manajemen bblr
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mangement of baby with low birth weightTRANSCRIPT
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Manajemen BBLR
Abdul Haris Khoironi, dr
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Sumber Adamkin DH, 2009. Enteral feeding guideline practicum. Dalam : Adamkin DH, Editor: Nutritional strategies for the very low birth weight infant. Cambridge University press; New York: 107-15 13
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Gambar 1.1 Kurva pertumbuhan intrauterin perempuan5
Sumber : Reproduced with permission from: Olsen IE, Groveman S, Lawson ML, Clark R, Zemel B. New intrauterine growth curves based on U.S. data. Pediatrics, Volume 125, Pages e214-e244. Copyright 2010 by the American Academy of Pediatrics. Data source: Pediatrix Medical Group 14
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Gambar 1.1 Kurva pertumbuhan intrauterine laki-laki5
Sumber : Reproduced with permission from: Olsen IE, Groveman S, Lawson ML, Clark R, Zemel B. New intrauterine growth curves based on U.S. data. Pediatrics, Volume 125, Pages e214-e244. Copyright 2010 by the American Academy of Pediatrics. Data source: Pediatrix Medical Group
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Nutrisi Enteral Bayi puasa
Luminal starvation
Nutrisi Enteral Minimal
Integritas usus terjaga 16
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Keuntungan Nutrisi Enteral Minimal:
• Merangsang hormon pencernaan;• Mencegah atrofi vili usus;• Menurunkan feeding intolerance;• Mempercepat tercapainya nutrisi enteral penuh;• Memperpendek durasi nutrisi parenteral;• Menurunkan insiden kolestasis;• Menurunkan kejadian infeksi nosokomial;• Mempercepat kenaikan berat badan;• Menurunkan kelainan penyakit metabolik tulang;• Memperpendek lama perawatan di Rumah Sakit.• Tanpa meningkatkan angka kejadian NEC
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Prosedur Pemberian Asupan Enteral
Berikan
trophic feedin
g
Tingkatkan secara bertahap
Pantau adany
a intoler
ansi
Pantau
Antropome
trik18
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Apa yang harus diberikan?
• Colostrum• Air Susu Ibu• Air Susu Ibu• Air Susu Ibu
Jika tidak tersedia maka:
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Formula Bayi Kurang Bulan
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Metode pemberian nutrisi enteral beserta pertimbangan medisnya
Metode Pertimbangan
ASI/botolPaling fisiologisMasa gestasi > 34 mingguTanda vital stabilRR< 60 kali permenit
Pipa naso/orogastrik
Suplementasi ASI botolMasa gestasi < 32 mingguRR 60-80 kali permenitBayi terintubasiBayi kelainan neurologik
Pipa transpilorikTidak ada toleransi terhadap pemberian naso/orogastrikBayi dengan resiko aspirasiBayi terintubasiMotilitas usus menurun
GastrostomiMalformasi traktus respirasi dan gastrointestinal (fistel trakeoesofagus)Kelainan neurologik
Sumber, Kalhan SC, Price PT. Nutriotion for the high risk infant. Br Med J. 1998;317:1481-7 20
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Sumber : Deirdre E, Diane Ml. Nutrition. Dalam : Cloherty JP, Eichenwald EC, Stark AR. Editor. Manual of neonatal care. Edisi ke-7. Philadelphia:Lippincott William Wilkins; 2012. Hal. 230-62
Birth Weight (g) Initial rate (mL/kg/day) Volume increase( mL/kg every 12 hours)
<1000 10 101001 – 1250 10 – 20 101251 – 1500 20 – 30 10 – 151501 – 1800 30 151801 – 2500 30 – 40 15 – 20
- The recommended volume goal for feedings is 140 – 160 ml/kg/day. These guidelines do not apply to infant capable of ad libitum feedings.
- AAP merekomendasikan untuk mendukung pertumbuhan BKB dengan suplementasi besi 2-4 mg/kg/hari mulai umur 2 minggu – 12 bulan
Panduan Asupan Melalui Oro Atau Nasogastric Tube
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• Residual dari gastric aspirate >1-2 mL/kg atau >15-20% dari volume total
• Retensi warna hijau
• Abdomen distensi
• Test feses guiac positif
• Adanya gejala infeksi atau sepsis
Tanda Feeding Intolerance
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ASI-Pertumbuhan
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Fortifikasi pada ASI• Pada BKB fortifikasi diberikan saat sudah mampu minum 100 ml/kg/hari~
powdered bovine milk based (Berat lahir <1500 g)• Fortifikasi dimulai saat sudah mampu minum 60 ml/kg/hari bila
menggunakan liquid human milk based (Berat lahir <1250 g)
Tabel. Fortifikasi ASI dengan HMF
• Bila tidak ada HMF gunakan suplementasi dg Post discharge Formula
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