Coresponden: Parida Hanum
Email: [email protected]
INTRODUCTION
Low birth
weight babies or abbreviated as LBW are newborn babies with a body weight of
less than 2500 grams. Pregnancy period less than 37 weeks can cause
complications in the baby (Sholiha
& Sumarmi, 2015). LBW
can caused by the baby being born prematurely, too small, or both. The lower
the baby's weight, the more important it is to monitor development in the weeks
after birth (Pristya
et al., 2020).
LBW is the
main cause of death in children in Indonesia (Oktriyanto et al., 2022). LBW babies
generally have a greater risk of morbidity and death compared to babies with
normal weight. LBW babies also have lower chance of survival and more
susceptibility to disease in mature age. It is more likely that babies will be
born with LBW experience cognitive impairment, growth and development
disorders, and infections can lead to death (Pristya
et al., 2020).
The World
Health Organization (WHO), estimates 15-20% of all births in the world are LBW,
which is more than 20 million per year. In the year of In 2019, LBW births
accounted for 14.9% of all births throughout world. The percentages decreased
to 1.9% and 2.2%, 13% and 12.7% in worldwide in 2020 and 2021 respectively.
Initiatives for reduce the number of LBW births by 30% by 2025 (WHO, 2022).
Nationally,
the Infant Mortality Rate (IMR) has decreased from 24 deaths per 1,000 Live
Births to 16.85 deaths per 1,000 Live Births (Lau et al., 2013).These
results show a significant decline, even exceeding the target in 2022, namely
18.6% deaths per 1,000 Live Births. This must be maintained to support the
target in 2024, namely 16 deaths per 1,000 births lives and 12 deaths per 1,000
live births in 2030 (Sari
et al., 2023).
LBW suffer
from many problems including hypothermia, syndrome respiratory disorders intracranial
hemorrhage, hyperbilirubinemia, and hypoglycemia because the sucking reflex
(baby sucking) is weak so resulting in insufficient intake (Qurvinalia
et al., 2015).
Suction mechanism and Premature babies' swallowing is not yet well developed.
Lack of giving Mature breast milk in premature babies is characterized by
problems giving food orally, thereby causing a delay in administration Breast
milk, LBW and dehydration in the first few weeks after birth. This weakness in
sucking is related to the maturity of the baby's nervous structure and oral
muscle strength (Li et
al., 2020).
One
intervention that can be done to improve the sucking reflex and increase body
weight in LBW is oral stimulation. Oral motor skills are one of them the most
important skill a baby can have. Oral motor skills includes coordination of
movement of hard tissue, soft tissue and blood vessels and control of the
facial and oral nerves. According to another view, Oromotor skills refer to the
movements of the muscles of the face, jaw, lips, palate, and tongue for
sucking, swallowing, biting, blowing, chewing, and talking. This means that
motor skills are important for supports eating and drinking (Fatin
& Rahmawati, 2023).
Previous research
conducted by (Maghfuroh
et al., 2021),
regarding Oral Motorcycles Improve Suction Reflexes for LBW Babies in Hospital
NICU Rooms Muhammadiyah Lamongan obtained the results that there was a
therapeutic effect Oral motor exercise on the sucking reflex of LBW babies at
Muhamadiyah Hospital Lamongan in 2021. With a strong sucking reflex, babies can
suck breast milk according to its needs so that the baby's nutrition can be met
and it is hoped that the baby can grow and develop according to his age, that
the risk factor for birth weight less than 2500 grams has an influence on the
incidence of stunting among toddlers in Indonesia (Maghfuroh
et al ., 2021).
Another
research conducted by (Fatmawati
et al., 2021) on The
Effect of Stimulation on Gaining Weight Gain in LBW results showed an increase
in body weight before oral stimulation occurred a percentage of 87.0% means
that LBW babies experience a lot of weight loss. After oral stimulation, body
weight increased as much as was experienced almost all respondents with a
percentage of 95.7% with a value (p=0.000) <0.05 means there is an effect of
oral stimulation on increasing body weight LBW baby. So with oral stimulation
in babies it will provide good nutrition to the baby by providing adequate
nutrition well so that the baby's weight will increase �(Fatmawati
et al., 2021).
