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Perbandingan Pemberian Vitamin K Dosis Tunggal Intramuskular pada Bayi Prematur dan Aterm Terhadap Masa Protrombin

Latar belakang. Defisiensi vitamin K atau hypoprothrombinemia pada bayi baru lahir dapat menyebabkan perdarahan karena faktor koagulasi yang bergantung vitamin K tidak adekuat. Bayi prematur kurang memperlihatkan respon optimal dengan pemberian vitamin K disebabkan imaturitas sel hati. Tujuan penelitian. Mengetahui apakah vitamin K dosis tunggal intramuskular sama efektifnya pada bayi prematur dibandingkan dengan bayi aterm terhadap masa protrombin. Metode. Uji klinis bayi baru lahir prematur dan aterm yang dirawat antara bulan Februari – Juli 2006 di Rumah Sakit Pirngadi Medan. Kriteria eksklusi ialah menggunakan antibiotik, bayi dengan hiperbilirubinemia. Pemeriksaan masa protrombin (PT) dilakukan sebelum pemberian vitamin K pada hari pertama dan diulapng pemeriksaan PT pada hari ketiga terhadap bayi prematur dan aterm. Analisis statistik secara uji t independen dan berpasangan, indeks kepercayaan 95%, kemaknaan p<0,05. Hasil. Dari 38 bayi prematur, 20 laki-laki, 18 perempuan dan 38 bayi aterm, 18 laki, 20 perempuan. Nilai PT bayi prematur hari pertama; rata-rata 38,7±18,4 detik, hari ketiga; 22,9±6,6 detik. Pada bayi aterm PT hari pertama; rata-rata 30,0±17,7 detik, pada hari ketiga rata-rata 16.9±7.3 detik. Tidak bermakna nilai PT pada hari pertama, namun terdapat perbedaan bermakna nilai PT pada hari ketiga antara bayi prematur dan aterm. Rata-rata terjadi penurunan nilai PT pada hari ketiga. Kesimpulan. Terdapat perbedaan bermakna nilai PT antara bayi prematur dengan aterm sebelum dan sesudah diberikan vitamin K dosis tunggal intramuskular. Perubahan nilai PT antara hari pertama dengan hari ketiga baik pada bayi aterm maupun prematur setelah diberikan vitamin K

Peran Eritropoetin pada Anemia Bayi Prematur

Anemia sering terjadi pada bayi prematur, ditandai oleh penurunan nilai hematokrit, retikulosit dan kadar eritropoetin endogen rendah. Di Amerika Serikat, 60-80% bayi berat lahir sangat rendah (BBLSR) mengalami anemia dan membutuhkan transfusi sel darah merah berulang sehingga mempunyai risiko terjadi komplikasi penularan penyakit. Salah satu upaya menurunkan kebutuhan transfusi tersebut dengan pemberian eritropoetin eksogen yaitu recombinant human eritropoietin (r-HU EPO) yang berfungsi merangsang proliferasi, diferensiasi dan maturasi sel darah merah dalam sumsum tulang. Walaupun pada bayi prematur dijumpai kadar eritropoetin yang sangat rendah, namun progenitor eritroid tetap sensitif terhadap eritropoetin eksogen. Pemberian r-HU EPO dapat meningkatkan eritropoesis sehingga bermanfaat mengurangi kebutuhan transfusi pada anemia bayi prematur. Pemberian dalam dosis cukup pada usia dini, suplementasi preparat besi dan protein mempunyai efektifitas yang baik. Berbagai penelitian terhadap penggunaan r-HU EPO pada anemia bayi prematur telah dilakukan tetapi belum ada kesepakatan mengenai protokol pemberian, termasuk waktu, dosis, cara, dan durasi pemberian. [

Hemolytic anemia in falciparum and vivax malarial patients based on serum bilirubin examination

Objective To examine hemolysis in falciparum and vivax malarial patients based on serum bilirubin examination. Methods A cross sectional study was conducted on children younger than 15 years of age who visited public health center in the district of Mandailing Natal with complaints of fever, shivering, pale, jaundice, diarrhea, or headache between April 9 th and April 19 th 2001. Variables recorded were age, gender, body weight, body height, symptoms and signs, anti malarial drugs, and laboratory test results. Thin and thick blood smears were done as diagnostic tools of malaria. Thin blood smear was also performed to deter- mine the level of malaria parasites in blood (parasitemia) and to examine the morphology of red blood cells. Hemolysis was deter- mined by bilirubin examination. Results In P. falciparum malaria, there was a moderate correlation (r=0.68, p<0.0001) between parasitemia and indirect bilirubin con- centration. While in P. vivax malaria, there was only a weak corre- lation (r=0.46, p=0.007) between parasitemia and indirect bilirubin concentration. It was also found that in falciparum malaria, para- sitemia, total and indirect bilirubin concentrations were significantly higher than that in vivax malaria, with p values of 0.009, 0.015 and 0.003, respectively. Conclusion Hemolysis in falciparum malaria is more severe than that in P. vivax malaria, with marked elevation of indirect bilirubin. The elevation of serum bilirubin correlated with parasitemia

