Archives of Pediatric Gastroenterology, Hepatology, and Nutrition
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition (APGHN) is the official journal issued by the Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (Perhimpunan Gastroenterologi, Hepatologi, dan Nutrisi Anak Indonesia).
The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition
The Role of Gut Microbiota in Pediatric Obesity: A Systematic Review and Meta Analysis of Microbiota Profiles in Obese versus Normal Weight Children
Background: Pediatric obesity is increasingly acknowledged as a significant public health issue with the gut microbiome identified as a potential contributing factor. Increasing evidence indicated that the gut microbiome is integral to metabolic health and the etiology of obesity. Nonetheless, data pertaining specifically to pediatric populations is still limited and underexplored. This study compared the composition of gut microbiota between obese and normal-weight children and to identify microbial patterns associated with pediatric obesity. Methods: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A thorough literature search was performed across various databases. We looked at eligible studies and then rated their quality and analyzed them with Newcastle–Ottawa Scale (NOS) and Review Manager (RevMan) 5.4. Result: This systematic review and meta-analysis included ten studies involving 562 children, utilizing cross-sectional and case-control methodologies. The meta-analysis, which included two studies with 124 participants (64 obese and 60 normal-weight), showed that the Firmicutes to Bacteroidetes (F/B) ratio was much higher in obese children than in normal-weight (mean difference = 5.15; p < 0.00001). Taxonomic analysis showed obese children had more members of the phylum Firmicutes, such as Lactobacillus, Clostridium, and Megamonas. On the other hand, Bacteroidetes, especially Prevotella and Bacteroides, were usually less abundant. Conclusion: The results indicate that dysbiosis in gut microbiota may contribute to pediatric obesity. These results underscore the potential of gut microbiota modulation as a treatment for childhood obesity. Research is necessary to clarify causal mechanisms and investigate microbiota-based-interventions.
Copyright (c) 2025 Karina Fitria Alhaq, Fayyaza, Athifah, Pricilia, Filla https://creativecommons.org/licenses/by-nc/4.0
Nutritional Formula Selection in Pediatric High-Output Stoma with Acute Kidney Injury: A Review Article
Background: High-output stoma (HOS) is a common complication in pediatric patients with ileostomy, often leading to dehydration, electrolyte imbalance, and malnutrition. These complications increase the risk of acute kidney injury (AKI), which is associated with high morbidity and mortality. Nutritional management in children with HOS and AKI is challenging, requiring careful formula selection to maintain adequate energy and protein intake, fluid and electrolyte balance, and optimize gastrointestinal tolerance. Discussion: In children with HOS and AKI, the selection of an appropriate enteral formula represents a critical component of nutritional management, aiming to mitigate dehydration, electrolyte disturbances, and protein-energy malnutrition. Isotonic or mildly hypotonic solutions are preferred to minimize osmotic losses. Electrolyte composition must be adjusted to account for impaired renal handling in AKI. Semi-elemental formulas are generally recommended as first-line therapy due to their enhanced absorptive properties and relatively lower potassium and phosphate content compared with polymeric preparations. Transition to polymeric formulas may be considered once stoma output stabilizes and renal function improves. Elemental formulas are reserved for severe malabsorption, intolerance, or when strict electrolyte restriction is required. Continuous enteral infusion is preferred during the acute phase to reduce stoma output volume and nutrient loss, with a gradual transition to intermittent bolus feeding to promote intestinal adaptation and stimulate gut hormone. Conclusion: Individualized nutritional management is essential in pediatric patients with HOS and AKI. Semi-elemental formulas, electrolyte adjustments based on renal function, and tailored feeding strategies help maintain fluid–electrolyte balance, prevent malnutrition, and support recovery and growth.
Copyright (c) 2025 Gisheila Ruth Anggitha, Ariani Dewi Widodo, Adrian Himawan Singgih https://creativecommons.org/licenses/by-nc/4.0
Treatment of Severe Unconjugated Hyperbilirubinemia with Phenobarbitone in Two First-Degree Siblings with Crigler-Najjar Syndrome (CNS) Type 2: A Success Story
Background: Crigler–Najjar syndrome (CNS) type 2 is a rare autosomal recessive disorder of bilirubin conjugation caused by mutations in the UGT1A1 gene. It presents in infancy with unconjugated hyperbilirubinemia that does not respond to phototherapy but improves with phenobarbitone, which enhances residual enzyme activity. Although phenobarbitone remains the cornerstone of treatment, familial recurrence of CNS type 2 is rarely reported in pediatric literature. Case: We report two siblings born to consanguineous parents who presented with progressive jaundice during early infancy. The first child, a 2-month-old boy, had multiple hospitalisations for phototherapy without benefit. Laboratory evaluation revealed total bilirubin of 31 mg/dL with normal liver function and no evidence of hemolysis. Genetic testing confirmed a homozygous UGT1A1 (c.1456T>G; p.Tyr486Asp) mutation. He was treated with phenobarbitone (5–8 mg/kg/day) and calcium phosphate, achieving a bilirubin level <10 mg/dL within 4 weeks. Three years later, his younger sister developed similar unconjugated jaundice from day 4 of life and harboured the same mutation; she responded well to phenobarbitone alone. Both siblings remain well on long-term follow-up. Discussion: This case highlights the genetic basis and favorable response of CNS type 2 to phenobarbitone, which induces hepatic UGT1A1 expression. Familial clustering of CNS 2, though reported in few global studies, is seldom documented from India. Conclusion: Early genetic diagnosis, timely institution of phenobarbitone, and family counselling are critical for successful management of CNS type 2. These cases reaffirm the long-term safety and efficacy of phenobarbitone in familial presentations of this rare disorder.
