dr. tetty - nutrisi parenteral dan enteral pada neonatus

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@[\\M@[C[I

UMXGK

Rkakrjggo : Ptge  Pul Lgnmgo Rkrmogtdcdnm Lgnmgo Mciu Akskfgtgo Goga,Egauctgs Akhdatkrgo [ORGH/\P Fgsgo Pghmamo Lgohuon

Rkohmhmago Edrigc: 7=>=-7=65 Akhdatkrgo [iui Egauctgs Akhdatkrgo [omvkrsmtgs

Rghjghjgrgo

7==0-7==5 Ppksmgcmsgsm Mciu Akskfgtgo GogaEgauctgs Akhdatkrgo [omvkrsmtgs Rghjghjgrgo

Rkohmhmago Cgmo : Xrgmomon Om`u hm hgcgi h Cugr Oknkrm  

Hr. Xktty ]uomgtm, hrPp.G(A)

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Outrmsm Rgrkotkrgc hgo Kotkrgc

Rghg Okdogtus 

Xktty ]uomgtm

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Aklutufgo Kskosmgc Okdogtus

@gmrgo, kckatrdcmt,igogjkiko outrmsm

(Pkiug lgym)

Adotrdc cmonauongo(Pkiug lgym)

Igogjkiko pkrogpgsgo,

@UP, @OP(Pklgnmgo lgym)

Igogjkiko moekasm(Pklgnmgo lgym)

0

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Ptgtus outrmsm sktkcgf cgfmrikokotuago akcugrgo lgym

CGFM\

Pupcgm outrmsm hgrm pcgskotgikohghga lkrfkotm

GPM ikrupgago outrmsmpdst-ogtgc tkrlgma

Pklgnmgo okdogtus tmhga

hgpgt ikipkrdckf outrmsm

kotkrgc skfmonng hmpkrcuagooutrmsm pgrkotkrgc

Xrgosmsm Outrmsm

8

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• Huauongo outrmsm hmom jung ikimcmam pkrgogopkotmon hgcgi pkrgwgtgo okdogtus

Rkilkrmgo outrmsm hmom okdogtus

 Gigo

Huauongo tkrfghgp pkrtuilufgo hgopkrakilgongo dtga

Iko`kngf tkrjghmoyg hgipga jgonag pgojgonngonnugo okurdadnomtme

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X[IL[F & AKILGON

LMD-RPMAD-PDPMGC

LMDCDNM

Nkoktma

Pkas

\mwgygt akfgimcgo

\mwgygt pkrsgcmogo

Outrmsm

Miuomsgsm

RPMADCDNMP :

Gsmf Gsgf

Gsuf

PDPMGC :

Xa. Rkohmhmago Dr-tu

Xa. Pds ‐ Ka

Fmnmkok-Pgomtgsm

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 GP[F :* Ikilkrm imoui &

igagogo lkrnmzm*Ikilkrm miuomsgsm

 GPMF :

* Ikilkrm pkrfgtmgo*Ikilkrm agsmf sgygon

 GPGF :*Ptmiucgsm ikotgc hmom*Ikilkrm pkohmhmago &

pkilkcgjgrgo

*Ikilkrm pkohmhmago gngig  

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Rkilkrmgo outrmsm Rghg Okdogtus

• Cklmf gwgc, gnrksme , hgo wgatu sknkrg

sktkcgf akcgfmrgo hkongo agcdrm hgoprdtkmo ghkaugt

• Puilkr outrmsm ghkaugt

• Ikohuauon pkrtuilufgo hgopkrakilgongo

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• Rkrtgilgfgo lkrgt lghgo:

75 ‐76 n/fgrm lgym prkigtur

<2 ‐02 n/fgrm pghg lgym `uauplucgo

• Rgojgon lghgo

7.7 `i/inn

• Cmonagr akpgcg

2.> `i/inn e rdotgc-d``mpmtgc`mr`uiekrko`k (ED@)

Xgrnkt Rkrtuilufgo

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Igcoutrmsm

Lgym prkigtur

ygon suhgflkrusmg 0 lucgo

krg 

R\K-Outrmsm

Rgrkotkrgc Xdtgc

72

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Outrmsm pgrkotkrgc tdtgc (ORX)

Huauongo outrmsm pghg okdogtus ygon tmhgaikohgpgt outrmsm kotkrgc ghkaugt

Hmlkrmago ikcgcum jgcur motrgvkog pkrmekrgtgu skotrgc

Moeus motrgvkog ikongohuon skiug outrmkopkotmon uotua aklutufgo kokrnm lgsgc,

iktgldcmsik hgo pkrtuilufgo

77

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Pupcgm aklutufgo outrmsm hgo iktgldcma tmhga ldckf tkrfkotmdckf akcgfmrgo

Outrmsm motrgvkog skcgcu ikrupgago mohmagsm jmag aklutufgooutrmsm hgo iktgldcma tmhga hgpgt hmpkoufm outrmsm kotkrgc

Jgi, luago fgrm, ghgcgf wgatu ygon pgojgon uotua lgymygon tmhga ikokrmig outrmsm lgma motrgvkog gtgupuo drgc

