PENGARUH WAKTU PENJEPITAN TALI PUSAT TERHADAP KADAR HEMOGLOBIN DAN HEMATOKRIT BAYI BARU LAHIR THE EFFECT OF UMBILICAL CORD CLAMPING TIME TO THE LEVEL OF HEMOGLOBIN AND HEMATOCRITE OF NEONATES

Abstract

Backgrounds: After the baby was born, before delivery of placenta, there are roles exchange in oxygenation from placenta to baby’s lungs. At that time, oxygen delivery from placenta still continued (placental transfusion). If oxygenation from placenta suddenly stop (early clamping), whether lung’s function not optimal yet, cerebral blood flow becomes inadequate. When should we clamp the umbilical cord is still controversy and has been debated over more than one century, but still have no answer whether early or delayed clamping is the best for the baby. Objectives: To prove the effect of umbilical cord clamping time to the level of hemoglobin (Hb) and hematocrite(Ht) of neonates. Methods: Posttest-only control group design, analyze effect of 45 seconds umbilical cord clamping (delayed clamping) after babies was born to the neonate’s Hb and Ht level compare with 15 seconds (early clamping). Hypothesis: the level of Hb and Ht of neonates are higher in the delayed clamping. Subject: 36 newborn babies (19 with early clamping), not asphyxiated, normal birth weight, aterm, spontaneous delivery with single baby, location at Dr.Kariadi Hospital and private midwife, between August 2007 and February 2008. Shapiro-Wilks used for normality test and independent t-test for mean difference between two groups. Level of significance, p < 0.05 was chosen, with 95% CI. Results: The neonate’s Hb level in early clamping group were 13.4-18.4g% and delayed clamping were 14.5-20.1g%; Ht level in early clamping group were 37.6-54.7% and delayed clamping were 41.6-60.6%. There were significance differences in subject Hb between early and delayed clamping (16.3g%±1.36 and 17.34g%±1.67) and Ht (47.08%±4.54 and 51.34%±6.07) with significancies p=0.048 and p=0.022. Conclusion: Mean Hb and Ht level in delayed cord clamping group (45 seconds) are significantly higher than early clamping group. Latar belakang: Masa setelah bayi lahir, sebelum plasenta dilahirkan, terjadilah peralihan peran oksigenasi dari plasenta ke paru bayi. Selama masa tersebut, oksigenasi bayi melalui plasenta masih berlanjut, darah masih ditransfusikan ke bayi (disebut transfusi plasenta). Jika peran oksigenasi plasenta dihentikan mendadak (penjepitan tali pusat dini), sementara paru belum berfungsi optimal, maka cerebral blood flow menjadi tidak adekuat. Kapan penjepitan tali pusat seharusnya dilakukan, masih menjadi kontroversi dan perdebatan lebih dari satu abad, namun mana yang lebih baik bagi bayi, penjepitan dini atau lanjut dan kapan penjepitan tali pusat dilakukan, para ahli masih berbeda pandangan. Tujuan: Membuktikan adanya pengaruh waktu penjepitan tali pusat setelah bayi lahir terhadap kadar hemoglobin(Hb) dan hematokrit(Ht) bayi baru lahir. Metode: Penelitian dengan Posttest-Only Control Group Design, menganalisis pengaruh waktu penjepitan tali pusat 45 detik (penjepitan lanjut) setelah bayi lahir terhadap kadar Hb dan Ht bayi baru lahir dibandingkan dengan 15 detik (penjepitan dini). Hipotesis penelitian, kadar Hb dan Ht lebih tinggi pada bayi baru lahir yang dilakukan penjepitan tali dengan dengan waktu yang lebih lama. Subyek: 36 bayi baru lahir (19 subyek dilakukan penjepitan dini), tidak asfiksia, berat lahir normal, aterm, kehamilan tunggal dengan persalinan spontan, di RSUP Dr.Kariadi Semarang dan rumah Bidan praktek swasta, antara Agustus 2007 s.d. Februari 2008. Uji normalitas data digunakan Uji Shapiro-Wilks, uji beda rerata menggunakan independent t-test. Batas kemaknaan p ≤ 0.05, IK 95%. Hasil: Kadar Hb subyek kelompok penjepitan dini: 13.4 s.d. 18.4g% dan penjepitan lanjut: 14.5 s.d. 20.1g%. Kadar Ht bayi penjepitan 15 detik: 37,6 s.d. 54,7% dan penjepitan 45 detik antara 41,6 s.d. 60,6%. Pada kelompok penjepitan 15 dan 45 detik terdapat perbedaan bermakna rerata Hb subyek (16.30g%±1.36 dan 17.34g%±1.67) dan Ht (47.08%±4.54 dan 51.34 %±6.07) dengan angka signifikansi berturut-turut p=0.048 dan p=0.022. Simpulan: Rerata kadar Hb dan Ht kelompok penjepitan tali pusat 45 detik lebih tinggi secara statistik bermakna dibandingkan kelompok penjepitan 15 detik. Kata kunci: Waktu penjepitan tali pusat,hemoglobin bayi baru lahir,hematokrit