Kadar Secretory Immunoglobulin A Dan Human ß Defensin-2 Tinja Pada Neonatus Prematur Yang Mendapat Air Susu Ibu Saja, Susu Formula Saja, Dan Kombinasi

Primawardani, Putri (2019) Kadar Secretory Immunoglobulin A Dan Human ß Defensin-2 Tinja Pada Neonatus Prematur Yang Mendapat Air Susu Ibu Saja, Susu Formula Saja, Dan Kombinasi. Magister thesis, Universitas Brawijaya.

Abstract

Kelahiran prematur memengaruhi ±10% kelahiran hidup di seluruh dunia. Insiden sepsis neonatal terjadi pada 10-40% prematur (usia kehamilan ibu <37 minggu), dan bukti klinis menunjukkan bahwa etiologi patogen sepsis dapat terjadi karena translokasi bakteri dari saluran cerna, dimana kejadian inflamasi tersering berasal dari saluran cerna dan paling cepat terjadi pada usia 8—10 hari. Salah satu komponen kunci untuk meningkatkan angka harapan hidup neonatus prematur adalah pemberian nutrisi optimal yakni penggunaan air susu ibu (ASI). Air susu ibu mengandung zat bioaktif yang melindungi dari infeksi dan menginduksi kolonisasi flora normal yang berperan pada imunitas saluran cerna yakni melalui peran imunoglobulin dan peptida antimikroba. Imunoglobulin dan peptida teridentifikasi pada tinja neonatus selama minggu pertama kehidupan, salah satunya yakni sekretori imunoglobulin A (SIgA) dan defensin. Sekretori imunoglobulin A yang terdeteksi dalam tinja merupakan bagian dari penghalang mukosa dan berperan protektif terhadap infeksi. Sementara itu, defensin yang disekresi pada epitel (terutama saluran cerna) dan berhubungan dengan reaksi inflamasi yakni human ß-defensin 2. Human ß-defensin 2 (hBD-2) terbukti memiliki efek protektif selama peradangan dan apoptosis, serta mampu menstimulasi perbaikan epitel saluran cerna. Penelitian yang membandingkan pemberian nutrisi enteral dengan kejadian inflamasi saluran cerna masih terbatas. Oleh karena itu, penelitian ini dilakukan bertujuan untuk mengetahui kadar sekretori imunoglobulin A dan human ß-defensin 2 tinja sebagai biomarker inflamasi neonatus prematur terkait nutrisi yang dikonsumsi yakni ASI saja, susu formula saja, maupun ASI dan susu formula pada usia empat belas hari. Tiga puluh sembilan neonatus prematur sesuai kriteria inklusi dikumpulkan pada bulan Juni sampai Agustus 2019 di ruang neonatologi RSUD Dr. Saiful Anwar Malang dan dikelompokkan menjadi tiga kelompok sampel penelitian (kelompok yang mendapatkan ASI saja, ASI dan susu formula, serta iii susu formula saja). Karakteristik dasar sampel penelitian yang diamati adalah neonatus (jenis kelamin, cara persalinan, usia kehamilan, berat badan lahir, panjang badan lahir, dan lingkar kepala), serta karakteristik dasar ibu (preeklampsia, eklampsia, riwayat ketuban pecah dini, dan kehamilan gemeli). Kadar SIgA dan hBD-2 tinja neonatus prematur diambil dari ketiga kelompok sampel pada hari keempat belas serta diukur dengan metode ELISA. Uji komparatif perbedaan mean kadar SIgA tinja dan hBD-2 tinja dari setiap kelompok sampel dilakukan dengan uji ANOVA. Hasil penelitian menunjukkan kadar SIgA tinja tertinggi terdapat pada kelompok neonatus prematur yang mengonsumsi ASI saja (2091,2 μg/mL) dan nilai terendah (194,77 μg/mL) didapatkan pada kelompok neonatus prematur yang mendapatkan susu formula saja. Pada kelompok neonatus prematur yang mengonsumsi ASI saja, kadar SIgA tinja pada (835,8—2091,2 μg/mL) lebih tinggi dibandingkan kelompok neonatus prematur yang mengonsumsi ASI dan susu formula (453,78—1104,02 μg/mL) serta kelompok neonatus prematur yang mengonsumsi susu formula saja (194,77—714,87 μg/mL). Sementara itu, kadar hBD-2 tinja tertinggi diperoleh pada kelompok neonatus prematur yang mengonsumsi susu formula yakni 492 ng/mL dan nilai terendah didapatkan pada kelompok neonatus prematur yang mengonsumsi ASI saja yakni 151,775 ng/mL. Mean hBD-2 tinja pada kelompok susu formula saja lebih tinggi dibandingkan kelompok lain (375,73 + 69,13), namun tidak berbeda bermakna dengan yang mengonsumsi ASI dan susu formula (p=0.463). Sebaliknya, mean kadar hBD-2 tinja neonatus prematur pada kelompok yang mengosumsi ASI saja berbeda bermakna (p=0,00) terhadap kedua kelompok lainnya. Dapat disimpulkan bahwa kadar SIgA tinja neonatus yang mengonsumsi ASI saja lebih tinggi bermakna dibandingkan kadar SIgA tinja pada kelompok neonatus yang mengonsumsi ASI dan susu formula maupun susu formula saja. Selain itu, kadar human ß-defensin 2 tinja neonatus prematur yang mengonsumsi susu formula saja lebih tinggi bermakna dibandingkan kadar human ß-defensin 2 tinja neonatus prematur yang mengonsumsi ASI saja, namun tidak berbeda signifikan dengan kadar hBD-2 tinja yang mengonsumsi ASI dan susu formula. Pemberian nutrisi berupa ASI saja, ASI dan susu formula, maupun susu formula saja memengaruhi kadar SIgA dan human ß-defensin 2 tinja.

