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Abstrak :
Latar Belakang: Bayi sangat prematur rentan terjadi retriksi pertumbuhan ekstra uterin yang berakibat gangguan neurodevelopmental. Hal ini dapat dicegah dengan pemberian nutrisi parenteral agresif dini dan nutrisi enteral sesuai protokol nutrisi bayi prematur. Tujuan pemberian nutrisi parenteral agresif dini adalah mencegah terjadinya katabolisme dan menjamin pertumbuhan yang sama dengan intrauteri. Pengukuran kecepatan pertumbuhan adalah salah satu metode pengukuran pertumbuhan untuk menilai status nutrisi pada bayi prematur. Nilai kecepatan pertumbuhan diukur pada usia 28 hari dikarenakan pada saat ini telah terjadi pertumbuhan pesat setelah bayi kembali ke berat lahir. Tujuan: Mengetahui nilai kecepatan pertumbuhan usia 28 hari bayi sangat prematur dan atau bayi berat lahir sangat rendah serta faktor-faktor yang memengaruhinya setelah mendapatkan protokol standar nutrisi bayi prematur yang berlaku di RSCM. Metode: Studi kohort prospektif dengan metode konsekutif sampling pada bayi sangat prematur dan atau bayi berat lahir sangat rendah yang lahir di RSCM pada bulan Februari sampai dengan November 2020. Hasil: Didapatkan 64 subjek penelitian yang diamati. Terdapat 33/64 (51,6%) subjek dengan transfusi berulang, 22/64 (34,4%) asidosis metabolik memanjang , 5/64 (7,8%) EKN derajat II, 12/64 (18,8%) DAP Hs, 37/64 (57,8%) penyakit membran hialin derajat IV, 37/64 (57,8%) intoleransi minum, 55/64 (85,9%) SMK dan 9/64 (14,1%) KMK. Rerata kecepatan pertumbuhan adalah 17,98 gram/kgBB/hari, SMK 18,22 gram/kgBB/hari dan KMK 16,50 gram/kgBB/hari. Faktor yang paling memengaruhi adalah asidosis metabolik memanjang dengan nilai p 0,01. Kesimpulan : Kecepatan pertumbuhan usia 28 hari bayi sangat prematur dan atau bayi berat lahir sangat rendah setelah mendapat protokol standar nutrisi bayi prematur RSCM adalah 17,98 gr/kgBB/hari. Asidosis metabolik memanjang memengaruhi kecepatan pertumbuhan. ......Background: Very preterm infants are susceptible to extrauterine growth restriction resulting in neurodevelopmental disorders. This can be prevented by providing early aggressive parenteral and enteral nutrition, aiming to prevent catabolism and ensure similar intrauterine growth. Growth velocity is a growth measurement method for assessing nutritional status in preterm infants, which is measured at 28 days of age since it is the moment of rapid growth after the baby has returned to birth weight. Aims : To determine the growth velocity at 28 days of age for very preterm and/or very low birth weight infants and assess affecting factors in applying the standard protocol of preterm infant nutrition in Cipto Mangunkusumo Hospital (CMH). Methods: Prospective cohort study with consecutive sampling method on very preterm and/or very low birth weight infants born in CMH since February to November 2020. Results: Among 64 subjects, the number of appropriate- and small-for-gestationalage (AGA and SGA) were 55 (85.9%) and 9 (14.1%), respectively. The associated conditions were as following; sepsis with repeated transfusions (33/64, 51.6%), prolonged metabolic acidosis (22/64, 34.4%), grade II necrotizing enterocolitis (5/64, 7.8%), hemodynamically-significant patent ductus arteriosus (12/64, 18.8%), grade IV hyaline membrane disease (37/64, 57.8%), and feeding intolerance (37/64, 57.8%). The mean growth velocity was 17.98 g/kg/day, specifically 18.22 g/kg/day in AGA and 16.50 g/kg/day in SGA infants, respectively. The most influencing factor in applying nutritional protocol was prolonged metabolic acidosis (p value = 0.01). Conclusion: The growth velocity at 28 days of very preterm and/or very low birth weight infants after receiving standard nutritional protocol for preterm infants in CMH was 17.98 g/kg/day. Prolonged metabolic acidosis has significant influence on growth velocity.

