PDF Editor-in-Chief - UNUD

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Editor-in-Chief

Prof. Dr. Sri Maliawan, SpBS (Scopus ID), (Google scholar)

[email protected] / [email protected] Department of Neuro Surgery, Udayana University Sanglah General Hospital

Bali - Indonesia

Associate Editor

Prof. Putra Manuaba, M.Phil (Scopus ID), (Google Scholar)

[email protected] / [email protected] Biomedicine Postgraduate Program, Udayana University Bali - Indonesia

Prof. Ketut Suwiyoga, SpOG (Scopus ID)

[email protected]

Faculty of Medicine, Udayana University, Sanglah Hospital Denpasar, Bali-Indonesia

Editorial Board for Regional America

Ankit Sakhuja, M.B.B.S., F.A.C.P., F.A.S.N.

(Scopus ID)

[email protected]

Nephrology and Hypertension Cleveland Clinic (United States)

Editorial Board for Regional Australia

Prof. John Svigos, MB. BS. DRCOG., FRCOG., RANZCOG (Scopus ID)

[email protected]

Ashford Hospital & Faculty of Health Sciences, University of Adelaide, Australia

dr Deasy Ayuningtyas Tandio MPH-MBA.

(orcidID)

[email protected]

James Cook University Australia Master of Public Health Master Of Business Administration, Indonesia

Editorial Board for Regional Europa

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Prof. Harald Hoekstra (Scopus ID)

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Universitair Medisch Centrum Groningen, Division of Surgical Oncology, Groningen the Netherland

Editorial Board for Regional Asia

Prof Huang Qin (Scopus ID)

[email protected]

Chairman Dept. of Neurosurgery, Guangdong 999 Hospital Guangzhou China

Assoc. Prof. Mohammad Amin Bahrami (Scopus ID)

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Head of healthcare management department, Shahid Sadoughi University of Medical Sciences, Yazd,Iran

Dr. Tanveer Beg, PhD (Scopus ID)

[email protected]

Assistant Professor, Department of Biology, Faculty of Science, Jazan University, Jazan, Saudi Arabia.

Editorial Board Members

Prof. Andi Asadul Islam (Scopus ID), (Google Scholar) [email protected]

Faculty of Medicine Hasanudin University, Makasar-Indonesia

Prof. Dr. dr. Abdul Hafid Bajamal, Sp.BS (Scopus ID)

[email protected]

Faculty of Medicine Airlangga University, Surabaya-Indonesia

Dr. dr. I Wayan Sudarsa, Sp.B(K) Onk, FINACS, FICS.

(Scopus ID), (Google Scholar), (Researchgate)

dr. I.B. Amertha P. Manuaba, SKed, MBiomed.

(Scopus ID), (Google Scholar), (Orcid), (Researcher ID) (Researchgate) [email protected] / [email protected]

Biomedicine Magister Program, Udayana University, Indonesia

Editorial inquiries to be addressed to: [email protected]

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Vol 8, No 1 (2019): (Available online 1 April 2019)

Table of Contents

Correlation of Interleukin-6 serum level and surgical site infection in post major surgery patient Supomo Supomo

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The effectiveness of art therapy with sand play method on behavioral disorders, emotional problems, and communication skills of children

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The factors associated with discharge against medical advice: Comparing older and younger patients in ShahidBeheshti Hospital Complex, Kashan-Iran

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Comparison of intramuscular injection of ketorolac and conventional treatment in the field of cost-effectiveness, length of stay and pain relief in patients admitted to the emergency department with renal colic

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Antimicrobial susceptibility and the pattern of a biofilm-forming pair of organisms from patients treated in intensive care units in Dr. Soetomo General Hospital, Indonesia

Dewi Klarita Furtuna Kartuti Debora Eddy Bagus Wasito Download PDF | View PDF |

Comparison of the technical efficiency of the hospital sector: Panel data analysis of the Iranian hospitals using parametric and non-parametric approaches

Mohammad Mehdi Kiani Behzad Raei Parivash Afradi Asbagharani Mahmood Yousefi Seyed Abdolhossein Mousavi Rigi Marzieh Salehi Shabnam Mirabi Shiraz

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Dewandaru fruit extracts (Eugenia uniflora L) reduce oxidative stress and increase Superoxide Dismutase level in excessive activity-induced rats

Puguh Santoso I Made Bakta I.B. Putra Manuaba Baus Komang Satriyasa Download PDF | View PDF |

Correlation between serum S100β protein level with neurological deficit in patients with acute intracerebral hemorrhage

