Tesis

Insidens Pneumonia Terkait Ventilator Awitan Dini pada Neonatus dan Faktor-Faktor Risiko yang Mempengaruhinya di Unit Perinatologi RS Cipto Mangunkusumo = Incidence of Early-Onset Ventilator Associated Pneumonia and Its Risk Factors in the Neonatology Unit of Cipto Mangunkusumo General Hospital.

Latar belakang: Masalah respiratori neonatus pada beberapa kasus memerlukan tata laksana bantuan respirasi dengan ventilasi mekanis. Akan tetapi hal ini dapat menimbulkan komplikasi, salah satunya adalah pneumonia terkait ventilator. Penelitan mengenai pneumonia terkait ventilator pada neonatus di Indonesia sangat terbatas. Tujuan: Mengetahui insidens pneumonia terkait ventilator awitan dini pada neonatus dan faktor-faktor yang mempengaruhinya Metode: Studi kohort retrospektif dari data sekunder rekam medis Unit Perinatologi RS Cipto Mangunkusumo pada periode Januari 2017 sampai Agustus 2018. Semua neonatus yang lahir di RS Cipto Mangunkusumo dan berusia kronologis ≤ 28 hari yang menggunakan ventilasi mekanis ≥ 48 jam. Subyek dieksklusi bila mendapat ventilasi mekanis dengan ventilasi tekanan positif manual, kelainan bentuk saluran napas, kecurigaan kelainan bawaan dan rekam medis tidak lengkap Pencatatan terhadap subyek meliputi gejala klinis, pemeriksaan darah perifer lengkap, dan foto Rontgen toraks pada hari ketiga atau hari kelima pertama setelah inisiasi ventilasi mekanis terutama bila terdapat perburukan gejala klinis. Kriteria diagnosis pneumonia terkait ventilator menggunakan kriteria Centers for Disease Control and Prevention pada bayi usia < 1 tahun. Hasil: Studi dilakukan terhadap 105 subyek mendapatkan insidens pneumonia terkait ventilator awitan dini pada neonatus dalam satu tahun sebesar 15,4%. Tidak ada perbedaan bermakna secara statistik karakteristik kelompok pneumonia terkait ventilator awitan dini. Analisis multivariat faktor risiko yang bermakna dalam terjadinya pneumonia terkait ventilator awitan dini pada studi ini adalah infeksi aliran darah (RO 3,399; IK 95% 1,248 – 9,257). Simpulan: Insidens pneumonia terkait ventilator awitan dini pada neonatus dalam satu tahun sebesar 15,4%. Infeksi aliran darah merupakan faktor risiko yang bermakna dalam terjadinya pneumonia terkait ventilator awitan dini.
Kata kunci: neonatus, pneumonia, ventilator, nosokomial


Background: Some respiratory problems in neonates require respiratory support using mechanical ventilation, but this could lead to complications such as ventilator-associated pneumonia. Studies on ventilator-associated pneumonia among neonates in Indonesia are still limited. Aim: To determine the incidence of early-onset ventilator-associated pneumonia in neonates and its risk factors. Method: This was a retrospective cohort study from secondary medical record data at the Neonatology Unit of Cipto Mangunkusumo General Hospital between January 2017 – August 2018. All neonates born in Cipto Mangunkusumo General Hospital with a chronological age of ≤ 28 days using mechanical ventilation for ≥ 48 hours were included in the study. Subjects were excluded if they use mechanical ventilation with manual positive pressure, had respiratory tract morphology disorders, were suspected of having congenital disorders, and incomplete medical records. Data collected from the subjects include clinical symptoms, complete peripheral blood count, and chest x-ray results at the third day or fifth day since the initiation of mechanical ventilation, particularly if worsening of symptoms were observed. The diagnostic criteria for pneumonia used the Centers of Disease Control and Prevention criteria for infants aged < 1 year old. Results: A total of 105 subjects were included in the study, and the incidence of earlyonset ventilator-associated pneumonia in neonates within a time period of one year was 15.4%. There were no statistically significant differences between the characteristics of the groups related to early-onset ventilator-associated pneumonia. A multivariate analysis for early-onset ventilator-associated pneumonia in this study found that bloodstream infection was a significant risk factor (OR 3,399; CI 95% 1,248 – 9,257). Conclusion: The incidence of early-onset ventilator-associated pneumonia in neonates within a year was found to be 15.4%. Bloodstream infection is a significant risk factor in the occurrence of early-onset ventilator-associated pneumonia.
Key words: neonates, pneumonia, ventilator, nosocomial