Senin, 06 April 2015

BBLR dapat diatasi dengan pemberian ASI eksklusif

Nama :

  1. ISNA MARANTIKA/ 130200729
  2. FEBRIYANTI PUJI L/130200704
  3. INDRIANI/130200696
  4. DWI RIDARWATI/130200733
  5. NURUL ABIDAH/130200730

Judul Jurnal
Exclusive breastfeeding of low birth weight infants for the first six months: infant morbidity and maternal and infant anthropometry

Background: to report anthropometry and morbidity among term low birth weight infants and anthropometry oftheir first time mothers during the first six months in relation to breastfeeding practice. Methods: we examineddata from a randomized controlled trial in Manila, the Philippines. Of the 204 mothers randomized, 68 mothers received eight postpartum breastfeeding counseling sessions, the rest did not. Maternal and infant anthropometricdata at birth, 2, 4 and 6 months were taken. During seven follow-up hospital visits, an independent interviewer recorded feeding data. Results: the 24 infants exclusively breastfed from birth to six months did not have diarrhea compared to 134 partially breastfed (mean 2.3 days) and 21 non-breastfed infants (mean 2.5 days). Partially breastfed and non-breastfed infants compared to exclusively breastfed infants had more frequent, as well as
more severe episodes of respiratory infections. At six months, neither overall gain in infant weight, length and head circumferences nor mean maternal weight and body mass index differed significantly between the feeding groups. Conclusions: exclusive breastfeeding for 6 months can be recommended in term low birth weight infants, who were protected from diarrhea, had fewer respiratory infections, required no hospitalization and had catch up growth. Exclusively breastfeeding mothers did not differ from mothers who breastfed partially or thosewho did not breastfeed with regard to weight changes at six months.

The World Health Organization’s recommendation for mothers to exclusively breastfeed infants for the first six months requires a broader appraisal of its effects on both infants and mothers.1 This is particularly important for infants born with low birth weight (<2500 grams) and mothers with health risks.2,3 Low maternal BMI (<20) is associated with increased morbidity.4 Low birth weight (LBW) infants present unique problems in breastfeeding as newborns,5 and are at increased risk of serious health outcomes and long-term disabilities.6,7
LBW infants in the Philippines and elsewhere are breastfed to a smaller extent compared to infants with normal birth weights.8,9 Exclusive breastfeeding leads to nutritional and immunological benefits as well as improved cognitive outcome. 10 No growth deficiency was found in Honduran LBW infants exclusively breastfed from birth to six months.11 Mothers who breastfeed exclusively are able to space childbirth and are less likely to have menstruation at six months or earlier,12 which conserves nutrients such as iron.13 Breastfeeding helps mothers bond with their infants. Among low –income families, the financial cost savings derived from breastfeeding is huge. We have recently reported results of a randomized controlled trial in which postpartum peer counseling among mothers of term and low birth weight infants have been shown to increase exclusive breastfeeding up to six months.14 Since the studied mothers and infants constitute a population at risk for poor health, the aim of this paper is to compare maternal and infant anthropometry and infant morbidity in relation to breastfeeding practice during the first six months.

Infant anthropometry
Weight, length and head circumference measurements of the infants were taken within 30 minutes after birth by a pediatrician on duty. The study physician, blinded to group, made all subsequent measurements. At infant ages 2, 4, and 6 months, undressed infants were weighed using an electronic weighing scale (Nakamura®, Japan). Body weight was measured to the nearest gram. The average of three weight measurements was recorded as infant weight. The weighing scale was calibrated daily using standardweights. The study physician and an assistant took infant length by use of an infantometer (Nakamura®, Japan), recorded as the average of two readings to the nearest cm. The infant’s head (occipito-frontal) circumference was measured to the nearest 0.1 cm using a non-elastic measure tape. An average of two readings was recorded.

