BAB 6. KESIMPULAN DAN SARAN
6.2. Saran
6.2.1. Perlu adanya skrining pendengaran bayi baru lahir di RSUP H. Adam Malik Medan baik menggunakan alat DPOAEs maupun ABR
sebagai upaya preventif dan promotif gangguan pendengaran sedini mungkin.
6.2.2. Diperlukan penelitian lebih lanjut terutama dengan jumlah sampel yang lebih besar agar dapat diketahui angka kejadian hasil pemeriksaan DPOAEs dan ABR yang lebih akurat.
6.2.3. Diperlukan penelitian lebih lanjut untuk mengetahui ada atau tidaknya hubungan faktor risiko penyerta lainnya dengan kejadian gangguan pendengaran pada BBLR .
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Lampiran 1
STATUS PENELITIAN
No. urut : No. rekam medis: Tanggal : I. Identitas Pasien Nama Bayi : Anak ke- : Tanggal Lahir/Umur : Jenis kelamin : Alamat : Nama Ibu : Umur : Pendidikan : Pekerjaan : Penyakit : Nama Ayah : Umur : Pendidikan : Pekerjaan : Penyakit :
II. Riwayat Kehamilan/Persalinan
a. Umur kehamilan:………..minggu b. Berat badan waktu lahir ………..gram
III. Pemeriksaan Fisik
a. Telinga: Kanan Kiri Daun telinga ………. ……...………… Liang telinga ……….. ………... Membran timpani ……….. ……….. b. Kelainan bawaan lainnya:
(0) tidak ada
(1) ada, sebutkan………..
IV. Pemeriksaan DPOAEs (Distortion Product Otoacoustic Emission)
a. Telinga Kanan : Pass/ Refer b. Telinga Kiri : Pass/ Refer V. Pemeriksaan ABR (Auditory Brainstem Response)
a. Telinga Kanan : Pass/Refer b. Telinga Kiri : Pass/Refer
Lampiran 2
LEMBAR PENJELASAN SUBYEK PENELITIAN
Salam sejahtera
Saya dr. Sara Yosephine Aruan sedang menjalani pendidikan magister THT di RSUP H. Adam Malik. Saya akan mengadakan penelitian dengan judul Gambaran Distortion Product Otoacoustic Emissions (DPOAEs) dan
Auditory Brainstem Response (ABR) Pada Bayi Berat Lahir Rendah (BBLR) Di RSUP H. Adam Malik Medan. Saya mengikutsertakan bayi anda dalam penelitian yang bertujuan untuk mengetahui fungsi pendengaran bayi anda khususnya fungsi telinga bagian dalam dan sentral.
Dalam penelitian ini, bayi anda akan menjalani pemeriksaan THT rutin, kemudian akan diperiksa fungsi pendengaran dengan menggunakan alat
DPOAEs yang merupakan suatu alat / probe yang dimasukkan ke dalam liang telinga dan dihubungkan pada alat perekam. Kemudian alat akan bekerja selama ± 30 detik dan akan memberikan hasil. Pemeriksaan akan dilanjutkan dengan ABR dimana suatu elektroda akan dilekatkan di dahi dan belakang telinga kemudian dihubungkan pada alat perekam, alat akan bekerja selama selama ± 5 menit dan akan memberikan hasil. Tidak ada bahaya yang ditimbulkan oleh alat tersebut, karena tidak menimbulkan sakit, tidak menimbulkan efek samping dan waktu pemeriksaan yang singkat.
Saya akan mencatat identitas orang tua bayi (nama, alamat, usia, riwayat penyakit, usia kehamilan ibu), identitas bayi (nama, umur, jenis kelamin, tanggal lahir, berat badan lahir) pemeriksaan fisik bayi pada lembaran penelitian. Selanjutnya saya akan mencatat hasil pemeriksaan
DPOAEs dan hasil pemeriksaan ABR.
