I. Gusti Lanang Sidiartha

Background: Stunting remains a pressing health concern in many countries. The condition often begins during the prenatal period and may persist after birth, particularly in infants being born preterm. Objectives: This study explores how common stunting is among preterm newborns and examines the factors that contribute to its occurrence. Methods: A retrospective study was carried out at Prof. Ngoerah Hospital, using medical records of preterm infants born between January and December 2022. Neonatal stunting was defined using the Intergrowth-21st curve, with length-for-gestational age classified below the 10th percentile. The relationship between neonatal stunting in preterm newborns and its potential risk factors was analyzed using the Chi-Square test and logistic regression analysis. Significantly was considered if p-value<0.05. Results: Out of 185 preterm newborns, 174 (94%) met the inclusion criteria for this study. The average gestational age was 32.8 weeks, with 52.3% of the infants being male and 47.7% female. Among the eligible newborns, 34 (19.5%) were identified as experiencing neonatal stunting. Multivariable analysis revealed a significant association between neonatal stunting and being small for gestational age (aOR = 8.59; 95% CI: 2.92–25.25; p-value<0.001), as well as a history of asphyxia (aOR = 4.53; 95% CI: 1.54–13.30; p-value=0.006). Conclusions: The prevalence of neonatal stunting among preterm newborns was foundto be 19.5%. Preterm infants who were small for gestational age showed a significant association with stunting. Additionally, neonatal stunting was more likely to occur in those with a history of asphyxia at birth.

Acute Kidney Injury (AKI) and sepsis are major causes of morbidity and mortality in pediatric intensive care units (PICUs), especially when they occur concurrently. Despite advancements in critical care, the identification of risk factors remains essential to improve survival outcomes in children. To determine the risk factors associated with mortality in children diagnosed as sepsis with treated in the PICU. This was an observational analytic study with a case-control design, conducted in the PICU of Prof. Dr. I. G. N. G. Ngoerah Hospital from 2022 to 2024. Pediatric patients aged 1 month to <18 years with diagnoses of AKI and sepsis were included. Variables analyzed included nutritional status, duration of PICU stay, requirement of mechanical ventilation, involvement of a pediatric nephrologist, history of nephrotoxic drug use, and the number of nephrotoxic drugs used. Bivariate and multivariate analyses were performed using logistic regression. Total of 126 patients were analyzed. Bivariate analysis showed a significant relationship between mortality and the need for mechanical ventilation (OR 6.2; p 0.001) and the absence of pediatric nephrology care (OR 2.1; p = 0.047). In multivariate analysis, the need for mechanical ventilation (OR 16.5; 95% CI 3.5-77.2; p = 0.001) and pediatric nephrology care (OR 6.7; 95% CI 1.6-28.0; p = 0.009) were independently associated with mortality. The need for mechanical ventilation and the lack of pediatric nephrology consultation are significant risk factors for mortality in septic children with AKI treated in the PICU.

Background: Stunting remains a significant global health issue, particularly in low- and middle-income countries (LMICs). Globally, around 22% of children under five are affected, with high rates persisting in South and Southeast Asia. This review examines government-led programs in high-performing LMICs (Nepal, Bangladesh, and Vietnam) to identify key strategies and opportunities for effective intervention. Methods: A literature search was conducted on PubMed using keywords and Medical Subject Heading terms, including “stunting”, “child undernutrition”, “malnutrition” and the names of the three specified countries. Articles were evaluated for relevance based on their focus on stunting prevalence, risk factors, and interventions in these countries, without restrictions on publication date or language. Results: Stunting prevalence among children under five has significantly declined in Nepal, Bangladesh, and Vietnam over the past two decades, reflecting the impact of sustained nutrition and health interventions. Nepal reduced stunting from 55.8% in 2000 to 26.7% in 2022, Bangladesh from 54.7% to 26.4%, and Vietnam from 41.5% to 19.3%. Successful strategies included multisectoral approaches integrating nutrition-specific and nutrition-sensitive interventions, enhanced policy frameworks, and strong governance. Despite progress, challenges remain, such as high wasting prevalence in Nepal and disparities among marginalized communities in Vietnam, emphasizing the need for targeted, context-specific interventions. Conclusions: Effective stunting reduction requires multisectoral strategies addressing underlying, intermediate, and immediate determinants. Insights from Nepal, Bangladesh, and Vietnam highlight the importance of sustained government commitment, robust policies, and coordinated interventions. Adapting these successful strategies to local contexts can support stunting prevention and management, promoting healthier and more resilient communities.

