Gut Primming
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Transcript of Gut Primming
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Konsep ‘Gut feeding’
Kelompok Kerja PerinatologiRSAB Harapan Kita
J akarta
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Perkembangan saluran cerna
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Pada praktek sehari hari,
penundaan nutrisi enteral sering dilakukanpada bayi dengan :
• Asfiksia• Kateter umbilikal
• Apnu, bradikardi
• Ventilasi mekanik, CPAP
• Obat vasoaktif
NEC ? , intoleransi minum ?
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Bayi dengan TPN :
Maksimal 100 kkal/kg/hari
Protein 3,5 gram/kg/hari
Ehrenkranz, 2001 :
< 1750 gr ; < 34 minggu
120 kkal/kg/hari, 3 gr/kg/hari protein
• Akhir minggu I
defisit 335 - 406 kkal/kg
defisit 12 - 14 gr/kg protein
• Akhir minggu V
Defisit 382 - 813 kkal/kg
Defisit protein 13 - 23 gr/kg
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Akibat terlambat memberi nutrisi :
Komplikasi
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Komplikasi :
• Malabsorbsi
• Sepsis• TPN lama
• Kolestasis
• Inflamasi saluran cerna
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‘Minimal feeding’
Awal 1980 :
- ‘Trophic feeding’
- ‘Gut priming’- ‘Gut feeding’
à Memberikan sejumlah minimal minum
secara enteral dan tidak bertujuan utamauntuk memberi nutrisi bayi
(Lucas et al, 1980; Lucas et al 1982)
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Cochrane database systematic review
(Tyson dkk, 2003)
- Pencapaian minum penuh
- ‘NEC’ à tidak jelas
- Motilitas
- Aktivitas lactase
- Perkembangan saluran cerna
- Hormon
• Entero glukagon• Gastrin
• Motilin
• neurotensin
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Gut feeding vs umbilical artery catheter
Tidak ada komplikasi yang ditimbulkan
akibat pemberian ‘gut feeding’ pada bayi
dengan akses kateter arteri umbilikal
(Dunn et al, 1988 ; Schanler & Shulman,1999)
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Mulailah ‘gut feeding’ , meski bayi dengan :
• Asfiksia
• Kateter umbilical
• Apnu, bradikardi
• Ventilasi mekanik , CPAP
• Obat vasoaktif
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‘gut feeding’
- Kapan memulai ?
- ASI ? Susu formula ?- Bagaimana caranya ?
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• Memberi minum 20 ml/kg/hariselama 7 hari memperbaiki
maturasi usus
• Tidak ada perbedaan antara ASIdan susu formula
Saenz de Pipaon, 2004
Senter di Eropa
Mulai pada 10 ml/kg/hari, ditingkatkanbertahap maks. 40 ml/kg/hari (hr ke 7)
Atau:
20 ml/kg/hari pada hari ke 1, dinaikkan20 ml/kg/hari (bila tdk ada KI)
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J Neu & Bernstein, 2006
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ASI
• Keuntungan : – Komposisi protein
– Faktor imun
– Dampak terhadap neurodevelopmental
• Defisiensi: energi, protein, minerals, vitaminsà bila ASI + HMF (penambahan protein, Ca, P dan
Natrium)
• Mulai ‘kangaroo method’ bila : – usia kehamilan sudah 34-35 minggu – klinis stabil
– tidak dalam ventilasi mekanik
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Kontra indikasi mutlak ‘gut feeding’
• NEC
• Obstruksi saluran cerna
• Gangguan sirkulasi akut
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- Minimal feeding
à mempercepat pencapaian minum penuh
à mempercepat pencapaian kalori
à mengurangi risiko TPN lama
- Mulailah pada hari 0-1 , bila tidak ada KI
- ASI à pilihan I. SF selanjutnya merupakan alternatif
- Mulai pada 5-10 ml/kg/hari
à dinaikkan bertahap sampai 25 – 40 ml/kg/haripada hari ke 7. Evaluasi intoleransi
- Frekuensi pemberian bervariasi : 6-12x/hari
kesimpulan
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