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““Maternity” Pablo Picasso Maternity” Pablo Picasso 19051905

Pemberian ASI EksklusifPemberian ASI Eksklusif

Dewi Robinar

Bagian Kesehatan Anak

RSUD AA – Pekanbaru

2007

ASI menguntungkan biologis, fisiologis, psikologis & ekonomi.

ASI sebagai makanan alamiah terbaik Komposisi ASI berubah sesuai

kebutuhan Keputusan Menteri Kesehatan RI

tentang pemberian ASI Eksklusif

Rekomendasi WHO (2001 )Pemberian ASI eksklusif ( ASIE ) selama 6

bulan Pemberian ASI sampai 2 tahun bersama

makanan lain yang adekuat dan sesuai usia.

Alasan ( Penelusuran literatur )Pertumnuhan bayi ASIE 6 bulan tidak kurang

dari ASIE 4 bulanMorbiditas bayi dengan ASIE 6 bulan lebih

kecil daripada ASIE 4 bulanASIE 6 bulan dapat digunakan sebagai

Metode KB (LAM )

Manfaat bagi ibuManfaat bagi ibu Mencegah perdarahan postpartum &

mempercepat involusi uterus Mencegah anemia defisiensi zat besi Mempercepat ibu kembali ke berat

sebelum hamil Menunda kesuburan Menimbulkan perasaan dibutuhkan Mengurangi kemungkinan kanker

payudara dan ovarium

Manfaat bagi bayiManfaat bagi bayi Komposisi sesuai kebutuhan Kalori dari ASI memenuhi kebutuhan bayi

sampai 6 bulan ASI mengandung zat pelindung Perkembangan psikomotorik lebih cepat Menunjang perkembangan kognitif Menunjang perkembangan penglihatan Dasar untuk perkembangan emosi yang

hangat Dasar untuk perkembangan kepribadian yang

percaya diri

Manfaat bagi keluargaManfaat bagi keluarga

Mudah pemberian Mengurangi biaya rumah tangga Mengurangi biaya pengobatan

Manfaat ASI ditinjau dari :Manfaat ASI ditinjau dari :

1. Aspek gizi ASI

2. Aspek imunologik

Aspek Gizi ASIAspek Gizi ASI

Makanan alamiah

Perubahan komposisi ASI 3 stadium Kolostrum ( minggu 1 )

Warna kekuningan Volume : 2 – 20 ml/x menyusu ( 3 hari

pertama ) Protein > karbohidrat / lemak Ig > ASI matur Pencahar yang baik

ASI peralihan ( ASI transisional ) Hari ke 7 – 14 ( sp minggu ke 5 ) Ig & protein total makin menurun Laktosa, lemak, vitamin & kalori total

meningkat

ASI Matur Setelah ASI peralihan Volume tahun 1 : 400 – 800 ml/hari Volume tahun 2 : 200 – 450 ml/hari Volume bila frekuensi pemberian

Komposisi ASI MaturKomposisi ASI Matur Karbohidrat

Laktosa (70%) fermentasi suasana asam

Protein Kadar konstan dr lemak ASI mengandung protease mudah dicerna Asam Amino : Sistin somatik

Taurin otak

Lemak Sumber energi utama Untuk pertumbuhan normal Asam lemak Pelarut vitamin

Vitamin Garam dan mineral

Aspek ImunologikAspek Imunologik

Mendapat ASI jarang sakit

Zat kekebalan :1. Faktor pertumbuhan

Laktobasilus bifidus suasana asam menghambat pertumbuhan E. coli ( Goldman dan Smith, 1973 )

2. Laktoferin

Protien terikat zat besi dari ASI

Khasiat :

Menghambat pertumbuhan Stafilokokus, E. coli, jamur candida.

Konsentrasi dalam kolostrum sangat tinggi ( Lawrence, 1989; Roberts, 1989 )

3. Faktor anti Statfilokokus ( Gyorgy dkk., 1971 )

4. Antibodi IgG, IgM, IgA, SIgA, IgD dan IgE

Terbanyak di kolostrum, SIgA ( 90 % ) - (Lawrence, 1989; Roberts, 1989 )

Khasiat SIgA :

Membentuk lapisan permukaan usus melindungi kuman patogen

Laktobasilus bifidus suasana asam menghambat pertumbuhan E. coli ( Goldman dan Smith, 1973 )

5. Komplemen ( C3 dan C4 )

Mempunyai daya opsonik, anafilatoksik dan kemotaksis

6. Lisozim

Khasiat : bakteriolitik antiviral

7. Imunitas selular Makrofag ( 90 % ) dan limfosit ( 10 % )

8. Hormon dalam ASI 15 macam hormon ( Roberts, 1989 )

9. Laktoperoksidase antibakteri Streptokokus

Manajemen LaktasiAdalah upaya-upaya yang dilakukan pada periode kehamilan ( antenatal ), periode segera setelah lahir ( perinatal ) dan periode selama menyusui ( pascanatal ) untuk menunjang keberhasilan menyusui.