Poppy Kristina Sasmita Ismail Setyopranoto Samekto Wibowo Ahmad Hamim Sadewa Download PDF | View PDF |

Analysis of Soluble Cluster of Differentiation 40 Ligand (SD40L) levels between thrombocyte apheresis and thrombocyte whole blood products in Sanglah General Hospital blood bank Ni Kadek Mulyantari I Putu Yuda Prabawa

Validation Test of Indonesian Female Sexual Function Index (Indonesian FSFI) Nuring Pangastuti Budi Iman Santoso Denny Agustiningsih Ova Emilia

Dengue hemorrhagic fever: The role of Soluble E-Selektin, Soluble Intra Cellular Adhesion

Molecule-1 (Sicam-1) and Soluble Vascular Cellular Adhesion Molecule -1 (Svcam-1) in overweight children

Ni Kadek Elmy Saniathi Bambang Udji Djoko Rianto Mohammad Juffrie Soetjiningsih Soetjiningsih Download PDF | View PDF |

Correction of aggregation level of basic regular blood elements in patients with hypertension and dyslipidemia receiving rosuvastatin and non-medicinal treatment

Irina Alexandrovna Skoryatina Ilya Nikolayevich Medvedev Download PDF | View PDF |

Diagnostics of early dysfunctions of anticoagulant and fibrinolytic features of rats’ vessels in the course of metabolic syndrome formation with the help of fructose model

Boris Veniaminovich Usha Svetlana Yurevna Zavalishina Yuri Anatolyevich Vatnikov Evgeniy Vladimirovich Kulikov Vladimir Ivanovich Kuznetsov Nikolay Vladimirovich Sturov Margarita

Vasilievna Kochneva Anton Alexandrovich Poddubsky Alina Vadimovna Petryaeva Tatyana Ivanovna Glagoleva

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Aspects of Salmonellosis pathogenesis using chicken models

Lenchenko E. M. Lozovoy D. A. Gavrilov V.A. Gnezdilova L. A. Vera N. Zimina V. N. Kuznetsov V. L.

Annikov V. V. Medvedev I. N. Petryaeva E. V.

Effect of a combination of arterial hypertension and insulin resistance on hemostasis activity Svetlana Yurevna Zavalishina Yuri Anatolyevich Vatnikov Evgeniy Vladimirovich Kulikov Tursumbay Satimbaevich Kubatbekov Ilya Fedorovich Vilkovysky Alexander Konstantinovich Petrov Andrey Leonidovich Tishchenko Stanislav Gennadievich Drukovsky Andrei Nikolaevich Zharov Victor Nikolaevich Grishin Tatyana Ivanovna Glagoleva

Preparedness of Hormozgan province hospitals against disasters in 2016 Salahaddin Safari Lafti Somayeh Hessam Abbas Yazdanpanah

A randomized control trial related to meal order of fruit, vegetable and high glycaemic

carbohydrate in healthy adults and its effects on blood glucose levels and waist circumference Damas Satrio Nagoro Didik Gunawan Tamtomo Dono Indarto

Balinese Traditional Beliefs and Epilepsy Dewa Putu Gede Purwa Samatra

Correlation between Leucocyte Count, Neutrophil Lymphocyte Ratio (NLR), C-reactive Protein (CRP) and Coronary Artery Stenosis Degree on Stable Coronary Artery Disease

Edward Kurnia Setiawan L Purwanto Adhipireno Imam Budiwiyono Download PDF | View PDF |

The relationship between sodium, potassium, and hypothyroidism in Chronic Kidney Disease (CKD) patients

Indranila Kustarini Samsuria Download PDF | View PDF |

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Analysis of Prostate Specific Antigen (PSA) level on Medical Check-up (MCU) Participants Linda Rosita Gloscindy Arma Occifa

Comparison of HbA1c measurement methods between automatic boronate affinity point of care testing and high-performance liquid chromatography

Ricky Tjahjadi Astuti Giantini Download PDF | View PDF |

The role of social support and coping strategies in the prediction of psychological well-being in type 2 diabetic patients of Zahedan

Azizollah Mojahed Mahbubeh Fallah Alireza Ganjali Zahra Heidari Download PDF | View PDF |

Laser acupuncture at BL20 Point Stimulate Pancreatic Beta cell in type 1 diabetes mellitus Abdurachman H. Suhariningsih Suhariningsih Agus Rubiyanto

The impact of health reform on maternal and child health indicators in developing countries: A systematic review

