review jurnal Patent Ductus Arteriosus

BAB I PENDAHULUAN

1.1 Latar Belakang

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Paten Ductus Arteriosus (PDA) adalah kegagalan kegagalan menutupnya menutupnya ductus ductus arteriosus arteriosus (arteri yang menghubungkan aorta dan arteri pulmonal) pada minggu pertama kehidupan, yang yang menye menyebab babkan kan mengali mengalirny rnyaa darah darah dari dari aorta aorta yang yang bertek bertekana anan n tinggi tinggi ke arteri arteri pulmonal yang bertekanan rendah. Pada !" bayi baru lahir, penutupan duktus ter#adi dalam $aktu %&' #am. Penya Penyakit kit #antun #antung g kongen kongenita itall atau penya penyakit kit #antun #antung g ba$aan ba$aan adalah adalah sekump sekumpula ulan n mal*or mal*ormas masii strukt struktur ur #antun #antung g atau atau pembul pembuluh uh darah darah besar besar yang yang telah telah ada se#ak se#ak lahir lahir.. Penya Penyakit kit #antun #antung g ba$aan ba$aan yang yang komple kompleks ks teruta terutama ma ditemu ditemukan kan pada pada bayi bayi dan anak. anak. Apabil Apabilaa tidak tidak dioper dioperasi asi,, kebany kebanyaka akan n akan akan mening meninggal gal $aktu $aktu bayi. bayi. Apabi Apabila la penya penyakit kit #antung ba$aan ditemukan pada orang de$asa, hal ini menun#ukkan bah$a pasien tersebut mampu melalui seleksi alam, atau telah mengalami tindakan operasi dini pada usia muda.(+PD -+,1/) Diperkirakan Diperkirakan insidens dari PDA sebesar sebesar 1 dari 000 kelahiran kelahiran normal, dan insiden insiden pada bayi perempuan dua kali lebih banyak dari bayi laki'laki. edangkan pada bayi prematur diperkirakan sebesar 1! ". -elainan ini bisa ter#adi baik pada bayi prematur maupun pada bayi cukup umur, dan ditemukan pada 1 diantara !00'!000 bayi. 1. 2u#uan 2u#uan Penulisan Penulisan 1.

3emaparkan in*ormasi terkini terkait dengan dengan topic patent topic patent ductus arteriosus untuk arteriosus untuk pasien dengan penyakit #antung ba$aan.

2.

3eningkatkan kritikal thinking tentang man*aat hasil penelitian tersebut bagi dunia kepera$atan.

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BAB II JURNAL PENELITIAN

45nteral eeding during +ndomethacin and +bupro*en + bupro*en 2reatment 2reatment o* a Patent Ductus Arteriosus6

Abstrak :

2o test the hypothesis that in*ants $ho are #ust being introduced to enteral *eedings $ill $ill ad7a ad7anc ncee to *ull *ull enter enteral al nutr nutrit itio ion n at a *ast *aster er rate rate i* they they recei recei7e 7e 4trop 4trophi hic6 c6 (1! (1! mL8kg8 mL8kg8d) d) enteral enteral *eeding *eedingss $hile $hile recei7i recei7ing ng indom indometha ethacin cin or ibupro ibupro*en *en treatme treatment nt *or patent ductus arteriosus. Methods :

2his prospecti7e randomi9ed study $as conducted bet$een ctober 00& and ;une 01 at 1< sites a*ter obtaining institutional re7ie$ board appro7al. +n*ants $ere eligible *or the study i* they $ere <18'<0/8 $eeks= gestation, $eighed %01'1!0 g at birth, recei7ed ma>imum enteral 7olumes ?/0 mL8kg8d, and $ere about to be treated $ith indomethacin or ibupro*en. A standardi9ed 4*eeding ad7ance regimen6 re gimen6 and guidelines *or managing *eeding intolerance $ere *ollo$ed at each site (@  1<). Result :

+n*ants +n*ants (@  1, /.<  1. $eeks= mean  D gestation) gestation) $ere randomi9ed randomi9ed at /.!  <. days to recei7e recei7e 4trophi 4trophic6 c6 *eeds *eeds (4*eedi (4*eeding6 ng6 group, group, n  &1: indometh indomethacin acin &0", ibupro*en 0") or no *eeds (4*asting Cnil per os6 group, n  /: indomethacin !", ibupro*en !") during the drug administration period. 3a>imum daily enteral 7olumes be*ore study entry $ere 1%  1! mL8kg8d. mL8kg8d. A*ter A*ter drug treatment, in*ants randomi9ed to the 4*eeding6 arm reEuired *e$er days to reach the study=s *eeding 7olume end point (10 mL8kg8d). Although the enteral *eeding end point $as reached at an earlier postnatal age, the age at $hich central 7enous lines $ere remo7ed did not di**er bet$een the  groups.











