case hiperbilirubin - 25-7-15

7/23/2019 Case Hiperbilirubin - 25-7-15

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CASE REPORT

BY. NY. C

Alberta Claudia

Jean Valeria (20

Vanessa A T (20

dr. Har



IDENTITAS

Nama : Bayi Ny. C. Jenis kelamin : perempuan Tanggal/jam lahir : !"#"

$!%# / !&:!'sia saa( )RS : & hari * jamPersalinan : PSP

Keluhan utama: +ayi (ampak kekuningan pa,

+a,an sejak -# jam S)RS



Riaya( Penyaki(Sekarang

uli( pasien kuning sejak -# jam S)RS- pa,aseluruh +a,an 0ajah- ,a,a- a+,1men- eks(remi(assampai ke (elapak2

3anya minum AS4 567 per hari 0,urasi %!"%#meni(2

)enyusu ,engan kua(- +ayi melepas sen,iri seusaimenyusu



Riaya( Penyaki(Sekarang

9eses kuning ke81kla(an- (i,ak+erarna ,empul- 57 per hari

emam 0"2

BA +erarna seper(i (eh 0"2

;1l1ngan ,arah +ayi: +elum ,ike(ahui



Re<ie 1= sys(em

0"2 palpi(a(i1n 0"2 ,yspnea

0"2 hem1p(ysis 0"2 a+,1minal pain

0"2 ,iarrhea 0"2 81ns(ipa(i1n

0"2 +lee,ing 0"2 pall1r 0"2 rashes



Riaya( eluarga

& hari * jam

$**! gram

(-)diabetes

(-)asthma

(-)hipertensi



Riaya( Prena(al

4+u usia $ (ahun- P%A! -3P3T $!"6"$!%#0&!"&% minggu2

Riaya( ANC (era(ur se+anyak 67 ,ipuskesmas

Riaya( penyaki( yang ,i,eri(a i+u,isangkal

Riaya( penggunaan 1+a("1+a( ,isangkal

Pernikahan per(ama

4n=eksi ma(ernal ,isangkal



Riaya( Prena(al

>ahir se8ara persalinan sp1n(an per<aginam

Air ke(u+an: jernih

Tan,a"(an,a <i(al i+u

;1l1ngan ,arah i+u: O?

Ti,ak a,a =ak(1r resik1 sepsis may1r@(er,apa( =ak(1r resik1 sepsis min1r:kepu(ihan 0pu(ih- (i,ak +er+au- (i,ak ga(al2

TD: 120/80mmHg

RR:16x/menit

HR:80x/menit

S:36,!"

D##:13$x/menit



>ahir ! )ei $!%#- !&.!

)eni( %

• 3anga(kan- +ul+su8(i1n- keringkan

• T1nus 1(1( kua(• 3R %!7/mn(• Bayi menangis kua(• Akr1sian1sis 0?2• S1me e7i1n• AP;AR 6

)eni( #

• )enangis kua(• T1nus 1(1( kua(•

3R %$#7/mn(• Akr1sian1sis 0?2• AP;AR *

)eni( %#" !

• Bayi mena• 3R: %$#7/m• Akr1sian1s• T1nus 1(1( • i(amin !

pa,a m. <ala(eralis sin• l1ram=eni

OS.



Bera( Ba,an >ahir $*#! gram0P$#"P#!2

Panjang Ba,an >ahir &6 8m 0P$#"P#!2

>ingkar epala 8m 0P$#"P#!2

>ingkar a,a % 8m>ingkar Peru( !-# 8m>ingkar >engan A(as %% 8m

D9A ! " 0"$2 S giFi +aik " "



Riaya( imunisasi



%eme&i'(aan )i(i'

ea,aan umum: (ampak ak(i=- +ayi menangis ku

esa,aran: 81mp1s men(is

3R: %$& 7/meni(

RR: GH 7/meni(

S : H-$ OC

Reeks: )1r1 ?- r11(ing ?- su8king ?- palmar grplan(ar grasp ?



%eme&i'(aan )i(i'

Ke*ala: ''B (er+uka 8m 7 $ 8m- (era+a lem+u(- ,a(ar- mgra,e ! pa,a su(ura sagi(alis- m1lase gra,e 444 pa,a su(uram1lase gra,e ! pa,a su(ura lam+,1i,ea- '' % 8m 7 % 8msu88a,enum 0"2- ajah (ampak kekuningan

+ata: k1njung(i<a anemis "/"- sklera ik(erik ?/?- reeks 8alangsung ,an (i,ak langsung ?/? - sekre( "/"- leuk181ria "/"1range ree7 ?/?

Hiung: ,e<iasi sep(um "- sekre( "/"- nasal are "/"

Telinga: mea(us akus(ikus eks(ernus ?/?- sekre( "/"- mem

(impani in(ak ?/?



