Saat Terbaik Pemberian Suplementasi Zat Besi pada Bayi 0 Bulan sampai 6 Bulan

Harapan Parlindungan Ringoringo, Iskandar Wahidiyat, Bambang Sutrisna, Rahayuningsih Setiabudy, Rulina Suradi, Rianto Setiabudy, Sapatawati Bardososono

Sari


Latar belakang. Anemia defisiensi besi (ADB) merupakan salah satu masalah kesehatan gizi di Indonesia. Survei kesehatan rumah tangga (SKRT) tahun 2001 menunjukkan prevalensi ADB pada bayi 0-6 bulan 61,3%.
Tujuan. Mengetahui berapa insidens defisiensi besi dengan atau tanpa anemia, dan kapan mulai terjadi deplesi besi atau defisiensi besi sebelum terjadi ADB pada bayi berusia 0-6 bulan.
Metode. Desain penelitian adalah studi kohort prospektif dengan pembanding eksternal. Di antara 211 bayi yang ikut penelitian, terdiri dari 143 bayi yang lahir dari ibu tanpa anemia dan 68 bayi yang lahir dari ibu dengan anemia. Pemeriksaan darah tepi lengkap, gambaran darah tepi, saturasi transferin (ST) dilakukan saat bayi berusia 0, 1, 2, 3, 4, 5, dan 6 bulan. Diagnosis ADB berdasarkan 1) kadar Hb <14g/dL untuk usia 0-3 hari, <11g/dL untuk usia 1 bulan, <10g/dL untuk usia 2-6 bulan, 2) mikrositik dan atau hipokrom, 3) kadar Hb meningkat setelah diberi terapi besi, 4) RDW >14%, 5) Indeks Mentzer >13; 6) Indeks RDW >22,0. Deplesi besi bila ST <30% untuk usia 0-1 bulan, ST <21% untuk usia 2-6 bulan. Defisiensi besi bila ST <20% untuk usia 0-1 bulan, ST <16% untuk usia 2-6 bulan.
Hasil. Insidens deplesi besi, defisiensi besi, ADB berturut-turut 28,0, 27,0, dan 40,8%; artinya 95,8% bayi mempunyai status besi bermasalah. Insidens deplesi besi, defisiensi besi, ADB paling tinggi pada bayi berusia 0 bulan, berturut-turut 9,5, 14,2, dan 11,8%.
Kesimpulan. Insidens deplesi besi, defisiensi besi, ADB paling tinggi pada bayi berusia 0 bulan. Suplementasi zat besi elemental dengan dosis 1 mg/kg/hari hendaknya diberikan pada semua bayi aterm sejak lahir.


Kata Kunci


ADB; insidens; suplementasi besi

Teks Lengkap:

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Referensi


Untoro R, Falah TS, Atmarita, Sukarno R, Kemalawati R, Siswono. Anemia gizi besi. Dalam: Untoro R, Falah TS, Atmarita, Sukarno R, Kemalawati R, Siswono, penyunting. Gizi dalam angka sampai dengan tahun 2003. Jakarta: Depkes RI; 2005. h. 41-4.

Susilowati H, Suwarti S, Ernawati F, Sukraniti DP, Putri SD, Sudirman H. Faktor-faktor yang mempengaruhi kejadian anemia pada bayi usia 2,3 dan 4 bulan. Bogor: Puslitbang Gizi dan Makanan Balitbang Kesehatan Depkes; 2005.

Dallman PR. Iron deficiency anemia : a synthesis of current scientific knowledge and U.S. recommendations for prevention and treatment. Dalam: Earl R, Woteki CE, penyunting. Iron deficiency anemia : recommended guidelines for prevention, detection, and management among U.S children and women of childbearing age. Didapat dari: http://www.nap.edu/catalog/2251.html.

Pee S, Bloem MW, Sari M, Kiess L, Yip R, Kosen S. The high prevalence of low hemoglobin concentration among Indonesian infants aged 3-5 months is related to maternal anemia. J Nutr 2002;132:2215-21.

Oski FA. Iron deficiency in infancy and childhood. N Engl J Med 1993; 329: 190-3.

Vasquez-Seoan P, Windom R, Pearson HA. Disappearance of iron deficiency anaemia in a high risk infant population given supplemental iron. N Engl J Med 1985;313:1239-40.

Yip R, Walsh KM, Goldfarb MG, Binkin MJ. Declining prevalence of anaemia in childhood in a middle-class setting: a paediatric success story? Pediatrics 1987;80:330-4.

Tunnessen WW Jr, Oski FA. Consequences of starting whole cow milk at 6 months of age. J Pediatr 1987;111:813-6.

Helen Keller International (Indonesia). Iron deficiency anemia in Indonesia. Report of the policy workshop on iron deficiency anemia in Indonesia. Jakarta: 1997. h.1-16.

Lundstorm UL, Siimes MA, Dallman PR. At what age does iron supplementation become necessary in low-birth-weight infants? J Pediatr 1977;91:878-83.

Andrews NC. Iron deficiency and related disorders. Dalam: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B, penyunting. Wintrobe’s Clinical Hematology. Edisi kesebelas, vol 1. Philadelphia:Lippincott William & Wilkins; 2004. h. 979-1009.

Glader B. Anemia: general considerations. Dalam: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B, penyunting. Wintrobe’s clinical hematology. Edisi kesebelas, vol 1. Philadelphia:Lippincott William & Wilkins; 2004. h. 947-78.

