Formulir Rekapitulasi Kegiatan Pelayanan Neonatal, Bayi, dan Balita | Periode Bulanan
| NO | JENIS KEGIATAN | RUJUKAN | NON RUJUKAN | DIRUJUK | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MEDIS | NON MEDIS | MEDIS | NON MEDIS | |||||||||||||
| Rumah Sakit | Bidan | Puskesmas | Faskes Lainnya | Jumlah Hidup | Jumlah Mati | Total Rujukan Medis | Jumlah Hidup | Jumlah Mati | Total Rujukan Non Medis | Jumlah Hidup | Jumlah Mati | Total Non Rujukan | ||||
| A | NEONATAL | |||||||||||||||
| 1 | Bayi Lahir Hidup | 1 | 0 | 0 | 2 | 0 | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 3 | 1 | |
| 1.1 | Lahir Prematur (< 37 minggu) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 1.1.1 | 1500 - <2500 gram (BBLR) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 1.1.2 | 1000 - <1500 gram (BBLSR) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 1.1.3 | <1000 gram (BBLER) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 1.2 | Lahir Non Prematur (> 37 - 41 minggu) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 1.2.1 | 1500 - <2500 gram (BBLR) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 1.2.2 | 2500 - <4000 gram (BBLN) | 1 | 0 | 0 | 2 | 3 | 0 | 3 | 0 | 0 | 0 | 3 | 0 | 3 | 1 | |
| 1.2.3 | ≥4000 gram (BBLL) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 1.3 | Lahir Lebih dari 41 minggu | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 1.3.1 | 1500 - <2500 gram (BBLR) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 1.3.2 | 2500 - <4000 gram (BBLN) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 1.3.3 | ≥4000 gram (BBLL) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 2 | Lahir Mati | 0 | 0 | 0 | 2 | 0 | 1 | 2 | 0 | 0 | 0 | 0 | 1 | 2 | 0 | |
| 2.1 | Lahir Mati Antepartum | 0 | 0 | 0 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | |
| 2.2 | Lahir Mati Intrapartum | 0 | 0 | 0 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | |
| 3 | Kematian Neonatal dan Perinatal | 1 | 0 | 0 | 2 | 0 | 1 | 3 | 0 | 0 | 0 | 0 | 1 | 3 | 1 | |
| 3.1 | Kematian Neonatal Dini (0 - 7 hari) | 0 | 0 | 0 | 2 | 0 | 2 | 2 | 0 | 0 | 0 | 0 | 2 | 2 | 1 | |
| 3.2 | Kematian Neonatal Lanjut Perinatal (8 - 28 hari) | 0 | 0 | 0 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | |
| 4 | Komplikasi Neonatal | 1 | 0 | 0 | 2 | 3 | 0 | 3 | 0 | 0 | 0 | 3 | 0 | 3 | 1 | |
| 4.1 | Asfiksia | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 4.2 | Trauma Kelahiran | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 4.3 | BBLR | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 4.4 | Tetanus Neonatorum | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 4.5 | Kelianan Bawaan | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 4.6 | Covid-19 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 4.7 | Infeksi / Sepsis | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 4.8 | Komplikasi lainnya | 1 | 0 | 0 | 2 | 3 | 0 | 3 | 0 | 0 | 0 | 3 | 0 | 3 | 1 | |
| 5 | Bayi BBLR yang dilakukan perawatan metode kanguru | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 6 | Bayi baru lahir yang dilakukan IMD | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 7 | Bayi baru lahir yang dilakukan Skrining Hipertiroid Kongenital | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| TOTAL A | 11 | 6 | 5 | 11 | 6 | 5 | 0 | 6 | 5 | 11 | 3 | |||||
