Professional Documents
Culture Documents
2015
Tachypnea in Newborns
Hyalin Membrane Diseases
Radiographic features
Patophysiology on plain Xray Treatment
Sepsis Neonatal. Pedoman Pelayanan Medis. Ikatan Dokter Anak Indonesia 2010.
Risk Factor
Diagnosis
Antibiotik
27
Children with Down syndrome have multiple
malformations, medical conditions, and
Down Syndrome cognitive impairment because of the presence
of extra genetic material from chromosome 21
(trisomy 21)
Incidence 1:733
Spina
Bifida
Kurangnya asupan asam folat
Acute
Chronic (Kernicterus)
Kernicterus
Conjugated –
- Biliary atresia
- Neonatal hepatic
syndrome
Hemolytic disease as a cause of jaundice?
• Family history of hemolytic disease
• Bilirubin rise of >0.5 mg/dL/h
• Failure of phototherapy to lower serum bilirubin levels
• Ethnicity suggestive of inherited disease (e.g., glucose 6-
phosphate dehydrogenase deficiency)
• Onset of jaundice before 24 hours of age
• Reticulocytosis (>8% at birth, >5% during first 2-3 days,
>2% after first week)
• Changes in peripheral smear (microspherocytosis,
anisocytosis, target cells)
• Significant decrease in hemoglobin
• Pallor and hepatosplenomegaly
Definisi
Inkompatibilitas
• Terjadi pada bayi golongan darah A atau B dengan ibu O
• Isoantibodi pada golongan O merupakan IgG yang dapat
ABO
menembus plasenta
Klinis
• Hemolisis signifikan terjadi <1%
• Jaundice
• Anemia
• Hepatosplenomegaly
• Sering muncul 24 jam pertama
Laboratorium
• Peningkatan retikulosit, eritroblast
• Coombs test direct newborn
• Coombs test indirect ibu
Hyperbilirubinemia in breast-fed infants
Breast-feeding Jaundice Breast-milk Jaundice
Onset During the first week of life After the first week of life
(early onset) (late onset)
Etiology Poor caloric intake and/or increased enterohepatic circulation of
dehydration bilirubin as a result of the presence of
Weight loss >8-10% beta-glucuronidase in human milk and/or
Wet diapers<6x/day by day to the inhibition of the hepatic
3-4 glucuronosyl transferase by a factor such
Stool<4x/day by day 3-4 as free fatty acids in some human milk
Nursing<8x/day
Usual time of 3-6 days 5-15 days
peak bilirubin
Peak TSB >12 mg/dl >10mg/dl
Incidence 12-13% 2-4%
Temporary interruption of breastfeeding is rarely needed and is not recommended unless
serum bilirubin levels reach 20 mg/dL (340 µmol/L)
Kolestasis
Manifestasi
Bilirubin direk >1mg/dl bila bil.total • Ikterus tidak menghilang usia >3 minggu
<5mg/dl ; atau bilirubin direk >20% (bayi kurang bulan); atau >2 minggu
(bayi cukup bulan)
bila bil.total >5mg/dl
• Urin berwarna lebih gelap
• Tinja pucat atau warna dempul (acholik)
Intrahepatik Ekstrahepatik
• Peningkatan • Peningkatan
SGOT/SGPT >10 kali, SGOT/SGPT <5 kali,
dengan peningkatan dengan peningkatan
gamma GT <5 kali gamma GT >5 kali
• Penyebab : proses • Penyebab tersering :
infeksi hepatoseluler, atresia bilier
kelainan
metabolik/endokrin
Penunjang
• USG
• Kolangiografi
• Biopsi
Guideline for Intensive Phototherapy
Guideline for Exchange Transfusion
Penatalaksanaan
Usia Terapi sinar Transfusi Tukar
Bayi sehat Faktor Risiko* Bayi sehat Faktor Risiko*
Carditis Fever
Erythema Marginatum
Penyakit Jantung Bawaan –Tanda Gejala
Acyanotic vs Cyanotic
Heart auscultation sites –punctum
maximum?
Congenital Heart Typical Heart Sounds
Disease
ASD S1 normal/mengeras, S2 split lebar dan menetap. Daerah
pulmonal terdengar murmur ejeksi sistolik akibat stenosis
pulmonal relatif
VSD Pansistolik murmur, bisa didahului early systolic click.
Punctum maximum di SIC III-IV LPS sinistra.
PDA Murmur kontinu pada SIC II-III LPS sinistra
ToF S1 normal, S2 tunggal. Murmur ejeksi sistolik di daerah
pulmonal akibat stenosis pulmonal.