Copyright (c) 2025 Sachin Kumar, Siddhavatam Rahul Karthik, Gandharav Pahuja, Sarthak Chakrabarti, Prateek Kumar Panda, Indar Kumar Sharawat https://creativecommons.org/licenses/by-nc/4.0
Aerobic Exercise as a Therapeutic Strategy in Children and Adolescents with Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) and Obesity: A Systematic Review
Background: Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) is the most prevalent chronic liver disease in children and adolescents, particularly those with obesity. MASLD often progresses to serious hepatic and metabolic complications. Although aerobic exercise (AE) is widely recommended as a first-line lifestyle intervention, its therapeutic efficacy remains unclear. This study evaluates the effects of AE on body composition, liver enzyme, lipid profile, metabolic markers, and liver imaging. Methods: A comprehensive literature search was conducted across PubMed, Cochrane Library, Scopus, and EBSCOhost. Clinical studies involving AE in pediatric patients (≤18 years) with MASLD and BMI ≥ 85th percentile were independently screened. Result: From 141 records, five studies (3 RCT, 2 Interventional Study) involving 97 children (mean age 13.22±2.24 years) met the inclusion criteria. AE protocols typically consisted of 30-60 minutes sessions, thrice weekly, over 1-12 months. AE intervention had significantly decreased BMI in 2 of 3 studies, and visceral fat in 1 of 2, with no change in lean mass. Significant improvements of AST and ALT (Δ –1.0 to –34.0 and –1.0 to –27.17) were reported in 3 of 5 studies. However, lipid profiles showed inconsistent effects, and most metabolic markers (glucose, insulin, HOMA-IR, adiponectin, leptin) showed no significant changes. Liver imaging from 3 studies reported resolution or reduced MASLD severity. Conclusion: AE provides selective benefits in MASLD-obese children and adolescents. Improvements were observed in BMI, liver enzymes, and liver imaging, while the effects on lipid and metabolic markers remain inconsistent.
Copyright (c) 2025 Nerissa Arviana Fuad, Annisa Alifianti, Nabila Annisa Harum, William Cheng https://creativecommons.org/licenses/by-nc/4.0
Pediatric Hepatic Abscess in a Resource-Limited Setting: A Case Report
Background: Liver abscess is a rare but serious pediatric infection, more common in developing regions where malnutrition, poor sanitation, and limited healthcare access increase risk. It is broadly classified into pyogenic and amoebic types, with the latter more prevalent in tropical areas. Symptoms such as fever, abdominal pain, and hepatomegaly are often nonspecific, making diagnosis difficult in low-resource settings. Ultrasound plays a crucial role when advanced diagnostics are unavailable. This case illustrates these challenges in a remote hospital in Eastern Indonesia. Case: A 13-year-old boy presented with right upper quadrant pain, intermittent fever, and hepatomegaly. Ultrasound revealed a 7 × 6 cm hepatic abscess. He received empiric intravenous antibiotics, but due to limited facilities for image-guided drainage, exploratory laparotomy with abscess evacuation was performed. The patient showed steady postoperative improvement, was discharged in good condition, and achieved full recovery on follow-up. Discussion: This case illustrates how resource availability influences diagnostic and therapeutic decisions for pediatric liver abscess. Although ultrasound-guided drainage is the preferred minimally invasive approach, the absence of interventional radiology services required surgical management. The patient’s improvement with empiric antibiotics and intraoperative findings supported a pyogenic etiology, underscoring the value of clinical judgment when microbiological testing is unavailable. In settings such as Eastern Indonesia, early imaging and timely empiric treatment remain crucial to guide care despite limited diagnostic resources. Conclusion: Pediatric liver abscess can still be effectively managed in low-resource settings through prompt diagnosis, empiric therapy, and timely surgical intervention.
Copyright (c) 2025 Adinda Paramitha Sukma Damayanti , Khalisah Nurjihany Salsabila, Bethseba Brontang Pulinggomang https://creativecommons.org/licenses/by-nc/4.0
The Role of Green Banana in The Dietary Management of Children with Diarrhea: A Systematic Review and Meta Analysis
Background: Diarrheal disease is a leading cause of morbidity and mortality among children under five, particularly in developing countries. Green bananas have shown therapeutic potential in managing pediatric diarrhea. This systematic review and meta-analysis compared the effectiveness of green banana supplementation versus non-green banana dietary management in children with diarrhea, alongside the use of ORS (oral rehydration solution) and Zinc. Outcomes assessed were recovery days, dehydration status, and progression to persistent diarrhea. Methods: A systematic search was conducted across PubMed, Cochrane, Scopus, and ProQuest databases, following the PRISMA guidelines. Qualitative analysis was assessed using the RoB 2.0. Quantitative analysis was performed using RevMan 5.4 with forest plot visualization. Result: From 57 identified studies, eight were included for review (seven randomized controlled trials and one pilot study). Among 1,486 children receiving green bananas, 1,370 recovered from diarrhea within seven days. Meta analysis showed significantly improved diarrheal recovery with green banana on day 3 (OR 3.41, 95% CI: 2.93-3.98, P<0.00001), day 5 (OR 3.48, 95% CI: 2.15-5.62, P<0.00001), and day 7 (OR 2.86, 95% CI: 2.14-3.82, P<0.00001). Green banana supplementation also showed less frequent dehydration (OR 0.38, 95% CI: 0.16-0.92, P=0.03) and reduced the progression to persistent diarrhea (OR 0.29, 95% CI: 0.21-0.39, P<0.00001). Conclusion: Green banana with high pectin and amylose-resistant starch (ARS), is an effective dietary adjunct in the management of pediatric diarrhea, in terms of improving recovery, reducing dehydration, and preventing prolonged diarrhea in children due to their antimicrobial and anti-inflammatory compounds.
Copyright (c) 2025 Nida Ghitha, Anjani Larasati, Heidi Satari, Fiona Maharani Indira, Yoga Devaera, Pramita Gayatri https://creativecommons.org/licenses/by-nc/4.0
Diagnostic and Management Approach of Obesity with Multiple Complications in a Child: A Case Report
Background: Adults with obesity may already experience obesity during childhood or adolescence, highlighting the critical importance of early intervention. This is particularly concerning given that childhood obesity, a growing component of Indonesia's "triple burden of malnutrition," significantly increases the risk of developing severe non-communicable diseases and reducing life expectancy. Case: A 10-year-old male patient presented with a chief complaint of shortness of breath for the past two weeks, worsened when lying down and improved when sitting up. The patient also snored, often woke up due to difficulty breathing. The patient had experienced rapid weight gain since the age of 2 years. He ate in large portions, frequently snacked, and consumed sugary drinks daily. He had no regular physical activity and was mostly sedentary. He showed signs of obesity (BMI 35.8 kg/m²), short stature, and physical abnormalities including a rounded face, double chin, acanthosis nigricans, and bowed legs. Discussion: Diagnosing obesity requires comprehensive history and physical examination to distinguish between primary and secondary causes. Our patient's early-onset obesity and hyperphagia prompted leptin level evaluation, although the result was within normal limit, leptin resistance or receptor imbalance was suspected. In this case, familial lifestyle factors appear to play a role, highlighting the importance of a family-centered approach. Management of obesity includes dietary modification, physical activity, sleep and behavioral regulation, and pharmacologic therapy when indicated. Conclusion: An accurate diagnostic approach is crucial to guide optimal management strategies in complicated cases of obesity.
