Kelas Ibu Hamil ASN Maret 2021

 

KEBERHA KEBER HASI SILA LAN N MEN MENYU YUSU SUII DIMULAI SAAT KEHAMILAN disampaik paikan an untuk ASN dan Non Non ASN Lintas Kemente Kementerian rian disam Sela Se lasa sa 9 Mare Marett SpA, 2021 20 21 IBCLC dr. Wiyarni Pambudi,

 

Jutaa Jut aan n sel hid hidup up,, ter terma masu suk k sel pun punca ca >1000 protein tumbuh kembang, sistem imun, pembe pem bent ntuk ukan an sel sar saraf af >20 asam amin amino, o, termasuk termasuk nukle nukleoti otida da >300 oligosakarida   pre prebio biotik tik bak bakter terii bai baik k unt untuk uk perlind perl indung ungan an salur saluran an cern cerna a dan otak >40 enzim   bioa bioavai vailibi libitas tas kont konten en ASI Growth facto Growth factors rs dan bera beragam gam hor hormon mon lain Antibodi: 5 jenis immunog immunoglobuli lobulin n LCPUFA LCPU FA

pembent pemb entuka ukan n sel sara saraff dan mata

>1400 micr microRN oRNAs As

regulasi regu lasi ekspr ekspresi esi gen

Berub Ber ubah ah din dinam amis, is, sesua sesuaii kon kondi disi si bay bayii (da (dan n ibu)

 

Water Carbohydrates (energy source) • Lactose • Oligosaccharides (see below) Carboxylic acid • Alpha hydroxy acid • Lactic acid Proteins (building muscles and bones) • Whey protein • Alpha-lactalbumin • HAMLET (Human Alpha-lactalbumin Made Lethal to Tumour Tumour cells) • Lactoferrin • Many antimicrobial factors (see below)

• Casein • Serum albumin Non-protein nitrogens • Creatine • Creatinine • Urea • Uric acid • Peptides (see below) Amino Acids (the building blocks of proteins) • Alanine • Arginine • Aspartate

•• • • • • • • • • • • • • • • •

Clycine Cystine Glutamate Histidine Isoleucine Leucine Lycine Methionine Phenylalanine Proline Serine Taurine Theronine Tryptophan Tyrosine Valine Carnitine (amino acid compound necessary to make use of fatty acids as an energy source)

Nucleotides (chemical compounds that Phospholipids are the structural units of RNA and • Phosphatidylcholine • Phosphatidylethanolamine DNA) • 5’-Adenosine monophosphate (5”- • Phosphatidylinositol AMP) • Lysophosphatidylcholine • 3’:5’ 3’:5’-Cyclicadenosine • Lysophosphatidylethanolamine monophosphate (3’:5’-cyclic AMP) • Plasmalogens Sphingolipids • 5’-Cytidine monophosphate (5’CMP) • Sphingomyelin • Cytidine diphosphate choline (CDP • Gangliosides choline) • GM1 • Guanosine diphosphate (UDP) • GM2 • Guanosinediphosphate – mannose • GM3 • 3’- Uridine monophosphate (3’-UMP) • Glucosylceramide

• • • • •

• 5’-Uridine monophosphate (5’-UMP) • Glycosphingolipids • Uridine diphosphate (UDP) • Galactosylceramide • Uridine diphosphate hexose (UDPH) • Lactosylceramide • Uridinediphosphate-N-acetyl• Globotriaosylceramide(GB3) hexosamine (UDPAH) • Globoside (GB4) • Uridine diphosphoglucuronic diphosphoglucuronic acid Sterolds • Squalene (UDPGA) • Several more novel nucleotides of the • Lanosterol • Dimethylsterol UDP type • Methosterol Fats • Triglycerides • Lathosterol • Long-chain polyunsaturated fatty • Desmosterol acids • Triacylglycerol • Docosahexaenoic acid (DHA) • Cholesterol

