Prognosis Anak dengan Riwayat Prematur terhadap Pneumonia Berulang dan Gangguan Bahasa Ekspresif

MARTINUS NUHERWAN D, dr. Amalia Setyati, SpA(K); dr. Alifah Anggraini, M.Sc. Sp.A (K)

2022 | Tesis-Spesialis | ILMU KESEHATAN ANAK

Latar belakang: Prematuritas adalah penyebab terbesar kematian neonatus di dunia. Indonesia merupakan salah satu dari 11 negara di dunia yang memiliki angka kelahiran prematur terbanyak, yaitu >15% dari seluruh kelahiran hidup. Bayi prematur memiliki risiko untuk mengalami berbagai morbiditas dan mortalitas pasca lahir. Infeksi berulang, anemia, gangguan emosi dan gangguan perkembangan merupakan sebagian komplikasi yang sering terjadi pada bayi prematur. Kasus: Anak perempuan dengan riwayat lahir prematur dari ibu usia 29 tahun G3P2A1 dengan usia kehamilan 31 minggu (Dubowitz 32+4 minggu) dan riwayat perawatan di NICU dengan diagnosis neonatal pneumonia pasca lahir. Anak sempat menggunakan bantuan ventilasi menggunakan CPAP dan menjalani perawatan selama 19 hari. Anak kembali mengalami pneumonia pada saat usia 6 bulan. Anak dirawat di ruang PICU atas indikasi pneumonia berat. Anak dirawat selama 10 hari kemudian dijinkan rawat jalan. Pemantuan kasus ini dimulai saat anak berusia 14 bulan. Pada saat pemantuan dimulai anak dengan kondisi gizi stunted, gangguan bahasa dan gangguan motorik kasar. Intervensi pada anak dilakukan selama 1 tahun. Intervensi yang dilakukan termasuk pencegahan pneumonia berulang dengan melengkapi imunisasi pneumococcus, perbaikan status nutrisi dan konsultasi rutin terkait masalah tumbuh kembang. Selama pemantauan, imunisasi berhasil dilengkapi dengan 1 kali pemberian pada saat usia > 2 tahun. Intervensi oleh divisi tumbuh kembang menunjukan hasil ketiadaan gangguan motorik kasar, namun gangguan bahasa masih menetap. Perkembangan arah gizi anak juga membaik pasca intervensi dengan hasil akhir anak berstatus gizi baik.

Background: Prematurity is the biggest cause of neonatal death in the world. Indonesia is one of 11 countries worldwide with the highest preterm birth rate, which is >15% of all live births. Premature babies are at risk of experiencing various postnatal morbidity and mortality. Recurrent infections, anemia, emotional disturbances, and developmental disorders are some of the complications that often occur in premature babies. Case: A girl with a history of premature birth to a mother aged 29 years G3P2A1 with a gestational age of 31 weeks (Dubowitz 32+4 weeks) and a history of treatment in the NICU with a diagnosis of neonatal pneumonia after birth. The child had time to use assisted ventilation using CPAP and underwent treatment for 19 days. The child had pneumonia again at the age of 6 months. The child was admitted to the PICU room for indications of severe pneumonia. The child was treated for 10 days and then allowed outpatient care. Monitoring of this case began when the child was 14 months old. At the time the monitoring was started the child was in a stunted nutritional condition, language disorder, and gross motor disorder. Intervention in children carried out for 1 year. Interventions included preventing recurrent pneumonia by completing pneumococcal immunization, improving nutritional status, and routine consultations related to growth and development problems. During monitoring, immunization was completed with 1 administration at the age of > 2 years. Intervention by the growth and development division showed results in the absence of gross motor disorders, but language disorders persisted. The development of the direction of children's nutrition also improved after the intervention with the final result being that the child had a good nutritional status

Kata Kunci : anak, prematur, pneumonia, gangguan bahasa