Module 3

Group 14

Baby Low Birth Weight

Scenario 2

A 3 days old baby boy, referred to Hospital’s

emergency department with note : the baby look yellow on
the face and body. From Alloanamnesis, found history of
mother was on hyperemesis (heavy) and the pregnancy
was terminated on gestational age 8 months, birth weight
was 1600 gram.
Key words

1. A 3 days old baby boy

2. The baby look yellow on the face and body
3. History of mother was on hyperemesis (heavy)
4. Pregnancy was terminated on gestational age 8 months
5. Birth weight was 1600 gram
Questions

1. Is there any correlation between mother’s history of hyperemesis and neonatal

jaundice?
2. Is there any correlation between the termination and neonatal jaundice?
3. Is there any correlation between the neonatal jaundice and BLBW?
4. Is there any correlation between hyperemesis gravidarum and the termination?
5. Is there any correlation between hyperemesis gravidarum and BLBW?
6. How to diagnose and interpretation of the scenario?
7. How is the first line management based on the scenario?
 Neonatal Jaundice
Jaundice Physiology
Physiological jaundice is jaundice arising on
the second day and the third day and has no
basis in pathology or do not have the
potential to be due to jaundice. As for the
signs as follows:
1. Embossed on second and third day
2. The indirect bilirubin levels do not exceed
10 mg% in neonates at term.
3. Speed bilirubin levels do not exceed 5%
per day.
4. bilirubin direk not exceed 1 mg%.
Queensland Maternity and Neonatal ClinicalGuideline : MN12.7-V4-R17 Neonatal Jaundice
Jaundice Pathology
Pathological jaundice is warranted pathological
jaundice or bilirubin levels reaches a value called
hyperbilirubinemia. The signs are as follows:
1. Jaundice occurs in the first 24 hours.
Tukar ke Indonesia
2. bilirubin level exceeds 10 mg% ON OR neonates
Just months exceeded 12.5% AT neonates Less
months.
3. Appointment of bilirubin more than 5 mg% per
day.
4. After 2 weeks Jaundice Residential First.
5. bilirubin direk exceed 1 mg%.
6. Having Relationship WITH hemolytic process.
 Kramer Index

Zone 1 2 3 4 5

Definition Head Upper Lower Arms Palms

and neck trunk trunk and and
and lower soles
thighs legs

TSB 100 150 200 250 >250

(micromol/L)

Queensland Maternity and Neonatal ClinicalGuideline : MN12.7-V4-R17 Neonatal Jaundice

 Termination of pregnancy
• Termination of pregnancy is terminating a pregnancy with fetal
spending efforts prematurely or before reaching the age of 36-40
weeks gestation pregnancies with specific indications

Termination of pregnancy
Indication Gestation> 28 weeks
• Abortion delayed 1. 50 mcg intravaginal misoprostol, which may
• Eggs empty (blighted ovum) be repeated 1 time 6 hours after the first
• hydatidiform mole administration
• Abortion insipiens
• Incomplete Abortion 2. installation metrolia 100 cc 12 hours before
• Membranes ruptured prematurely (KPSW) the induction for the installation of the cervix
• Pregnancy expiration (not effective when performed in the KPD)
• The growth retardation (IUGR) weight
• The death of the fetus in the womb 3. The administration of oxytocin 5 IU drops in
• Indications mother: diseases that endanger Dektrose 5% from 20 drops per minute to a
the mother if the pregnancy is passed-like maximum of 60 drops for primi and
preeklampsi / eclampsia multigravida, 40 drops of as much as 2
multigravida grande pumpkin.
Cunningham, F, Gant, N, Leveno, J, Gillstrap III L, Hauth, J, Wenstrom K. OBSTETRI WILLIAM, edisi 21. EGC, Jakarta, 2004.
Termination and neonatal jaundice
correlation Nausea and vomiting are the clinical
symptoms of hyperemesis gravidarum,
This disease can cause elevated levels of
usually occurs in pregnancy months to two
transaminases, BSP retention, fatty
to four, severe vomiting will cause
infiltration of the liver, jaundice is rare and
dehydration, acidosis starvation, alkalosis
usually mild
due to loss of hydrochloric acid and
hipokanemia

SEVERE HYPEREMESIS • Balance of fluid,

GRAVIDARUM • Electrolyte and
• Acid-base body

Nausea, vomiting, and anorexia (lack of appetite) may occur lack of fluids and nutrients, so
there is an abnormality the liver with jaundice, for their lobushepar central necrosis. Bilirubin
levels increased to 2.0 to 5.5%
NEONATAL
JAUNDICE
1. Wright R. Liver disease in pregnancy. Medicine International 1986; 2: 1210–1.\
2. MalikT.Jauadice in pregnancy. In: Hamdani SAR, ed. Symposium Liver Disease. Bahawalpur: Hamdard
Foundation Press, 1984; 12–5.
3. Pritchard JA, MacDonald PC, Gant NF. Williams Obstetrics. 7th ed. Connecticut: Appleton-Century-Crofts,
1986; 611–5.
 Classification of BLBW

