[Latar Belakang: Sepsis saat ini masih merupakan masalah utama di bidangperawatan dan pelayanan neonatus dengan angka mortalitas 24% pada tahun2012. Gangguan sistem koagulasi pada sepsis akibat aktivasi endotel danpengeluaran faktor jaringan ditandai dengan eksaserbasi proses koagulasi,gangguan sistem anti-koagulasi, dan penurunan degradasi fibrin yangmengakibatkan terbentuknya trombosis mikrosirkulasi, deposisi bekuan fibrin,hipoperfusi jaringan serta hasil akhir berupa disfungsi organ. Kaskade koagulasimenunjukkan trombin memiliki peran penting dan salah satu komponen antikoagulanutama diperankan oleh antitrombin (AT). Seratus persen neonatusdengan sepsis menderita defisiensi AT namun belum ada data pada neonatus yangsecara klinis menderita sepsis.Tujuan: Mengetahui profil dan perubahan kadar antitrombin pada neonatus yangsecara klinis menderita sepsis awitan dini di unit perawatan PerinatologiDepartemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangunkusumo.Metode: Penelitian bersifat deskriptif prospektif yang dilakukan pada bulanAgustus-November 2013. Subjek penelitian adalah neonatus usia gestasi 28-40minggu (berat lahir >1000 gram) yang secara klinis terdiagnosis sepsis dandirawat di ruang Perawatan Perinatologi Rumah Sakit Cipto Mangunkusumo.Dilakukan pengukuran kadar serum AT secara serial pada perawatan hari pertama,ketiga dan kelima. Kadar serum AT disajikan dalam bentuk nilai rerata dansimpang baku. Analisis statistik dilakukan untuk melihat perbedaan antar rerataAT pada hari pertama, ketiga dan kelima perawatan dengan menggunakan ujiAnova (analisis bivariat).Hasil: Penelitian ini dilakukan pada 62 neonatus yang secara klinis menderitasepsis. Pada penelitian ini didapatkan peningkatan rerata AT yang meningkatsecara bermakna pada ketiga pengukuran AT (P=0,000) dan kecenderunganpeningkatan kadar AT yang lebih tinggi pada pasien yang hidup dibandingkanpasien yang mati. Terdapat 56,5% neonatus dengan defisiensi antitrombin padapemeriksaan hari pertama perawatan dengan profil nilai rerata AT pasienpenelitian sebesar 30,01% (SD 17,36) pada pemeriksaan hari pertama, 37,9% (SD19,34) pada pemeriksaan hari ketiga dan 47,05% (SD 18,25) pada pemeriksaanhari kelima perawatan.Simpulan: Terdapat profil kadar AT yang rendah dan peningkatan kadar AT padapasien neonatus yang secara klinis menderita sepsis. Antitrombin masih mungkinmemiliki peran sebagai faktor prognostik., Background: Neonatal sepsis still becomes one of major problems in neonatalcare. The problem can be seen from the 24% mortality in 2012. Within thepathophysiology of sepsis, coagulation derangements caused by endothelialactivation and secretion of tissue factor, are characterized by coagulationexacerbation, impaired anticoagulation system, and decreased fibrin removal.These derangements are marked by the generation of microcirculation thrombosiswith deposition of microclots and obstruction of circulation, impairing blood flowcontributing to tissue hypoperfusion and consequently organ dysfunction. Inaddition to this, coagulation cascade demonstrates that thrombin has major role inthe formation of fibrin. One of the main anticoagulant against the coagulationactivity is played by antithrombin (AT). Eventhough all neonate with neonatalinfection have AT deficiency, there is no data in clinically early-onset neonatalinfection.Objectives: This study was designed to identify the profile and changes in AT inclinically early-onset neonatal infection in Perinatology ward CiptoMangunkusumo Hospital.Method: A descriptive in prospectively was conducted from August untilNovember 2013. Subjects were neonate 28-40 weeks gestational ages (birthweight >1000 gram) who clinically diagnosed with neonatal infection andhospitalized in Perinatology ward Cipto Mangunkusumo Hospital. Serum ATlevel was measured serially in the first, third, and fifth day of the hospitalization.Data AT profile was presented by the mean and confidence interval. Anova testwas used to analyze the difference between measurements (bivariate analysis).Result: This study found that the mean of serum AT level increase significantly inthe serial measurement (p=0,000) and there was a trend showing higherincreamental level of AT in survived patient compared to the died one. Theseresults are taken from samples of 62 neonates with clinically early-onset neonatalinfection. From the samples, 56,5% of neonates were having antithrombindeficiency from the first day of the hospitalization. In addition to this, the meansserum AT level was 30,01% (SD 17,36) in the first day, 37,9% (SD 19,34) in thethird day and 47,05% (SD 18,25) in the fifth day of hospitalization.Conclusion: There was low level of antithrombin profile and increasing serumlevel AT in clinically early-onset neonatal infection. Antithrombin may havebeneficial effect as a prognostic factor.] |