Copyright (c) 2025 Siti Azura Putri Dilla Sari, Cut Nurul Hafifah https://creativecommons.org/licenses/by-nc/4.0
Unlocking The Efficacy of Tetrahydrobiopterin (BH4) Towards Metabolic Profile and Growth Status in Children with Phenylketonuria: A Meta Analysis
Background: Phenylketonuria (PKU) is one of the most common types of inborn error of metabolism. Low-phenylalanine diet has been the main treatment for children with PKU. However, recent therapeutic alternatives have emerged as a solution in children with PKU in the form of tetrahydrobiopterin (BH4). This meta analysis aims to assess the effectiveness of BH4 in terms of response rate, metabolic profile and growth status. Methods: Meta analysis was conducted by searching databases such as PubMed, ScienceDirect, Cochrane Library, medRxiv, and Scopus based on the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. Data synthesis and analyses were conducted using R version 4.5.1 (R Foundation for Statistical Computing). Result: Fifteen studies were involved in this research, consisting of 1280 children (1063 given BH4). Eight studies reported BH4 reduced plasma phenylalanine concentration by around (686.83 mg/day [95% CI 394.85 to 978.82], p <0.001). Additionally, two studies reported a reduction in plasma phenylalanine concentration, measured in mg/kg/day, following BH4 administration. Children given BH4 and low phenylalanine diet combination showed a higher response rate compared to BH4 only (100% vs 76%). Two studies showed no difference in growth outcomes, which remained within the normal range. Conclusion: BH4 shows promise as an adjunct therapy for children with PKU, but confirmation through larger, standardized, long-term studies assessing outcomes such as growth status and long-term neurocognitive outcome is needed.
Copyright (c) 2025 Rafi Alfian Razan, Nur Aisiyah Widjaja, Anggie Lorenza, Vianca Samara Andhary, Naoval Diza Ananda https://creativecommons.org/licenses/by-nc/4.0
Syphilitic Hepatitis in Infancy Presenting with Cholestatic Jaundice and Inguinal Hernia: A Case Report
Background: Congenital syphilis can involve multiple organ systems and, in rare cases, present with syphilitic hepatitis, a cause of cholestatic jaundice in infancy. Early recognition is challenging due to its non-specific presentation and overlap with other etiologies of neonatal cholestasis. This case highlights a rare case of a cholestatic infant with syphilitic hepatitis and concurrent inguinal hernia, emphasizing diagnostic challenges and management in resource-limited settings. Case: A 1-month-26-day-old infant presented with a left inguinal mass and jaundice. The mother had latent syphilis during pregnancy and received benzathine penicillin G only one week before delivery. The infant had persistent jaundice, pale stools, elevated direct bilirubin, transaminases, and alkaline phosphatase. Abdominal ultrasonography showed normal liver echotexture and gallbladder contractility, with no biliary dilatation. Based on clinical, laboratory, and maternal history, a presumptive diagnosis of biliary atresia with differential syphilitic hepatitis was made. Supportive therapy with ursodeoxycholic acid, fat-soluble vitamins, and antibiotics was initiated. The patient was referred for further evaluation by pediatric gastroenterohepatology. Discussion: The infant presented with postnatal jaundice, acholic stools, and elevated indirect bilirubin, initially raising suspicion of biliary atresia. However, the maternal history was positive for syphilis, making syphilitic hepatitis a presumptive diagnosis. Careful clinical evaluation and close serial follow-up are essential for establishing the diagnosis and guiding management. Early antenatal screening and timely maternal treatment remain key strategies to prevent vertical transmission. Conclusion: Syphilitic hepatitis should be considered in the differential diagnosis of neonatal cholestasis, particularly in infants born to mothers with inadequately treated syphilis.
Copyright (c) 2025 Agus Indra Yudhistira Diva Putra, Putu Pradnyanita Mustika, Anak Agung Made Sucipta https://creativecommons.org/licenses/by-nc/4.0
Climate Change and Its Emerging Impact on Pediatric Gastrointestinal Infections in Indonesia – A Review Article
Background: Pediatric gastrointestinal (GI) infections remain a major public health issue in Indonesia, particularly among children under five. These infections are closely linked to poor sanitation, unsafe water, malnutrition, and inadequate healthcare access. Climate change has intensified these challenges, with rising temperatures, floods, and droughts increasingly influencing disease patterns. Despite this growing threat, limited research has explored how environmental changes specifically impact pediatric GI infections in Indonesia. Discussion: Climate change acts as a multiplier of risk for GI infections by disrupting water and sanitation systems, affecting food safety, and limiting hygiene practices. Floods often contaminate drinking water, while extreme heat enhances pathogen survival in food and water. Droughts reduce water availability, limiting handwashing and sanitation. These environmental stressors disproportionately affect vulnerable populations, especially children living in poverty or disaster-prone areas. In addition, climate-related events often disrupt healthcare services and contribute to malnutrition, further increasing children's susceptibility to infections. However, Indonesia’s health and climate policies remain fragmented. There is a lack of integrated research, limited disease surveillance, and insufficient public health preparedness that specifically addresses pediatric needs in a changing climate. Conclusion: To address the growing threat of climate-sensitive pediatric GI infections, Indonesia must strengthen its surveillance systems, invest in climate-resilient health infrastructure, and integrate environmental risks into child health strategies. A coordinated, multisectoral response that prioritizes vulnerable children is essential to reduce disease burden and improve health outcomes in the face of climate change.
