Tesis

Gambaran Ultrasonografi Paru Pada Neonatus Dengan Sesak Nafas Akibat Pneumonia = View of lung ultrasound in neonates with respiratory distress because of pneumonia.

Latar Belakang : Infeksi neonatus berasal dari penyebab yang bervariasi namun kematian terbanyak berasal dari pneumonia. Manifestasi klinis pneumonia memiliki kesamaan dengan etiologi gangguan pernafasan lain seperti sindrom distres respiratori, transient tachypnea of the newborn, dan sindrom aspirasi mekonium yaitu distres pernafasan. Praktik penggunaan ultrasonografi paru secara langsung di ruangan neonatal intensive care unit (NICU) yang disebut sebagai POCUS (point-of-care ultrasonography) dapat membantu klinisi dalam melakukan klasifikasi diagnosis distres pernafasan akut pada neonatus. Tujuan : Penelitian ini bertujuan mengetahui insidens dan gambaran ultrasonografi neonatus baru lahir yang mengalami distres pernafasan akibat pneumonia neonatal. Metode : Uji potong lintang yang bersifat deskriptif dilakukan di Unit Perawatan Neonatal RS Cipto Mangunkusumo pada 73 orang neonatus yang mengalami distres pernafasan saat lahir kemudian dilakukan evaluasi klinis saat usia 72 jam. Pemeriksaan ultrasonografi paru dilakukan dalam posisi telentang dan miring yang meliputi 12 area yakni 6 area hemitoraks kanan dan 6 area hemitoraks kiri dan dibagi menjadi anterior atas, anterior bawah, posterior atas, posterior bawah lateral atas dan lateral bawah. Hasil : Insidens pneumonia pada neonatus baru lahir dengan distres pernafasan adalah 32,9%. Terdapat hubungan yang bermakna gambaran ultrasonografi paru yaitu abnormalitas pleural line (p=0,002, OR : 14,5; 95% CI : 1,8 – 116,9), B-line (p = 0,001, OR : 7,1; 95% CI : 2,2 – 22,5), konsolidasi paru (p=0,000, OR : 6,1; 95% CI : 3,2 – 11,5) dan air bronchogram (p = 0,001, OR : 10,7; 95% CI : 2,5 – 44,5) dengan kejadian pneumonia pada neonatus. Terdapat hubungan yang bermakna gambaran ultrasonografi paru yaitu peningkatan ekogenitas pleural line abnormal (p=0.024,OR: 4.344; 95%CI: 1.135 – 16.628), B line (p=0.000, OR: 6.458; 95%CI:2.163-19.281),konsolidasi paru (p=0,000, OR:9.722; 95%CI: 3.161 -29.901) dan air bronchogram (p=0,001, OR :9.167; 95%CI: 2.235 – 37.599) terhadap neonatus yang menggunakan ventilasi mekanik invasif. Pemberian antibiotik dilakukan kepada 93.1% neonatus yang lahir dengan distres pernafasan sejak lahir hingga usia 72 jam. Simpulan : Insidens pneumonia pada neonatus baru lahir dengan distres pernafasan adalah 32,9%. Gambaran ultrasonografi paru yaitu abnormalitas pleural line, B-line, konsolidasi paru, dan air-bronchogram bermakna dalam mendiagnosis pneumonia pada neonatus yang lahir dengan distres pernafasan. Pada neonatus yang membutuhkan alat bantu nafas, gambaran ultrasonografi paru yaitu abnormalitas pleural line, B-line, konsolidasi paru dan airbronchogram bermakna terhadap neonatus yang membutuhkan ventilasi mekanik invasif. Adanya ultrasonografi mampu memutuskan kelanjutan penggunaan antibiotik pada neonatus yang mengalami distres pernafasan pasca lahir.
Kata kunci : Pneumonia, sesak nafas, ultrasonografi paru


Background : Source of neonatal infections could come from variety of causes but most of the mortalities are belong to pneumonia. Clinical manifestations of pneumonia are similar to other respiratory disorders such as respiratory distress syndrome, transient tachypnea ofthe newborn, and mekonium aspiration syndrome, namely respiratory distress. Direct utilization of lung ultrasound at the neonatal intensive care unit (NICU) as known as POCUS (point-of-care ultrasonography), can assist clinicians to classify the etiology of acute respiratory distress in neonates. Objective: This study aims to determine the incidence and ultrasound features of newborns who suffered from respiratory distress due to neonatal pneumonia. Method: A desciptive cross-sectional tests were conducted in the Neonatal Care Unit of Cipto Mangunkusumo Hospital on 73 newborns who suffered from respiratory distress at birth, then clinical evaluation was carried out at 72 hours of age. Lung ultrasound scan was performed in supine and oblique positions comprising 12 areas of thoracic region consisted of 6 areas of the right hemithorax and 6 areas of the left hemithorax and then divided into anterior upper, anterior lower, posterior upper, posterior lower lateral upper and lateral lower. Results: The incidence of pneumonia in newborns with respiratory distress was 32.9%. There were significant relationship between artefacts view of lung ultrasound namely pleural line abnormalities (p = 0.002, OR: 14.5; 95% CI: 1.8 - 116.9), B-line (p = 0.001, OR: 7.1; 95% CI: 2.2 - 22.5), lung consolidation (p = 0.000, OR: 6.1; 95% CI: 3.2 - 11.5) and air bronchogram (p = 0.001, OR: 10.7; 95% CI: 2.5 - 44.5) with the incidence of pneumonia in neonates. There were significant relationship between view of lung ultrasound namely abnormal pleural line (p=0.024,OR: 4.344; 95%CI: 1.135 – 16.628), B-line (p=0.000, OR: 6.458; 95%CI:2.163- 19.281), lung consolidation (p=0,000, OR:9.722; 95%CI: 3.161 -29.901) and air bronchogram (p=0,001, OR :9.167; 95%CI: 2.235 – 37.599) in neonates need invasive mechanical respiratory support. Antibiotic treatment applied to 93,1% neonates representing respiratory distress since birth until 72 hours. Conclusion: The incidence of pneumonia in newborns with respiratory distress was 32.9%. Lung ultrasound view, namely pleural line abnormalities, B-line, lung consolidation, and airbronchogram were significant in diagnosing pneumonia in neonates born with respiratory distress. In neonates provided with respiratory support, the lung ultrasound artefacts namely pleural line abnormalities, B-line, lung consolidation and air bronchogram were the significant ultrasound view for neonates need invasive mechanical respiratory support. Ultrasonography has the ability to conclude the continuation of antibiotic therapy in neonates who experience respiratory distress after birth.
Keywords: Pneumonia, respiratory distress, lung ultrasound