Based on a
preliminary survey in November 2023. Data obtained at Bunda Patimah Primary
Clinic that there are mothers who have started from September-November LBW was
32 people. From the results of the interview 5 mothers who had LBW said that 3
of them were babies they have a weak sucking reflex so the baby often cries
because still feel hungry and don't gain or gain weight. Based on the above
background, the formulation of this research problem is formulated, namely
"Is there an effect of providing oral stimulation on increasing the
sucking reflex and increasing the weight of LBW babies at the Pratama Bunda
Patimah Clinic in 2023?". The urgency of this study is to determine the
effect of giving oral stimulation on increasing the sucking reflex and increasing
the weight of LBW babies at the Pratama Bunda Patimah Clinic in 2023. So that
the purpose of this study is to determine the increase in sucking reflex and
increase in body weight of LBW babies before giving oral stimulation. To
determine the increase in Sucking Reflex and increase in body weight of LBW
babies after oral stimulation. To determine the effect of giving oral
stimulation on increasing the sucking reflex and increasing the weight of LBW
babies. The benefits and implications of this research are for Educational
Institutions, It is hoped that it can provide information and education for
midwifery profession students about the benefits of oral stimulation in
increasing the sucking reflex and increasing body weight in LBW babies. For
Related Agencies, It is hoped that the results of this study can provide
information for the Bunda Patimah Pratama Clinic agency in improving the
ability to suck and increase body weight in LBW. For Further Researchers, It is
hoped that the results of this study will become a basic guideline for further
researchers in conducting further research related to improving the ability to
suck and increasing body weight in LBW.
METHOD
This research uses a type of quantitative research
that uses a pre-test and post-test one group design (Notoatmodjo et al., 2018), with a
Quasi-Experimental design without a control group that compares the evaluation
results before and after treatment of respondents. The research population was
all 32 mothers who had LBW babies who were treated at the Pratama Bunda Patimah
Clinic. The sample for this study included all 32 mothers who had LBW babies
who were treated at the Pratama Bunda Patimah Clinic. Sampling used total
sampling technique. This data was obtained using observation techniques to
determine the effect of oral stimulation on sucking reflex ability and increase
in body weight in LBW. Measurement Aspects 1. Oral Stimulation Oral stimulation
is given for 15 minutes every day for 7 day by applying gentle pressure on the
baby's cheeks alternately, around the lips in a clockwise direction, rubbing
gently in an o shape on the gum area, gently rubbing the tongue from the inside
out, then rubbing the palate, finally placing the baby's finger on the tongue
and paying attention to the reflex. baby. 2. Sucking Reflex Ability The sucking
reflex ability in research is the respondent's ability to suck the nipple.
Measurements were taken before and after treatment. After oral stimulation, the
baby is observed to determine whether the baby's sucking reflex increases or
not by giving him a drink from a spoon. The value is 0 if the baby cannot drink
from a spoon, 1 if the baby can drink from a spoon. Weak: If the respondent
gets a score of 0 Strong: If the respondent gets a score of 1 3. Weight Gain.
Measurement of the baby's weight gain is carried out before and after
treatment. Use standardized baby scales and use observation sheets. Increased:
If the baby's weight increases by more than 200 grams Not increased: If the
baby's weight increases by less than 200 grams.
RESULTS AND DISCUSSION
Table 1. Frequency
Distribution of Characteristics
of Respondents from Mothers
with LBW Babies (n=32)
|
Characteristics
|
Frequency
(f)
|
Percentage
(%)
|
|
Work:
Work
Doesn't work
|
8
24
|
25
75
|
|
Total
|
32
|
100
|
|
Education:
Junior High School
Senior High School
S1
|
4
20
8
|
12,5
62,5
25
|
|
Total
|
32
|
100
|
Based on
Table 1, it is known that the majority of mothers who do not work are 24 (75%),
and the minority of mothers who do not work are 8 (25%). Meanwhile, the
majority of mothers' education levels were high school education, 20 people
(62.5%), and the minority had junior high school education levels, 4 people
(12.5%).
Table 2. Frequency Distribution of
Characteristics of Babies with LBW (n=32)
|
Characteristics
|
Frequency
(f)
|
Percentage
(%)
|
|
Gender:
Man
Woman
|
20
12
|
62,5
37,5
|
|
Total
|
32
|
100
|
|
Gestational
Age:
<37 Week
37-42 Week
|
8
24
|
25
75
|
|
Total
|
32
|
100
|
|
BB
Birth:
< 2000 gram
2000-2300
gram
|
4
28
|
12,5
87,5
|
|
Total
|
32
|
100
|
Based on Table 2, it is known that the majority of baby
respondents were 20 male (62.5), and the minority were 12 female babies (37.5).