Abstrak :
Latar Belakang: Bayi sangat prematur adalah kelompok bayi risiko tinggi yang rentan terhadap luaran neurodevelopmental yang buruk. Penelitian menunjukkan bahwa pemberian nutrisi secara dini dan agresif dapat mengurangi kejadian malnutrisi pada bayi sangat prematur. Saat ini, RSUP Fatmawati belum mempunyai protokol nutrisi yang standar untuk bayi prematurnya dan ingin melakukan perubahan dengan menerapkan protokol standar nutrisi bayi prematur dari RSCM. Tujuan: Untuk mengetahui beda waktu kembali ke berat lahir dan pola pemberian nutrisi bayi sangat prematur/BBLSR yang lahir dan dirawat di Unit Neonatologi RSUP Fatmawati sebelum dan sesudah penerapan protokol standar nutrisi bayi prematur RSCM. Metode: Dilakukan penelitian quasi eksperimental terhadap 23 bayi sangat prematur/berat lahir sangat rendah di Unit Neonatologi RSUP Fatmawati pada bulan Juli – November 2019. Bayi dieksklusi bila orangtua menolak berpartisipasi atau mempunyai kelainan kongenital yang mempengaruhi status nutrisi. Sampel pada kelompok intervensi diberikan nutrisi sesuai protokol standar nutrisi bayi prematur RSCM dan diikuti hingga kembali ke berat lahir dan mencapai fullfeed. Pola pemberian nutrisi yang juga dievaluasi sebagai luaran sekunder (waktu dimulainya nutrisi enteral dan mencapai fullfeed, waktu dimulainya pemberian protein dan lipid, waktu tercapainya protein, lipid dan kalori tertinggi serta jumlah protein, lipid, kalori dan GIR tertinggi). Data pasien pada kelompok kontrol diambil dari data rekam medik bayi sangat prematur/berat lahir sangat rendah yang sudah pulang dari RSUP Fatmawati dari Januari 2016 – Juni 2019 dan dibandingkan dengan kelompok intervensi. Hasil: Penerapan protokol standar nutrisi bayi prematur RSCM dapat mempercepat waktu kembali ke berat lahir (kontrol vs intervensi: 16,7 (5,1) vs 7,4(3,5) hari, p= 0,00) dan mempercepat growth velocity (kontrol vs intervention: 8,9 (6,9) vs 14,6 (6,0), p=0,002) pada bayi sangat prematur/BBLSR yang dirawat di Unit Neonatologi di RSUP Fatmawati. Kesimpulan: Penerapan protokol standar nutrisi bayi prematur RSCM dapat mempercepat waktu kembali ke berat lahir dan growth velocity pada bayi sangat prematur/BBLSR yang dirawat di Unit Neonatologi RSUP Fatmawati. Kata kunci: nutrisi bayi prematur, nutrisi agresif dini, waktu kembali ke berat lahir, growth velocity. .....Background: Very premature infants are a group of high-risk infants who are vulnerable to poor neurodevelopmental outcomes. Research shows that early and aggressive nutrition can reduce the incidence of malnutrition in very premature infants. At present, Fatmawati Hospital does not yet have a standard nutritional protocol for premature infants and want to make changes by implementing a standard protocol for preterm infant nutrition from RSCM. Objective: To determine the difference in days to regain birth weight and the pattern of nutrition for very premature/very low birth weight infants who were born and hospitalized in the Neonatology Unit of RSUP Fatmawati before and after the application of the standard protocol of premature infant nutrition of RSCM. Methods: A quasi-experimental study of 23 very preterm/very low birth weight infants in the Neonatology Unit of Fatmawati Hospital from July to November 2019. Infants were excluded if parents refused to participate or had congenital abnormalities that affects nutritional status. Samples in the intervention group were given nutrition according to RSCM premature infant nutrition protocol and followed until they return to birth weight and achieve fullfeed. Nutritional patterns were also evaluated as secondary outcome (day to begin enteral nutrition, growth velocity, days to reach fullfeed, days to start protein and lipid, days to reach the highest protein, lipid and calorie intake and the highest amount of protein, lipid, calories and GIR given). Data of samples in the control group were taken from medical records of very premature/very low birth weight babies discharged from Fatmawati Hospital from January 2016 - June 2019 and compared with the intervention group. Results: The application of RSCM premature infant nutrition protocol can shorten the days to regain birth weight (control vs intervention: 16.73 vs 7.43 days, p = 0.00) and fasten growth velocity (control vs intervention: 8,9 (6,9) vs 14,6(6,0), p=0,002) in very premature/low birth weight infant who were treated in the Neonatology Unit of Fatmawati. Conclusion: The application of RSCM premature infant nutrition standard protocol can accelerate time to regain birth weight and growth velocity in very premature/low birth weight infant in the Neonatology Unit, Fatmawati Hospital.