Laporan Kasus Respiratory Distress in Newborn [PDF]

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REFLEKSI KASUS
 Respiratory Distress in Newborn Athaya Ardelia 19/440565/KU/21352



Identitas Pasien • Nama • Umur • Tanggal Lahir • Jenis Kelamin • Nomor RM.



: By. Ny. RA : 6 hari : 28 Maret 2020 : Perempuan : 00.74.XX.XX



Anamnesis



Keluhan Utama



Berat bayi lahir rendah



Riwayat Kehamilan dan Persalinan Bayi perempuan baru lahir, gemelli monochorion diamnion dari Ibu berusia 41 tahun G2P1A0 dengan usia kehamilan 30 minggu (Dubowitz 31+6) lahir secara spontan. BBL 1682 gr, PB 41 cm, LK 24 cm, LD 26 cm, LiLA kiri 8,5 cm. Bayi lahir langsung menangis. Pada resusitasi sampai dengan langkah awal A/S 7/9. Faktor resiko ibu : HbsAg (-), Leukositosis (-), ISK (-), Keputihan (-). DM(-), Hipertensi (-), Anemia (-) Terapi profilaksis steroid (-) Pasca lahir sudah BAB dan BAK dalam 24 jam



Riwayat Penyakit Sekarang HMRS Setelah persalinan, saat bayi tiba di perinatal, didapatkan RR bayi sebanyak 62 kali permenit, ditemukan retraksi ringan, sianosis (-). Downes score 2, temperatur 35.8C. Dilakukan termoregulasi dan pemberian O2 LF 1lpm dengan FiO2 21%. Evaluasi menunjukkan hipotermia teratasi, Downes score 0. 2HMRS Muncul ikterik pada bayi, dengan Kramer score 4. Letargis (-), kejang (-), hepatosplenomegali (-)



Silsilah Keluarga



Ç



41 th



43th



Ç



12 tahun, lahir sehat dan normal



6 hari



6 hari



Pemeriksaan Fisik



Pemeriksaan Fisik •



Keadaan Umum : gerak aktif, tangis kuat • BBL :1682g (28/3)->1492 (1/4) PB : 41 cm LK : 24 cm LD : 26 cm LLA : 8,5 cm Kelainan yang mencolok : tidak ada



Tanda Vital − HR



: 138x/menit



− RR : 40x/menit, tipe thoracoabdominal − T : 37,10C instabilitas suhu 36-36,4



Pemeriksaan Fisik • Kulit



: tidak ada sianosis, tidak ada ikterik



• Kepala



: tidak ada hematom, tidak ada facies dismorfik



• Mata



: tidak ada ikterik, tidak ada conjunctiva anemis



• Hidung hidung



: tidak ada deviasi septum, tidak ada nafas cuping



• Telinga



: tidak ada sekret yang keluar, tidak ada low set ear



• Mulut/lidah



: natal teeth (+), tidak ada labioskisis



• Leher



: tidak ada kaku kuduk, tidak ada webbed neck



Kesimpulan : Pemeriksaan kepala-leher dalam batas normal



Pemeriksaan Fisik •



Toraks



: simetris, tidak ada retraksi



Jantung



: tidak ada bising



Paru



: vesikuler +/+, air entry baik +/+



Abdomen



: tidak ada distensi



Hati



: tidak teraba



Limpa



: tidak teraba



•



Anus



: ada, BAB dalam 24 jam (+)



•



Genital



: jenis kelamin perempuan, BAK dalam 24 jam (+)



•



Kesimpulan : pemeriksaan toraks, abdomen, dan genital dalam batas normal



Pemeriksaan Fisik •



Ekstremitas



Ekstremitas



Tonus



Trofi



Clonus



Ref. fisiologis



Ref. patologis



Superior -



Kanan



Normal



Eutrofi



Positif



-



Kiri



Normal



Eutrofi



Positif



Inferior -



Kanan



Normal



Eutrofi



Negatif



Positif



Negatif



-



Kiri



Normal



Eutrofi



Negatif



Positif



Negatif



• Refleks primitive: R. Moro : Positif R. memegang : Positif R. menghisap : Positif R. tonik leher : Positif R. plantar : Positif



Kesimpulan : pemeriksaan ektremitas dan refleks dalam batas normal



Pemeriksaan Penunjang HEMATOLOGI



Hasil



Referensi



HEMATOLOGI



Hasil



Referensi



Leukosit (10^3/μL) - Neutrofil (%)



10.67



8.0-24.0



Bilirubin total



4.47



60 tpm) is most common. Breath sounds can be clear or reveal rales on auscultation.



