Tesis

Profil antitrombin pada sepsis neonatorum awitan dini di RS Cipto Mangunkusumo = Antithrombin profile in early-onset neonatal infection in Cipto Mangunkusumo Hospital.

Latar Belakang: Sepsis saat ini masih merupakan masalah utama di bidang
perawatan dan pelayanan neonatus dengan angka mortalitas 24% pada tahun
2012. Gangguan sistem koagulasi pada sepsis akibat aktivasi endotel dan
pengeluaran faktor jaringan ditandai dengan eksaserbasi proses koagulasi,
gangguan sistem anti-koagulasi, dan penurunan degradasi fibrin yang
mengakibatkan terbentuknya trombosis mikrosirkulasi, deposisi bekuan fibrin,
hipoperfusi jaringan serta hasil akhir berupa disfungsi organ. Kaskade koagulasi
menunjukkan trombin memiliki peran penting dan salah satu komponen antikoagulan

utama diperankan oleh antitrombin (AT). Seratus persen neonatus
dengan sepsis menderita defisiensi AT namun belum ada data pada neonatus yang
secara klinis menderita sepsis.

Tujuan: Mengetahui profil dan perubahan kadar antitrombin pada neonatus yang
secara klinis menderita sepsis awitan dini di unit perawatan Perinatologi
Departemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangunkusumo.
Metode: Penelitian bersifat deskriptif prospektif yang dilakukan pada bulan
Agustus-November 2013. Subjek penelitian adalah neonatus usia gestasi 28-40
minggu (berat lahir >1000 gram) yang secara klinis terdiagnosis sepsis dan
dirawat 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 dan
simpang baku. Analisis statistik dilakukan untuk melihat perbedaan antar rerata
AT pada hari pertama, ketiga dan kelima perawatan dengan menggunakan uji
Anova (analisis bivariat).

Hasil: Penelitian ini dilakukan pada 62 neonatus yang secara klinis menderita
sepsis. Pada penelitian ini didapatkan peningkatan rerata AT yang meningkat
secara bermakna pada ketiga pengukuran AT (P=0,000) dan kecenderungan
peningkatan kadar AT yang lebih tinggi pada pasien yang hidup dibandingkan
pasien yang mati. Terdapat 56,5% neonatus dengan defisiensi antitrombin pada
pemeriksaan hari pertama perawatan dengan profil nilai rerata AT pasien
penelitian sebesar 30,01% (SD 17,36) pada pemeriksaan hari pertama, 37,9% (SD
19,34) pada pemeriksaan hari ketiga dan 47,05% (SD 18,25) pada pemeriksaan
hari kelima perawatan.
Simpulan: Terdapat profil kadar AT yang rendah dan peningkatan kadar AT pada
pasien neonatus yang secara klinis menderita sepsis. Antitrombin masih mungkin
memiliki peran sebagai faktor prognostik.
Kata Kunci: neonatus, sepsis, awitan dini, antitrombin


Background: Neonatal sepsis still becomes one of major problems in neonatal
care. The problem can be seen from the 24% mortality in 2012. Within the
pathophysiology of sepsis, coagulation derangements caused by endothelial
activation and secretion of tissue factor, are characterized by coagulation
exacerbation, impaired anticoagulation system, and decreased fibrin removal.
These derangements are marked by the generation of microcirculation thrombosis
with deposition of microclots and obstruction of circulation, impairing blood flow
contributing to tissue hypoperfusion and consequently organ dysfunction. In
addition to this, coagulation cascade demonstrates that thrombin has major role in
the formation of fibrin. One of the main anticoagulant against the coagulation
activity is played by antithrombin (AT). Eventhough all neonate with neonatal
infection have AT deficiency, there is no data in clinically early-onset neonatal
infection.

Objectives: This study was designed to identify the profile and changes in AT in
clinically early-onset neonatal infection in Perinatology ward Cipto
Mangunkusumo Hospital.

Method: A descriptive in prospectively was conducted from August until
November 2013. Subjects were neonate 28-40 weeks gestational ages (birth
weight >1000 gram) who clinically diagnosed with neonatal infection and
hospitalized in Perinatology ward Cipto Mangunkusumo Hospital. Serum AT
level 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 test
was used to analyze the difference between measurements (bivariate analysis).

Result: This study found that the mean of serum AT level increase significantly in
the serial measurement (p=0,000) and there was a trend showing higher
increamental level of AT in survived patient compared to the died one. These
results are taken from samples of 62 neonates with clinically early-onset neonatal
infection. From the samples, 56,5% of neonates were having antithrombin
deficiency from the first day of the hospitalization. In addition to this, the means
serum AT level was 30,01% (SD 17,36) in the first day, 37,9% (SD 19,34) in the
third day and 47,05% (SD 18,25) in the fifth day of hospitalization.

Conclusion: There was low level of antithrombin profile and increasing serum
level AT in clinically early-onset neonatal infection. Antithrombin may have
beneficial effect as a prognostic factor.
Key words: neonate, early-onset infection, antithrombin