Derajat Sindroma Distres Respirasi pada Foto Thorax dan Derajat Asfiksia pada Neonatus Prematur

Abstract

The degrees of respiratory distress syndrome from thorax X-ray and degrees of asphyxia in preterm neonates
Background: Respiration Distress Syndrome (RDS) is a complication of prematurity lung disorder and common causes of premature neonatal morbidity. Clinically RDS provides signs of asphyxia that can be assessed with APGAR score. Chest X-ray can also diagnose and determine the degree of RDS radiologically. This study aims to find the relationship degree of RDS clinically with radiologically.
Methods: Analytic observational study with cross-sectional design. The subjects were premature neonates with asphyxia in Kariadi General Hospital Semarang who had APGAR score and RDS on the standard Chest x-ray examination and selected using consecutive sampling method. The relationship between the RDS clinical degree based on APGAR score with radiological degrees tested with the Chi square test (X2) and Kendall tau-b. There were four grading for RDS. Chest x-ray images were interpretated by 2 expert radiologists independently and then Kappa value was evaluated.
Results: There were 23 RDS cases consisted 12 severe, 8 moderate and 3 mild asphyxia cases. Radiologically showed grade I (9), grade II (5), grade III (5) and grade IV (4) neonates. Kappa value=1 (p<0.001). Chi square test (X2) showed clinical asphyxia degree was not significantly different with the degree of RDS on chest x-ray. Kendall tau-b correlation test showed a significant and moderate degree correlation (r=0.5; p=0.01).
Conclusions: The degree of asphyxia in premature infants are in line with radiological images.

ABSTRAK
Latar belakang: Sindroma distres respirasi (SDR) yang bermanifestasi dalam bentuk asfiksia merupakan kelainan paru komplikasi prematuritas penyebab tersering morbiditas neonatus prematur. X-foto thorax membantu diagnosis SDR sekaligus menentukan derajat SDR. Penelitian ini bertujuan menilai hubungan derajat klinis SDR dengan derajat radiologi.
Metode: Studi observasional analitik dengan rancangan cross-sectional. Subjek penelitian adalah neonatus prematur dengan asfiksia di RSUP Dr. Kariadi Semarang yang mempunyai skor APGAR serta mendapatkan pemeriksaan X-foto thoraks standar. Pemilihan subjek menggunakan metode consecutive sampling. Terdapat empat derajat SDR secara radiologis Hubungan antara derajat klinis SDR berdasarkan skor APGAR dengan derajat radiologis diuji dengan Chi square(X2) dan derajat korelasi dengan uji Kendall tau-b. Hasil X-foto thorax diinterpretasi terpisah oleh 2 ahli radiologi dan diuji Kappa.
Hasil: Dijumpai 23 asfiksia neonatus prematur dengan SDR terdiri dari 12 kasus asfiksia berat, 8 kasus asfiksia sedang dan 3 kasus asfiksia ringan. Secara radiologis ditemukan SDR derajat I sebanyak 9, 5 derajat II, 5 derajat III dan derajat IV pada 4 neonatus. Nilai Kappa=1 (p<0,001). Derajat asfiksia secara klinis tidak berbeda bermakna dengan derajat radiologi SDR (Chi square(X2) p=0,007). Uji korelasi Kendall tau-b menunjukkan korelasi bermakna tingkat sedang (r=0,5; p=0,01) antara derajat asfiksia secara klinis dengan derajat radiologi SDR.
Simpulan: Derajat asfiksia pada bayi prematur sejalan dengan derajat radiologik foto thorax pada SDR.