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 Absent Below 100 Above 100

(heart rate)

GRIMACE No response Grimace or Good cry

(reflex irritability) weak cry

ACTIVITY Flaccid Some flexion of Well flexed, or active

(muscle tone) extremities movements of extremities

RESPIRATIONS Absent Weak, irregular, Good crying

or gasping

============================================
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 1’8 dan 5’10

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 Absent Below 100 Above 100

(heart rate)

GRIMACE No response Grimace or Good cry

(reflex irritability) weak cry

ACTIVITY Flaccid Some flexion of Well flexed, or active

(muscle tone) extremities movements of extremities

RESPIRATIONS Absent Weak, irregular, Good crying

or gasping

============================================
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 dalam 15- 20 menit
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