BLOK 22 - SKENARIO D – 2019

NEONATAL CASE

A male newborn was delivered at private clinic, assisted by midwife. He was delivered from a 36
years old women, primigravida. Mrs. Siti, the baby’s mother had premature ruptured of
membrane since 4 days ago. The liquor was thick, snelly and greenish. She had fever since one
day before delivery. She also had history of hypertension during the last trisemester of
pregnancy. The pregnancy wass full term, 39 weeks. The baby was not cried spontaneously after
birth. The midwife cleared the baby’s airway using manual suction and stimulate the baby by
patting his feet. The midwife said Apgar score 1 for 1st minute and 2 for 5th minutes and 5 at 10th
minute. The baby had difficulity while breathing, and had grunting. The midwife then reffered
him to Moh Hoesin Hospital.

Physical examination revealed body weight was 2300 grams. Body lenght 48 cms, head
circumference 35 cms. His temperature was 36oC. He looked hypoactive and tachypnoe,
respiratory rate 72 breaths perminute, there were chest indrawing, grunting could be heard using
stethiscope, breathing sound was normal, he still looked cyanotic even after been giving nasal
oxygen sucking reflex was weak. Heart was 174 beats per minute. Abdomen was tender with
normal bowel sound. There was meconenum staining at umbilical cord and skin. Other
examination within normal.

I. Klarifikasi Istilah

Istilah Definisi
Apgar Score Skor yang digunakan untuk menilai bayi dalam 1, 5, dan 10
menit pertama setelah kelahiran
Premature ruptured of Ketuban pecah dini, pecahnya ketuban sebelum fase aktif
membrane persalinan.
Grunting Bunyi pernapasan abnormal saat ekspirasi yang
menunjukan bahwa glottis telah menutup aliran udara dari
paru, biasanya untuk mencegah kolaps paru.
Meconium staining Kondisi dimana meconium terdeposit pada plasenta, kulit,
mukosa, dan permukaan janin lainnya yang menandakan
fetal distress dan harus segera dilahirkan.
Suction Prosedur penghisapan cairan, saliva, darah dari saluran
 pernapasan pasien untuk mencegah aspirasi pulmonal
Stimulate baby by patting his Prosedur yang dilakukan untuk merangsang tangisan
feet pertama bayi
Chest indrawing Retraksi dada menggunakan otot asesoris pernapasan
Sucking reflex Gerakan menghisap yang dapat dipicu dengan
menyentuhkan sebuah objek ke bibir bayi
Hypoactive Tidak banyak bergerak.
New born Bayi baru lahir sampai dengan 4 minggu pertama setelah
kelahiran
Head Circumference Pengukuran melingkar pada kepala yang dimulai dan
diakhiri di glabella dan melewati protuberentia occipitalis.
Tachypnoe Pernapasan yang sangat cepat lebih dari 60x/menit.
Body Length Pengukuran tubuh dari puncak kepala sampai ujung tumit
salah satu kaki.

II. Identifikasi Masalah

1. A male newborn was delivered at private clinic, assisted by midwife. The baby was not cried
spontaneously after birth. The midwife cleared the baby’s airway using manual suction and
stimulate the baby by patting his feet. The midwife said Apgar score 1 for 1st minute and 2
for 5th minutes and 5 at 10th minute. The baby had difficulity while breathing, and had
grunting. The midwife then reffered him to Moh Hoesin Hospital.
2. He was delivered from a 36 years old women, primigravida. Mrs. Siti, the baby’s mother had
premature ruptured of membrane since 4 days ago. The liquor was thick, snelly and greenish.
She had fever since one day before delivery. She also had history of hypertension during the
last trisemester of pregnancy. The pregnancy wass full term, 39 weeks.
3. Physical examination revealed body weight was 2300 grams. Body lenght 48 cms, head
circumference 35 cms. His temperature was 36oC. He looked hypoactive and tachypnoe,
respiratory rate 72 breaths perminute, there were chest indrawing, grunting could be heard
using stethiscope, breathing sound was normal, he still looked cyanotic even after been
giving nasal oxygen sucking reflex was weak. Heart was 174 beats per minute. Abdomen was
tender with normal bowel sound. There was meconenum staining at umbilical cord and skin.
Other examination within normal.

