Evaluasi Penggunaan Fototerapi Konvensional dalam Tata laksana Hiperbilirubinemia Neonatal: Efektif, tetapi Tidak Efisien

Abstract

Latar belakang. Hiperbilirubinemia merupakan masalah umum yang sering dijumpai pada bayi baru lahir. Tata laksana hiperbilirubinemia neonatal dilakukan untuk mencegah timbulnya komplikasi dan fototerapi merupakan metode yang paling sering digunakan. Fototerapi konvensional menurunkan kadar bilirubin lebih lama dibanding fototerapi intensif sehingga berpotensi menyebabkan inefisiensi. Saat penelitian ini dilakukan, RSUD Prof.dr. Margono Soekarjo (RSMS) Purwokerto hanya memiliki alat fototerapi konvensional.Tujuan. Mengevaluasi pengelolaan hiperbilirubinemia neonatal dengan fototerapi konvensional. Metode. Penelitian crossectional melibatkan 157 subjek dengan kiteria inklusi adalah hiperbilirubinemia neonatal, yang dirawat inap pada Januari–September 2018 di RSMS Purwokerto, dengan menggunakan data sekunder rekam medis. Analisis data dan statistik digunakan SPSS dan uji Wilcoxon digunakan untuk mengalisis perbedaan antara kadar bilirubin serum total (BST) pra dan pascafototerapi. Hasil. Sebanyak 157 bayi (13,08 %) dirawat dengan hiperbilirubinemia, dengan usia tersering 3 hari. Rerata lama fototerapi 60,27 jam. Analisis komparatif antara kadar BST pra dan pascafototerapi, terdapat penurunan BST yang signifikan (p <0,001) dari 17.23±5.04 mg/dL (prafototerapi) menjadi 10,18±2,02 mg/dL (pascafototerapi). Rerata lama rawat inap 4,48±4,47 hari. Kecepatan penurunan kadar bilirubin 0,12 mg/dL per jam. Kesimpulan. Fototerapi konvensional efektif menurunkan kadar BST hiperbilirubinemia neonatal, tetapi tidak efisien.

Cylindrical intensive vs. double surface LED phototherapy for neonatal hyperbilirubinemia

“…Because bilirubin is yellow, high bilirubin may turn the infant's skin, sclera, and other body tissues yellow. 1,2 Elevated levels of bilirubin may cause a dangerous complication called kernicterus, also known as bilirubin encephalopathy, in which brain damage occurs due to indirect bilirubin adhesion to the brain, specifically in the corpus striatum, thalamus, nucleus, hippocampus subthalamus, red nucleus, and nucleus at the base of the fourth ventricle. Clinically, kernicterus may cause unusual eye movements, lethargy, seizures, feeding disorders, muscle spasms, and increased muscle tone.…”

“…This condition should be treated through phototherapy or exchange transfusion, though phototherapy is the method of choice because it is widely available and has fewer side effects than exchange transfusion. [1][2][3] Phototherapy is a medical treatment that utilizes a light wavelength of 420-480 nm, which can reduce bilirubin levels in neonates through a process called photo-oxidation. The phototherapy unit used to treat infants with neonatal hyperbilirubinemia converts accumulated unconjugated bilirubin on the skin surface area.…”

“…8,9 The Bilisphere manufacturer claims to be able to significantly reduce the duration of therapy compared to other phototherapy units like single or double LED. 2,10,11 A study of 200 neonates with hyperbilirubinemia reported that cylindrical intensive phototherapy might reduce the need for exchange transfusion to only 16% compared to the control group (66%) (P<0.001), reduce the duration of phototherapy by 1.7 days compared to control group (4.1 days) P<0.001), and reduce bilirubin levels up to 5.7 mg/dL. 12 Another study reported that in 157 neonates with hyperbilirubinemia using conventional phototherapy, total serum bilirubin significantly decreased (from 17.23 (SD 5.04) mg/dL to 10.18 (SD 2.02) mg/dL, with an average duration of treatment 4.48 (SD 4.47) days and rate of bilirubin decrease of 0.12 mg/dL per hour.…”

“…They also showed that conventional phototherapy was less efficient compared to intensive phototherapy, with four times longer duration of therapy. 2 Cylindrical intensive phototherapy is considered to be more cost-efficient, because the shorter duration of phototherapy shortens the hospital length of stay. 2,10,11 At Syamsudin SH District Hospital, Sukabumi, West Java, two types of phototherapy are available: cylincrical intensive 360 degrees phototherapy and double surface LED phototherapy.…”

“…2 Cylindrical intensive phototherapy is considered to be more cost-efficient, because the shorter duration of phototherapy shortens the hospital length of stay. 2,10,11 At Syamsudin SH District Hospital, Sukabumi, West Java, two types of phototherapy are available: cylincrical intensive 360 degrees phototherapy and double surface LED phototherapy. The LED phototherapy has been available since 2016, while cylindrical intensive phototherapy is relatively new, as it was first implemented in early 2020.…”