Concluson :

+n*ants reEuired less time to reach the *eeding 7olume end point i* they $ere gi7en 4trophic6 4trophic6 enteral *eedings *eedings $hen they recei7ed recei7ed indomethacin indomethacin or ibupro*en ibupro*en treatments. treatments. (; Pediatr 01<)

2he prostaglandin synthase inhibitors indomethacin and ibupro*en are the only drugs licensed in the  *or the treatment o* patent ductus arteriosus (PDA) in preterm in*ants. n*ortunate n*ortunately ly,, both drugs ha7e gastrointest gastrointestinal inal side e**ects: e**ects: indomethac indomethacin in decreases decreases intesti intestinal nal blood blood *lo$, *lo$, inhibi inhibits ts the normal normal postpr postprand andial ial hyper hyperemi emicc respon response, se,1 1 and inter*eres $ith gastrointestinal mucosal barrier *unction. Although ibupro*en does not appear to ha7e the same e**ect as indomethacin on intestinal blood *lo$, it does produce similar alterations alterations in gastrointest gastrointestinal inal permeability permeability.. 2hus, there is a concern that the introductio introduction n o* enteral enteral *eedings *eedings ($hich promote promote intestinal intestinal bacterial bacterial coloni9atio coloni9ation n and increase intestinal o>ygen demands) may be ha9ardous $hen these drugs are used.

Because o* this concern, in*ants enrolled in clinical trials, conducted to license indo indome meth thac acin in and and ibup ibupro ro*e *en n *or *or PDA PDA trea treatm tmen entt $ith $ith the the  ood ood and and Drug Drug Administration, $ere *asted (nil per os Cnpo) and recei7ed only intra7enous nutrition during during study study drug drug admini administra stratio tion. n. Furren Furrently tly,, &!" o*  neonat neonatolo ologis gists ts report report they $ithhold enteral *eedings $hen treating in*ants $ith indomethacin or ibupro*en.

2he practice practice o* $ithho $ithholdi lding ng *eedin *eedings gs and makin making g in*ant in*antss npo may ha7e ha7e its o$n unintended conseEuences. tudies in animals and humans demonstrate that $ithholding enteral nutrition nutrition and pro7iding pro7iding only parenteral parenteral nutrition nutrition *or periods periods as short as  hours can cause cause duoden duodenal al mucos mucosal al atrophy atrophy,, impair impaired ed intesti intestinal nal *uncti *unction, on, abnorm abnormal al gut permeability, subseEuent subseEuent *eeding *eeding intolerance, intolerance, and longer hospital stays. 2he longer it takes to attain *ull enteral nutrition, the longer in*ants need intra7enous nutrition and the more more likely likely they they are to de7elo de7elop p septic septicemi emiaa and cholest cholestasis asis.. 2here 2here*ore *ore,, $ithho $ithholdi lding ng *eeding *eedingss *or se7eral se7eral days days during during treatm treatment ent $ith $ith indome indometha thacin cin or ibupro ibupro*en *en may be











Furrently, there are no published controlled randomi9ed trials addressing $hether it is better to *eed or *ast an in*ant during indomethacin or ibupro*en treatment. e7eral studies studies ha7e sho$n that small amounts amounts o* enteral nutrition nutrition ha7e trophic trophic e**ects e**ects that can minimi minimi9e 9e some some o* the intesti intestinal nal proble problems ms caused caused by total total parent parentera erall nutrit nutrition ion.. Ge hypothesi9ed that in*ants $ho are to be treated $ith indomethacin or ibupro*en and $ho are #ust being introduced to enteral *eedings $ill ad7ance to *ull enteral nutrition at a *aster rate i* they recei7e recei7e 4trophic6 4trophic6 enteral *eedings $hile recei7ing the drug treatment. treatment. Ge conducted conducted a randomi9ed controlled trial to test tes t this hypothesis.