| B | BAYI DAN ANAK BALITA | |||||||||||||||
| 8 | Bayi dan Anak Balita | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 8.1 | Bayi Baru Lahir (0 - 28 hari) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 6 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 8.2 | Bayi (29 hari - 11 bulan) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 8.3 | Anak Balita (12 - 59 bulan) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 9 | Balita Gizi Buruk | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 9.1 | Balita Gizi Buruk usia 0-5 bulan | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 9.2 | Balita Gizi Buruk usia 6-59 bulan | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 10 | Balita menggunakan Buku KIA | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 11 | Balita dilakukan skrining pertumbuhan dan perkembangan | 1 | 1 | 0 | 2 | 0 | 0 | 4 | 0 | 0 | 0 | 0 | 0 | 4 | 1 | |
| 11.1 | Skrining Pertumbuhan sesuai umur | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 11.2 | Skrining perkembangan sesuai umur | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 11.3 | Skrining keterlambatan bicara dan bahasa | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | |
| 11.4 | Assessment kelainan motorik | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | |
| 11.5 | Skrining Kelainan Perilaku | 0 | 0 | 0 | 2 | 2 | 0 | 2 | 0 | 0 | 0 | 2 | 0 | 2 | 1 | |
| 11.6 | Skrining Gangguan Pendengaran | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 11.7 | Skrining Gangguan Penglihatan | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 12 | Bayi mendapatkan imunisasi, Vitamin, dan Pengobatan Profilaksis | 20 | 15 | 10 | 5 | 0 | 0 | 50 | 0 | 0 | 0 | 0 | 0 | 50 | 7 | |
| 12.1 | Hb 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 12.2 | BCG | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 12.3 | Polio 1,2,3 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 12.4 | DPT-HB-HiB 1, 2,3,4 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 12.5 | IPV | 8 | 6 | 4 | 2 | 20 | 0 | 20 | 0 | 0 | 0 | 20 | 0 | 20 | 3 | |
| 12.6 | Campak-Rubella | 3 | 2 | 1 | 2 | 8 | 0 | 8 | 0 | 0 | 0 | 8 | 0 | 8 | 2 | |
| 12.7 | Vitamin A 100.000 SI (1 kali dalam setahun) | 8 | 6 | 4 | 4 | 22 | 0 | 22 | 0 | 0 | 0 | 22 | 0 | 22 | 2 | |
| 12.8 | Pemberian Komunikasi, Informasi dan Edukasi (KIE) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 13 | Bayi yang lahir dari Ibu HIV + | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | |
| 13.1 | Pemeriksaan Early Infant Diagnosis (EID) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 13.2 | Pengobatan ARV bagi balita HIV+ | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 13.3 | Pengobatan profilaksis kotrimoksazol | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | |
| 14 | Bayi yang lahir dari Ibu Sifilis + | 2 | 1 | 1 | 1 | 2 | 0 | 5 | 0 | 0 | 0 | 2 | 0 | 5 | 0 | |
| 14.1 | Pemeriksaan Titer RPR | 1 | 0 | 0 | 2 | 3 | 0 | 3 | 0 | 0 | 0 | 3 | 0 | 3 | 0 | |