Maternal anthropometry
A trained research assistant measured the mid-upper arm circumference (MUAC) and took the weights of all mothers before discharge at 12 to 72 hours postpartum and then at infant ages two, four, and six months. The MUAC was measured using a non-elastic tape, calibrated to the nearest 0.1 cm, at the midpoint of the upper arm between the acromion process and the tip of the olecranon process. In addition a height measurement was performed at infant age 2 weeks. A beam balance weighing scale (Detecto®, USA) calibrated to 100 grams was used to weigh the mothers. To compute for body mass index (BMI), the weight (kg) is divided by squared height in meter. A BMI of 20 is regarded as normal, 18.5-20 is low and <18.5
represents chronic energy deficiency (CED).16

Infant morbidity
The mothers brought their infants to the study physician when they observed cough, colds or stool changes in the infants. Diarrhea was diagnosed when the infants had stools that were looser, more watery and more frequent than usual. All infant health consultations made by the mother outside the study clinic were verified and recorded by the study physician. All infant illnesses in the study were diagnosed and managed by the study physician.

Statistical analysis
Data were analyzed using the STATA 7.0 statistical software. Descriptive analysis included frequencies and contingency tables. Weight-for-age, length-for-age, and head circumference-for-age z scores were calculated by using EPI INFO 2000 (CDC, Atlanta).17 Weight at birth and head circumference at birth analysis were compared using ANOVA. Changes in infant anthropometry and maternal weight, BMI and MUAC over time and interaction between
time and groups were tested using repeated measures ANOVA. Morbidity outcomes were analyzed by chisquare test and Fischer’s exact tests where appropriate. Mean duration of morbidity were compared using ANOVA.

All 179 infants were born at term (39±0.5 weeks). There were more female than male infants in all groups: 54% of the exclusively breast fed, 60% of the partially breastfed and 57% of the formula fed. The infants had no asphyxia or other medical conditions warranting further stay at the hospital and were discharged within 48 hours postpartum.

Infant morbidity
None of the 24 exclusively breastfed infants had diarrhoea during the study period (Table 1). Comparably, 44/134 (32.8%) partially breastfed infants and 15/21 (71.4%) non-breastfed infants had a mean of 2.3 days and 2.5 days of diarrhea, respectively. Ten of twenty-one nonbreastfed infants had 2 episodes of diarrhea during the

Exclusive breastfeeding for the first six months study period; two of them required intravenous fluids. Twelve of one hundred thirty-four (8.9%) partially breastfed infants had 2 or 3 episodes of respiratory tract infections during the study period. There were significantly more partially breastfed infants 35/134 (26.1%) and nonbreastfed infants 12/21 (57.1%) compared to exclusively breastfed infants 2/24 (8.3%) who received antibiotics for respiratory infections. None of the exclusively breastfed infants were hospitalized for respiratory infections compared to 12/134 (8.9%) of the partially breastfed infants and 8/21 (38%) of the non-breastfed infants. Two of the twelve (16.6%) partially breastfed infants and two of the eight (25%) non-breastfed infants hospitalized for bronchopneumonia required intensive care (Table 1). No infant in the study died.
Infant anthropometry
Table 2 shows infant mean weight at birth, 2, 4 and 6 months. Body length and head circumference at birth and at 6 months is also shown. The exclusively breastfed infants did not differ from those partially breastfed and the non-breastfed infants in any of these parameters. Table 3 shows gains in weight, body length and head circumference in the groups from birth to six months. Weight gains were largest between birth and two months and lowest
between four and six months. During the latter period the weight gain of the partially breastfed and non-breastfed infants were significantly higher than that of those who
were exclusively breastfed (p <0.05). However, overall weight gain from birth to six months did not differ between the groups. Neither did the gains of length or head circumference from birth to six months differ. Figure 1 shows the development of mean weight-for-age z score
(WAZ) during 6 months. Neither WAZ (Figure 1) nor mean length-for-age z score (LAZ) or mean head circumference- z score for age at birth, 2, 4, and 6 months differedbetween the groups. When tested by ANOVA there were no significant differences between the group over time. There was no difference in any of the groups with
With respect to: age, number of prenatal visits, education,
income or employment outside the home; mothers who
breastfed exclusively did not differ from those who
breastfed partially.
Maternal anthropometry
Table 4 shows maternal anthropometry. Mean height did not differ between the groups. Mean weight, BMI and MUAC were not statistically different between the groups at 24-48 hour postpartum, or at 2, 4 and 6 months. Neither did the mean weight loss, decrease in BMI or MUAC during the six months differ. ANOVA-analysis showed that there were no significant changes in MUAC over time. However, there were significant changes in weight as well as in BMI but the changes did not differ among the groups for weight or for BMI. The proportions of mothers with low BMI and CED (Table 5) increased as compared to the situation at baseline. However, there were no significant differences among groups at any time point.