Methods

2his prospecti7e randomi9ed study $as conducted bet$een ctober 00& and ;une 01 at 1< sites a*ter obtaining institutional re7ie$ board appro7al. Gritten in*ormed parental consent $as obtained be*ore enrollment. +n*ants $ere eligible *or the study i* they $ere: (1) deli7ered bet$een <18'<0/8 $eeks= gestationH () $eighed %01'1!0 g at birthH (<) $ere #ust beginning enteral *eedings (recei7ing ?/0 mL8kg8d)H and (%) $ere about to recei7e pharmacologic treatment to close their PDA. 2he decision to treat the PDA $as made by the in*ants= clinical care teams. +n*ants $ere e>cluded *rom the trial i* they had pre7iously recei7ed enteral *eedings 7olumes I/0 mL8kg8d or i* there $ere contra contraind indicat ication ionss *or the use o* indome indometha thacin cin or ibupro ibupro*en *en,, contrai contraindi ndicati cations ons *or *eedings, *eedings, chromosomal chromosomal anomalies, anomalies, congenital congenital or acEuired acEuired gastrointest gastrointestinal inal anomalies, anomalies, prior episodes o* necroti9ing enterocolitis (@5F) or intestinal per*oration, or inotropic support *or hypotension at the time o* entry. 2he presence o* an umbilical artery or 7ein catheter $as not a reason *or e>clusion.

ur intention $as to e>amine the e**ects o* the *eeding inter7ention on the entire population o* indomethacin and ibupro*en'treated in*ants as $ell as on the in*ants in each indi7idual drug treatment subgroup. 2o distribute the drug treatment eEually among the study populations, each study site=s research pharmacist initially randomi9ed the in*ants to either indomethacin or ibupro*en. A*ter the drug treatment assignment, in*ants $ere randomi9ed to the study=s *eeding inter7ention: either 4*eeding6 or 4*asting (npo)6 duri during ng the the 4stu 4study dy drug drug admi admini nist stra rati tion on peri period od66 (de* (de*in init itio ion n gi7e gi7en n late later) r)

Bloc Block k











2he drug assignment $as masked *rom the clinical sta** in the beginning o* the trialH ho$e7er, this could not be achie7ed as the study progressed due to drug a7ailability that *orced *orced both both the indometha indomethacin cin and the ibupro*e ibupro*en n arms arms o* the study study to be closed closed at di**erent points in time. As a result, !&" o* thein *ants $ere treated $ith either open' label indomethacin or ibupro*en. 2hroughout the trial, in*ants recei7ed only the drug they $ere initially assigned i* they reEuired retreatment o* their PDA. Ghen indomethacin $as the study drug, drug, in*ants recei7ed % doses per treatment course (0., 0.1, 0.1, and 0.1 mg8kg8dose at 0, 1, % and %& hours, respecti7ely, i* they $ere ?1000 g at birth and J days old, or 0. mg8 kg8dose *or each o* the % doses i* they $ere I1000 g at birth or K days old). Ghen ibupro*en $as the study drug, in*ants recei7ed the same < doses o* ibupro*en ibupro*en (independent (independent o* birth $eight or postnatal postnatal age): 10, !, and ! mg8kg8dos mg8kg8dosee at 0, %, and %& hours, respecti7ely.

All in*ants had an echocardiogram and Doppler study per*ormed be*ore study entry to document the presence o* a PDA. An echocardiogram and Doppler study $ere per*ormed $ithin % hours o* the last dose o* study drug to determine residual ductus patency. Additional courses o* study drug could be administered at the discretion o* the attending neonatologists $ho also decided i* and $hen the PDA needed to be ligated.