Hossein Jabbari Beyrami Salaheddin Asadi Leila Doshmangir Download PDF | View PDF |

Assessment of outcome of using amniotic membrane enriched with stem cells in scar formation and wound healing in patients with burn wounds

Mohamad Hossein Lashgari Mohamad Hossein Hesami Rostami Omid Etemad Download PDF | View PDF |

The association between hypertension, physical activity, and brushing technique with periodontal disease

Indirawati Tjahja Notohartojo Made Lely Suratri Vivi Setiawaty Download PDF | View PDF |

The effect of communication skills training on the self-efficacy of nurses: a systematic review and meta-analysis study

Mojtaba Fattahi Ardakani Mohammad Ali Morowati Sharifabad Mohammad Amin Bahrami Amin

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Salehi Abargouei

Effect of hyperbaric oxygen therapy to IFNγ and TNFα expression in pregnant Rattus novergicus infected with Tachyzoite of Toxoplasma gondii

Arif Rahman Nurdianto A Aryati Mohammad Guritno Suryokusumo M Mufasirin Download PDF | View PDF |

Investigating the impact of the Emergency Department's overcrowding on educational indices and emergency deputies' satisfaction with clinical education

Mehdi Yarahmadi Mehri Ayati Download PDF | View PDF |

Strategic alignment, meaningful work, and employee engagement among teaching hospital's workforce in 2017

Hasan Abolghasem Gorgi Hamed Fattahi Azad Shokri Fatemeh Manafi Samira Alirezaei Mozhgan Sadat Ghaemmohamadi Mahmoud Khodadost Khadije Maajani

Genetic polymorphism in CYP1A1 affected susceptibility to acne vulgaris in Pekanbaru Indonesian Population, Desember 2013 - Maret 2014

Endang Darmani Eryati Darwin Irma Damayanti Adnil Edwin Nurdin Download PDF | View PDF |

Concentrations of endothelin-1 associated with aging of prehypertension patients in Denpasar and Badung Districts, Bali, Indonesia.

Luh Gede Sri Yenny

Correlation between Superoxide Dismutase Level and Disease Activity of Vitiligo Nelva K Jusuf Kamaliah Muis Kharina Y Putri

Affecting Factors on nurses outflows in Iran 2018: a systematic review Soudabeh Vatankhah Samira Alirezaei Hasan Abolghasem Gorji

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Botulinum toxin type A (BTX-A) to improve the treatment of keloid and hypertrophic scars: A double-blinded randomized clinical trial

Imam Habibi Allahyar Taheri Keshvad Hedayatyanfard Farzaneh Farazmand Behnam Habibi Download PDF | View PDF |

The effect of mustard greens (Brassica rapa l.) ethanol extract on blood glucose and malondialdehyde levels of hyperglycemic Wistar rats

Sri Wahjuni I Wayan Gede Gunawan Ika Yolanda Dewi Malindo Download PDF | View PDF |

Validity of Pediatric Yorkhill Malnutrition Score to detect pediatric hospitalized malnutrition Benny Herlianto I Gusti Lanang Sidiartha I Gusti Ayu Putu Eka Pratiwi

Therapeutic drug monitoring of rifampicin, isoniazid, and pyrazinamide in newly-diagnosed pulmonary tuberculosis outpatients in Denpasar area

Ida Ayu Alit Widhiartini Made Agus Gelgel Wirasuta Dewa Made Sukrama Ida Bagus Ngurah Rai Download PDF | View PDF |

The role of circulating MicroRNA-21 (miR-21) in epithelial ovarian cancer Addin Trirahmanto Sofa Mubarika Haryana Moh Hakimi Heru Pradjatmo Download PDF | View PDF |

Mangosteen extract reduce apoptosis via inhibition of oxidative process in rat model of traumatic brain injury

RR Suzy Indharty Iskandar Japardi Andre MP Siahaan Steven Tandean Download PDF | View PDF |

The impact of the severity of HIV infection on the prevalence of liver fibrosis in children

Ida Bagus Gde Suwibawa Putra Ketut Dewi Kumara Wati I Putu Gede Karyana I Gusti Ngurah Sanjaya Putra Ni Nyoman Metriani Nesa

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The effect of storage on energy, carbohydrate, fat, and protein content of breast milk Putu Andina Pramitasari I Gusti Lanang Sidiartha I Gusti Ayu Putu Eka Pratiwi

The combination effect of brisk walking and relaxation toward hs-crp and anxiety levels in subject with central obesity in Singaraja, Bali