Aklutufgo outrmsm hgo iktgldcma skdrgon okdogtus sgiggtgu cklmf lksgr hmlgohmon sggt jgomo

Outrmsm Motrgvkog: Kipgt Rrmosmp [iui:

– mcc Fgy”s \ucks’ 

7

<

0

8

7<

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Rrgatka ygon lkrcgonsuon:ikouohg pkilkrmgo ORX sgipgm <-0 fgrm  ikouonnu stglmcmtgs kckatrdcmt,

iktgldcma hgo fkidhmogima

Igsgcgf:

Xmhga ghg gcgsgo ikhms/mcimgf uotuaikouohg

Xkrjghm ncuadokdnkoksms gtgu prdtkdcmsms

Momsmgsm ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

70

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Rrmosmp:igamo sgamt hgo ak`mc skdrgon lgym

  `ghgongo outrmsm imomigc hgo

pkrcu huauongo outrmsm cklmf lksgr

Lgym LC 3 7;22 nrgi hgo/gtgu 3 02 imonnu

 ORX hmiucgm hgcgi 86 jgi sktkcgf cgfmrLgym LC 3 7222 nrgi ORX hmiucgm hgcgi <8 jgi sktkcgf cgfmr

…Momsmgsm ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

78

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…Momsmgsm ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

Lgym prkigtur lutuf 7-7,; n prdtkmo/an/fgrmuotua ikonfkigt `ghgongo prdtkmo kohdnko

Rkoykhmggo ? >2 aagc/an/fgrm hgo<,>-0,; n prdtkmo/an/fgrm  ikohuauon pkrtuilufgo hgo lgcgos

omtrdnko pdsmtme pghg lgym prkigtur

7;

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Mohmagsm iutcga

Igcedrigsm adonkomtgc trgatus ngstrdmotkstmogc

Rdst dpkrgsm ngstrdmotkstmogc

Ok`rdtmsmon kotkrd`dcmtms

Hmgrk motrgatglkc

Pfdrt nut syohrdik

Mohmagsm ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

75

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Adipdoko ORX

@gmrgo

Igardoutrmko 

Agrldfmhrgt (hkastrdsg) Rrdtkmo (gsgi gimod)

Ckiga hgo

Imardoutrmko

Kckatrdcmt

Xrg`k kckikots

 Umtgimo

Outrmsm pgrkotkrgc tdtgc (ORX)

7>

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 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

@gmrgo

Lkrgt Fgrm 7-< Fgrm 0-7; Fgrm ? 7;

?<;22 n >2 702 702+

7;27-<;22 n 62 772 702+

7<;7-7;22 n =2 7<2 702+

7227-7<;2 n 722 702 782+

>;2-7222 n 72; 782 7;2+76

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... aklutufgo `gmrgo

[N

(imonnu)

M^C [rmok Ek`gc Xdtgc

(iC/an/fgrm)

08-82 82 02-;2 ;-72 >;-722

02-08 52-7<2 02-;2 ;-72 =;-762

302 62-7;2 02-;2 ;-72 77;-<72

XE M 9 (M^C + [rmok + stddc wgtkr) + nrdwtf

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…@gmrgo

7=

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<2

Egatdr ]gon Ikipkongrufm Aklutufgo @gmrgo

Egatdr ygon tkragmt hkongo lgym, skpkrtm [smg nkstgsm: ←[N ↜ ↗ aklutufgo `gmrgo

Ngwgt ogpgs: ↗EO ↜ ↗ aklutufgo `gmrgo

Hkigi: ↗ X ↜ ↗ aklutufgo `gmrgo

Egatdr ygon tkragmt hkongo cmonauongo, skpkrtm Xmhur hkongo \ghmgot wgrikr  ↜ ↗ aklutufgo `gmrgo

Rcgstm` fkgt sfmkch  ↜ ← aklutufgo `gmrgo

Xkrgpm smogr ↜ ↗ aklutufgo `gmrgo

... aklutufgo `gmrgo Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…@gmrgo

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Ak`uaupgo `gmrgo

Rkomcgmgo ak`uaupgo `gmrgo:

Rkikrmasggo emsms: turndr aucmt, khkig, [[L

Lkrgt lghgo

Akskmilgongo `gmrgo hgo hmurksms

Dsidcgcmtgs pcgsig: Og LJ urmo

... aklutufgo `gmrgo Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…@gmrgo

<7

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Adipdoko kokrnm

agc/an/fgrm

\kstmon kokrny kxpkohmturk 82-;2

@dch strkss 2-72

 Gatmvmtgs / fgohcmon 2-72

Ptddc cdssks 2-72

Keka tkrima ekkhmon 72% hgrm tdtgc agcdrm

Rkrtuilufgo 2-<2

Xdtgc 88-772

 Gsupgo `gmrgoKokrnm

Outrmsm pgrkotkrgc tdtgc (ORX)

<<

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Adipdoko kokrnm Gsupgo `gmrgo…Kokrnm

Outrmsm pgrkotkrgc tdtgc (ORX)