Copyright (c) 2025 Daffa Arkananta Putra Yanni, Rafiqa Rais Akbar https://creativecommons.org/licenses/by-nc/4.0
Silent Splenic Infarction Following Infectious Mononucleosis Associated with Antiphospholipid Antibodies in a Pediatric Patient: A Case Report
Background: The splenic infarction (SI) is a rare complication of infectious mononucleosis (IM), especially in paediatric population. The clinical presentation of this condition can vary widely, but it is most often symptomatic (e.g. pain in the left upper quadrant). Case: We report a case of a previously healthy 12 year old female with a silent splenic infarction (SI) following IM by Epstein-Barr virus (EBV), positive for antiphospholipid anti-cardiolipin IgM antibodies (ACA IgM). Discussion: Numerous pathogenetic mechanisms have been proposed for the SI in the course of IM. The definitive diagnosis of SI is made with CT; in our case, given the lack of urgent clinical indications, the definitive diagnosis was made with MRI. Follow-up was continued using ultrasound and therapeutic management was conservative. Conclusion: We describe a rare case of asymptomatic splenic infarction, in a girl with no underlying predisposing condition. It is important for a pediatrician to be aware of this possible complication and its correct therapeutic management.
Copyright (c) 2025 Davide Scarponi, Branislava Cosic, Costanza Fiorilli, Anna Rita Di Biase, Lorenzo Iughetti https://creativecommons.org/licenses/by-nc/4.0
The Effect of Giving One Egg Per Day on Stunted Children Aged 2-5 Years in Buton Regency on Zinc Levels
Background: Despite can be prevented with good nutrition, average prevalence of stunting in Indonesia remains high at 30.8%. The effects of stunting are detrimental to the individual and Indonesia's human resources. Stunted children had low blood zinc levels which disrupted enzyme and antioxidant activity, as well as bone growth processes and bone homeostasis. Eggs that contain zinc and have high bioavailability are expected to be able to increase low blood zinc levels. This study was designed to examine the impact of routine egg consumption on zinc levels in stunted children. Methods: This experimental quantitative study was conducted in the Siontapina Health Center, Buton Regency, Southeast Sulawesi. and included 22 participants which divided into intervention and control groups. The intervention was carried out by health workers giving one egg per day for 30 days with the same type of cooking per day to the participants. Zinc levels were assessed using a spectrophotometer and analyzed using statistical software. Result: The results showed a significant difference between the two groups (p <0.05). The average zinc level in the intervention group was 718.8133 ug/dL, which was higher than the control group (143.4536 ug/dL). Thus, giving 1 egg a day for 30 days caused a significant change in blood zinc levels in stunted children aged 2-5 years in Buton Regency. Conclusion: Stunted children supplemented with one egg daily for 30 days had significantly higher zinc levels than unsupplemented children.
Copyright (c) 2025 Alvreyna Cherienda Laviashna Saputro, Dwirini Retno Gunarti https://creativecommons.org/licenses/by-nc/4.0
Risk Factors of Stunted Children Aged 0-23 Months at Jatibaru Public Health Center Bima, West Nusa Tenggara: A Case Control Study
Background: Nutritional status in children under-five profoundly affects linear growth, cognitive development, and long-term disease. Stunting, defined as a child being too short for their age, results from prolonged malnutrition, particularly in the first 1000 days. In West Nusa Tenggara (NTB), stunting prevalence is the fourth highest at 32.7%, with 31.2% affected in Bima. This study aims to compare previous exposure between stunted children and non - stunted children in primary health care settings in Bima. Methods: A case-control study was conducted involving children aged 0–23 months who accessed integrated health services, bring a Maternal and Child Health Book (MCH), and had recorded health data at the Jatibaru Primary Health Center. Children with congenital anomalies were excluded. Maternal and child-related risk factors were assessed through anthropometric measurements (WHO standards) and structured interviews with validated questionnaire. Bivariate analysis (Chi-square, p < 0.25) was followed by multivariate logistic regression (p < 0.05). Result: A total of 124 participants were included (62 cases, 62 controls). Multivariate analysis revealed that maternal factors significantly associated with stunted growth in children were poor nutritional status (AOR 7.519, p = 0.000) and low nutrition knowledge (AOR 6.930, p = 0.000). Among child-related factors, stunted children were significantly associated with low birth weight (AOR 17.013, p = 0.000) and inadequate breastfeeding (AOR 7.434, p = 0.006). Conclusion: The mother’s nutritional status and children’s birth weight are the main risk factors of stunted children. Targeted interventions addressing maternal education and perinatal care are recommended to reduce stunting prevalence.
Copyright (c) 2025 Khafifah Puja Atmalia, Rania Reiza Faris Balfas, Nurfathonah Aryana, Wulandari Hidaya, Nina Dwi Putri https://creativecommons.org/licenses/by-nc/4.0
Endoscopic Management of a Distal Ileal Foreign Body in a Child with Developmental Delay - A Case Report
Background: Foreign body ingestion is a common problem in the paediatric age group, with most cases involving the upper gastrointestinal tract. Foreign bodies that pass through the oesophagus can be safely observed. Impaction in the bowel can cause intestinal obstruction or perforation. Complicated foreign bodies can be retrieved either surgically or endoscopically. Case: A 4-year-and-6-month-old girl with multiple medical conditions presented four days after the ingestion of two foreign bodies (Hair pins). The child was irritable and experienced a vague lower abdominal pain, which was more pronounced in the right iliac fossa (RIF). With conservative management and a rectal enema one foreign body passed with stool. Over the next day she exhibited increasing distress and worsening RIF tenderness. Colonoscopy without air insufflation revealed an impacted foreign body in the distal ileum about 10cm from the ileocecal valve. Successful retrieval improved her clinical status, and she was discharged two days later. Discussion: Blunt foreign bodies that passed beyond the duodenum require intervention only if they fail to pass in a standard time frame or if a complication arises. Initial conservative management was attempted as she did not have features of generalized peritonism. However, colonoscopy was performed due to worsening distress and localized peritoneal signs, especially given her complex medical background. The procedure was conducted without gas insufflation to avoid pneumoperitoneum in the event of a potential intestinal perforation. Successful retrieval alleviated her clinical symptoms. Conclusion: Colonoscopy with ileal intubation is an effective method for retrieving impacted distal ileal foreign bodies in patients with localized peritoneal signs.