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Correlation of VEGF-C tissue expression and cervical lesion diameter on cervical cancer patients given neoadjuvant therapy

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The relationship between ABO blood group typing with tinea corporis and or tinea cruris in Tanjung Gusta Prison, Medan-Indonesia

Marlentine M Nelva K Jusuf Kamaliah Muis Download PDF | View PDF |

Thiol-producing microbiota of the intestine modulate oxidative stress and inflammation in Chronic Kidney Disease

Ika Nindya Kadariswantiningsih Mochammad Thaha Cahyo Wibisono Nugroho Maulana Antiyan Empitu

Analysis of serum 25-Hydroxyvitamin D level in keloid patients Vira Indhiratamin Damanik Imam B Putra Oratna Ginting

Bacterial pattern and its susceptibility toward antibiotic on burn infection in Burn Unit Sanglah General Hospital

Anak Agung Bagus Bramardipa I Dewa Made Sukrama Ni Nyoman Sri Budayanti Download PDF | View PDF |

A new modified medium for Simultaneous Cystinase and elek tests of bacteria causing diphtheria Fitriana Fitriana Sunarno Sunarno Armaji Kamaludi Syarif Muhammad Karyana Yeva Rosana Lucky

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Comparison of TLR2/1, NF-кB p105/50, NF-кB p65, and TNF-α expressions in the macrophages between multibacillary leprosy patients with and without erythema nodosum leprosum signifying innate immune system activity

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The build-up phase outcome of subcutaneous immunotherapy for pediatric allergic asthma: A retrospective cohort study from Surabaya, Indonesia

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The role of stem cell metabolites derived from placenta for skin regeneration: An in vitro study Purwati Sumorejo Muhammad Yulianto Listiawan Ardhiah Iswanda Putri Fedik Abdul Rantam Helen Susilowati Eryk Hendrianto

The potency of Centella asiatica in protecting organs of rats with type 2 diabetes mellitus Fitria Dhenok Palupi Brian Wasita Adi Magna Patriadi Nuhriawangsa

The antiplasmodial activity of chalcone derivative through the inhibition of haemozoin formation and the induction of stomatocytes formation

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ORIGINAL ARTICLE

Bali Medical Journal (Bali Med J) 2019, Volume 8, Number 1: 78-82 P-ISSN.2089-1180, E-ISSN.2302-2914

78 Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj

CrossMark

Published by DiscoverSys

ABSTRACT

Introduction: Hospitalized malnutrition in children is a nutritional imbalance that occurs during hospital treatment, regardless the nutritional status at admission. Hospitalized malnutrition can be prevented, with periodic evaluation of nutrition status and early detection of hospital malnutrition. Pediatric Yorkhill Malnutrition Score (PYMS) can be one of the instruments used at Sanglah Hospital to prevent hospital malnutrition. This study aims to know the validity of PYMS to detect hospitalized malnutrition in pediatric patient at Sanglah Hospital.

Method: This Study was a prospective cohort study, performed at Sanglah Hospital Denpasar between August and December 2017. The subjects were collected using consecutive sampling method. PYMS

was measured when admitted. Hospitalized malnutrition was defined if there is any weight loss during hospitalization. Between August and December 2017, 240 subjects were retained for analysis.

Result: The incidence of hospitalized malnutrition was 14.1%. The combined high risk and medium risk of PYMS had 97.1% sensitivity, and 47.1% specificity, positive predictive value (PPV) 23.2% and negative predictive value (NPV) 98.9% for detecting children who are at risk for hospitalized malnutrition.

Conclusion: Pediatric Yorkhill Malnutrition Score is acceptable for a screening tool, however it also important to ensure to the staff low score does not negate referral for dietetic assessment.

Keywords: Hospitalized malnutrition, screening tool, PYMS

Cite this Article: Herlianto, B., Sidiartha, I.G.L., Pratiwi, I.G.A.P.E. 2019. Validity of Pediatric Yorkhill Malnutrition Score to detect pediatric hospitalized malnutrition. Bali Medical Journal 8(1): 78‑82. DOI:10.15562/bmj.v8i1.1299

Validity of Pediatric Yorkhill Malnutrition Score to detect pediatric hospitalized malnutrition

Benny Herlianto,^1,2* I Gusti Lanang Sidiartha,³ I Gusti Ayu Putu Eka Pratiwi³

INTRODUCTION

Hospitalized malnutrition in children is a nutritional imbalance that occurs during hospital treatment, regardless the nutritional status at admission.

