly, with your son. Your son has died,
then ask for a reward from Allah. "

Abu Talha said, angrily, "You've let me, until after I berjunub for associating with you, you posthukan
about my son." Then he went sholallahu came to the Prophet 'alaihi respectfully to memposthukan
what happened.

Sholallahu Rasulullah 'alaihi respectfully justify what has been done by Umm Sulaym, then said: "May
Allah bless the night you two."

Umm Sulaym later gave birth to a son whom they named Abdullah Prophet sholallahu 'alaihi respectfully
and one among the Ansar said, "Then I saw seven children, all of them are good at reading the Quran,
the sons of Abdullah. All of it, not because the granting of the prayer of the Prophet sholallahu 'alaihi
respectfully when he prayed, "Lord, give a blessing to them both.'

God has said in the Qur'an about the creation of man

َْ ِ‫َُمبِينَ َخ ِصيمَ ه ََُو فَ ِإذَا نُ ْطفَةَ م‬
َ ‫ن اإل ْن‬
ََ‫سانََ َخلَق‬

"He has created man from a sperm, she suddenly became a real contender."

In this verse explains that God created man from nuthfah well known in the medical world with the
terms contained in the spermatozoon and an ovum himself in women.

2. Surah Al-Hajj verse 5

‫ن َخلَ ْقنَا ُك َْم فَ ِإنَّا‬

َْ ِ‫ن ث ُ ََّم ت َُرابَ م‬ َْ ‫ن ث ََُّم نُ ْطفَةَ ِم‬ َ ‫ن ث ََُّم‬
َْ ِ‫علَقَةَ م‬ َْ ِ‫ضغَةَ م‬ َ ‫َام فِي َونُقِرَ لَ ُك َْم ِلنُبَيِِّنََ ُم َخلَّقَةَ َو‬
ْ ‫غي َِْر ُم َخلَّقَةَ ُم‬ ْ ‫س ًّمى أَجَلَ إِلَى نَشَا َُء َما‬
َِ ‫األرح‬ َ ‫ُم‬
ُ‫ن َومِ ْن ُك َْم أَشُ َّد ُك َْم ِلت َ ْبلُغُوا ث ُ ََّم طِ ْفال نُ ْخ ِر ُج ُك َْم ث ََّم‬ َّ ْ
َْ ‫ن َومِ ن ُك َْم يُت َ َوفى َم‬ َ َ َ ْ َ
َْ ‫ن يَ ْعل ََم ِل َكيْال العُ ُم َِر أ ْرذ َِل إِلى يُ َردَ َم‬ ْ
َْ ِ‫ش ْيئ ًا ِعلمَ بَ ْع َِد م‬

"...... We have made you from dust, then from a drop of sperm, then from a clot, then from a lump of
meat perfect and imperfect occurrence, so we explain to you, and we set in the womb, what we want
until the time that has been determined, then we remove you as infants, then (with gradually) you came
to maturity, and among you there are diwafatkan and (unisex) among you who stretched his age to
dementia, so she does not know anymore nothing that they had previously been known .... "

Surah Al-Mu'minun paragraph 14

َ‫علَقَةًَ الن ْطفَ َةَ َخلَ ْقنَا ث ُ َّم‬

َ ‫ضغَةًَ ا ْلعَلَقَ َةَ فَ َخلَ ْقنَا‬
ْ ‫ضغَ َةَ فَ َخلَ ْقنَا ُم‬ َ ‫َاركََ آ َخ ََر َخ ْلقًا أ َ ْنشَأْنَاهَُ ث ُ ََّم لَحْ ًما ا ْل ِع‬
َ ‫ظا ََم فَ َك‬
َ ‫س ْونَا ِع‬
ْ ‫ظا ًما ا ْل ُم‬ َ ‫ّللاُ فَتَب‬ َ ْ‫ا ْل َخا ِلقِينََ أَح‬
ََّ َُ‫سن‬

"Then semen We gave blood clot, then a blood clot We made a lump of meat, and then we made a lump
of flesh bones, then We wrap the bones with flesh. then We made him a creature (shaped) else. So that
lessons Supreme God, the Creator of the most good. "

In this verse Allah explains that the semen s.w.t He developed it in a few weeks so that it becomes a
clot. From the blood used as a piece of flesh, and a lump of meat was part of it that God made the
bones, and there are other parts of the elements which made flesh meat. Then Allah wrap the bones
with flesh, like clothes cover the body, then God made creatures (shaped) else. Once the soul is blown
into it, then be a perfect man, able to talk, see, hear, think that was just an inanimate object only. So
blessed be Allah, the Creator of the Most Good.

