Review: Refluks Gastroesofageal pada Bayi Prematur

Abstract

Abstrak
Refluks gastroesofageal merupakan fenomena fisiologis pada bayi prematur yang dapat menjadi penyakit jika terjadi
komplikasi seperti esofagitis, kesulitan minum, kegagalan penambahan berat badan, gangguan tidur, gangguan
pernapasan, pendarahan saluran cerna, atau apnea. Prevalensi refluks gastroesofageal 22% lebih tinggi pada bayi
prematur. Diagnosis umumnya ditegakkan berdasarkan penilaian klinis. Refluks gastroesofageal menjadi sebuah
fenomena klinis penting di neonatal intensive care unit (NICU) akibat memanjangnya lama rawat di rumah sakit dan
naiknya biaya perawatan. Tata laksana non-medikamentosa merupakan terapi lini pertama pada bayi dengan refluks
gastroesofageal fisiologis dan penyakit refluks gastroesofageal tanpa komplikasi. Tatalaksana non-medikamentosa
mencakup posisi tubuh dengan left lateral positioning (LLP) atau pronasi, strategi pemberian minum lebih sering
dengan volume lebih sedikit, thickened feeding, pemilihan extensively-hydrolyzed formula, transpyloric feedings,
dan penurunan feeding flow rates. Tata laksana medikamentosa bayi dengan penyakit refluks gastroesofageal
dipertimbangkan saat penanganan konservatif tidak berhasil. Dalam beberapa tahun terakhir terdapat penggunaan
luas 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 refluks
gastroesofageal. Pendekatan yang cermat untuk menilai risiko dan manfaat untuk setiap obat harus dipertimbangkan
sebelum memulai pengobatan.
Kata kunci: refluks gastroesofageal, bayi prematur, neonatus

Abstract
Gastroesophageal reflux which is a physiological phenomenon in preterm infants can become a disease when
causing complications such as esophagitis, feeding difficulties, failure to gain weight, sleep disturbances, respiratory
problems, gastrointestinal bleeding, or apnea. The prevalence of gastroesophageal reflux is 22% higher in preterm
infants. Diagnosis is generally made by clinical judgment. Gastroesophageal reflux is an important phenomenon
in the neonatal intensive care unit (NICU) due to the length of stay in hospital and high cost of care. Non-medical
management is the first-line therapy in infants with physiological gastroesophageal reflux and uncomplicated
gastroesophageal reflux disease. Non-medical management includes left lateral positioning (LLP) or pronation,
more frequent with less volume feeding, thickened feeding, selecting extensively-hydrolyzed formulas, transpyloric
feedings, and decreasing thefeeding flow rates. Medical management of infants with gastroesophageal reflux disease
is considered when conservative treatment is unsuccessful. There has been widespread use of empirical anti-reflux
drugs 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 support
the use of medical therapy in preterm infants with gastroesophageal reflux. Careful approach for each drug must be
considered before starting the treatment.
Keywords: gastroesophageal reflux, reflux, preterm infants; neonates