Bibir sumbing dengan penyakit jantung bawaan: laporan kasus

Abstract

Background: Congenital malformations contribute to neonates’ mortality. Cleft lip is one of the most common congenital malformations. It’s usually accompanied by other organs’ malformations, such as cardiovascular system. This case report aims to increase the awareness about other congenital malformations which can accompany cleft lip. Case: Baby girl born by sectio caesarea from 39 weeks of pregnancy with premature rupture of membrane. Antenatal USG examination showed that baby was in breech position and suspect congenital malformation. She cried immediately after delivery and had good muscle tone. On examinations, she weighed 2.200 grams, her length was 46 cm, and her head circumference was 30 cm. Her vital signs showed heart rate 152 beats/minute, respiratory rate 50 times/minute, temperature 36.8oC, and SpO2 98%. A cleft on right nose, lip, and palate was found. No abnormalities in thorax, abdomen, vertebra, and extremities examinations. Echocardiography examination showed suspect PFO, mild tricuspid regurgitation, and trivial mitral regurgitation. Her SpO2 dropped to 90% while in perinatology room so she received 0.5-1 liter/minute oxygen supplementation using nasal cannula. On the 7th day, we found secrets on both eyes. Gram examination was done and it tested negative. She received levofloxacin eye drop every 2 hours on both eyes. She was breastfed using specially-designed pacifier. On the 10th day, she was discharged in a good condition. Conclusion: Cleft lip is usually accompanied by other organs’ malformations, such as cardiovascular system. Comprehensive examinations must be done for every baby born with cleft lip.   Latar Belakang: Malformasi kongenital berkontribusi terhadap angka mortalitas bayi. Bibir sumbing merupakan kelainan kongenital yang sering terjadi dan biasanya disertai malformasi organ lain, seperti sistem kardiovaskular. Penulisan laporan kasus ini bertujuan meningkatkan kewaspadaan terhadap kelainan bawaan yang mungkin menyertai bibir sumbing. Kasus: Bayi perempuan dilahirkan secara sectio caesarea dari kehamilan berusia 39 minggu 6 hari yang disertai ketuban pecah dini. Pemeriksaan USG saat kehamilan menunjukkan bayi letak sungsang dan curiga kelainan kongenital. Ketika lahir, bayi segera menangis dan tonus kuat sehingga dilakukan perawatan rutin. Pada pemeriksaan, bayi memiliki berat lahir 2.200 gram, panjang badan 46 cm, dan lingkar kepala 30 cm. Tanda vital menunjukkan denyut jantung 152 kali/menit, laju pernafasan 50 kali/menit, suhu 36.8oC, dan SpO2 98%. Pada pemeriksaan kepala ditemukan celah pada hidung, bibir, dan langit-langit mulut kanan serta tidak ditemukan kelainan pada thoraks, abdomen, vertebra, dan ekstremitas. Pemeriksaan echocardiography menunjukkan suspek PFO, mild tricuspid regurgitation, dan  trivial mitral regurgitation. Saat perawatan di ruang perinatologi, terjadi penurunan SpO2 menjadi 90% sehingga bayi menerima suplementasi oksigen dengan kanula nasal 0.5-1 liter/menit. Pada hari ke 7, ditemukan sekret putih kekuningan di kedua mata sehingga dilakukan pemeriksaan gram dan hasilnya negatif. Bayi kemudian diberikan levofloksasin tetes mata setiap 2 jam di kedua mata. ASI tetap diberikan menggunakan dot khusus dan pada hari ke 10 bayi diizinkan pulang dalam keadaan baik. Simpulan: Bibir sumbing biasanya disertai kelainan organ lain seperti sistem kardiovaskular. Oleh karena itu, pemeriksaan yang komprehensif harus dilakukan pada setiap kasus bibir sumbing.