ASKEP PADA BAYI DENGAN IBU DM

Ns. Herlina, S.Kep

DEFINISI

• bayi yang dilahirkan dari ibu penderita diabetes.

INSIDEN• Satu dari 500-1000 wanita hamil adalah

penderita diabetes, • satu dari 120 kehamilan adalah gestasional

diabetes.

PATOLOGI

• glukosa dapat berdifusi melalui plasenta,• insulin ibu tidak dapat ditransfer ke janin

• Level Glukosa darah janin meningkat

• pangkreas janin terstimulasi untuk memproduksi insulin sendiri dengan >>>

• Insulin >>> (salah satu hormon pertumbuhan/GH)

• Mempercepat transpor asam amino ke dalam sel

• Pembentukan protein >>>

• Makrosomia: LGA

Lahir : Fraktur, trauma lahir --- pemecahan Hb >>> --- Hiperbilirubin --- kern Ikterus

MK Resiko Cedera

• Insulin mempengaruhi perbandingan Lesitin dan Spingomielin ( 2: 1 menunjukkan maturitas paru)

• Surfaktan di Paru-Paru <<<

LAHIR : Complience Paru <<< RDSMK Gangguan Pola nafas

• Peningkatan Insulin di ikuti oleh peningkatan kalsium janin

• Direspon oleh Paratioid

• Hipotiroid

Congenital Malformations:The Laundry List

Congenital Malformations

Skeletal/CNS• Caudal regression syndrome

not considered pathognomonic occurs 600x more frequently among IDDM

• Neural tube defects • Microcephaly

Caudal Regression Syndrome• Spectrum of malformation

– cessation of growth of rostral portion of spinal cord

– abnormal neural, muscular, skeletal and vascular components

Caudal Regression with limbsintact but malformed

SirenomeliaSirenomeliaAbsence of hind limbs, external genitalia, anus and rectum; Potter sequence secondary renal agenesis

Congenital MalformationsCardiac• Transposition + VSD• Ventricular septal defect • Coarctation + VSD or PDA• Atrial septal defect• Hypertrophic Cardiomyopathy

Congenital Malformations

Renal • Hydronephrosis• Renal agenesis• Ureteral

duplication

Congenital Malformations

GI• Duodenal atresia• Anorectal atresia• Small left colon

syndrome

Perinatal and Neonatal Complications

• Disorders of fetal growth• Intrauterine and perinatal asphyxia• Hypoglycemia• Respiratory distress syndrome

• Hypertrophic Cardiomyopathy• Polycythemia• Hyperbilirubinemia• Hypocalcemia

Perinatal and Neonatal Complications

Disorders of Fetal Growth

Macrosomia• Birth Weight > 4000 g or > 90th %-ile• Incidence 15 to 45% among IODM• Increased rate of C-section• Birth Trauma

shoulder and body dystocia brachial plexus injury facial nerve injury asphyxia abdominal trauma

Intrauterine Growth Restriction

• Incidence reported as high as 20 %• Contributing factors:– Maternal vascular disease– Hypertension – Intrauterine infection– Chromosomal abnormalities

Intrauterine Growth Restriction• Oligohydramnios• Hypoxia• Fetal distress• Asphyxia• Intrauterine and neonatal death

Birth Asphyxia• Incidence – 20 TO 30%

• Primary Risk factors:– Prematurity– Fetal growth disorders – Maternal vascular disease– Peripartum maternal hyperglycemia

• Drives catabolism of the oversupply of nutrients – depletes fetal O2 stores episodic fetal hypoxia

Hypoglycemia• Risk Factors– Prematurity– Birth asphyxia– Cesarean section– Disorders of fetal growth– Stimulation of the fetal pancreas

• Pedersen Hypothesis

Signs of Hypoglycemia

• Tremors • Jitteriness • Irritability• Lethargy• Apnea

• Cyanosis• Hypothermia• Weak or high

pitched cry• Poor feeding • Seizures

HypoglycemiaDiagnosis• Test within 30-60 minutes of admission• Glucose < 40 confirm with serum glucose• Do not delay treatment pending results

Hypoglycemia• Management– Oral Feeding– IV bolus D10 (2cc/kg) over 2 to 5 min.– Continuous infusion D10 @ 6 to 8 mg/kg/min– Careful attention to total fluid administration

• Increase glucose concentration– Resolution of hyperinsulinemia

• 24 to 48 hrs.

Respiratory Distress Syndrome

• Risk: – 3 to 5 times the risk in the non-diabetic population

• Contributing Factors:– Prematurity – Maternal glycemic control

Hypertrophic Cardiomyopathy

• IDDM and GDM with poor glycemic control• Incidence 20 to 30 %• Manifestation of generalized organomegally• catecholamines – hypertension, cardiac remodeling and hypertrophy

Hypertrophic Cardiomyopathy

• LV and RV hypertrophy• Asymmetric ventricular septal

hypertrophy • Valves and great vessels normal

Which baby is the infant of the diabetic mother?

A B

PERUBAHAN SETELAH LAHIR

• Terputusnya sirkulasi maternal fetal• Glukosa darah janin menurun, tetapi insulin

tetap tinggi

• Hipoglikemia• Cedera Neuron• KematianMK : Koping Keluarga kurang Efektif

PENATALAKSANAAN MEDIS

• Pada saat datang atau umur 3 jam, kemudian tiap 6 jam sampai 24 jam atau bila kadar glukosa 45 gr% dua kali berturut-turut.

• Pemantauan elektrolit• Pemberian glukosa parenteral sesuai indikasi• Bolus glukosa parenteral sesuai indikasi• Hidrokortison 5 mg/kg/hari IM dalam dua dosis

bila pemberian glukosa parenteral tidak efektif

Intervensi Keperawatan1. Periksa kadar gula darah bayi segera setelah

lahir. Selanjutnya, control setiap jam sampai kadar gula darah normal dan stabil. Level glukosa dipertahankan 45-50 mg/dl

2. Jika kondisi bayi baik, berikan minuman setelah 2-3 jam kelahiran. Jika bayi sulit mengisap, beri makanan melalui intravena.

3. Mengatasi hipoglikemia dengan cara memberi infuse glukosa 10% , injeksi bolus glukosa kadar tinggi harus dihindarkan karena dapat menyebabkan hiper insulinemia.

Evaluasi keperawatan1. Bayi tidak mengalami RDS dan perubahan

metabolism berarti 2. Orangtua memahami penyebab masalah

kesehatan pada bayi dan langkah pencegahan yang cepat dimulai untuk menurunkan dampak diabetes dari ibu pada bayi.

3. Orang tua menyatakan perhatiannya terhadap masalah bayi dan memahami alasan yang melatar belakangi manajemen (penatalaksanaan) yang dilakukan terhadap bayi mereka.

DAFTAR PUSTAKA

• Ackley Bety J, Ladwig Gail B.(2011). Nursing diagnosis handbook: An evidence-based guide to planning care. Ed 9th.USA: Mosby Elsevier

• Hockenberry Marilyn, Wilson David. (2009). Wong’s essentials of pediatric nursing. Ed 8th. USA: Mosby Elsevier

• Nelson Waldo E. (2000). Ilmu kesehatan anak. Ed 15. Vol 2. Jakarta: EGC

• Potts Nicki L, Mandleco Barbara L.(2007).Pediatric nursing: caring for children and their families. Ed 2nd. Clifton Park NY: Thomson Delmar learning

• Wong Donna L, Hockenberry Marilyn.(2009).Wong buku ajar keperawatan pediatrik. Vol 2. Jakarta: EGC