Hospitalized malnutrition is associated with increased length of stay, increased morbidity, and increased mortality.^1,2 In children nutrition needed not only for growth and development but also for healing process, reduced length of stay and reduced the occurrence of complication.^2,3 The incidence of hospitalized malnutrition increased with increas- ing length of stay.⁴ The prevalence of hospitalized malnutrition in inpatient children were 6.1-51.6%.³ The incidence hospitalized malnutrition in inpatient children at Sanglah hospital was 30.1%.⁴ Hospitalized malnutrition is one indicator of hospital care.³

Early detection of hospital malnutrition is important, but there were currently no appropriate indicators for early detection of hospital malnutrition. Most hospital malnutrition checks take considerable time with analytical methods and often require laboratory tests, making it less appropriate to use as a screening tool.³ Pediatric Yorkhill Malnutrition Score (PYMS) is one of the instruments to detect hospital malnutrition, that was developed in tertiary children’s hospital Royal Hospital for Sick Children (RSHC), Yorkhill,

Glasgow. PYMS examination quite simple, by assessing the four variables of body mass index, history of weight loss, decreased ability to eat and the patient’s clinical condition affecting the patient’s nutritional status. PYMS may be used in pediatric patients as well as in pediatric surgery patients.⁵

Hospitalized malnutrition can be prevented, with periodic evaluation of nutrition status and early detection of hospital malnutrition.² Pediatric Yorkhill Malnutrition Score can be one of the instruments used at Sanglah Hospital to prevent hospital malnutrition, despite research on the validity of PYMS were limited. This study aims to evaluate the validity of PYMS to detect hospitalized malnutrition in pediatric patient at Sanglah Hospital.

METHOD

This observational analytic study was using prospective cohort approach. This study was done on August 2017 until December 2017 at Sanglah Hospital Denpasar. Target population was pediatric patients. The reachable population was pediatric patients at Sanglah hospital Denpasar. Informed consent was obtained from the parents. The inclusion criteria were pediatric patient aged 1 month until 17 years old with

1Resident in Pediatric Medicine, Faculty of Medicine, Udayana University‑Sanglah General Hospital, Bali‑Indonesia

2Biomedcine Magister Program, Post Graduate Program, Udayana University

3Department of Child Health, Faculty of Medicine, Udayana University‑Sanglah General Hospital, Bali‑Indonesia

*Corresponding to: Benny Herlianto, Resident in Pediatric Medicine, Faculty of Medicine, Udayana University‑Sanglah General Hospital, Bali‑Indonesia, Biomedcine Magister Program, Post Graduate Program, Udayana University

[email protected]

Received: 2018‑08‑21 Accepted: 2018‑10‑14 Published: 2019‑4‑1

Volume No.: 8 Issue: 1

First page No.: 78 P-ISSN.2089-1180 E-ISSN.2302-2914

Doi: http://dx.doi.org/10.15562/bmj.v8i1.1299

ORIGINAL ARTICLE

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79 Published by DiscoverSys | Bali Med J 2019; 8(1): 78-82 | doi: 10.15562/bmj.v8i1.1299

ORIGINAL ARTICLE

expected length of stay (LOS) at least one day.

Patients with incomplete data were excluded.

This study was performed under supervision of Nutrition and Metabolic Disease Subdivision, Department of Child Health in Sanglah Hospital, Medical School of Udayana University and approved by ethical clearance 2018.02.1.0517 from the Ethics Committee of Faculty of Medicine, Udayana University-Sanglah General Hospital, Bali-Indonesia.

Subjects were consecutively enrolled until complete the required sample size. Based on previous study, the prevalence of hospitalized malnutrition in children is 30,1%.⁴ The minimum subjects required in this study is 238 subjects. Age, sex, nutritional status, and PYMS score were recorded.

Weight was measured at admission and discharge by trained medical staff. Nutritional status was categorized as malnourished, well-nourished, and obese.

Descriptive data are shown as median and percentage in table. Unpaired t-test was used to compare between hospitalized malnutrition subject and subject without hospitalized malnutrition if the data was not normal using Mann-Whitney test.

Categorical data were compared with Chi-square and Fisher test if the Chi-square condition unfulfilled.

PYMS is a screening tool for risk of nutritional status and growth for children. A score of 0 indicates low risk, 1 indicates medium risk and 2 or above high risk. PYMS consists of 4 question with a maximum score 7 points:

a. Is the patient’s BMI below the limit on the BMI table?

- Yes (2 points) - No (0 points)

b. Has the child lost weight recently?

