Journal of Maternal and Child Health, Vol. 11 No. 3 (2026) 

Risk Factors for Prolonged Hospitalization in Children with Acute Lymphoblastic Leukemia and Pneumonia

Asti Pramita Sari, Department of Pediatrics, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia Dr. Moewardi General Hospital, Surakarta, Indonesia
David Anggara Putra, Department of Pediatrics, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia Dr. Moewardi General Hospital, Surakarta, Indonesia
Septin Widiretnani, Department of Pediatrics, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia Dr. Moewardi General Hospital, Surakarta, Indonesia

Abstract
Background: Acute lymphoblastic leukemia (ALL) is a common malignancy in children, particularly those aged 2-5 years. Disease-related immunosuppression and chemotherapy side effects increase the risk of infection. Pneumonia is the foremost common complication amid chemotherapy in children with ALL. Length of hospitalization is an indicator of pneumonia severity, but there is insufficient evidence to determine the risk factors for prolonged of hospitalization in pediatric patients with ALL. The objective of this study was to analyze the risk factors for prolonged of hospitalization in pediatric pneumonia patients with ALL.  
Subjects and Methods: A cross-sectional study involving 50 pediatric ALL patients with pneumonia aged 1 month to <18 years. Patients diagnosed with Covid-19, discharged from the ward at their own request, incomplete medical record documentation, and those who died during treatment were excluded. Proposed risk factors for prolonged of hospitalization include neutropenia, anemia, malnutrition, time of diagnosis, complications, and antibiotic type. Data analysis used chi-square/Fisher exact test and binary logistic regression.  
Result: Most patients were ≥6 years old (64%) with a mean of age 7.4 years, male (60%), had anemia (74%), and were malnourished (56%). Neutropenia was found in 38% of patients, more than half were in the induction chemotherapy phase, and the majority were in the high-risk stratification (82%). The mean of hospitalization was 
13.94 days. Patients reaching hospital was promptly in most subjects (62%), antibiotics were used according to WHO standards (72%), the majority had no complications (96%), and showed positive culture results (86%) with the most common type of microorganism was Klebsiella pneumoniae (20%).  
Conclusion: Nutritional status and duration prior to seeking care were independent risk factors for prolonged of hospitalization in pediatric patients with pneumonia and ALL. The predictive power of duration prior to seeking care was more dominant than nutritional status. 
Keywords: Prolonged of hospitalization, risk factor, pneumonia, ALL