Kamis, 05 Mei 2011
CHAPTER I
INTRODUCTION
A. Background
Modern technology and good nursing care has significantly improved health and all mengontribusi survival of infants at risk due to gestational age or weight infants born lahir.namun long before aterm and survival experience conditions that negatively affect quality of life baby baby tersebut.klasifikasinewborns based on gestational age are as follows:
• premature.lahir preterm or before 37 weeks gestation, regardless of weight.
• Term (aterm). Born between the beginning of week 38 and end 42 weeks gestation.
• Pascaterm (Postdate). Born after 42 weeks gestation.
• Pascamatur. Born after 42 weeks' gestation, after suffering the progressive effects of placental insufficiency
Causes of preterm birth and most have not been diketahui.Namun pascaterm incidence of preterm delivery was highest in lower socioeconomic groups. This is probably due to the lack of a comprehensive prenatal health care.Other factors associated with preterm birth include preklamsia, twin pregnancies (multifetal), and the problem of the placenta.
Birth weight infants have a normal range for each gestational age in weeks. Classification of newborns based on body weight were as follows:
• Large for gestational age (BMK) (Large for gestational age [LGA]). Weight above the 90th percentile in any week.
• As the pregnancy (SMK). Weight percentile between the 10th and 90th for infant age.
• Small for gestational age (KMK). Weight below the 10th percentile (or 2 or more standard deviations below the normal value
• Babies with low birth weight (LBW). Baby weighs 2500 grams or less at birth.
• very low birth weight. Baby weighs 1500 g or less at birth.
B. Purpose And Objectives
Aside from what is disclosed above regarding the purpose of this paper the author makes to provide understanding to the public about the causes of low birth weight infants (LBW) in order to recognize early on the effects of low birth weight so they can be anticipated. Also the writing is intended to meet service obligations to the Child Nursing subject.
C. Writing Methods
Writing method used in this paper is pnulisan description method is a method used to collect data and information
CHAPTER II
DISCUSSION
A. Definition
Low birth weight babies (LBW) is a baby with birth weight less than 2500 grams regardless of gestation. Weight birth weight babies are weighed within 1 (one) hour after birth.
B. Epidemiology
The prevalence of low birth weight babies (LBW) is estimated 15% of all births in the world with limits 3.3% -38% and more common in developing countries or low socio-economic. The statistics show 90% incidence of LBW is obtained in developing countries and death rates 35 times higher than in babies with birth weight more than 2500 grams. LBW including major factor in increased mortality, morbidity and disability neonates, infants and children and provide long-term impact on his life in the future. The incidence in Indonesia is very varied from one region to another, and it ranged between 9% -30%, the results of multicenter study in 7 regions obtained LBW rates by 2.1% -17.2% range. Nationally, based on further analysis IDHS, the rate of LBW of about 7.5%. This figure is targeted toward nutrition improvement program Healthy Indonesia 2010 ie a maximum of 7%.
C. Etiology
LBW is the most common cause of premature birth. Another factor is maternal age, parity, and others. Placental factors such as vascular disease, pregnancy twin / double, and fetal factors is also a cause of LBW.
(1) maternal factors
a. Disease
Such as malaria, anemia, syphilis, TORCH infections, etc.
b. Complications in pregnancy.
Complication that occurs in pregnancy such as maternal antepartum hemorrhage, severe pre-eclampsia, eclampsia, and preterm delivery.
c. Age of mother and parity
The highest incidence of LBW was found in infants born to mothers with age <>
d. Factors maternal habits
Habits is also influential maternal factors such as maternal smoking, alcoholic mother and maternal drug users.
(2) Factors Fetus
Premature, hidramion, pregnancy twin / double (gemeli), chromosomal abnormalities.
(3) Environmental Factors
Which may affect, among others; place to live in high land, radiation, socio-economic and exposure to toxic substances.
D. Complication
Direct complications that can occur in low birth weight babies, among others:
Hypothermia
Hypoglycemia
Fluid and electrolyte disorders
Hyperbilirubinemia
Respiratory distress syndrome
Patent ductus arteriosus
Infection
Bleeding intraventrikuler
Apnea of Prematurity
Anemia
Long-term problems that may arise in infants with low birth weight (LBW) among others:
Developmental disorder
Impaired growth
Impaired vision (Retinopathy)
Hearing loss
Chronic lung disease
The increase in morbidity and frequent hospitalization
Increase the frequency of congenital abnormalities
E. Diagnosis
Diagnosis is by measuring the weight of LBW infants born within a period of <> can be known with anamesis, physical examination and investigation.
