Status Epileptikus Neonatus dan Pneumonia Aspirasi pada Bayi Usia 20 Hari: Laporan Kasus

Amira Nabila, Shinta Nareswari

Abstract

Latar Belakang: Kejang neonatus merupakan kedaruratan neurologis akibat disfungsi sistem saraf pusat pada bayi berusia 0–28 hari. Berbagai faktor risiko pada masa antenatal dan intranatal, serta penundaan penanganan medis akibat faktor sosial budaya, memicu komplikasi gawat napas berat, seperti pneumonia aspirasi, dan memperburuk klinis pasien.

Laporan Kasus: Seorang bayi laki-laki berusia 20 hari (Neonatus Cukup Bulan Sesuai Masa Kehamilan/NCB-SMK) dirujuk ke RSUD Dr. H. Abdul Moeloek dengan diagnosis status epileptikus neonatal tipe tonik dan pneumonia bilateral. Pasien memiliki riwayat kejang berulang sejak usia 3 hari, yang mengalami eksaserbasi dengan durasi hingga 2,5 jam setelah dibawa ke pengobatan tradisional (dukun pijat). Pemberian minum menggunakan sendok pada fase pasca-iktal memicu tersedak hebat yang disertai tanda gawat napas (takipnea 60 kali/menit, sianosis sirkumoral, hipersalivasi, retraksi suprasternal, dan ronki basah halus bilateral), serta distensi abdomen sekunder akibat ileus paralitik. Pemeriksaan laboratorium menunjukkan leukositosis dengan dominasi neutrofil (71%) serta asidosis metabolik ringan. Foto toraks menunjukkan opasifikasi pada lapang bawah paru kanan dan lapang tengah paru kiri, yang mendukung diagnosis pneumonia aspirasi bilateral. Pasien kemudian ditatalaksana secara intensif menggunakan intubasi endotrakeal untuk mendukungan ventilasi mekanik, dekompresi saluran cerna dengan pipa orogastrik (Orogastric Tube/OGT), pemberian fenobarbital dosis rumatan (10,8 mg/12 jam IV), deksametason, serta antibiotik empiris spektrum luas (kombinasi ampisilin-sulbaktam dan amikasin).

Kesimpulan: Kasus ini menegaskan bahwa status epileptikus dengan pneumonia aspirasi memerlukan diagnosis dan tata laksana klinis yang komprehensif. Rendahnya literasi kesehatan keluarga dan preferensi terhadap pengobatan alternatif dapat memicu perburukan klinis yang mengancam nyawa neonatus, sehingga diperlukan penanganan intensif dan agresif di Neonatal Intensive Care Unit (NICU).

Background: Neonatal seizures are a neurological emergency resulting from central nervous system dysfunction in infants aged 0–28 days. Various antenatal and intranatal risk factors, as well as delayed medical treatment due to sociocultural factors, trigger severe respiratory complications, such as aspiration pneumonia, and worsen the patient's clinical condition.

Case Report: A 20-day-old male infant (Term Neonate for Gestational Age/NCB-SMK) was referred to Dr. H. Abdul Moeloek Regional General Hospital with a diagnosis of tonic neonatal status epilepticus and bilateral pneumonia. The patient had a history of recurrent seizures since the age of 3 days, which experienced exacerbations lasting up to 2.5 hours after being taken to traditional medicine (traditional massage therapist). Feeding with a spoon in the post-ictal phase triggered severe choking accompanied by signs of respiratory distress (tachypnea 60 breaths/minute, circumoral cyanosis, hypersalivation, suprasternal retractions, and bilateral fine rhonchi), as well as abdominal distension secondary to paralytic ileus. Laboratory examinations showed leukocytosis with a predominance of neutrophils (71%) and mild metabolic acidosis. A chest X-ray showed opacification in the right lower lung field and left mid-lung field, which supported the diagnosis of bilateral aspiration pneumonia. The patient was then managed intensively using endotracheal intubation to support mechanical ventilation, gastrointestinal decompression with an orogastric tube (OGT), administration of maintenance doses of phenobarbital (10.8 mg/12 hours IV), dexamethasone, and broad-spectrum empirical antibiotics (a combination of ampicillin-sulbactam and amikacin).

Conclusion: This case shows that status epilepticus with aspiration pneumonia requires comprehensive diagnosis and management. Low family health literacy and preference for alternative treatments can cause life-threatening deterioration in neonates, requiring intensive and aggressive NICU care.