Tesis

Pengaruh transfusi packed red cell (PRC) terhadap status besi bayi prematur usia gestasi 28-32 minggu = Effect of packed red cell (PRC) on the iron status of preterm infants 28-32 weeks gestasional age.

Latar belakang: Prematuritas merupakan penyebab mortalitas dan morbiditas neonatus tertinggi. Sebagian besar prematur mendapat transfusi PRC berulang selama perawatan. Sementara itu, transfusi PRC berulang dapat meningkatkan kadar zat besi. Namun, hingga saat ini belum ada konsensus mengenai suplementasi besi pada prematur yang telah mendapat transfusi PRC berulang. Tujuan: Penelitian ini bertujuan untuk mengetahui status besi pada bayi prematur usia gestasi 28-32 minggu yang telah mendapat transfusi PRC berulang dan membuat rekomendasi mengenai pemberian suplementasi besi Metode: Penelitian kohort prospektif terhadap 70 bayi prematur yang lahir di RSCM bulan Maret 2021 – Mei 2021. Profil besi diperiksa usia kronologis 1, 2 dan 3 bulan Hasil: Profil besi bayi prematur yang mendapat transfusi PRC > 2 kali lebih tinggi secara signifikan dibandingkan ≤ 2 kali (p < 0,05). Titik potong total volume transfusi PRC yang menyebabkan status besi berlebih adalah PRC ≥ 50 mL/kgBB. Median feritin serum pada usia kronologis 1 bulan adalah 498,11 µg/L (358-885,62 µg/L), dua bulan adalah 232,66 µg/L (60,85-538,44 µg/L), tiga bulan adalah 42 µg/L (40,1-168,63 µg/L). Faktor risiko yang memengaruhi status besi berlebih pada bayi prematur adalah riwayat sepsis (OR 5,918 (IK 95%: 2,027-17,277)) Simpulan: Bayi prematur yang mendapat transfusi PRC >2 kali memiliki profil besi yang lebih tinggi dibandingkan ≤ 2 kali pada usia kronologis 1 bulan. Bayi premtur yang mendapat transfusi PRC ≥ 50 mL/kgBB memiliki status besi berlebih di usia kronologis 1 bulan sehingga suplementasi besi sebaiknya diberikan pada usia kronologis 2 bulan.
Kata kunci: neonatus, prematur, transfusi PRC berulang, status besi berlebih


Background: Prematurity is the most common cause of neonatal mortality and morbidity. Most of the preterm babies received multiple PRC transfusions during hospitalized. Meanwhile, multiple PRC transfusions can increase iron levels. However, to date there is no consensus regarding iron supplementation in preterm who have received multiple PRC transfusions. Objective: This study aims to determine iron status in premature infants aged 28-32 weeks who have received multiple PRC transfusions and make recommendations regarding iron supplementation. Methods: A prospective cohort study of 70 preterm babies born at the Cipto Mangunkusumo Hospital in March 2021 – May 2021. Iron profiles were examined chronologically age at 1, 2 and 3 months of age. Results: The iron profile of preterm infants who received PRC transfusion was > 2 times significantly higher than ≤ 2 times (p < 0.05). The cut-off point for the total volume of PRC transfusion that causes iron overload status is ≥ 50 mL/kgBW. The median serum ferritin at 1 month of age was 498.11 g/L (358885.62 g/L), two months was 232.66 g/L (60.85-538.44 g/L), three months is 42 g/L (40.1-168.63 g/L). The risk factor influencing iron overload status in preterm infants was a history of neonatal sepsis (OR 5.918 (95% CI: 2.02717.277)) Conclusion: Preterm infants who received PRC transfusion > 2 times had a higher iron profile than ≤ 2 times at 1 month chronological age. Preterm infants who received PRC transfusions ≥ 50 mL/kgBW had iron overload status at 1 month of chronological age therefore iron supplementation should be given at 2 months of chronological age.
Keywords: neonate, preterm, multiple PRC transfusion, iron overload