Bayi Baru Lahir.ppt

8/17/2019 Bayi Baru Lahir.ppt

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Neonatology DivisionDept. of Child Health Medical School

University of Sumatera Utara

NEWBORN INFANT


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Gradation of CountryDeveloving depend on :

• G N P• Expective Life

• Infant Mortality Rate (IMR

• !epang : "#$ %• &ingapura : '# %

• Indone)ia : "*#+ %


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PediatricsObstetrics

Perinatology

PERINATOLOGY


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Perinatology Coverage

• '' ,ee-) .orn / Mo

(G1 2 + 3ont0

• 45)tetric Pediatric

(pregnancy 3onitor 6 Neonatologi)t 7

(intensif care


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Neonatal care

• Level I : 8 9ealt0y neonate)

8 Roo3ing in

• Level II : 8 Low dependent

- High dependent

• Level III : Neonatal Intensive Care Unit (NICU)

•


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Normal newborn :

Term infants : 37 – 42 weeks GA

Birth weight : 2500 – 4000 g

Birth Length : 44 – 53 m

!ea" ir#mferene : 32 $ 37 m A%gar &ore : 7 – '0

(ongenital anomalies : negati)e


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Perinatal period :

Statistic usage

!" #ee$s %%%%%%% & #ee$ after birth

Science and Service usage

conception %%%%% & month after birth

Neonatal period

'irth%%%%%%%%% & month after birth


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(etus Neonates

)

) (etal circulation ) Neonatal circulation

) O! depend to Utero ) O! * o#n produce

placental circulation by breathing

) Nutrition depend on ) (eed %%%% 'reast feeding

maternal status


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(etus Neonate

'irth

+esuscitationdaptatio

n

NEONATAL ADAPTATION


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NEONATAL ADAPTATION

Adaptation :

the %roess b* whih onea"+#sts an" beomes more

att#ne" to the en)ironment,

Neonatal adaptation :

-#ntional a"+#stment fromintra#terine to e.tra#terine life

Abilit* to a"+#st $$$ !/1/&TA&&

ala"a%tation $$$ orbi"it*


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N,ON--/ -D-P-0ON

AATAT/N "e%en"on :

AT6AT/N

NT6T/NAL &TAT&

T/LA6AN(1 AAT1 (AA(T8


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AATAT/N "e%en" on :

AT6AT/N

Related to gestationalage

NT6T/NAL &TAT&

T/LA6AN(1

AATAT/N

N,ON--/ -D-P-0ON


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AATAT/N "e%en" on :

AT6AT/N

NT6T/NAL &TAT&

6elate" to birthweight

T/LA6AN(1

AATAT/N

N,ON--/ -D-P-0ON


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N,ON--/ -D-P-0ON

AATAT/N "e%en" on :

AT6AT/N

NT6T/NAL &TAT&

T/LA6AN(1

The ability to overcomethe new environment

Tolerabilit* to h*%o.ia9h*%ogl*emia9 alori intake9et,

AATAT/N


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AATAT/N "e%en" on :

AT6AT/N

NT6T/NAL &TAT&

T/LA6AN(1

AAT1 (AA(T8

the %otential or abilit*of a s*stem to a"a%t tothe eets of hange

N,ON--/ -D-P-0ON


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NEONATAL ADAPTATION

(ar"io$ir#lator* s*stem

6es%irator* s*stem

ntestinal trat etabolism

(entral ner)o#s s*stem

Adaptation involvedmultiorgan function,include :


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Circulatory daptation

(etus 8 fro3 ,ee-) until 5irt0 organ)

3ature to )upport external life

(etal circulation

; u35ilical8placental circuit via u35ilical cord ; circulatory )0unt) to 5ypa))

Liver

ductu) veno)u) to inferior vena cava

Lung)1 fora3en ovale 5et,een rig0t < left atria

= ductu) arterio)u) connect) pul3onary artery

to aorta


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CIRCULATORY ADAPTATION

#UCTU%&'N!%U%

(" $A%% I


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-/6A1N/AL1

(" $A%%

II


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AT1NT(T&

A6T16/&&

(" $A%% III


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)'TA CIRCUATI!N!igh %#lmonar* resistaneLow resistane in s*stemi bloo" ;ow

RI*+T to ')Tshunt

)oramen !vale


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N'!NATA CIRCUATI!N

rofo#n" hanges of ir#lation at birth

nrease" %#lmonar* bloo" ;ow "#e to the

"ro%s of %#lmonar* resistane $ l#nge.%ansions,

eno#s ret#rn from l#ng inrease,

Left arterial %ress, is raise"> 6ight

art,%ress,"erease foramen o)ale lose", &*stemi resistane higher than %#lmonar*resistane


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NEONATAL ADAPTATION

CIRCUAT!R" A#A$TATI!N

)etus Newborn

Pul3onary

circulation

1ctive> le))develop#

1ctive> increa)eddevelop3ent

?ora3en ovale 4pen Clo)e

Ductu) arterio)u).otali

4pen Clo)e

Ductu) @eno)u) 1rantii

4pen Clo)e

&y)te3iccirculation

1ctive ,it0 lo,re)i)tance

1ctive ,it0increa)ere)i)tance


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CirculatoryAdaptation


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)'TA $U!NAR"#'&'!$'NT

Al)eoli %resent : 25

weeks ?ll with l#ng ;#i"s

Breathing mo)ements:

@ ntermittentl*

@ L#ng "e)elo%ments

@ (ontrol of

breathing

-et#s : gas e.hange

%laenta


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NEONATAL ADAPTATION

FIRST

BREATHMechanical

Proprioceptive

Chemoreceptor

Temperature

Touch

Diafragm

Neonatal 6es%iration

rreg#lar

Ab"ominal res%iration

Pain


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$U!NAR" A#A$TATI!N

(!AN /- 11NT& A-T16 -6&TB61AT! :

※ Converts fetal to adult circulation

※ Empties the lung fluids.