• • • • • • • • • •

(important for brain development) • Arachidonic acid (AHA) (important for brain development) • Linoleic acid • Alpha-linolenic acid (ALA) • Eicosapentaen Eicosapentaenoic oic acid (EPA) • Conjugated linoleic acid (Rumenic acid) Free Fatty Acids Monounsaturated fatty acids • Oleic acid • Palmitoleic acid • Heptadecenoic acid Saturated fatty acids • Stearic • Palmitic acid • Lauric acid • Myristic acid

•• • • • • •

7-dehydrocholesterol Stigma-and campesterol 7-ketocholesterol Sitosterol   β-lathosterol Vitamin D metabolites Steroid hormones Vitamins • Vitamin A • Beta carotene • Vitamin B6 • Vitamin B8 (Inositol) • Vitamin B12 • Vitamin C • Vitamin D • Vitamin E • a-Tocopherol • Vitamin K • Thiamine

Riboflavin Niacin Folic acid Pantothenic acid Biotin Minerals • Calcium • Sodium • Potassium • Iron • Zinc • Chloride • Phosphorus • Magnesium

Tumor necrosis factor-α Interferon-γ Epithelial growth factor (EGF) Transforming growth factor-α (TGFα) • TGF β1 • TGF-β2 • Insulin-like growth factor-I (IGF-I) (also known as somatomedin C) • Insulin-like growth factor- II • Nerve growth factor (NGF) • Erythropoietin Peptides (combinations of amino acids) • HMGF I (Human growth factor)

• • • •

Copper • Manganese • Iodine • • Selenium Choline • Sulpher • Chromium • Cobalt Fluorine • Nickel • Metal • • Molybdenum (essential element in • many enzymes) Growth Factors (aid in the maturation of • the intestinal lining) Cytokines Interleukin-1β (IL-1β) IL-2 IL-4 IL-6 IL-8 IL-10 Granulocyte-colonystimulating factor (G-CSF) • Macrophage-colonystimulating factor (M-CSF) • Platelet derived growth factors (PDGF) • Vascular endothelial growth factor (VEGF) • Hepatocyte growth factor -α (HGF-α) • HGF-β

• • • • • • •

• • • • • • • •

intake)

carry signals from one cell, or group of cells, to another via the blood) Cortisol Triiodothyronine (T3) Thyroxine (T4) Thyroid stimulating hormone (TSH) (also known as thyrotropin) Thyroid releasing hormone (TRH) Prolactin Oxytocin Insulin Corticosterone Thrombopoietin Gonadotropin-releasing Gonadotropin-releas ing hormone (GnRH) GRH

immunoglobulin A) • sIgA (Secretory immunoglobulin

• Ghrelin (aids in regulation of food • • • • • • • • •

intake) Adiponectin Feedback inhibitor of lactation (FIL) Eicosanoids Prostaglandinss (enzymatically Prostaglandin derived from fatty acids) PG-E1 PG-E2 PG-F2 Leukotrienes Thromboxanes

HMGF II • Prostacyclins Enzymes (catalysts that support HMGF III chemical reactions in the body) Cholecystokinin Cholecystokin in (CCK)   β-endorphins • Amylase • Arysulfatase Parathyroid hormone (PTH) Parathyroid hormone-related peptide • Catalase • Histaminase (PTHrP)   β-defensin-1 • Lipase • Lysozyme Calcitonin • PAF-acetylhydrolase Gastrin • Phosphatase Motilin Bombesin (gastric releasing peptide, • Xanthine oxidase Antiproteases (thought to bind also known as neuromedin neuromedin B) themselves to macromolecules such Neurotensin

Somatostatin •Hormones (chemical messengers that

• • • •

• Leptin (aids in regulation of food

as enzymes and as a result prevent allergic and anaphylactic reactions)

• a-1-antitrypsin • a-1-antichymotrypsin

• • • • • • • • • • • • • • • • • • • • • • •

(the most important antiinfective factor) IgA2 IgG IgD IgM IgE Complement C1 Complement C2 Complement C3 Complement C4 Complement C5 Complement C6

Complement C7 Complement C8 Complement C9 Glycoproteins Mucins (attaches to bacteria and viruses to prevent them from clinging to mucousal mucousal tissues) Lactadherin Alpha-lactoglobulin Alpha-2 macroglobulin Lewis antigens Ribonuclease Haemagglutinininhibitors Bifidus Factor (increases (increases growth of

