Tesis

Pola Pertumbuhan Bayi Prematur dengan Usia Gestasi Kurang dari 32 Minggu pada Usia Koreksi Aterm hingga Usia Koreksi 6 Bulan: Perbandingan Kurva Fenton, Kurva INTERGROWTH-21 st, dan Kurva Standar WHO = Growth Patterns of Preterm Infants Less than 32 Weeks of Gestational Age at Term until 6 Months Corrected Age: Comparison of Fenton, INTERGROWTH-21 st, and WHO Growth Standards.

Latar belakang: Pemantauan pertumbuhan yang akurat merupakan hal penting dalam penanganan masalah nutrisi pada bayi prematur. Saat ini belum ada kesepakatan internasional terkait kurva pertumbuhan yang tepat digunakan untuk bayi prematur. Tujuan penelitian ini adalah untuk membandingkan proporsi bayi sangat prematur yang mengalami extrauterine growth restriction (EUGR) pada berat badan, panjang badan, dan lingkar kepala berdasarkan kurva Fenton dan kurva INTERGROWTH-21 st Postnatal Preterm Growth Standards (IG-PPGS) serta membandingkan kesesuaiann kedua kurva tersebut terhadap status undernutrition berdasarkan skor Z berat badan, panjang badan, dan lingkar kepala kurva standar WHO pada usia koreksi 3 bulan dan 6 bulan. Metode: Penelitian kohort prospektif ini melibatkan subjek dengan usia gestasi kurang dari 32 minggu yang lahir di RSUPN Cipto Mangunkusumo selama periode Januari Agustus 2024. Pengukuran antropometri dilakukan saat lahir hingga usia koreksi 6 bulan. Pertumbuhan dipantau dengan kurva Fenton, kurva IG-PPGS, serta kurva standar WHO. Hasil penelitian: Dari 71 subjek yang memenuhi kriteria eligibilitas dan mencapai usia koreksi aterm, 61 subjek dapat diikuti hingga usia koreksi 3 bulan, dan 58 subjek hingga usia koreksi 6 bulan. EUGR berat badan, panjang badan, dan lingkar kepala pada usia koreksi aterm secara konsisten lebih rendah pada kurva IG-PPGS dibandingkan dengan kurva Fenton. Penurunan skor Z berat badan lebih dari 1 SD menggunakan kurva Fenton dan IG-PPGS memiliki kesesuaian signifikan terhadap status underweight saat usia koreksi 3 bulan dan 6 bulan berdasarkan kurva standar WHO (p < 0,05; nilai Kappa tertinggi 0,475 untuk Fenton dan 0,417 untuk IG-PPGS). Berbeda dengan kurva Fenton, penurunan skor Z panjang badan dan lingkar kepala lebih dari 1,2 SD menggunakan kurva IG-PPGS memiliki kesesuaian signifikan terhadap status stunted dan mikrosefali berdasarkan kurva standar WHO (p < 0,05; nilai Kappa tertinggi 0,394 untuk parameter panjang badan dan 0,413 untuk parameter lingkar kepala). Kesimpulan: Insidens EUGR pada kurva IG-PPGS lebih rendah dibandingkan dengan kurva Fenton. EUGR berat badan menurut kurva Fenton dan kurva IG-PPGS memiliki kesesuaian terhadap status underweight berdasarkan kurva WHO. EUGR panjang badan dan EUGR lingkar kepala menurut kurva IG-PPGS memiliki kesesuaian lebih baik terhadap status stunted dan mikrosefali berdasarkan kurva WHO.
Kata kunci : Bayi sangat prematur, kurva Fenton, kurva INTERGROWTH-21 st


Background: Accurate growth monitoring is critical for nutritional management in preterm infants. Currently there is no international consensus regarding which growth chart is suitable to monitor growth patterns ofpreterm infants. This study was to compare the proportion of very preterm infants with extrauterine growth restriction (EUGR) in weight, length, and head circumference based on Fenton charts and INTERGROWTH- 21 st Preterm Postnatal Growth Standards (IG-PPGS) and to compare their correlations to undernutrition status based on Z-score of weight, length, and head circumference of the WHO growth standards at 3 months and 6 months corrected age. Methods: This prospective cohort study involved preterm infants less than 32 weeks of gestational age in Cipto Mangunkusumo National Hospital during January - August 2024. All subjects were evaluated for anthropometric measurements from birth until 6 months corrected age. Growth was monitored using Fenton, IG-PPGS, and WHO growth standards. Results: Of the 71 subjects who met the eligibility criteria and reached term corrected age, 61 subjects could be followed up to 3 months corrected age, and 58 subjects up to 6 months corrected age. The incidence of EUGR infants in weight, length, and head circumference at term corrected age was consistently lower on IG-PPGS compared to Fenton. A decrease in weight Z score ofmore than 1 SD from birth to term corrected age using Fenton and IG-PPGS had significant correlations to underweight status at 3 months and 6 months corrected age based on WHO growth standards (p < 0.05; highest Kappa value 0.475 for Fenton and 0.417 for IG-PPGS). Different from Fenton, a decrease in length and head circumference Z score of more than 1.2 SD from birth to term corrected age using the IG-PPGS had significant correlations to stunted and microcephaly status based on WHO growth standards (p < 0.05; highest Kappa value 0.394 for length and 0.413 for head circumference parameter). Conclusions: Incidence of EUGR on IG-PPGS is lower than Fenton. EUGR in weight using Fenton and IG-PPGS have correlations to the underweight status based on WHO growth standrds. EUGR in length and head circumference using IG-PPGS have better correlations to the stunted and microcephaly status based on WHO growth standards.
Keywords: Very preterm infants, Fenton charts, INTERGROWTH-21 st charts