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    Skrining PJB Kritis Dan Non Kritis - Ikm

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    This document discusses screening for congenital heart disease (CHD) in newborns. It provides statistics on CHD prevalence and outlines the importance of pulse oximetry screening to detect critical CHD before one month of age. The study conducted pulse oximetry screening in 4 hospitals in Yogyakarta from July to September 2021 and detected 6 cases of CHD. Challenges with the screening included short postpartum care duration and lack of standardized newborn pulse oximetry.

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    Skrining PJB Kritis Dan Non Kritis - Ikm

    Uploaded by

    siti
    14 views14 pages
    This document discusses screening for congenital heart disease (CHD) in newborns. It provides statistics on CHD prevalence and outlines the importance of pulse oximetry screening to detect critical CHD before one month of age. The study conducted pulse oximetry screening in 4 hospitals in Yogyakarta from July to September 2021 and detected 6 cases of CHD. Challenges with the screening included short postpartum care duration and lack of standardized newborn pulse oximetry.

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    Skrining PJB kritis dan non kritis_ikm

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    This document discusses screening for congenital heart disease (CHD) in newborns. It provides statistics on CHD prevalence and outlines the importance of pulse oximetry screening to detect critical CHD before one month of age. The study conducted pulse oximetry screening in 4 hospitals in Yogyakarta from July to September 2021 and detected 6 cases of CHD. Challenges with the screening included short postpartum care duration and lack of standardized newborn pulse oximetry.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    14 views14 pages

    Skrining PJB Kritis Dan Non Kritis - Ikm

    Uploaded by

    siti
    This document discusses screening for congenital heart disease (CHD) in newborns. It provides statistics on CHD prevalence and outlines the importance of pulse oximetry screening to detect critical CHD before one month of age. The study conducted pulse oximetry screening in 4 hospitals in Yogyakarta from July to September 2021 and detected 6 cases of CHD. Challenges with the screening included short postpartum care duration and lack of standardized newborn pulse oximetry.

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    of 14

    Skrining PJB Kritis dan

    Deteksi Dini PJB (non-kritis)


    UKK KARDIOLOGI
    IKATAN DOKTER ANAK INDONESIA
    Penyakit Jantung Bawaan
    5 juta bayi lahir per tahun, sekitar 50.000 bayi lahir
    dengan PJB
    dan 12.500 PJB Kritis

    1%1 dari 100dengan


    bayi lahir
    PJB

    25% 25 dari 100 PJB


    adalah PJB Kritis

    PJB kritis adalah PJB yang harus dilakukan tindakan segera sebelum usia 1
    bulan
    karena dapat menyebabkan kematian atau kecacatan
    Contoh PJB Kritis
    Manifestasi PJB Kritis

    Sirkulasi sistemik Sirkulasi paru


    tergantung duktus tergantung duktus
    • Sirkulasi kolaps • Sianosis
    (seperti syok septik) • Desaturasi oksigen
    • Gangguan perfusi
    • Denyut nadi
    femoral lemah

    PADA NEONATUS YANG


    SEBELUMNYA TAMPAK SEHAT
    “My child had recurrent cough and wasted, so the doctor
    diagnosed tuberculosis infection. After having tuberculosis
    treatment, he did not improve.”
    “My child frequently had cough, hard breathing, and did not
    easily gain weight, but the doctor only suggested to give more
    feeding.”
    “My child had been diagnosed CHD since age of two months,
    but the doctor suggested to wait until he grew older.”
    “When crying he started to get bluish. The midwife said that it
    was normal to get bluish when crying.”
    “I felt it was not OK if my child consumed drugs every day. I
    decided not seeing the doctor anymore.”
    “Since birth, my child had been suspected of having CHD, but
    because of financial problems I saw the doctor just after
    having health insurance.”
    “I was sure that it (CHD) could spontaneously close since she
    looked healthy.”
    Delayed diagnosis in Dr Sardjito Hospital:
    - Acyanotic CHD was 54.9% (373/679)
    “I did not believe that my child had CHD since she looked OK.”
    - Cyanotic CHD was 86.2% (137/159) “I never saw the healthcare workers since my child never
    - Critical CHD was 85.9% (164/191) complained of being sick.”
    “I decided giving her an alternative medicine rather than
    seeing the doctor.”
    Mengapa perlu dilakukan skrining PJB kritis?
    • Bayi dengan PJB kritis biasanya lahir tampak sehat
    • Sianosis tidak terlihat pada bayi baru lahir bila saturasi
    oksigen tidak lebih rendah dari 80%
    • Separuh bayi dengan PJB kritis tidak ditemukan bising
    jantung
    • Prenatal USG jarang dilakukan dan hanya mendeteksi
    setengah dari PJB kritis
    • Pemeriksaan baku emas PJB adalah ekokardiografi
    • Pulse oksimeter dapat digunakan untuk skrining PJB
    Algoritma Skrining Pulse Oksimeter untuk Skrining PJB Kritis
    Interpretasi Hasil

