Selasa, 15 November 2011

NEONATUS

Neonate is the first life outside the womb until the age of 28 days, where there is a very big change from life in the womb would be beyond the uterus. During this maturation occurs in nearly all organ systems. Neonates are not miniature adults, nor even a miniature child. Neonates experienced the change from life in the womb is completely dependent on the mother is a life outside the womb is completely independent. The period of greatest change occurred during the first 24-72 hours. This transition involves virtually every organ system but most importantly for the anesthesia is respiratory circulatory system, kidneys and liver. Therefore it is necessary arrangement and preparation to commit an act against neonatal anesthesia.

The occurrence of Factors Contributing to Low Birth Weight Babies

    
* Mother Factor
          
o Nutrition during pregnancy is less
Lack of nutrition during pregnancy will adversely impact the fetus. Determination of good nutritional status is by measuring maternal weight before pregnancy and increase weight gain during pregnancy. Malnutrition in pregnant women can affect fetal growth process and can cause miscarriage, abortion, stillbirth, neonatal death, birth defects, anemia in infants, asphyxia. Intra-partum (die in the womb) of low birth weight (LBW). Weight gain during pregnancy an average of 0.3 to 0.5 kg / week. When associated with pregnancy, weight gain during early pregnancy 5 kg, then each trimester (II and III) each increase of 5 kg. At the end of pregnancy, weight gain was 9-12 kg total. If there is excessive weight gain, to consider the risk of swelling, multiple pregnancy, hidroamnion, or a big kid. [Citation needed] Another indicator to determine the nutritional status of pregnant women is to measure the LLA. LLA is Upper Arm Circumference. LLA is less than 23.5 cm is a strong indicator for nutritional status are less / worse. Mothers at risk to give birth to children with Low Birth Weight (LBW). Thus, if it is found early in pregnancy, the officer may motivate him to pay more attention to maternal health (Hidayati, 2009). [Citation needed]

    
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o Age
Low birth weight is also correlated with maternal age. The highest percentage of babies with low birth weight found in groups of adolescents and women aged over 40 years. Mothers who are too young are often emotionally and physically immature, in addition to the generally low education, young mothers who are still dependent on others. LBW births was higher in young mothers aged less than 20 years. Teenagers often gave birth to babies with lower weight. This happens because they are not yet mature, and they do not have placental transfer system as efficiently as adult women. In women who are parents even though they have experienced, but his condition and his health had started to decline so that it can affect intra-uterine fetus and can cause low birth weight births. Maternal age factor is not the main factor of LBW births, but the birth of low birth weight appears to be increasing in women aged beyond the age of 20 to 35 years. [Citation needed]

    
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o Distance pregnancy and maternity are too close
Distance of less than 2 years of pregnancy can cause poor fetal growth, prolonged labor and bleeding in the uterus during labor because of circumstances not recovered properly. Mothers who gave birth to a child with a very close distance (under two years) will experience an increased risk of bleeding in third trimester, including for reasons of placenta previa, anemia and premature rupture of membranes and can give birth to low birth weight babies. [Citation needed]

    
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o Parity mother
Children over 4 can lead to impaired fetal growth that gave birth to babies with low birth weight and bleeding during delivery because the uterus is usually already weak state.

    
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o maternal chronic disease
                
Asthma + bronkiale:
Effect of asthma on the mother and the fetus depends on the frequent and heavy attacks, because the mother and fetus to be deprived of oxygen (O2) or hypoxia. State of hypoxia if not addressed will certainly affect the fetus, and frequent miscarriage, premature labor or fetal weight do not correspond with gestational age (fetal growth disorders).

    
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o
                
+ Urinary tract infection with bacteriuria without symptoms (asymptomatic):
Frequency of asymptomatic bacteriuria approximately 20-10%, and is influenced by parity, race, socioeconomic pregnant women. Some researchers have an association with an increased incidence of bacteriuria incidence of anemia in pregnancy, premature delivery, impaired fetal growth, and preeclampsia.