- Yes, unintentional weight loss, clothes looser, poor weight gain (if <2 years) (1 point) - No (0 point)

c. Has the child had a reduced intake (including feeds) for at least the past week?

- Yes, no intake (or a few sips of feed only) for at least the past week (2 point)

- Yes, decrease of usual intake for at least the past week (1 point)

- No, usual intake (0 point)

d. Will the child’s nutrition be affected by the recent admission/condition for at least the next week?

- Yes, no intake (or a few sips of feed only) for at least the next week (2 point)

- Yes, for at least the next week decreased intake and/or increased requirements and/

or increased losses (1 point) - No (0 point)

Hospitalized malnutrition define if the patient has weight loss > 2% if the patient length of stay less than one week, or 5% if more than one month, or 10% if more than six-month hospitalization.

RESULT

Between August and December 2017, 389 subjects fulfilled the inclusion criteria. One hundred and forty-nine subjects were excluded because incomplete data. Two hundred and forty subjects were retained for analysis.

The characteristics of subjects are described in table 1. The median age of all subjects was three year, 53% was male and 40.6% was female. In this study, 45% subject was malnourished, 40.4% subject was well nourished, and 14.6% was obese. The minimum length of stay was three days, the longest length of stay was 100 days. There was 14.1% suffered hospitalized malnutrition. There were 40.8% of subject with low risk, 13.3% medium risk and 45.8% high risk.

Result of validity was presented in two table based on the group of malnutrition risk. The high risk of PYMS had 64.7% sensitivity, and 57.2%

specificity, PPV 20% and NPV 90.7%. (Table 2) However, when the high risk was combined with the medium risk the PYMS had 97.1% sensitivity, and 47.1% specificity, PPV 23.2% and NPV 98.9%

for detecting children who are at risk for hospitalized malnutrition (Table 3).

There was no different between subject with hospitalized malnutrition and subject without hospitalized malnutrition in sexes, ages, and nutritional status. There was significant difference in length of stay. The subject with hospitalized malnutrition had a longer lengths of stay (p<0.05) (Table 4).

DISCUSSION

Hospitalized malnutrition can be caused by decrease in appetite due to the illness so that the nutrient intake was low, on the other hand nutritional requirements are indispensable for the healing process. Hospitalized malnutrition alone will sever the underlying disease and slow the healing period.⁴ European Society for Parenteral and Enteral Nutrition (ESPEN) recommended every hospital to use hospital malnutrition screening tools to the patient to detect nutritional deficiencies

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ORIGINAL ARTICLE

and whether these nutritional deficiencies can occur when the patient is in care. Based on ESPEN the hospital’s malnutrition screening tool should include at least four basic questions:^6,7

1. How is the actual condition now? This item concerns the actual body composition of the patient. Height and weight can be measured to allow calculation of SD-scores or BMI

2. Is the condition stable? This item embodies recent weight loss that can be obtained from the patient’s history, or even better, from previous measurements in medical records

3. Will the condition worsen? This question may be answered by asking whether food intake has been decreased up to the time of screening and if so by approximately how much and for how 4. Will the disease process accelerate nutritional long deterioration? This item covers the underlying disease process which may increase nutritional requirements due to the stress metabolism associated with the severity of the underlying disease, causing nutritional status to worsen more rapidly or to develop a poor nutritional status rapidly from fairly normal states.

Pediatric Yorkhill Malnutrition Score was based on the basic principles laid down by ESPEN. The basic screening principles by using PYMS to look at the nutritional status at the time of hospitalization, the previous weight loss, the reduced intake due to the underlying disease, and the severity of the disease that causes interruption of the patient’s feed intake at the time of treatment.^6,7 The objective of PYMS is to identify the nutritional status of the patient, the need for intervention to the nutritional status of the patient, and to predict the nutritional status outcome without intervention from the patient.⁷ Pediatric Yorkhill Malnutrition Score screening tool is a questionnaire consisting of four questions. The patient’s current nutritional status measured using anthropometric status, making the PYMS easy to use by anyone at the time of inpatient care, on the other hand there was a problem of differences in the determination of risk status when screening done by different people.^5,7 In this study PYMS conducted by the researcher who is a senior pediatric resident.

