Skenario

KEMENTERIAN PENDIDIKAN DAN KEBUDAYAANUNIVERSITAS SRIWIJAYAFAKULTAS KEDOKTERANUNIT PENDIDIKAN KEDOKTERAN (UPK)Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 580061 atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 352342, Fax. 0711 373438,

Skenario C Blok 23 Tahun 2014

A female baby was born at Moh.Hoesin Hospital from a 19 years old woman. Her mother, Mrs. Solehah was hospitalized at Moh.Hoesin Hospital due to contraction. It was her first pregnancy. She forgot when her first day of last period, but she thought that her pregnancy was about 8 months. She said that she never had hypertension or other illness during her pregnancy. Six hours after admitted, she delivered her baby spontaneously. The labor process was 30 minutes, and rupture of membrane happened one hour before delivery. The baby didnt cry spontaneously after birth, and resuscitation was done. APGAR score at 1 minute was 1, at 5 minute was 3, and at 10 minutes was 7. One hour later the baby still had grunting and cyanosis.

On physical examination: Body weight was 1400 gr, body length was 40 cm, and head circumference was 30 cm. The muscle tone decreased, she poorly flexed at the limbs, she had thin skin, more lanugo over the body and plantar creased at 1/3 anterior. At 10 minutes of age, she still had grunting and cyanosis on the whole body. The respiratory rate was 70 x/min, heart rate was 150 bpm, the temperature was 36oC. There was chest indrawing. Other physical examinations were within normal limit.

As a general practitioner please analyze the problem and the management.------------------------------------------------------------------------------------------------------------

For Tutors OnlyLearning Objectives: Students must be able to:1. Explain the definition and classification of low birth weight infant. 2. Explain risk factors which predispose of low birth weight infant3. Diagnose low birth weight infant4. Manage low birth weight infant5. Explain the definition, risk factor, diagnosis and management of asphyxia neonatorum6. Explain the definition, risk factor, diagnosis and management of respiratory distress

Klarifikasi Istilah1 Contraction (perut mules)2 Rupture of membrane (pecah ketuban)3 First day of last period (HPHT)4 Apgar score5 Lanugo6 Plantar creased7 Grunting (merintih)8 Cyanosis (biru)9 Chest indrawing (retraksi dinding dada)

Identifikasi Masalah1. Bayi Ny. Solehah, perempuan, berat badan lahir 1400 gram2. HPHT lupa dan usia kehamilan kira-kira 8 bulan.3. Bayi lahir tidak langsung menangis, APGAR skor 1/3/74. Bayi merintih dan biru.

Analisis Masalah1. Berat badan 1400 gram, berdasarkan berat badan lahir bayi ini diklasifikasikan sebagai apa? 2. HPHT lupa dan ibu mengatakan usia kehamilannya kira-kira 8 bulan. Dengan menggunakan apa kita dapat menentukan berapa minggu masa gestasinya? 3. Berdasarkan masa gestasi dan berat badan lahir bayi ini diklasifikasikan sebagai apa? Apa yang digunakan untuk mengklasifikasikan bayi baru lahir berdasarkan berat lahir dan masa gestasi baru baru lahir?4. Bayi tidak langsung menangis setelah lahir, Apgar score rendah, apa diagnosisnya?5. Bayi merintih dan biru, apa yang diderita bayi ini?6. Apa diagnosis bandingnya? 7. Apa kemungkinan diagnosisnya?8. Pemeriksaan apa yang diperlukan pada penderita ini?9. Bagaimana tatalaksana penderita ini? HipotesisBayi Ny. Solehah, preterm, SGA (sesuai dengan usia kehamilan), BBLSR lahir spontan dengan asfiksia perinatal dan respiratory distress. Kemungkinan penyebabnya (diagnosisnya) adalah penyakit membran hialin.

Sintesis1. Berat badan 1400 gram. Berdasarkan berat badan lahir, bayi ini diklasifikasikan sebagai BBLSR2. HPHT tidak diketahui. Pada penderita ini kita dapati kulit tipis, banyak lanugo dan plantar creased hanya didapati 1/3 bagian depan telapak kaki, dari sini kita dapat memperkirakan bahwa bayi termasuk bayi preterm. Lalu lakukan penentuan masa gestasi dengan menggunakan Ballards score. Faktor risiko pencetus kehamilan prematur pada skenario ini adalah faktor usia ibu yang muda (