Presented by :DESTRIYANTI RUKMANA SARI

20070310097

Adviser : dr. Anik dwiani, SpAExaminer : dr. Bambang Edi m.kes, SpA

Name : By. FNLBorn : 20 Mei 2012Age : 3 daysGender : BoyProblem :referred from Nur

Hidayah hospital with ikteric. Baby born at 20 MEI 2012 from G1P0A0 UK 35mg. Fever (-), cough (-), flu (-), diarhea (-) . KPD (+), AK keruh

BBL 2400gr, BBS 2150gr, PB 45cm, LK 32cm,LD 31cm, LLA 10cm, S:37,6 HR:128x, RR:38x

Head

Reguler +, Bising -

secret (-)

neck

Retraction (-)chest

Conjungtiva Anemi -/-, Sklera Ikterik -/-

COR

nose

Limfonodi unpalpable

Sianosis (-), Candidiasis (-)mouth

Pulmo Vesiculer (-)

Peristaltik (+), Simetris (+)ABDOMEN

unpalpableHEPAR

EKSTREMITAS Warm (+), Udem (-)

unpalpableLIEN

BBLR/KB/SMKIkterik neonatus ec infection, prematur

1. Production2. Transportation3. Conjugation4. Excretion

Prematurity albumin decrease indirect bilirubin increase ikterik neonatorum

Examination Result Normal value

Routin blood test

Hb 17,8 gr% 13-17

AL (leukositopenia)

8,7 ribu/ul 9-12

AE 6.07 juta/ul 4,5-5,5

AT 213 ribu/ul 150-450

HMT 56,9 ribu/ul 42-52

Leucocyte count

Eosinofil 8 % 2-4

Basofil 1% 0-1

Batang 8% 2-5

segmen 53% 51-67

Lymposit 21% 20-35

Monosit 9 % 4-8

CRP kuntitatif 7 mg/l < 6

Bilirubin total : 22,46 Bilirubin direk : 0,64 Bilirubin indirek : 21,82

1. What are cause of jaundice in neonatus?2. Jaundice degrees in neonatus based on

kramer3. Relation between ASI and jaundice

1. a. Massive productionexample: incompatibility RH, deficiency enzim Glucose 6-PD, sepsis

b. Uptake proccess and conjugated disordersexamples: immaturity hepar, disorder of hepar function, less of substrat to hepar conjugate

c. Transportation disorderexample: deficiency of albumin

d. Excretion disorderexample: obstruction in hepar (cholestatis, cholelithiasis, hepatitis), abnormality congenital (atresia bilier)

2. Kriteria kramer1 head – neck : 5mg%2 body – upper umbilical : 9 mg%3 under umbilical – knee : 11 mg%4 knee – ankle or shoulder – wrist : 12 mg%5 extremitas : 16 mg%

Examination .. Push in bones examples: nose, clavicula, knee, etc

3. Relation breastfeeding with jaundicea. Early onset (36-72hours) caused of consume breastfeedingb. Late onset (the first 4-7 days of life and can persist for 3-12 weeks) this type of jaundice is thought to be caused by a substance in the breast milk that inhibits uridine diphosphoglucuronic acid (UDPGA) glucuronyl transferase resulting in a prolonged unconjugated hyperbilirubinemia. Accumulation of unconjugated bilirubin pigment in the skin causes jaundice. Physiologic jaundice results from immaturity of newborn's liver and its inability to produce enough UDPGA glucuronyl transferase, the enzyme required to conjugate bilirubin.

- Infus D5% 5 tpm- Inj Ampicillin 2x110mg- Fototerapy 24 hours- KC=120x2,15=258cc- Diit=10x(10-15cc)