Background: Stunting remains a major health concern among children in low- and middle-income countries, often beginning in the intrauterine period and detectable at birth. Pregnancy represents a physiological stress state that can elevate maternal serum C-reactive protein (CRP) levels, which may contribute to adverse outcomes such as preterm birth and stunting. This study aims to explore the association between maternal serum CRP levels and the occurrence of stunting at birth in preterm infants. Methods: Preterm neonates with stunting at birth were selected as the case group, while those without stunting served as the control group, using a 1:2 matching ratio. Serum CRP levels were measured and compared between groups, with statistical significance defined as p < 0.05. Data were analyzed using SPSS version 20.0 for Windows. Results: A total of 108 preterm infants were included, comprising 36 stunted (cases) and 72 non-stunted (controls) neonates. The mean serum CRP concentration was higher in the stunted group (2.73 mg/dL) compared to the control group (1.0 mg/dL), with a statistically significant difference (p = 0.042; mean difference [95% CI]: 1.73 mg/dL [0.06–3.40 mg/dL]). The proportion of infants with markedly elevated CRP levels (>10 mg/dL) was also higher in the stunted group (8.3%) versus none in the control group (0%), yielding a significant odds ratio (p = 0.035; OR [95% CI]: 3.18 [2.39–4.22]). Conclusion: Maternal serum CRP levels are significantly elevated in preterm infants presenting with stunting at birth. These findings suggest a potential role of inflammation in early growth impairment, warranting further investigation into anti-inflammatory strategies as a preventive intervention for stunting both at birth and during postnatal development.

Latar belakang. Gizi buruk pada anak bawah lima tahun (balita) masih menjadi beban di negara berkembang. Anak balita gizi buruk perlu menjalani pemeriksaan lengkap secara klinis dan laboratoris untuk mengidentifikasi ada tidaknya tanda bahaya atau komplikasinya. Tujuan. Untuk mengetahui prevalens gangguan serum elektrolit anak balita dengan gizi buruk dan karakteristiknya.Metode. Penetilian retrospektif dengan rancangan cross-sectional menggunakan data rekam medis pasien. Kriteria gizi buruk adalah berat menurut panjang atau tinggi badan < -3 SD menurut standar WHO. Hubungan antara variabel diuji dengan uji chi-square.Hasil. Jumlah pasien yang memenuhi kriteria adalah 94 pasien, terdiri dari 56 laki (59,6%) dan 38 perempuan (40,4%), 22,3% usia dibawah 6 bulan dan 77,7% usia 6 bulan keatas. Prevalensi hiponatremia, hipokalemia, hipokalsemia dan hipokloridemia masing-masing 64,9%, 26,6%, 52,1% dan 60,6%. Gangguan elektrolit kalium signifikans lebih tinggi pada usia dibawah 6 bulan (p=0,011), sedangkan gangguan elektrolit kalsium signifikans lebih tinggi pada usia 6-59 bulan (p=042).Kesimpulan. Anak balita dengan gizi buruk mayoritas mengalami hiponatremia dan hipokalsemia. Gangguan kalium signifikans lebih tinggi pada anak gizi buruk usia dibawah 6 bulan, sedangkan gangguan kalsium signifikans lebih tinggi pada usia 6-59 bulan.

Background Extrauterine growth restriction (EUGR) is common in preterm infants and has been shown to affect their neurodevelopment. Significant variability exists in the criteria used to define EUGR and a standard definition has not yet been established. Several factors associated with EUGR have been identified, yet EUGR remains a problem in preterm infants. There is still much to be explored regarding risk factors associated with EUGR. Objective To determine the prevalence and factors associated with EUGR in preterm infants. Methods This cross-sectional study included randomly selected premature infants (Results Of 185 subjects, the prevalence of EUGR in preterm infants was 47% and there were significant associations between EUGR and birth weight 48 hours (PR 2.23; 95%CI: 1.21 to 4.09; P=0.014) and length of stay/LOS >14 days (PR 8.11; 95%CI: 4.13 to 15.9; P=0.000). Multivariate analysis revealed birth weight 14 days (aPR 4.93; 95%CI: 2.15 to 11.31; P=0.000) maintained positive significant associations with EUGR. Conclusion The prevalence of EUGR in preterm infants is 47%. Birth weight 14 days are associated with EUGR in preterm infants.

Introduction: Acute malnutrition in children is still high in our country. It needs optimal nutrition support during and after discharge from the hospital. We evaluated the benefit of oral nutrition supplements (ONS) in improving acute malnutrition in children in a hospital outpatient setting. Methods: A retrospective cohort study was conducted among 124 children under five with acute malnutrition (weight-for-height < -2SD, according to the WHO growth standard). All the children were followed during six months of treatment. At the end, the change of nutritional status was calculated and associated factors were studied. Results: Among 124 children, 70 (56.5%) were males and 54 (43.5%) were females with a median age of nine months. On recruitment, 41 children (33.1%) had severe acute malnutrition (SAM) and 83 children (66.9%) had moderate acute malnutrition (MAM). In the end, five children (4.1%) improved from SAM to well-nourished, 22 children (17.7%) improved from MAM to well-nourished, and 13 children (10.5%) improved from SAM to MAM, respectively. Initial SAM status and frequent visits were significantly associated with the improvement in nutritional status. Conclusions: Treatment with ONS for six months in children under five with acute malnutrition improved their nutritional status by approximately 32.3%, in which 21.8% had complete improvement. Independent factors for improvement were initial SAM status and frequent visits to the outpatient clinic.

