FAKTOR PREDIKTOR KEGAGALAN NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE PADA BAYI KURANG BULAN DENGAN DISTRES RESPIRASI

WINDA INTAN P, Dr. dr. Ekawaty Lutfia Haksari, MPH Sp.A(K), dr. Amalia Setyati Sp.A(K)

2020 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar belakang: Distres respirasi merupakan penyebab mortalitas dan morbiditas utama pada bayi yang lahir kurang bulan. Insidensi kegagalan nasal CPAP cukup tinggi. Penelitian terkait penggunaan nasal CPAP masih sedikit di Indonesia, dan penelitian ini diharapkan dapat menjadi acuan dalam melakukan tindakan preventif untuk menurunkan angka mortalitas dan morbiditas pada bayi kurang bulan. Tujuan: Mengkaji faktor prediktor kegagalan nasal CPAP pada bayi kurang bulan dengan distres respirasi. Metode: Penelitian observasional kohort retrospektif mengunakan data rekam medis bayi kurang bulan dengan distres respirasi di bangsal neonatologi RSUP Dr. Sardjito Yogyakarta selama kurun waktu Januari 2017 hingga Juli 2019. Analisis bivariat Chi-square test atau Fisher's exact test digunakan untuk mengetahui hubungan antara variabel bebas dengan variabel tergantung dilanjutkan analisis multivariat regresi logistik metode backward. Hasil: Sebanyak 150 bayi disertakan dalam penelitian ini. Lima puluh tiga (37,8%) bayi mengalami kegagalan nasal CPAP. Analisis bivariat menunjukkan jumlah kehamilan, berat lahir, skor APGAR, ketuban pecah dini, skor Downes awal dan kebutuhan inisiasi FiO2 berisiko mengalami kegagalan nasal CPAP. Namun hanya kehamilan tunggal (p=0,026; OR 4,47; IK 95% 1,19-16,7), berat lahir <1000 gram (p=0,022; OR 11,55; IK 95% 1,18-112,45), skor Downes awal (p=0,035; OR 2,68; IK 95% 3,10-24,11), dan FiO2>=30% (p=0,0001; OR 8,65; IK 95% 3,10-24,11) yang terbukti secara signifikan sebagai faktor prediktor kegagalan nasal CPAP. Kesimpulan: Berat lahir <1000 gram, kehamilan tunggal, skor Downes awal dan kebutuhan inisiasi FiO2>=30% merupakan prediktor kegagalan nasal CPAP pada bayi kurang bulan dengan distres respirasi.

morbidity in preterm infants. The incidence of nasal continuous positive airway pressure (CPAP) failure is remarkably high. There are limited data available regarding nasal CPAP failure in Indonesia, and this study is expected to be a reference in taking preventive measures to reduce mortality and morbidity in preterm infants. Objective: To determine predictive factors of nasal CPAP failure in preterm infants with respiratory distress. Methods: A retrospective cohort study was conducted in preterm infants with respiratory distress at the neonatology ward of Dr. Sardjito Hospital during January 2017- July 2019. Chi-square or Fisher's exact tests, variable with p<0,25, and followed by multivariate logistic regression analysis with backward method were used to identify factors contributing to nasal CPAP failure. Results: A total of 150 infants were included in this study. Fifty-three (37.8%) infants had nasal CPAP failure. Bivariate analysis showed birth weight <1000 grams, single birth, APGAR score, premature rupture of membrane (PROM), Downes score and initiation of FiO2 requirement were all risk factors of nasal CPAP failure. However, only singleton (p=0,026; OR 4,47; IK 95% 1,19-16,7), birth weight <1000 grams (p=0.022; OR 2.69; CI 95%: 1.34-5.44), initial Downes score (p=0,035; OR 2,68; CI 95% 3,10-24,11), and initiation of fractional concentration of inspired (FiO2) requirement >=30% (p=0.0001; OR 3.03; CI 95%: 2.04-4.50) were significant predictors for nasal CPAP failure by multivariate analysis. Conclusions: Birth weight <1000 grams, singleton, initial Downes score and initiation of FiO2 requirement >=30% were significant predictors of nasal CPAP failure in preterm infants with respiratory distress.

Kata Kunci : bayi kurang bulan, distres respirasi, continuous positive airway pressure/ preterm infants, continuous positive airway pressure, respiratory distress