UJI DIAGNOSTIK STANDAR PELAYANAN MEDIS IKATAN DOKTER ANAK INDONESIA UNTUK SEPSIS NEONATORUM

Oki Fitiani, dr, Prof. dr. Purnomo S., DTM&H., Ph.D., DSc(hon)., Sp.A(K)

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

Latar belakang: Sepsis neonatorum masih merupakan penyebab penting morbiditas dan mortalitas neonatus. Penentuan atau penegakan diagnosis sepsis bukan merupakan suatu hal yang mudah, oleh karena sepsis pada neonatus tidak menunjukkan manifestasi klinis yang khas. Baku emas diagnosis yaitu biakan darah memerlukan waktu lama, biaya relatif mahal, dan belum semua fasilitas kesehatan mampu menyediakannya, sedangkan penundaan terapi dapat berakibat fatal. Standar pelayanan medik yang ada untuk menegakkan diagnosis klinis sepsis diharapkan dapat mengurangi keterlambatan diagnosis sepsis. Tujuan: mangetahui akurasi diagnosis klinis sepsis neonatorum berdasarkan biakan darah menurut kriteria SPM IDAI 2004. Metode: Penelitian uji diagnostik potong lintang dilaksanakan di Bangsal Perinatal Instalasi Maternal Perinatal RS Dr. Sardjito, antara tanggal 1 Juni 2010 sampai dengan 30 November 2010. Kriteria inklusi adalah neonatus yang dirawat di Bangsal Perinatologi dan memiliki gejala atau tanda infeksi yang memenuhi kriteria diagnosis kecurigaan sepsis. Neonatus dengan kelainan kongenital, kelainan darah, dan ibu mendapat antibiotik intrapartum dieksklusi dari penelitian. Hasil pemeriksaan dengan kriteria SPM IDAI dibandingkan secara tersamar dengan hasil biakan darah. Hasil: Sebanyak 193 neonatus menjadi subjek penelitian. Diagnosis klinis sepsis neonatorum dibuat berdasar kriteria SPM IDAI. Semua subjek dilakukan diambil sampel darah untuk pemeriksaan hitung leukosit, rasio IT, dan biakan darah. Luaran yang diteliti adalah sepsis definitif, yaitu hasil biakan darah tumbuh kuman. Diagnosis klinis sepsis neonatorum berdasar kriteria SPM IDAI mempunyai nilai sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, rasio kecenderungan positif, rasio kecenderungan negatif, dan akurasi sebesar (secara urutan) 88%, 17%, 53%, 57%, 1,06, 0,71, dan 53%. Diagnosis klinis sepsis neonatorum dapat dipergunakan untuk mendiagnosis awal sepsis. Simpulan: Kriteria diagnosis klinis sepsis neonatorum SPM IDAI memiliki sensitivitas cukup tinggi untuk mendiagnosis sepsis neonatorum berdasar hasil biakan darah.

Background: Neonatal sepsis is still known as a leading cause of neonatal morbidity and mortality. It is hard to diagnose sepsis clinically due to no specific signs and symptoms. Confirmation of the diagnosis may take time, costly, and it is not easily performed in any hospital. There is an urgent need to know whether the baby has sepsis to institute treatment as quickly as possible, according to the Indonesian pediatrician society (IDAI) medical standards for diagnose sepsis clinically. Objective: to evaluate diagnostic accuracy of IDAI medical standards to diagnose neonatal sepsis based on blood culture result. Method: This study was a cross-sectional and carried out at the Perinatal ward of Maternal Perinatal Unit Dr. Sardjito Hospital Yogyakarta between June 1st, 2010 to November 31st, 2010. The inclusion criteria was neonate who admitted to Perinatololy ward and had symptom or sign of sepsis based on Sardjito medical standards. Neonates with congenital anomaly, blood disorder, or the mother took antibiotic intrapartum were excluded from this study. The neonates got diagnose from IDAI medical standards and further were blind validated with blood culture. Result: A total of 193 babies with signs of sepsis were evaluated. The clinical diagnosis was made based on IDAI medical standards (known as SPM IDAI). Leucocyte count, immature/total neutrophil ratio, and blood culture were performed in all subjects at enrollment. The outcome of interest was ‘definite sepsis’, defined as blood culture positive. The SPM IDAI had sensitivity, specificity, PPV, NPV, LR+, LR−, and accuracy of 88%, 17%, 53%, 57%, 1,06, 0,71, and 53% respectively. The ‘clinical sepsis’ can be used by clinicians to diagnose sepsis at the beginning. Conclusion: SPM IDAI had high sensitivity for diagnose neonatal sepsis based on result of blood culture.

Kata Kunci : uji diagnosis, SPM IDAI, sepsis neonatorum