Mikroflora usus memegang peranan penting bagi kesehatan bayi baru lahir. ...
68 infants appropriate for gestational age given birth by normal spontaneous ...
PENGARUH PEMBERIAN ANTIBIOTIK DAN PROBIOTIK TERHADAP KETAHANAN KOLONISASI PADA BAYI CUKUP BULAN YANG MINUM ASI
THE EFFECT OF ANTIBIOTICS AND PROBIOTICS ADMINISTRATION AGAINST COLONIZATION RESISTANCE IN BREAST FED INFANTS APPROPRIATE FOR GESTATIONAL AGE
J.I Christie Manoppo1, Nasrum Massi2, Agus Firmansyah3 1
Department of Child Health, Medical School Sam Ratulangi University, 2 Department of Child Health, Hassanudin University, 3 Department of Child Health, Medical School University of Indonesia
Alamat Koresponden: J I Christiene Manoppo Fakultas Kedokteran Universitas Sam Ratulangi Manado 95115 HP 085214422003 Email :
[email protected]
Abstrak Mikroflora usus memegang peranan penting bagi kesehatan bayi baru lahir. Penggunaan antibiotik, probiotik dan air susu ibu memberi dampak terhadap ketahanan kolonisasi usus dan mempengaruhi perkembangan sistim imun dan penyakit pada saluran cerna. Tujuan penelitian ini untuk mengetahui pengaruh pemberian antibiotik, probiotik terhadap ketahanan kolonisasi usus bayi cukup bulan sesuai masa kehamilan yang minum ASI. Penelitian ini menggunakan metode analitik komperatif dengan pendekatan kohort prospektif. Subjek penelitian yaitu semua bayi baru lahir di ruang rawat inap neonatologi BLU RSUP Prof. Dr. R.D. Kandou Manado yang memenuhi kriteria inklusi dan eksklusi pada bulan Juni 2011 sampai Desember 2012. Data yang dikumpulkan antara lain anamnesis, pemeriksaan fisik, dan pemeriksaan RT PCR tinja bayi. Dilakukan analisis deskriptif dengan uji multivariat dengan uji Anova dengan Fisher exact dan uji Kruskal Wallis. Didapat hasil 69 bayi dalam penelitian ini. Keseluruhan sampel dikelompokkan menjadi kelompok A 21 bayi diberi ASI, antibiotik dan probiotik; kelompok B 24 bayi diberi antibiotik dan ASI dan kelompok C 24 bayi sehat yang hanya diberi ASI saja. Terdapat penurunan ketahanan kolonisasi pada kelompok B dibandingkan kelompok C (p=0,143), ketahanan kolonisasi lebih tinggi pada kelompok A dibandingkan kelompok B (p=0,101). Terdapat kenaikan proporsi Bifidobacteria dan Lactobacillus pada hari ke tujuh dibandingkan hari pertama, namun terjadi penurunan proporsi E.Coli, Bacteriodes, Clostridium dan Enterococcus pada hari ke tujuh dibandingkan hari pertama. Pemberian antibiotik tidak menurunkan ketahanan kolonisasi pada bayi yang minum ASI dan pemberian probiotik tidak meningkatkan ketahanan kolonisasi pada bayi baru lahir yang minum ASI.Selama tujuh hari bayi lahir cukup bulan yang minum ASI baik dengan antibiotik dan probiotik akan meningkatkan ketahanan kolonisasi usus. kata kunci: mikrobiota usus, bayi baru lahir, sepsis, antibiotic, probiotik, ASI
Abstract Human intestinal microflora plays an important role in maintaining host health, especially in newborns. The use of antibiotics, probiotics and breastfeeding will bring an impact on the colonization resistance of the intestinal microflora and therefore interfere the development of the mucosal immune system and cause disease in the gastrointestinal mucosa. To determine the impact of antibiotic and probiotics administration against the colonization resistance of the intestinal microflora in breast fed infants appropriate for gestational age. We conducted a comparative analytic with prospective cohort approach. The study subjects were all newborns in the neonatology wards at BLU Prof.Dr.R.D.Kandou Hospital Manado who meet the inclusion and exclusion criteria between June 2011 to December 2012. The data collected included history, physical examination, and examination of infant faeces RT PCR. A descriptive analytic with multivariate test with Fisher exact test Anova and KruskalWallis test was done. Sixty-nine infants were included in the study. The entire sample divided into group A, 21 infants given breast milk, antibiotics and probiotics; Group B, 24 infants given antibiotics an breast milk, and group C, 24 healthy infants who received breast milk only. There was no difference in the colonization resistance of the intestinal microflora between group A and group C (P=0,375) nor with group B and C (P=0,918), but there was a significant change in the proportion of Enterococcus between group A and group C (P=0,017). Administration of antibiotics has no impact in reducing colonization resistance in breastfed infants and probiotics has noimpact in increasing colonization resistance in breastfed infants appropriate for gestational age. Infant appropriate gestational age who received breast milk with or without antibiotic and probiotic will increase the intestinal colonization resistance, therefore, it is advisable that the administration of breast milk is required in newborn baby appropriate gestational age who received antibiotic. Key Words: Intestinal microbiota, newborns, sepsis, antibiotics, probiotics, breastfeeding
INTRODUCTION Human intestinal microbiota plays an important and complex role in maintaining the host health. This role includes the digestion of polysaccharides, regulation of energy balance, modulating the immune system and to protect the host from pathogenic bacteria (Cusack et al., 2010; Penders et al., 2005). After birth, normally in the digestive system facultative bacteria are available (Enterobacteria Streptococcus, Staphylococcus). This colonization is followed by the gradual increase of anaerobe bacteria such as Bacteria such as Bifidobacterium, Eubacterium, coccus anearob and Clostridia. (Sepp et al., 2000; Jareguy et al., 2004). With the increase of age, community of microbiota in the gastrointestinal will reach to a more stable level (Favier et al., 2003; Bezirtzoglou et al., 2011). To determine the impact of antibiotic and probiotic administration against the colonization resistance of the intestinal microbiota in breast fed infants appropriate for gestational age.
METHODS Study Design The study design used a comparative analytic with prospective cohort approach. Population and Sample 68 infants appropriate for gestational age given birth by normal spontaneous vaginal delivery, in the neonatology wards at BLU Prof.Dr.R.D.Kandou Hospital Manado between June 2011 to December 2012. The subjects that met the inclusion and exclusion criteria were included. The inclusion criteria were infants appropriate for gestational age with suspected sepsis admitted in the neonatal intensive care unit BLU Prof.Dr.R.D.Kandou Hospital Manado, the infants was breastfed, received caftazidime, probiotics supplementation and parents agreed to include their infants in the experiment. The exclusion criteria were infants with congenital anomalies, infants from mothers who have received antibiotics therapy formerly. The sample was divided into 3 groups that is 21 infants appropriate for gestational age who received antibiotics, probiotics and breast milk, 24 infants appropriate for gestational age that received antibiotics and breast milk and 24 infants appropriate for gestational age that were breastfed. Infants were classified as suspected sepsis if they matched with the 2 major criteria or
1 major and 2 minor criteria. The major risk factors were rupture of amniotic fluid > 24 hours before delivery, intrapartum fever > 38oC, chorioamnionitis, infants heart beat > 160x/minutes, greenish and bad odour amniotic fluid with thick consistency. The minor risk factors were rupture of amniotic membranes > 12 hours, intrapartum fever > 37,5oC, low APGAR scores (first minute
