Perbandingan Efektifitas Jarak Fototerapi pada Neonatus dengan Hiperbilirubinemia Indirek

Abstract

Background: Hyperbilirubinemia is one of the most common problems in newborns and the phototherapy is the most widespread treatment for lowering bilirubin concentration in neonates. The phototherapy with near distance to neonates could increase effectiveness of phototherapy. Objective: To compare the effectiveness of phototherapy with 20 cm distance between light source and neonates and phototherapy with 40 cm distance in decreasing serum bilirubin and increasing spectral irradiance Methods: An open, randomized controlled trial was conducted at both H. Adam Malik Hospital Medan and Pirngadi Hospital Medan since August 2009 to March 2010. Subject divided into 2 group, one group received 20cm distance phototherapy (n=30) and the other received 40 cm distance phototherapy (n=30). The criteria for inclusion in the study were newborns with neonatal jaundice presenting in the first week of life. Serum bilirubin level and average spectral irradiation level measured at baseline and after 12 h, 24 h of phototherapy. Results: The mean total bilirubin level of 20 cm distance phototherapy and 40 cm distance phototherapy groups at the beginning of therapy were 18.79 (SD 1.01) and 17.68 (SD 0.83) mg/dl respectively, there was no significant difference between the values. After 24 hours of therapy the mean decrease in total serum bilirubin levels of 20 cm distance and 40 cm distance phototherapy group were 7.62 (SD 1.01) and 1.94 (SD 0.83) mg/dl respectively. The mean decreased in total serum bilirubin levels were significant differences between two groups (p < 0.05). During the study period the sum of average spectral irradiance by 20 cm distance phototherapy was significantly higher than of the 40 cm distance phototherapy (p < 0.05). Conclusion: Our study showed that phototherapy with near distance between light source and neonates is more effective in reduction of bilirubin in newborns with hyperbilirubinemia.

Latar belakang : Hiperbilirubinemia merupakan salah satu dari banyak permasalahan pada bayi cukup bulan dan fototerapi merupakan terapi yang banyak digunakan untuk menurunkan kadar bilirubin pada bayi. Fototerapi dengan jarak yang lebih dekat dari bayi dapat meningkatkan efektivitas fototerapi. Tujuan : Untuk membandingkan efektivitas fototerapi berjarak 20 cm dan fototerapi berjarak 40 cm dalam menurunkan kadar bilirubin dan meningkatkan intensitas sinar Metode : Uji klinis acak terbuka, dilakukan di 2 RS, RS.H. Adam Malik dan RS. Dr. Pirngadi Medan. Penelitian dimulai bulan Agustus 2009 sampai Maret 2010, sampel dibagi 2 kelompok. Kelompok A dengan menggunakan fototerapi berjarak 20 cm (n=30) dan kelompok B menggunakan fototerapi berjarak 40 cm (n=30). Kriteria inklusi pada penelitian ini adalah bayi yang secara klinis dijumpai ikterus atau kuning pada minggu pertama kehidupan. Serum bilirubin diukur pada awal, 12 jam dan setelah 24 jam fototerapi. Hasil : Rerata kadar bilirubin awal pada ke dua grup yang menggunakan fototerapi berjarak 20 cm dan berjarak 40 cm saat dimulai fototerapi yaitu 17 sampai 18 mg/dL, tidak ada perbedaan yang signifikan antara ke 2 grup. Setelah 24 jam fototerapi terjadi penurunan kadar bilirubin pada grup fototerapi berjarak 20 cm yaitu 7.62 ( SD 1.01) mg/dL dan grup fototerapi berjarak 40 cm yaitu 1.94 (SD 0.83) mg/dL. Penurunan rerata kadar serum bilirubin berbeda signifikan antara ke 2 grup (p< 0.05). Selama penelitian , intensitas sinar secara signifikan lebih tinggi pada grup fototerapi berjarak 20 cm dibandingkan fototerapi berjarak 40 cm. Kesimpulan : Pada penelitinan kami didapati bahwa fototerapi dengan jarak sinar lebih dekat ke neonatus lebih efektif dalam menurunkan kadar bilirubin pada bayi-bayi dengan hiperbilirubinemia.