Disertasi

Deteksi dini palsi serebral pada bayi risiko tinggi: peran berbagai variabel klinis dan USG kepala. = Early detection of cerebral palsy in high-risk babies: The role of clinical variables and cerebral ultrasound.

Latar belakang. Palsi serebral (PS) adalah gangguan fungsi motorik dan postur, akibat gangguan perkembangan otak. Insidens PS meningkat dengan peningkatan jumlah bayi risiko tinggi. Masalahnya adalah bagaimana deteksi dini PS dengan cara yang mudah. Tujuan; (1) menentukan proporsi PS pada bayi risiko tinggi, (2) menentukan kesintasan PS pada tahun pertama, (3) faktor-faktor risiko yang berhubungan dan memengaruhi kesintasan PS, (4) deteksi dini dengan parameter keterlambatan motorik, pemeriksaan neurologi dan USG kepala. Metode penelitian. Studi kohort prospektif dilakukan pada 150 bayi risiko tinggi sampai usia 12 bulan. Anamnesis kemampuan motorik, pemeriksaan 5 refleks primitif dan 2 reaksi postural dilakukan saat usia 4 dan 6 bulan. Diagnosis PS ditegakkan saat usia 6 dan 12 bulan. Hasil penelitian. Proporsi PS pada bayi-bayi risiko tinggi saat usia 6 dan 12 bulan berturut-turut adalah 26 % dan 24 %. Mayoritas PS (88,7 %) terdeteksi pada 6 bulan pertama kehidupan. Faktor risiko yang memengaruhi kejadian dan kesintasan PS adalah abnormalitas USG kepala, ensefalopati-hipoksik iskemik , perdarahan intrakranial dan meningitis. Saat usia 4 bulan, pemeriksaan respons tarikan, fisting, refleks palmar dan crossed extensor dapat dipakai untuk mendeteksi dini PS usia 6 bulan. Keterlambatan motorik, refleks palmar, respons tarikan, fisting dan reaksi protektif-ekstensi saat usia 6 bulan dapat mendeteksi dini PS usia 12 bulan. Saat usia 9-10 bulan keterlambatan motorik, reaksi protektif-ekstensi dan parasut dapat dipakai untuk deteksi dini PS usia 12 bulan. Pemeriksaan USG kepala dapat dipakai untuk mendeteksi dini PS usia 6 dan 12 bulan. Simpulan. PS dapat dideteksi dini pada 6 bulan pertama kehidupan. Keterlambatan motorik, pemeriksaan neurologi dan USG kepala dapat dipakai untuk deteksi dini PS.
Kata kunci : deteksi dini , keterlambatan motorik, palsi serebral, reaksi postural, refleks primitif, USG kepala.



Background. Cerebral palsy (CP) is a motor and postural disorder due to an insult on the developing brain. The incidence of CP increases with the increasing number of high-risk babies. There is a need for a simple method for the early detection of CP. Objectives. To determine the proportion of CP in high-risk babies, time to the occurrence of CP in the first year, risk factors associated with and influencing the time to the occurrence of CP, to determine the performance of an early detection method using parameters of motor delay, neurological examination, and cerebral ultrasound. Methods. A prospective cohort study was done on 150 high-risk babies up to the postmenstrual age of 12 months. We obtained history of motor ability and performed examination of 5 primitive reflexes and 2 postural reactions at the age of 4 and 6 months. The diagnosis of CP was established at 6 and 12 months of age. Results. The proportion of CP in high-risk babies was 26 % at 6 months of age and 24 % at 12 months of age. In the majority of subjects (88.7 %), CP was detected in the first 6 months of life. Risk factors that influenced the occurrence and time to occurrence of CP were cerebral ultrasound abnormalities, hypoxic-ischemic encephalopathy, intracranial hemorrhage, and meningitis. At 4 months corrected age, abnormality on traction response test, fisting, positive palmar grasp and a positive crossed-extensor reflex predicted CP at 6 months of age. The presence of motor delay, a positive palmar grasp reflex, abnormality on traction response test, fisting, and absence of the protective extension reflex at 6 months of age predicted CP at 12 months of age. At 9 to 10 months of age, motor delays, an absent of protective extension reflex, and a negative parachute reaction predicted CP at 12 months of age. The presence of abnormalities on cerebral ultrasound predicted CP at 6 and 12 months of age. Conclusions. Early detection of CP can be done since the first 6 months of life. Assessment for motor delays, physical examination, and cerebral ultrasound can be used for the early detection of CP.
Keywords. cerebral palsy, cerebral ultrasound, early detection, motor delay, postural reaction, primitive reflex.