!eedn" Re"#en

2he only clinical management controlled by the study $as the *eeding regimen. Because the time to achie7e a speci*ic enteral *eeding 7olume (10 mL8kg8d) $as the primary end point o* the trial, the *eeding regimen needed to be directi7e rather than le*t to the discretion o* the clinicians. 2here*ore, a standardi9ed 4*eeding ad7ance regimen6 $as instituted at each o* the participating centers be*ore the start o* the trial. 2he *eeding ad7ance regimen speci*ied the number o* days (based on birth $eight) o* 4trophic6 *eedings *eedings (1! mL8kg8d) mL8kg8d) that in*ants had to tolerate tolerate be*ore their enteral 7olumes could be increased increased (2abl (2ablee +). Friteria de*ining de*ining *eeding intolerance and its management management $ere also established established (2able (2able ++H a7ailable a7ailable at $$$.#peds.com $$$.#peds.com). ). Breast milk $as the primary source o* enteral nutrition. A 0 cal8o9 premature *ormula could be substituted *or breast milk i* mother=s mother=s milk $as una7ailable. una7ailable. Faloric *orti*ication *orti*ication o* enteral *eedings *eedings did not occur











$tud% Inter&enton

Althou Although gh the *eeding *eeding inter7 inter7ent ention ion $as random randomi9ed i9ed,, $e could could not mask mask $hich $hich inter7ention (4*eeding6 or 4*asting Cnpo6) the in*ants recei7ed during the 4study drug administration period6the time bet$een the *irst dose o* study drug and % hours a*ter the last dose o* study drug. +n*ants randomi9ed to the 4*eeding6 group recei7ed 4trophic6 enteral nutrition (1! mL8kg8d) during the 4study drug administration period.6 +n*ants, $ho recei7ed additional courses o* study drug as part o* their initial PDA treatment or later in the hospitali9ation, recei7ed 1! mL8kg8d o* enteral nutrition during the 4study drug administration period6 o* each additional course. +n*ants randomi9ed to the 4*asting (npo)6 group $ere made npo during the 4study drug administration period6 o* the *irst and any subseEuent treatment courses. nce the 4study drug administration period6 $as comple completed, ted, entera enterall *eeding *eeding $as return returned ed to the 7olume 7olume and rates o* ad7anc ad7anceme ement nt speci*ied by the in*ant=s standardi9ed *eeding ad7ance regimen.













Pr#ar% End Pont and 'utco#es

2he primary end point o* the study $as achie7ed $hen a daily enteral *eeding o* 10 mL8kg8 mL8kg8d d $as reached. reached. Because Because the postna postnatal tal age $hen the prima primary ry end point $as achie7ed could 7ary, based on the age $hen *eedings initially $ere started and the in*ant in*ants= s= birth birth $eight $eightMsp Mspeci eci*ic, *ic, *eedin *eeding g ad7anc ad7ancee regime regimen, n, $e created created a ne$ 7ariab 7ariable le (4ideal number6 o* days to reach 10 mL8kg8d) to re*lect the number o* days an in*ant $ould be e>pected to take, *rom the day the 4study drug administration period6 $as completed until the enteral *eeding goal o* 10 mL8kg8d $as reached (assuming nothing interrupted the prescribed *eeding ad7ance regimen).

2he 4ideal number6 o* days to reach 10mL8kg8d 10mL8kg8d $as calculated at the time o* study entry, entry, be*ore randomi9ati randomi9ation, on, and $as based on the assumption assumption that the in*ant $ould be *asted (npo) during the 4study drug administration period.6 2he 4ideal number6 o* days $as de*ined as the di**erence bet$een the day o* *eeding at $hich the in*ant started on completion o* the 4study drug administration period6 (re*er to column A in 2able +) and the day o* *eeding on the 4*eeding ad7ance regimen6 $hen 10 mL8kg8d $as anticipated to be reached reached.. 2he 2he ma>imu ma>imum m entera enterall 7olume 7olume an in*ant in*ant recei7e recei7ed d be*ore be*ore study entry determined the in*ant=s starting position on the 4*eeding ad7ance regimen6 once the 4study drug administration period6 $as completed (re*er to column A in 2able +). or e>ample, a /00'g birth $eight in*ant $ho had ne7er been *ed should, ideally, ha7e reEuired 11 days to reach 10 mL8kg8d (2able +). +* the in*ant had started enteral *eeding and tolerated only 1 day o* 1! mL8kg8d be*ore study entry, he or she $ould be e>pected to start at 4day 6 o* the standardi9ed 4*eeding ad7ance regimen6 once the 4study drug administration period6 $as completed and $ould 4ideally6 reEuire 10 days to reach and tolerat toleratee 10 mL8kg8 mL8kg8d d (assumi (assuming ng no *eedin *eeding g di**ic di**iculti ulties es occurr occurred ed during during the *eedin *eeding g











