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8/11/2019 Lung Maturation in Preterm Infants
1/23
LUNGMATURATIONINPRETERMINFANTS
Pembimbing :
dr. Gioseffi, Sp.OG
Disusun oleh :
Karlina Liwang / 406121003Krisma Kristiana / 406121004
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PRELIMINARY
To this day, neonatal mortality and morbidity in
preterm infants is still high.
This is related to the maturity of the babysorgans
such as the lungs, brain, and gastrointestinal.
Good obstetric approach to preterm labor will give
hope to the survival and quality of life of premature
infants.
Respiratory distress syndrom is the leading cause
of death for babies born prematurely.
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LUNGMATURATIONINPRETERMINFANTS
Premature babies are babies born at gestational
age less than 37 weeks.
Antenatal corticosteroid therapy in women who are
at high risk for preterm delivery has been
recommended.
Corticosteroid therapy in pregnant women who will
deliver prematurely used to enhance fetal lung
maturation.
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DEFINITIONSANDCRITERIAOFRESPIRATORY
DISTRESSSYNDROM
Dypsnea
Tachypnea
Persistent cyanosis
On chest radiograph: patchy alveolar infiltrates,atelectasis, vaskular congestion, hemorrhage,
pulmonary edema
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IMPORTANTFACTORINTHESURFACTANT
DEFICIENCY
Premature
Perinatal asfiksia
Maternal diabetic
Seksio sesaria
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Respiratory Distress Syndrom (RDS) or Hyaline
Membran Disease (HMD) obtained in 10% ofpremature infants, due to a deficiency of surfactant
in infants born with a gestational age of less.
Surfactant is usually found in the mature
pulmonary. Surfactant function : keep the alveoli pockets keep
growing and air filled. So in preterm infants, where
surfactant undeveloped cause growing power of
lung reduced and the infants experiencing
shortness of breath. The symptom appeared soon
after the baby is born and getting worse.
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Clinical symptoms were seen:
Takipnea in newborns (>60x/minutes)
Nostril breathing
Grunting
Intercostal retraction
Sianosis
The symptom settled within 48-96 hours after birth.
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On chest radiograph, criteria Bomsel there are 4
stage, namely :
Stage 1 : there are very few spots retikulogranular and
few airbronchogram.
Stage 2 : spots retikulogranular homogeneous on bothlungs and air bronchogram seen more clearly and
extends to the peripheral cover the heart shadow with
decreased lung aeration.
Stage 3 : collection of collapsed alveoli so both lungs
field appear more opaque and the heart shadow almost
invisible, airbronchogram wider.
Stage 4 : all of thorax very opaque (white lung) so the
heart cantbe seen.
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PATHOPHYSIOLOGYRESPIRATORYDISTRESS
SYNDROMONPREMATUREINFANTS
Thoraks wall still weak
Production of surfactantisnt perfect
Collaps alveolus
The lungs become stiff
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CORTICOSTEROIDSINLUNGMATURATION
Physiological effect glucocorticoid on lung
maturation is increase lung surfactant.
And also increased lung compliance and maximal
volume of lungs.
Glucocorticoid its also increase activity of
antioxidant enzym and induce proteins involved in
the clearance of air lung. This is used to help
breathing.
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THEUSEDOFCORTICOSTEROIDSON
ANTENATAL
Corticosteroid antenatal on pregnant women at risk
of preterm birth is one therphy the most efective
and important.
Corticosteroids can repaired function of infants lung
and protected infants of premature death.
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INDICATIONOFANTENATALCORTICOSTEROIDAT24
34 WEEKSOFGESTATION
Preterm labor
Haemorragic antepartum
Premature ruptur of the membran (PROM)
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Doses used for :
Deksametason 6mg intramuskular : 4 times at intervals
of 12 hours.
Betametason 12 mg intramuskular : 2 times at intervals
of 24 hours.
Higher dose or more frequency, its not enhance
benefits of corticosteroid theraphy and actually
increase the loss of effect.
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TIMINGOFCORTICOSTEROID
Based on between the time interval and birth, the
baby will born 48 hours up to 7 days after theraphy
of glucocorticoid, provide the greatest benefit.
Levels of surfactant can decreases again in time 8
up to 10 days.
Repeated theraphy if baby birth has not occurred
on 7 days since the first theraphy and the risk of
premature birth still have.
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Antenatal corticosteroid its not recommended
before gestational age 24 weeks and after 34
weeks.
All fetuses at risk preterm delivery can be
considered antenatal corticosteroid theraphy on
gestational age 2434 weeks.
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CORTICOSTEROIDINMULTIPLEPERGNANCY
Multiple pregnancy can increased the risk for
premature labor.
Twin pregnancy have the risk >40% for premature
labor.
Antenatal corticosteroid in multiple pregnancy its
recommended, but significant reduction RDS not
been demonstrated.
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ADVANTAGEANTENATALCORTICOSTEROIDS
Theraphy antenatal corticosteroid in preterm infants
shown to reduce neonatal mortality and incident
RDS.
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DISADVANTAGEOFGIVINGANTENATAL
CORTICOSTEROID
Risks to the fetus and neonatus after giving
antenatal glucocorticoid is rare to happens and
reversible.
The most common complications of corticosteroids
antenatal is infection and supretion adrenal.
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REPEATANTENATALCORTICOSTEROID
Not known advantages and effects of theraphy
repeat antenatal corticosteroid. But, many docters
used theraphy repeat antenatal corticosteroid every
weeks until 34 weeks gestational weeks.
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CONCLUSION
Premature babies are born on gestational age < 37
weeks have a high risk for prematurity diseases.
Antenatal corticosteroid used to helped matury of
infants lungs.
Antenatal cortocosteroids on pregnant women is
recommended for who have the risk have
premature delivery up to 7 days ahead.
Drugs used are betametason and deksametason,
often called glococorticoid, given antenatal for push
ahead maturity of infants lung.
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Antenatal corticosteroid can increased outcome on
babies who have born on gestational age 24 -34
weeks.
And also more usefull if childbirth happens at least
on 24 hours after first dosing and before 7 days
after the last dosing drug.
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Recommended