Az-Zumar verse 6:

‫ثالث ظلمات في خلق بعد من خلقا أمهاتكم بطون في يخلقكم أزواج ثمانية األنعام من لكم وأنزل زوجها منها جعل ثم واحدة نفس من خلقكم‬
‫تصرفون فأنى هو إال إله ال الملك له ربكم هللا ذلكم‬

"He created you from a single self, then He made thereof wife, and sent down for you eight head of
cattle in pairs. He made you in your mother's belly three events have in the darkness, who (do) so it is
Allah, your Lord, that the Kingdom of God. there is no god but him, then how can you be turned away? "

In this verse Allah s.w.t explains that He created man in the beginning of a course. God created man of
diverse colors and the language of Adam. Then God created Eve partner. Then God explained that he
also is creating eight head of cattle in pairs. A pair of goats, sheep a pair, a pair of camels and a pair of
After that, God explains more about the incident the next man. Human beings are created through a
process of events have. The process happened first is as a germ, then gone through the process as the
process for the sake of gore then as the fetus. At the perfect moment into a fetus that God created the
soul in it so it takes on a living creature. Signs of life can be seen from the heartbeat with ear pressed to
the mother's stomach.

In addition, God s.w.t explained that when a baby is in the womb he is in three darkness, namely: 1) the
darkness of the womb, 2) the darkness of the placenta (afterbirth), 3)

Surah Al-Ghafir paragraph 67

‫ش َّد ُكمَ لتبلُغُوا ث ََُّم طفال يُخر ُج ُكمَ ث ََُّم علقةَ منَ ث ََُّم نُطفةَ منَ ث ََُّم تُرابَ منَ خلق ُكمَ الَّذَي ه َُو‬
ُ ‫شيُو ًخا لت ُكونُوا ث ََُّم أ‬ َُ ‫ولتبلُغُوا قب‬
ُ َ‫ل منَ يُتوفَّى منَ ومن ُكم‬
‫تعقلُونَ ولعلَّ ُكمَ ُمس ًّمى أجال‬

"He who created you from clay and then from a drop of sperm, then from a clot, then birth to you as a
child, then (you are allowed to live) so that you get to age (adult), then (let you live again) to old, among
you there are diwafatkan before it. (We do so) that you may come to death determined and so that you
may understand (it). "

In this verse Allah explains that He had made man on the ground, then became a drop of semen, from a
drop of sperm into something attached, and a blood clot into a lump of flesh, then born into the world
in human form.

The commentators explain that what is meant by God s.w.t made man of the soil, that is God made man
from the quintessence s.w.t coming from the ground. A father and a mother eating food from the
ground, from animals and from plants. Animals eat plants and grow using substances derived from soil.
As food eaten mother or father was a seminal. Eggs mani mani mother met with the father in the womb,
so that it becomes a clot of blood and so on. Most commentators others argue that what is meant by
"God created man on the ground, is the father of man God created Adam s.w.t of land.

replies will God give to parents who experience the death of a child who is not baligh is:

1. Wake up to a house in heaven praise Allah:

From Abu Musa that the Messenger of Allah said, "When the son of a slave died, God spoke to His
angels," have you clutching children of my servant? 'The angel answered,' Yes. 'God says, "What said my
servant? 'the angel answered,' praise be to thee, and he uttered istirja '(wa inna inna lillahi ilaihi roji'un,
pen). Then God said, 'Wake him a house in Paradise and namakanlah house with the name' house of
praise "(HR. At Tirmidhi)