the 4study 4study drug drug admini administra stratio tion n period period66 could could be applie applied d to their their 4*eedin 4*eeding g ad7anc ad7ancee regimen.6 or e>ample, i* the /00'g in*ant, re*erred to earlier ($ho tolerated 1 day o* 1! mL8kg8d *eedings be*ore study entry), $as assigned to the 4*eeding6 group and the in*ant tolerat tolerated ed all < days days o* the 4trophic6 4trophic6 (1! mL8kg8d mL8kg8d)) *eeding *eedingss during during the 4study 4study drug drug administration period,6 he or she could start at 4day !6 o* the standardi9ed 4*eeding ad7ance regimen6 once the 4study drug administration period6 $as completed because he or she already recei7ed % days o* 1! mL8kg8d. +* no *eeding di**iculties occurred, this in*ant could take only  days to reach 10 mL8kg8d and the di**erence bet$een actual number number ( days) days) and 4ideal number6 (10 days, see earlier) to reach 10 mL8kg8d mL8kg8d $ould be ' < days.

$a#(le $)e

ample ample si9e $as determined determined using the time to reach the primary primary *eeding 7olume end point (10 mL8kg8d). ur prior data indicated that in*ants $ith birth $eights N1000 g $ho had a PDA reEuiring drug treatment achie7ed enteral *eedings o* 10 mL8kg8d at <0  1< days a*ter birth.Ge estimated that $e $ould need a total o* %00 in*ants to detect a signi*icant di**erence (o* % days) bet$een the 4*eeding6 and 4*asting (npo)6 groups ($ith a probability o* &0") i* the D $as 1< days. An interim analysis $as planned, once !0" o* the sub#ects had been enrolled, to calculate the actual D in our study population and to determine the *inal number o* sub#ects to be enrolled.

Ge planned planned to complete complete the study in < years. years. Oo$e7er, Oo$e7er, se7eral *actors pre7ented pre7ented us *rom completing the study during this inter7al: (1) indomethacin and ibupro*en became una7ailable at di**erent points in timeH and () a signi*icant shi*t in the approach to PDA treatment made many in*ants no longer eligible *or the study (there $as a shi*t at most











$tatstcal Anal%ses

ni7ariate analyses $ere per*ormed using thec test *or categorical 7ariables and tudent t test *or continuous 7ariables. Although this $as a randomi9ed controlled trial, some o* the demographic demographic 7ariables 7ariables $ere uneEually uneEually distributed distributed bet$een the *eeding *eeding and non*eeding groups (2ables +++ and +H 2able + a7ailable at $$$.#peds.com $$$.#peds.com). ). 2here*ore, multi7ariable analyses $ere per*ormed to ad#ust the study outcomes *or any possible demographic di**erences. Demographic 7ariables $ere included in the statistical models i* their uni7ariate P 7alue $as J.10. +n addition, because <" o* the in*ants enrolled in the trial $ere t$ins or triplets (2able +++) and %/" o* the multiple gestation in*ants had a sibling enrolled in the trial, $e used generali9ed estimating eEuations to ad#ust *or any nonind nonindepe epende ndence nce o* the clustered clustered data data that that might might be a**ecte a**ected d by shared shared geneti geneticc or en7ironmenta en7ironmentall *actors. *actors. aQs (*or binary outcomes) and correlation correlation coe**icients coe**icients (*or contin continuou uouss outcom outcomes) es) $ith $ith !" F+s $ere $ere calcul calculated ated using using genera generali9e li9ed d estimat estimating ing eEuations. Ghen models $ere unable to run using an e>changeable correlation structure, an independen independentt correlation correlation structure $as substituted substituted.. A P 7alue o* J.0! $as considered considered signi*icant. All analyses $ere per*ormed using 2A2A 11 (tataForp, Follege tation, 2e>as) statistical so*t$are.

