Guslihan Dasa Tjipta

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

Rasio Bilirubin Albumin pada Neonatus dengan Hiperbilirubinemia

Latar belakang. Bilirubin tidak terikat potensial membahayakan sistem susunan saraf pusat, dan dapat menyebabkan kerusakan neurologis yang berat dan permanen.Rasio total bilirubin dan albumin dianggap parameter mewakili bilirubin yang tidak terikat,dalam menentukan modalitas terapi untuk hiperbilirubinemia. Tujuan. Mengetahui rasio bilirubin albumin pada pasien hiperbilirubinemia. Metode .Penelitian menggunakan studi sekat lintang yang dilakukan di Divisi Neonatologi RS. H. Adam Malik Medan dan RS. Pirngadi Medan mulai Agustus 2009 – Maret 2010. Hasil. Terdapat hubungan yang bermakna antara kadar albumin dan toral serum bilirubin dengan p<0,05. Kesimpulan. Rasio bilirubin-albumin merupakan parameter jumlah bilirubin bebas, dan dapat digunakan sebagai indikator yang lebih baik dalam penentuan terapi, untuk menurunkan kejadian bilirubin-induced neurologic damage.

Penggunaan Metilxantin pada Bayi Prematur dengan Apne Idiopatik

Apne idiopatik pada bayi prematur terjadi tanpa faktor predisposisi yang teridentifikasi. Insidens apne idiopatik bervariasi, berbanding terbalik dengan usia gestasi. Awitan apne idiopatik biasanya terjadi pada hari kedua sampai hari ketujuh kehidupan, jarang pada hari pertama. Diagnosis dibuat berdasarkan gejala klinis. Apne pada bayi prematur yang bukan disebabkan oleh faktor yang teridentifikasi dapat diobati dengan metilxantin (kafein, teofilin). Metilxantin merangsang ventilasi melalui mekanisme sentral atau dengan peningkatan kekuatan diafragma. Kafein lebih disukai daripada teofilin karena kafein mempunyai beberapa keuntungan dan efek samping yang lebih sedikit. Pemberian obat harus disertai monitoring konsentrasi plasma dan klinis yang hati-hati.

Rebound serum bilirubin levels after single vs. double phototherapy

Background Hyperbilirubinemia is the most common clinical phenomenon found in newborns. Phototherapy is the standard treatment for lowering bilirubin levels in neonates. While intensive (double) phototherapy produces a more rapid decline in serum bilirubin levels than standard (single) phototherapy, greater rebound effects may occur. Objective To assess bilirubin levels in neonates with hyperbilirubinemia who underwent single or double phototherapy, including rebound bilirubin levels after phototherapy termination. Methods An open, randomized, controlled trial was con ducted at H. Adam Malik Hospital and Dr. Pirngadi Hospital, Medan, from August 2009 until January 2010. Subjects with indirect hyperbilirubinemia were divided into two groups. One group received single phototherapy (n = 41) and other received double photo therapy (n = 40) . Measurements of total plasma bilirubin level were conducted at 12 hours and at 24 hours of phototherapy, as well as at 24 hours after phot otherapy termination. Rebound bilirubin serum level was defined as an increment of about 1 - 2 mg/dL serum bilirubin after phototherapy discontinuation. Results The decreases in serum bilirubin levels were significantly greater in the do uble phototherapy group for observations at 12 h ours , 24 h ours, and 24 hours after phototherapy t ermination (P = 0.0001). At the 24-hour observation after terminationofphototherapy, only 1 neonate (2.7%) in the single phototherapy group compared to 4 neonates (10.8%) in the double phototherapy group had serum bilirubin level increases of 1 - 2 mg/dL. Fishers exact test did not reveal a significant difference in rebound serum bilirubin occurrence in the two groups (P = 0.358). Conclusion Double phototherapy shows significantly greater decrease in bilirubin level compared to single phototherapy within a same period of time. Rebound serum bilirubin levels after single and double phototherapy may occur in some patients with hyperbilirubinemia, as bilirubin production continues. However, 260 • Paediatr Irulones, Vol. 54, No. 5, September 2014 there is no significant difference in rebound effects between single vs. double phototherapy.

Breast milk vs. non-nutritive sucking to reduce pain from minor invasive procedures in neonates

Background Neonates undergo many uncomfortable, invasive minor procedures during their first hospital stay. Nonpharmacological interventions may provide valuable alternatives for pain relief in neonates during minor procedures. Objective To compare the analgesic effect of orally administered breast milk vs. non-nutritive sucking (NNS) in neonates who underwent minor invasive procedures. Methods A randomized, open trial was performed at the Haji Adam Malik Hospital from September to December 2009. Subjects were 96 healthy, term infants who received injections of either intramuscular hepatitis B immunization or vitamin K. Subjects were randomly allocated into two groups, those were the breast milk group (n = 48) and the NNS group (n= 48). Breast milk and NNS were given two minutes before the injection. The events were recorded by video recorder. Transcutaneous heart rate, oxygen saturation and crying times were recorded. Two observers used the premature infant pain profile (PIPP) scale to evaluate all subjects. Result.s In the breast milk group, there was significant reduction in meanPIPPscore (P= 0.001) and mean crying time (P= 0.03) compared to the NNS group. There were no significant differences in mean PIPP score and crying times between males and females (P= 0.4 and P=0.5, respectively). However, there was a significantly lower mean PIPP score for vitamin K injection than for hepatitis B immunization (P=0.002), although mean crying times were not significantly different (P= 0.06). We observed significantly less Oz desaturation at 150 seconds postinjection in the breast milk group compared to that of the NNS group. However, there was no significant difference in heart rate between the two groups throughout the observation period. Conclusion Breast milk administered before an invasive minor procedure effectively reduces pain in neonates. Breast milk administered to neonates prior to injection has reduced mean PIPP scores, crying times, and Oz desaturation, compared to neonates who received NNS in the form of pacifiers.