The majority gestational age is 37-42 weeks as many as 24 people (75%), and the
minority gestational age is <37 weeks as many as 8 people (25%). Meanwhile,
the majority of birth weights were 2000-2300 grams as many as 28 people
(87.5%), and the minority birth weights were <2000 grams as many as 4 people
(12.5%).
Table 3. Frequency Distribution
of Sucking Reflex
and Increase in Body Weight in
LBW Before Oral Stimulation in LBW
|
Characteristics
|
Frequency
(f)
|
Percentage
(%)
|
|
Sucking
Reflex
Weak
Strong
|
28
4
|
87,5
12,5
|
|
Total
|
32
|
100
|
|
Weight
Gain
Increase
Not Increasing
|
0
32
|
0
100
|
|
Total
|
32
|
100
|
Based on the measurement results from Table 3, it shows
that before Oral Stimulation was carried out the majority were in the Weak
category as many as 28 people (87.5%), and the minority in the Strong category
were 4 people (12.5%). Meanwhile, the majority of weight gain in the Not Increased
category was 32 people (100%), and the minority in the Increased category was 0
(0%).
Table 4. Frequency Distribution
of Sucking Reflex
�and Increase in Body Weight in LBW After Oral
Stimulation in LBW
|
Characteristics
|
Frequency
(f)
|
Percentage
(%)
|
|
Sucking
Reflex
Weak
Strong
|
2
30
|
6,3
93,7
|
|
Total
|
32
|
100
|
|
Weight
Gain
Increase
Not
Increasing
|
28
4
|
87,5
12,5
|
|
Total
|
32
|
100
|
Based on the measurement results from
Table 4, it shows that after Oral Stimulation there was a difference in Sucking
Reflex, the majority in the strong category were 30 people (93.7%), and those
in the minority were in the weak category, 2 people (6.3%). Meanwhile, in
weight gain, the majority in the category increased by 28 people (87.5%), and
the minority in the category did not increase by 4 people (12.5%).
Table 5. Effect of Giving
Oral Stimulation on Sucking Reflex
in LBW Before (pretest) and after
(posttest) Giving Oral Stimulation
|
Variabel
|
Mean
Rank
|
Sum
of Rank
|
N
|
Z
|
P
Value
|
|
Negative
Rank
|
0.00
|
0.00
|
0
|
|
0,000
|
|
Positive
Rank
|
13.50
|
351.00
|
26
|
-5.099
|
|
The results from table 5 show that there
are differences in Sucking Reflex and after being given Oral Stimulation to
LBW, which illustrates that 26 respondents experienced an increase in Sucking
Reflex with a Mean Rank value of 13.50 and there were ties or similarity values
in this study as many as 6 respondents from before to after the
intervention. The results of the analysis based on the Wilcoxon test obtained a
p value of 0.000, which means the p value <0.05, so it can be concluded that
Ho is rejected and Ha is accepted, which means there is an influence of giving
oral stimulation on the sucking reflex in LBW.
Table 6. Effect of giving oral
stimulation on weight gain in
�LBW before (pretest) and after (posttest)
giving oral stimulation
|
Variabel
|
Mean
Rank
|
Sum
of Rank
|
N
|
Z
|
P
Value
|
|
Negative
Rank
|
0.00
|
0.00
|
0
|
|
0,000
|
|
Positive
Rank
|
14.00
|
378.00
|
27
|
-5.196
|
|
The results from table 6 show that there
is a difference in body weight after being given oral stimulation to LBW, which
shows that 27 respondents experienced an increase in body weight with a mean
rank value of 14.00 and there were ties or similarity values in
this study as many as 5 respondents from before to after the intervention. The
results of the analysis based on the Wilcoxon test obtained a p value of 0.000,
which means the p value <0.05, so it can be concluded that Ho is rejected
and Ha is accepted, which means there is an influence of giving oral
stimulation on increasing body weight in LBW.
Sucking Reflex and Increase in Body
Weight before Oral Stimulation is given to LBW
The results of
research conducted at the Bunda Patimah Pratama Clinic showed that before Oral
Stimulation the majority of sucking reflexes were in the Weak category, 28
people (87.5%), and the minority of sucking reflexes were in the Strong
category, 4 people (12.5%). Meanwhile, the majority of weight gain in the Not
Increased category was 32 people (100%), and the minority in the Increased
category was 0 (0%).
The results
obtained from this study are in accordance with the findings of (Syaiful et al., 2019),
showing that the picture of the suction reflex before oral stimulation was
carried out was that the majority had poor suction reflexes, namely 15
respondents (54%) and a small percentage had good suction reflexes, namely 1
respondents (3%). And in research conducted by (Fatmawati et al., 2021),
results showed that 20 respondents (87%) experienced a decrease in body weight
before oral stimulation was carried out.