The prevalence of hospitalized malnutrition in pediatric ward Sanglah Hospital was 14.1%. The prevalence of hospitalized malnutrition varied from 15.5% too 51.6%.^8,9 This difference was happened due to different criteria for hospitalized Table 1 Subject characteristic based on risk of malnutrition

Variables n = 240

Age (year), median (minimum-maximum) 3 (1-17) Sex

Male, n (%) 128 (53.3)

Female, n (%) 112 (46.7)

Nutritional status

Malnourished, n (%) 108 (45)

Well-nourished, n (%) 97 (40.4)

Obese, n (%) 35 (14.6)

Length of stay, median (minimum-maximum) 7 (3-100) Body mass index

Below the limit, n (%) 94 (39.2)

Above the limit, n (%) 146 (60.8)

Weight loss recently

No, n (%) 216 (90)

Yes, n (%) 24 (10)

Decrease food intake

No, n (%) 185 (77.1)

Yes, decrease intake, n (%) 53 (22.1)

Yes, no intake, n (%) 2 (0.8)

Clinical condition affect food intake

No, n (%) 207 (86.3)

Yes, decrease intake, n (%) 28 (11.7)

Yes, no intake, n (%) 5 (2.1)

Hospitalized Malnutrition

No, n (%) 206 (85.9)

Yes, n (%) 34 (14.1)

Risk of malnutrition

Low risk, n (%) 98 (40.8)

Medium risk, n (%) 32 (13.3)

High risk, n (%) 110 (45.8)

Table 2 Sensitivity and specificity of PYMS in high risk and low + medium risk group

Hospitalized malnutrition

Yes No

Malnutrition Risk High risk 22 88

Low + medium risk 12 118

Sensitivity 64.7%

Specificity 57.2%

Positive predictive value 20.0%

Negative predictive value 90.7%

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ORIGINAL ARTICLE

malnutrition. Some researchers use the criteria of any weight loss, some use decrease of Z-score weight per height more than 0,5 SD, others define as a loss of weight greater than 2% or a decrease in BMI greater than 0.25 SD.^4,10

In our study there was significant difference in length of stay in each group. Length of stay signifi- cantly longer in hospitalized malnutrition group.

This finding was previously reported in previous study.¹¹ However, length of stay is related to adverse effect of immune system vulnerability, increased risk of infections, gastrointestinal complication, impaired organ function, higher treatment cost and increased mortality.^11,12 Length of hospital stay is negatively related with satisfaction of hospital food in inpatient children patient, that could lead to lack of intake of nutrition in the patient.¹⁰ In our study, the median for length of stay was seven day.

There was a significant difference between subject with hospitalized malnutrition group and subject without hospitalized malnutrition group (p<0.05) in length of stay in hospital. In previous study at

Sanglah hospital found that length of stay more than fourteen days increased 8.1 times the risk of hospitalized malnutrition.¹³ The patients with chronic illness tended to have a higher PYMS score, and tend to have a longer length of stay.¹⁴ This study did not analyze the disease of the patient, whether acute or chronic disease.

There is discrepancy between hospitalized malnutrition and nutritional status on admission.

In the study before found that normal weight and mildly malnourished patients do not draw the attention of the healthcare team to a possible need of nutritional support, while patient with moderate malnutrition receives special care.¹⁰ In this study there were no differences in prevalence of hospitalized malnutrition in each of nutritional status (Table 4), with p-value was 0.5. In Sanglah hospital every patient in pediatric ward will be done nutrition assessment by the resident, then they all will be followed up by the nutritionist, although they have no malnutrition. In this study we used Waterlow classification to determine nutritional status, while in PYMS used BMI.

The study that held in Hasan Sadikin Bandung Hospital found that the sensitivity of PYMS was 95.1% and the specificity was 76.2%.⁶ That found PYMS much better than the other screening tool like modified Simple Pediatric Nutritional Risk Score (SNRS), STRONG-kids and STAMP. On previous study at Sanglah hospital found that modified SNRS had 79% sensitivity and 71% specificity.¹⁵ On the Gerasimidis study that compares STAMP, PYMS and SGNA, which involved 2.174 children found that PYMS had 85% sensitivity and 87% specificity and was conclude that PYMS was a better screening tool to identified hospitalized malnutrition risk in children.⁵ In our study the sensitivity of high-risk group was 64.7% and the specificity was 57.2%. However when the high risk combined with medium risk the sensitivity was 97.1% and the specificity was 47.1%. Patients who had BMI less than -2 SD were in the high-risk group due to PYMS score at hospital admission, these made false positive frequently occurred espe- cially in patients with patients with short length of stay. These might be happening because the policy in Sanglah hospital to do the nutritional assessment in all pediatric patient that came to hospital. The nutritionist team could make early intervention by at Sanglah Hospital when the pediatric patient came to hospital, which made numbers of false-positive case increase and decreased the specificity.

