GANGGUAN PERKEMBANGAN NEUROLOGIS PADA BAYI DENGAN RIWAYAT HIPERBILIRUBINEMIA NEURODEVELOPMENTAL DISORDER AMONG BABIES WITH HISTORY OF HYPERBILIRUBINEMIA

Abstract

Latar belakang : Salah satu penyebab gangguan perkembangan neurologis (GPN) bayi adalah hiperbilirubinemia, yang dapat menimbulkan kerusakan neuron permanen. Peran bilirubin indirek serum (BIS) penting karena dapat melewati sawar darah otak (SDO). Terbukanya SDO meningkatkan permeabilitas otak terhadap bilirubin. Terdapat beberapa faktor yang menyebabkan terbukanya SDO, yang selanjutnya meningkatkan risiko GPN bayi. Tujuan penelitian : Mengetahui hubungan antara kadar BIS neonatal dengan GPN bayi. Metode : Desain longitudinal prospektif, subyek 48 neonatus dengan kadar BIS >10 mg/dL, yang dirawat di Bagian IKA FK UNDIP/ RSUP Dr. Kariadi, Oktober 2004– Agustus 2005, dan difollow-up pada usia 3, 6 dan 9 bulan dengan Bayley Infant Neurodevelopmental Screener (BINS). Analisis statistik dilakukan dengan uji korelasi Spearman, Receiver Operating Curve, dan uji multivariat Cox-regression. Hasil Penelitian : Rerata kadar BIS pada kelompok risiko GPN bayi adalah 20,5 mg/dL (SD=6,06;p<0,001). Dijumpai 19 (39,6%) subyek dengan risiko GPN bayi. Ada hubungan bermakna antara tingginya kadar BIS neonatal dengan waktu timbulnya risiko GPN bayi (R=-0,63;p<0,001). Receiver Operating Curve (ROC) menunjukkan kadar BIS neonatal dapat digunakan sebagai prediktor GPN bayi dengan cut-off point BIS 14,68 mg/dL. Ada hubungan bermakna antara kadar BIS neonatal dengan GPN bayi (χ2:18,657;p<0,001). Dari uji Multivariat Cox-regression : infeksi (Hazard ratio/HR 4.0;CI=0.9;18,1), kadar BIS >14,68 mg/dL (HR 2.5;CI=0.5;12,1) dan tidak mendapat fototerapi dengan atau tanpa tranfusi tukar (HR 2.1;CI=0.8;5,6) mempunyai risiko GPN bayi. Asidosis dan hipoglikemia bukan faktor risiko. 17 Simpulan : Ada hubungan bermakna antara tingginya kadar BIS neonatal dengan risiko GPN bayi. Kadar BIS dapat digunakan sebagai prediktor GPN. Infeksi, kadar BIS >14,68 mg/dL dan tidak mendapat fototerapi dengan atau tanpa tranfusi tukar merupakan faktor yang dapat meningkatkan risiko GPN bayi dengan riwayat hiperbilirubinemia. Background : Hyperbilirubinemia, as one of the major cause of neurodevelopmental disorders (NDD) leads to permanent damage of the brain cell. Indirect bilirubin of the blood serum (IBS) is important since its capabilities to infiltrate blood brain barrier (BBB). BBB damage can increase brain permeability of bilirubin. There are many factors involving the damage process of this BBB, which subsequently increasing risk factors of neurodevelopmental disorders. Objective : To define the correlation between the value of neonatal IBS and the risk of NDD. Methods : A prospective longitudinal study was done among 48 neonates admitted to Dr. Kariadi Hospital with IBS level >10 mg/dL since October 2004-August 2005. Follow-up was done at the age of 3, 6, and 9 months with Bayley Infant Neurodevelopmental Screener (BINS) scoring system. Statistical analyses was performed using Spearman analysis, Receiver Operating Curve and Cox-regression analysis. Results: Mean IBS level of subject with NDD risk was 20.5 mg/dL (SD=6.06;p<0.001), 19 (39.6%) subjects had NDD risk. There was significant correlation between IBS level and the onset of NDD (R=-0.63; p< 0.001). Receiver Operating Curve (ROC) showed IBS level could be used as outcome predictor for NDD among babies, with BIS cut-off point 14.68 mg/dL. There was significant 19 correlation between IBS and NDD (X2:18,657; p<0.001). Multivariat Cox-regression analysis showed that factors which might have impacts on NDD were infection (Hazard ratio 4.0;CI=0.9;18.1), BIS level >14.68 mg/dL (Hazard ratio 2.5;CI=0.5;12.1) and no phototheraphy with or without exchange tranfusion (Hazard ratio 2.1;CI=0.8;5.6). Acidosis and hypoglicaemia were not risk factors for NDD. Conclusion: There was a significant correlation between neonatal BIS level and the risk of NDD in babies. IBS level could be used as outcome predictor for NDD. Infection, IBS level >14.68 mg/dL and no phototheraphy with or without exchange tranfusion were factors that increase the risk for NDD among babies with history of hyperbilirubinemia.