Coarctasio Aorta
• Right to left shunt (cyanosis)
Hypoxemic spell hallmark severe TOF “Tet Spell”
Muncul usia 4-6 bulan
Bayi muncul saat menangis atau menetek
Anak muncul saat bermain
Tanda :
• Sianosis/sianosis memburuk
• Sesak nafas
• Iritabel/syncope
• Murmur sistolik berkurang/hilang
klinis
0 - 5 mm : negatif
5 - 9 mm :
meragukan
> 10 mm : positif
Bila Negatif:
1. Tidak ada infeksi TB
2. Masa inkubasi
3. Anergi
Diagnosis TB
Anak
0 - - - -
+ Profilaksis I
1 - -
+ + Profilaksis II
2 -
3 + + + terapi
Profilaksis Primer
• Mencegah Infeksi TB
• Kontak (+), Infeksi (-) uji tuberkulin negatif
• Obat: INH 5 - 10 mg/kgBB/hari
• Selama kontak ada: kontak harus diobati
• 3-6 bulan
• Ulang uji tuberkulin:
– Negatif: berhasil, stop INH
– Positif: gagal, lacak apakah infeksi atau sakit ??
Profilaksis sekunder
• Mencegah sakit TB: paparan (?), infeksi (+), sakit (-)
• Uji tuberkulin positif
• Populasi risiko tinggi
– BALITA, Pubertas
– Penggunaan steroid yang lama
– Keganasan
– Infeksi khusus: campak, pertusis
• Obat: INH 5 - 10 mg/kgBB/hari
• Lama: 6-12 bulan
Wheezing on Children
Diagnosis Ciri
Derajat Serangan
Derajat Keparahan
•Ringan
KNAA:
•Episodik Jarang •Sedang
•Episodik Sering •Berat
•Persistent
WHO/GINA:
Level Kontrol
•Intermitent
•Persisten ringan •Terkontrol
•Persisten sedang •Partially controlled
•Persisten Berat •Tidak terkontrol
Asthma pattern (KNAA)
Asthma pattern (GINA)
Terapi Berdasarkan Derajat Serangan
• Ringan:
– 1 kali nebulisasi membaik
– Observasi 1-2 jam respon bertahan pulang.
Dibekali B-agonis (inhalasi/oral) tiap 4-6 jam.
– Jika dalam 2 jam gejala timbul kembali: derajat
sedang.
• Sedang:
– 2-3 kali nebulisasi incomplete respon.
– Dirawat di ruang rawat sehari. Berikan kortikosteroid
oral Metilprednisolon (0,5-1 mg/kgBB/ hari selama 3-
5 hari.
Terapi Berdasarkan Derajat Serangan
• Berat:
– Jika 3 kali nebulisasi tidak ada respon
– O2 2-4 L/m (diberikan termasuk saat nebulisasi)
– Steroid intravena (0,5-1 mg/KgBB/hari) diberikan 6-8 jam.
– Nebulisasi B+agonis+antikolinergiik+O2 dilanjutkan tiap 1-2 jam. Jika
4-6 kali pemberian membaik dikurangi menjadi tiap 4-6 jam
– Aminofilin IV:
• Jika belum mendapat aminofilin berikan dosis inisial (6-8 mg/kgBB
dilarutkan dalam D5%/NaCl 20 ml, berikan dalam 20-30 menit
• Jika sebelumnya sudah mendapat (<4 jam) berikan ½ dosis inisial
• Selanjutnya diberikan dosis rumatan (0,5-1 mg/KgBB/jam)
– Jika membaik, berikan nebulisasi tiap 6 jam selama 24 jam. Ganti
streoid dan aminofilin menjadi oral
– Jika dalam 24 jam stabil pulangkan, bekali B-agonis (inhalasi/oral) +
steroid oral
Pneumonia Fast breathing
Etiologi : Streptococcus pneumonia (tersering), 2-11mo RR≥50
1-5yr RR≥40
Staphylococcus aureus (perburukan cepat)
Klasifikasi Klinis Terapi
Pneumonia Batuk atau sulit bernafas Amoxicillin oral 40
ditambah adanya nafas cepat atau mg/kgBB/12 jam (3 atau 5
tarikan dinding dada bawah hari)
Rawat jalan, kontrol 3 hari
Pneumonia Batuk atau sulit bernafas dengan: Ampicillin 50 mg/kgBB
berat ■Saturasi oksigen <90% atau atau benzylpenicillin 50
central cyanosis 000 U/kgBB IM/IV per 6
■Distres pernafasan (merintih, jam (5 hari), ditambah
tarikan dinding dada berat) Gentamicin 7.5 mg/kgBB
■Tanda pneumonia dengan tanda IM /IV per 24 jam (5 hari)
bahaya umum (tidak mau Rawat inap, O2 bila
menetek, letargi/penurunan SaO2<90%, manajemen
kesadaran, kejang) airway dan demam
WHO Pocket Book of Hospital Care for Children, 2013
S. pneumonia Klebsiella pneumoniae
Diagnosis Gejala
Croup - Batuk Menggonggong, Low grade fever
- Suara Serak, Distress pernafasan
Benda Asing - Riwayat tiba-tiba tersedak
- Distres Pernafasan
Difteri - Imunisasi DPT tidak ada/tidak lengkap
- Bull neck
- Tenggorokan merah / faringitis
- Membran putih keabuan di faring/tonsil -> pseudomembran
Laryngomalacia Chronic stridor, anak usia < 2 tahun
Laryngomalacia
Supraglotis Epiglotitis
Thumb sign
Epiglotitis: Halloween Sign (-)
Epiglotitis
• Newborns: 55%-68%
• One (1) week of age: 47%-65%
• One (1) month of age: 37%-49%
• Three (3) months of age: 30%-36%
• One (1) year of age: 29%-41%
• Ten (10) years of age: 36%-40%
• Adult males: 42%-54%
• Adult women: 38%-46%
• Adult pregnant women: about 30% - 34% lower limits and
46% upper limits
O2 2-4 l/menit
Dengue Larutan isotonis 20ml/kgbb/jam
syok RL / RA / NS
secepatnya (max 30 menit)
Evaluasi. Perbaikan?
