Tesis

Prevalens dan Faktor Risiko Sindrom Refeeding di Unit Perawatan Intensif Anak = Prevalence and Risk Factors of Refeeding Syndrome in Pediatric Intensive Care Unit.

Latar Belakang: Pada pasien di unit perawatan intensif anak, sindrom refeeding meningkatkan morbiditas dan mortalitas. Sindrom refeeding seringkali tidak terdiagnosis dan tidak diobati karena manifestasi klinisnya yang tidak spesifik. Saat ini belum ada data yang tersedia yang menggambarkan prevalens dan faktor risiko sindrom refeeding pada pasien di unit perawatan intensif anak di Indonesia. Tujuan: Penelitian ini bertujuan untuk menentukan prevalens sindrom refeeding dan mengevaluasi faktor risiko sindrom refeeding di unit perawatan intensif anak. Metode: Penelitian ini adalah studi analitik observasional dengan desain kohort retrospektif untuk menilai prevalens sindrom refeeding di unit perawatan intensif anak. Penelitian mencakup anak-anak berusia 1 bulan hingga 18 tahun yang dirawat selama minimal lima hari di unit perawatan intensif anak Rumah Sakit Dr. Cipto Mangunkusumo sejak bulan Januari 2021 hingga Januari 2022. Kriteria eksklusi adalah pasien dengan refleks batang otak negatif atau memiliki status "do not resuscitate" dan pasien dengan gangguan elektrolit yang diketahui merupakan bagian dari penyakit atau terapi penyakit yang mendasarinya (seperti pasien dengan gagal ginjal, gagal jantung, ketoasidosis diabetik, pasca paratiroidectomi, dan pasien yang menggunakan diuretik atau obat pengikat fosfat). Kriteria ASPEN digunakan untuk mendiagnosis sindrom refeeding. Hasil: Dari 105 subjek penelitian, 43 anak (41%) diidentifikasi mengalami sindrom refeeding. Pasien dengan sindrom refeeding memiliki nilai tengah usia 48 bulan, skor PELOD-2 sebesar 8, dan status nutrisi yang tidak berbeda bermakna dibandingkan dengan pasien tanpa sindrom refeeding. Asupan kalori hari pertama merupakan faktor risiko terjadinya sindrom refeeding. Pasien dengan sindrom refeeding mendapatkan asupan kalori hari pertama sebanyak 40 kkal/kg berat badan atau 51% kebutuhan energi, lebih tinggi secara signifikan dibandingkan dengan pasien tanpa sindrom refeeding yang mendapatkan asupan kalori hari pertama sebanyak 25 kkal/kg berat badan atau 31% kebutuhan energi. Kesimpulan: Prevalens sindrom refeeding tinggi di unit perawatan intensif anak. Asupan kalori hari pertama di atas 50% kebutuhan energi merupakan faktor risiko terjadinya sindrom refeeding. Penelitian lanjutan dengan desain prospektif dan jumlah sampel yang lebih besar perlu dilakukan dengan penambahan data status gizi harian, asupan kalori dan obat-obatan harian, serta evaluasi lama penggunaan ventilator, lama rawat inap, dan mortalitas pada pasien di unit perawatan intensif anak.
Kata kunci: sindrom refeeding, perawatan intensif, pediatrik


Background: In pediatric intensive care unit patients, refeeding syndrome increases morbidity, mortality, and medical costs. Refeeding syndrome is often underdiagnosed dan untreated due to its nonspecific clinical manifestations, and there are currently no screening policies for pediatric intensive care unit patients. This population is vulnerable to refeeding syndrome, and there is currently no available data describing prevalence and risk factors of refeeding syndrome in pediatric intensive care unit patients in Indonesia. Objective: This study aims to determine the prevalence of refeeding syndrome in pediatric intensive care unit and to evaluate the risk factor of the patients who experience refeeding syndrome in pediatric intensive care unit. Method: This study is an analytic observational study with a retrospective cohort design to assess the prevalence of refeeding syndrome in pediatric intensive care unit patients. This study includes children aged 1 month to 18 years and critically ill children who were hospitalized for a minimum of five days in the pediatric intensive care unit at Dr. Cipto Mangunkusumo Hospital from January 2021 to January 2022. Exclusion criteria are patients with a negative brainstem reflex or having a “do not resuscitate” status, and patients with electrolyte disturbances known to be part of their underlying disease or treatment (such as patients with kidney failure, heart failure, diabetic ketoacidosis, post parathyroidectomy, and patients using diuretics or phosphate-binding medications). The ASPEN criteria were used to identify those with refeeding syndrome. Results: Out of 105 study subjects, 43 children (41%) were identified as experiencing refeeding syndrome. Patients with refeeding syndrome have a median age of 48 months, a PELOD-2 score of 8, and nutritional status that is not significantly different compared to patients without refeeding syndrome. The first-day calorie intake is a risk factor for the occurrence of refeeding syndrome. Patients with refeeding syndrome received a first-day calorie intake of 40 kcal/kg body weight or 51% of energy requirements, significantly higher compared to patients without refeeding syndrome who received a first-day calorie intake of 25 kcal/kg body weight or 31% of energy requirements. Conclusion: The prevalence of refeeding syndrome is high in the pediatric intensive care unit. A first-day calorie intake exceeding 50% of energy requirements is a significant risk factor for refeeding syndrome. Further research with a prospective design and a larger sample size is needed, including additional data on daily nutritional status, daily calorie and medication intake, as well as an evaluation of the duration of ventilator use, length of hospital stay, and mortality in pediatric intensive care unit patients.
Keywords: refeeding syndrome, intensive care, pediatric