%eme&i'(aan )i(i'

Pulm1:4: gerakan na=as (ampak sime(ris- re(raksi "P: gerakan na=as (era+a sime(risA: +r1nk1<esikuler ?/? (era(ur- rh1nki "/"- hee

C1r:4: i8(us 81r,is (i,ak (ampakP: i8(us 81r,is (era+a pa,a 4CS 4 linea mi,8la<

sinis(raA: S% ,an S$ reguler- gall1p "- murmur



%eme&i'(aan )i(i'

A+,1men: 4: (ampak 8em+ung- a+,1minal ,e=ek 0"2- kuli( a+,1me

kekuningan P: supel- hepar (era+a $ 8m ,i+aah ar8us 81s(ae ,e7

(ajam- permukaan ra(a- k1nsis(ensi kenyal- li<er e,ge 8m ,ari um+ilikus ke arah arkus 81s(ae- li<er e,ge kiri,ari um+ilikus ke arah pr18. 7iph1i,eus- lien (i,ak (era,is(ensi 0"2- massa 0"2

P: li<er span linea mi,kla<ikularis ,eks(ra: &-# 8m- li<elinea mi,s(ernalis: $-# 8m

A: B' ? "& kali/meni(



%eme&i'(aan )i(i'

Eks(remi(as: CRT I $ s- akral hanga(- Barl1 "- Or(h1lani sejajar- (ampak kekuningan pa,a seluruh eks(remi(as

(elapak kaki ,an (elapak (angan- (1nus 1(1( +ai

uli(: (urg1r +aik- jaun,i8e ramer ?- rash "

Punggung: sa8ral ,imple "- alignmen( <er(e+ra +aik- la

;eni(alia: la+ia may1r menu(upi la+ia min1r- sekre( "

B1k1ng: anus ?- perianal rash "



Re(ume Diagn.(i

By. Ny. C- perempuan

•uning -# jam S)RS pa,a seluruh+a,an

P9 :ea,aan umum: (ampak ak(i=- +ayimenangis kua(esa,aran: 81mp1s men(is3R : %$& 7/meni(

RR : GH 7/meni(S : H-$ OC

•uli(: kuning seluruh +a,an hingga(elapak (angan ,an kaki 0ramer #2

By. Ny. C- ne1na(us u jam- BB$**! gram->&-# 8m- jenis keperempuan ,engan

+reas(=ee,ing jaun,i8

/:•Breas( milk jaun,i8e•S(a(us giFi +aik men•S(a(us imunisasi leng

usia menuru( 4A4



Pen,eka(an iagn1sis

Berman’s Pediatrics Decision Making 5 th Edition



Hi(t.& : )a't.& Ri(i'.Hi*e&ili&uinemia

+a.& Ka(u( +in.&

TSB le<el se+elum pulang (inggi Ti,ak ,i8ek TSB le<el se+elum pulang in(erme,ia(e

Jaun,i8e ,alam $& jam per(amakehi,upan

" Jaun,i8e se+elum pulang

4nk1mpa(i+ili(as g1l1ngan ,arah " )akr1s1mia 0i+u )2

eluarga ,engan ;GP Ti,ak ,i8ek 'sia ma(ernal $# (ahun

'sia kehamilan #"G minggu " 'sia kehamilan H 6 min

)emiliki sau,ara ,engan riaya(=1(1 (erapi

" )emiliki sau,ara ,enganriaya( jaun,i8e

Cephal1hema(1ma " >aki"laki

ASI e'('lu(i

Ras Asia Timur "

eluarga ,engan ;il+er( Syn,r1meNelson Tetbook o! Pediatrics "# th edition



Pemeriksaan Ksik

1 Small 1r large =1r ges(a(i1nal age 0S;A- >;A2

2 Pre(erm

3 E78essi<e eigh( l1ss sin8e +ir(h

4 Ru,,iness

$ Bruising 1r 8ephal1hema(1mas 6 3epa(1splen1megaly 0as a sign 1= in=e8(i1n- hem1lysis-

1r li<er ,isease2

A+,1minal ,is(en(i1n 0as a sign 1= 1+s(ru8(i1n2

8 i(al sign a+n1rmali(ies 0as a sign 1= in=e8(i1n2

Berman’s Pediatrics Decision Making 5 th Edition



Tatala'(ana

Raa( ,alam +17 ,i +angsal S1ka

91(1(erapi % 7 $& jam

AS4 on demand

Cek ulang +iliru+in (1(al ,an g1l1ngan ,arah

TT per jam

Cek +alan8e per 6 jam

E,ukasi i+u pasien 8ara menyusui yang +enar



Nelson Tetbook o! Pediatrics "# th edition



%eme&i'(aan *enun5ang

T1(al serum +iliru+in:

%H.G mg/,>



$$P



Nelson Tetbook o! Pediatrics "# th edition



iagn1sis Anamnesis:

Ka(u( &ea(teeing 5auni7e &ea(tmil'

)un8ul hari ke & I'te&i' mun7ul u(ia 2$ ha&i4k(erik mun8

minggu

Cephal18au,al I'te&i' 7e*hal.7aual

1nsumsi AS4 +aik@ p1sisimenyusu salah

Bayi kurang sering ,i+eri AS4/ AS4se,iki(/ *.(i(i menu(u (alah

ai meng'.ai' a

Anak per(ama-eih (e&ing *aa ana'

