OPTIMALISASI PERTUMBUHAN DAN PERKEMBANGAN PASIEN SINDROM RUBELA KONGENITAL

GALIH LINGGAR ASTU, dr. Sasmito Nugroho, Sp.A (K).; dr. Sasmito Nugroho, Sp.A (K).

2016 | Tesis-Spesialis | SP ILMU KESEHATAN ANAK

LATAR BELAKANG: Pasien sindrom rubela kongenital (congenital rubella syndrome, CRS)memerlukan pemantauan pertumbuhan, perkembangan, dan risiko sekuele akibat CRS sehingga anak bisa tumbuh sehat dan berkembang secara optimal. TUJUAN: Untuk mendeteksi permasalahan yang berhubungan dengan kondisi gangguan penglihatan, gangguan pendengaran, penyakit jantung bawaan, infeksi, gangguan endokrin, hipertensi, dan gangguan pertumbuhan serta perkembangan, sehingga dapat dilakukan intervensi segera. Anak diharapkan dapat tumbuh dan berkembang dengan optimal serta mencapai kemandirian dalam melakukan aktivitas sehari-hari. METODE: Pengamatan dengan metode observasional time series dilakukan pada April 2014 sampai dengan September 2015 dengan variabel yang diamati yaitu gangguan penglihatan, gangguan pendengaran, stenosis pulmonal, infeksi Cytomegalovirus (CMV), imunisasi, status nutrisi, gangguan perkembangan, diabetes mellitus, gangguan hormon hipotiroid, kondisi rumah, dan kualitas hidup. HASIL: Komplikasi mata paska operasi katarak dan gangguan endokrin tidak ditemukan. Intervensi untuk kondisi profound SNHL belum mencapai hasil yang maksimal. Pulmonal stenosis sudah dilakukan PTBV. Infeksi CMV sudah mendapatkan terapi gansiklovir dengan hasil evaluasi menunjukkan antigenemia CMV darah dan urin negatif. Luaran pertumbuhan anak membaik, dari sebelumnya severely underweight menjadi normal, sedangkan stunted membaik dari perhitungan SD dengan laju pertumbuhan berat badan dan panjang badan baik. Ukuran kepala anak masih mikrosefal, dengan pelebaran ventrikel membaik sesuai dengan hasil CT scan evaluasi. Perkembangan motorik kasar, halus, personal sosial, dan bahasa belum ada perbaikan. Imunisasi belum sesuai program Ikatan Dokter Anak Indonesia (IDAI), namun terkendala biaya. Kondisi rumah membaik sehingga memenuhi kriteria rumah sehat. Pada akhir evaluasi, nilai PEDS-QL 66,66. KESIMPULAN: Pengelolaan anak CRS memerlukan pendekatan holistik, komprehensif, dan berkelanjutan sehingga tercapai tumbuh kembang optimal, dan kualitas hidup yang baik.

BACKGROUND: Congenital rubella syndrome (CRS)patients require monitoring of growth, development, and risk of sequelae due to CRS so that children can grow up healthily and develop optimally. AIM: To detect the problems associated with the condition of visual impairment, hearing impairment, congenital heart disease, infection, endocrine disorders, hypertension, and impaired growth and development, so that interventions can be done immediately. The child is expected to grow and develop optimally and achieve independence in performing everyday activities. METHODE: Observations with the time series observational method conducted in April 2014 until September 2015 with the observed variables i.e. visual impairment, hearing impairment, pulmonary stenosis, cytomegalovirus (CMV)infection, immunizations, nutritional status, developmental disorders, diabetes mellitus, hypothyroidism, the housing condition, and quality of life. RESULT: Postoperative complications of cataracts and endocrine disorders cannot be found. Intervention for profound sensorineural hearing loss (SNHL)conditions not yet to achieve maximum results. Pulmonary stenosis has already done PTBV. Cytomegalovirus infection have received ganciclovir therapy with evaluation results indicate negative CMV antigen in blood and urine. Improved child growth outcomes, from the previously severely underweight to be normal, while improved stunted from the calculations of standard deviation (SD), but the growth rate of weight and body length either. The size of a child's head is still microcephaly, with improved ventricular dilation in accordance with the results of the CT scan evaluation. No improvement in gross motor development, fine motor development, personal social, and language. Immunization is not appropriate based on Ikatan Dokter Anak Indonesia (IDAI)program, due to cost limitation. The housing condition was improved that meet the criteria for a healthy home. At the end of the evaluation, PEDS-QL value 66.66. CONCLUSION: Management of CRS patient requires a holistic, comprehensive, and sustained approach in order to achieve optimal growth, and quality of life.

Kata Kunci : Congenital Rubella syndrome, CRS, cataracts, hearing loss, congenital heart disease