Lactobacillus bifidus – which is a good bacteria) • Lactoferrin (binds to iron which

Antimicrobial factors (used by the • immune system to identify and • neutralize foreign objects, such as bacteria and viruses) • • Leukocytes (white blood cells) • Phagocytes • Basophils • Neutrophils • • Eosinophils • Macrophages • Lymphocytes • B lymphocytes (also known as B cells) • T lymphocytes (also known as C cells)

prevents harmful bacteria from using the iron to grow) Lactoperoxidase B12 binding protein (deprives microorganisms microorgan isms of vitamin B12) Fibronectin (makes phagocytes more aggressive, minimizes inflammation, and repairs damage caused by inflammation) Oligosaccharides Oligosaccharid es (more than 200 differentkinds!)

 

lahir Kolostrum memberikan

9-12 bulan

3-4 bulan Kalori ASI meningkat untuk

memenuhi kebutuhan imunitas & perlindungan saluran cerna perkembangan motorik

Asam amino menjamin kebutuhan protein untuk pertumbuhan otot & optimalisasi IQ

4-6 minggu

6 bulan

Puncak kadar antibodi dalam ASI, prevensi alergi &

Kandungan asam omega esensial berlimpah untuk perkembangan sel otak

risiko infeksi

& tabungan HAMLET

 

lingk gkunga ungan n Satu dari Satu dari li lima ma ibu mem memutu utusk skan an berh berhen enti ti meny menyus usui ui kare karena na tekanan tekanan lin Satu Sa tu da dari ri empa empatt ib ibu u menyerah ka karen rena a menyusui menyusui ter terasa asa suli sulitt & mele melelah lahkan kan Dua Du a dari dari tiga tiga ib ibu u me meng ngal alam amii kris krisis is pe pede de (b (beru erula lang ng)) sel selama ama menyus menyusui ui

DUKUNGAN

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Kurangnya

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Masa Ma sala lah h fis fisik ik & em emos osii TE TERA RABA BAIK IKAN AN ◘

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Terpengaruh

Kekhawatiran ASI ‘kurang’

PROMOSI

formula bayi

 

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Mis-i Mi s-inf nfor orma masi si / mi mito toss me meny nyus usui ui & pr prom omos osii PA PASI SI

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Titi Titik k be bera ratt pa pada da AS ASI, I, b buk ukan an me meny nyus usui ui

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Terbat Ter batasn asnya ya kes kesemp empata atan n kon konsel seling ing men menyus yusui ui

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Terb Te rbat atas asny nya a ba bant ntua uan n pr prak akti tiss me meny nyus usui ui

Kesulilita Kesu tan n ak akse sess AS ASII do dono norr ◘ Min Minimn imnya ya dukung dukungan an lin lingku gkung ngan an ◘

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Harapan Hara pan ya yang ng ti tidak dak real realistis istis

 

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Baga Ba gaim iman ana a re renc ncan ana a pe pemb mber eria ian n AS ASI? I?

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Berapa Ber apa la lama ma ing ingin in men menyus yusui? ui?

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Dukung Duk ungan an apa yan yang g dibutu dibutuhka hkan? n?

pili liha han n pe pemb mber eria ian n ma maka kan n ba bayi yi?? Bagaimana pi  Be Berrap apa a la lama ma se seba baik ikny nya a sa saya ya me meny nyus usui ui?? 



Duk Du kun unga gan n ap apa a ya yang ng b bis isa a di dibe beri rik kan an??

 

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Hamil → men mengap gapa a & baga bagaima imana na

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Bersalin → IMD

Nifas → RG & bant bantuan uan pra prakti ktiss ◘ Pe Pema mant ntau auan an ru ruti tin n ba badu duta ta ◘

 

K

K

K2 2

K1 1

K K+ +

K

K

K+ +

K3 3

K

K+ + K

K4 4

K

K55

K

K66

K

K77 K

K+ +

 