Jmag ORX:Akskmilgongo omtrdnko pdsmtme hgpgt tkr`gpgm

hkongo 52 agc/an/fgrm hgo prdtkmo <.; n/an/fgrm Gsupgo agcdrm imomigc uotua tuiluf skamtgr62 agc/an/fgrm

Jmag outrmsm kotkrgc:Hmpkrcuago 7<2 agc/an/fgrm uotua tuiluf

<0

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Rkrlgohmongo prdtkmo : odo prdtkmo

Agrldfmhrgt ;2-;;%, prdtkmo 7;-<2%, ckiga <2-02%

Kokrnm odo prdtkmo: Xkrutgig agrldfmhrgt <;% lkrupg cmpmh (jmag tgopg cmpmh hgpgt tkrjghm cmpdnkoksms hgrm

ncuadsg ygon ikilutufago kokrnm cklmf) 

\gsmd omtrdnko : odo prdtkmo `gcdrmk  9 7 : 7;2-<;2(7 nrgi omtrdnko 9 5,<; nrgi prdtkmo)

Imomiui <; agcdrm odo prdtkmo/nrgi GG   Xgrnkt 62 agcdrm odo prdtkmo/nrgi GG pghg fgrm ak-5 ORX

Igasmigc =2 agcdrm odo prdtkmo/nrgi GG

Adipdoko kokrnm Gsupgo `gmrgo…Kokrnm

Outrmsm pgrkotkrgc tdtgc (ORX)

<8

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7 nrgi hkastrdsk 9 0,8 aagc

Hkastrdsk iucgm 8-5 in/an/ikomt,ogmaago NM\ 7 ‐ < in/an/ikomt/fgrm sgipgm 7< in/an/ikomt pkrtgfgoago ncuadsg pcgsig ;2-7<2 in/hC

@grg ikogmaago NM\: Ikogmaago ak`kpgtgo moeus Ikogmaago adoskotrgsm ncuadsg

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

Agrldfmhrgt

<;

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NM\9 Ncu`dsk moeusmdo rgtk

%ncuadsg x ak`kpgtgo moeus(iC/jgi) x 2,75>lkrgt lghgo (an)

@DOXDF:

Lgym < an ikohgpgt hkastrdsk 72%

> iC/jgi (68 iC/an/fgrm)

NM\ 9 72 x > x 2.75>

<

9 ;.6 in/an/ikomt

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

Agrldfmhrgt

<5

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NM\ 6-72 in/an/ikomt pghg LLCGP\ ikoykhmgago

82-;2 aagc/an/fgrm  ikonfkigt `ghgongo ncuadsg Rghg lgym 3 7,< an aklutufgo ncuadsg sgongt tmonnm.

[otua iko`kngf ncuadokdnkoksms  NM\ ? 7< in/an/ikomt  

Jgongo ikilkrm moeus hkastrdsk ? 7<,;% ikcgcum vkogpkrmekr

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…Agrldfmhrgt

<>

m m c c ( )

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Rkilkrmgo agrldfmhrgt lkrcklmfgo gago

ikoyklglago:Rkomonagtgo LI\

Motdckrgosm ncuadsg:

fmpkrncmakimg, ncmadsurmg, hmurksms dsidtmaRkrckigago fgtm

Adckstgsms

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…Agrldfmhrgt

<6

O m m c c (ORX)

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7 nrgi Gsgi gimod 9 8 aagc  

Rkilkrmgo prdtkmo hmom ikonfgsmcago akskmilgongoomtrdnko pdsmtme ygon hmtdckrmr hkongo lgma tgopgikomonagtago aghgr gsgi gimod pcgsig pghg lgym

prkigtur sgamt skagcmpuo

Rrdtkmo hmlutufago uotua pkrtuilufgo

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

Rrdtkmo

<=

O t m m t c t t c (ORX)

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Ikiucgm moeus gsgi gimod:

Lgym 3 7 an   7 n/an/fgrm

Lgym ? 7 an  7  ‐  0 n/an/fgrm

Ogmaago gsgi gimod 7 n/an/fgrm ikouju tgrnkt:- Cklmf `kpgt pghg lgym lksgr- Cklmf cgilgt pghg ngngc nmojgc

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…Rrdtkmo 

02

O t m m t c t t c (ORX)

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Aklutufgo prdtkmo lkrlgohmon tkrlgcma tkrfghgpusmg nkstgsm hgo lkrgt lgym, lkragmtgo hkongoak`kpgtgo pkrtuilufgo ygon `kpgt hgoakfmcgongo prdtkmo cklmf lksgr pghg lgym prkigtur

Xgrnkt:

Odrigc: <.;  ‐  0.; n/an/fgrm

Cklmf tmonnm pghg: pdst dpkrgsm, OK@,prdtkmo cdsmon stgtk, `fycdtfdrgx

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…Rrdtkmo 

07

O t m m t c t t c (ORX)

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... gsgi gimod

Akaurgongo gsgi gimod: Ngngc tuiluf

Fmpdgcluimokimg Khkig

Akcklmfgo gsgi gimod:

•  Fmpkrgidokimg•  Aktmhgaskmilgongo gsgi gimod skrui•  Gsmhdsms iktgldcma•  Adckstgsms

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…Rrdtkmo 

0<

O t m m t c t t c (ORX)

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Rkilkrmgo GG <.8 n/an/fgrm hgcgi < jgi pgs`g cgfmr  hgipga cklmf lgma hmlgohmonago pkilkrmgo

fgrmgo GG ygon hmogmaago pkrcgfgo

Xk Lrggak E^J, kt gc. J Rkhmgtr <22;178>:8;>-57.Rdmohkxtkr LL. J Rkhmgtr <22;178>:8<2-7.