Lack of mature
sucking development in LBW babies is characterized by the emergence of oral
feeding problems which will cause delays in breastfeeding, low body weight and
dehydration during the early weeks after birth. This weakness in sucking is
associated with the maturity of the baby's nerve structure and the strength of
the mouth muscles. This is in accordance with the theory that babies less than
1 week old usually experience delays in oral feeding problems (Syaiful et al., 2019).
The sucking
reflex component begins to appear at 28 weeks of gestation, but synchronization
is still irregular, and the baby easily becomes tired. In line with the
maturation process, a more regular mechanism will be obtained at 32-36 weeks of
gestation. Various studies have shown a strong relationship between the
maturity of the baby and the organization of the suckling pattern (Saputro & Megawati, 2019).
Babies with LBW
often cause problems including hypothermia, respiratory distress syndrome,
intracranial bleeding, hyperbillirubinemia and hypoglycemia due to weak sucking
reflexes. This is due to the immaturity of the function of the vital organs.
Babies with weak sucking reflexes before oral stimulation have a significant
impact on nutritional intake. If the baby's nutrition is not met, the most
obvious consequence will be weight loss which will result in other pathological
conditions as mentioned above (Saputro & Megawati, 2019).
The condition of
a baby with LBW will have difficulty gaining weight because it is caused by
their body's poor ability to respond to everything, including the nutrients
that enter the body. Reduced ability to drink will have an impact on health,
including the continued growth and development of the baby (Fatmawati et al., 2021).
�According to researchers' assumptions, the
baby's ability to suck well is very necessary because with good sucking, good
nutrition can be provided, so that nutrition is met. If a baby's sucking or a
baby's ability to drink is lacking, it will pose a risk to the baby because
nutritional intake cannot enter so that nutrition is also not fulfilled, which
will result in apnea, bradycardia and a decrease in oxygen saturation. The lack
of ability to swallow is also due to the premature age of the baby because the
suction muscles are still weak.
Sucking Reflex and Increase in Body
Weight after being given Oral Stimulation to LBW
From the results
of the research that has been carried out, after carrying out the intervention
there was a difference in the Sucking Reflex before and after being given Oral Stimulation,
namely that there was an increase in the Sucking Reflex of the majority in the
strong category by 30 people (93.7%), and those in the minority in the weak
category by 2 people. (6.3%). A total of 2 people did not experience an
increase in Sucking Reflex, this was because the respondents did not carry out
the Oral Stimulation stages according to the SOP. Meanwhile, in weight gain,
the majority in the category increased by 28 people (87.5%), and the minority
in the category did not increase by 4 people (12.5%). A total of 4 people did
not experience weight gain, this was because the mothers were more focused on
post-SC health rather than breastfeeding their babies and needed to adjust as
mothers.
The results
obtained from this study are in accordance with the findings of Sholikhah et al
(2020), showing that the picture of the suction reflex after oral stimulation
was that the majority had adequate suction reflexes, namely 18 respondents
(64%) and a small percentage had inadequate suction reflexes, namely 4
respondents (14%). And in research conducted by (Fatmawati et
al., 2021), the results
were that 22 respondents (95.7%) experienced an increase in body weight after
oral stimulation.
A strong sucking
reflex in babies occurs 30 minutes after birth, so it is highly recommended
that if the baby's reflex is strong within 30 minutes of being given breast
milk. A sign of a strong sucking reflex is that if stimulation is given to the
baby's mouth, the baby immediately sucks it. This reflex is an inherent (built
in) reaction to certain stimuli and small babies will automatically respond to
adapt to their environment. Reflexes regulate the movements of a newborn baby.
The nature of this reflex is automatic and beyond the newborn baby's control.
The sucking ability of newborn babies varies. Some newborn babies suck
efficiently and vigorously to obtain milk, while other babies are less skilled
and become exhausted before they are even full (Saputro & Megawati, 2019).
According to the
researchers' assumption, this weight gain is influenced by the respondent's own
condition, which is getting better day by day, so that the ability to drink
becomes stronger and nutrition can be received by the body well. According to
the theory of oral stimulation, you will have better oral motor skills so that
you can improve your ability to drink and suck, thus helping to form a
relationship between feelings of fullness and satisfaction with mouth
movements, so that nutritional intake is met and the baby's weight can
increase.