Partisipasi bayi anda dalam penelitian ini bersifat sukarela. Tidak akan terjadi perubahan mutu pelayanan dari dokter anda bila anda tidak bersedia mengikuti penelitian ini. Anda akan tetap mendapatkan
pelayanan kesehatan standar rutin sesuai dengan standar prosedur pelayanan.
Pada penelitian identitas orang tua dan bayi disamarkan. Hanya dokter peneliti, anggota peneliti, dan anggota komisi etik yang bisa melihat data anda. Kerahasiaan data orangtua dan bayi akan dijamin sepenuhnya. Bila data tersebut dipublikasikan, kerahasiaan tetap dijaga.
Jika terjadi keluhan setelah pameriksaan atau untuk mendapat keterangan lebih lanjut, anda dapat menghubungi saya dr. Sara Yosephine Aruan di Departemen THT-KL RSUP H. Adam Malik Medan, atau pada no 08370762005, Jl. Pukat Gg. Taqwa no. 2 Medan 20226.
Lampiran 3
LEMBAR PERSETUJUAN SETELAH PENJELASAN
Saya yang namanya tersebut di bawah ini
Nama :
Umur :
Jenis Kelamin :
Alamat :
Pekerjaan :
Hub Dgn Bayi : Ayah / Ibu
Setelah mendapatkan keterangan dan penjelasan secara lengkap, maka dengan penuh kesadaran dan tanpa paksaan. Saya menandatangani dan menyatakan bersedia mengikutsertakan bayi saya pada penelitian ini. Bila saya ingin mendapatkan penjelasan lebih lanjut saya akan bisa mendapatkannya dari dokter peneliti
Medan, / / 20
Dokter peneliti Orangtua Peserta Penelitian
Dr.SaraYosephine Aruan Dept. THT-KL RSUP H. Adam Malik
No Tanggal No Rekam Medis Nama Jenis Kelamin Kelompok berat lahir Kelompok umur bayi Kelompok umur kehamilan ibu DPOAEs Kanan DPOAEs Kiri Hasil DPOAEs ABR Kanan ABR Kiri Hasil ABR 1 2-Jan-13 54.06.30 JMM 2 2 2 2 1 1 1 1 1 1 2 2-Jan-13 54.03.19 TS 2 2 2 2 1 1 1 1 1 1 3 2-Jan-13 53.88.26 MA 1 2 1 2 1 1 1 1 1 1 4 2-Jan-13 53.34.58 L 2 1 2 1 1 2 2 1 1 1 5 2-Jan-13 53.62.11 IB 2 1 2 1 1 1 1 2 2 2 6 4-Jan-13 54.39.66 SS 1 2 2 1 1 1 1 1 1 1 7 5-Jan-13 54.06.95 I 2 1 2 1 2 1 2 1 1 1 8 7-Jan-13 54.35.98 AL 2 1 2 2 1 1 1 2 2 2 9 8-Jan-13 54.35.82 VP 2 1 2 1 1 1 1 2 2 2 10 9-Jan-13 54.11.73 P 1 1 2 1 1 1 1 1 1 1 11 10-Jan-13 54.13.10 S 1 2 2 2 2 2 2 1 1 1 12 10-Jan-13 54.39.02 T 2 2 1 2 1 1 1 1 1 1 13 11-Jan-13 54.19.40 TBA 2 1 2 1 1 1 1 1 1 1 14 19-Jan-13 52.84.32 N 1 1 2 2 1 1 1 1 1 1 15 29-Jan-13 54.63.51 ISE 2 2 2 2 2 2 2 1 1 1 16 10-Feb-13 54.75.13 SAH 1 1 1 2 1 1 1 1 1 1 17 12-Feb-13 54.93.63 AR 2 1 1 2 2 2 2 2 2 2 18 14-Feb-13 54.79.50 KAR II 1 2 1 2 1 1 1 1 1 1 19 14-Feb-13 54.79.52 KAR I 2 2 1 2 2 2 2 2 2 2 20 16-Feb-13 54.74.95 YUN 2 1 1 2 1 1 1 2 2 2 21 20-Feb-13 54.90.11 SU 1 2 1 2 1 1 1 1 1 1