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…Rrdtkmo 

Ptuhm jgonag pgojgon pghg LLCGP\ hkongo rgtg-rgtgLC 622 n hgo [N <5 imonnu ygon hmlkrm moeus GG hmomikipkrcmfgtago pkrtuilufgo smnomemago pghg usmgpdstikostrugc 05 imonnu.

Rdmohkxtkr LL, kt gc. J Rkhmgtr <2251786:022-;.00

O t m m t c t t c (ORX)

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Idomtdr

[rkui pgcmon hmpkr`gyg

• Xmonnm (?02): prdtkmo tkrcgcu lgoyga

• \kohgf (3 ;): gsupgo prdtkmo tmhga ghkaugt

Fmpkrgiidokimg hgo gsmhdsms:prdtkmo tkrcgcu lgoyga

Rrdtkmo skrui adotrdvkrsmgc

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…Rrdtkmo 

08

O t m m t c t t c (ORX)

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Kskosmgc uotua tuiluf akilgon

Rkrakilgongo hgo euonsm rktmog

Rkrakilgongo dtga

Ptruatur skc

 Gsupgo ckiga ghkaugt iko`kngf hkemsmkosm gsgickiga kskosmgc

Akskmilgongo omtrdnko pdsmtme

Dptmigcmsgsm pkonnuoggo kokrnm

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

Ckiga cmpmh

0;

O t msm pg kotk gc tdtgc (ORX)

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Kiucsm ckiga: 72% goh <2%

Ckiga <2%- Ikilutufago `gmrgo cklmf skhmamt- Ikoykhmgago rgsmd edsedcmpmh-trmncmskrmh cklmf rkohgf

[otua iko`kngf hkemsmkosm gsgi ckiga kskosmgc8-6% agcdrm odo-prdtkmo fgrus lkrupg C@-R[EG(cmodckm` goh gceg cmodckom` g`mh )

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…Ckiga

05

Outrmsm pgrkotkrgc tdtgc (ORX)

7/24/2019 Dr. Tetty - Nutrisi Parenteral Dan Enteral Pada Neonatus

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Iucgm 7 n/an/fgrm, ogmaago 2.; ‐ 7 n/an/fgrm

Xgrnkt: 0 n/an/fgrm (sygrgt: XN3<22 in/hC)

Moeus adotmoyu skcgig 76-<8 jgi

Lgtgsm ckiga < n/an/fgrm pghg:

skpsms hkongo gsmhdsms smnomemago

fmpkrlmcmrulmokimg ? 7< in/hC

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

…Ckiga

0>

Outrmsm pgrkotkrgc tdtgc (ORX)

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Ogtrmui <-8 iKq/an/fgrm (2 in fgrm M)

Agcmui <-8 iKq/an/fgrm (2 in fgrm M) 

Ignoksmui 2.<-2.; iKq/an/fgrm

@gcsmui <22 in/an/fgrm

Edsegt 7-< iidc/an/fgrm (tgrnkt 9 7.;)

 Gsupgo `gmrgoAdipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

Kckatrdcmt

06

Outrmsm pgrkotkrgc tdtgc (ORX)

7/24/2019 Dr. Tetty - Nutrisi Parenteral Dan Enteral Pada Neonatus

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Hdsms:

2.7 iC  ‐  2.< iC/an/fgrm (Okdtrg`k)

Jgongo cklmf hgrm 7 iC/fgrm

Adotrgmohmagsm: 

Igongo hgo @u hgpgt ikipkrlurua adckstgsms

Okdtrg`k tmhga hmlkrm lmcg lmcmrulmo hmrka ? 0 ‐ 8 in/hC

@frdimui hmkasarksm hm nmojgc, fgtm-fgtm pghg ngngc nmojgc

Adipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

Xrg`k ckikots

0=

Outrmsm pgrkotkrgc tdtgc (ORX)

7/24/2019 Dr. Tetty - Nutrisi Parenteral Dan Enteral Pada Neonatus

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Kckikot &[omts

@urrkot \k`diikohkhgiduot pkr an/hgy

Okdtrg`k 8 `do`.Hdsk B rgtk de 2.< iC/an/hgy

prdvmhksZmo` (Zo)

i`n7;2 momtmgc up td 822

?78 hgys022

@dppkr (@u)i`n

75-<2 <2

@frdimui (@r)

i`n

2.8 2.7>

Igongoksk (Io)i`n < - 72 ;

Pkckomui (Pk)i`n 7.0  ‐  <.2 2

Mdhmhk (M)i`n 7.2 2 

Adipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

Xrg`k ckikots

82

Outrmsm pgrkotkrgc tdtgc (ORX)

