2020 Bayi Dari Ibu Hepatitis B [PDF]

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LAPORAN KASUS DARI RS PANTI RAPIH YOGYAKARTA



BAYI LAHIR DARI IBU HEPATITIS B fx. wikan indrarto WEBINAR IDAI CABANG DIY MINGGU, 20 DESEMBER 2020



LAPORAN KASUS RSPR 1. Bayi lahir dari ibu berpenyakit infeksi. 2. Risiko penularan pada bayi dan tindakan medis segara



3. Skrining pemeriksaan antenatal 4. PMS, Hepatitis B, HIV dan COVID-19



LAPORAN KASUS RSPR Skrining pemeriksaan antenatal 2020 : 1. 2. 3. 4.



PMS (TPHA) : 0 bayi Hepatitis B (HBsAg) : 8 bayi. HIV (serologi) : 1 bayi. COVID-19 (skrining, rapid test, RT PCR) : 10 bayi.



LAPORAN KASUS RSPR 1. By. AF (RM : 1176290), ibu HBsAg (+), lahir spontan, 16 Oktober 2020, pk. 1 2. Bayi bugar, tidak asfiksia A/S : 7/8. 3. Pemeriksaan jasmani : dbn 4. Diagnosis : 1. BAYI LAHIR (NORMAL) (P00.9) 2. LAHIR DG RIWAYAT IBU HEPATITIS (P00.8) 5. Terapi : RG, ASI eksklusif, injeksi vit K (Rp. 2.134), HBIG (Rp. 2.692.000), HB 0 (Rp. 107.355)



LAPORAN KASUS 16 Oktober 2020, pk. 10.36, usia 1 hari 1. Muntah 2x, tidak ada keluhan lain, mulai menetek.



2. Pemeriksaan fisik : dbn 3. Diagnosis : 1. BAYI LAHIR (NORMAL) (P00.9) 2. LAHIR DG RIWAYAT IBU HEPATITIS (P00.8) 3. VOMITUS NEWBORN (P92.0) 4. Terapi : Observasi, RG, ASI eksklusif



LAPORAN KASUS 17 Oktober 2020, pk. 10.14, usia 2 hari 1. Tidak muntah, tidak ada keluhan lain, mulai lancar menetek.



2. Pemeriksaan fisik : dbn 3. Diagnosis : 1. BAYI LAHIR (NORMAL) (P00.9) 2. LAHIR DG RIWAYAT IBU HEPATITIS (P00.8) 4. Terapi : Boleh pulang sesuai ibu, ASI eksklusif



LAPORAN KASUS Kontrol 22 Oktober 2020 (4 hari), pk. 09.45 1. Keluhan Utama : Kontrol bbl lahir spontan bb lahir 3655 gr, Tali pusat belum puput dan agak berdarah, ASI, Sudah imunisasi hep b1, demam sepulang dari RS suhu 38,7 dan rewel, selama 2 hari, hari ketiga sudah turun jadi 37 naik menjadi 38,0, kembali turun. 2. Pemeriksaan jasmani : dbn, ikterik K2 3. Diagnosis : 1. JAUNDICE NEONATAL (P59.9) 2. BAYI LAHIR DG RIWAYAT IBU HEPATITIS (P00.8) 4. Terapi : edukasi dan motivasi ASI eksklusif, kontrol 1



DISKUSI 1 WHO (July 2020) :



1. Elimination of HBV infection as a public health threat requires a reduction in the prevalence of hepatitis B surface antigen (HBsAg) to below 0.1% in children 5 years of age. 2. This can be achieved through universal immunization of newborns against hepatitis B and other interventions to prevent mother-to-child transmission of HBV https://www.who.int/publications/i/item/978-92-4-000270-8



Prevention of mother-to-child transmission of hepatitis B virus: Guidelines on antiviral prophylaxis in pregnancy, 27 July 2020



DISKUSI 2 Preventing perinatal HBV transmission in the United States : 1. Screening of pregnant women for HBsAg during each pregnancy.



2. Screening all HBsAg-positive pregnant women for HBV DNA to use of maternal antiviral therapy during pregnancy (DNA is >200 IU/mL). 3. Case management of HBsAg-positive mothers and their infants. 4. Provision of immunoprophylaxis for infants born to infected mothers, including hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth 5. Routine vaccination of all infants with the hepatitis B vaccine series, with the first dose administered within 24 hours of birth https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm



DISKUSI 3 1. Due to very low to low quality evidence found in this review, we are uncertain of the effect of benefit of antenatal HBIG administration to the HBV-infected mothers on newborn outcomes, such as HBsAg, HBV-DNA, and HBeAg compared with no intervention. 2. The results of the effects of HBIG on HBsAg and HBeAg are surrogate outcomes (raising risk of indirectness), and we need to be critical while interpreting the findings. 3. Well-designed randomised clinical trials are needed to determine the benefits and harms of HBIG versus placebo in prevention of MTCT of HBV. Eke AC, Eleje GU, Eke UA, Xia Y, Liu J, 2017, Hepatitis B immunoglobulin (HBIG) during pregnancy for MTCT of hepatitis B virus (HBV), https://www.cochrane.org/CD008545/



DISKUSI 4 Hepatitis B and breastfeeding (WHO, 1996) : 1. There is no evidence that breastfeeding from an HBV infected mother poses an additional risk of HBV infection to her infant, even without immunization. 2. Thus, even where HBV infection is highly endemic and immunization against HBV is not available, breastfeeding remains the recommended method of infant feeding. https://www.who.int/maternal_child_adolescent/documents/pdfs/hepatitis_b_and_ breastfeeding.pdf



DISKUSI 5 Neonatal jaundice and HBV mother : 1. Neonatal jaundice was seen in 50% neonates, but majority were mild and physiological and did not require NICU admission in most of the cases. 2. None of the neonates developed sepsis in the present study. Sujatha, A, et al, 2019, Study on Hepatitis B Virus Infection in Pregnant Women and its RiskFactors, International Journal of Contemporary Medical Research, Volume 6, pp. 2454-7379



DISKUSI 6 Neonatal fever and HBV mother : Symptoms of acute HBV infection in neonates are indistinguishable from those of other types of hepatitis, including nausea, vomiting, anorexia, lowgrade fever, myalgias, and fatigue. Nelson, N, Jamieson, D., and Murphy, T, 2014, Prevention of Perinatal Hepatitis B Virus Transmission, J Pediatric Infect Dis Soc. 2014 Sep; 3(Suppl 1): S7–S12.



EVALUASI Pertanyaan : 1. Hubungan demam dan ikterik pada BBL dengan ibu Hepatitis B?



2. Membedakan ikterik fisiologis dengan hepatitis pada BBL? 3. Bagaimana kalau HBIG tidak tersedia? 4. Kapan pemeriksaan serologi hepatitis B diperlukan? 1. HbsAg (Rp. 176.500) 2. HBeAg (Rp. 403.500) 3. Anti HBs (Rp 387.500)



MATUR NUWUN



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