The Effect of Giving Oral Stimulation on
Sucking Reflex and Increase in Body Weight in LBW
Based on the
results of the analysis of different tests using the Wilcoxon test, it shows
that there is a significant difference (p<0.05), namely the values
before and after intervention with Asymp.sig. (2-tailed) is 0.000
so Ho is rejected and Ha is accepted. This shows that there is an effect of
giving oral stimulation on the Sucking Reflex and Increase in Body Weight in
LBW.
The results
obtained from this study are in accordance with research conducted by Maghfuroh
et al (2020), the results of the analysis were t= -16.233, p=0.000 where
p<0.05 means there is an effect of oral motor exercise therapy on the
sucking reflex of LBW babies. Oral motor exercise for babies with LBW can
improve the baby's sucking reflex so that their nutritional needs are met and
can improve the baby's condition so that they can reduce care time in the
nursery.
In previous research, the analysis results showed a
significance value of p=0.000, where p<0.05 means that there is an effect of
oral stimulation on body weight in LBW babies (Fatmawati et al., 2021). The
effect of oral stimulation on the sucking ability of LBW babies can be seen
from the increase in the volume of milk they drink and the increase in body
weight and length (cm/day) which are measured once a week. Measuring body
weight aims to assess whether nutritional and fluid administration is adequate,
identify problems related to LBW, monitor growth, and calculate drug doses and
fluid amounts.
Giving oral
stimulation to LBW is very important to stimulate the weak sucking reflex to
become stronger. This shows that the research results are in accordance with
the theory that the oral stimulation reflex has a significant influence on the
sucking reflex in LBW babies. Basically, the sucking reflex is not influenced
by the baby's gender or weight. The suction reflex tends to be related to nerve
maturity, because the suction reflex is triggered by stimulation of the cranial
nerves consisting of the Trigeminal, Facial, Glossopharyngeal and Vagus nerves (Saputro & Megawati, 2019).
Oral stimulation
can improve the immune system, increase the flow of lymph fluid throughout the
body to cleanse harmful substances in the body, change brain waves positively,
improve blood circulation and breathing, stimulate digestive and excretory functions,
increase weight gain, reduce depression and tension, make you sleep soundly,
reduce pain, reduce bloating and colic (stomach ache), improve the inner
relationship between parents and their babies, increase the volume of breast
milk, develop communication, understand the baby's signals, increase
self-confidence (Sugiati & Sudiari, nd).
One of the
management measures that needs to be taken into account is that monitoring of
nutrition must be carried out carefully and carefully. The obstacle that occurs
in LBW in relation to nutritional monitoring is that the baby's sucking reflex
is not yet perfect or is still weak. Therefore, nutrition must be provided
carefully (Hanum et al., 2022).
According to
researchers' assumptions, the condition of a LBW baby will be seen as a reduced
ability to suck or drink because it is caused by the body's poor ability to
respond to everything. Reduced ability to suck or drink will have an impact on
the baby. A baby's sucking reflex ability will be influenced by the stimulation
given to the baby. The more often the baby is given oral stimulation, the
better trained the baby will be to suck or drink. So, by providing oral
stimulation to the baby, the baby will provide good nutrition because the
baby's suction and ability to drink can be given good nutrition by the mother
so that the baby's weight will increase and there will be no apnea and
bradycardia in the baby.
CONCLUSION
Based
on the research that has been carried out, it was concluded that 1) Before Oral
Stimulation was carried out, the majority were in the Weak category, 28 people
(87.5%). Meanwhile, the majority of weight gain in the Not Increased category
was 32 people (100%). 2) After being given Oral Stimulation, there was an
increase in the Sucking Reflex of the majority in the strong category, 30
people (93.7%). Meanwhile, in weight gain, the majority in the category
increased by 28 people (87.5%). 3) Based on the results of the analysis, it
shows that there is a significant difference (p<0.05), namely the values
before and after intervention with Asymp.sig. (2tailed) is 0.000
so Ho is rejected and Ha is accepted. This shows that there is an effect of
giving oral stimulation on the Sucking Reflex and Increase in Body Weight in
LBW. From the results of this study, the researcher wrote several suggestions,
namely 1) Providing oral stimulation will be more effective if it is done
correctly according to standard operating procedures (SOP), carried out from an
early age continuously and sustainably. 2) For health workers to be able to
carry out oral stimulation treatment as midwifery care for babies, and provide
education for mothers and families about oral stimulation, and involve families
in LBW care. 3) For future researchers to be able to develop further research
with more accurate data collection methods and techniques, and the results of
this research can be used as material or as a comparison for research on topics
related to oral stimulation in LBW.
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