Tesis

Pengaruh Nutrisi Enteral Tinggi Protein Pada Anak Sakit Kritis Pascabedah: Kajian Terhadap Imbang Nitrogen Dan Intestinal Fatty Acid Binding Protein = The Effect of High-Protein Enteral Nutrition on Critically Ill PostSurgery Children: A Study on Nitrogen Balance and Intestinal Fatty Acid Binding Protein.

Latar Belakang: Anak sakit kritis pascabedah memiliki risiko mengalami malnutrisi. Terapi nutrisi optimal mampu mencegah morbiditas dan menurunkan mortalitas. Asupan protein yang adekuat mempercepat tercapainya anabolisme. Saat ini belum ada data yang tersedia mengenai pengaruh suplementasi protein enteral terhadap imbang nitrogen dan kadar Intestinal Fatty Acid Binding Protein (I-FABP. Tujuan: Penelitian ini bertujuan untuk menganalisis apakah peningkatan asupan protein nutrisi enteral berhubungan dengan perbaikan imbang nitrogen dan penurunan kadar serum I-FABP pada anak sakit kritis pascabedah. Metode: Penelitian ini merupakan uji klinis acak terkontrol dengan penyamaran ganda, melibatkan anak sakit kritis pascabedah usia 1 -5 tahun yang mendapat nutrisi enteral dalam 48 jam. Total 76 subjek dibagi menjadi dua kelompok: kelompok dengan protein standar (3,0 g/100 mL) dan kelompok dengan protein tinggi (4,35 g/100 mL). Penilaian imbang nitrogen dilakukan 24 jam pertama dan ketiga setelah pemberian nutrisi enteral, sedangkan kadar I-FABP diperiksa sebelum dan sesudah enteral. Hasil: Terjadi peningkatan signifikan rerata imbang nitrogen pada kelompok protein tinggi 114,7 (SB 53) mg/kg/hari dibandingkan kelompok protein standar 283,4 (SB 82,5) mg/kg/hari, dengan nilai p < 0,0001. Tidak terjadi penurunan signifikan kadar I-FABP pada kelompok peningkatan imbang nitrogen di atas rerata dibandingkan kelompok peningkatan imbang nitrogen di bawah rerata. Kesimpulan: Pemberian suplementasi enteral protein tinggi meningkatkan imbang nitrogen pada anak sakit kritis pascabedah tanpa efek samping yang merugikan.
Kata kunci: anak; nutrisi enteral protein; sakit kritis; suplementasi


Background: Critically ill post-surgical children are at risk of malnutrition. Optimal nutritional therapy can prevent morbidity and reduce mortality. Adequate protein intake accelerates the achievement of anabolism. Currently, no data is available regarding the effect of enteral protein supplementation on nitrogen balance and levels of Intestinal Fatty Acid Binding Protein (I-FABP). Objective: This study aims to analyze whether increasing protein intake in enteral nutrition is associated with improved nitrogen balance and reduced serum I-FABP levels in critically ill post-surgical children. Methods: This was a double-blind randomized controlled trial involving critically ill post-surgical children aged 1 -5 years receiving enteral nutrition within 48 hours. A total of 76 subjects were divided into two groups: the standard protein group (3.0 g/100 mL) and the high-protein group (4.35 g/100 mL). Nitrogen balance was assessed on the first and third days after enteral nutrition administration, while I-FABP levels were examined before and after enteral feeding. Results: There was a significant increase in the average nitrogen balance in the highprotein group, 114.7 (SD 53) mg/kg/day, compared to the standard protein group, 283.4 (SD 82.5) mg/kg/day, with p < 0.0001. There was no significant decrease in I-FABP levels in the group with nitrogen balance improvement above the average compared to the group with nitrogen balance improvement below the average. Conclusion: High-protein enteral supplementation improves nitrogen balance in critically ill post-surgical children without adverse side effects.
Keywords: children; enteral protein nutrition; critical illness; supplementation