MANFAAT PEMBERIAN DIET TAMBAHAN TERHADAP PERTUMBUHAN PADA ANAK DENGAN PENYAKIT JANTUNG BAWAAN ASIANOTIK ( THE BENEFIT OF SUPPLEMENTARY FEEDING TO GROWTH OF CHILD WITH ACYANOTIC CONGENITAL HEART DISEASE.)

Abstract

Background: Children with congenital heart disease were at risk to suffer growth disorders.In the Pediatric Cardiology Outpatient Unit Dr. Kariadi Hospital 80,4 % of children with acyanotic congenital heart disease suffered low nutritional status. Supplementary feeding could hopefully improved the children’s nutritional status and also their growth. Aim: To investigate the benefit of the supplementary feeding on the growth of the children’s with acyanotic congenital heart disease. Method: This was a clinical trial using one group with pre and post test design of children with acyanotic congenital heart disease who visited the Pediatric Cardiology Outpatient Unit of Dr Kariadi Hospital, Semarang. Twenty two subjects aged between 6 to 57 month were given biscuits as supplementary feeding up to 20 % above the Indonesian RDA for 3 months. Each biscuit contains: 31,8 calory, fat 0,48 g, carbohydrate 6,42 g, protein 0,44 g, thiamin 0,022 mg, iron 1,68 mg, calsium 40 mg,fiber 0,4 g. Body weight was measured using digital weight scale every month, height was measured using microtoise and length was measured using supine length table for children < 2 years. The data were analyzed using Wilcoxon test and Repeated measured test with the significancy of p < 0,05. Result: Before supplementation the mean of WAZ was -1,57 SD ± 0,9 SD, HAZ -0,75 ± 1,97 SD, WHZ -0,89 ± 1,7 SD and after supplementation the mean WAZ became -1,41 ± 1 SD, HAZ -0,42 ± 1,8 SD, WHZ -0,88 ± 1,6 SD . The average increase of growth before and after supplementation were : WAZ 0,16 SD, HAZ 0,33 SD and WHZ 0,01 SD. There was a significant improvement of WAZ and HAZ, whereas no significant changes for WHZ. The acceptability increased significantly every month. After 3 months supplementation the calory and protein intakes were increased, 151,2 kkal/d and 5,5 g/d respectively. According to the Indonesian RDA, the average increasing for the energy intake was 15,6 % and 21,4 % for protein. There were significant differences in both analysis. There were significant changes in WAZ before and after supplementation in > 24 bulan months old group, anatomical diagnosis ASD and there was a significant difference in NYHA I and NYHA II groups. There were significant HAZ changes before and after supplementation in > 24 bulan month, anatomical diagnosis ASD, ASD+VSD, NYHA I group and group without any medication. There were no significant changes in WHZ variables. Conclusion: There was a benefit for the growth of the children with acyanotic congenital heart disease who got supplementary feeding with biscuits for 3 months. Latar belakang: Anak dengan penyakit jantung bawaan merupakan kelompok anak yang rawan mengalami gangguan pertumbuhan. Di Poliklinik Jantung Anak RSDK, 80,4 % anak dengan penyakit jantung bawaan asianotik mengalami gizi kurang.Pemberian diet tambahan diharapkan dapat memperbaiki status gizi yang selanjutnya memperbaiki pertumbuhan. Tujuan penelitian: Mengetahui manfaat pemberian diet tambahan anak dengan penyakit jantung bawaan asianotik terhadap pertumbuhan. Metode: Penelitian ini merupakan uji klinis menggunakan one group dengan pre and post test design, dilakukan pada anak dengan penyakit jantung bawaan asianotik yang berkunjung ke Poliklinik Jantung Anak RSDK Semarang. Subyek sebanyak 22 orang berumur 6-57 bulan. Diberikan perlakuan dengan pemberian biskuit sampai dengan 20 % diatas Angka Kecukupan Gizi selama 3 bulan. Setiap keping biskuit mengandung: 31,8 kalori, lemak 0,48 gram, karbohidrat 6,42 gram, protein 0,44 gram, thiamin 0,022 mg, besi 1,68 mg, calsium 40 mg,serat 0,4 g. Setiap bulan berat badan diukur dengan timbangan digital, tinggi badan diukur dengan mikrotoise dan panjang badan diukur dengan supine length table untuk anak < 2 tahun. Data dianalisis dengan uji Wilcoxon dan uji Repeated Measured dengan batas kemaknaan p<0,05. Hasil: Sebelum perlakuan rerata z skor BB/U -1,57 ± 0,9 SB, z skor TB/U -0,75 ± 1,97 SB, z skor BB/TB rerata -0,89 ± 1,7 SB dan sesudah perlakuan rerata z skor BB/U - 1,41 ± 1 SB, z skor TB/U -0,42 ± 1,8 SB, z skor BB/TB -0,88 ± 1,6 SB . Peningkatan rerata pertumbuhan sebelum dan sesudah perlakuan WAZ: 0,16 SB, HAZ 0,33 SB dan WHZ 0,01 SB. Dari hasil analisis didapatkan perbedaan bermakna pada WAZ dan HAZ sedangkan WHZ tidak berbeda bermakna. Akseptabilitas setiap bulannya meningkat. Selama 3 bulan terjadi peningkatan rerata asupan energi dan protein masing- masing sebesar 151,2 kkal/hari dan 5,5 g/hari.Berdasarkan AKG peningkatan rerata asupan energi sebesar 15,6 % dan protein sebesar 21,4 %. Dari hasil analisis keduanya didapatkan perbedaan bermakna. Didapatkan perubahan WAZ bermakna sebelum dan sesudah perlakuan pada kelompok umur > 24 bulan, diagnosis anatomi ASD dan terdapat perbedaan bermakna pada kelompok NYHA I dan NYHA II. Terdapat perubahan HAZ bermakna sebelum dan sesudah perlakuan pada kelompok umur > 24 bulan, diagnosis anatomi ASD dan ASD+VSD, kelompok NYHA I dan kelompok yang tidak mendapat terapi medikamentosa. Perubahan variabel WHZ sebelum dan sesudah perlakuan tidak bermakna. Simpulan: Pemberian biskuit selama 3 bulan pada anak PJB asianotik meningkatkan pertumbuhan.