Pneumonia Aspirasi pada Neonatus

Pneumonia Aspirasi pada Neonatus

Definisi

Teraspirasinya cairan amnion yang mengandung verniks kaseosa, sel epitel, mekonium, atau benda-benda dari saluran lahir, serta bakteri patogen yg dpt memblokade jalan napas dan mengganggu pertukaran oksigen dan karbondioksida

apat

2

Etiologi

Intubated infants

Gastroesophageal reflux

Anestesi

Swallowing dysfunction

Agen infeksi

Virus : Herpes simplex, cytomegalovirus, rubella

Bakteri : T. palidum, Listeria monocytogenes, streptococcus Grup B, E. coli, B. fragilis, Prevotella, Porphyromonas, Bacteriodes spp.

Jamur : Candida

Epidemiologi

Angka mortalitas sangat tinggi di negara maju, yaitu 20-50%. Angka mortalitas di Indonesia diduga lebih tinggi

Insiden pneumonia neonatal pada bayi cukup bulan (1%), bayi kurang bulan (10%)

Klasifikasi

P23 Congenital pneumonia

Incl.: infective pneumonia acquired in utero or during birth Excl.: neonatal pneumonia resulting from aspiration (P24.-)

P23.0 Congenital pneumonia due to viral agent Excl.: congenital rubella pneumonitis (P35.0)

P23.1 Congenital pneumonia due to Chlamydia

P23.2 Congenital pneumonia due to staphylococcus

P23.3 Congenital pneumonia due to streptococcus, group B

P23.4 Congenital pneumonia due to Escherichia coli

P23.5 Congenital pneumonia due to Pseudomonas

P23.6 Congenital pneumonia due to other bacterial agents Haemophilus influenzae Klebsiella pneumoniae Mycoplasma Streptococcus, except group B

P23.8 Congenital pneumonia due to other organisms

P23.9 Congenital pneumonia, unspecified

Klasifikasi

P24 Neonatal aspiration syndromes

Incl.: neonatal pneumonia resulting from aspiration

P24.0 Neonatal aspiration of meconium

P24.1 Neonatal aspiration of amniotic fluid and mucus Aspiration of liquor (amnii)

P24.2 Neonatal aspiration of blood

P24.3 Neonatal aspiration of milk and regurgitated food

P24.8 Other neonatal aspiration syndromes

P24.9 Neonatal aspiration syndrome, unspecified Neonatal aspiration pneumonia NOS

Manifestasi Klinis

Gejala tidak khas berupa: serangan apnea, sianosis, merintih, napas cuping hidung, takipnea, letargi, muntah, tidak mau minum, takikardi atau bradikardi, retraksi subkosta, demam. Pada bayi BBLR sering terjadi hipotermi

Diagnosis

Cultures of tracheal aspirate, pleural fluids, needle aspirate of the lungs, blood cultures

Bacterial infection tend to be more alveolar and viral infections more interstisial for this reason:

Radiating parahilar streakingness and diffuse, hazzy, or reticulonodular lungs favor viral disease

Coarse, patchy parenchymal infiltrates and consolidatins (rare in neonates) favor bacterial disease

Pleural effusions are relatively common with bacterial infections but quite rare with viral infections

Rarely, viral infections can produce calsifications later in life

Diagnosis

Pada bayi berusia di bawah 2 bulan

Pneumonia

Bila ada napas cepat (>60 x/menit) atau sesak napas

Harus dirawat & diberikan antibiotik

Bukan pneumonia

Tidak ada napas cepat atau sesak napas

Tidak perlu dirawat, cukup diberikan pengobatan simptomatis

Penatalaksanaan

Pengobatan kausal

Terapi antibiotik 10-14 hari dan diperpanjang sampai 21 hari (kasus jarang)

Chlamydia trachomatis eritromisin, sulfisoxazole

Pneumonia rawat jalan:

Antibiotik oral lini pertama: amoksisilin (dosis: 25 mg/kgBB) atau kotrimoksazol (dosis: 4 mg/kgBB)

Pneumonia rawat inap:

Antibiotik golongan beta-laktam atau kloramfenikol, getamisin, amikasin, sefalosporin diteruskan selama 7-10 hari

Antibiotik yg direkomendasikan antibiotik intravena spektrum luas spt kombinasi beta-laktam/klavulanat dengan aminoglikosid, atau sefalosporin generasi ketiga. Bila keadaan sudah stabil ganti antibiotik oral selama 10 hari

Prognosis

Angka mortalitas tinggi

Prognosis akhir bergantung pada luasnya jejas sistem saraf pusat akibat asfiksia

REFERENSI

Nelson-Ilmu Kesehatan Anak

Respirologi Anak-IDAI

Clinical Infectious Disease-David Schlossberg

Anaerobic Infections: Diagnosis and Management-Itzhak Brook