Sri Wahyuni, M.Mid Prodi D IV Kebidanan Poltekkes Surakarta September 17, 2018September 17, 2018 Regulasi suhu BBL Sri Wahyuni, M.Mid Prodi D IV Kebidanan Poltekkes Surakarta

Perubahan Segera Setelah lahir Perubahan lingkungan dalam uterus ke luar uterus mengakibatkan neonatus menerima rangsangan kimiawi, mekanik, termik

Heat Processing 3 proses pengaturan suhu tubuh: September 17, 2018 Heat Processing 3 proses pengaturan suhu tubuh: Heat Generation (Pembentukan Panas) – proses dimana panas diproduksi (dalam tubuh) Heat Conservation (Insulation) - mekanisme dimana panas dicegah keluar Heat Loss – secara fisik proses kehilangan panas dari permukaan tubuh

Heat Conservation (Insulation September 17, 2018 Panas dibentuk berdasarkan proporsi massa Shivering/menggigil – tidak digunakan oleh BBL/neonatus Large body movements – sedikit digunakan oleh BBL/neonatuss Brown Fat – organ neonatus Heat Generation Heat Conservation (Insulation Heat Loss

Heat Conservation (Insulation September 17, 2018 Brown Fat: Tidak ada pada orang dewasa Terletak di inti tubuh, di bawah scapula dan retro- peritoneal cavity. Merupakan organ pembentuk panan White Fat: Ada sepanjang hidup Di subcutanpada periphery . Merup organ penyimpanan dan pemeliharaan Heat Generation Heat Conservation (Insulation Heat Loss

Prematures and Heat Generation Heat Conservation (Insulation September 17, 2018 Heat Generation Prematures and Heat Generation Prematur mempunyai sedikit massa, shg pembentukan panas minimal Premature tidak menggigil dan tidak punya gerakan tubuh yang besar Premature do not have much brown fat as it is laid down mainly in the third trimester Heat Conservation (Insulation Heat Loss

Heat Conservation (Insulation September 17, 2018 Mechanisms of Heat Conservation - Insulation Heat Generation White Fat , terletak di dermis untuk pemeliharaan. Neurological control : pembuluh darah menghubungkan superficial dan venous plexuses dalam (dibalik lemak), dikulit akan terlihat seberapa banyak darah yang mencapai peripher. Untuk menaikkan suhu tubuh pembuluh darah akan menutup dan darah tidak sampai di periphery. (tubuh kelihatan kebiruan dan teraba dingin) Untuk menurunkan suhu tubuh, pembuluh darah membuka dan darah mencapai permukaan kulit (Tubuh kemerahan dan hangat) Heat Conservation (Insulation Heat Loss

Heat Conservation (Insulation September 17, 2018 Prematures and Insulation Heat Generation Premature tidak punya banyak white fat yang terbentuk pada trimester 3 Premature tidak dapat mengontrol vasodilatation dan vasoconstriction secara adequat untuk mengontrol aliran darah dari dalam ke luar vena plexuses Heat Conservation (Insulation Heat Loss

Heat Conservation (Insulation September 17, 2018 Mecanisms Heat Loss Heat Generation Convection From warm body surface to the cooler air currents Radiation Heat transfers from the heated body rise to the coller surface & object not direct contanct with the body Evaporation Loss of heat incurred when ater is converted to a vapor Conduction Loss of heat to a coller surface by direct skin contact Heat Conservation (Insulation Heat Loss

September 17, 2018

Cold Stress: Cold O2 Consumption Frek breathing Glycolysis anaerobic O2 need in lung O2 tissues vasoconstriction of lungs vasoconstriction of peripheral in PO2 and pH Metabolic Acydosis

Heat Loss 2 jalan kehilangan panas : Internal core: inti tubuh dan permukaan kulit sangat besar perbedaan suhu, sehingga cepat perpindahan panas 2. External body surface ke suhu lingkungan Perpindahan diikuti dengan peningkatan konsumsi O2, penurunan simpanan glikogen dan metabolisme brown fat

Thermogenesis Several mechanisms that increase heat production: Muscular activity Chemical thermogenesis (nonshivering thermogenesis/ NST)---- use brown adipose tissue (BAT)/brown fat Basal metabolic rate

September 17, 2018

Temperature Regulation Maintenance keseimbangan antara kehilangan panas dan produksi panas dalam tubuh Bisa turun 2 – 3C setelah persalinan, karena evaporative Thermoregulation berhubungan dengan metabolism & konsumsi oxygen TNZ (thermal neutral zone)-- a specific enviromental range

Gangguan Umum Suhu diluar uterus lebih rendah Kehilangan panas melalui evaporasi, konveksi, radiasi Penurunan suhu 2 derajat / 15 menit Kehilangan kalori 200 kal/kgBB/menit

Gangguan Umum Metabolisme jaringan meningkat Asidosis metabolik Membutuhkan oksigen Hipoglikemia Memerlukan nutrisi: ASI

How do we assist Neonates with Temperature Control? September 17, 2018 How do we assist Neonates with Temperature Control? Kita hanya membantu mencegah kehilangan panas. Do nothing untuk pembentukan dan pemeliharaan panas. Radiant Warmers dan Isolettes sering digunakan. Keduanya punya keuntungan dan kekurangan masing2

September 17, 2018 Isolette vs. Radiant Warmer These only control heat loss. They have no effect on Heat Generation or Insulation. Isolette Conduction – no advantage of either system Convection – convective losses well controlled. Air flow in an isolette follows a flow plan which minimizes heat loss of infant. Evaporation – can control humidity well Radiation – heat loss by this mechanism is well controlled especially in double walled isolettes Radiant Warmer Conduction – no advantage of either system Convection – no control over convective heat losses. Evaporation – no ability to control humidity – huge disadvantage Radiation – different in each direction – a problem for little prematures

September 17, 2018

Isolette vs.. Radiant Warmer September 17, 2018 Isolette vs.. Radiant Warmer Isolettes are generally better in all aspects of temperature control than Radiant Warmers. Access is much better with Radiant Warmers – thus their use at admission to nurseries (when more procedures are done) and in larger infants.

September 17, 2018