Background Disease-related malnutrition (DRM) is a common complication in chronic diseases. An oral nutrition supplement (ONS) is a formula with high energy density which is commonly used to treat malnutrition. Objective To identify the prevalence of DRM in children with chronic disease and evaluate the benefits of ONS. Methods A retrospective study was conducted at Prof. IGNG Ngoerah Hospital, Denpasar, Bali. Data were collected from medical records of patients who were admitted from January to December 2021. Inclusion criteria were patients aged 1-18 years with chronic diseases. Patients with organomegaly, edema, and incomplete medical record data were excluded. Disease-related malnutrition was defined as weight-for-height (for < 5 years of age) or BMI-for-age < -2SD (for > 5 years of age), according to the WHO growth charts. Subjects who received ONS for more than 80% of total energy during hospitalization were classified as part of the ONS group and the rest as standard group. Several variables between ONS and standard group were analyzed and considered significant if P value < 0.05. Results Of 313 subjects with chronic disease, 139 (44.4%) were diagnosed with DRM. Among of 139 subjects with DRM, a total of 64 subjects were analyzed in the ONS and standard feeding groups. No significant difference was found between groups with regards to age, gender, weight, height, white blood cell count, and lymphocyte cell count. Subjects with severe malnutrition significantly more classified as an ONS group than subjects with moderate malnutrition (P=0.001). Mean length of hospital stay was significantly shorter in the ONS group [11.8 (SD 6.7) days] than in the standard group [16.1 (SD 6.6) days]; (P=0.012). Conclusion Malnutrition related to chronic disease in children is prevalent. Use of ONS is associated with a shorter length of hospital stay. Thus, routine nutritional status assessment to identify malnutrition in children with chronic disease is needed to treat with ONS in order to improve prognoses.

Background: Optimal nutrition care in hospitalized children is essential to improve the prognosis of diseases. One strategy is the implementation of Pediatric Nutrition care (PNC) in all hospitalized children. Objectives: to compare the macronutrient calculation in PNC with Angka Kecukupan Gizi (AKG). Methods: A cross-sectional study was conducted in hospitalized children aged six months to 18 at the Pediatric Ward Sanglah General Hospital, Denpasar, Bali, from January to December 2020. Macronutrient calculation in PNC using Recommended Daily Allowance (RDA) was compared with AKG in all subjects during hospitalization. The difference was analyzed using a paired-t test with significance if p-value < 0.05. Results: A total of 97 subjects were included, 52 male (53.6%) and 45 female (46.4%). Most of the subjects were aged above five years old (58.8%), well nourished (49.5%), had acute diseases (60.8%), and length of stay of fewer than seven days (66%). The mean calculation of carbohydrates, lipids, and protein according to RDA and AKG were 162.3 g vs. 250 g (pConclusions: Protein calculation using RDA is significantly higher, conversely to carbohydrate and lipids is lower. Sick children commonly need more protein against their diseases, so using RDA to calculate the macronutrient requirement is recommended.

Introduction: Growing recognition of coexisting obesity and hypertension epidemics in children and adolescents could prevent it from being an insurmountable burden following its trajectory into adulthood.Objectives: To determine the predictive ability of obesity indices for paediatric hypertension.Method: In this retrospective cross-sectional study, multi-stage sampling method was employed to recruit proportional population-based samples across Bali, Indonesia. A total of 436 students aged 6-17 years who had no prior history of hypertension / prolonged use of drugs affecting blood pressure were included in the analysis. Nutritional status assessment warranted a two-step assessment using weight-for-height and body mass index (BMI)-for-age CDC 2000 charts for each gender. Bivariate and multivariate analyses were done to find associated factors. Receiver operating characteristic (ROC) curve analysis was done to assess the predictive ability of waist circumference.Results: In this study there were 229 children with hypertension. The prevalence of overweight (14.7%) and obesity (40.8%) in hypertensive students was greater than the overall overweight (13.1%) and obesity (32.8%) prevalence. Age, nutritional status and waist circumference were significantly increased in the group with hypertension on bivariate analysis. After multivariate analysis, increasing age (prevalence ratio [PR] 1.106; 95%CI 1.015-1.205) and obesity (PR 2.174; 95%CI 1.371-3.445) were significantly associated with hypertension but not waist circumference. Optimal cut-off points for male (65.5 cm) and female (62.5 cm) waist circumference were obtained.Conclusions: Obesity status and waist circumference served as promising predictors of hypertension.Sri Lanka Journal of Child Health, 2022; 51(1): 20-28