Copyright (c) 2025 Anuradha Lenagala, Jeewan Samarasena https://creativecommons.org/licenses/by-nc/4.0
CMV-Positive Biliary Atresia in Infants: A Review of Prognosis and Therapeutic Impact
Background: Biliary atresia (BA) is a progressive cholangiopathy of infancy that can lead to end-stage liver disease and is the leading indication for pediatric liver transplantation. Among various proposed etiologies, cytomegalovirus (CMV) infection has emerged as a significant factor, giving rise to a distinct clinical subset known as CMV-positive BA. Discussion: CMV-positive BA is frequently associated with delayed diagnosis, increased incidence of postoperative cholangitis, and advanced liver fibrosis at initial presentation. These features contribute to lower rates of jaundice clearance and native liver survival. Mortality is also higher in CMV-positive patients than in their CMV-negative. Diagnostic methods include performing polymerase chain reaction (PCR) tests on saliva, urine, or dried blood spot samples, as well as conducting abdominal ultrasound examinations that focus on identifying specific indicators, such as the triangular cord sign, which is commonly observed in patients with BA. Antiviral therapy, particularly with ganciclovir or valganciclovir, shows promise in improving native liver outcomes in CMV-positive BA patients. Early surgical intervention remains critical, yet CMV-positive BA often presents later, worsening prognosis. Preventive strategies are under investigation, including maternal CMV screening and neonatal testing. Conclusion: Early identification and tailored antiviral intervention may play a critical role in altering the disease trajectory. Increased awareness of CMV-positive BA is essential for timely diagnosis and optimal management. This review emphasizes the need to recognize CMV-positive BA as a clinically important biliary atresia subset with distinct pathophysiology and worse prognosis, underscoring the importance of early CMV screening and targeted antiviral therapy.
Copyright (c) 2025 Qonita Rahmadiena, Nailah Rahmah, Mulya Rahma Karyanti, Himawan Aulia Rahman https://creativecommons.org/licenses/by-nc/4.0
Impact of Probiotics or Synbiotics Supplementation on Weight Gain and Diarrhea in Children with Severe Acute Malnutrition: A Systematic Review and Meta-Analysis
Background: Malnutrition remains a critical global health concern, with both short- and long-term consequences. Children suffering from malnutrition frequently exhibit gut dysfunction, which leads to growth retardation, impaired absorption of essential nutrients and vitamins, and immune dysfunction. Diarrhea is one of the most common conditions in children with malnutrition and can further worsen their condition. Probiotics have been proposed as a potential adjunctive therapy in malnutrition due to their role in modulating gut microbiota. This study aims to evaluate the effects of probiotics on weight gain and diarrhea specifically in children with severe acute malnutrition (SAM). Methods: A systematic literature search was conducted across six databases (PubMed, Cochrane Library, ProQuest, EBSCOhost, ScienceDirect, Google Scholar) using relevant keywords. Data were extracted and analyzed using Review Manager for meta-analysis. Result: Four studies, encompassing a total 1662 patient met the inclusion criteria. Probiotics are proven to reduce significantly the duration of diarrhea and improve the recovery (SMD -0.70; 95% CI -0.89 to -0.50; I² = 0%, p < 0.00001). However, they are not diminishing the incidence of diarrhea. Moreover, this study concluded that the use of probiotics or synbiotics did not significantly impact weight gain. Conclusion: Probiotics demonstrated efficacy in reducing the duration of diarrhea, but not its incidence, potentially contributing to improved recovery outcomes. However, their impact on weight gain in children with SAM remains inconclusive. Further research with larger studies is warranted to identify factors influencing probiotic efficacy and to explore their potential role in the comprehensive management of SAM.
Copyright (c) 2025 Hermelien Sabrina, Nadira Muthi Tsania, Mirari Prasadajudio https://creativecommons.org/licenses/by-nc/4.0
Acute Intestinal Obstruction Due to Ascariasis in a Child: A Case from a Resource Limited Setting
Background: Ascariasis remains a widespread and frequently undiagnosed condition, with most cases being asymptomatic. However, severe manifestations can result in total or partial intestinal obstruction. In resource-limited settings, diagnosis primarily depends on clinical presentation, stool examination, and basic radiographic imaging. Case: A three-year-old child from rural Southwest Sumba presented with vomiting, fever, abdominal pain, and constipation. Physical examination, faecal examination, and imaging revealed partial small bowel obstruction due to an Ascaris bolus, complicated by mild to moderate dehydration. Following conservative management including fluid resuscitation, NPO status, NGT insertion, and single dose albendazole, the patient passed numerous worms, improved clinically, and was discharged on day five. Discussion: This case report highlights the diagnostic and management challenges of a severe form of ascariasis that caused partial small bowel obstruction in a resource-limited setting. The patient's differential diagnoses included intussusception, mesenteric cyst, and abdominal tuberculosis. The patient presented with risk factors including young age, frequent barefoot contact with soil, poverty, residence in an area with limited access to water and healthcare, and a lack of participation in deworming programs. Through clinical assessment, the patient was successfully managed with conservative treatment and antihelminthic therapy. Conclusion: While small bowel obstruction presents a diagnostic challenge with a wide range of differential diagnoses, ascariasis offers distinct risk factors and can be readily confirmed with basic diagnostic tools. Ascariasis remains a significant public health issue, highlighting the urgent need for intensified community education on hygiene and improved public health infrastructure in Southwest Sumba.
