Review: Refluks Gastroesofageal pada Bayi Prematur - Putri M. T. Marsubrin; Kamajaya Mulyana; Rosalina D. Roeslani (Fakultas Kedokteran Universitas Kristen Indonesia, 2019)
AbstrakRefluks gastroesofageal merupakan fenomena fisiologis pada bayi prematur yang dapat menjadi penyakit jika terjadikomplikasi seperti esofagitis, kesulitan minum, kegagalan penambahan berat badan, gangguan tidur, gangguanpernapasan, pendarahan saluran cerna, atau apnea. Prevalensi refluks gastroesofageal 22% lebih tinggi pada bayiprematur. Diagnosis umumnya ditegakkan berdasarkan penilaian klinis. Refluks gastroesofageal menjadi sebuahfenomena klinis penting di neonatal intensive care unit (NICU) akibat memanjangnya lama rawat di rumah sakit dannaiknya biaya perawatan. Tata laksana non-medikamentosa merupakan terapi lini pertama pada bayi dengan refluksgastroesofageal fisiologis dan penyakit refluks gastroesofageal tanpa komplikasi. Tatalaksana non-medikamentosamencakup posisi tubuh dengan left lateral positioning (LLP) atau pronasi, strategi pemberian minum lebih seringdengan volume lebih sedikit, thickened feeding, pemilihan extensively-hydrolyzed formula, transpyloric feedings,dan penurunan feeding flow rates. Tata laksana medikamentosa bayi dengan penyakit refluks gastroesofagealdipertimbangkan saat penanganan konservatif tidak berhasil. Dalam beberapa tahun terakhir terdapat penggunaanluas obat-obatan anti-refluks empiris pada bayi, termasuk bayi prematur. Obat-obatan anti-refluks meliputi acidbuffering agents, Histamine-2 (H2) receptor blockers, proton pump inhibitors (PPIs), agen prokinetik, dan baklofen.Belum banyak penelitian yang mendukung penggunaan terapi medikamentosa pada bayi prematur dengan refluksgastroesofageal. Pendekatan yang cermat untuk menilai risiko dan manfaat untuk setiap obat harus dipertimbangkansebelum memulai pengobatan.Kata kunci: refluks gastroesofageal, bayi prematur, neonatus AbstractGastroesophageal reflux which is a physiological phenomenon in preterm infants can become a disease whencausing complications such as esophagitis, feeding difficulties, failure to gain weight, sleep disturbances, respiratoryproblems, gastrointestinal bleeding, or apnea. The prevalence of gastroesophageal reflux is 22% higher in preterminfants. Diagnosis is generally made by clinical judgment. Gastroesophageal reflux is an important phenomenonin the neonatal intensive care unit (NICU) due to the length of stay in hospital and high cost of care. Non-medicalmanagement is the first-line therapy in infants with physiological gastroesophageal reflux and uncomplicatedgastroesophageal reflux disease. Non-medical management includes left lateral positioning (LLP) or pronation,more frequent with less volume feeding, thickened feeding, selecting extensively-hydrolyzed formulas, transpyloricfeedings, and decreasing thefeeding flow rates. Medical management of infants with gastroesophageal reflux diseaseis considered when conservative treatment is unsuccessful. There has been widespread use of empirical anti-refluxdrugs in infants, including in preterm infants. Anti-reflux drugs include acid-buffering agents, Histamine-2 (H2)receptor blockers, proton pump inhibitors (PPIs), prokinetic agents, and baclofen. There are few studies that supportthe use of medical therapy in preterm infants with gastroesophageal reflux. Careful approach for each drug must beconsidered before starting the treatment.Keywords: gastroesophageal reflux, reflux, preterm infants; neonates