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