Limitation of this study is sensitivity and specificity found in the group in a combination of high risk with a combination of low and medium risk is low enough so that it is less relevant as a tool for diagnostic.

Table 3 Sensitivity and specificity of PYMS in nutritionally medium + high risk and low-risk group

Hospitalized malnutrition

Yes No

Malnutrition Risk Medium + high risk 33 109

Low risk 1 97

Sensitivity 97.1%

Specificity 47.1%

Positive predictive value 23.2%

Negative predictive value 98.9%

Table 4 Comparison between subject with hospitalized malnutrition and subject without hospitalized malnutrition

Hospitalized Malnutrition

p-value

Yes No

Sex 0.579*

Male, n (%) 20 (58.8) 108 (52.4)

Female, n (%) 14 (41.2) 98 (47.6)

Age (year), median

(minimum-maximum) 3,5 (1-16) 3 (1-17) 0.972**

Nutritional status 0.547*

Malnourished, n (%) 18 (52.9) 90 (43.7)

Wellnourished, n (%) 11 (32.4) 86 (41.7)

Obese, n (%) 5 (14.7) 30 (14.6)

Length of stay, days, median

(minimum-maximum) 24.5 (3-100) 7 (3-42) <0.05**

* Chi-Square test

** Mann –Whitney

(18)

ORIGINAL ARTICLE

CONCLUSION

The sensitivity of PYMS in high-risk group was 64.7% and the specificity was 57.2%. However when the high risk combined with medium risk the sensitivity was 97.1% and the specificity was 47.1%. This result is acceptable for a screening tool, however it also important to ensure to the staff low score does not negate referral for dietetic assessment for other valid reasons.

CONFLICT OF INTEREST

Author have no conflict of interest regarding all aspect in this study.

REFERENCES

1. Sidiartha IGL. Insidence of malnutrition in sanglah general hospital. Medicina. 2012;32:15-18.

2. Juliaty A. Malnutrition in Wahidin Sudirohusodo Hospital, Makasar. Sari Pediatri; 2013;15(2):65-8.

3. Sjarif D, Lestari E, Mexitalia M, Nasar S. Malnutrisi rumah sakit. Dalam: Buku ajar nutrisi pediatrik dan penyakit metabolik. Jakarta: Ikatan Dokter Anak Indonesia. 2011.

p.165-75.

4. Sidiartha IGL. Malnutrition in child and toddler in Sanglah General Hospital. Sari Pediatri. 2008;9(6):381-5.

5. Gerasimidis K, Keane O, Macleod I, Flynn DM, Wright CM. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. British Journal of Nutrition. 2010;104:751-6.

6. Wonoputri N, Djais JTB, Rosalina I. Validity for nutritional screening tools for hospitalized children. J Nutr Metab. 2014; 2014: 143649.

7. Joosten KFM, Hulst JM. Nutritional screening tools for hospitalized children: methodological consideration.

Clinical nutrition. 2014;33(1):1-5.

8. Geila AR, Rocha EJM, Martins CV. The effects of hospitalization on the nutritional status of children. J Pediatr (Rio J). 2006;82:70-4.

9. Kac G, Camacho-Dias P, Silva-Coutinho D, Silveira-Lopes R, Vilas-Boas V, Pinheiro ABV. Length of stay is associated with incidence of in-hospital malnutrition in a group of low-income Brazillian children. Salud Publica Mex. 2000;42:407-12.

10. Gouvia MAC, Silva GAP. Hospital malnutrition in pediatric patients: a review. Ann Nutr Disord & Ther.

2017;4(2):1042.

11. Hecth C, Weber M, Grote V, Daskalou E, Dell’era L, Flynn, et al. Disease associated malnutrition correlates with length of stay in children. Clinical nutrition. 2015;34(1):53-9.

12. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and health care system. Int J Environ Res Public Health.

2011;8:514-27.

13. Girsang SN, Sidiartha IGL. The incidence of in-hospital malnutrition in children at Sanglah Hospital Denpasar and its association with length of stay. Medicina.

2017;48(2):98-102.

14. Beser OF, Cokugras FC, Erkan T, Kutlu T, Yagci RV.

Evaluation of malnutrition development risk in hospitalized children. Nutrition. 2018;48:40-7.

15. Nesa NNM, Sidiartha IGL, Prawitohartono EP, Suandi KG.

Accuracy of modified simple pediatric nutritional risk score to detect in-hospital malnutrition. Paediatr Indones.

2010;50(5):305-9.

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