Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Latar belakang: Morbiditas akibat duktus arteriosus paten (DAP) pada neonatus cukup bulan (NCB) cukup tinggi. Peran prostaglandin E2 (PGE2), trombosit (immature platelet fraction, IPF), dan vascular endothelial growth factor (VEGF) pada penutupan DA secara fungsional dan anatomis pada NCB belum banyak diteliti. Patofisiologi terjadinya DAP dapat memengaruhi tata laksana farmakologi dini yang belum terstandardisasi pada NCB. Penggunaan obat antiinflamasi nonsteroid seperti ibuprofen dimungkinkan dapat menghambat jalur sintesis prostaglandin dengan efek samping minimal. Tujuan: Mengkaji peran prostaglandin E2, VEGF, IPF, dan efek pemberian ibuprofen oral dalam proses penutupan DA pada NCB. Metode: Penelitian dilakukan di rumah sakit (RS) Sanglah Denpasar, RS Prima Medika Denpasar, dan RS Umum Daerah Wangaya Denpasar, dalam periode Maret sampai Agustus 2015. Penelitian terdiri dari 2 desain, pertama desain potong lintang pada pasien dengan DAP dan tanpa DAP secara consecutive sampling dan desain kedua uji klinis acak terkontrol ganda pada pasien DAP usia ≥ 48 jam. Pasien dengan DAP kemudian dimasukkan dalam uji klinis, dilakukan randomisasi untuk diberikan perlakuan ibuprofen oral dosis hari pertama 10 mg/kg, hari kedua dan ketiga 5 mg/kg atau plasebo. Pemantauan hemodinamik dan efek samping obat dilakukan selama pemberian perlakuan. Pemeriksaan ekokardiografi, PGE2, VEGF, IPF, dan kreatinin dilakukan pada hari pertama dan keempat pascapemberian perlakuan. Hasil: Terdapat 64 subjek yang diteliti pada desain pertama dan 32 subjek pada desain kedua. Rerata kadar PGE2 lebih tinggi pada kelompok dengan DAP dibanding tanpa DAP, sedangkan rerata kadar VEGF dan IPF tidak berbeda. Ibuprofen oral tidak terbukti menurunkan diameter DA pascaperlakuan, tidak terdapat perbedaan rerata diameter pada kedua kelompok. Terdapat hubungan positif sedang terhadap perubahan kadar PGE2 dengan perubahan diameter DAP pascaperlakuan. Tidak terdapat perubahan hemodinamik atau efek samping akibat pemberian ibuprofen oral atau plasebo pada NCB dengan DAP. Simpulan: Tingginya kadar PGE2 terbukti berperan dalam patensi DA pada NCB. Ibuprofen oral dosis 10 - 5 - 5 mg/kgBB tidak mengecilkan diameter DAP.

---

Background: Serious morbidity impact due to patent ductus arteriosus (PDA) in full-term neonates remains high. The functional role of prostaglandin E2 (PGE2), platelet (immature platelet fraction, IPF), and vascular endothelial growth factor (VEGF) has not been studied in the closure mechanism of ductus arteriosus (DA). Understanding of pathophysiology of PDA may influence early pharmacological treatments, which have not been standardized in full-term neonates. The use of non-steroidal anti-inflammatory drugs such as ibuprofen can be beneficial as a pharmacological agent in enhancing the closure of PDA with minimal adverse effects. Objectives: To evaluate the role of prostaglandin E2, VEGF, IPF, and the effect of oral ibuprofen in the process of DA closure in full-term neonates. Methods: This study was conducted in Sanglah General Hospital, Prima Medika Hospital, and Wangaya Hospital Denpasar. The study consisted of two designs, the first was cross-sectional design in subjects with and without PDA using consecutive sampling and the second was double blind randomized controlled trial in full-term infant aged ≥ 48 hours. Subjects with PDA were randomized to oral ibuprofen and placebo administration, in which ibuprofen was given consecutively 10 - 5 - 5 mg/kg. All subjects underwent echocardiography, PGE2, VEGF, and IPF assays. Hemodynamics monitoring was evaluated during trial and adverse effect due to ibuprofen was recorded by measuring urine volume and plasma creatinine level. Results: From March to August 2015, there were 64 subjects recruited for the first design and 32 subjects in the second design. The mean level of PGE2 was higher significantly in the group with PDA than non PDA group, while the mean levels of VEGF and IPF showed no difference. In the second design, oral ibuprofen showed no effect in reducing DA diameter after treatment. There were no differences in mean diameter of DA in both groups before and after treatments. There was moderate positive relationship between levels of PGE2 and the change of PDA diameter. There were neither hemodynamic changes nor adverse effect due to the administration of oral ibuprofen or placebo. Conclusions: A high level of PGE2 appears to play a pivotal role in DA patency of full-term neonates. Administration of oral ibuprofen in 10 - 5 - 5 mg/kg schedule could not induce PDA closure in full-term neonates.

