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PERAWATAN METODE KANGURU (PMK) DI NICU

Risa Etika / Rosalina D.R / Bernie E./ Ema A. / SuginartiTim PMK RSUD Dr. Soetomo / RSCM / RSU Dr. Wahidin / Dep. Kes RI

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Janin itu tidak lebih besar dari telapak tangan ayahnya, tetapi ayahnya meletakkan anaknya itu dalam oven, yang telah diatur membuatnya berkembang, dengan mengatur suhu, yang terukur secara seksama dengan termometer

Laurence Sterine-(Fanaroff, Care of the high risk neonate, 5th Ed., 2001)*

*DAFTAR SINGKATAN :

ASI: Air Susu IbuBBLR: Bayi Berat Lahir RendahIMR: Infant Mortality RateKMC: Kangaroo Mother CareNICU: Neonatal Intensive Care UnitPMK: Perawatan Metode KanguruRCT: Randomized Control TrialSDM: Sumber Daya Manusia

*POKOK BAHASANPENDAHULUANTUJUANDEFINISI PMKDEKLARASI PMKTIPE PMKKEUNTUNGAN PMKIMPLEMENTASI PMKKMC in NICUTATA LAKSANA PMKTAKE HOME MESSAGE

* Indonesia: IMR 25%o (SKRT Depkes 2001) BBLR 29% Asfiksia 27% Sepsis 5,4%

RSUD. Dr. Soetomo: BBLR 18,6%, meninggal 22.1%(Lap. Tahunan Div Neo 2006)BBLR 990 kasus/tahun, meninggal 31% (Lap. Tahunan Div Neo 2008) WHAT ?PENDAHULUAN

*WHAT ?Masalah Obstetri yang berperan dalam morbiditas / mortalitas perinatal: Pre Eklampsia / Eklampsia Infeksi / Ketuban pecah dini

Keterbatasan SDM Distribusi SDM Fasilitas rujukan perinatal tidak mendukung

PENDAHULUAN

*WHY KANGAROO?Lahir prematurMammalia : Hangat (kontak kulit dengan kulit) Nutrisi (ASI) ProteksiPENDAHULUAN

*WHY ? Dr. Rey & Martinez (1979) Bogota, Columbia Amerika Selatan:Rise on survival rate

Bergman NJ, et al. Acta Pediatrica 2004 vol 93 (b) : 779-785RCT of skin to skin contact from birth vsconventional incubator care for physiological stabilisationIn 1200 and 2199 gram newbornsPENDAHULUAN

BWBefore KMC %KMC %

501 1000 g0721001 1500 g2789

*TUJUAN UMUM

Menurunkan mortalitas dan morbiditas BBLR

Intervensi dan prosentase penurunan mortalitas neonatus

( Darmstadt GL,et al. Lancet,March 2004)TUJUAN

Pencegahan& manajemen hipotermiaResusitasi neonatusASIPMK Infeksi18 42%6 - 42%55 87 %57%27%

*TUJUAN KHUSUSMemperkenalkan konsepkeuntunganimplementasitata laksanaBBLR dengan Metode Kanguru (kontak kulit dengan kulit)

TUJUAN

*DEFINISIPMK atau kontak kulit dengan kulit yaitu: cara merawat BBLR, bayi baru lahir dalam keadaan telanjang (hanya memakai popok dan topi) diletakkan dalam posisi vertikal di dada antara kedua payudara ibunya (ayah, anggota keluarga lainnya) dalam keadaan telanjang dada kemudian diselimuti tanpa waktu yang spesifik.DEFINISI

*WHEN ?KMC (Kangaroo Mother Care) is a basic right of the newborn,and should be an intregral part of the management of low birth weight and fullterm newborns, in all settings and at all levels of care, in all contries (Bogota Declaration of KMC, International Network of KMC 1998). DEKLARASI PMK

*HOW ?Tipe PMK:

PMK Intermiten

PMK KontinyuTIPE PMK

*PMK terdiri 4 komponen :

Posisi

Nutrisi

Discharge (pulang)

Support (dukungan keluarga)

Dying Infant (5)TIPE PMK

*TIPE PMK

*HOW ?1. Untuk Bayi :

Stabilitas suhu,denyut jantung,dan pola nafasASI Eksklusif Mengurangi infeksi Waktu tidur lebih lamaMengurangi kebutuhan kaloriBerat badan lebih cepat meningkatPerkembangan otak optimalMengurangi tangisan

Keuntungan PMKKEUNTUNGAN PMK

*.... Keuntungan PMK HOW ?2. Untuk Ibu :

Bonding Percaya diriKeberhasilan menyusui

3. Untuk Ayah :BondingPeran ayah pada perawatan bayinya

KEUNTUNGAN PMK

*4. Untuk Rumah Sakit :Kebutuhan staf, alat dan ruangan minimalBayi lebih cepat pulangHemat/murah