    UKK KARDIOLOGI IDAI 8


    PJB yang Dapat Dideteksi dengan Skrining Pulse Oksimeter

    • Hypoplastic left heart syndrome


    • Pulmonary atresia
    • Tetralogy of Fallot
    • Total anomalous pulmonary venous return
    • Transposition of the great arteries
    • Tricuspid atresia
    • Truncus arteriosus

    UKK KARDIOLOGI IDAI 9


    Permasalahan Detail

    Regulasi Lama perawatan pascasalin relatif singkat, skrining dilakukan < usia 24 jam.

    Pengukuran pulse oximetry belum menjadi bagian dari standar perawatan bayi baru

    lahir yang sehat sebelum dipulangkan sehingga beberapa pemeriksaan kesehatan

    (terutama perawat dan bidan) tidak rutin dilakukan meskipun penelitian ini telah
    Studi dilakukan di 4 RS
    DIY: RSUP Dr Sardjito, dilakukan.
    2 RSKIA, 1 RS swasta, Bayi dengan hasil skrining positif tidak segera menjalani ekokardiografi karena
    Juli-September 2021
    ekokardiografi hanya dilakukan di rumah sakit umum dan tersier sementara mereka

    masih harus menjalani rawat inap.

    Peralatan Kurangnya alat pulse oksimeter di bangsal, dengan pulse oksimeter hanya tersedia

    di NICU
    Sensor dengan pita/tape tidak tersedia secara luas, padahal alat tersebut lebih
    Prevalensi PJB
    6/1000 kelahiran mudah dan lebih cepat digunakan daripada pulse oksimeter yang diletakan di ujung

    hidup jari .
    2 Ebstein Anomaly Probe dewasa untuk bayi baru lahir juga digunakan karena sumber yang terbatas di
    2 Tricuspid atresia
    1 PA-VSD bangsal
    1 Mitral atresia, HLHS Tenaga Medis Petugas kesehatan sibuk dengan tugas klinis lainnya dan lupa melakukan skrining.
    1 DORV, TGA, VSD
    1 Unbalanced AVSD Keadaan Bayi Beberapa bayi baru lahir yang terus-menerus menangis atau bergerak membuat

    oksimetri sulit digunakan.


    Informasi Pelaksanaan Skrining
    • Umur kehamilan/gestasi saat bayi lahir setidaknya sudah memasuki
    35 minggu. Petugas kesehatan perlu melakukan pengecekan pada
    Faktor Ibu rekam medis/status bayi serta menanyakan kepada Ibu bayi untuk
    menyesuaikan dengan kriteria umur gestasi bayi.

    Waktu • Pemeriksaan dilakukan saat sebelum bayi dan orang tua pulang dari
    puskesmas/klinik rawat inap, dan atau sebisa mungkin mendekati
    Pemeriksaan usia 24 jam.

    • Area pemeriksaan (bagian tubuh bayi): di tangan kanan dan atau


    Area Pemeriksaan bagian kaki

    • Apabila skrining pulse oksimeter negatif atau lolos, tidak perlu pemeriksaan
    Rencana Tindak lanjutan atau rujukan. Bidan/Perawat perlu menginformasikan terkait
    Lanjut perlunya pemeriksaan/ monitoring kondisi bayi saat usia 1-2 bulan atau lebih
    untuk mengantisipasi terjadinya gejala PJB yang tidak kritis.
    UKK KARDIOLOGI IDAI 11
    Contoh PJB Non-Kritis
    Left-to-right shunt

    (VSD, ASD, PDA)


    Efek Curah Jantung Menurun
    Gejala Muncul di usia sekitar 2 bulan
    Tanda (Saat tahanan vaskuler paru
    menurun)
    PJB
    • Batuk > 2 minggu
    • Menetek terputus putus
    (sesak napas saat aktivitas)
    TIDAK BIRU • Berat badan sulit naik
    (75%)
    • Bayi nyaman tidur dengan
    bantal tinggi atau digendong
    (tidur nyaman denganbantal
    tinggi - ortopneu)
    • Bengkak di mata, perut,
    tungkai

    BIRU • Kebiruan di jari tangan, kaki,


    (25%) bibir dan lidah www.aboutkidshealth.ca/heartfailure
    Murni, 2022
    Murni, 2023
    Terimakasih
    UKK KARDIOLOGI

    14
    Sehatkan Jantung
    @kardiologi_idai
    Anak Indonesia

    UKK KARDIOLOGI IDAI

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