Pencegahan dan penatalaksanaan asfiksia neonatorum.pdf. Gangguan pernapasan pada bayi penderita asfiksia neonatus masih belum dapat diketahui. ASKEP ASFIKSIA NEONATORUM A. PENGERTIAN Asfiksia Neonatus adalah suatu keadaan bayi baru lahir yang tidak. Komplikasi yang muncul pada asfiksia neonatus antara. ASKEP ASFIKSIA NEONATORUM ASKEP ASFIKSIA NEONATORUM A. PENGERTIAN Asfiksia Neonatus adalah suatu keadaan bayi baru lahir yang tidak segera bernafas secara spontan dan teratur setelah dilahirkan. (Mochtar, 1989) Asfiksia neonatus adalah keadaan bayi yang tidak dapat bernafas spontan dan teratur, sehingga dapat meurunkan O2 dan makin meningkatkan CO2 yang menimbulkan akibat buruk dalam kehidupan lebih lanjut. (Manuaba, 1998) Asfiksia neonatus adalah keadaan bayi baru lahir yang tidak dapat bernafas secara spontan dan teratur dalam satu menit setelah lahir (Mansjoer, 2000) Asfiksia berarti hipoksia yang progresif, penimbunan CO2 dan asidosis, bila proses ini berlangsung terlalu jauh dapat mengakibatkan kerusakan otak atau kematian. Asfiksia juga dapat mempengaruhi fungsi organ vital lainnya. (Saiffudin, 2001) Asfiksia lahir ditandai dengan hipoksemia (penurunan PaO2), hiperkarbia (peningkatan PaCO2), dan asidosis (penurunan PH). JENIS ASFIKSIA Ada dua macam jenis asfiksia, yaitu: 1. Asfiksia livida (biru) 2. Asfiksia pallida (putih) C. KLSIFIKASI ASFIKSIA Klasifikasi asfiksia berdasarkan nilai APGAR a. Asfiksia berat dengan nilai APGAR 0-3 b. Asfiksia ringan sedang dengan nilai APGAR 4-6 c. Bayi normal atau sedikit asfiksia dengan nilai APGAR 7-9 d. Bayi normal dengan nilai APGAR 10 D. ETIOLOGI Penyebab asfiksia menurut Mochtar (1989) adalah: 1. Asfiksia dalam kehamilan a. Penyakit infeksi akut b. Penyakit infeksi kronik c. Keracunan oleh obat-obat bius d. Uraemia dan toksemia gravidarum e. Anemia berat f. Cacat bawaan g. Asfiksia dalam persalinan a. Kekurangan O2. I…. • Partus lama (CPD, rigid serviks dan atonia/ insersi uteri) • Ruptur uteri yang memberat, kontraksi uterus yang terus-menerus mengganggu sirkulasi darah ke uri. • Tekanan terlalu kuat dari kepala anak pada plasenta. • Prolaps fenikuli tali pusat akan tertekan antara kepaladan panggul. • Pemberian obat bius terlalu banyak dan tidak tepat pada waktunya. • Perdarahan banyak: plasenta previa dan solutio plasenta. • Kalau plasenta sudah tua: postmaturitas (serotinus), disfungsi uteri. Paralisis pusat pernafasan • Trauma dari luar seperti oleh tindakan forseps • Trauma dari dalam: akibat obet bius. Penyebab asfiksia Stright (2004) 1. Faktor ibu, meliputi amnionitis, anemia, diabetes hioertensi ynag diinduksi oleh kehamilan, obat-obatan iinfeksi. Faktor uterus, meliputi persalinan lama, persentasi janin abnormal. Faktor plasenta, meliputi plasenta previa, solusio plasenta, insufisiensi plasenta. Faktor umbilikal, meliputi prolaps tali pusat, lilitan tali pusat. Faktor janin, meliputi disproporsi sefalopelvis, kelainan kongenital, kesulitan kelahiran. MANIFESTASI KLINIK 1. Pada Kehamilan Denyut jantung janin lebih cepat dari 160 x/mnt atau kurang dari 100 x/mnt, halus dan ireguler serta adanya pengeluaran mekonium. • Jika DJJ normal dan ada mekonium: janin mulai asfiksia • Jika DJJ 160 x/mnt ke atas dan ada mekonium: janin sedang asfiksia • Jika DJJ 100 x/mnt ke bawah dan ada mekonium: janin dalam gawat 2. Pada bayi setelah lahir a. Bayi pucat dan kebiru-biruan b. Usaha bernafas minimal atau tidak ada c. Asidosis metabolik atau respiratori e. Perubahan fungsi jantung f. Kegagalan sistem multiorgan g. Kalau sudah mengalami perdarahan di otak maka ada gejala neurologik: kejang, nistagmus, dan menangis kurang baik/ tidak menangis. PATOFISIOLOGI Bila janin kekurangan O2 dan kadar CO2 bertambah, timbulah rangsangan terhadap nervus vagus sehingga DJJ (denyut jantung janin) menjadi lambat. Jika kekurangan O2 terus berlangsung maka nervus vagus tidak dapat dipengaruhi lagi. Timbulah kini rangsangan dari nervus simpatikus sehingga DJJ menjadi lebih cepat akhirnya ireguler dan menghilang. Janin akan mengadakan pernafasan intrauterin dan bila kita periksa kemudian terdapat banyak air ketuban dan mekonium dalam paru, bronkus tersumbat dan terjadi atelektasis. Bila janin lahir, alveoli tidak berkembang. Apabila asfiksia berlanjut, gerakan pernafasan akan ganti, denyut jantung mulai menurun sedangkan tonus neuromuskuler berkurang secara berangsur-angsur dan bayi memasuki periode apneu primer.
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