1. Anamnesis
History is necessary to ask the mother in seeking to enforce anamesis etiology and factors that influence the occurrence of LBW:
Age mother
History The first day of menstruation terakir
History of previous deliveries
Parity, previous birth spacing
Weight gain during pregnancy
Activity
Illness during pregnancy
The drugs taken during pregnancy
2. Physical examination
Which can be found on physical examination in the LBW infants include:
Weight <>
Signs of prematurity (in infants less months)
Signs a baby just months or more months (when baby is small for gestational age).
3. Investigations
Investigations that can be done include:
Ballard score examination
Shake test (shake test), encouraged for infants less month
Blood routine, blood glucose, if necessary and available facilities inspected electrolyte levels and blood gas analysis.
Photo chest or babygram necessary in newborns with gestational age less months starting at the age of 8 hours or derived / expected to happen respiratory distress syndrome.
Ultrasound head, especially in infants with gestational age <>
F. Treatment / therapy
a) Medical
Giving vitamin K1:
1 mg IM injection once a gift, or
Per oral administration of 2 mg once or 1 mg 3 times giving (at birth, age 3-10 days, and the age of 4-6 weeks)
b) Diatetik
Premature or low birth weight infants have feeding problems due to weak suck reflex. For such babies should be breastfed removed by pump or blackmailed and is given to infants with gastric tube or pipette. By holding the head and held under the chin, the baby can be trained to suck while breast milk has been issued provided with a pipette or a small hose attached to the nipple. Breast milk is the main choice:
When babies are breastfed, make sure the baby receives a sufficient amount in any way, notice how the value of breastfeeding and infant sucking ability at least once a day.
If the baby is not getting IV fluids and the weight increase of 20 g / day for 3 consecutive days, the baby weighed 2 times a week.
Provision of drinking low birth weight babies (LBW) according to birth weight and infant conditions are as follows:
a. Birth weight 1750 - 2500 grams
- Healthy Babies
Let the baby feeds on mother infant arbitrarily. Remember that little baby is easier to feel tired and lazy to drink, encourage your baby to breastfeed more frequently (eg every 2 hours) if necessary.
Monitor the provision of drinking and weight gain to assess the effectiveness of breastfeeding. If the baby is less to suck, add a squeeze milk using an alternative way of drinking.
- Baby Pain
If the baby can drink by mouth and do not require IV fluids, give drink as in healthy infants.
If infants require intravenous fluids:
• Give intravenous fluids only during the first 24 hours
• Start drinking provided orally on day 2 or soon after the baby is stable. Encourage breastfeeding when the mother and the baby showed no signs ready to suckle.
• If the problem is the pain hinder the process of nursing (eg breathing problems, seizures), give milk squeezed through a gastric tube:
o Give IV fluid and breast milk by age
o Provide a drink 8 times in 24 hours (eg 3 hours or so). If the baby has got to drink 160 ml / kg per day but still seems hungry to give extra milk every time you drink. Let the baby suckle a baby if the situation has stabilized and the baby shows a desire to breastfeed and to breastfeed without coughing or choking.
b. Birth weight 1500-1749 grams
- Healthy Babies
Give a squeeze to breast milk cup / spoon. If the amount needed can not be given using the cup / spoon or no risk of aspiration into the lungs (cough or choke), give drink to the gastric tube. Continue with the provision of using the cup / spoon if the baby can swallow without coughing or choking (setela This can take 1-2 days but sometimes takes more than 1 week)
Give drink 8 times in 24 hours (eg every 3 hours). If the baby has gained 160/kgBB drink per day but still seems hungry, give drink extra milk every time.
If the baby has been getting good use drinking cups / spoons, try to breastfeed directly.
- Baby Pain
Give intravenous fluids only during the first 24 hours
Give milk squeezed by stomach tube from day-to-2 and reduce the amount of IV fluids slowly.
Give drink 8 times in 24 hours (eg every 3 hours). If the baby has gained 160/kgBB drink per day but still seems hungry, give drink extra milk every time.
Continue provision of drinking a cup / spoon if the baby's condition was stable and the baby can swallow without coughing or choking
If the baby has been getting good use drinking cups / spoons, try to breastfeed directly.
c. Birth weight 1250-1499 grams
- Healthy Babies
Give milk squeezed through a gastric tube
Give drink 8 times in 24 hours (eg every 3 hours). If the baby has been getting drinking 160 ml / kg per day but still seems hungry, give drink extra milk every time
Continue provision of drinking a cup / spoon.
If the baby has been getting good use drinking cups / spoons, try to breastfeed directly.
- Baby Pain
Give intravenous fluids only during the first 24 hours.
Give milk squeezed through a stomach tube from day-to-2 and reduce the amount of intravenous fluids slowly.