III. Analisis Masalah

1. A male newborn was delivered at private clinic, assisted by midwife. The baby was not cried
spontaneously after birth. The midwife cleared the baby’s airway using manual suction and
stimulate the baby by patting his feet. The midwife said Apgar score 1 for 1st minute and 2
for 5th minutes and 5 at 10th minute. The baby had difficulity while breathing, and had
grunting. The midwife then reffered him to Moh Hoesin Hospital.
a. Apa hubungan jenis kelamin anak dan pembantu persalinan pada kasus? Haiqal Aldo
Akila
b. Apa makna klinis, penyebab, dan mekanisme dari “The baby was not cried spontaneously
after birth”? Haiqal Aldo Akila
Makna klinis:
Menurut (Marmi & Kukuh, 2012:268) Asfiksia Neonatorum adalah

keadaan bayi dimana bayi tidak dapat bernafas secara spontan dan

teratur segera setelah lahir. Keadaan ini disertai hipoksia, hiperkapnia,

dan berakhir dengan asidosis.

Penyebab:
Asfiksia janin/bayi baru lahir terjadi apabila terdapat gangguan

pertukaran gas atau transport oksigen dari ibu kejanin.

Gangguan transport oksigen tersebut dapat timbul pada masa

kehamilan, persalinan atau segera setelah lahir.

Menurut (Marmi & Kukuh, 2012) Ada beberapa faktor

penyebab etiologi asfiksia yaitu:

(1) Faktor ibu

(a) Hipoksia ibu dan gangguan aliran darah uterus

(b) Pre-eklamsia dan eklamsia

(c) Perdarahan anterpartum

(d) Partus lama

(e) Demam selama hamil

(f) Infeksi Berat (malaria, sifilis dan TBC)

(g) Pospartum

(2) Faktor plasenta

Pertukaran gas antara ibu dan janin dipengarahi oleh luas

dan kondisi plasenta. Asfiksia janin akan terjadi bila

terdapat gangguan mendadak pada plasent, misalnya

solusio plasenta, perdarahan plasenta dll.

(3) Faktor fetus

(a) Kompresi umbilicus akan mengakibatkan

terganggunya aliran darah dalam pembuluh darah

umbilicus dan menghambat pertukaran gas antara ibu

dan janin.

(b) Lilitan tali pusat

(c) Tali pusat pendek

(d) Simpil tali pusat

(e) Prolapsus tali pusat

(4) Faktor neonatus

(a) Bayi premature

(b)Mekonium dalam ketuban

(c) Depresi pusat pernafasan pada bayi baru lahir yang

terjadi

karena beberapa hal, yaitu: Pemakaian obat anestesi

atau analgetika yang berlebihan pada ibu secara

langsung dapat menimbulkan depresi pusat pernafasan

janin, trauma yang terjadi pada persalinan, kelainan

kongenital pada bayi.

 c. Apa makna klinis dari “The midwife cleared the baby’s airway using manual suction and
stimulate the baby by patting his feet”? Bella Tasya
d. Bagaimana cara penilaian Apgar score dan interpretasi pada kasus? Ozi Vincent Bella
e. Apa makna klinis, penyebab, dan mekanisme dari “The baby had difficulity while
breathing, and had grunting”? Haiqal Aldo Akila
f. Mengapa bayi di rujuk ke RS Moh Hosein? Haiqal Aldo Akila
g. Bagaimana cara merujuk ke faskes yang lebih tinggi? Haiqal Aldo Akila
h. Apakah tindakan yang dilakukan penolong sudah tepat dan bagaimana prosedur yang
tepat? Haiqal Aldo Akila

