Background: Hospital Acquired Malnutrition (HAM) is characterized by inadequate nutritional therapy and the risk of developing malnutrition during the hospital stay. In clinical practice, there are many measurements to determine nutritional status. Total lymphocyte count (TLC) is associated with impaired function of immune system in malnutrition. The purpose of this study was to evaluate the prognostic value of TLC to the occurrence of HAM in pediatric patients.Materials and Methods: This an observational study with a prospective cohort design. Subjects were assessed for weight at the first day of hospitalization, then the subjects were followed until they were discharged. Body weight was re-measured on discharge to determine the presence or absence of HAM. This research was conducted at Sanglah Hospital from May-December 2019. Subjects who met the inclusion and exclusion criteria were enrolled in the study.Results: Among 120 subjects, 55 subjects or 45.8% were malnourished on admission. Subjects with a low TLC compared to a normal TLC had a 3.9-fold risk of experiencing hospital acquired malnutrition (95% Confidence Interval: 1.59 to 7.19, p=0.001). Subjects who had a low TLC had HAM of 61.8%, while subjects who had a normal TLC had HAM of 32.3%. In multivariate analysis, low TLC was the only risk factor for HAM in this research.Conclusion: This study proved that low TLC is the risk of HAM. Total lymphocyte count could be used as predictor of the risk of HAM in hospitalization children.Keywords: hospital malnutrition, total lymphocyte, children

The purpose of this study was to investigate the number of referral neonates came with an unstable condition (according to a S.T.A.B.L.E program) and characteristic of unstable conditions of the referred neonates. Observational prospective study was conducted for the period of two years from 1st January 2018 to 31st December 2019 in Emergency Department of Sanglah Hospital, Bali, Indonesia. Referred neonates were assessed in term of gender, gestational age, referral characteristic, and condition on arrival at hospital according to S.T.A.B.L.E criteria. According to S.T.A.B.L.E criteria, 283 neonates (54.8%) came on unstable condition. Prematurity (42.6%) was the main reason of referral, 37.9% of them were very low birth weight. Most of them were referred from Denpasar (33.9%), the equipment of transportation were incubator transport (41.8%). T-piece resuscitator used in 30.4% of referred neonates. Characteristics of unstable conditions were mostly hypoglycemia (33%) and 36% of unstable neonates had more than one conditions of instability. This study revealed 283 neonates were unstable and the main reason of transfer neonates is prematurity. Most of them come with unstable conditions that could lead to higher mortality. This study could be as a reference for improvement in neonatal transportation system in Bali.

Medium chain acyl-CoA dehydrogenase deficiency (MCADD) is the commonest fatty acid oxidation disorder.Patients usually presented between the ages of 4 months and 4 years with acute hypoglycaemic encephalopathy and liver dysfunction; some deteriorated rapidly and died. Symptomatic presentation of MCADD is precipitated by fasting due to infection, characterized by metabolic crisis, includes lethargy, vomiting, hypoketotic hypoglycaemia, and encephalopathy, and could progress to coma and death. MCADD is not part of new-born screening in Indonesia; children are likely to be missed if routine hypoglycaemia screening is not instituted. This is a case of an otherwise healthy 8-month-old baby boy who presented with recurrent infection followed by severe hypoglycaemia and cow's milk protein allergy presentation with some initial diagnostic dilemma. This study was to describe the clinical manifestation, workup diagnostic, and management in children with MCADD disorder. An eight-months-old boy came with recurrent hypoglycaemia following infections. Blood gas analysis showed acidosis metabolic with increase anion gap. Patient was moderate malnutrition due to recurrent illness. There was no consanguineous in his parents. Laboratory test revealed leucocytosis, hypoglycaemia, and metabolic acidosis. No ketone on urine sample. Short chain fatty acid decrease. Ig-E total increase and benzidine test positive. Dried blood spots and urine spot by liquid chromatography-tandem mass spectrometry revealed of MCADD. Patient was given intravenous fluid containing dextrose, treated by antibiotics for infection, and recovered after few days hospitalization. Patient was also given amino-acid-based formula and he responds was good. Parent were educated for the illness and told to avoided fasting for long period. Children with MCADD should remain under follow-up with a specialist Metabolic Paediatrician Consultant and Dietician with regular reviews in early childhood. Parents should be allowed direct access to the local hospital's paediatric service so that lengthy waits in emergency departments are avoided.