Abstrak 
Hubungan Kadar Tsh Dengan Maturitas Dan Umur Pascanatal Pada Masa Neonatal Dini
Nia Kania, Dedi Subardja, Sjarif Hidajat Effendi, Diet S. Rustama
Unpad
Indonesia
Unpad
kadar TSH, maturitas, maturity, neonates, neonatus, postnatal age, TSH level, umur pascanatal
Profil fungsi tiroid pada masa neonatal dini dipengaruhi oleh maturitas dan umur pascanatal saat pengambilan spesimen. Keadaan ini akan mempengaruhi interpretasi hasil uji tapis hipotiroid kongenital yang telah dilakukan di beberapa daerah di Jawa Barat sebagai bagian program pendahuluan uji tapis nasional. Di Indonesia data mengenai fungsi tiroid pada masa neonatal dini yang sudah dipublikasikan masih kurang, peneliti bermaksud untuk meneliti fungsi tiroid pada masa neonatal dini dengan menganalisis kadar thyroid stimulating hormone (TSH) hasil program uji tapis hipotiroid kongenital selama tahun 2003 dan mencoba mencari hubungannya dengan maturitas dan umur pascanatal. Data kadar TSH diambil secara retrospektif dari rekam medis Bagian Ilmu Kesehatan Anak Perjan RS. Dr. Hasan Sadikin Bandung. Subjek yang diteliti adalah bayi sehat, dibagi menurut maturitas yaitu bayi kurang bulan (BKB) dan bayi cukup bulan (BCB) dan menurut umur pascanatal yaitu 2 hari dan > 2 hari. Kadar TSH dikelompokkan dengan menggunakan nilai cut off dari WHO menjadi kadar TSH normal ( 20 mU/L) dan abnormal (> 20 mU/L); nilai kadar TSH abnormal diidentifikasi pada tiap kelompok. Perbedaan kadar TSH tiap kelompok dianalisis dengan uji t dan two way anova. Dari 829 bayi yang diteliti diperoleh 72 (8,7%) BKB dan 757 (91,3%) BCB. Umur pascanatal saat pengambilan spesimen pada BKB 52,8% diambil umur > 2 hari; sedangkan pada BCB 67,2% diambil umur 2 hari. Ditemukan 9 (1,1%) bayi dengan kadar TSH abnormal pada kelompok BCB, tetapi 8 bayi diantaranya dilakukan uji tapis pada umur pascanatal 2 hari. Pada pemantauan selanjutnya hasil pemeriksaan kadar TSH ulang 9 bayi menjadi normal, yang menunjukkan hasil positif palsu pada pemeriksaan pertama. Kadar TSH rata-rata pada BKB adalah 4,87 (SB 4,10) mU/L dan pada BCB 6,92 (SB 5,47) mU/L (t = -3,92; p = 0,001). Kadar TSH rata-rata umur pascanatal 2 hari adalah 8,01 6,00 mU/L dan pada umur > 2 hari 4,62 4,60 mU/L (t = 9,10; p = 0,001). Analisis two way anova menunjukkan tidak ada interaksi antara maturitas dan umur pascanatal terhadap kadar TSH (F=1,19; p =0,276). Kadar TSH berhubungan dengan maturitas dan umur pascanatal. Lebih matur bayi, kadar TSH lebih rendah dan lebih awal uji tapis dilakukan, kadar TSH lebih tinggi. Peluang nilai kadar TSH abnormal lebih banyak ditemukan pada kelompok umur pascanatal 2 hari.
Thyroid function profile during early neonatal period is affected by maturity and postnatal age when the blood specimen was taken. This condition will affect the interpretation the results of the screening test for congenital hypothyroidism which has been conducted in some areas of West Java as part of a national pilot study. We lack of published data on early neonatal thyroid function. We intend to study the thyroid function based on serum TSH level in early neonates by analyzing the data of TSH level obtained through “congenital hypothyroidism screening program” in the year 2003 with its association with maturity and postnatal age. The data of TSH level were obtained retrospectively from Department of Child Health Hasan Sadikin Hospital Bandung medical records. Subjects were healthy infants grouped according to their maturity into preterm and term infants, and according to their postnatal age when the blood specimen was taken at 2 days or less and after 2 days. Using cut off point from WHO, results of TSH level were classified into normal (≤ 20 mU/L) and abnormal (> 20 mU/L); abnormal TSH level were identified in each group. Differerence of TSH level between groups were analyzed by t-test and two-way anova methods. Of the 829 infants studied, 72 (8.7%) were preterm and 757 (91.3%) were term infants. In the 52.8% preterm infants, blood sample were drawn at after 2 days, whereas 67.2% term infants were 2 days or less. All nine inafnts (1.1%) with abnormal TSH level were term, but eight of them were screened at the age before or days. Further evaluation showed that their TSH level were eventually found to be normal, confirming false positive result at first. The mean TSH level of preterm infants was 4.87 (SD 4.10) mU/L, while in the term infants was 6.92 (SD 5.47) mU/L (t = -3.92; p = 0.001). The mean TSH level in 2 days or less was 8.01 (SD 6.00) mU/L and for after 2 days 4.62 ± 4.60 (t = 9.10; p = 0.001). Two way anova analysis showed no interaction between maturity and postnatal age on the level of TSH (F = 1.19; p = 0.276). Level of serum TSH is associated with maturity and postnatal age. The more mature the neonates the lower the TSH level was and the earlier the blood screening was done the higher the TSH level was.There are more abnormal value of serum TSH level found when screening performed at before or days 2.