ANTENATALANTENATALPeriode kehamilanPeriode kehamilan

a. Mental

b. Fisik Gizi Ibu Persiapan Payudara sejak hamil 6 bulan

Fisiologi LaktasiFisiologi Laktasi

Refleks pada ibu

a. Refleks Prolaktin

b. Refleks Aliran

Refleks pada bayi

a. Rooting reflex

b. Refleks mengisap

c. Refleks menelan

Proses LaktasiProses LaktasiIsapan / menyusu

Stimulasi syaraf sensoris puting susu

Sistem saraf pusat

Syaraf sensoris afferent

hipotalamus

Pars anterior hipofise

prolaktin

Aliran darah

Kelj sekretori epitel

Produksi susu

Pars posterior hipofise

Oksitosin

Aliran darah

Sel mioepitel

Let-down reflex

( Applebaum, 1975 )

PERINATALPERINATALSaat lahirSaat lahir

a. Tanpa pemberian susu formula prelakteal, air gula atau madu

b. Inisiasi Laktasi : Segera disusukan setelah lahir

c. Rawat Gabung

d. Tidak memberi dot

e. Susui bayi dari kedua payudara secara bergantian

PASCANATALPASCANATAL

a. Perhatikan teknik/cara menyusui yang baik dan benar

b. MP-ASI setelah bayi umur 6 bulan

c. Konsultasi ke klinik laktasi

d. Berikan ASI sampai umur 2 tahun

e. Menyapih secara bertahap

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The Remarkable First Hour of The Remarkable First Hour of LifeLife

When healthy infants are placed skin-to-skin on their mother’s abdomen and chest immediately after birth, ………they exhibit remarkable capabilities. They are alert. They can crawl, stimulated by mother’s gentle touch, across her abdomen, reaching her breast. They begin to touch and massage the breast finally, he or she attaches to the breast and first feeds.

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1. Sensory inputs1. Sensory inputs

1.1. OlfactoryBabies preferred their mother’s unwashed breast to her washed breast, soon after birth. (Varendi et al, 1994). Besides secreting milk and colostrum, the nipple and areola are dense in glands that perhaps secrete attractive odors. (Makin and Porter, 1999).

1.2. VisualIllingworth (1987) stating that a newborn baby shows more interest in a black and white pattern than in a blank grey card.Newborns can recognize their mother’s face (Bushnell et al, 1989) and can follow it for a short distance (Brazelton and Cramer, 1199)

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1.3. TasteAmniotic fluid on the infant’s hands probably also explains part of the interest in suckling the hands and fingers. The baby uses the taste and smell of amniotic fluid on its hands to make a connection with a certain lipid substance on the nipple related to the amniotic fluid (Klaus and Kennel, 2001).

1.4. AuditoryNewborn infants prefer the sound of the maternal voice and also suckle for longer when they hear it (DeCasper and Fifer, 1980; Fifer and Moon, 1994). They can discriminate the language heard in utero from another language (Mehler et al, 1988)The rhythmic sound of the mother’s heart-beat can also have a calming influence on the baby. (Salk L, 1960; Salk L, 1962).

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1.5. Touch

Skin to skin touch provides heat and variety of other tactile impuls Helps maintain temperature (Christensson et al, 1992) Facilitates metabolic adaptations especially sugar levels and

acid-base balance (Christensson et al, 1992) Results in less crying (Christensson et al, 1992; Christensson et

al, 1995) Facilitates bonding (Widström et al, 1990) Causes oxytocin release in the mother Improves immediate and long term breastfeeding success:

(Righard and Alade, 1990; WHO, 1998; DeChateau and Wiberg, 1977)

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2. Central component2. Central component

The newborn’s brain is optimally ready to integrate various sensory inputs and other components of the breast crawl soon after birth.

Widström et al (1987) recorded a state of wakefulness during the Breast Crawl according to Brazelton’s Neonatal Behavior Assessment Scale (BNBAS). At 15 minutes, the children’s median state was 4. Alertness gradually decreased until 150 minutes after birth, when they were all asleep.

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3. Motor outputs :3. Motor outputs :

3.1. Orofacial

Around 30-40 minutes after birth, the newborn begins making mouthing movements, sometimes with lip smacking. Suckling of hands and fingers is commonly seen. After attaching successfully, newborns continued to suckle for 20 minutes

(Righard and Alade, 1990).

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3.2. Lower & Upper limb

The Stepping Reflex helps the newborn to push against her mother’s abdomen to propel her towards the breast. Pressure from the infant’s feet on the abdomen may also help to expel placenta and reduce uterine bleeding (Klaus

and Kennel, 2001).

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The ability to move its hand in a reaching motion enables the baby to claim the nipple. This helps to stimulate, elongate and protract the nipple (Klaus and Kennel, 2001).

When the baby massages the breast and subsequently suckles, a large oxytocin surge is induced from the mother’s pituitary gland into her bloodstream. This also

helps in the manufacture of prolactin.