The infants who were exclusively breastfed from birth to six months were protected from diarrhea as well as severe respiratory infections and had catch up growth. The mean weight loss and decrease in BMI and MUAC through six months did not differ among these first time mothers who breastfed infants exclusively or partially or gave formula.This isreassuring for mothers of low birth weight infants, who commonly have nutritional problems. Breastfeeding has been reported to lower incidence and percentage of infant ill days, and to result in shorter episodes of diarrhea and acute respiratory infection.18 We obtained no differences among groups with regard to the number of respiratory infections, even though the partially breastfed infants had more severe infections. Our data are consistent with results from studies from the Philippines as well as with data from other developing countries demonstrating that breastfeeding confers protection against diarrhea. Exclusive breastfeeding protects against diarrhea by eliminating exposure to water- and food borne pathogens.19-21 It also provides protection through several factors such as SIgA, antibodies, lactoferrin and
lysoszyme.22 Gains in weight, length and head circumference during the six months study period did not differ among the study infants. Further, similar average gains in weight, length and head circumferences were observed even among infants of mothers with low BMI or CED. The mean weight, length and head circumference of the infants of all groups through six months were well within the normal range for LBW Filipino infants.23 The average gains in infant weight, length and head circumference over the six-month period were similar to those observed in other low-income country studies.24 Despite the smaller weight gain achieved by infants of all groups between 4 and 6 months, growth faltering is difficult to evaluate during the short observation period and by using the NCHS growth chart, which is based on a sample of predominantly formula-fed infants, born appropriate for age. The LBW infants in this study who were breastfed exclusively for their first 6 months had catch up growth implying that breast milk alone is sufficient to support growth. Considering the benefits of exclusive breastfeeding from birth the need to collect this kind of information should be kept in mind and that the use of 24 hours recall of infant feeding might have  imitations as to accuracy. Studies involving mothers from developed countries have not shown any relationship between postpartum maternal weight loss and breastfeeding.25,26 Our findings confirm results showing that the duration and exclusivity of breastfeeding was not associated with increased postpartum maternal weight loss at six months.27,28 Therefore,
exclusive breastfeeding from birth to six months, as recommended by the WHO, is not disadvantageous with respect to maternal physical status. There are some limitations in our study. First, there were a small number of exclusively breastfed infants. Secondly, our data was derived from a randomized trial, of which the primary objective was to test the efficacy of peer counselling on the exclusivity and duration of breastfeeding through six months. Even though breastfeeding was self-reported the recall period was short and hence more reliable.29
The strength of the study is attributable to the fact that data was derived from a randomised controlled trial. Only one study physician verified infant illnesses and made all body measurements. Furthermore, one and the same researcher made all maternal measurements during the entire study period. The high quality of the data is strengthened by careful, longitudinal and repeated measurements over time.
In conclusion, exclusive breastfeeding from birth to six months was associated with catch up growth and protected LBW infants from diarrhea and more severe respiratory tract infections. It is reassuring that exclusively breastfeeding mothers did not loose more weight than those partially breastfeeding or the mothers who did not breastfeed. Exclusive breastfeeding of term low birth weight infant is thus beneficial for both mother and infant.