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Adipdoko ORX

Outrmsm pgrkotkrgc tdtgc (ORX)

Umtgimo

@krokvmt® 2,<; iC/an/fgrm

\k`diikohkh Rgrkotkrgc Motgak de Umtgimos edr Xkri goh Rrktkri Moegots

Gikrm`go Pd`mkty edr @cmom`gc Outrmtmdo, Pul`diimttkk do Rkhmgtrm` Rgrkotkrgc Outrmkot \kqumrkikot

87

Outrmsm pgrkotkrgc tdtgc (ORX)

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Xks Erkaukosm

Ncmadsurmg Hug agcm skfgrm

Nucg hgrgf Pktmgp fgrm

(cklmf skrmon pghg fgrm gwgc akfmhupgo/hkongo ncmadsurmg)

Ogtrmui, agcmui, GNH Gwgcoyg sktmgp fgrm cgcu 0 agcm pkr imonnu

Agcsmui, ignoksmui 0 agcm pkr imonnu

[rkui, arkgtmomo < agcm pkr imonnu

Xrdildsmt < agcm pkr imonnuLmcmrulmo Xmgp fgrm gtgu cklmf skrmon jmag auomon

Euonsm fgtm Jmag lmcmrulmo hmrka ikomonagt

Xrmncmskrmh Xmgp fgrm sggt ikohgpgt ckiga

Idomtdrmon

Outrmsm pgrkotkrgc tdtgc (ORX)

8<

Outrmsm pgrkotkrgc tdtgc (ORX)

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Fmpdncmakim1 gsupgo ncuadsg tmhga ghkaugt

Fmpkrncmakim1 rksmstkosm mosucmo, rkspdos tkrfghgp strks

Fmpkrcmpmhkimg1 pkik`gfgo ckiga hgcgi akghggo strks iktgldcma

Adckstgsms

Dstkdpkomg

Pkpsms

Xrdildsmtdpkom Matkrus1 gsgi ckiga lklgs ikckpgsago magtgo lmcmrulmo hkongo gcluimo

Outrmsm pgrkotkrgc tdtgc (ORX)

Adipcmagsm

80

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CDND

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8;

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Outrmsm Kotkrgc pghg Okdogtus \msmad Xmonnm

Agpgo ikilkrmago gsupgo 4@grg ikilkrmago gsupgo 4 Gpg ygon fgrus hmlkrmago 4

85

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Agpgo Ikilkrmago Gsupgo 4

Pkhmom Iuonamo

Rkilkrmgo Gsupgo Hmom

 Motdckrgosm tkrfghgp pkilkrmgo gsupgo Gsupgo kotkrgc pkouf hm`gpgm cklmf hmom

 Fgrm outrmsm pgrkotkrgc

 Adckstgsms

 Juicgf fgrm rgwgt hm ruigf sgamt

Xmhga ghg pkomonagtgo mosmhko KAO

8>

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Hmiucgmoyg pkilkrmgo gsupgo kotkrgc !

Xmhga ghgadotrg mohmagsm iutcga hgo rkcgtmeuotua outrmsm kotkrgc

 Fkidhmogima stglmc

86

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ADOX\G MOHMAGPM \KCGXME O[X\MPM KOXK\GC

\k`kot kxtulgtmdo

 G`utk rkspmrgtdry egmcurk

Iktgldcm` g`mhdsms

Rdst `grhmg` grrkst

Fypdtkosmdo goh sfd`a, usk MU modtrdpks

@grhmg` `gtfktkrmzgtmdo

Rrkdpkrgtmvkcy (6f) goh pdstdpkrgtmvkcy

Pkrmdus moek`tmdos (pgrgcytm` mckus suspk`tkh)

 Glhdimogc hmstkosmdo, kx`kssmvk/ lmck stgmokh ngstrm`

gspmrgtksPkvkrk gspfyxmg (Pgrogt stgnks MM goh MMM)

Lkedrk goh getkr kx`fgonk trgoseusmdo

Fyhrdps ektgcms

8=

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@grg Rkilkrmgo Gsupgo 4 

tkrngotuon usmg akfgimcgo hgo adohmsm acmoms

Aktkrgipmcgo drdidtdrma‐pkrakilgongo odrigc

• \keckas Ngn :  76 imonnu akfgimcgo

• \keckas Msgp : 

Odo outrmtme 02-0< imonnu akfgimcgo

Xmhga tkraddrhmogsm 0<-08 imonnu akfgimcgo

Xkraddrhmogsm 0;-05 imonnu akfgimcgo

• \ddtmon rkeckx :  0> imonnu akfgimcgo

;2

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Lgngmigog Ikilkrmago Gsupgo 4

Rkilkrmgo gsupgo drgc 

Pktmhgaoyg usmg 00 imonnu akfgimcgo

Xmhga tkrhgpgt ngwgt ogpgs (\\ 3 52 V / ikomt)

Rkilkrmgo gsupgo ikcgcum skcgon ogsd/drdngstrma

Aurgon hgrm 00 imonnu akfgimcgo

Ngonnugo okurdcdnms (msgp/okcgo glodrigc)