Copyright (c) 2025 Christin Andriani, Awliya Syamsul Munir, Ni Made Dwiyathi Utami https://creativecommons.org/licenses/by-nc/4.0
Current Evidence of Probiotics in Pediatrics with Short Bowel Syndrome, Is It Safe and Beneficial? A Literature Review
Background: Short Bowel Syndrome (SBS) presents significant challenges in pediatric care, particularly due to its high incidence in neonates and the associated health burdens, including elevated mortality rates primarily from hepatic failure and sepsis. SBS in infants and young children primarily arises from congenital defects or acquired conditions that necessitate significant bowel resection. The predominant cause of SBS during the neonatal period is necrotizing enterocolitis (NEC), accounting for 35% to 50% of cases. In older children, SBS is frequently associated with midgut volvulus or traumatic injuries. Discussion: Managing pediatric SBS requires a multidisciplinary approach that involves evaluating dietary, pharmacology, and surgical factors. Key strategies focus on improving absorptive capacity, promoting intestinal adaptation, and regulating bowel motility. In infants and young children, SBS often leads to a range of complications, including nutrient deficiencies, fluid imbalances, and growth delays. The condition necessitates careful medical management to address these challenges and promote optimal health outcomes. Recent studies have investigated probiotics as an adjuvant treatment for SBS, demonstrating enhanced growth, nutritional status, and inhibition of harmful microbes in afflicted children Conclusion: The use of probiotics in children with SBS has shown both safety and beneficial effects, making it a feasible alternative therapy in routine medical practice. However, the lack of significant clinical data highlights the need for more study to better understand the efficacy of probiotics in the treatment of SBS.
Copyright (c) 2025 Vianca Samara Andhary, Rafi Alfian Razan, I Gusti Ayu Nyoman Partiwi https://creativecommons.org/licenses/by-nc/4.0
Multiple Thrombi in Portal Vein with Protein C and Protein S Deficiency: A Case Report
Background: Portal vein thrombosis (PVT) is a rare but significant cause of the gastrointestinal bleeding, often leading to delayed diagnosis due to its subtle presentation. PVT can result in portal hypertension, which cause the formation of portosystemic collaterals as a compensatory mechanism. Deficiencies in protein C and protein S are recognized as risk factor for PVT. This study aims to describe a rare underlying condition of PVT in children. Case: A 14-year-old boy presented with recurrent hematemesis and melena over the past eight years. Physical examination revealed no epigastric pain but showed splenomegaly. Laboratory findings showed pancytopenia, mildly elevated AST, prolonged plasma prothrombin time and partial thromboplastin time, increased INR, and low protein C and S. Endoscopic evaluation revealed esophageal and fundal varices, with portal hypertensive gastropathy. Multi-slice CT (MSCT) confirmed thrombosis in the main, right, and left portal veins, supporting the diagnosis of PVT. The patient was also diagnosed with an underlying myeloproliferative disorder, further contributing to his condition. Discussion: Protein C and S deficiency is a prominent risk factor of PVT. Identification of risk factors is essential to accurately treat the condition and prevent worse outcomes. Imaging modalities remain essential for diagnosing PVT. Management focuses on treating complication, particularly those related to portal hypertension, with endoscopic variceal ligation as the preferred treatment. Conclusion: Comprehensive investigation on etiology and risk factors, close monitoring and individualized treatment are essential in PVT management, especially in pediatric patients.
Copyright (c) 2025 Ninung Rose Diana Kusumawati, Juwita Pratiwi https://creativecommons.org/licenses/by-nc/4.0
Pediatrics Upper Gastrointestinal Endoscopy Profile in Riau in 2020 and 2021
Background: Children's limited communication skills when expressing complaints often limit healthcare practitioners in making diagnoses and treatment decisions, particularly regarding gastrointestinal issues. Endoscopy is a valuable tool for determining the appropriate course of action in these cases. This study aims to describe the characteristics of pediatric patients who underwent upper gastrointestinal endoscopic procedures in Riau between 2020 and 2021. Methods: This retrospective study used secondary data from endoscopy registries and patient medical records at two tertiary hospitals in Riau between Januari 2020 to December 2021. Results: A total of 114 patients underwent upper gastrointestinal endoscopy from 2020 to 2021. It was found that the adolescent age group (42%) was the most frequently encountered group. The female sex (65%) was more prevalent than male. Meanwhile, the most common problem encountered was abdominal pain (57%). Gastroscopy alone was the most frequently performed procedure in this study (65%), with the most common endoscopic finding being hyperemic gastritis (54%). Conclusion: Upper gastrointestinal endoscopy in pediatric patients is a safe and very helpful procedure in diagnostics and therapeutics.
Copyright (c) 2025 Deddy Satriya Putra https://creativecommons.org/licenses/by-nc/4.0
Prevalence of Soil-Transmitted Helminthiasis and Its Association with Pediatric Diarrhea in Perobatang Village, Southwest Sumba
Background: Diarrhea is a prevalent health issues in developing countries and often linked to soil-transmitted helminthiasis (STH). This study aims to investigate the association between STH and diarrhea in Perobatang, Southwest Sumba. Method: A cross-sectional study was conducted in Perobatang, January 2017. Participants were children aged 1–15 years. Stool samples were collected from each child and examined macroscopically for signs of diarrhea and microscopically for STH eggs. Positive cases were treated with albendazole 400 mg. Result: A total of 333 samples were analyzed and 257 children were infected with STH (77%). The prevalence of A. lumbricoides was 56%, T. trichiura was 55%, and hookworm was 5%. Mixed infections were more common in children 6–15 years. 92 children (28%) had diarrhea. There is an association between the STH infection (combination of all three worm species) and diarrhea incidence (chi-square test, p=0.041). However, there is no association between the prevalence of single infections or the combination of two worm species and diarrhea incidence. Conclusion: STH infections are associated with incidence of diarrhea in Perobatang, Sumba Barat Daya. This finding highlights the necessity for targeted, community- based interventions by local stakeholders to effectively address and mitigate this public health challenge.