Give drink 8 times in 24 hours (every 3 hours). If the baby has been getting drinking 160 ml / kg per day but still seems hungry, give drink extra milk every time
Continue provision of drinking a cup / spoon.
If the baby has been getting good use drinking cups / spoons, try to breastfeed directly.
d. Birth weight <> does not depend on condition)
Give intravenous fluids only during the first 48 hours
Give breast milk through a stomach tube starting on day 3 and decrease slowly giving intravenous fluids.
Give drink 12 times in 24 hours (every 2 hours). If the baby has been getting drinking 160 ml / kg per day but still seems hungry, give drink extra milk every time
Continue provision of drinking a cup / spoon.
If the baby has been getting good use drinking cups / spoons, try to breastfeed directly.
c) Supportive
The main thing to do is to maintain normal body temperature (3):
Use one of the ways to warm and maintain the baby's body temperature, such as skin to skin contact, kangaroo mother care, heat transmitter, an incubator or warm room is available at local health facilities as directed.
Do not bathe or touch the baby with a cold hand
Measure the temperature with periodic
What also must be considered for this treatment is supportive:
Maintain and monitor airway patency
Monitor the adequacy of nutrition, fluid and electrolyte
In the event of complications, should be corrected immediately (eg hypothermia, convulsions, respiratory disorders, hyperbilirubinemia)
Provide emotional support to the mother and other family members
Instruct the mother to stay with the baby. If not possible, let the mother visited every moment and go get a room for breastfeeding.
G. Monitoring (Monitoring)
Monitoring while being treated
a. Therapy
When required therapy to be given permanent complications
Iron preparations as supplements began to be given at age 2 weeks
b. Growth and development
Monitor the baby's weight periodically
The baby will lose weight during the first 7-10 days (up to 10% for infants weighing ≥ 1500 g Lair and 15% for infants with birth weight <1500>
When the baby is fully breastfed (in all categories of birth weight) and were older than 7 days:
- Increase the number of premises milk 20 ml / kg / day until the number reached 180 ml / kg / day
- Increase the amount of milk according to infant weight gain for the number of breastfeeding still 180 ml / kg / day
- If weight gain is inadequate, increase the amount of breast feeding up to 200 ml / kg / day
- Measure weight every day, body length and head circumference every week.
Monitoring after coming home
Require monitoring after returning to find out the baby's development and prevent / reduce the possibility for the occurrence of complications after returning as follows (3,4):
After the return day of the 2nd, 10th, 20th, 30th, was continued every month.
Calculate the age correction
Growth, body weight, body length and head circumference.
Test development, the Denver Development Screening Test (DDST)
Watch the congenital abnormalities
H. Prevention
In cases of low birth weight babies (LBW) prevention / preventive is an important step. The things you can do:
1. Improving antenatal care on a regular basis at least 4 times during pregnancy and starting from a young gestational age. Pregnant women who are allegedly at risk, particularly risk factors that lead to low birth weight babies should be quickly reported, monitored and referred to health care institutions are better able to
2. Health counseling about fetal growth and development in the womb, danger signs during pregnancy and self-care during pregnancy so that they can maintain their health and well-conceived fetus
3. Should the mother can plan delivery in a healthy range of reproductive age (20-34 years)
4. Need to support other relevant sectors to contribute to improving maternal education and family economic status so that they can increase access to antenatal care utilization and maternal nutritional status during pregnancy.
CHAPTER III
CLOSING
A. Conclusion
LBW is a new-born babies weighing less than 2500 grams, an interruption of growth and maturation (maturity), an organ that can cause death.
Etiology
a. In connection with the newborn is less month
- Toxemia gravidarum.
- Acute systemic disease in the mother (pneumonia, pyelonephritis, typus, appendiksi-
acute tis).
- Twin Pregnancy
- No known cause (50%)
b. In connection with the infant KMK (Small Gestation), mothers with:
- Diabetes Mellitus
- Hypertension
- Pre-eclampsia
- Infection
- Malnutrition
- Drugs
B. Suggestion
Such tasks should be often held for further broaden students.
REFERENCES
1. United Nations Children's Fund / World Health Organization. Low Birthweight. UNICEF, New York, 2004.Avaliable from: http://www.childinfo.org/areas/birthweight.htm.
2. Setyowati T. Factors Affecting the Baby Born with Low Body Weight (IDHS data analysis 1994). Health Research Agency, 1996. Avaliable from: http://www.digilib.litbang.depkes.go.id.
3. Indonesian Pediatric Association (IDAI). Low Birth Weight Infants. In: Standards of Medical Services Child Health.Edition I.
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