Ngwgt ogpgs (tgopg fmpdasmg)

Xkrngotuon pghg vkotmcgtdr  

;7

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Gpg ]gon Fgrus Hmlkrmago 4

Rmcmfgo susu uotua pkilkrmgo gsupgo gwgc

@dcdst ruis  gtgu Gmr Pusu Mlu 

Msdtdoma

Lklgo akrjg nmojgc rkohgfAkuotuongo miuodcdnms

Akuotuongo psmadsdsmgc

Mlu fgrus ikikrgf GPM oyg sktmgp 8 jgi GPM gigo hmsmipgo 86 jgi hm ermhnkLmgrago hm sufu rugongo 7; ikomt uotua hmfgongtago sklkcui hmpgagm

;<

GPM - Rkrtuilufgo

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  Lgym prkigtur lkrusmg 7; fgrm ikohgpgt 7;2 iC/anLL/fgrm GPM

 =2 -722 aagc/anLL/fgrm, <- <,; n/anLL/fgrm prdtkmo

 Gpgagf GPMsgjg

ikighgm

uotuapkrtuilufgo

lgymprkigtur

4

 GPM - Rkrtuilufgo

Adcdstrui Rrkigtur GPM Igtur

Agcdrm Aagc / hc  5> 5> 5>

Rrdtkmo n/hc 0,7 7,8 7,2;

Cgatdsg n/hc  8,7 5,5 >,<

Ckiga n/hc  <  ‐<,; 0,;- 8 0,;  ‐ 8,;

Adipdsmsm lklkrgpg susu

Adipdsmsm GPM

;0

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Kstmigsm Aklutufgo Agcdrm uotua Lgym Rrkigtur

ygon skhgon Xuiluf

(GGR 7=6;)

aagc / anLL / fgrm

Xmonagt iktgldcmsik pghg mstmrgfgt ;2Ptrkss hmonmo 72

 Gatmemtgs 7;Keka smotksms/tkrima hgrm gsupgo 6Rkonkcugrgo eksks 7<Rkrtuilufgo <;

Xdtgc 7<2

Xgrnkt:7<2 aagc/anLL/fgrm, 0-0,6 n prdtkmo/ anLL/fgrm

;8

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Edrtmemagsm GPM/ FIE :agrldfmhrgt, prdtkmo, imokrgc, vmtgimo

Imoyga I@X : 7 iC 9 >,> aagc

Imoyga agodcg : 7 iC 9 6,2 aagc

Rdcmadsk: ncuadsg pdcmikr

Outrm`di `gcdrm` (; n 9 7= aagc)

;;

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 Ghmtme/supckikotgsm iucgm hmlkrmago sktkcgf 7-0

imonnu lgym imoui

Ikcmputm agcdrm, prdtkmo, @g, R, Og, vmtgimo

Pupckikotgsm lksm hmiucgm pghg usmg 5-6 imonnu

(cmfgt tglkc), sggt rktmaucdsmt iucgm ikomonagtEdrtmemagsm susu fmonng lkrgt lgym iko`gpgm7622-<222 n

;5

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Lkrmago

gsupgo

trdpfm`ekkhmon

Xmonagtago

lkrtgfgp

pkilkrmgogsupgo

Rgotgu

tdckrgosm

gsupgo

Rkigotgugo

gotrdpdiktrma

;>

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Rkilkrmgo –Xrdpfm` Ekkhmon’ 

Iucgm sknkrg sktkcgf lgym stglmc 7-0 fgrm

 GPM gtgu edriucg 72 iC/anLL/fgrm

Lkrmago gsupgo sktmgp 0 gtgu 8 jgiCgojutago hkongo vdcuik ygon sgig

Xmonagtago pkilkrmgo gsupgo gpglmcg tdckrgosmimoui lgma hgo lgym stglmc sk`grg ikhms

- Hmsklut jung nut prmimon, fypd`gcdrm` ekkhmon

- Ptmiucgsm pkrakilgongo smstki ngstrdmotkstmogc pdst ogtgc

- Hmnuogago pgrgckc hkongo outrmsm pgrkotkrgc

;6

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Iucgm hkongo 72 iC/anLL/fgrm

Xmonagtago sklgoyga ;-<2 iC/anLL/fgrm

^gatu tkr`gpgmoyg gsupgo sk`grg pkouf

20-2; fgrm pghg lgym ? <.222 n 72-78 fgrm pghg lgym 3 7.<;2 n

;=

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LL 3 7222 n : sktmgp jgiLL 3 7;22 n : sktmgp < jgi

LL 7;22-7622 n : sktmgp 0 jgi

LL 7622-<222 n : sktmgp 8 jgi

LL ? <222 n : sktmgp 8 jgi gtgu

do hkigoh

52

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Jgongo iucgm ikilkrmago supckikotgsmvmtgimo hgo imokrgc fmonng lgym tkcgftdckrgo tkrfghgp ekkhmon lklkrgpg fgrm

Pggt gsupgo 7<2 aagc/anLL/fgrm

Iuctmvmtgimo hrdp: 2,0 iC/fgrm

57

Kotkrgc m rdo mo tgak rk`diikohgt mdo edr

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prktkri moegots mo stglck ̀ c mo m`gc ̀ doh m t mdo