The correlation between platelet count and parasite density in children with malaria infection

Abstract Objective To assess the correlation between platelet count and parasite density. Methods A cross-sectional study of febrile children was conducted in Batubara Regency, North Sumatra, Indonesia. We used rapid diagnostic tests and blood smears to identify children with malaria infection. Platelet counts and measurement of parasite density were performed manually using a microscope. Results A total of 72 children with positive malaria infection were enrolled in the study. Sixty one children had Plasmodium vivax , two children had Plasmodium falciparum , and nine children had mixed infection. The mean platelet count from all patients was (230 940.00 ± 96 611.53)/µL and the mean parasite density was (2 254.83 ± 1 432.55)/µL. There was a weak negative correlation between the platelet count and the parasitemia count ( r = –0.145). The platelet count in the mixed infection group was significantly lower [(175 444.44 ± 48 093.95)/µL] than that in the vivax malaria group [(231 927.87 ± 99 475.28)/µL] (P = 0.024). Children with splenomegaly had a significantly lower platelet count [(189 655.56 ± 80 115.76)/µL versus (245 230.77 ± 98 380.74)/µL, P = 0.04] and a higher parasite density [(3 635.78 ± 1 623.70)/µL versus (1 789.88 ± 927.29)/µL, P Conclusions There was a weak negative correlation between the platelet count and parasite count.

Growth velocity in elementary school children with iron deficiency anemia after iron therapy

Background Iron supplementation in children with iron deficiency anemia could decrease the incidence of stunting. Objective To study the effect of iron therapy on growth velocity in children with iron deficiency anemia. Methods A randomized clinical trial study was conducted at Labuhan Batu on November 2006 to May 2007. Iron deficiency anemia was diagnosed if there were anemia, with mean corpuscular hemoglobin concentration 220, and Mentzer index> 13. Elementary school children (6-12 year old) with iron deficiency anemia were randomly assigned either to iron therapy group (children were given 6 mg iron/kg/day) or to placebo group for 3 months. Results Among 300 children recruited, there were 125 children, who suffered from iron deficiency anemia. After one month of iron therapy, means of hemoglobin concentration were 12.4 g/dl in iron group and 11.7 g/dl in placebo group. There was a significant increase of height in iron group (129.9 (SD 7.58) em vs. 132.2 (SD 7.23) em) and in placebo (130.8 (SD 8.78) em vs. 128.7 (SD 8. 79) em), However, no significant difference was found in the mean of growth velocity between placebo and iron groups (2.1 (SD 0.01) em vs. 2.0 (SD 0.9) em. Conclusion There is a significant increase in height, but no significant difference between both groups in growth velocity.

Parental knowledge, attitude and practice on malaria in Mandailing Natal district

Background Malaria is still considered to be an important health problem in Indonesia. Malaria has been found in islands with different degree of endemicity. Behavior of the community is one of the factors affecting the incidence of malaria in Mandailing Natal district. Objective To know the parental knowledge, attitude, and practice among parents whose children suffered from malaria or not. Methods A cross sectional study was conducted in six primary schools and one health centre in October 2004. Subjects were parents whose children were malaria positive and malaria negative based on laboratory examination. Sample size was 85 parents for each group. Selected respondents were interviewed using structured questionnaire. Degree of knowledge, attitude, and practice on malaria were established using scoring system within three categories: good, less, and poor. Data were collected and presented using chi-square and P<0.05 was considered as a level of significant. Results The mean age of 85 parents whose children were positive malaria, was 38.47 years (SD 6.67) and the mean age of those whose children were negative malaria was 40.41 years (SD 8.05). Parent’s education level was 62.9% primary school and 90% of their children were school-aged. There were significant differences on parental knowledge, attitude and practice in each group (P<0.05). There was also a significant correlation between occupation and knowledge, but not between parental education level and parental age. Parental knowledge and attitude on the incidence of malaria in Mandailing Natal district were good, though their practice were poor. Conclusion There are significant differences on parental knowledge, attitude and practice, between parents whose children were positive and negative for malaria.