Page 369 - Abstract Book KONIKA 18

Nutrition & Metabolic Diseases

P–NMD–023
Outcomes of Critically Ill Children with Malnutrition
in Pediatric Intensive Care Unit Prof. Dr. R.D. Kandou Hospital Manado

Eva Astria, Ronald Rompies, Adrian Umboh
Department of Child Health, Faculty of Medicine, Universitas Sam Ratulangi/
Prof. Dr. R.D. Kandou Hospital, Manado, North Sulawesi, Indonesia

Abstract
Background Malnutrition has been shown to be associated with increased morbidity and mortality. Nutritional
status in critically ill children can be deteriorate during hospitalization and may have negative effects on
patients’ outcome. Objective To evaluate the prevalence of malnutrition and their outcomesin critically
ill children.Methods Observational study in critically ill children, one month to 17 years old, admitted
to Paediatric Intensive Care Unit (PICU) Prof. Dr. R.D. Kandou Hospital Manado between February to
September 2020. Nutritional status was assessed using Z-score in children younger than five years and
CDC 2000 in 5 to 18 years old children. Patients were divided into severely wasted, wasted, normal weight,
overweight and obese. Various outcomes such as mortality, duration of PICU stay and duration of mechanical
ventilation were also analyzed. Results Out of 67 critically ill children, 26 of 67 patients (38.8%) were
wasted/severely wasted, 31 of 67 patients (46.26%) were normal weight and 10 of 67 patients (14.92%) were
overweight/obese based on weight-for-height chart on admission. Severely wasted/wasted and overweight/
obese patient had higher odds for prolonged PICU stay [OR 3.29, 95%CI 1.07 to 10.08; P=0.03] and [OR
1.82, 95%CI 0.42 to 7.76; P=0.41] respectively. There was no significant difference in mortality and duration
of mechanical ventilation support among the groups. Conclusion Prevalence of malnutrition in critically
ill patient is high and it is associated with poor outcome. Assessment of nutritional status by anthropometry
should be performed on PICU admission to set an optimal therapyand nutritional strategies aimed at preventing
further nutritional deterioration.
Keywords: nutritional status; critically ill children; outcome

P–NMD–024
Lessons Learned from Siblings with Methylmalonic Acidemia:
Early Detection for Better Prognosis
Ayu Diriantini , Cut Nurul Hafifah , Damayanti Rusli Sjarif 2
1
2
Department of Child Health and Nutrition and Metabolic Division, Department of Child Health ,
2
1
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Abstract
Background Methylmalonic acidemia (MMA) is a rare inherited metabolic disorder classified as organic
acidemia. It usually presents as acute encephalopathy in neonatal period and can mimic other diseases, such
as neonatal sepsis. Neonates who experience this disorder are usually born under normal circumstances and
symptoms will appear within hours or weeks. Early detection is important to prevent further complication.
Objective To describe two cases of MMA in siblings with different outcomes. Case The first baby girl
presented at 3 days-old with respiratory distress after a period of normal newborn period. On laboratory
examination we found hyperammonia, hyperlactatemia and metabolic acidosis. She died at the age of 13
days with suspicion of organic acidemia.The younger sibling was born 1,5 year after the first baby died.
Before he was born, a special preparation was done (examination plan and special protein formula). However
he presented with respiratory distress,vomiting and loss of consciousness at 1 day-old. We also found
hypoglycemia, metabolic acidosis, hyperammonia, and hyperlactatemia.Amino acids, acylcarnitine, and
organic acids of urine test was carried out which confirmed the diagnosis of MMA.Genetic analysis showing
compound heterozygote pathogenic variants on MUT gene (c.1561-2A>G and c.1358G>C), consistent with
MMA type Mut0. Initial management during decompensation phase were administration of glucose only with
cessation of protein and lipid intake for approximately 48 hours and introduction of special medical formula.
He is now 2 years old with only minor problems in growth and development. Conclusion Early diagnosis
and appropriate management is essential for better prognosis in IEM presenting with acute encephalopathy.
Keywords: organic academia; methylmalonic academia; acute encephalopathy; newborn

KONIKA XVIII Abstract Book 321