2. He was delivered from a 36 years old women, primigravida. Mrs. Siti, the baby’s mother had
premature ruptured of membrane since 4 days ago. The liquor was thick, snelly and greenish.
She had fever since one day before delivery. She also had history of hypertension during the
last trisemester of pregnancy. The pregnancy wass full term, 39 weeks.
a. Apa hubungan usia, status gravida dengan kondisi ibu (premature ruptured of membrane,
hipertensi, korioamnionitis)? Ozi Vincent Zahwan
b. Apa hubungan kondisi ibu “premature ruptured of membrane” dengan riwayat hipertensi
pada kehamilan dan korioamnionitis? Ozi Vincent Zahwan
c. Bagaimana hubungan kondisi ibu dengan kondisi bayi yang lahir? Ozi Vincent Zahwan
d. Bagaimana makna klinis, penyebab, dan mekanisme dari “The liquor was thick, snelly
and greenish”? Akila Yuffa Debby
e. Bagaimana makna klinis, penyebab, dan mekanisme dari “She had fever since one day
before delivery”? Akila Yuffa Debby

3. Physical examination revealed body weight was 2300 grams. Body length 48 cms, head
circumference 35 cms. His temperature was 36oC. He looked hypoactive and tachypnoe,
respiratory rate 72 breaths perminute, there were chest indrawing, grunting could be heard
using stethoscope, breathing sound was normal, he still looked cyanotic even after been
giving nasal oxygen sucking reflex was weak. Heart was 174 beats per minute. Abdomen was
tender with normal bowel sound. There was meconenum staining at umbilical cord and skin.
Other examination within normal.
a. Bagaimana interpetasi dari pemeriksaan fisik? Tasya Yuffa
b. Bagaimana mekanisme abnormal dari pemeriksaan fisik? Tasya Yuffa
c. Bagaimana gambaran mekonium staning? Tasya Yuffa
d. Berapa skor downe dan interpretasi pada kasus? Tasya Yuffa
e. Apa saja pemeriksaan lain yang dibutuhkan? Tasya Yuffa
Neonatus laki-laki fullterm (39 minggu) BBL 2300 gram, panjang tubuh 48 cm, lingkar
kepala 35 cm, diduga mengalami respiratory distress ec MAS dan HIE ec perinatal asfiksia
 1. Bagaimana diagnosis banding dari kasus tersebut? Bella, Ozy, Vincent
2. Bagaimana algoritma penegakan diagnosis dari kasus tersebut?
3. Apa diagnosis kerja dari kasus tersebut?
4. Apa definisi dari diagnosis kerja?
5. Apa etiologi dari dari kasus tersebut?
6. Bagaimana epidemiologi dari kasus tersebut?
7. Apa faktor risiko dari kasus tersebut? Haiqal, Akila, Aldo, Zahwan
8. Bagaimana patogenesis dari kasus tersebut?
9. Bagaimana patofisiologi dari kasus tersebut?
10. Apa klarifikasi dari kasus tersebut?
11. Apa manifestasi klinis dari kasus tersebut?
12. Apa pemeriksaan penunjang dari kasus tersebut? Tasya, Yuffa, Debby
13. Bagaimana tatalaksana farmakologi dan non farmakologi dari kasus tersebut?
14. Apa komplikasi dari kasus tersebut?
15. Bagaimana prognosis dari kasus tersebut?
16. Apa edukasi dari kasus tersebut?
17. Apa SKDI dari kasus tersebut?

IV. Sintesis
1. Anatomi dan fisiologi sistem pernapasan neonatus Haiqal Aldo
2. Respiratory distress (MAS) Ozi Vincent Bella
3. Ketuban Pecah Dini Ozi Vincent Zahwan
4. Sepsis neonatal Akila Yuffa Debby
5. Perinatal asfiksia dan HIE Haiqal Aldo Akila
6. Pemfis neonatus Tasya Yuffa
7. Resusitasi neonatus Bella Tasya
8. BBLR Zahwan Debby

V. Kerangka Konsep
VI. Simpulan