Tesis

Efektivitas Suplementasi Enteral Vitamin D Dosis 800 IU Dibandingkan 400 IU dalam Meningkatkan Kadar 25(OH)D Bayi Sangat Prematur dan Prematur Sedang yang Dirawat di Unit Perawatan Neonatal = Effectiveness of Enteral Vitamin D Supplementation at a Dose of 800 IU Compared to 400 IU in Increasing 25(OH)D Levels in Very Preterm and Moderate Preterm Infants Treated in Neonatal Care Unit.

Latar belakang: Defisiensi vitamin D pada bayi prematur dapat mengakibatkan terjadinya metabolic bone diseases (MBD) dan berpengaruh pada berbagai komplikasi akibat prematuritas. Saat ini ditemukan berbagai rekomendasi mengenai dosis suplementasi yang efektif bagi bayi prematur. Tujuan: Untuk mengetahui efektivitas pemberian suplementasi enteral vitamin D dosis 800 IU dalam meningkatkan kadar 25(OH)D bayi prematur usia gestasi 28 – 33 minggu. Metode: Uji klinis acak terkontrol tersamar tunggal dilaksanakan pada bulan Juli – November 2024. Kriteria inklusi adalah bayi usia gestasi 28 - 33 minggu dan telah menoleransi asupan enteral > 30 ml/kg/hari. Randomisasi blok dilakukan pada 68 sampel yang memenuhi kriteria inklusi dan dibagi menjadi 2 kelompok yaitu perlakuan dan kontrol. Pemeriksaan 25(OH)D, kalsium, fosfat anorganik dilakukan sebelum pemberian suplementasi dan diulangi kembali setelah pemberian suplementasi selama 28 hari, ditambah pemeriksaan alkali fosfatase. Hasil: Proporsi kejadian defisiensi dan insufisiensi vitamin D pada penelitian ini adalah 45/68 dan 16/68. Median kadar 25(OH)D pada penelitian ini adalah 14,25 (11,26 – 21,68) ng/mL. Terdapat perbedaan signifikan rerata kenaikan 25(OH)D setelah diberikan intervensi pada kelompok perlakuan 13,75 (11,81) ng/mL dibandingkan kontrol 7,62 (7,88) ng/mL (p=0,026). Tidak terdapat perbedaan signifikan pada rerata kenaikan kadar kalsium maupun fosfat anorganik, dan tidak ditemukan tanda gangguan mineralisasi tulang. Simpulan: Suplementasi vitamin D dosis 800 IU dapat meningkatkan hampir dua kali lipat kadar 25(OH)D bayi prematur usia gestasi 28 – 33 minggu dalam jangka waktu pemberian suplementasi 28 hari. Monitoring berkala kadar 25(OH)D sebaiknya dilakukan untuk menghindari ekses vitamin D.
Kata Kunci: suplementasi vitamin D, bayi prematur


Background: The transfer of vitamin D and minerals occurs during the third trimester. Vitamin D deficiency in premature infants can lead to metabolic bone disease and various complications associated with prematurity. Currently, various recommendations exist regarding effective supplementation doses for premature infants. Objection: To determine the effectiveness of enteral vitamin D supplementation at a dose of 800 IU compared to 400 IU in increasing 25(OH)D levels very preterm and moderate preterm infants. Methods: A single-blind randomized controlled trial conducted from July to November 2024. Inclusion criteria included infants born at 28 - 33 weeks gestation who tolerated enteral intake of > 30 ml/kg/day. Block randomization was performed on 68 samples meeting the inclusion criteria, dividing them into experimental and control groups. Measurements of 25(OH)D, calcium, and phosphate were taken before supplementation and repeated after 28 days of supplementation, along with alkaline phosphatase levels as early marker ofmetabolic bone diseases. Results: The incidence of vitamin D deficiency and insufficiency in this study was 45/68 and 16/68. The median level of 25(OH)D was 14.25 (11.26 – 21.68) ng/mL. A significant difference found in the mean increase of 25(OH)D, an increase of 13.75 (11.81) ng/mL in the intervention group compared to the control group at 7.62 (7.88) ng/mL (p=0.026). No signs of bone mineralization disorders were found. Conclusion: Enteral vitamin D supplementation at a dose of 800 IU could almost bifold the levels of 25(OH)D in very preterm and moderate preterm infants after 28 days of supplementation. Continuous monitoring of 25(OH)D should be done to avoid vitamin D excess.
Keywords: vitamin D supplementation, preterm infants