Pemberian nutrisi secara enteral dan parenteral penting untuk pertumbuhan dan perbaikan DBP. Pemberian nutrisi parenteral pada beberapa hari pertama setelah kelahiran maupun penggunaan regimen makanan secara agresif merupakan hal penting dalam keberhasilan bayi dengan DBP.
Displasia Bronkopulmonal: Pencegahan dan Penatalaksanaan
2. Kafein
Dosis pemberian kafein ialah 20 mg/kg, dosis pemeliharaan sebesar 5 mg/ kg/hari, dan dapat ditingkatkan sampai 10 mg/kg/hari.35
3. Diuretik
Edema paru merupakan komponen mayor dari DBP. Furosemid berfungsi untuk meningkatkan mekanisme paru dan pertukaran gas.45 Pemberian
diuretik dalam jangka panjang memerlukan suplementasi KCl. Fungsi suplementasi KCl ialah mencegah alkalosis metabolik akibat diuretik, yang berhubungan dengan hipokloremia dan hipokalemia. Bila bayi tidak mendapatkan suplementasi KCl adekuat dapat mengakibatkan bayi kehilangan potasium dan klorida, dan alkalosis metabolik primer.2
4. Bronkodilator
Displasia bronkopulmonal secara signifikan meningkatkan terjadinya resistensi jalan napas dan sesak yang persisten atau intermiten. Pemberian b2 agonis adrenergik meningkatkan ventilasi. Penyebab pembatasan
penggunaan bronkodilator secara sistemik ialah insidens efek samping yang tinggi dan indeks terapi yang sangat sempit.46
5. Pasca-natal kortikosteroid
The american academy of pediatrics dan the canadian pediatrics society
merekomendasikan pembatasan pemberian pasca-natal kortikosteroid untuk penelitian DBP kecuali dalam keadaan parah dan setelah memberikan informasi secara lengkap kepada orangtua mengenai potensi hasil luaran masalah perkembangan saraf.1 Pemberian DART regimen
setelah usia 7 hari untuk bayi yang sangat prematur yang masih tergantung ventilator dapat menurunkan insidens DBP. Dosis DART regimen:47
IV, Oral (secara intravena dan oral):
y Hari ke 1, 2. 3: 0,075 mg/kg/12 jam untuk 6x dosis y Hari ke 4, 5, 6: 0,05 mg/kg/12 jam untuk 6x dosis y Hari ke 7, 8: 0,025 mg/kg/12 jam untuk 4x dosis y Hari ke 9, 10: 0,01 mg/kg/12 jam untuk 4x dosis y Dosis dapat di ulang bila dibutuhkan
Pendidikan Kedokteran Berkelanjutan Ilmu Kesehatan Anak lXVII
Simpulan
y Displasia bronkopulmonal (DBP) yang juga dikenal dengan nama chronic lung disease merupakan salah satu penyebab utama penyakit paru pada bayi prematur.
y Displasia bronkopulmonal didefinisikan sebagai ketergantungan oksigen yang persisten sampai usia 28 hari.
y DBP merupakan upaya pencegahan bayi lahir prematur dengan sindrom
gawat napat serta mengurangi faktor risiko yang terdiri dari: pemberian antenatal kortikosteroid, surfaktan, nutrisi dan pembatasan cairan, antioksidan, nitrit oksida inhalasi, kafein, pasca natal kortikosteroid, pentoxifilline, dan sel induk mesenkim.
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