5. Untuk Pemerintah :Menghemat anggaran Menurunkan morbiditas dan mortalitas BBLR

HOW ?.... Keuntungan PMK KEUNTUNGAN PMK

*KMC FRAME WORKCARE VARIABLENice Bad Initiation Birth 12h >4h >1h

*researchStable rate. 1More regular breathing: 75% decrease in apneic episodes. 1Improved O2 saturation levels. 2No cold stress more stable temperature. 2

Ludington Hoe SM, Swinth JV, Thimpson C, Hadeed AJ. Randomized controlled trial of kangaroo care: cardiorespiratory and thermal effects on healthy preterm infants. Neonatal Netw. 2004;23:39-48Acolet D, Sleath K, Whitelaw A. Oxygenation, heart rate, and temperature in very low birthweight infant during skin-to-skin contact with their mothers. Acta Pediatr Scand. 1989;78:189-193.KEUNTUNGAN PMK

*Longer periods of sleep.3Less caloric expenditures.3More rapis weight gain.4More rapid brain development.5

3. Ludington-Hoe SM, Kasper CE.A physiologic method of monitoring preterm infants during kangaroo care. JNurs Manag. 1995;3:13-294. Charpak N, Ruiz-Pelaez JG, Figueroa de CZ, charpak Y. A randomized, controlled trial of kangaroo mother care: result of a follow-up at one year of corrected age. Pediatrics.2001;108:1072-10795. Feldman R, Eidelman A, Sirota L, Weller A. Comparison of skin-to-skin Kangaroo and traditional care: parentingoutcomes and preterm infant development. Pediatrics.2002;110:16-26researchKEUNTUNGAN PMK

*Decreased crying.6More successful breastfeeding episodes.7Increased breastfeeding duration.8Earlier hospital discharge.9

6. Ludington-Hoe SM, Cong X, Hashemi F. Infant crying: nature, physiologic consequences, and select intervention. Neonatal Netw. 2002;21:29-36.7. Whitelaw A, Heisterkanp G, Sleath K, et. al. Skin-to-skin contact for very low birthweight infants and their mothers. Arch Dis Child. 1988;63:1377-1381.8. Hurst NM, Valentine CJ, Renfro L, et al. skin-to-skin holding in the neonatal intensive care unit influences maternal milk volume. J Perinatol 1997;17:213-217.9. Charpak N, Ruiz-Pelaez JG, Figueroa de CZ, charpak Y. A randomized, controlled trial of kangaroo mother care: result of a follow-up at one year of correcred age. Pediatrics. 2001;108:1072-79. researchKEUNTUNGAN PMK

*KMC in NICUWhich KMC type do we use in NICU ?Current : Intermittent KMC2 times per day, period: > 1 hoursContinous KMC24 hours skin-to-skin contact, stable infant with medical support.

*Research:India 2006:

The KMC babies ad better average weight gain per day (KMC 23.99 g vc CC:15.58 g. p

*Research:Africa:

KMC babies stabile at the mean age 4.5 days vs CMC: 5.4 days, indicating that babies in the KMC group were stabilized 24 hour earlier.

The survival babies in KMC group were better, mortality rate KMC 14/62 (22.5%) vs 24/63 (38%) p

ABSTRACT

Humanity first, Technology second reducing Infant Mortalityrate with Kangaroo Mother Care: practical evidence from South AfricaRisa Etika*, Rosalina D. Roeslani**, Ema Alasiry***, Bernie Endyarni**, Suginarti$, Bergman NJ$$(*Univ of Airlangga, **Univ of Indonesia, ***Univ of Hasanuddin, $Ministry of Health RI, $$South Africa KMC Foundation)

As a team from Indonesia the authors got a golden opportunity to observe the Kangaroo Mother Care (KMC) in South Africa (SA) where KMC was widely practiced. Actually there are many similarities between Indonesia and SA, including diversity of population, economic and health indicators. Fund was came from The Ministry of Health (MoH) supported by USAID as a sponsor given to the team who consist of 14 health workers (paediatricians, doctor, midwives, and nurses) representing MoH, Indonesian Pediatric Society (IDAI), and 3 Teaching Hospitals to explore ways of improving our newborn care. Program consisted of orientation to understand country similarities and differences, theoretical teaching and implementation strategy. We had practical exposure, training, and visited 5 hospitals (tertiary and secondary), 2 primary midwife obstetric units and 1 private clinic.The theory of KMC is based on neuroscience, and shows that mother and baby are a dyad that should not be separated. Infant brain development requires maternal sensory stimulation based on skin-to-skin contact. The incubator separates mother and baby, and results in poorer neurodevelopment. RCT trials in SA (Bergman NJ, et all 2004. Acta Paediatrica vol 93, p. 779-785) shown that skin-to-skin contact from birth is superior to incubator care for LBW infants. KMC is a care strategy with 4 components: position, nutrition, discharge and support. Health services we visited practiced KMC in many ways with different techniques, and we gained experience in different methods of doing KMC. For health services, KMC can be implemented in understaffed and under equipped circumstances. These advantages (1) stay as warm as incubators (2) are more psychologically stable (3) bond better with mothers (4) fewer serious infections (5) go home sooners (6) breastfeeding better and for longer do lead to decreasing infant morbidity and mortality rate. Nationwide surveys show 30% reduction in hospital ENND rate where it is implemented. As a suggestion we invite colleagues to work with, to find ways to adapt the model to be implemented in our country.