Result

Bet$een ctober 00& and ;une 01, there $ere !1 in*ants $ho $ere eligible *or the study. e7enty'*our $ere e>cluded because o* parental re*usal, and 1 sub#ects $ere enrolled in the study. Because o* drug shortages, only %0 in*ants $ere treated $ith ibup ibupro ro*e *en, n, and and 1< 1< $ere $ere trea treated ted $ith $ith indo indome meth thaci acin. n. 2her 2heree $ere $ere no signi signi*i *ican cantt demographic di**erences bet$een the 4*eeding6 and 4*asting (npo)6 arms in the total











appeared to be uneEually distributed bet$een the 4*eeding6 and 4*asting (npo)6 groups (2able +++). 2here*ore, $e per*ormed multi7ariable analyses to ad#ust the study outcomes *or any possible demographic di**erences. +n the multi7ariable statistical models, $e included all o* the demographic 7ariables that di**ered bet$een the  groups $ith a P 7alue J.10. 2hese included multiple birth, respiratory distress syndrome, $hite race, umbilical 7enous catheter present at enrollment, PDA ligation during the hospitali9ation, and age $hen *irst *ed (2ables +++ and ++).











Ghen Ghen our analy analyses ses $ere ad#ust ad#usted ed *or these these possib possible le demogr demograph aphic ic 7ariat 7ariation ions, s, the di** di**ere erenc ncee in *eed *eedin ing g outco outcome mess bet$ bet$ee een n the the  study study grou groups ps becam becamee e7en e7en more more signi*icant: in*ants randomi9ed to the 4*eeding6 arm reEuired *e$er days to reach 10 mL8kg8d enteral *eedings a*ter the 4study drug administration period6 (P  .001), and reached the study=s *eeding 7olume end point at a younger postnatal age (P  .00) (2able ++).













e7eral other neonatal morbidities $ere e>amined in the study population. Although there appeared to be signi*icant di**erences bet$een the 4*eeding6 and 4*asting (npo)6 groups in the incidence o* bronchopulmonary dysplasia (BPD), death or BPD, and death, @5F, or BPD in the uni7ariate analysis, these di**erences $ere no longer present $hen the analyses $ere ad#usted *or the demographic di**erences bet$een the  groups as described earlier (2ables (2ables  and ++).











*eedings during the time they recei7ed indomethacin or ibupro*en. Although Although $e obser7ed no increase in the incidence o* *eedingrelated morbidities, our study $as only po$ered to detect a 1./'*old 1./'*old increase in the incidence incidence o* in*ection in*ection and a .%' *old increase in @5F. maller increases in morbidity could ha7e been missedH ho$e7er, neither the Q *or in*ection (0./<) nor the Q *or @5F (during the hospitali9ation: Q 0.), suggest a trend to$ard increased morbidity in the 4*eeding6 group (2able ++). ur *indings are simil similar ar to a recen recentt caseM caseMco cont ntro roll stud study y that that sugg suggest ested ed that that *eed *eedin ing g in*an in*ants ts durin during g indomethacin treatment appears to ha7e no detrimental e**ects and may decrease the time needed *or in*ants to achie7e *ull enteral *eedings.











BAB III PEMBAHA$AN

<.1 <.1 Pro* Pro*il il Penel Penelit itia ian n 1.

;udul Penelitian

:

5nteral eeding during +ndomethacin and ibupro*en treatment o* a patent ductus arteriosus . Peng engarang a. b. c. d. e. *.

:

Qona Qonald ld Fly Flyman, man,3D 3D Andrea Gickremasinghe, Gickremasinghe, 3D @am @ami ;h ;ha7er a7eri, i, 3D Deni Denise se F. F. Oas Oassin singe ger, r, 3D ;oshu ;oshuaa 2. 2. Attri ttridg dge, e, 3D 3D lan lanaa an ano ocka, cka, 3D











5nteral *eeding, indomethacin, ibu pro*en, Patent Ductus Arteriousus !. Abstract

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Abstrak :

ntu ntuk k meng mengu# u#ii hipo hipote tesi siss bah$ bah$aa bayi bayi yang yang baru baru sa#a sa#a dipe diperk rken enal alka kan n deng dengan an makanan melalui enteral akan memiliki nutrisi enteral lebih cepat #ika mereka menerima T tro*ik T ( 1! mL 8 kg 8 d ) pemberian makanan melalui enteral dengan menggunakan indometasin atau ibupro*en untuk pengobatan patent ductus arteriosus . Metode :