Ya Tidak
Lanjutkan pemberian
10 ml/KgBB/jam Kedua; atau pertimbangkan
pemberian koloid 10-
dalam 2-4 jam 20ml/kgBB/jam (max 30 ml.kgBB/24
jam
Evaluasi ketat Tidak teratasi
Syok teratasi
Klinis stabil Ht
turun naik
Stop cairan tidak >48 jam
transfusi koloid
setelah syok teratasi
Inotropik Tdk ada perbaikan
IV fluid rates – Holiday-Segar
Tx:
• Anti Difteri Serum 40.000
IU im/iv
Tonsillitis Akut Membranosa:
• Penicillin Prokain 50.000
IU / kgBB / im (7 hari)
Diphteria
• Tanda tarikan dinding
dada bagian bawah ke
dalam yang berat dan
gelisah merupakan indikasi
dilakukan trakeostomi
(atau intubasi)
• Komplikasi campak:
– Pneumonia
– Dehidrasi
– Gizi buruk
– Ensefalitis
– OMA
TRIAS RUBELLA CONGENITAL
1. Sensory neural deafness (58% of
patients)
2. Eye abnormalities—
especially retinopathy, cataract and
microphtalmia (43% of patients)
3. Congenital heart disease
Scarlet Fever
Group A Streptococcus
Strawberry tongue
Sandpaper texture,
pastia line
“Slapped cheek”
Parvovirus B19
Etiologi : Virus Coxsackie A16 (Genus Enterovirus)
Complications:
Deafness (SNHL), meningitis and/or
encephalitis, painful swelling of the
testicles or ovaries, and rarely sterility.
PEDIATRIK IMMUNOLOGY
Reaksi Hipersensitivitas
“Non-Toxic Adverse Food Reactions”
• Food Allergy
– Ingestion of food results in hypersensitivity
reactions mediated most commonly by IgE
• Food Intolerance
– Ingestion of food results in symptoms not
immunologically mediated, e.g: digestive and
absorptive limitations of host (e.g., lactase
deficiency)
Lactose Intolerance
• Inability to digest lactose
• Deficiency of the intestinal enzyme lactase
that splits lactose into two smaller
sugars, glucose and galactose
• Symptoms: diarrhea, flatulence, abdominal
pain, abdominal bloating, nausea
Type of Lactose Intolerance
• kadar IgE susu sapi yang positif (uji tusuk kulit atau uji
IgE RAST).
• timbul dalam waktu 30 menit sampai 1 jam.
• urtikaria, angioedema, ruam kulit, dermatitis atopik,
muntah, nyeri perut, diare,bronkospasme, dan
anafilaksis.
National Institute of Health and Clinical Excellence. The diagnosis and management of the epilepsies in adults and
children in primary and secondary care. 2012.
Cerebrospinal Fluid
Appearance Opening Leukosit Dominansi Protein Glucose
Pressure leukosit
NORMAL Clear <18 cmH2O 0-3 (-) 15-45 45-80
sel/mm3
Pyogenic Yellowish, PMN
bacterial turbid
Meningitis
Viral Clear N Limfosit N/ N/
Meningitis
Tuberculous Yellowish N Limfosit
Menigitis and viscous
(N/slightly
cloudy)
Fungal Yellowish Limfosit N/
Meningitis and viscous
(fibrin web)
Acute Bacterial Meningitis
• A number of strains of bacteria can cause
acute bacterial meningitis. The most common
include:
– Streptococcus pneumoniae (pneumococcus)*
– Neisseria meningitidis (meningococcus)*
– Haemophilus influenzae (haemophilus)*
– Listeria monocytogenes (listeria)
*)tersedia vaksin
Meningeal Signs
Nuchal Rigidity
Kernig’s Sign
Brudzinski’s Contralateral Sign