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KEGAWATAN
PADA
NEONATUS
D a n g e r signs
Asphyxia Abdominal
Lethargy distension Yellow
Hypothermi palms/soles
Bleeding
a
Excessive weight
Respiratory loss Vomiting
distress Cyanosis Diarrhea
Convulsion
APGAR
Scores
Sign Score = 0 Score = 1 Score = 2
---------------------------------------------------------------------------------------------------
APPEARANCE Blue all over, Acrocyanosis Pink all over or
(color) 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.
Ya
DIAGRAM ALUR
Ber nap as atau m en an g i s? P e r a w a t a n rutin:
To n u s b a i k ? Pastikan bayi tetap hangat
K e r i n g k a n ba y i
Ti dak
L anj ut k an o bs e rv as i p e r n a p as a n ,
BANTUAN?
PADASETIAP LANGKAH TANYAKAN: APAKAH ANDAMEMBUTUHKAN
A t u r po s i s i d a n b e r s i hk a n j a l a n n a p a s
Keringkan
Pos is ikan k em bal i
d a n s t i m u l as i
Keteran gan:
P a d a b a y i d e n g a n be r at DI
≤ 1 5 0 0 g r a m , ba y i l a n g s u n g
d i b u n g k u s plastik b en i n g
O b s e r v a s i u s a h a n a p a s , l aj u d e n y u t j a n t u n g ( L D J ) , d a n t o n u s o t o t t a n p a di k er i ng k a n t e r l eb i h
dahulu kecuali wajahnya,
FASILITAS
k e m u d i a n d i p a s a n g t opi .
Tid ak bernap as/
m e g a p -m e g a p , d an atau
Bernapas spontan
B ay i tetap d apa t distimulasi
wa l a u p u n d i b u n g k u s plastik
PELAYANA
atau L D J < 100x/ m enit
Distres n ap a s
( Ta k i p n u , r e t r a k s i , a t a u
S i a n o s i s s en t r al
persisten
N
detik
merintih)
30
` Ve n t i l as i
t e k a n a n positif
(VTP)
Co n ti n uo us positive
P e rt i m ba ngk a n
s uplementasi ok sigen
KESEHATAN
a i r w a y p r e s s u r e ( C PA P )
P E E P 5-8 c m H 2O
Pemantauan SpO 2
Pemantauan SpO2
Pemantauan SpO 2
RUJUKAN
K eterangan:
G ag al C PA P
Bila LDJ te t ap A pa b i l a L D J > 1 0 0 k al i p e r
< 1 00 kali/ m e n i t P E E P 8 c m H 2O
F iO2 > 4 0 %
m e n i t d a n t ar g et s at ur a s i
o k s i g e n t er c ap ai :
FASILITAS
Setiap 30 detik sekali nilai laju denyut jantung, usaha napas dan tonus
D e n g a n d i s t r es n a p a s Ta n p a a la t kanutLanj k e
P e rti m b an g ka n intubasi peraw atan observasi
LENGKAP
D e n g a n a la t kanutLanj
ke per aw ata n pask a-
Peng embang an dada adekuat?
resusitasi
Ya T id a k Wa k t u d a r i
Target S p O 2
Lahir
Preduktal
K eterangan:
I nt u ba s i e n d o t r a k e a d a p a t
dipertimbangkan pa da
L D J < 60/ m en i t? l a n g k a h ini ap a b i l a V T P t i d ak
ef ek t i f a t a u t el a h d i l a k u k a n
s elam a 2 menit
P e r t i m b a n g k a n p e m b e r i a n o b a t d a n c a i r a n i n t r av e n a
Lethargy and poor sucking
In a preterm baby
needs careful assessment
because it may be due to cold stress or immaturity
VOLPE,
Level of Penampila 2008
Respo Respon Motorik
Alertnes n Bayi n Kuantitas Kualitas
s Bangu
n
Gut rotation
Structure
Villi
Digestive enzymes
F Swallow
u
n
c Gastrointestinal motor activity
t
i
o Organized motility
n
37.5o
Normal range
36.5o
Cold stress
Cause for concern
36.0o
Moderate hypothermia
Danger, warm baby
32.0o
Severe hypothermia Outlook grave, skilled
care urgently needed
Respiratory problems
RR > 60 / min*
Retractions
Grunting
Central cyanosis
Apnea
* R a t e s h o u l d be c o u n t e d in a q u i e t
s t a t e a n d n o t immediately a f t e r f e e d
Cyanosis
Peripheral
Normal at birth
Seen in extremities
due to cold
Central
Always needs te referral
appropria
Seen on lips and
mucosa
Indicates cardiac
or pulmonary
disease
Wood DW, Downes’ JJ, Locks HI. A clinical score for the diagnosis of respiratory
failure. Amer J Dis Child 1972; 123: 227-9.
Convulsion
17
ABDOMINAL DISTENSION
Feeding Intolerance
Stop enteral feeds and reassess:
Bilious (or greenish residuals)
Vomiting
Acute increase in abdominal girth >2 cm
Frankly bloody or very watery stool
Increased residuals
Other signs of illness
Yellow staining of soles
19
• Cephalocaudal progression
– face 5 mg/dL (approximately)
– upper chest 10 mg/dL (approximately)
– abdomen and upper thighs 15 mg/dL (approximately)
– soles of feet 20 mg/dL (approximately)
BLEEDING
Disseminated Intravascular
Coagulation
22
Bleeding infant
Screening tests
Activated partial thromboplastin time (aPTT)
Thrombin clotting time (TCT)
Prothrombin Time (PT)
Fibrinogen (Fbg)
Platelet Count
Bleeding Time (BT)
Failure to pass
meconium &
urine
F a i l u r e t o pass meconium
Majority pass within 24 hrs
Delayed passage
May have passed in –utero
Suspect obstruction
F a i l u r e t o pass u r i n e
Majority pass within 48 hrs
Delayed passage
Exclude obstructive uropathy or renal
agenesis
Vomiting*
Diarrhea
Infective diarrhea*
(often non breast fed baby)
Metabolic disorders
Maternal drug addiction