Pengaruh Posisi Bayi terhadap Kadar Bilirubin pada Fototerapi Konvensional

Abstract

Background. Hyperbilirubinemia is one of the most common problems in newborn that occur during the first day of life. Phototherapy is a conventional method of decreasing serum bilirubin in newborn hyperbilirubinemia. Changing the position of baby with hyperbilirubinemia every 3 hours during phototherapy can reduce serum bilirubin levels more rapidly. Objectives. To compare the decrease in total serum bilirubin concentration during conventional phototherapy in infants treated in supine position exclusively versus infant alternated between exposure in supine and prone position every three hours. Methods. A randomized controlled trial study conducted in July 2012 to October 2012 in Perinatology unit in H. Adam Malik Hospital Medan and Dr. Pirngadi General Hospital Medan. Sample is selected by simple randomization using the closed envelope which is physiological neonatal hyperbilirubinemia, with gestational age between ≥ 32 weeks ≤ 42 weeks who fulfill the inclusion and exclusion criteria were included in the study. Total bilirubin serum was measured at the beginning of phototherapy before and after 24 hours. The analysis use a paired t test and independent t test. Results. A total of 76 neonatal physiological hyperbilirubinemia with gestational age is in range ≥ 32 weeks and ≤ 42 weeks. In each group, 38 neonatal physiological hyperbilirubinemia of TBS level was decreased after 24 hours of phototherapy in group position changes every 3 hours (2.42%) with (P = 0751) while the supine position (1.23%) with (P = 0751). Conclusion. There were no significant differences in total bilirubin reduction between supine position with changes baby position every 3 hours while conventional phototherapy performed.

Latar belakang: Hiperbilirubinemia merupakan suatu masalah yang paling sering dijumpai pada bayi baru lahir. Fototerapi konvensional adalah metode yang digunakan untuk menurunkan kadar serum bilirubin pada bayi hiperbilirubinemia. Mengubah posisi bayi hiperbilirubinemia setiap 3 jam selama fototerapi diyakini mampu meningkatkan efektifitas fototerapi dalam menurunkan kadar serum bilirubin lebih cepat. Tujuan: Untuk mengetahui perbedaan penurunan kadar serum bilirubin setelah fototerapi konvensional antara posisi yang dirubah-ubah setiap 3 jam dengan posisi telentang. Metode: Studi randomized controlled trial dilakukan pada bulan Juli 2012 sampai Oktober 2012 di unit Perinatologi RS.H. Adam Malik Medan dan RS. Dr. Pirngadi Medan. Sampel dipilih secara randomisasi sederhana dengan menggunakan amplop tertutup yaitu neonatus hiperbilirubinemia fisiologis, usia kehamilan ≥ 32 minggu ≤ 42 minggu yang memenuhi kriteria inklusi dan ekslusi diikut sertakan dalam penelitian. Kadar serum bilirubin diukur pada awal fototerapi dan setelah 24 jam fototerapi. Analisis yang digunakan adalah uji t-dependent dan uji t-independent. Hasil: Sebanyak 76 neonatus hiperbilirubinemia fisiologis yang mengikuti penelitian rentan usia kehamilan ≥ 32 minggu ≤ 42 minggu. Pada masing-masing kelompok penelitian 38 neonatus hiperbilirubinemia fisiologis, dijumpai penurunan total serum bilirubin setelah 24 jam fototerapi pada kelompok mengubah posisi setiap 3 jam (2.42%) dengan (P=0.751) sedangkan kelompok posisi telentang (1.23%) dengan (P= 0.751) Kesimpulan: Terjadi penurunan kadar serum bilirubin signifikan pada masing-masing kelompok posisi telentang dengan mengubah posisi setiap 3 jam setelah 24 jam fototerapi. Tetapi tidak terdapat perbedaan yang bermakna dalam jumlah penurunan kadar serum bilirubin antara posisi telentang dengan mengubah posisi setiap 3 jam selama fototerapi konvensional