APNUE OF PREMATURITY Apnea of prematurity as a condition in which premature infants stop breathing for 15 to 20 seconds during sleep.

Generally, babies who are born at less than 35 weeks' gestation have periods when they stop breathing or their heart rates drop. (The medical name for a slowed heart rate is bradycardia.) These breathing abnormalities may begin after 2 days of life and last for up to 2 to 3 months after the birth. Although it's normal for all infants to have pauses in breathing and heart rates, those with AOP have drops in heart rate below 80 beats per minute, which causes them to become pale or bluish. They may also appear limp and their breathing may be noisy. They then either start breathing again by themselves or require help to resume breathing Apnea is defined as the cessation of breathing for more than 20 seconds or apnea or the cessation of breathing for less than 20 seconds if it is accompanied by bradycardia or oxygen (O 2) desaturation.[9] Bradycardia in a premature neonate is considered clinically significant when the heart rate slows by least 30 bpm from the resting heart rate. An O2 saturation level of more than 85% is considered pathologic in this age group, as is a decrease in O2 saturation should it persist for 5 seconds or longer. Balance Protein Positif pada Neonatus Pemberian protein untuk menjaga balance nitrogen positif, dimana protein berfungsi untuk regenerasi sel, enzim, dan berbagai reaksi biologis dalam tubuh. Untuk itu diperlukan 1 gram /BB/ hari. Yang paling diperlukan L-asam amino, oleh karena proses pembentukan protein lebih cepat. Perlu diingat larutan asam amino juga mengandung karbohidrat dan elektrolit. Pemberian asam amino/protein saja tanpa diberikan kebutuhan kalori, menyebabkan asam amino dirobah menjadi energi melalui jalur glukoneogenesis. Dengan demikian pada pemberian asam amino yang bertujuan menjaga balance nitrogen positif, perlu ada perlindungan kalori 25 kcal tiap 1 gram asam amino. Misalnya pada pemberian asam amino/protein 50 gram, dibutuhkan 1200 kcal atau 300 gram karbohidrat. Jika asam amino bertujuan sebagai nitrogen sparing effect dimana menjaga agar protein viscera atau otot tidak dirobah menjadi kalori, jadi balance nitrogen sama dengan nol, maka tidak perlu diberikan kalori. Pemberian asam amino pada bayi prematur dapat dimulai dari hari pertama kehidupan29,30. Balans protein positif akan dicapai dan tidak terbukti adanya toksisitas terhadap protein secara laboratorium The ammonia produced in the latter two reactions is excreted as NH4+ in the urine, where it helps maintain urine pH in the normal range of pH4 to pH8. The extensive production of ammonia by peripheral tissue or hepatic glutamate dehydrogenase is not feasible because of the highly toxic effects of circulating ammonia. Normal serum ammonium concentrations are in the range of 20 40M, and an increase in circulating ammonia to about 400M causes alkalosis and neurotoxicity. Earlier it was noted that ammonia was neurotoxic. Marked brain damage is seen in cases of failure to make urea via the urea cycle or to eliminate urea through the kidneys. The result of either of these events is a buildup of circulating levels of ammonium ion. Aside from its effect on blood pH, ammonia readily traverses the brain blood barrier and in the brain is converted to glutamate via

glutamate dehydrogenase, depleting the brain of -KG. As the -KG is depleted, oxaloacetate falls correspondingly, and ultimately TCA cycle activity comes to a halt. In the absence of aerobic oxidative phosphorylation and TCA cycle activity, irreparable cell damage and neural cell death ensue. In addition, the increased glutamate leads to glutamine formation. This depletes glutamate stores which are needed in neural tissue since glutamate is both a neurotransmitter and a precursor for the synthesis of -aminobutyrate: GABA, another neurotransmitter. Therefore, reductions in brain glutamate affect energy production as well as neurotransmission. Additional untoward consequences are the result of elevations in neural glutamine concentration. Glial cell (astrocytes) volume is controlled by intracellular organic osmolyte metabolism. The organic osmolyte is glutamine. As glutamine levels rise in the brain the volume of fluid within glial cells increases resulting in the cerebral edema seen in infants with hyperammonemia caused by urea cycle defects. Sail sign One of the major differences between the normal chest of an adult or child and a neonate is the presence of the thymus. It is routinely identified on chest x-rays from birth to approximately age 2 years. The thymus is usually seen as a widening of the soft tissues of the upper mediastinum, although occasionally it may appear to project out into the lung (the sail sign) (Fig. 96). Some people mistakenly think that the sail sign is an indication that a pneumothorax is present. This is not true. Sail sign itu adalah kelenjar timus yang melebar pada soft tissue di atas mediastinum yang muncul sampai usia 2 tahun

MAP Normal Bayi Sehat MAP = Tekanan Diastolik + 1/3 (Tekanan Sistolik Tekanan Diastolik ) BBL= (Usia gestasi + 5) Syarat Pemberian Lipid Pada Neonatus Parenteral lipid intake should usually be limited to a maximum of 34 g/kg per day (0.13 0.17 g/kg per hour) in infants. There were case reports about a condition called fat overload syndrome, which may appear with rapid infusion of high dosages of lipid emulsions and may

present with coagulopathies, hepatomegaly, elevated liver enzymes, hyperbilirubinaemia, respiratory distress and thrombocytopenia. However, it seems reasonable to accept slightly higher triglyceride levels of 250 mg/dl during lipid infusion as the upper limit in newborns, premature and term infants. Administration of lipids is important in premature infants requiring PN to provide essential fatty acids and increase caloric intake with a low volume. Premature infants fed parenterally without lipids may develop biochemical evidence of essential fatty acid (EFA) deciency within 23 days. Intravenous lipids may be well tolerated from the rst day of life onwards