English Abstract

Premature birth affects ± 10% of live births worldwide. The incidence of neonatal sepsis occurs in 10-40% of preterm neonates (maternal gestational age <37 weeks), and clinical evidence shows etiology of neonatal sepsis occur due to bactery translocation of digestive tract which earliest occurs at 8—10 days. One of the key components for increasing life expectancy in premature neonates is the provision of optimal nutrition by giving breast milk. Human breast milk contains bioactive substances that protect babies against infection and induce colonization of normal flora that have role in intestinal immunity. The bioactive substance of breast milk as a barrier function of digestive tract is through the role of immunoglobulins and antimicrobial peptides. Immunoglobulins and peptides were identified in neonatal feces during the first week of life, one of which is secretory immunoglobulin A (SIgA) and defensins. The secretory immunoglobulin A (SIgA) detected in the stool is part of the mucosal barrier and plays a protective role against infection. Meanwhile, defensins are secreted in the epithelium (especially the digestive tract) and are associated with an inflammatory reaction are mainly human ß-defensin 2. Human ß-defensin 2 (hBD-2) has been shown to have a protective effect during inflammation and apoptosis, and is able to stimulate epithelial repair in gastrointestinal tract. Thirty-nine preterm neonates according to inclusion criteria were collected from June to August 2019 in neonatology ward of Dr. Saiful Anwar Malang hospital and grouped into three research sample (breastfeeding, breast milk and preterm formula milk, and preterm formula milk). Basic characteristics of study samples were observed in neonate (gender, mode of delivery, gestational age, birth weight, birth length, and head circumference), and mother (preeclampsia, eclampsia, history of premature rupture of membranes, and gemelli). The level of SIgA and hBD-2 fecal of premature neonates were taken from three sample groups on the fourteenth days then measured by ELISA method. Comparative v test of mean differences in level of sIgA and hBD-2 feces from each sample group was carried out by ANOVA test. This research showed the highest SIgA fecal levels were found in the group of preterm neonates who consumed breast milk (2091.2 μg/mL) and the lowest value (194.77 μg/mL) was found in the group who received formula milk. In the group who consumed breast milk, SIgA feces levels (835.8-2091.2 μg/mL) were higher than those in the preterm neonates who consumed breast milk and formula milk (453.78-1104.02 μg/mL) and premature neonates who consumed formula milk (194.77-714.87 μg/mL). Meanwhile, the highest levels of hBD-2 fecal were obtained in the preterm neonate who consumed formula milk which was 492 ng/mL and the lowest value was obtained in the preterm neonate who consumed breast milk which was 151.775 ng/mL. In the group who consumed breast milk, levels of hBD-2 fecal (151.77-272.77 ng/mL) were lower than those in the preterm neonate who consumed breast milk and formula milk or formula milk that is 304.27-430.27 ng/mL and 311.22 - 492.27 ng/mL. This research concluded that level of SIgA fecal consuming breast milk is significantly higher than the level of SIgA fecal in the neonate group that consumes breast milk and formula milk or formula milk only. In addition, the levels of human β-defensin 2 fecal that consume formula milk are significantly higher than premature who consume breast milk, but not significantly different from the levels of hBD-2 fecal that consume breast milk and formula milk. Nutrition in the form of breast milk only, breast milk and formula milk, as well as formula milk only affects the levels of SIgA and human ß-defensus 2 fecal.

Other obstract

-

Item Type:	Thesis (Magister)
Identification Number:	TES/618.920 11/PRI/k/2019/042001911
Uncontrolled Keywords:	Secretory Immunoglobulin A, Human ß Defensin-2 Tinja, Neonatus Prematur
Subjects:	600 Technology (Applied sciences) > 618 Gynecology, obstetrics, pediatrics, geriatrics > 618.9 Pediatrics and geriatrics > 618.92 Pediatrics / Infants--Care / Infants--Development > 618.920 11 Premature infants
Divisions:	S2/S3 > Magister Ilmu Biomedis, Fakultas Kedokteran
Depositing User:	Endang Susworini
Date Deposited:	07 Jun 2022 08:25
Last Modified:	07 Jun 2022 08:25
URI:	http://repository.ub.ac.id/id/eprint/190854

Text putri primawardani (2).pdf Download (3MB)

Actions (login required)

View Item