22 20-Feb-13 55.88.31 YUN II 2 1 1 1 1 1 1 1 1 1 23 20-Feb-13 54.75.02 BV 1 1 1 2 1 1 1 2 2 2 24 22-Feb-13 54.92.62 MH 2 2 1 2 2 1 2 2 2 2 25 23-Feb-13 54.76.05 SR 1 1 1 1 2 2 2 1 1 1 26 25-Feb-13 54.92.65 RZ 2 1 1 1 1 1 1 1 1 1 27 28-Feb-13 54.92.73 Vivi 2 1 1 2 1 1 1 1 1 1 28 14-Mar-13 55.09.49 IMS 1 1 1 1 1 1 1 1 1 1 29 22-Mar-13 55.00.28 NN 2 2 2 1 1 1 1 1 1 1 30 23-Mar-13 55.15.86 EKP 1 1 1 2 1 1 1 1 1 1 31 25-Mar-13 55.01.82 MAR 1 2 2 2 1 1 1 1 1 1 32 29-Mar-13 55.29.25 WAR 1 1 1 2 1 1 1 1 1 1
Keterangan:
Jenis DPOAEs Kanan ABR Kanan
1. Laki-laki 1. Pass 1. Pass
2. Perempuan 2. Refer 2. Refer
Kelompok berat lahir DPOAEs Kiri ABR Kiri
1. ≤1477 gram 1. Pass 1. Pass
2. >1477 gram 2. Refer 2. Refer
Kelompok umur
bayi Hasil DPOAEs Hasil ABR
1. ≤15 hari 1. Pass 1. Pass
Lampiran 7. Output Statistik
Frequencies
Umur (Hari) Kelompok Umur (Hari) Jenis Kelamin Berat Lahir (gram) Kelompok Berat Lahir (gram) Umur kehamilan (minggu) Kelompok Umur kehamilan (minggu) DPOAEs Kanan N Valid 32 32 32 32 32 32 32 32 Missing 0 0 0 0 0 0 0 0 Mean 15.22 2.13 1.56 1477.81 2.44 1.09 1.22 Median 15.00 2.00 2.00 1500.00 3.00 1.00 1.00 Std. Deviation 9.294 .907 .504 365.855 .669 .296 .420 Variance 86.370 .823 .254 133849.899 .448 .088 .176 Range 28 2 1 1600 2 1 1 DPOAEs Kiri Hasil DPOAEs ABRKanan ABR Kiri
Hasil ABR N Valid 32 32 32 32 32 Missing 0 0 0 0 0 Mean 1.19 1.34 1.25 1.25 1.25 Median 1.00 1.00 1.00 1.00 1.00 Std. Deviation .397 .653 .440 .440 .440 Variance .157 .426 .194 .194 .194 Range 1 2 1 1 1 Jenis Kelamin
Frequency Percent Valid Percent Cumulative Percent
Valid Laki-laki 14 43.8 43.8 43.8
Perempuan 18 56.3 56.3 100.0
Kelompok Berat Lahir (gram)
Frequency Percent Valid Percent
Cumulative Percent
Valid <= 1500 21 65.6 65.6 65.6
> 1500 11 34.4 34.4 100.0
Total 32 100.0 100.0
Kelompok Umur (Hari)
Frequency Percent Valid Percent
Cumulative Percent
Valid <= 15 17 53.1 53.1 53.1
> 15 15 46.9 46.9 100.0
Total 32 100.0 100.0
Kelompok Umur kehamilan (minggu)
Frequency Percent Valid Percent
Cumulative Percent
Valid <= 33 12 37.5 37.5 37.5
> 33 20 62.5 62.5 100.0
Crosstabs
Jenis Kelamin * Hasil DPOAEs Crosstabulation Hasil DPOAEs
Total
Pass Refer
Jenis Kelamin Laki-laki Count 12 2 14
% within Jenis Kelamin 85.7% 14.3% 100.0%
Perempuan Count 12 6 18
% within Jenis Kelamin 66.7% 33.3% 100.0%
Total Count 24 8 32
% within Jenis Kelamin 75.0% 25.0% 100.0%
Chi-Square Tests Value df Asymp. Sig. (2-sided) Exact Sig. (2- sided) Exact Sig. (1- sided) Pearson Chi-Square 1.524a 1 .217 Continuity Correctionb .677 1 .411 Likelihood Ratio 1.592 1 .207
Fisher's Exact Test .412 .207
Linear-by-Linear Association
1.476 1 .224
N of Valid Cases 32
a. 2 cells (50,0%) have expected count less than 5. The minimum expected count is 3,50. b. Computed only for a 2x2 table
Tests of Homogeneity of the Odds Ratio Chi-Squared df Asymp. Sig. (2- sided) Breslow-Day .000 0 . Tarone's .000 0 .