Penelitian Penelitian ini dilakukan dilakukan secara prospekti* prospekti* randomi9ed randomi9ed dilakukan antara ktober ktober 00& 00& dan dan ;uni ;uni 01 01 di 1< loka lokasi si setel setelah ah mend mendap apat at perse persetu tu#u #uan an de$a de$an n peni penin# n#au au kelembagaan . Bayi yang memenuhi syarat untuk penelitian #ika kehamilan <1 8 '<0/ 8  minggu , berat %01'1!0 g saat lahir , menerima 7olume enteral maksimum ?/0 mL 8 kg 8 d , dan bersedia diobati dengan indometasin atau ibupro*en . ebuah standar T *eeding ad7ance regimen T dan pedoman untuk mengelola intoleransi makan diikuti pada setiap lokasi ( @  1< ) . Hasl :

Bayi ( @  1 , /,<  1, minggu rata'rata  D kehamilan ) diacak pada /,!  <, <, hari hari untu untuk k mene menerim rimaa T tro* tro*ik ik T *eed *eed (kel (kelom ompo pok k yang ang dibe diberi ri maka makan n

n  &1 :











/. 2angga nggall Pub Publi lika kasi si : ! ! #anu #anuar arii 01< 01<

<. Deskripsi Penelitian Berdasarkan 3etode P+F 1. 2u#uan Penelitian

:

2u#ua 2u#uan n peneli penelitian tian ini adalah adalah dengan dengan memerik memeriksa sa e*ek e*ek dari dari inter7 inter7ens ensii pemberi pemberian an indome indometach tachin in dan ibupro ibupro*en *en terhada terhadap p in*ant in*ant.se .setela telah h treatme treatmen n obat obat dilaku dilakukan kan.. +n*an +n*an dirandom sesuai inter7ensi : *eeding atau *asting (puasa8 parenteral8 npo (nil per os)) selama periode pemberian obat. Block Qamdomisasi in*ant berdasarkan berat badan lahir berkisar %01'00g, 01'1000g, 01'1000g, dan 1001'1!0g. 1001'1!0g. . Desain Penelitian

:

Peneli Penelitia tian n ini menggu menggunak nakan an teknik teknik random random prospe prospecti cti7e 7e yang yang dilaku dilakukan kan dianta diantara ra kto ktobe berr 00& 00& dan dan ;uni ;uni 01 01 setel setelah ah mend mendap apatk atkan an i#in i#in tertu tertuli liss inst instit itus usii dan dan sura suratt persetu#uan orang tua pasien untuk dilakukan penelitian. Pera$atan yang dilakukan kepada in*ant menggunakan tim pera$atan klinis. <.

Populasi8 ample :













%. +nter7ention

:

ntuk ntuk indometachin, indometachin, in*ant memperoleh memperoleh % dosis per treatment : 0,H 0,1H 0,1H0,1 mg8kg8dose pada 0, 1,% dan %& #am berturut' turut #ika in*ant ?1000g saat lahir dan usia J hari, atau 0, mg8kg8dose memperoleh % dosis #ika in*att memiliki berat badan lahir I 1000g atau usia K hari. ntu ntuk k ibu ibu pro* pro*en en,, in*a in*ant nt dapa dapatt mene meneri rima ma < dosi dosiss yang ang sama sama : 10,! 10,! dan dan ! mg8kg8dose pada 0,% dan %& #am berturut'turut.etelah study obat dilakukan, in*an dibagi dibagi me#adi me#adi dua sub'gr sub'grub ub yaitu yaitu : *eedin *eeding8t g8trop rophic hic (1!ml8 (1!ml8kg8 kg8d d dalam dalam < hari) hari) dan *asting8npo ( 10ml8kg8d dalam '10 hari) grub. emua emua in*ant in*ant mendapatk mendapatkan an penanganan penanganan 5FR dab Doopler sebelum sebelum melakukan melakukan pengisian dokumen penelitian untuk PDA. Penelitian untuk 5FR dan Dopopler











ke usus halus, menghalangi menghalangi respon hiperemi hiperemi normal normal setelah makan, mengganggu mengganggu *ungsi pertahanan mukosa gastrointestinal. edangkan e*ek samping dari ibupro*en bere*ek pada permeabilitas dari gastrointestinal (i ;oung Oan et al, 011)

!. Fomparator

:

1 bayi diacak pada /,!  <, hari untuk menerima nutrisi T tro*ik T *eed ( kelompok yang diberi makan, n: &1 indometasin &0 " , ibupro*en 0 ") dan (kelompok yang dipu dipuas asak akan an n/ n/

