Tesis

Efektivitas Stimulasi Isapan Non Nutritif terhadap Kemampuan Mengisap Bayi Prematur dengan Riwayat Penggunaan Continuous Positive Airway Pressure (CPAP) = Effectiveness of Non-Nutritive Sucking Stimulation on Sucking Ability of Preterm Infants with a History of Continuous Positive Airway Pressure (CPAP).

Latar belakang: Masalah pemberian minum per oral merupakan tantangan yang dihadapi bayi prematur. Stimulasi isapan non nutritif diketahui dapat meningkatkan keterampilan minum per oral bayi prematur. Namun penerapan protokol ini masih belum konsisten di rumah sakit Indonesia. Objektif: Untuk menilai efektivitas stimulasi isapan non nutritif (NNS) terhadap kemampuan mengisap yang terdiri dari tekanan isapan, durasi jeda antar burst, jumlah isapan per burst, dan ritme isapan pada bayi prematur dengan riwayat penggunaan CPAP. Metode: Penelitian ini merupakan uji klinis acak terkontrol tersamar ganda terhadap dua kelompok dimana kelompok intervensi mendapatkan stimulasi oral dan stimulasi isapan non nutritif menggunakan empeng bayi prematur dan kelompok kontrol mendapatkan stimulasi oral saja, masing-masing selama 10 hari berturut-turut. Penelitian dilakukan di Neonatal High Care Unit RSUPN Dr. Cipto Mangunkusumo, Jakarta. Pengukuran nilai tekanan isapan, durasi jeda antar burst, jumlah isapan dalam satu burst, dan ritme isapan secara objektifdilakukan sebelum dan sesudah intervensi menggunakan alat ukur NNS CMI-201. Hasil: Jumlah subjek penelitian yang dapat dianalisis sebesar 27 subjek, dengan 14 subjek pada kelompok intervensi dan 13 subjek pada kelompok kontrol. Rerata post menstrual age 33,79+1,12 minggu pada kelompok intervensi dan 33,92+1,71 minggu pada kelompok kontrol. Didapatkan perbedaan signifikan secara statistik (nilai p < 0,05) terhadap peningkatan tekanan isapan, jumlah isapan per burst dan ritme isapan pada kelompok intervensi dengan nilai median masing-masing 43,5 (13,9-78,2) mmHg, 8 (6-12,3) isapan/burst, 5,2 (3-9) burst/menit dan 30 (11,2-47) mmHg, 6 (4-9,5) isapan/burst, dan 3,1 (2-6,3) burst/menit pada kelompok kontrol. Perbedaan signifikan secara statistik juga didapatkan pada penurunan durasi jeda antar burst pada kelompok intervensi dengan nilai median 8,3 (1,6-28) detik dan 18 (4,9-45) detik pada kelompok kontrol (nilai p < 0,05). Kesimpulan: Stimulasi isapan non nutritif terbukti efektif dalam meningkatkan kemampuan mengisap yang terdiri dari tekanan isapan, jumlah isapan per burst, dan ritme isapan, serta menurunkan durasi jeda antar burst pada bayi prematur dengan riwayat penggunaan CPAP.
Kata kunci: Stimulasi isapan non nutritif, bayi prematur, penggunaan CPAP, kemampuan mengisap, tekanan isapan, durasi jeda antar burst, jumlah isapan per burst, ritme isapan.


Background: Premature birth facing challenges with oral feeding due to immaturity. Non-nutritive sucking (NNS) has shown promise in improving oral feeding skills. However, the implementation of NNS protocols remains inconsistent in Indonesian hospitals. Objective: To assess the effectiveness of non-nutritive sucking stimulation (NNS) on sucking ability consisting of sucking pressure, burst pause duration, number of sucks per burst, and sucking rhythm in preterm infants with a history of CPAP use. Method: This study was a double-blind randomized controlled trial of two groups where the intervention group received oral stimulation and non-nutritive sucking stimulation using preterm infant pacifiers and the control group received oral stimulation only, each for 10 consecutive days. The study was conducted at the NHCU of RSCM, Jakarta. Measurement of sucking pressure, burst pause duration, number of sucks per burst, and sucking rhythm were objectively carried out before and after the intervention using the CMI-201 NNS measurement tool. Results: Total subjects that could be analyzed was 27 subjects, with 14 subjects in the intervention group and 13 subjects in the control group. The mean ofgestational age was 31.43+2.59 weeks in the intervention group and 31.85+2.15 weeks in the control group. The mean of post menstrual age was 33.79+1.12 weeks in the intervention group and 33.92+1.71 weeks in the control group. There was a statistically significant difference (p value < 0.05) in the increase in sucking pressure, number of sucks per burst and sucking rhythm in the intervention group with median values of 43.5 (13.9-78.2) mmHg, 8 (6-12.3) sucks/burst, 5.2 (3-9) bursts/minute and 30 (11.2-47) mmHg, 6 (4-9.5) sucks/burst, and 3.1 (2-6.3) bursts/minute in the control group. A statistically significant difference was also found in the decrease in the duration of bursts pause in the intervention group with a median value of 8.3 (1.6-28) seconds and 18 (4.9-45) seconds in the control group (p value < 0.05). Conclusion: Non-nutritive sucking stimulation has been proven effective in improving sucking ability in preterm infants with a history of CPAP use.
Keywords: Non-nutritive sucking, preterm infants, continuous positive airway pressure (CPAP), sucking pressure, burst pause, sucks per burst, sucking rhythm.