Tests of Conditional Independence
Chi-Squared df
Asymp. Sig. (2- sided)
Cochran's 1.524 1 .217
Mantel-Haenszel .656 1 .418
Under the conditional independence assumption, Cochran's statistic is asymptotically distributed as a 1 df chi-squared distribution, only if the number of strata is fixed, while the Mantel-Haenszel statistic is always asymptotically distributed as a 1 df chi-squared distribution. Note that the continuity correction is removed from the Mantel- Haenszel statistic when the sum of the differences between the observed and the expected is 0.
Mantel-Haenszel Common Odds Ratio Estimate
Estimate 3.000
ln(Estimate) 1.099
Std. Error of ln(Estimate) .913
Asymp. Sig. (2-sided) .229
Asymp. 95% Confidence Interval
Common Odds Ratio Lower Bound .501
Upper Bound 17.954
ln(Common Odds Ratio) Lower Bound -.691
Upper Bound 2.888
The Mantel-Haenszel common odds ratio estimate is asymptotically normally distributed under the common odds ratio of 1,000 assumption. So is the natural log of the estimate.
Jenis Kelamin * Hasil ABR
Chi-Square Tests Value df Asymp. Sig. (2- sided) Exact Sig. (2- sided) Exact Sig. (1- sided) Pearson Chi-Square 4.233a 1 .040 Continuity Correctionb 2.709 1 .100 Likelihood Ratio 4.728 1 .030Fisher's Exact Test .053 .047
Linear-by-Linear Association
4.101 1 .043
N of Valid Cases 32
a. 2 cells (50,0%) have expected count less than 5. The minimum expected count is 3,50. b. Computed only for a 2x2 table
Tests of Homogeneity of the Odds Ratio
Chi-Squared df Asymp. Sig. (2- sided) Breslow-Day .000 0 . Tarone's .000 0 . Crosstab Hasil ABR Total Pass Refer
Jenis Kelamin Laki-laki Count 13 1 14
% within Jenis Kelamin 92.9% 7.1% 100.0%
Perempuan Count 11 7 18
% within Jenis Kelamin 61.1% 38.9% 100.0%
Total Count 24 8 32
Tests of Conditional Independence Chi-Squared df Asymp. Sig. (2- sided) Cochran's 4.233 1 .040 Mantel-Haenszel 2.624 1 .105
Under the conditional independence assumption, Cochran's statistic is asymptotically distributed as a 1 df chi-squared distribution, only if the number of strata is fixed, while the Mantel-Haenszel statistic is always asymptotically distributed as a 1 df chi-squared distribution. Note that the continuity correction is removed from the Mantel-Haenszel statistic when the sum of the differences between the observed and the expected is 0.