: indo indome meta tasi sin n ! " , ibup ibupro ro*e *en n ! " ). Oasi Oasill pene peneli liti tian an

menun#ukkan tidak ada perbedaan data demogra*i yang sikni*ikan antara kelompok yang diberi makan dan kelompok yang dipuasakan kecuali beberapa 7ariabel berikut: ke#adian kehamilan multiple, adanya pemasangan kateter 7ena pada umbilikus saat





















. kami melakuk melakukan an analisis analisis multi7ariabe multi7ariabell untuk menyes menyesuaikan uaikan hasil hasil penelitian penelitian untuk untuk setiap setiap demogr demogra*i a*iss yang yang mungk mungkin in ter#ad ter#adii perbed perbedaan. aan. Dalam Dalam model model statisti statistik k multi7ariabel, kami memasukkan semua 7ariabel demogra*is yang berbeda antara  kelom kelompok pok dengan dengan nilai nilai P J0,10. J0,10. +ni termas termasuk uk dalam dalam beberap beberapaa kelahi kelahiran ran dengan dengan sindro sindrom m ganggu gangguan an pernapasa pernapasan, n, ras kulit kulit putih, putih, pusar pusar 7ena kateter, kateter,

pada pada saat

penda*taran PDA,dilakukan ligasi selama ra$at inap, dan ketika pemasukan makanan nutrisi pertama kali. <. analisis analisis kami disesuaik disesuaikan an untuk untuk 7ariasi 7ariasi demogra*is demogra*is yang yang mungkin mungkin terdapat terdapat perbedaa perbedaan n dari hasil makanan antara  kelompok studi yang bahkan lebih signi*ikan: bayi secara acak TmakanT menggunakan tangan dibutuhkan lebih sedikit sehari untuk mencapai 10 mL 8 kg 8 hari, pemberian pemasukan makanan makanan setelah Ttudi periode pemberian obatT (P  .001), dan mencapai titik makan 7olume akhir studi di usia postnatal muda (P  0,00).











Dalam Dalam #urnal #urnal ini #uga #uga dipapa dipaparka rkan n pember pemberian ian dosis dosis secara secara rinci rinci yang yang disesu disesuaik aikan an dengan berat badan in*ant. -elemahan : peniliti berencana untuk menyelesaikan penelitian dalam $aktui < tahun namun $aktu penelitian men#adi meman#ang karena beberapa *actor yang mencegah peneliti menyelesaikan penelitian yaitu : 1. +ndomethacin +ndomethacin dan dan ibupro*en ibupro*en tidak tidak tersedia tersedia untuk untuk tu#uan tu#uan yang yang berbeda. berbeda. . 2erdapat 2erdapat perubaha perubahan n yang signi*ikan signi*ikan pada pada pendekatan pendekatan pera$atan pera$atan PDA yang membuat membuat banyak bayi tidak memnuhi memnuhi syarat untuk penelitian.

&.

3an 3an*aat *aat Oasil asil Pen Penelit elitia ian n Bagi Bagi -ep -epera$ era$at atan an













Pene Peneli litia tian n ini ini dila dilaku kuka kan n untu untuk k meng mengu# u#ii hipo hipotes tesis is bah$ bah$aa bayi bayi yang baru baru sa#a sa#a diperkenalk diperkenalkan an dengan dengan makanan makanan melalui melalui enteral enteral akan memiliki memiliki nutrisi nutrisi yang lebih baik #ika menerima menerima tro*ik dengan menggunak menggunakan an terapi indometasi indometasin n atau ibupro*en ibupro*en untuk pengobatan pengobatan patent ductus arteriosus, penelitian dilakukan secara prospekti* random pada bulan ktober 00& hingga hingga tahun 01 di 1< lokasi. Bayi dikatakan dikatakan memenuhi memenuhi syarat syarat untuk untuk penelitian penelitian #ika berusia  minggu (prematur) dengan berat badan %01'1!0 g saat lahir, menerima makanan melalui melalui enteral enteral maksimum maksimum ?/0 mL 8 kg 8 d, dan bersedia diobati diobati dengan indometasin indometasin atau





















review jurnal Patent Ductus Arteriosus

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