FAKTOR PREDIKTOR MORTALITAS SEPSIS NEONATORUM AWITAN DINI DI RSUP DR.SARDJITO YOGYAKARTA

Melna Agustriani Purba, dr. Ekawaty Lutfia aksari, MPH, Sp.A(K)

2011 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar Belakang: Sepsis neonatorum awitan dini biasanya berkembang dengan cepat serta cenderung mengakibatkan keterlibatan multiorgan sehingga memiliki mortalitas lebih tinggi dibandingkan dengan sepsis awitan lambat. Tidak hanya kecepatan serta ketepatan diagnosis dan tatalaksana, namun juga perlu diketahui faktor-faktor prediktor yang mempengaruhi luaran mortalitas neonatus sehingga dapat dilakukan tindakan medis yang lebih agresif. Tujuan: Untuk mengetahui faktor-faktor prediktor mortalitas sepsis neonatorum awitan dini, khususnya yang berkaitan dengan faktor maternal dan klinis neonatus. p Metode: Penelitian kohort retrospektif dengan menggunakan data sekunder dari data dasar neonatus dan catatan medik asien Instalasi Maternal dan Perinatologi RSUP Dr.Sardjito Yogyakarta dalam periode 4 tahun (2007-2010). Neonatus yang didiagnosis sepsis secara klinis dalam 72 jam pertama kehidupan dan dibuktikan dengan kultur darah yang positif diikutsertakan dalam penelitian dan dinilai luaran sampai usia 14 hari. Faktor-faktor maternal dan klinis neonatus yang diduga sebagai prediktor mortalitas sepsis neonatorum awitan dini dianalisis dan pengukuran hubungan ditampilkan dengan Risk Ratio (RR) dan Interval Kepercayaan 95% (IK 95%). Hasil: Total 182 neonatus, dimana 12,1% (22) neonatus meninggal dan 87,9% (160) neonatus bertahan hidup. Hasil akhir dalam analisis multivariat diperoleh bahwa yang terbukti secara independen sebagai prediktor mortalitas adalah ketuban pecah dini (RR 3,62 IK 95% 1,16-11,57), kasus rujukan (RR 5,42 IK 95% 1,67-17,98), kurang bulan (RR 6,30 IK 95% 1,05-37,84), dan grunting (RR 6,40 IK 95% 1,66- 25,37). Sedangkan faktor-faktor lain seperti antenatal care, penolong persalinan, gawat janin, berat lahir rendah, abnormalitas suhu, feeding intolerance, dan waktu pengisian kapiler tidak terbukti bermakna sebagai faktor prediktor mortalitas sepsis awitan dini. Simpulan: Faktor prediktor mortalitas sepsis neonatorum awitan dini adalah ketuban pecah dini, kasus rujukan, kurang bulan, dan grunting.

Background: Early onset neonatal sepsis grows rapidly and tends to involve multiple organs, causing higher mortality of neonates than late onset sepsis. It is not only how fast and accurate the diagnosis and treatment are, but also the predictor factors affecting mortality of neonates are needed to be well-understood. Thus, the predictor factors can be utilized to determine the more aggressive medical treatment. Objective: To understand the predictor factors of mortality of neonates caused by early onset neonatal sepsis, especially those related to maternal and clinical factors of the neonates. Method: Cohort-retrospective was conducted by using secondary data from basic neonates data and medical records in the Maternal and Perinatal Installation RSUP Dr.Sardjito Yogyakarta within 4 years period from 2007 to 2010. Neonates diagnosed with sepsis clinically within first 72 hours of their lives and proved with the positive blood culture were included in this study and the outcomes were measured until the age of 14 days. Maternal and clinical factors of the neonates, analyzed as the predictors of neonatal mortality, were assessed and presented in the parameters of Risk Ratio (RR) and Confidential Interval 95% (CI 95%). Result: There were 182 neonates based on inclusion and exclusion criteria in our study, 12.1% (22) of whom died and 87.9% (160) lived. The results of the multivariate analysis showed that premature rupture of membrane (RR 3.62; CI 95% 1.16-11.57), referral case (RR 5.42; CI 95% 1.67-17.98), preterm (RR 6.30; CI 95% 1.05-37.84), and grunting (RR 6.40; CI 95% 1.66-25.37) were statistically proven as the independent predictor factors of mortality of neonates. However, antenatal care, birth attendance, fetal distress, low birth weight, temperature abnormality, feeding intolerance, and capillary refill time were not proven statistically significant as predictor factors. Conclusion: Predictor factors in mortality of early onset neonatal sepsis included premature rupture of membrane, referral case, preterm, and grunting.

Kata Kunci : prediktor, mortalitas, sepsis neonatorum