kebidanan terkini evidence based

klik disini

https://drive.google.com/open?id=0B72c_c1FfNwXNmRVT3h2TW0wejg&authuser=0

tugas 2 Nama kelompok : Isna Marantika,Dwi Ridarwati,Nurul Abidah,Indriani,Nurfaida suprihatin,Febriyanti Puji L

https://drive.google.com/open?id=0B72c_c1FfNwXaHM5VWZ6bDlqTEU&authuser=0

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.

INTRODUCTION

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.

RESULTS

Infants

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

Mothers

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.

DISCUSSION

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.

CONCLUSION

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.

ANALISIS ISI JURNAL.

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.

asuhan kebidanan

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

Daftar isi

• 1 Pelayanan Kebidanan (Midwifery Service)
• 2 Praktik Kebidanan
• 3 Manajemen Asuhan Kebidanan
• 4 Asuhan Kebidanan
• 5 Lihat pula
• 6 Pranala luar

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

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