Pengaruh durasi metode kangaroo mother care (KMC) di rumah terhadap peningkatan berat pada bayi berat lahir rendah (BBLR)

MULIANI, Prof. dr. Djauhar Ismail, MPH.,Ph.D.,Sp.A(K)

2010 | Tesis | S2 Ilmu Kedokteran Klinik

Perawatan metode Kangaroo Mother Care (KMC) secara kontak langsung kulit ibu dan bayi dapat meningkatan berat pada BBLR. Bentuk pelayanan ini bertujuan untuk memaksimalkan kestabilan kondisi bayi karena relatif lebih efisien, efektif, mudah, murah, serta aman bagi ibu dan bayi. Dalam penelitian ini menerapkan metode KMC terhadap bayi berat lahir (800-2000 gram) hingga berat bayi saat pulang dari rumah sakit 1240-2223 gram, kemudian perawatan dilanjutkan di rumah dengan durasi ≥4jam/hari dan berat bayi dipantau selama 3 kali kunjungan ulangan. Metode ini dapat dilakukan tanpa mengganggu aktifitas ibu sehari-hari, namun memerlukan pembiasaan dan ketekunan ibu serta dukungan keluarga. Metode KMC dapat dilaksanakan diberbagai sarana pelayanan kesehatan dan dapat dilanjutkan di rumah serta dijadikan sebagai pedoman pelayanan kesehatan BBLR pada setiap jenjang sarana kesehatan. Tujuan penelitian ini diketahuinya pengaruh durasi KMC terhadap peningkatan berat pada BBLR saat kunjungan ulangan selama 3 kali kunjungan di RSUP DR. Sardjito Yogyakarta. Metode penelitian bersifat kuasi eksperimental dengan rancangan The one-group Pretest-Posttest design. Subyek penelitian bayi lahir riwayat BBLR/kurang bulan dengan berat lahir 800–2000 gram, yang dirawat di ruang perinatal RSUP DR. Sardjito Yogyakarta dan menerima metode KMC selama perawatan dan bersedia melanjutkan di rumah, selanjutnya melakukan kunjungan ulang sebanyak 3 kali sesuai jadual yang ditetapkan. Penelitian dimulai saat bayi pulang yang telah ditetapkan berdasarkan kriteria inklusi dan eksklusi selama periode Maret-Juni 2010. Besar sampel 70 pasang ibu-BBLR yang dipilih secara Consecutive Sampling dari bayi yang telah memenuhi kriteria pulang. Metode analisis dengan uji statistik Chi-square dan paired t-test serta multivariat regeresi logistik. Hasil penelitian menunjukkan bahwa selisih rerata BB sebanyak 3 kali kunjungan ulang secara signifikan terdapat perbedaan bermakna dengan durasi KMC ≥4 jam/hari dengan masing-masing selisih rerata BB masing-masing (80,7 gram; 297,5 gram; 400,4 gram) IK 95% (57,6-103,8; 241,4-353,5; 297,8-502,9) nilai p=0,001. Bayi yang di KMC ≥4 jam/hari secara signifikan meningkatkan efek risiko kenaikan BB bayi rata-rata 30 gram/hari, (kunjungan I RR 2,1; IK 95% 1,16-3,81; p=0,02 dan kunjungn II RR 1,9; IK95% 1,04-4,69; nilai p=0,03), namun kunjungan ulang III tidak bermakna secara signifikan nilai p=0,56 (>0,05). Hasil analisis multivariat regresi logistic menunjukkan kemaknaan secara signifikan antara metode KMC dengan durasi ≥4 jam/hari terhadap peningkatan berat pada BBLR dengan OR 4,1; IK 95% 1,4-12,1 dan nilai p=0,01 (<0,05). Kesimpulan penelitian bahwa penerapan durasi KMC ≥4 jam/hari selama di rumah berpeluang meningkatkan berat bayi ≥30 gram/hari sebesar 4 kali lebih besar dibanding bayi yang KMC <4 jam/hari.

Kangaroo Mother Care (KMC) method with direct skin contact between mothers and babies can increase weight of LBW infants. This type of service aims to maximize stability of the baby's condition since it is relatively more efficient, effective, easier, cheaper and safer for both the mother and the baby. In this study applying the KMC method on infant birth weight 800-2000 gr until the baby from hospital discharge 1240-2223 gr, then treatment continued at home with a duration of ≥4 hours/day and weight babies were followed for three times revisit. It can be practiced without disrupting mothers' daily activities, but it needs their familiarity and diligence as well as support of the family. KMC method can be practiced in various health facilities and continued at home and used as a guide of health service for LBW infants in every level of health facilities. The objective of the study was to identify effect of KMC method on weight gain of LBW infants in every repeated visit for three times at Dr. Sardjito Hospital Yogyakarta. The study was a quasi experiment that used one group pre-test post-test design. The subjects of the study were LBW infants of 800-2000 grams hospitalized at perinatal room of Dr. Sardjito Hospital who received KMC method during hospitalization and were willing to continue it at home and made repeated visits for three times by the specified schedule. The study began when the babies were discharged based on inclusion and exclusion criteria during March-June 2010. The sample consisted of 70 pairs of mothers-LBW infants selected according to consecutive sampling of babies who met discharge criteria. Analysis used chi-square statistical-test, paired t-test and logistic regression. Average weight during three time-repeated visits showed significant difference at KMC duration ≥4 hours/day with average weight difference of 80.7 grams; 297.5 grams; 400.4 grams, CI 95% (57.6-103.8; 241.4-353.5; 297.8-502.9) with p=0.001. Infants under going KMC method ≥4 hours/day significantly increased effect of weight gain at average 30 grams/day (visit I RR 2.1; CI 95% 1.16-3.81; p=0.02 and visit II RR 1.9; CI 95% 1.04-4.69; p=0.03). However, 3rd visit was insignificant with p=0.56 (>.0.5). The result of logistic regression multivariate analysis exhibited that the practice of KMC method at the duration ≥4 hours/day had significant the influence to weight gain of LBW at OR 4,1; CI 95% 1.4-12.1 and p=0.001 (<0.05). The implementation of KMC method at home at the duration of ≥4 hours/day could increase weight of infants ≥30 grams/day four times greater than infants with KMC<4 hours/day.

Kata Kunci : Durasi,Kangaroo mother care (KMC),BBLR,Kunjungan ulangan, Duration, Kangaroo Mother Care (KMC), low birth weight, outpatient