WHO merekomendasikan untuk memberikan ASI ekslusif untuk anaknya sampai usia 6 bulan. ASI ekslusif adalah memeberikan asi tanpa memebrikan makanan pendamping apapun sampai usia bayi 6 bulan. Asi ekslusuif sangan bermanfaat baik bagi si ibu dan juga untuk bayiSalah satu cara efektif yang direkomendasikan oleh World Health Organization (WHO) dalam memenuhi kebutuhan nutrisi bayidengan berat badan lahir rendah adalah dengan memberikan ASI secara eksklusif sekurangnya selama usia 6 bulan pertama. Bayi berat lahir rendah (BBLR) merupakan bayi yang dilahirkan dengan berat lahir kurang dari 2500 gram tanpa memandang usia gestasi.
Air Susu Ibu (ASI) merupakan satusatunya makanan bagi bayi usia 6 bulan pertama yang mencukupi seluruh unsur kebutuhan bayi baik fisik, psikologi, sosial maupun spiritual. ASI sangat bermanfaat bagi bayi, terutama dalam mengurangi kejadian infeksi, karena ASI
24 jam pertama mengandung kolostrum yang berguna untuk meningkatkan daya tahan tubuh.
ASI juga mengandung whey (protein utama dari susu yang berbentuk cair) lebih banyak dari pada casein (protein utama dari susu yang berbentuk gumpalan) sehingga ASI lebih mudah diserap tubuh bayi, dan akan berpengaruh kepada peningkatan berat badan bayi (Baskoro, 2008).ASI dapat ditoleransi dengan lebih baik, mendukung pematangan usus, dan mengurangi resiko enterokolitis nekrotrikan. Sehingga mencegah terjadinya diare pada bayi, karena banyak bayi yang mengalami diare karena tidak mendapatkan asi. Di dalam ASI terdapat Minimal enteral trophic feeding yang terbukti merangsang saluran gastrointestinal bayi, mencegah atrofi mukosa dan selanjutnya menghindari kesulitan pemberian makan. Perubahan berat badan pada BBLR mencerminkan kondisi gizi atau nutrisi bayi dan erat kaitannya dengan daya tahan tubuh. Pada BBLR akan kehilangan berat badan pada minggu pertama kehidupannya sebesar 10-15%. Dan akan kembali lagi pada usia10-14 hari sebesar 25-30 gr per hari selama 3 bulan. Uji pengukuran berat (weighing test) sering digunakan untuk memperkirakan asupan susu bayi yang mendapat ASI. Bayi ditimbang sebelum dan sesudah mendapatkan ASI.
Pemberian ASI juga bermanfaat bagi Ibu diantaranya :
1.      Membantu mempercepat pengembalian uterus sehingga mencegah terjadinya perdarahan post partum.
2.      Menyusui secara teratur akan menurunkan berat badansecara bertahapkarena penegeluaran energi untuk ASI dan proses pembentukannya akan mempercepat kehilangan lemak.
3.      Mencegah terjadinya kanker payudara
4.      Sebagai alat kontrasepsi alami/Metode Amenore Laktasi (MAL)

Dapat disimpulkan bahwa  pemberian asi ekslusif mempunyai banyak manfaat diantaranya pada bayi dengan BBLR akan mengalami kenaikan berat badan, sehingga pemberian ASI sangat dianjurkan dalam memenuhi kebutuhan nutrisi bagi BBLR dan mencegah terjadinya diare pada bayi karena kandungan ASI yang sesuai dengan kebutuhan bayi serta untuk ibu dapat menurunkan berat badan secara bertahap.

