Bayi dengan kelainan bawaan sistim syaraf dan muskuloskeletal

WHAT FRACTURES ARE SEEN IN THE NEWBORN INFANT ?The claviclemost common.Fracture of the humerus, femur and skull are fortunately uncommon.When the bone is palpated bony crepitus.Confirm by X-Ray.

Perkembangan otak

Lahir: 400 gram50% dewasa32-36 cmPeriode perkembangan paling pentingDalam kandungan2 tahun pertama2-5 tahun5 tahun -.1212 th60%80%100%VolumeotakPerkembangan otakTabung saraf 3-4 mgOtak besar 2-3 blnSel saraf 3-4 blnCari tempat 3-5 bln0369Pasca natalMielinasi?SinaptogenesisNutrisiStimulasi6Zat besi dan pembentukan mielin

MyelinLemakSphingomyelin dll.Zat besiSinaps (sambungan antar sel saraf)

SinapsSinaps: membran sel memerlukan DHA + AADHA + AA

Hidrofilik10Pertumbuhan ujung saraf untuk sinaps sangat cepat pada awal kehidupan

Periode rawan tumbuh kembang otakPrenatalSaraf otak (10-18 minggu)

Trimester 3 pascanatalPertumbuhan sinaps, sel penunjang (glia) Disusul hilangnya sinaps secara selektif, makin tidak digunakan makin cepat hilang

PascanatalMielinisasi12Waktu dan kecepatan pembentukan dan hilangnya sinaps012515392-3TahunBulanPenglihatanPendengaranBicaraKepandaianGangguan pembentukan dan perkembangan SSPMaternalGenetikMalnutrisi, asam folatToksin/teratogen: alkohol, rokok, obatPenyakit ibu: jantung, paruInfeksi intrauterin: Toxo, rubella, CMV, HSV1, HSV2, HIV, HepatitisSosial-ekonomiGangguan plasentaJanin/bayiGangguan proses kelahiran: asfiksia neonatalGangguan pasca natal: hiperbilirubinemia, infeksi SSP, dllGenetik

Malformasi kongenital

Malnutrisi/ mikronutrien

Defisiensi asam folatInfeksi kongenitalToxoplasma

Infeksi kongenitalRubella

Malformasi/ infeksiHidrosefalus

Hidrosefalus

Ukuran/ bentuk kepala

Mikrosefali

Brachicephaly

ScapocephaliLingkar kepalaUkur setiap ke dokterTerutama 2 tahun pertama

Ukur lingkar kepala !Spina bifidaTulang punggung tidak menutupDapat dicegah dengan asam folat

Pemeriksaan NeurologisPemeriksaan neurologis pada bayi tidak gampang !Dasar utama: Mengetahui bagaimana proses perkembangan anak normalVariasi individual harus dipertimbangkan Perhatikan faktor yg mempengaruhi, yaitu:Waktu yang baik adalah 2-3 jam setelah bayi minumBayi dan anak dalam keadaan mengantuk atau letih akan memberikan reaksi berlainan Suhu ruangan yang baik berkisar antara 27o-29oCNext SlideKelainan Lingkar KepalaLingkar Kepala Mengecil (+2 SD)Bayi besarFamilial featureHidrosefalusMegaensefaliHidranensefaliTumor serebralEfusi subduralNext SlidePosisi Abnormal Bayi Baru LahirFrog PostureHemiplegiOpisthotonusHipotoniNext SlidePosisi bayi

Primitives and Postural ReflexesPresent of Exam0 mo 3 mo 6 mo 9 mo 12 mo Primitive ReflexesPostural ReflexesNext SlideREFLEKS PADA BAYI & ANAKBeberapa pemeriksaan refleks yang penting pada bayi dan anak, sbb:Next SlideJenis RefleksUsia Mulai Usia MenghilangRefleks MORORefleks Memegang (GRASP)PALMARPLANTARRefleks SNOUTRefleks TONIC NECKRefleks Berjalan (STEPPING)Reaksi Penempatan Taktil(PLACING RESPONSE)Refleks Terjun (PARACHUTE)Refleks LANDAUSejak lahir

Sejak lahirSejak lahirSejak lahirSejak lahirSejak lahir5 bulan

8 9 bulan3 bulan6 bulan

6 bulan9 10 bulan3 bulan5 6 bulan12 bulan-

Seterusnya ada21 bulanReflex

Plantar grasp ReflexGrasp ReflexRooting Reflex36Moro Reflex

37Paralysis

Seventh nerve palsy ; unilateral facial paralysisErb palsy38FACIAL PALSYMuscle weakness of one side of the face due to trauma to the facial nerve.

The affected side of the face droops.

Unable to close the eye tightly on the sideFacial/When crying the mouth is pulled across to the normal side.

Usually recovers spontaneously in a few days or weeks.

BRACHIAL PALSY / ERBS PALSYUsually happen in large and born at term with difficulty in delivering the shoulders.Infant does not move one arm due to weakness at the shoulders and below.

Brachial/The arm is fully extended, rotated inwards and held beside the body (the porters tip position).Asymmetrical moro reflex.No tenderness, pain or swelling of the arm unless fracture.TREATMENT OF BRACHIAL PALSYFlex the elbow and shoulders a few times a day to prevent contractures developing.If the arm is not better by 6 weeks no hope of spontaneous recovery; reffered for further investigation.

HOW ARE FRACTURES TREATED ?Fracture of the clavicle needs no treament and heals well.Fracture of the humerus immobilized.Fractureof the femur gallows traction.Paracetamol can be given.Depressed fracture of the skull surgical. WHAT IS THE MANAGEMENT OF LACERATIONS ?Usually made during a caesaren section.Small cuts closed with strapping.Large cuts must be sutured, asap.CLUBBED FEET AN MANAGEMENTMostly are slightly twisted inward due to position of the fetus just gentle pressure.Some are twisted inward and cannot be turned into a normal position clubbed feet!The cause maybe familial or oligohydramnios.Clubbed feet/Reffered to an orthopaedi clinic within a few days of life.Maybe need strapping or serial plaster of Paris Casts. May also need a minor operation

Inguinal/Hernia does not transilluminate.Danger if incarcerated surgical emergency.Elective surgency if baby 2500 g.Torsion of a testes can also present as a red, tender ans swollen scrotum.

FLUID HERNIA / HYDROCOELESThe scrotum transilluminates very well. (Fluid only not bowel)Most disappear after a few months and need no treatment.If they are very big, maybe require surgical correction at about 3 months old.