Disk Di skus usii sa saat at AN ANC C berm bermak akna na dalam memeng dalam memengaru aruhi hi kepu ke putu tusa san n ib ibu u untu untuk k memili mem ilih h metod metode e pemb pember eria ian n makan bayi, meningkatk meningkatkan an keyakinan menyusu keyakinan menyusui, i, dan membantu membant u mengidenti mengidentifikas fikasii pote po tens nsii ma masa salah lah menyu menyusu suii

 

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Manf Ma nfaa aatt me meny nyus usui ui & pe pemb mber eria ian n AS ASII

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Prinsip Prinsi p pro produk duksi si ASI ◘ Teknik menyusui ◘

Dukungan keluarga

Splatz et al. JOGN 2020

H a ri 1 - 2 5-15 mL

H a ri 3

H a ri 4 - 5

15-30 mL 30-60 mL

H a ri 6 - 7 > 5 0 mL

 



Tangisan awal





  5’

Rileksasi

Terjaga



Aktivitas



Istirahat



Tidur

50-90’

 

Mengisap



30-60’

Penyesuaian





Merayap

 

Untu Un tuk k ba bayi yi ◘

◘

◘ ◘

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Lebih Lebi h su suks kses es men menyu yusu sui, i, pertumb per tumbuha uhan n leb lebih ih optimal optimal Termoregulator, sistem kardio Termoregulator, kardio-respi res pira rasi si leb lebih ih stabi stabil, l, kad kadar ar gu gula la dara da rah h le lebi bih h ting tinggi gi Adap Ad apta tasi si sa salu lura ran n ce cern rna a le lebi bih h ba baik ik Pola tidur Pola tidur leb lebih ih teratur, teratur, amb ambang ang nyeri ny eri leb lebih ih rend rendah, ah, tang tangis is lebih lebih  jarang Bondin Bon ding g lebih lebih erat

Untu Un tuk k ib ibu u ◘

Menurunkan Menurunk an level stress ibu

◘

Meningk Men ingkatk atkan an per persep sepsi si & dukung dukungan an aya ayah h

◘

Menamb Men ambah ah per percay caya a diri/ra diri/rasa sa keibu keibuan an Cochrane Database Syst Rev 2011-2012

 

Tempera Temp eramen men bayi

Karak Kar akte terr ibu

Kondisi Kond isi medis Hisapan Hisap an efekt efektif if

Persepsi Perse psi

Bayi

Niat Budaya

Anak pertama

Ibu

Situ Si tuas asii so sosi sial al Promosi

kepercay keper cayaan aan

keyakina keyak inan n Komplika Komp likasi si medi mediss

Pengalaman

Tant Ta ntan anga gan n pe pemb mber eria ian n AS ASII Kerabat

Nakes ntegritas

Pelayanan

Aktivitas

PSP

kompetensi

 

•

•

•

•

•

•

•

 EBF 6 bulan (RR 2.04, CI 1.58–2.65)  EBF 4 bulan (RR 1.52, CI 1.14-2.0 1.14-2.03) 3)

formula-feedi -feeding ng 2 bulan pertama pertama (RR 0.69, CI 0.52-0.93)  full formula  problem menyusui (RR 0.24, CI 0.10-0.57)

 

saat terjadi masalah menyusui dukungan ayah  pengetahuan ibu tentang pemberian ASI (p≤0 001

(RR 1.43, CI 1.22-1.68)

 perilaku positif terhadap ASI & menyusui (p≤0 001 Mahesh et al. BMC Public Health Health 2018;1 2018;18:1140 8:1140

 

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Ibu dan bayi terpisah

Bayi terlalu lemah mengisap ◘ Ibu terlalu sakit/payudara nyeri hebat ◘

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Mempertahankan produksi ASI

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Persiapan relaktasi

 

BB tur turun un >10 >10% % da dari ri BB llah ahir ir Kuni ning ng ya yang ng be bert rtam amba bah h + bay bayii ‘malas’ minum ◘ Ku

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Kend Ke ndal ala a me meny nyus usui ui ek eksk sklu lusi siff da dari ri ke kedu dua a pa payu yuda dara ra

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Bay Ba yi te terp rpis isa ah da dari ri ib ibu u

 

Teknik menyusui yang kuran kurang g tepat adalah tanta tantangan ngan yang perlu diata diatasi si