Sumber :

marmi. (2014). Asuhan Kebidanan pada Masa Nifas " Pueperium Care". Yogyakarta: Pustaka Pelajar.
Soetjiningsih. (1997). ASI : Petunjuk untuk Tenaga Kesehatan. Jakarta: EGC.

Rabu, 18 Maret 2015

asuhan kebidanan


Kebidanan adalah satu bidang ilmu yang mempelajari keilmuan dan seni yang mempersiapkan kehamilan, menolong persalinan, nifas dan menyusui, masa interval dan pengaturan kesuburan, klimakterium dan menopause, bayi baru lahir dan balita, fungsi–fungsi reproduksi manusia serta memberikan bantuan/dukungan pada perempuan, keluarga dan komunitasnya

Pelayanan Kebidanan (Midwifery Service)

Pelayanan kebidanan adalah bagian integral dari sistem pelayanan kesehatan yang diberikan oleh bidan yang telah terdaftar (teregister) yang dapat dilakukan secara mandiri, kolaborasi atau rujukan.

Praktik Kebidanan

Praktik Kebidanan adalah implementasi dari ilmu kebidanan oleh bidan yang bersifat otonom, kepada perempuan, keluarga dan komunitasnya, didasari etika dan kode etik bidan.

Manajemen Asuhan Kebidanan

Manajemen Asuhan Kebidanan adalah pendekatan dan kerangka pikir yang digunakan oleh bidan dalam menerapkan metode pemecahan masalah secara sistematis mulai dari pengumpulan data, analisis data, diagnosa kebidanan, perencanaan, pelaksanaan dan evaluasi.

Asuhan Kebidanan

Rabu, 02 April 2014

bahaya petting

Sebelumnya udah pernah dibahas tentang Ciri-ciri Wanita Pecandu Seks ,sekarang gantian,gw share tentang ciri2 laki-laki pencandu seks..
Pecandu seks biasanya pemikirannya di domisili oleh seks.#Hiperseks
Satyriasis adalah sebutan #Hiperseks pria.
Nymphomania adalah sebutan #Hiperseks wanita.

Ukuran seseorang dikatan #HiperSeks jika melakukan hubungan intim 3-4 kali per hari , atau 20X per minggu.

Waspadalah jika pasangan mu tetap buruh masturbasi ,padahal sudah cukup sering melakukan hubungan intim dg mu. #HiperSeks

pria Hiperseks cenderung akan menenangkan pikirannya dg menonton video porno atau masturbasi. #ciriHiperSeks

pria hiperseks sangat hobby masturbasi sambil menonton film2 porno atau melihat gambar2 porno. #ciriHiperSeks

pria hiperseks cenderung bicara soal seks disaat yg tidak tepat. alias tidak bisa mengkontrol. #ciri HiperSeks
pria hiperseks Pastinya pinter Berbohong dengan pasangannya.#ciri HiperSeks

faktanya pria #HiperSeks tidak mau mengaku atau bahkan sulit menerima kenyataan kalau dirinya sudah kecanduan.

Alhasil ,,pria #HiperSeks akan bersikap Defensif ,mereka melakukan berbagai cara untuk membantah tuduhan siapa pun.

Peneliti membuktikan bahwa pria yg kecanduan film porno ,bisa sulit ereksi saat melakukan aktifitas seks yg nyata. #Ciri HiperSeks

pria yg kecanduan pornografi cenderung mengharapkan pengalaman seks yg lebih ekstrim untuk membuat terangsang. #ciriHiperSeks

ciri pria #Hiperseks tidak bisa menerima penolakan dari pasangan, terutama saat urusan bercinta. Alias Suka Maksa.

ciri pria #HiperSeks suka melakukan hal yg tidak lazim , misalnya : hubungan seks dg keadaan pintu & jendela terbuka .

yg lebih parah jika pria #HiperSeks suka EKSIBISIONIS alias perilaku menyimpang seks yg mndapat kepuasan dg Mempertonton kan kelaminnya.

pria #HiperSeks mrka tdk cukup bercinta atau masturbasi , mereka akn mencari cara lain utk melepaskan hasratnya. yaitu dg SELINGKUH.