    
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o
                
+ Hypertension:
Hypertensive disease in pregnancy is a vascular disorder that occurs before pregnancy or arising in pregnancy or at the beginning of labor, hypertension in pregnancy is an important cause of stillbirth and neonatal death. Mothers with hypertension will lead to the occurrence of placental insufficiency, fetal hypoxia so stunted growth and premature births often occur. Hypertension in pregnant women are the early symptoms of pre-eclampsia, eclampsia and causes of impaired fetal growth resulting in low birth weight.

    
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o Lifestyle
Consumption of drugs during pregnancy: Increasing use of drugs (between 11% and 27% of pregnant women, depending on geographic location) has resulted in increasingly high incidence of premature birth, low birth weight, congenital defects, learning disabilities, and drug withdrawal symptoms in the fetus (Bobak, 2004). Alcohol consumption during pregnancy: Use of alcohol during pregnancy is associated with miscarriage (spontaneous abortion), mental retardation, low birth weight and fetal alcohol syndrome.

    
* Factor of pregnancy
          
o Complications of Pregnancy
                
+ Pre-eclampsia / Eclampsia:
Pre-eclampsia / Eclampsia can cause growth retardation or IUGR fetus in the womb and stillbirth. This is because the mother will cause Pre-eklampsia/Eklampsia perkapuran in the placenta, while baby food and oxygen from the placenta, the presence in the region perkapuran placenta, which supplies food and oxygen into the fetus is reduced.

    
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o
                
Premature rupture of membranes +
Premature rupture of membranes when expressed prior to the delivery takes place. Premature rupture of membranes (PROM) is caused by due to the reduced strength of the membrane caused by an infection that can originate from the vagina and cervix. In normal labor or rupture of the membranes are usually resolved after a complete opening, if premature rupture of membranes, is an important issue in obstetric complications associated with preterm birth and maternal infection.

    
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o hydramnios
Hydramnios or sometimes also called polyhydramnios is a state in which the amount of amniotic fluid exceeding 2000 cc. Hydramnios symptoms occur solely because of mechanical factors as a result of a large uterus presses on the organs around him. Hydramnios should be considered a high risk pregnancy because it can harm the mother and child. Prognosis of children less well because of congenital abnormalities, prematurity, prolapse funikuli and others.

    
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o Pregnant double / Gemeli
Fetal weight in twin pregnancies is lighter than a single fetus in pregnancy at the same gestational age. Until 30 weeks of pregnancy weight gain twins with a single fetus pregnancies. After that, weight gain is smaller, probably due to excessive strain causing reducing placental blood circulation. Weight of the fetus in twin pregnancies on average 1000 grams lighter than the single-fetus pregnancy. Weight newborns in twin pregnancies is generally less than 2500 grams. An important factor in this trend is the occurrence of parturition prematurus.

    
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o antepartum haemorrhage
Antepartum hemorrhage is bleeding in pregnancy above 22 weeks until delivery mejelang ie before the baby is born (Saifuddin, 2002). The main complications of antepartum bleeding is bleeding that causes anemia and shock that caused the bad state of the mother. This situation is caused disruption to the placenta resulting in fetal anemia occurs even shock that resulted in intrauterine fetal intrauterine death (Wiknjosastro, 1999: 365). If the fetus can be saved, can occur low birth weight, respiratory failure syndrome and complications asphyxia.

    
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o Factors fetus
                
+ Congenital Defects (congenital abnormalities)
Congenital abnormalities are structural abnormalities in the baby's growth arising from the life of egg products of conception. Babies who are born with congenital abnormalities, generally will be born as Low Birth Weight Infants (LBW) or small baby to her pregnancy. Low Birth Weight Infants with severe congenital abnormalities which have approximately 20% die within the first week of life [2].

    
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o
                
+ Infection In Uterus
Infectious hepatitis in pregnancy comes from impaired liver function in regulating and maintaining the body's metabolism, so that the flow of nutrients to the fetus may be interrupted or reduced. Therefore, the influence of hepatitis infection causes abortion or birth prematurity and fetal death in utero. Pregnant women with rubella infection would adversely impact the fetus. These infections can cause low birth weight babies, birth defects and fetal death.

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