| 14.2 | Pengobatan dosis tunggal Benzatin Penicillin G | 0 | 0 | 0 | 2 | 2 | 0 | 2 | 0 | 0 | 0 | 2 | 0 | 2 | 0 | |
| 15 | Bayi yang lahir dari Ibu Hepatitis + | 0 | 0 | 0 | 2 | 2 | 0 | 2 | 0 | 0 | 0 | 2 | 0 | 2 | 0 | |
| 15.1 | Pemeriksaan serologis HBs Ag | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 15.2 | Pemberian Hb 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 15.3 | Pemberian Hb Ig | 0 | 0 | 0 | 2 | 2 | 0 | 2 | 0 | 0 | 0 | 2 | 0 | 2 | 0 | |
| 16 | Anak Balita (12 - 59 bulan) mendapatkan Imunisasi, Vitamin, dan Pengobatan profilaksis | 21 | 15 | 10 | 7 | 0 | 0 | 53 | 0 | 0 | 0 | 0 | 0 | 53 | 10 | |
| 16.1 | Campak-Rubela | 6 | 4 | 3 | 2 | 15 | 0 | 15 | 0 | 0 | 0 | 15 | 0 | 15 | 2 | |
| 16.2 | Vitamin A 200.000 SI (2kali dalam setahun) | 6 | 5 | 3 | 3 | 17 | 0 | 17 | 0 | 0 | 0 | 17 | 0 | 17 | 3 | |
| 16.3 | Anak balita mendapat obat pencegahan kecacingan 1 kali setahun | 4 | 3 | 2 | 2 | 11 | 0 | 11 | 0 | 0 | 0 | 11 | 0 | 11 | 2 | |
| 16.4 | Balita (0-59 bulan) terduga TBC/ kontak erat mendapat TPT | 3 | 2 | 1 | 2 | 8 | 0 | 8 | 0 | 0 | 0 | 8 | 0 | 8 | 2 | |
| 16.5 | Balita (0-59 bulan) TBC mendapatkan OAT | 0 | 0 | 0 | 2 | 2 | 0 | 2 | 0 | 0 | 0 | 2 | 0 | 2 | 1 | |
| 16.6 | Pemberian Komunikasi, Informasi dan Edukasi (KIE) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 17 | Balita Gizi Buruk mendapat perawatan | 2 | 1 | 1 | 1 | 3 | 0 | 5 | 0 | 0 | 0 | 3 | 0 | 5 | 1 | |
| 17.1 | Balita Gizi Buruk usia 0-5 bulan yang mendapat rawat inap | 0 | 0 | 0 | 2 | 2 | 0 | 2 | 0 | 0 | 0 | 2 | 0 | 2 | 0 | |
| 17.2 | Balita Gizi Buruk usia 6-59 bulan yang mendapat rawat inap | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| 17.3 | Balita Gizi Buruk usia 6-59 bulan yang mendapat rawat jalan | 1 | 0 | 0 | 2 | 3 | 0 | 3 | 0 | 0 | 0 | 3 | 0 | 3 | 1 | |
| TOTAL B | 120 | 120 | 0 | 120 | 120 | 0 | 0 | 120 | 0 | 120 | 19 | |||||
| TOTAL KESELURUHAN | 131 | 126 | 5 | 131 | 126 | 5 | 131 | 126 | 5 | 131 | 22 | |||||
1. Data kegiatan Neonatal, Bayi, dan Balita: Dilaporkan bulanan dari poli Kebidanan, poli Anak, poli Umum, dan ruang perawatan ibu dan bayi.
2. Bayi lahir hidup: Diisi berdasarkan usia janin saat lahir (Prematur <37 minggu, Non Prematur 37-41 minggu, Lebih dari 41 minggu) dan berat badan.
3. Lahir mati: Kematian janin sebelum lahir usia gestasi >28 minggu (berat ≥1000 gram/panjang ≥35 cm).
4. Kematian neonatal: Dini (0-7 hari) dan Lanjut Perinatal (8-28 hari).
5. Komplikasi neonatal: Termasuk Asfiksia, Trauma Kelahiran, BBLR, Tetanus Neonatorum, Kelainan Bawaan, Covid-19, Infeksi/Sepsis.
6. Bayi BBLR metode kanguru: Bayi berat lahir <2500 gram yang mendapat perawatan metode kanguru.
7. IMD: Inisiasi Menyusu Dini dalam 1 jam pertama setelah lahir.
8. Skrining Hipertiroid Kongenital: Deteksi dini kelainan tiroid pada bayi baru lahir.
9. Balita gizi buruk: Usia 0-5 bulan dan 6-59 bulan yang mendapat perawatan rawat inap/jalan.
Periode Pelaporan: MARET 2026 (31 hari)
Sumber Data Utama: Tabel pasien_bayi, reg_periksa, kamar_inap, rujuk_masuk, rujuk
Sumber Data Pendukung: Tabel pasien, poliklinik, bridging_sep
Status Tabel:
✅ pasien_bayi,
✅ reg_periksa
Tanggal Generate: 01/03/2026 10:12:40
Total Kegiatan: 131 kegiatan
Distribusi:
Neonatal: 11,
Bayi & Balita: 120