Ok guys ..sekian sharing tentang pria #HiperSeks ! jika pasangan mu demikan, konsultasikan dg Ahli Psikologi

bahaya dan efek samping onani

Gak sedikit para ahli kesehatan yg mengatakan bahwa melakukan Onani berlebih bisa mengurangi ukuran penis . # Efek Onani

tarikan dan sentakan yg terlalu over saat Onani bisa mengakibatkan Broken penis (penis pecah). #Efek onani

syaraf yg rusak membuat penis stress, mengakibatkan kurangnya perasaan saat berhubungan seks . #Efek Onani

penis tak bertulang / berotot , tp terdiri dr darah ,jaringan spons & jaringan parut , jika di sentak terlalu kuat bs pecah. #efek Onani

Saat melakukan #onani berlebih bnyk energi yg keluar, hal ini yg mengakibatkan kelelahan & menghambat kinerja seseorang dlm beraktifitas.

seseorang yg terlalu over onani, memory otak nya bisa menyimpan banyak hal2 yg berbau porno, susah untuk menghapusnya. bahaya onani

seseorang yg onaniholic kurang konsentrasi dan terobsesi pada seks . #efek onani

kelelahan otak disebabkan saat onani membakar banyak energi, hormon dan nutrisi . #efek onani

rasa bersalah bahkan bisa depresi karena takut dosa saat melakukan onani ,sedangkan otak nya tak kuasa mencegah. (kerusakan mental ).

ereksi yg berpanjangan mengepalkan otot2 ginjal dan exorsion ,dg tumpukan pembuluh darah di anus. #efek onani

berhati2lah saat onani, karena bisa me.gakibatkan kerusakan permanen pada diri sendiri. #Nasehat

"Gue heran kalo ada yg bilang Onani itu menyehatkan.. kenapa gak memperhatikan dampak buruknya? *Cerdaslah"


Kalimat #OralSex udah gak asing lagi di masyarakat, tapi gak sedikit yg faham Bahaya terkait dg Kanker Tenggorokan ,

Para peneliti telah menemukan bahwa Kanker Oropharyx (tengah tenggorokan ) dan amandel kemungkinan di sebabkan oleh HPV.#OralSex

Virus HPV (human papilloma virus) yg di tularkan secara #OralSex dapat Menyebabkan Kanker.

Berdasarkan studi The New England Journal Of Orofaringnal #OralSex itu beresiko.

#OralSex bisa menyebabkan pasangan Stres bagi beberapa pasangan ,tapi juga bisa Memungkinkan kenikmatan untuk Orang lain.

Stress yg terkait dg #OralSex berkaitan dg Masalah kebersihan Pasangan .

Terkadang Tidak semua pasangan Mau menerima #OralSex [ malu, geli,jorok] dLL respon pasangan.

Dinamika Adanya Sexsual inilah yg kemungkinan Menjadi bagian dari PRO & Kontra dari#OralSex

Virus HIV + AIDS bisa ditularkan melalui #OralSex

Herpes ( kutil di kelamin ) bisa di tularkan melalui #OralSex

Sifilis ( raja singa ) merupakan infeksi kelamin ,bisa di tularkan.melalui #OralSex

Penyakit "Gonore " infeksi kelamin ( kencing nanah) , bisa di tularkan melalui #OralSex

HPV (human papilloma virus ) yg di idap pada penderita Keputihan , bisa tertular melalui #OralSex

Meskipun Resiko yg di tularkan tidak SeBesar VaginalSex & AnalSex ,tapi #OralSex Tetep menimbulkan Resiko.

#OralSex kebanyakan di lakukan remaja , kareja mereka fikir jauh dari Resiko ke hamilan & hasrat terpuaskan.