Keywords: KMC, IMR, skin-to-skin contact

ABSTRACT

PERAWATAN METODE KANGURU di RSUD Dr. Soetomo SurabayaJuni 2008 Juli 2009(Pasca Pembelajaran PMK di Afrika Selatan)Elmi Aris / Wahyu Widiati / Choiriyah / Risa Etika / Fatimah Indarso / Bambang Permono

Pendahuluan : Bayi dengan berat badan lahir rendah merupakan salah satu penyebab utama tingginya angka kesakitan & kematian pada neonatus, hal ini bukan saja karena kondisi prematurnya tetapi juga diperberat oleh hipotermia & infeksi nosokomial. Bahan dan cara kerja : Di RSUD Dr. Soetomo, pada bulan Juni 2008 sampai Juli 2009 terdapat 821 bayi dengan BBLR dan 270 diantaranya mempunyai berat lahir kurang dari 2000 gram. Perawatan Metode Kanguru dilakukan pada bayi prematur / BBLR yang sudah melewati masa kritis atau sudah stabil secara intermitten minimal 2-3 jam/hari selama bayi dirawat di RS. Hasil : Selama periode Juni 2008 Juli 2009 terdapat 138 bayi BBLR yang dilakukan PMK intermitten . Selama bayi dirawat di RSUD Dr. Soetomo dan dilanjutkan setelah pulang ke rumah dengan follow up di Poliklinik Khusus Bayi RSUD Dr. Soetomo.Kesimpulan : Perawatan Metode Kanguru merupakan cara yang efektif dan efisien untuk memenuhi kebutuhan dasar bayi yaitu kehangatan (skin to skin contact), ASI, perlindungan terhadap infeksi, stimulasi & kasih sayang.

Kata kunci : BBLR, Hipotermia, PMK

*HOW ?IMPLEMENTASI PMKSemua Rumah Sakit (Tipe ABC) dan PuskesmasSemua level perawatanRuang rawat gabungRuang Intermediate NeonatalRuang NICUBerat lahir < 2500 gramRSU. Dr. Soetomo < 1800 gram Bayi stabil minimal 3 hari berturut-turutToleransi minum baikIbu bayi bersedia melakukan PMKIbu telah diedukasiTenaga medis dan perawat terampil

IMPLEMENTASI PMK

*TATA LAKSANA PMKHOW ?BBLR tunggal, gemelli & trippletKontak kulit dengan kulit minimal 1 jam/hari

Posisi bayi diantara payudara, tegak, dada bayi menempel ke dada ibu

Amankan posisi bayi dengan kain panjang/baju kanguru

Kepala bayi dipalingkan ke salah satu sisi dengan sedikit tengadah (ekstensi).Pastikan jalan nafas bayi terjamin tetap terbuka.

TATA LAKSANA PMK

*...TATA LAKSANA PMKHOW ?Pangkal paha dan lutut bayi fleksi (seperti katak),tangan bayi dalam posisi fleksi (posisi fetus) pastikan perut bayi tidak tertekan dan terletak di epigastrium ibu

Tenaga yang mengawasi : dokter dan perawat

Observasi tanda vital tiap 3 jam dan setelah pemberian minum

TATA LAKSANA PMK

( doc. Tim KMC RSUD Dr. Soetomo Surabaya )

*HOW ?INDIKASI BAYI DIPULANGKANTanda vital stabil dan berat badan naik 20 gram/hari Minimal 3 hari berturut-turut

Berat badan > 1800 gram

Ibu mampu dan percaya diri melakukan PMK

Ibu mampu memberi minum bayinya

Dukungan dari keluarga menjalankan PMK di rumah

TATA LAKSANA PMK

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PMK merupakan metode tepat guna(murah,mudah dan efektif)

PMK : Humanity first, Technology second (kontak kulit dengan kulit)

KMC in NICU : Yes!

. LANJUTKAN! LEBIH CEPAT LEBIH BAIK! Menurunkan mortalitas dan morbiditas BBLR

Take Home MessageTAKE HOME MESSAGE

*TERIMA KASIHSurvival intact

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