*e&tamaSemua anak

mengalami

Ak(i= ai a'ti

N1rmal Bayi ,apa( (ampak ,ehi,rasiBB +ayi men

mingg

BAB n1rmal BAB (er(un,a/ jarangemam 0"2- BAG"H7/hari- BAB

&7/



Diagn.(i( >a+1ra(1rium:

Ka(u( &ea(teeing 5auni7e

&ea(tmil'

TSB %H.G mg/,> TSB +iasanya I%#mg/,>

TSB ,apa( men8apeak hingga !

minggu

Ti,ak ,i8ek CBC ,alam +a(as n1rmal

Ti,ak ,ilakukan TSB p1s( AS4 $ jamp1s( s(1p AS4 %

mg/,

Ti,ak ,ilakukan TSB p1s( s(1p AS4 ,ras



).ll.9 u*

4 #uni 201$ ha&i &a9at II;



# ;

S Bayi ak(i=- menangis kua(- menyusu kua(- (1nus 1(1( +aik- jaun,i8e 0"2

O •ea,aan umum : Tampak ak(i= •esa,aran : 81mp1s men(is• Tan,a"(an,a <i(al : >aju na,i : %$! %G kali per meni( 0%%!"%&!7/ meni(2

>aju napas : ## GH kali per meni( 0&!"G! 7/meni(2 Suhu : H1 C 4npu( 1ral : %%! 88/%& jam 0L $.G 88/kg/hari2 Ou(pu( : urin : G.H 88/kg/jam@ 4D> : #6.$/%& jam

Balan8e : $$G.$ 88•P9 :epala: sklera ik(erik ?/?uli(: (urg1r kuli( +aik- jaun,i8e 0"2

A Ne1na(us usia # hari- BB%&##' gram PB%* cm +,%5 cm .enis kelamin peremp/an d

breast!eeding .a/ndice0,,/ +reas(milk jaun,i8e- ABO in81mpa(i+ili(y

P Raa( ,alam +angsal SOAAS4 1n ,eman,>anju(kan =1(1 (erapi ,1u+le sampai selesai % 7 $& jam 0%.!!2 TT per jamBalan8e per 6 jam)1ni(1r perkem+angan jaun,i8e91ll1 up hasil pemeriksaan +iliru+in (1(al



Sa&an : Cek +iliru+in $ ja

AS4- s(1p AS4 %$ j

0pem+erian TPN2+iliru+in (1(al

-a.&at.&ium :;1l. arah i+u : O/?;1l. arah anak : O/?



ANA>4SA AS'S



% i'



%eme&i'(aan

%enun5ang

Pada kas/s tidak dilak/kan

pemeriksaan bilir/bin direk

dan indirek



Ta(alaksana

Ka(u( &ea(teeing 5auni7e &ea(tmil' 5

AS4 1n ,eman, E,ukasi un(uk melanju(kan AS4 =rekuensi menyusui 0%!kali/$& jam2

E,ukasi un(uk melanj =rekuensi menyusu jam2 lalu 8ek TSB ,ala

Cek +iliru+in (1(al E,ukasi p1sisi ,alam menyusuiyang (epa(

91(1(erapi 91(1(erapi 91(1(erapi

Rooming-in + night feeding



T4NJA'AN P'STAA



&ea(tmil' 5auni7e

Epi,emi1l1gi:

TSB %$ mg/,>: %&M

TSB %# mg/,>: $M

E(i1l1gi: a,anya enFim glu81r1ni,ase pa,a AS4 i+u



Pa(1Ksi1l1gi

EnFim ;luk1r1ni,ase

pa,a AS4

un81upling+iliru+in ,an

glu81r1ni8 a8i,,i usus

+iliru+in in

rea+s1r+,alam si

en(er1he

TSB 0+iliru+inin,irek2



&ea(teeing 5auni7e

)un8ul pa,a minggu per(ama

Terja,i pa,a +ayi ,engan AS4

TSB %$ mg/,>

Epi,emi1l1gi: %$.*M TSB%$ mg/,>

>aki"lakiperempuan

Ras Asia (imur



Pa(1Ksi1l1gi

intake IIak(u (ransi(

usus

pr1ses,ek1njug

+iliru+in ,iin,irek

rea+s1r+melalui sirken(er1hep

TSB 0+iliru+inin,irek2



E<aluasi pa,a ne1na(us raa( jalan:

Bera( +a,an

Asupan

BA

BAB Jika jaun,i8e meningka( a(au keparahan jaun,i8e (i,ak jelas perik

a(au T8B

Skrining jaun,i8e:

Jika skrining uni<ersal (i,ak a,a TSB a(au T8B ,ilakukan un(uk semua ne1n,engan jaun,i8e I$& jam- jaun,i8e (i,ak sesuai usia- ,ereja( jaun,i8e (i,ak j



Pemilihan in(er<ensi +er,asarkan umur +ayi ,alam jam ,i+an,ingkankarena penye+a+nya.

E<aluasi peningka(an le<el +iliru+in 0periksa la+2 +er,asarkanin,ikasi



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case hiperbilirubin - 25-7-15

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