Mantel-Haenszel Common Odds Ratio Estimate
Estimate 8.273
ln(Estimate) 2.113
Std. Error of ln(Estimate) 1.145
Asymp. Sig. (2-sided) .065
Asymp. 95% Confidence Interval
Common Odds Ratio Lower Bound .877
Upper Bound 78.010
ln(Common Odds Ratio) Lower Bound -.131
Upper Bound 4.357
The Mantel-Haenszel common odds ratio estimate is asymptotically normally distributed under the common odds ratio of 1,000 assumption. So is the natural log of the estimate.
Frequencies
Statistics Kelompok Berat Lahir (gram)
N Valid 32 Missing 0 Mean 1.34 Median 1.00 Std. Deviation .483 Variance .233
Kelompok Berat Lahir (gram)
Frequency Percent Valid Percent
Cumulative Percent
Valid <= 1500 21 65.6 65.6 65.6
> 1500 11 34.4 34.4 100.0
Crosstabs
Kelompok Berat Lahir (gram) * Hasil DPOAEs
Crosstab Hasil DPOAEs Total Pass Refer Kelompok Berat Lahir (gram) <= 1500 Count 15 6 21 % within Kelompok Berat Lahir (gram) 71.4% 28.6% 100.0% > 1500 Count 9 2 11 % within Kelompok Berat Lahir (gram) 81.8% 18.2% 100.0% Total Count 24 8 32 % within Kelompok Berat Lahir (gram) 75.0% 25.0% 100.0% Chi-Square Tests Value df Asymp. Sig. (2- sided) Exact Sig. (2- sided) Exact Sig. (1- sided) Pearson Chi-Square .416a 1 .519 Continuity Correctionb .046 1 .830 Likelihood Ratio .431 1 .511
Fisher's Exact Test .681 .425
Linear-by-Linear Association
.403 1 .526
N of Valid Cases 32
Chi-Square Tests Value df Asymp. Sig. (2- sided) Exact Sig. (2- sided) Exact Sig. (1- sided) Pearson Chi-Square .416a 1 .519 Continuity Correctionb .046 1 .830 Likelihood Ratio .431 1 .511
Fisher's Exact Test .681 .425
Linear-by-Linear Association
.403 1 .526
N of Valid Cases 32
a. 1 cells (25,0%) have expected count less than 5. The minimum expected count is 2,75. b. Computed only for a 2x2 table
Tests of Homogeneity of the Odds Ratio
Chi-Squared df
Asymp. Sig. (2- sided)
Breslow-Day .000 0 .
Tarone's .000 0 .
Tests of Conditional Independence
Chi-Squared df
Asymp. Sig. (2- sided)
Cochran's .416 1 .519
Mantel-Haenszel .045 1 .832
Under the conditional independence assumption, Cochran's statistic is asymptotically distributed as a 1 df chi-squared distribution, only if the number of strata is fixed, while the Mantel-Haenszel statistic is always asymptotically distributed as a 1 df chi-squared distribution. Note that the continuity correction is removed from the Mantel-Haenszel statistic when the sum of the differences between the observed and the expected is 0.
Mantel-Haenszel Common Odds Ratio Estimate
Estimate .556
ln(Estimate) -.588
Std. Error of ln(Estimate) .919
Asymp. Sig. (2-sided) .522
Asymp. 95% Confidence Interval
Common Odds Ratio Lower Bound .092
Upper Bound 3.365
ln(Common Odds Ratio) Lower Bound -2.389
Upper Bound 1.213
The Mantel-Haenszel common odds ratio estimate is asymptotically normally distributed under the common odds ratio of 1,000 assumption. So is the natural log of the estimate.
Kelompok Berat Lahir (gram) * Hasil ABR
Crosstab
Hasil ABR
Total Pass Refer
Kelompok Berat Lahir (gram)
<= 1500 Count 15 6 21
% within Kelompok Berat Lahir (gram)
71.4% 28.6% 100.0%
> 1500 Count 9 2 11
% within Kelompok Berat Lahir (gram)
81.8% 18.2% 100.0%
Total Count 24 8 32
% within Kelompok Berat Lahir (gram)
Chi-Square Tests Value df Asymp. Sig. (2- sided)