Soegijanto S, Ugrasena. Anemia defisiensi besi pada bayi dan anak. Jakarta: Yayasan Penerbitan IDI;2004. h. 1-23.

American Academy of Pediatrics (Committee on Nutrition). Nutritional needs of low-birth-weight infants. Pediatrics 1985;75:976-86.

Franz AR, Mihatsch WA, Sander S, Kron M, Pohlandt F. Prospective randomized trial of early versus late enteral iron supplementation in infants with a birth weight of less than 1301 grams. Pediatrics 2000;106:700-6.

Braekke K, Bechensteen AG, Halvorsen BL, Blomhoff R, Haaland K, Staff AC. Oxidative stress markers and antioxidant status after oral iron supplementation to very low birth weight infants. J Pediatr 2007;151:23-8.

Dijkhuizen MA, Wieringa FT, West CE, Martuti S, Muhilal. Iron and zinc supplementation in Indonesian infants: effects on micronutrient status and growth. Dalam: Dijkhuizen MA, Wieringa FT, penyunting. Vitamin A, iron, and zinc deficiency in Indonesia. Micronutrient interactions and effects of supplementation. Wageningen: Wageningen University; 2001. h. 67-82.

Rios E, Lipschitz DA, Cook JD, Smith NJ. Relationship of maternal and infant iron stores as assessed by determination of plasma feritin. Pediatrics 1975;55:694-9.

Saarinen UM, Siimes MA. Developmental changes in serum iron, total iron-binding capacity, and transfering saturation in infancy. J Pediatr 1977;91:875-7.

Ziaei S, Hatefnia E, Togeh Gh. Iron status in newborns born to iron-deficient mothers. Iran J Med Sci 2002; 28:62-4.

Kilbride J, Baker TG, Parapia LA, Khoury SA, Shuqaidef, Jerwood D. Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy: a case-control study in Jordan. Int J Epid 1999;28:461-8.

Smith H. Normal values and appearance. Dalam: Smith H, penyunting. Diagnosis in paediatric haematology. New York:Churchill Livingstone; 1996. h. 1-33.

Ervasti M, Kotisaari S, Senkilampi U, Heinonen S, Punnonen K. The relationship between red blood cell and reticulocyte indices and serum markers of iron status in the cord blood of newborns. Clin Chem Lab Med 2007;45:1000-3.

Ringoringo HP, Windiastuti E. Profil parameter hematologik dan anemia defisiensi zat besi bayi berumur 0-6 bulan di RSUD Banjarbaru. Sari Pediatri 2006;7:214-8.

Yip R, Dallman PR. Iron. Dalam: Ziegler EE, Filer LJ, penyunting. Present knowledge in nutrition. Edisi ketujuh. Washington DC:ILSI Press; 1996. h. 277-92.

Singla PN, Tyagi M, Shankar R, Dash D, Kumar A. Fetal iron status in maternal anemia. Acta Paediatr 1996;85:1327–30.

Georgieff MK, Landon MB, Mills MM. Abnormal iron distribution in infants of diabetic mothers: spectrum and maternal antecedents. J Pediatr 1990;117:455–61.

Agarwal RMD, Tripathi AM, Agarwal KN: Cord blood hemoglobin, iron and ferritin status in maternal anemia. Acta Paediatr Scand 1983; 72: 545–8.

Erdem A, Erdem M, Arslan M, Yazici G, Eskandari R, Himmetoglu O: The effect of maternal anemia and iron deficiency on fetal erythropoiesis: comparison between serum erythropoietin, hemoglobin and ferritin levels in mothers and newborns. J Matern Fetal Neonatal Med 2002; 11:329–32.

Kelly AM, MacDonald DJ, Mc Dougall AN: Observations on maternal and fetal ferritin concentrations at term. Br J Obstet Gynaecol 1978;85:338–43.

Fenton V, Cavill I, Fisher J: Iron stores in pregnancy. Br J Haematol 1977;37:145–9.

Siegel EH, Stoltzfus RJ, Khatry SK, LeClerq S, Katz J, Tielsch JM. Epidemiology of anemia among 4-to 17-month children living in South Central Nepal. Eur J Clin Nutr 2006;60:228-35.

Soesmalijah S. Pengaruh zat besi terhadap kognisi. Disertasi. Jakarta: Universitas Indonesia; 1991. h. 216-35.

Steinmacher J, Pohlandt F, Bode H, Sander S, Kron M, Franz AR. Randomized trial of early versus late enteral iron supplementation in infants with a birth weight of less than 1301 grams: Neurocognitive development at 5.3 years’ corrected age. Pediatrics 2007;120:538-46.

Braekke K, Bechensteen AG, Halvorsen BL, Blomhoff R, Haaland K, Staff AC. Oxidative Stress Markers and Antioxidant Status after Oral Iron Supplementation to Very Low Birth Weight Infants. J Pediatr 2007;151:23-8.

Miller SM, McPherson RJ, Juul SE. Iron sulfate supplementation decrease Zinc protoporphyrin to heme ratio in premature infants. J Pediatr 2006; 148:44-8.

Ringoringo HP. Disertasi. Pendekatan diagnostik status besi bayi berusia 0 bulan sampai 6 bulan di Banjarbaru: saat terbaik pemberian suplementasi zat besi. Jakarta: Universitas Indonesia; 2008. h. 99-101.




DOI: http://dx.doi.org/10.14238/sp10.3.2008.163-70

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