Respiratory Distress Syndrome • Newborns born before 34 weeks’ gestation may have respiratory distress secondary to surfactant deficiency and lung immaturity. • 60-80% of cases occur in newborns born before 28 weeks’ gestation, 15-30% in newborns born in 32-36 weeks’ gestation, and 5% in and after 37 weeks’ gestation



Respiratory Distress Syndrome • When surfactant is deficient, the infant may not be able to generate the increased inspiratory pressure needed to inflate alveolar units, resulting in the development of progressive and diffuse atelectasis. Surfactant deficiency also leads to an inability to maintain open alveoli at low lung volume, for example, during end expiration



Respiratory Distress Syndrome



Respiratory Distress Syndrome • RDS symptoms (i.e., tachypnea, grunting, retractions, and cyanosis) occur immediately after birth. • Blood gas measurements show hypoxemia and acidosis. • Symptoms normally worsen in the first 12 to 24 hours. With advances in treatment such as surfactant and N-CPAP, most newborns with RDS recover without longterm effects.



Respiratory Distress Syndrome



Chest radiography shows a diffuse ground-glass appearance with air bronchograms and hypoexpansion



Respiratory Distress Syndrome • Antenatal corticosteroids given between 24 and 34 weeks’ gestation decrease RDS risk. A single dose of antenatal corticosteroids is beneficial if given more than 24 hours before delivery and provides coverage for seven days. • Betamethasone 12mg/dose IM for 2 doses 24 hours apart • OR dexamethasone 6mg/dose IM for 4 doses 12 hrs apart



Respiratory Distress Syndrome • Surfactant can be administered in 6 to 24 hours after birth if the newborn has severe RDS. • The next dose of surfactant can be given 2 hours after the initial dose if dyspnea persists and the newborn needs 30% or more of additional oxygen.



Respiratory Distress Syndrome



Meconium Aspiration Syndrome • Meconium-stained amniotic fluid is present in approximately 10% to 15% of deliveries, although the incidence of meconium aspiration syndrome is only 1%. • Because meconium excretion often represents fetal maturity, meconium aspiration syndrome occurs in term and postterm newborns



Meconium Aspiration Syndrome



Meconium Aspiration Syndrome • Meconium aspiration syndrome presents at birth as marked tachypnea, grunting, retractions, and cyanosis. Examination may reveal a barrel-shaped chest, with rales and rhonchi heard on auscultation.



Meconium Aspiration Syndrome



Bilateral fluffy densities with hyperinflation



Meconium Aspiration Syndrome • Management in the DR/OR: • Visualization of the vocal cords and tracheal suctioning before ambu bagging if the baby is not vigorous • Management in the NICU: • Empty stomach contents to avoid further aspiration • Suction frequently



Pneumonia • Early-onset pneumonia occurs within the first three days of life, resulting from placental transmission of bacteria or aspiration of infected amniotic fluid. • Late-onset pneumonia occurs after hospital discharge. Bacterial pathogens are similar to those that cause sepsis.



Pneumonia • Intravenous antibiotics are administered if bacterial infection is suspected. • Ampicillin and gentamicin are common antibiotics for early-onset infections, whereas vancomycin and/or oxacillin with an aminoglycoside are used for late-onset infections.



Pneumonia • Ampicillin : 25 – 50 mg/kgBB/dose; 1 week old : every 12 hrs 2 – 4 weeks : every 6 to 8 hours • Gentamycin: 5mg/kgBB/dose. • BW 1200gr : < 7 days: every 36 hrs, > 7 days every 24 hours



Pneumonia



Referensi Effendi, S. and Firdaus, A., 2010. Diagnosis Dan Penatalaksanaan Gagal Nafas Pada Neonatus. [online] Pustaka Ilmiah. Available at: [Accessed 1 April 2020]. Fajariyah, S., Bermawi, H. and Tasli, J., 2016. Terapi Surfaktan pada Penyakit Membran Hialin. Jurnal Kedokteran dan Kesehatan, 3(3), pp.194-202. Hermansen, C. and Mahajan, A., 2015. Newborn Respiratory Distress. American Family Physician, [online] 92(11), pp.994-1002. Available at: [Accessed 1 April 2020]. Richard, M., 2020. Overview Of Neonatal Respiratory Distress: Disorders Of Transition. [online] Uptodate.com. Available at: [Accessed 1 April 2020].



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