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Bayi Berat Badan Lahir rendah

A. PENGERTIAN

Bayi berat badan lahir rendah adalah bayi dengan berat badan kurang dari 2500 gram pada waktu lahir.
Dalam hal ini dibedakan menjadi :
  1. Prematuritas murni
    Yaitu bayi pada kehamilan <>
  2. Retardasi pertumbuhan janin intra uterin (IUGR)
    Yaitu bayi yang lahir dengan berat badan rendah dan tidak sesuai dengan usia kehamilan.


B. ETIOLOGI

Penyebab kelahiran prematur tidak diketahui, tapi ada beberapa faktor yang berhubungan, yaitu :
  1. Faktor ibu
    • Gizi saat hamil yang kurang, umur kurang dari 20 tahun atau diaatas 35 tahun
    • Jarak hamil dan persalinan terlalu dekat, pekerjaan yang terlalu berat
    • Penyakit menahun ibu : hipertensi, jantung, gangguan pembuluh darah, perokok

  2. Faktor kehamilan
    • Hamil dengan hidramnion, hamil ganda, perdarahan antepartum
    • Komplikasi kehamilan : preeklamsia/eklamsia, ketuban pecah dini

  3. Faktor janin
    • Cacat bawaan, infeksi dalam rahim

  4. Faktor yang masih belum diketahui


C. PENGKAJIAN KEPERAWATAN
  1. Prematuritas murni
    • BB <>
    • Masa gestasi <>
    • Kepala lebih besar dari pada badan, kulit tipis transparan, mengkilap dan licin
    • Lanugo (bulu-bulu halus) banyak terdapat terutama pada daerah dahi, pelipis, telinga dan lengan, lemak subkutan kurang, ubun-ubun dan sutura lebar
    • Genetalia belum sempurna, pada wanita labia minora belum tertutup oleh labia mayora, pada laki-laki testis belum turun.
    • Tulang rawan telinga belum sempurna, rajah tangan belum sempurna
    • Pembuluh darah kulit banyak terlihat, peristaltik usus dapat terlihat
    • Rambut tipis, halus, teranyam, puting susu belum terbentuk dengan baik
    • Bayi kecil, posisi masih posisi fetal, pergerakan kurang dan lemah
    • Banyak tidur, tangis lemah, pernafasan belum teratur dan sering mengalami apnea, otot masih hipotonik
    • Reflek tonus leher lemah, reflek menghisap, menelan dan batuk belum sempurna

  2. Dismaturitas
    • Kulit berselubung verniks kaseosa tipis/tak ada
    • Kulit pucat bernoda mekonium, kering, keriput, tipis
    • Jaringan lemak di bawah kulit tipis, bayi tampak gesit, aktif dan kuat
    • Tali pusat berwarna kuning kehijauan


D. KOMPLIKASI
  • Sindrom aspirasi mekonium, asfiksia neonatorum, sindrom distres respirasi, penyakit membran hialin
  • Dismatur preterm terutama bila masa gestasinya kurang dari 35 minggu
  • Hiperbilirubinemia, patent ductus arteriosus, perdarahan ventrikel otak
  • Hipotermia, Hipoglikemia, Hipokalsemia, Anemi, gangguan pembekuan darah
  • Infeksi, retrolental fibroplasia, necrotizing enterocolitis (NEC)
  • Bronchopulmonary dysplasia, malformasi konginetal


E. PENATALAKSANAAN MEDIS
  • Resusitasi yang adekuat, pengaturan suhu, terapi oksigen
  • Pengawasan terhadap PDA (Patent Ductus Arteriosus)
  • Keseimbangan cairan dan elektrolit, pemberian nutrisi yang cukup
  • Pengelolaan hiperbilirubinemia, penanganan infeksi dengan antibiotik yang tepat
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