Komplikasi Dan Prognosis

KOMPLIKASI DAN PROGNOSIS

NECROTIZING ENTEROCOLITIS

• Typically occurs in the second to third week of life in premature, formula-fed infants

• 60-80 % terjadi pada bayi prematur• The use of an all human milk diet can lower

the risk of necrotizing enterocolitis (NEC) by 79%.(NECsociety)

• NEC most commonly affects the terminal ileum and the proximal ascending colon.

An acute inflammatory disease with a multifactorial and controversial etiology

ETIOLOGY

ABNORMAL FLORA

INTESTINAL MUCOSA

IMMATURITY

INNATE GENETIC

PREDISPOTITON

MEDICATION

ABNORMAL INTESTINAL FLORA

• Bifidobacteria oligofructose dari ASI. • Susu formula tanpa oligofructose

predominan Clostridial

• Indomethacin patent ductus arteriosus dapat -- splanchnic vasoconstriction --- impaired intestinal integrity.

• Vitamin E, used to treat retinopathy of prematurity, is known to impair leukocyte function and has been associated with NEC

• The results from a multicenter, prospective, observational study suggest that ranitidine treatment in very low birth weight infants is associated with an increased risk of infections, a 6.6-fold higher risk of NEC, and a significantly higher mortality rate.

Bayi preterm

• in the preterm infant, mucosal cellular immaturity and the absence of mature antioxidative mechanisms may render the mucosal barrier more susceptible to injury. Intestinal regulatory T-cell aggregates are a first-line defense against luminal pathogens and may be induced by collections of small lymphoid aggregates, which are absent or deficient in the premature infant.

• the classic clinical triad consists of abdominal distension, bloody stools, and pneumatosis intestinalis (train-track lucency configuration).

CEREBRAL PALSY&

PERIVENTRICULAR LEUKOMALACIA

CEREBRAL PALSY

• Absolute risk of CP was 8.5% among children born at 23 to 27 weeks' gestation, 5.6% at 28 to 30 weeks, 2.0% at 31 to 33 weeks, 0.4% at 34 to 36 weeks, and 0.1% thereafter

• Imaturitas otak dan vaskuler cerebral palsy• Before term, the distribution of fetal circulation

to the brain results in the tendency for hypoperfusion to the periventricular white matter. Hypoperfusion can result in germinal matrix hemorrhages or periventricular leukomalacia.

• Between weeks 26 and 34 of gestation, the periventricular white matter areas near the lateral ventricles are most susceptible to injury. Because these areas carry fibers responsible for the motor control and muscle tone of the legs, injury can result in spastic diplegia (ie, predominant spasticity and weakness of the legs, with or without arm involvement of a lesser degree).