Drngomzgtmdo \k`diikohkh suppckikotgtmdo Ghhmtmdogc `dosmhkrgtmdo

Rdpucgtmdo & hdsk(in/an/h)

Momtmgtmdo Hurgtmdo

@diimttkk do Outrmtmdo,

GGRMoegot do fuigo imca : <.2

Moegot do edriucg imca: 7.2

Hurmon rFuKRD usk:

up td 5.2

7

idotf

7<

idotfs

Docy mrdo edrtmemkh edriucgs sfduch

lk uskh mo edriucg ekh prktkri

moegots

Outrmtmdo @diimttkk,

@goghmgo

Rkhmgtrm` Pd`mkty

Lmrtf wkmnft ? 7222 n:

<.2-0.2

Lmrtf wkmnft 3 7222 n:

0.2-8.2

5-6

wkkas

7<

idotfs

`drrk`tkh

gnk

G edriucg ̀ dotgmomon 7< in/c de mrdo

igy lk uskh td ikkt tfk mrdo

rkqumrkikots de moegots wmtf lmrtf

wkmnft ? 7222 n.

Ghhmtmdogc drgc mrdo suppckikotgtmdo

ms ok`kssgry edr edriucg ekh moegots

wmtf lmrtf wkmnft 3 7222 n@diimttkk do Outrmtmdo

de tfk Rrktkri Moegot,

Kurdpkgo

Pd`mkty de Rkhmgtrm`

Ngstrdkotkrdcdny goh

Outrmtmdo

Moegots do fuigo imca:

<.2-<.; (igx. 7; in/h)

Moegots do edriucg imca:

<.2-<.; (igx. 7; in/h)

erdi gcc sdur`ks

Od cgtkr

tfgo

6 wkkas

7<-7;

idotfs

G edriucg `dotgmomon 72-70 in/C de

mrdo ms rkqumrkh td ikkt tfk tdtgc mrdo

rkqumrkikot wmtfdut suppckikotgtmdo.

Hkcgy drgc mrdo suppckikotgtmdo uotmc

krytfrd`ytk trgoseusmdos fgvk ̀ kgskh

@cmo Rkrmogtdc 05 (<22=) <> ‐ 8<

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Rkomonagtgo uaurgo cmonagr pkrut gaut ? < `i

Udcuik `gmrgo rksmhu cgiluon pghg sgtu wgatu

? 0 iC/an

Iuotgf

Cgojutago imoui hkongo fgtm-fgtm

gtgu tuohg skikotgrg, jmag:

50

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Egksks tkrcmfgt lkrhgrgf

Mckus

Rokuigtdsms motkstmogcms gtgu uhgrg lklgs

motrg pkrmtdokgc\ksmhu cgiluon lkrwgrog akfmjgugo

 pgstmago pmpg luago trgospmcdrma

Fkotmago imoui fmonng pkikrmasggo

cgojutgo ikouojuaago gigo, jmag:

58

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Kotkrdadcmtms Okardtmagos

5;

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Rkilkrmgo Gsupgo Lgym J[smg akfgimcgo <6 imonnu, lkrgt cgfmr 7<22 n, \HP

Fgrm <: 

XH stglmc, hmstrks lkraurgon, ikonkcugrago ikadomui, glhdiko ckigs.Iucgm pkilkrmgo gsupgo (GPM 7 iC) ikcgcum skcgon drdngstrma sktmgp 5 jgi

Fgrm 0: 

@RGR,  pkilkrmgo gsupgo ikojghm < iC sktmgp 0 jgi

Fgrm 8: 

Dasmnko agouc ogsgc,  pkilkrmgo gsupgo fmonng 8 iC sktmgp 0 jgi

Fgrm ;: 

 pkilkrmgo gsupgo fmonng 5 iC sktmgp 0 jgi

Fgrm 5, >, 6: 

 pkilkrmgo gsupgo sklgoyga < ic sktmgp fgrm sgipgm 7< iC sktmgp 0 jgi

pkomonagtgo < iC/an/agcm pkilkrmgo gtgu 75 iC/fgrm gtgu 70 iC/an

55

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Rkilkrmgo Gsupgo Lgym J (cgojutgo) 

[smg akfgimcgo <6 imonnu, lkrgt cgfmr 7<22n, \HP

Fgrm =: 

7 V rksmhu 5 iC, akiuhmgo skagcm cgnm 6 iC, tmhga ghg cmonagrgo pkrut

 pkilkrmgo gsupgo fmonng 72 iC sktmgp 0 jgi

Fgrm 72:tmhga ghg rksmhu

 tmonagtago pkilkrmgo gsupgo ikojghm 7< ic sktmgp 0 jgi

Fgrm 77, 7<, 70: 

tmonagtago pkilkrmgo gsupgo ikojghm 7;, 76 hgo <7 iC sktmgp 0 jgiFgrm 78:

pkilkrmgo gsupgo pkouf <8 iCsktmgp 0 jgi

pkomonagtgo 0 iC/an/agcm pkilkrmgo gtgu <8 iC/fgrm gtgu <2 iC/an 

5>

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Iktdhk pkilkrmgo outrmsm:

