Oleh Admin Kalbe Medical pada October 09, 2017 07:30

Pencegahan Sepsis Onset Lambat pada Bayi dengan Probiotik

Sepsis onset lambat (late-onset sepsis/LOS) termasuk dalam salah satu penyebab dari morbiditas dan mortalitas pada bayi yang preterm. Kejadian ini muncul kurang lebih 20% pada bayi dengan berat badan lahir sangat rendah. Saat ini, berbagai evidence yang dipublikasikan melaporkan bahwa mikrobiota usus memegang peranan penting dalam mempromosikan dan memelihara respons imun yang seimbang dan dalam pembentukkan pertahanan usus di periode post natal.

Kolonisasi usus pada bayi preterm yang diberikan ASI berbeda dengan bayi preterm yang mendapatkan susu formula. ASI menyediakan nutrisi, karbohidrat prebiotik, probiotik endogen, dan berbagai faktor bioaktif yang memberikan efek menguntungkan langsung dan tidak langsung pada interaksi mikrobiota usus. Data terbaru menyebutkan bahwa efikasi probiotik diduga tergantung pada cara pemberian makanan, seperti pemberian ASI. Pada berbagai studi in vitro, pertumbuhan probiotik ditingkatkan dengan kehadiran oligosakarida dari ASI (human milk oligosaccharides).


Pada studi meta-analisis yang terbaru dilakukan evaluasi tehadap efek probiotik untuk pencegahan sepsis onset lambat pada bayi preterm berdasarkan cara pemberian makannya (ASI eksklusif vs formula eksklusif/campuran). Dari studi ini sekitar 5868 bayi (2934 bayi pada kelompok intervensi vs 2934 pada kelompok kontrol) di evaluasi. Terlepas dari proses menyusuinya, bayi yang mendapatkan probiotik mengalami risiko sepsis onset lambat yang lebih rendah dibandingkan dengan kelompok tanpa probiotik (p<0,0001). Sehubungan dengan proses menyusu, bayi preterm yang mendapatkan probiotik memiliki risiko mengalami sepsis onset lambat lebih rendah dibandingkan dengan kelompok kontrol (p<0,0001). Tidak terdapat perbedaan bermakna pada risiko terjadinya sepsis onset lambat (p=0,13) pada bayi preterm dengan formula dengan bayi preterm menyusu kombinasi (ASI dan formula)


Dari hasil di atas, studi mengenai probiotik juga dievaluasi. Pada 10 studi dengan jumlah total 2560 bayi; 128 bayi mendapatkan probiotik campuran dan 1279 bayi mendapatkan plasebo. Semuanya mendapatkan ASI eksklusif, dan hasilnya kelompok bayi ASI eksklusif probiotik campuran memiliki risiko lebih rendah bermakna dibandingkan dengan kelompok bayi ASI eksklusif dengan plasebo (p<0,00001). Simpulannya, suplementasi probiotik dapat menurunkan risiko terjadinya sepsis onset lambat pada bayi preterm terutama pada bayi dengan ASI eksklusif. ASI eksklusif sudah sepatutnya menjadi standar emas untuk semua bayi preterm, dan pemberian probiotik dapat digunakan sebagai tambahan. Ke depannya peneliti masih berusaha untuk mempelajari strain probiotik yang tepat untuk bayi-bayi preterm ini. (OEP)


Image : Ilustrasi
Referensi:
1.Aceti A, Maggio L, Beghetti I, Gori D, Barone G, Callegari ML, et al. Probiotics prevent late-onset sepsis in human milk-fed, very low birth weight preterm infants: Systematic review and meta-analysis. Nutrients Journal 2017. doi: 10.3390/nu9080904.
2.Stoll BJ, Hanses N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: The experience of the NICHD Neonatal Research Netwoek. Pediatrics 2002:110;285-91.

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