• Classification according to body weight at birth is

1. Infant birth weight over
2. The normal birth weight babies
3. Low Weigt Birth Weight (LWBW)
4. Very Low Birth Weight
5. Extreme Low Birth Weight
• Classification of LBW babies can be divided into two categories
• Classification of gestation and infants according to gestational age were
divided into 3 groups
• Baby classification according to weight and gestational age were divided
into three groups
Etika, R., Harianto, A., Indarso F., Damanik,S.M. Divisi Neonatologi Bagian Ilmu Kesehatan Anak FK Unair/RSU Dr. Soetomo – Surabaya. Hiperbilirubinemia pada Neonatus. Diakses
14 maret 2012. Website URLhttp://www.pediatrik.com/pkb/20060220-js9khg-pkb.pdf
 BLBW & neonatal jaundice
correlation
BLBW

Delayed Prolonged
Increased
maturation of enterohepatic
hemolysis
hepar circulation

Neonatal Jaundice
Margot van do Bor, MD, PhD, Thea M. van Zeben-van der Aa, MD, S. Pauline Verloove-Vanhorick, MD, PhD, Ronald Brand, PhD, and Jan H. Ruys, MD, PhD. Departments of Pediatrics and Medical Statistics, UnWersity Hospital, Leiden - the Netherlands. Pediatrics :
Hyperbilirubinemia in Preterm Infants and Neurodevelopmental Outcome at 2 Years of Age: Results of a National Collaborative Survey. Diakses 29 Maret 2017. Website http://pediatrics.aappublications.org/content/pediatrics/83/6/915.full.pdf
Hyperemesis grades and Hyperemesis
gravidarum

termination correlation Excessive

vomiting

Intake
decreased
Fetal and maternal
Dangers
Oligohydrma
Def. Thiamine Hyponatremi
nion

Wernicke
Spasm,
encephalopat
seizure, coma
Birth defect Termination
hy

Neuron Premature
demage Birth

Maternal Fetal

Hypocampal Impaired Brain

ischemic development

Cranial
Heart failure
malformation
Loh, K. Y., & Sivalingam, N. (2005). Understanding hyperemesis
gravidarum. The Medical journal of Malaysia, 60(3), 394-9.
Fetal loss
MacGibbon, K. W., Fejzo, M. S., & Mullin, P. M. (2015). Mortality
secondary to hyperemesis gravidarum: a case report. of, 7, 2.
Eka
 HYPEREMESIS

NEONATAL
JAUNDICE TERMINATION

BLBW
 Interpretation based on the scenario

Neonatus terminated in 8 months

gestational age, with weight 1600
gram, based on Lubchenco LO, and
Searls DT curved. It’s indicate that
the baby is moderately preterm,
appropriate for gestational age

Behrman, Richard E, et al. 1994. Nelson Ilmu Kesehatan Anak. Ed 12. Bag 1. EGC: Jakarta
 How to diagnose?

Anamnesis
– identification Data : 3 days old baby boy, terminated in 8 months
gestational age, birth weight was 1600 gram
– Main complaint : look yellow on the face and body
– History complaint
– Antepartum history : severe hyperemesis gravidarum
– Obstetric history
– Intrapartum history
– Maternal disease history, family and social environment.

Behrman, Richard E, et al. 1994. Nelson Ilmu Kesehatan Anak. Ed 12. Bag 1. EGC: Jakarta
 Cont.

Physical examination
Inspection
– Skin Colour
– Breathing (frequency, retraction of the chest wall, chest movement)
– Note the edema / swelling as a result of birth trauma (caput succadenum,
cephal hematome)
– Abnormalities in the spine and extremities
– Pay attension on eye disorders, ear, umbilicus, anus
– Activity / movement

Behrman, Richard E, et al. 1994. Nelson Ilmu Kesehatan Anak. Ed 12. Bag 1. EGC: Jakarta
 Cont.

Auscultation
– Grunting
– Cry
– Heart sound
Palpation
– Palpate if there’s a Caput or cephalhematoma
– pulsation a.femoralis
– Capillary refill time (CRT)
– Lymph gland, abdominal, testis in baby boy
Behrman, Richard E, et al. 1994. Nelson Ilmu Kesehatan Anak. Ed 12. Bag 1. EGC: Jakarta
 Cont.

Additional examination
–Total serum bilirubin level >18 mg/dl
–Conjugated bilirubin level >2 mg/dl

Behrman, Richard E, et al. 1994. Nelson Ilmu Kesehatan Anak. Ed 12. Bag 1. EGC: Jakarta
 1st line management based on scenario
Assesment by labour

Queensland Maternity and Neonatal Clinical Guidelines Program. 2009. Neonatal jaundice: prevention, assessment and management. Queensland Maternity and
Neonatal Clinical Guidelines Program. [https://www.health.qld.gov.au/qcg]
Maisels MJ, Watchko, JF. Treatment of jaundice in low birthweight infants. Dr Maisels, Department of
Pediatrics, William Beaumont Hospital, USA; jmaisels@beaumont.edu. [https://www.ncbi.nlm.nih.gov]
Thank You