Copyright (c) 2024 Saleha Sungkar, Imam Rahadian Soleman https://creativecommons.org/licenses/by-nc/4.0
Refeeding Syndrome in Malnutrition – Diagnosis and Management
Background: Refeeding Syndrome (RS) is a one of the potentially life-threatening complications in malnourished children. The diagnosis of RS is often challenging due to its diverse clinical manifestations. A comprehensive understanding of the risk factors, sign, symptoms and the management of RS is important to reduce morbidity and mortality. Discussion: The management of malnutrition consists of a ten-step process divided into three phases. Adherence to this protocol is important to mitigate the risk of RS. RS is a metabolic complication that occurs when malnourished children rapidly reintroduced to nutrition. This condition is characterized by a shift of electrolytes from the extracellular to the intracellular, leading to hypophosphatemia, hypokalemia, hypomagnesemia, and thiamine deficiency. Children with RS require aggressive electrolyte and vitamin supplementation, followed by a cautious nutritional re-initiation. A gradual approach to nutritional reintroduction and electrolyte supplementation, are a critical preventive measure of RS. Conclusion: All malnourished children are at risk of RS. Recognizing its risk factors and watchful monitoring are essential for early detection and prevention of RS.
Copyright (c) 2024 Mei Tsarah Aini, Klara Yuliarti https://creativecommons.org/licenses/by-nc/4.0
Cholestasis as Primary Manifestation of Cytomegalovirus Infection: A Case Report
Background: Jaundice, marked by yellow discoloration of the sclera, skin, and mucous membranes due to bilirubin accumulation, can be physiological in neonates but may also signal pathological conditions like cholestasis. Cholestasis is commonly associated with biliary atresia; however, it can arise from various causes such as cytomegalovirus (CMV) infection. Thus, this study aims to discuss the diagnostic approach on neonatal cholestasis as the main manifestation in CMV infection. Case: A 2-years-old boy referred to the hospital with chief complaint of jaundice in both eyes and skin since 4 days of age and persisted until the age of 40 days old. Abdominal ultrasound in prior hospital revealed obstruction of bile duct which indicative for biliary atresia. However, subsequent abdominal and ARFI ultrasound showed no showed results inconsistent with biliary atresia. Furthermore, other examinations indicating infection, which were confirmed as CMV infection through serological and PCR test. Patient was then treated using valganciclovir treatment. Discussion: The diagnostic approach for cholestasis includes comprehensive anamnesis and physical examination, laboratory tests including complete blood count, bilirubin levels, liver function analysis, and coagulation factors, as well as ultrasound. CMV infection should be considered a potential cause of neonatal cholestasis, even in the absence of specific manifestations beyond jaundice and gastrointestinal symptoms. Conclusion: CMV infection can present solely with cholestasis and gastrointestinal symptoms, without other typical CMV manifestations. Thus, comprehensive evaluation, CMV screening, and careful assessment of the patient’s condition are essential for accurate management.
Copyright (c) 2024 Dyah Suci Handayani, Muzal Kadim https://creativecommons.org/licenses/by-nc/4.0
Diagnostic and Management Approach of Pancreatic Pseudocyst in Children
Background: Pancreatic pseudocyst is a fluid-filled sac within the pancreas encapsulated by fibrous tissue. Blunt-abdominal trauma is the leading risk factor in children. Due to varied and non-specific clinical manifestations, diagnosis can be challenging. Thus, this study aimed to explain the diagnostic and management approach of pediatric pancreatic pseudocyst. Case: An 8-year-old boy presented with a 3-month history of progressive abdominal mass accompanied by abdominal pain, bilious vomiting, constipation, and weight loss. Physical examination revealed a skin-colored mass located in the epigastric region. A CT-scan confirmed a cystic lesion with well-defined borders in the pancreas. Laboratory tests indicated elevated levels of plasma amylase and lipase enzymes. The patient underwent endoscopic ultrasound (EUS), followed by cyst drainage. Analysis of the pseudocyst fluid revealed increased amylase and lipase enzymes, and carbohydrate antigen 19-9 (CA 19-9) levels. Discussion: A thorough patient history and physical examination are essential in diagnosing pancreatic pseudocyst. While CT-scan provides valuable information, EUS has higher sensitivity and specificity for diagnosis. Amylase and lipase enzymes levels are frequently elevated, and CA-19-9 can be useful, however, should be complemented with other biomarkers. Drainage is indicated for cysts that do not resolve spontaneously. Adequate nutrition is also crucial for successful patient management. Conclusion: Pancreatic pseudocysts should be considered in children with an abdominal mass following blunt-abdominal trauma. Endoscopic ultrasound (EUS) is a valuable tool for both diagnosing and assisting the management of pancreatic pseudocysts.
Copyright (c) 2024 Marcel Aditya Nugraha, Pramita Gayatri https://creativecommons.org/licenses/by-nc/4.0
Effect of Exclusive Breastfeeding on Neurodevelopmental of Children 6-24 Months: A Case-Control Study
Background: The ketogenic diet (KD) has long been prescribed to children with recurrent epilepsy due to its minimal neurotoxic effects. The side effects caused this diet to be abandoned. New diets are emerging as options such as modified Atkins diet (MAD), low glycemic index therapy (LGIT) and medium-chain triglyceride (MCT). This study compared the safety and effectiveness of the KD and these new methods. Method: Systematic review was conducted by searching databases such as PubMed, ScienceDirect, SpringerOpen, Cochrane, Proquest and Scopus based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Result: : A total of 439 pediatric patients aged 0 - 18 years who were intervened with a ketogenic diet compared with other dietary options. A total of five studies reported a higher mean reduction in seizure incidence >90% in children who were intervened with a ketogenic diet compared to other diets, one of which reported KD > MAD (53.3% KD vs. 26.6% MAD). Conclusion: Although KD remains effective, MAD, LGIT, MCT and Polyunsaturated Fatty Acids KD (PUFAKD) diets provide comparable benefits with potential for better adherence. The classic KD group showed a higher morbidity rate; however, it demonstrated significant effectiveness in lowering the incidence of recurrent seizures in children.