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3.4. Neuro-endocrine component

Oxytocin

- Induce uterine contraction

- Helps expel placenta

- Prevents excessive bleeding

- Helps mold maternal behavior

Causes the mother to feel relaxed, calmer, sedated

- Stimulates the release of GI hormones

- Increase skin temperature (flushing)

Prolactin

- “The milk-making hormone”

- “ Mothering hormone”

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Oxytocin level in a mother in relation to the infant’s massage like hand movements on mother’s

Mattthiesen A, Arvidson A, Nissen A, Moberg K. Postpartum Maternal Oxytocin Release by Newborns: Effect of Infant Hand Massage and Sucking; 2001. Birth, 2001, 28.

Infant’s massage of

mother’s breast

........... Fingers sucking

Breast sucking

Maternal oxytocin (Log

conc)

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D. ADVANTAGES OFFERED BY THED. ADVANTAGES OFFERED BY THE BREAST CRAWL BREAST CRAWL

4.1. For the Baby

4.1.1. Warmth Compared temperatures of newborns kept in skin-to-skin

contact in the Breast Crawl position with those kept in a cot in the first few hours after birth, the former had better body and skin temperatures.

(Christensson et al, 1992)

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Maternal and neonatal temperature changes from the moment of STS contact (time = 0) to 20 min after initiation of STS contact. The last measurement (marked “X”) was carried out 10 min after the newborn had been taken away from the STS position, wrapped in dry cloth. Bars above and below symbols indicate 95% confidence intervals

Bergstrom A, Okong P, Ransjo-Arvidson A-B; Immediate maternal thermal response to skin-to-skin care of newborn;2007

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4.1.2. Comfort

Christensson et al (1992) compared crying between babies kept in the Breast Crawl position with those kept in a cot next to the mother during the first 90 minutes after birth. The infants in the cot cried for a significantly longer time than the babies in Breast Crawl position during all

observation periods.

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Crying duration at various time intervalsCrying duration at various time intervals

Group Time Interval

At 25-30 mins At 55-60 mins At 85-90 mins

Babies in skin-to-skin contact (Breast Crawl)

60 sec 0 sec 10 sec

Babies in cot 1094 sec 985 sec 760 sec

Christensson et al, 1992

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4.1.3. Metabolic adaption

Babies kept in the Breast Crawl position had higher 90 minute blood sugar levels and more rapid recovery from transient acidosis at birth, as compared to babies separated and kept in a cot next to the mother (Christensson et al,

1992).

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4.1.4. Quality of attachment

Compared kept in uninterrupted and interrupted STS contact for 1 hour, the former had better and attached corectly (Righard and Alade, 1990).

These findings are crucial because the early suckling pattern is of prognostic value for the duration and success of breastfeeding

4.2. For the Mother

Expulsion of placenta and reduction of post partumhaemorrhage

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Duration of placental delivery of the early-Duration of placental delivery of the early-breastfeeding and control groupsbreastfeeding and control groups

Duration of placental delivery

Early-breastfeeding (n=36)

Control

(n=36)

5-10 min 30 (83.3%)a 15 (41.7%)a

11-20 min 6 (16.7%) 21 (58.3%)

a Significantly different from 11-20 min (p<0.05)

Bilgik D, Guler H, Cetin A, 2004

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Duration of placental delivery from the Duration of placental delivery from the beginning of early breastfeedingbeginning of early breastfeeding

Duration of placental delivery

5-10 min 11-20 min

Duration of

early-breastfeeding

2-9 min 25 (92.6%)a 2 (7.4%)

>10 min 5 (55.5%) 4 (44.5%)a Significantly different from >10 min (p<0.05)

Bilgik D, Guler H, Cetin A, 2004

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E. HINDERING FACTORSE. HINDERING FACTORS

Separation on the Breast Crawl Drugs Routinely procedures directly after delivery

- Suctioning- Weighing- Bathing- Wrapping- Vitamin K injection- Eye treatments

Penyimpanan ASI Penyimpanan ASI

Suhu ruang: 770 F / 250 C: 6 sampai 8 jam

1000 F / 380 C: tidak aman

Wadah terinsulasi dengan ice pack: 24 jam

Lemari pendingin 390 F / 40 C 24 - 48 jam

(sampai dengan 5 hari?)

Penyimpanan ASI Penyimpanan ASI

Freezer ekstra dingin yang sering dibuka:-40 F / -200 C : 6 sampai 12 bulan

Lemari es/freezer dengan pintu terpisah: 00 F / -180 C : 3 sampai 6 bulan

Freezer di dalam lemari pendingin: 50 F / -150 C : 2 minggu saja

Cairkan ASI beku dengan “slow defrost” selama satu malam dalam lemari pendingin.

Rendam susu dalam mangkuk berisi air suam kuku hingga hangat. Panas berlebihan akan memodifikasi atau menghancurkan enzim dan protein.

Cairkan keseluruhan ASI dalam wadah karena lemaknya terpisah selama proses pembekuan.

Jangan pernah menggunakan microwave untuk mencairkan atau menghangatkan ASI.

Setelah dicairkan, ASI harus digunakan dalam waktu 24 jam.

Mencairkan ASIMencairkan ASI

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