2. Replies to heaven

From Abu Hurairoh said, "Messenger of Allah said," Allah said, 'It is not a servant of faith get a reward if I
handheld the loved one of the world's population then she willingly with him unless he (will get to
heaven). "(HR . Bukhari)
Anas said, "Messenger of Allah said, 'It is not a Muslim was left dead three children who have baligh but
God will enter into heaven because of affection for them." (Muttafaq Alaihi)

3. Become a barrier for parents of hellfire

From Abu Said al Khudriy said, "A woman never met the Prophet and said, 'O Messenger of Allah men
earn (lessons) haditsmu then make your day one of us could come to you and you learn from anything
that God has taught you. The Prophet said, "Gather ye this day and it was. '

The women then gathered and the Prophet was approached them and teach anything that Allah taught
him saw then he Allah said, "It is not a woman among you who has three children (dead) unless they are
all going to be a hindrance for him from the Fire. ' then the woman said, 'What about the two children.?
"the Prophet said," Including two children. "(muttafaq Alaih)

Umm Salamah bint Milhan wife of Abu Talha who prayed for the Prophet when Abu Talha complained
about what to do for her. The Apostle also said, "May Allah bless the night you two." Then Ummu
Salamah pregnant-this is the reward of the world-and gave birth to Abdullah. One of the Ansar said, "I
watched the whole nine children memorize the Qur'an and all that is the children of Abdullah.

While a reply in the hereafter that Um Salamah was among those who dreamed of the Prophet and have
their voice heard in heaven as his saying of Allah, "I entered Paradise and I heard footsteps in front of
me. 'Then I asked,' (voice) what is' is answered, 'al Ghumaidha bint Milhan (Umm Salama, pen). "(HR.


Neonatal asphyxia is a condition in which a newborn baby can not breathe spontaneously soon after
birth and regular. This is caused by hypoxia and hypoxia fetus in utero is associated with factors that
arises in pregnancy, childbirth or soon after birth. Clinically state of asphyxia often called anoxia or
hypoxia (Amir, 2008).

in infants with Apgar score <3 then it should be done as soon as possible a medical resusitasi.tenaga that
are around to be skilled in resuscitation, speedily and accurately do it for life expectancy can be higher.

Tek deeds had broken one of which is a children's prayer that sholeh.bagi couples who have children
and children died when masi yet baligh then god will elevate the child to get into heaven gods and
brought both parents to equally as entered Heaven
V SPEECH briliant

Praise be to Allah SWT for His mercy and His grace I can finish the task of this case report. The author
would like to thank DR. DVM. Hj. Titik Djannatum the Coordinator Authors Block Elective and dr. Hj. RW.
Susilowati, M.Kes as Block Elective Coordinator. Gratitude to dr. eco and medics Hospital Emergency
Room. MARKET REBO who has helped and guided in making this case report.

The authors thank also to dr. Kamal H. Anas, Sp.B as lecturer of the field of emergency and to tutor
dr.Yurika Sandara, M.Biomed who have taken the time to guide the creation of this case report. And to
friends who had known each group Emergency help in carrying out this task, as well as all those who
have helped. Hopefully this fuss case manufacture can provide benefits for authors and for friends
sekalian.mohon sorry in the implementation of masi many deficiencies found.


Agusyanti. 2012. "Infant Mortality". Makassar: South Sulawesi Health Ministry.

Wiknjosastro, Gulardi Hanifa. Obstetrics Edition 4. Jakarta: YBP-SP. 2007

IDHS. 2012. Indonesia Demographic Health Survey. Jakarta.

Amir, A. 2008. For Death. In: Amir, A., 2nd ed. The series of Forensic Medicine. Terrain: Faculty of
Medicine, University of North Sumatra, 120- 125.

Part of Forensic Medicine. 1997. Deaths due to mechanical asphyxia. In: Science of Forensic Medicine.
Jakarta: Faculty of Medicine, University of Indonesia, 55-64.

Knight, B., 1996. Forensic Pathology. 2nd ed. New York: Oxford University Press, Inc., 347-351.

MOH (2008). Normal Delivery upbringing, JNPK-KR, Jakarta

MoH RI., 2009. Strategic Plan of the Ministry of Health in 2010, 2014. Jakarta.