Copyright (c) 2024 Armitha Putri, Irawan Mangunatmadja, Aida Rosita Tantri https://creativecommons.org/licenses/by-nc/4.0
Is the Ketogenic Diet Effective and Safe in Children with Intractable Epilepsy? A Systematic Review
Copyright (c) 2024 Rafi Alfian Razan, Meta Herdiana Hanindita, Ayuning Tetirah Ramadhani, Melvanda Gisela Putri, Nabila Annisa Harum, Kartika Nurrosyida https://creativecommons.org/licenses/by-nc/4.0
Diagnostic Approach of Mesenteric Cyst in Children: A Case Report
Background: Mesenteric cysts are intra-abdominal masses that arise from obstructed lymphatic drainage within the mesentery. Early diagnosis can be challenging, as it is often difficult to recognize based solely on clinical findings. The diagnosis is frequently made following imaging studies or during surgery. Despite their generally benign nature, delayed diagnosis can lead to serious complications. This case report aims to share our experience on the diagnostic approach for mesenteric cysts in children. Case: A 2-year-old boy presented with a 14-month history of slowly progressive abdominal distension and signs of bowel obstruction, including weight loss. Abdominal ultrasound revealed thin-walled, well-demarcated, septated fluid sacs consistent with a cyst. Abdominal CT-Scan showed massive ascites filling the intraperitoneal cavity and pushing the intestine upward along the thickened mesentery, causing bowel obstruction. Histopathological examination confirmed the diagnosis of cyst lymphangioma derived from mesentery. The cyst was successfully excised via laparotomy, and histological examination confirmed it as a cystic lymphangioma. Discussion: Our diagnostic approach focused on exclusion of differential diagnosis for abdominal distention in children, including ascites, abdominal tuberculosis, mesenteric cysts, and intra-abdominal masses. The absence of constitutional symptoms and lack of response to anti-tuberculosis therapy made it an unlikely diagnosis. While the CT-scan suggested ascites, the ultrasound results suggested a mesenteric cyst. Despite its large size, a complete excision of the cyst was successfully performed via laparotomy. Conclusion: The nonspecific nature of mesenteric cysts often delays diagnosis, making abdominal ultrasound an essential initial imaging modality for patients suspected of having this condition.
Copyright (c) 2024 Asep Aziz Purnama, Hanifah Oswari https://creativecommons.org/licenses/by-nc/4.0
The Predictive Value of Gamma-Glutamyl Transferase on Jaundice Clearance in Biliary Atresia: An Evidence-Based Case Report and Meta-Analysis
Background: Biliary atresia (BA) is a neonatal condition characterized by the obstruction of extrahepatic bile ducts. Case: A 2-year-old female with BA underwent a Kasai procedure at 3 months of age. Despite the surgery, she developed persistent jaundice and abdominal enlargement. Preoperative laboratory findings revealed elevated liver enzymes, GGT, and bilirubin levels. This case raises the clinical question of whether preoperative GGT levels can predict JC after the Kasai procedure, in addition to its role in diagnosis. Methods: A systematic literature search was performed on 4 databases (PubMed, Scopus, Cochrane, and Proquest) by using relevant keywords and identified seven high quality studies. Results: Five studies found higher GGT levels in patients who achieved JC following Kasai surgery, compared to those with unsuccessful jaundice clearance (JUC). However, two studies reported conflicting findings. A pooled analysis indicated a non-significant trend toward higher GGT levels in the JC group compared to the JUC group (WMD: 65.6, 95% CI: -58.6; 189.8). Conclusion: Elevated preoperative GGT levels may be associated with improved JC in BA patients. However, further investigation to validate these findings, determine the optimal role of GGT in assessing prognosis, and later, guiding treatment decisions in BA patients.
Copyright (c) 2024 Megan Quinka D Toding, Awliya Syamsul Munir, Mutiara Ramadhanty, Lowilius Wiyono https://creativecommons.org/licenses/by-nc/4.0
Background: Pediatric inflammatory bowel disease (IBD) is an idiopathic inflammatory disease in the digestive system with chronic onset, which often presents with unique and atypical phenotypes. This study aimed to dissect the important features of inflammatory bowel disease in children Discussion: The two types of inflammatory bowel disease (IBD) are ulcerative colitis (UC) and Crohn’s disease (CD). In children, IBD may exhibit classic symptoms such as weight loss, abdominal pain, and bloody diarrhea. However, many patient present with atypical symptoms such as isolated poor growth, anemia, or other extraintestinal manifestations. Early diagnosis of IBD in children is crucial as delayed diagnosis may lead to serious complications like bowel narrowing or abnormal connections, and stunted growth. The recommended initial evaluations in a pediatric patient with suspected IBD are complete blood test, stool examination, endoscopy and imaging. Furthermore, the aims of IBD treatment in children are to improve quality of life, relieve symptoms, promote normal growth, and prevent complications, all while minimizing medication side effects. Conclusion: Early diagnosis and treatment are essential in managing pediatric IBD. Additionally, addressing the disease's impact on bone health, growth, development, and psychosocial well-being is also crucial to achieve comprehensive management.
Copyright (c) 2024 Nabila Annisa Harum, Primadita Syahbani, Idznika Nurannisa Wibowo https://creativecommons.org/licenses/by-nc/4.0
Correlation Between Tuberculosis Type and Comorbidities with Nutritional Recovery Rates Post-Tuberculosis Treatment in Pediatric Patients
Background: Tuberculosis remains a significant cause of mortality in children. Nutritional status is one of the major risk factors for tuberculosis severity. This study investigated the factors influencing nutritional status in tuberculosis patients. Methods: This is a retrospective, cross-sectional study conducted in the tertiary national-referral hospital in Jakarta, Indonesia. Data were obtained from electronic health records from 2012-2018. This study included patients aged 0-18 years-old who were diagnosed and treated with anti-tuberculosis drugs. Patients who did not complete the therapy for minimum 2 months were excluded. Results: A total of 207 patients were included in this study. The type of tuberculosis was associated with the nutritional status of children after 2 months of treatment (p value = 0.014; 95% CI = 0.422 - 0.914). Children with extrapulmonary TB showed better improvement in nutritional status compared to those with pulmonary TB. Comorbidities were also associated with nutritional status (p-value = 0.020; CI95% = 1.063 - 2.382). Patient without comorbidities experience better nutritional status improvement than those with comorbidities. Conclusion: The nutritional status of tuberculosis patients improved after the 2-months of treatment. The type of tuberculosis and the presence of comorbidities influence the outcomes of nutritional status during anti-tuberculosis treatment.
Copyright (c) 2024 Safira Amelia, Nastiti Kaswandani https://creativecommons.org/licenses/by-nc/4.0