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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CIRCULATORY ADAPTATION
-/6A1N/AL1
(" $A%%
II
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CIRCULATORY ADAPTATION
AT1NT(T&
A6T16/&&
(" $A%% III
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CIRCULATORY ADAPTATION
)'TA CIRCUATI!N!igh %#lmonar* resistaneLow resistane in s*stemi bloo" ;ow
RI*+T to ')Tshunt
)oramen !vale
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CIRCULATORY ADAPTATION
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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