※ Begin pulmonary function.

H,N,2'O+N

+,SP0+-0ON',30N


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PULMONARY ADAPTATION

(,US N,2'O+N

-lveolus Colaps Develops

Pulmonary vessels Non active -ctive

Pulmonaryresistance

High Decrease

Pulmonary blood /o# 0ncrease

O4ygen needs Placenta /ung

CO! e4cretion Placenta /ung


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$rogressive developments of theduodenum, liver, pancreas and biliaryapparatus

*est-Age . w/

*est-Age 0

w/ #o"en#m : ol#"e" $ reformation of l#men – atresia

Li)er biliar* : Begin at C an" '2 weeks fail#re toanaliDation – biliar* atresia

anreas : ns#lin seretion an" gl#agon $ '0 an" '5


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*A%TR! INT'%TINAA#A$TATI!N

)'TU% : (alori an" n#tritional nee"s "eri)e" frommother %laenta,

ntestinal motilit* non ati)e

No nee" for enD*me metabolism,

N'1(!RN

ntestinal motilit* begin in f#ntion,

nrease nee"s of aloriEn#tritional an"

enD*me metabolism


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NEONATAL ADAPTATION

*A%TR!INT'%TINAA#A$TATI!N

)etus Newborn

Nutritionala5)orption

Non active 1ctive

.acterialcoloniAation

Negative Po)itive

?ece) Meconiu3 Meconiu3?ece)

EnAy3e Non function 1ctive


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UR!*'NITA A#A$TATI!N

6enal organogenesis – a ontin#o#s %roess– C till 3C weeks gestation

The "e)elo%ments of #rogenital f#ntionontin#o#s after birth

-etal #rine %ro"#tion – maintainingamnioti ;#i" )ol#me

ore than F0 newborn )oi" in the ?rst 24ho#rs,

NewbornH #rine %ro"#tion : '$2 mlEkg

BIEho#r,


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UR!*'NITA A#A$TATI!NALLERTNESS

/LG/!86AN/&

a* s#ggest renal agenesis> h*%o%lasia> "*s%lasia>#rinar* trat obstr#tion,

/L8!86AN/&

Gastrointestinal anomalies> trans%laental transf#sion

s*n"r,> ongenital

1LA81 (T6T/N #rine ;ow obstr#tion,


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IUN!!*IC %TATU% ofthe )'TU% andN'1(!RN(,US

P0agocytic cell)

Granulocyte) cell)

Monocyte) cell)

N,2'O+N

I33une )y)te3 even in ter3 8 lo,er t0an adult)#

.et,een "8/' 3o tran)ient i33unodeficiency#

B0e ri)- en0ance 5y :• Pre3aturity• Brau3atic delivery• Neonatal )tre))> etc#

PREVENTION FROM INFECTIONS

"enti?e" at 4

mo gestation,


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(ody Temperature in the N((ody Temperature in the N(

37.5 C

36.5 C

36.0 C

32.0 C

Normal rang

Col! "#r"" $$$$$$$$$$ Ca%" &or 'on'rn

(o!ra# )*+o#)rm,a $$$ -AR( BAB

S/r )*+o#)rm,a o%#loo1 gra/

&kille" are #rgentl* nee"e"


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T'$'RATUR' A#A$TATI!N-1T& :

Bo"* tem%erat#re intra#terineen)ironment

N1IB/6N :

1.%ose to e.tra #terine on"ition homeotherm* a%abilities is

limite" "#e to : large s#rfae area> %oorthermal ins#lation> low abilit* toonser)e heat,

PREVENT OF HET !OSS


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+'AT !%%-

C!N#UCTI!N

C!N&'CTI!N

'&A$!RATI!N

RA#IATI!N

Transfer of bo"* heatto skin s#rfae,

r* an" wra% thebab* lae in a warmmattress


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!1AT L/&&

C!N#UCTI!N

C!N&'CTI!N

'&A$!RATI!N

RA#IATI!N

&kin heat loss "e%en"son air tem%erat#reE;ow,

Ira% the bab* an"ontrol room

tem%erat#re


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+'AT !%%-

C!N#UCTI!N

C!N&'CTI!N

'&A$!RATI!N

RA#IATI!N

e%en" #%on airh#mi"it*

(ontrol h#mi"it*an" room

tem%erat#re


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+'AT !%%

C!N#UCTI!N

C!N&'CTI!N

'&A$!RATI!N

RA#IATI!N The transfer of bo"* heatto en)ironmentaltem%erat#re

6a"iant heater an"ontrol roomtem%erat#re


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