Lkrgt cgfmr 3 7;22 n

Iucgm hkongo moeus `gmrgo ruigtgo motrg vkog

Pkcgojutoyg, iucgm imoui ikcgcum pmpg

Jmag tdckrgosm imoui lgma:•  juicgf imoui lkrtgfgp hmogmaago hgo

•  juicgf `gmrgo motrgvkog lkrtgfgp hmaurgonm

56

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7;2702<2>

7;2772825

782=2;2; 7<2>2;28

722;2;20

6202;2<

62omc627

(ic/an/fgrm)(ic/an/fgrm)

Xdtgc `gmrgoImoui@gmrgo motrgvkogFgrm

(ic/an/fgrm)

6 omc 7;2 7;2

5=

7/24/2019 Dr. Tetty - Nutrisi Parenteral Dan Enteral Pada Neonatus

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Lkrgt cgfmr ? 7;22 n Imoui hmiucgm sggt lgru cgfmr, lmgsgoyg tmhga

ikikrcuago `gmrgo motrgvkog

 GPM gtgu susu edriucg iucgm hkongo 52 ic/an

pghg fgrm ak-7

Imoui lkrtgfgp hmogmaago fmonng 7;2 ic/an/fgrmpghg fgrm ak-;

>2

7/24/2019 Dr. Tetty - Nutrisi Parenteral Dan Enteral Pada Neonatus

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Iktdhk pkilkrmgo tkrngotuon pghg:

Lkrgt cgfmr hgo usmg nkstgsm Ghg tmhgaoyg ngonnugo ogegs

Xdckrgosm tkrfghgp pkilkrmgo imoui ikcgcum drgcgtgu pmpg cgiluon

Lmsmon usus Lkrgt rmongooyg sgamt

Lgym sgamt imoui skpkrtm lgym hkongo LC 3 7;22 n

>7

7/24/2019 Dr. Tetty - Nutrisi Parenteral Dan Enteral Pada Neonatus

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Agpgo Lgym Rrkigtur Rucgon \gwgt Mogp 4

Lkrgt  7622 n

Ptglmc: tgopg pkoygamtXuiluf

Drgon tug/Rkongsuf ikonkrtm hgo smgp ikrgwgt lgym

Rghg sggt pucgon

Lgym prkigtur cklmf ak`mc hgrm lgym `uaup lucgo@ghgongo outrmsm hgcgi tuluf cklmf rkohgfAklutufgo kokrnm cklmf tmonnm

><

Rkigotgugo Gotrdpdiktrm

7/24/2019 Dr. Tetty - Nutrisi Parenteral Dan Enteral Pada Neonatus

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Akogmagolkrgt /fgrm

-Xkri-0 lucgo

usmg adrkasm:<2 n

- 0-5 lucgousmg adrkasm:

7; n

Rkrtgilgfgopgojgon

7

`i/lucgo

Rkrtgilgfgo cmonagrakpgcg 

2,;`i/imonnu

>0

7/24/2019 Dr. Tetty - Nutrisi Parenteral Dan Enteral Pada Neonatus

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Ekotdo X\ : G okw ektgc-moegot

nrdwtf `fgrt edrprktkri moegots

hkvkcdpkh tfrdunf

g iktg-gogcysms de

pulcmsfkh rkekrko`k

stuhmks.

LI@ Rkhmgtrm`s<220,0:70

>8

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3 7622 n:<8 aagc/dzsusu 

[lgf ikojghm<< aagc/dz

pghg ? 7622 n, jmag lgym

iko`gpgmpkogilgfgo

lkrgt7;-82 n/fgrm

[lgf ikojghm<2 aagc/dzpghg usmg8-5 lucgo,

 jmag skiug

pgrgiktkrpkrtuilufgo ?pkrskotmc ak-<;

\kadikohgsm outrmsm sktkcgf akcugr \P

>;

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usmg ? 0 lucgo 

lkrgt lghgo ? 0 an 

gcluimo skrui ? 0 n/hC 

gcagcm edsegtgsk 3 022 M[/iC 

 Gturgo Pkhkrfgog

 GPM/susu edriucg

lmgsg

 jmag 

>5

7/24/2019 Dr. Tetty - Nutrisi Parenteral Dan Enteral Pada Neonatus

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Outrmsm ikrupgago sgcgf sgtu aklutufgo kskosmgc okdogtus

Jmag iuonamo, outrmsm hmlkrmago kotkrgc

 GPM ikrupgago outrmsm tkrlgmaPklgnmgo okdogtus ikikrcuago outrmsm pgrkotkrgc

[otua ikojgimo tuiluf akilgon goga, outrmsm pgrkotkrgcfgrus ikikoufm aklutufgo `gmrgo, agrldfmhrgt, prdtkmo,

ckiga, trg`k kckikots hgo vmtgimoRkilkrmgo outrmsm pgrkotkrgc ikilutufago idomtdrmon aktgtuotua iko`kngf tkrjghmoyg adipcmagsm

AKPMIR[CGO

>>

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CDND