Abstrak :
Manuver rekrutmen paru (MRP) adalah strategi mencegah kerusakan paru saat bayi menggunakan ventilator mekanis (VM). Dengan meningkatkan tekanan akhir ekspirasi (TAE) secara bertahap, MRP membuka alveolus, menurunkan kebutuhan oksigen hirup (FiO2) sekaligus meningkatkan ambilan oksigen paru. Hingga kini, belum cukup bukti ilmiah terkait pengaruh MRP menggunakan VM terhadap luaran bayi prematur. Penelitian ini adalah uji klinis tidak tersamar, dilakukan di RS Cipto Mangunkusumo dan RSIA Bunda Menteng, bertujuan mencari hubungan MRP dengan kejadian DBP dan atau kematian, curah jantung, cedera alveolus-endotel, penurunan diameter duktus arteriosus (DA), dan mikrosirkulasi kulit. Penelitian berlangsung Maret 2021–April 2022. Subjek penelitian adalah bayi prematur 24–32 minggu yang menggunakan ventilator mekanis saat usia < 48 jam. Protein surfaktan-D (SP-D) diukur menggunakan metode ELISA, mikropartikel endotel (CD-31+/CD-42–) menggunakan flowsitometri, curah jantung dan diameter DA menggunakan ekokardiografi, TcCO2–PaCO2, TcO2/PaO2 menggunakan monitor gas darah transkutan dan gas darah arteri, strong ion difference (SID) menggunakan elektrolit darah arteri. Pada usia koreksi 36 minggu, tidak terdapat perbedaan bermakna kejadian DBP atau kematian antara kelompok MRP dan tanpa MRP 38 (69,09%) vs. 43 (78,18%), p = 0,216. Pada 72 jam pasca-penggunaan VM, tidak didapati perbedaan kadar SP-D, CD 31+, Diameter DA, curah jantung, TcCO2 gap dan SID antara kelompok MRP dan tanpa MRP . Terdapat perbedaan bermakna TcO2 indeks 1,00 (1,00; 1,02) vs. 1,00 (0,99; 1,00), p = 0,009* antara kelompok MRP dibanding tanpa MRP. Pada bayi penyintas, MRP mempercepat waktu untuk mencapai FiO2 ter-rendah 60,0 (54,00; 75,00) vs. 435,00 (375,00; 495,00) menit, p < 0,0001 dan lama penggunaan alat bantu napas 25,0 (19,00; 37,00) vs. 36,83 (SB 19,11) hari, p = 0,044. Simpulan, MRP bayi prematur tidak terbukti mengurangi kejadian DBP dan atau kematian pada usia 36 minggu. Tidak ada perbedaan cedera alveolar-endotel, curah jantung kiri-kanan, dan diameter DA pada usia 72 jam. Tindakan MRP meningkatkan mikrosirkulasi. Pada kelompok penyintas, MRP mempersingkat waktu mencapai FiO2 terendah dan penggunaan alat bantu napas. ......Lung recruitment maneuver (LRM) is a strategy during mechanical ventilation which aim to open collapsed alveolus in order to increased oxygenation. This maneuver could be done by application of a stepwise increments of positive end expiratory pressure (PEEP) until lowest FiO2 (< 30%) is achieved. There is still lack of evidence regarding relationship between LRM and neonatal outcome. This study aimed to evaluate effectivity of LRM in order to reduce chronic lung disease and it’s influence to neonatal hemodynamic as well. This was unblinded randomized clinical trial which aimed to investigate relationship between LRM and neonatal death, bronchopulmonary dysplasia (BPD), cardiac output, reduction of ductus arteriosus (DA) diameter, skin microcirculations and alveolar-endotel injury. The study was conducted on March 2021 until April 2022 in Cipto Mangunkusumo and Bunda Menteng Hospital. Plasma surfactant protein-D (SP-D) was measured with ELISA, Microparticel endotel (CD-31+) with flowcytometri, left and right cardiac output (LVO and RVO) and DA diameter were measured by echocardiography, TcCO2–PaCO2, tcO2/PaO2 were measured form arterial blood gas and transcutaneous monitor and strong ion difference (SID) from plasma electrolyte. At 36 weeks follow up, there ware no significant difference of incident of DBP and/or death between MRP vs. without MRP groups 38 (69.09%) vs. 43 (78.18%), p = 0.216 (CI 95% 0.141–0.295). There were no difference between MRP and without MRP group at 72 hours, regarding : plasma SP-D, microparticle endotel, cardiac output, DA diameter, tcCO2 gap and SID. At. 72 hours, tcO2 index was better in MRP compared to control group 1.00 (1.00; 1.02) vs. 1.00 (0.99; 1.00), p = 0.009. There were no significant difference regarding other neonatal morbidity between the two group. Among survival subject, LRM reduced time to achieved lowest FiO2 60.00 (54.00; 75.00) vs. 435.00 (375.00; 495.00) hours, p < 0.0001 and length of respiratoy support 25.0 (19.00; 37.00) vs. 36.83 (SD 19.11) days, p=0.044. Conclusion When applied to 24–32 weeks preterm baby with invasive mechanical ventilation, LRM could not reduced DBP or death at 36 weeks of age. There was no any difference at 72 hours regarding alveolar and endothelial injury, left and right cardiac output and diameter DA. LRM was associated with better microcirculation. Among the survivor, LRM reduced high oxygen concentration exposure time and length of respiratory support.