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
Prediction of Development of Neonatal Jaundice by Cord Blood Bilirubin and Albumin
Background: Neonatal jaundice is a common cause of early postnatal readmission and contributes to both financial and socio-economic burden. In resource-constrained nations, where the patient-to-resource-constrained-bed ratio is very high, early prediction of hyperbilirubinaemia will help in early discharge, prevent re-hospitalization, and reduce the duration of hospital stay. This study aims to estimate the cord blood bilirubin (CBB) and albumin (CBA) levels for future prediction of neonatal jaundice among deliveries at Bhagat Phool Singh Government Medical College for Women (BPS GMC (W)). Methods: A prospective study was conducted among 384 randomly selected neonates delivered at BPS GMC (W). Socio-demographic data were recorded, and cord blood samples were collected at birth for bilirubin and albumin estimation. Neonates were followed for 10 days to assess the development of clinical jaundice. Result: Incidence of neonatal jaundice was 21.4% with 10 days of follow-up. 94.8% neonates developed jaundice with CBB level ≥ 2mg/dL, proving it statistically significant. Additionally, 62.7% of neonates with serum albumin < 3 g/dL developed jaundice. Cord blood Bilirubin-to-Albumin ratio proved a good indicator, as area under the curve is 0.933 with sensitivity and specificity of 68.30% and 99.0% respectively at a cut-off level of 0.61. Conclusion: Cord blood bilirubin and bilirubin-to-albumin ratio may help identify neonates at higher risk of subsequent jaundice and may assist in prioritizing follow-up in resource-limited settings. A bilirubin-to-albumin ratio ≥ 0.61 was found to be a highly specific predictor.
Copyright (c) 2026 Babita Rani, Leesha Kaushik, Preeti Raikwar, Renu Garg, Vijayata Sangwan, Sanjay Kumar Jha, Anita Punia, Deepika Kataria https://creativecommons.org/licenses/by-nc/4.0
From Paper to Precision: A Systematic Review on Digital Technologies for Improving the Quality of Childhood Growth Monitoring
Background: Childhood growth monitoring is essential for detecting malnutrition and growth disorders. However, traditional paper-based methods are prone to errors, incompleteness, and fragmentation. Digital technologies have emerged as potential tools to enhance efficiency of growth monitoring. This systematic review aims to synthesize evidence on the benefits and challenges of implementing digital technologies for growth monitoring in children. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across multiple databases. Eligible studies evaluated digital interventions such as mobile health applications with automated anthropometric calculations, computer-based growth monitoring integrated into the electronic health record, and chatbot-based reporting systems. Data were extracted on study design, population, technology features, and outcomes related to data and implementation. Result: Seven studies were analyzed, representing over 50,000 child growth assessments and involving approximately 400 frontline health workers. Digital technologies improved the completeness, accuracy, and timeliness of data collection. Automation reduced human error, supporting more consistent interpretation of nutritional status, earlier detection and reporting of inadequate growth, along with improved nutritional outcomes. These technologies were highly accepted by frontline health workers for their ability to simplify complex tasks. However, most challenges arose from constraints in digital infrastructure and uneven technology implementation across healthcare facilities. Conclusion: Digital technologies can transform growth monitoring from a manual, error-prone process into a precise and scalable system for early detection of malnutrition. Addressing challenges is essential for successful implementation and scale-up in health systems.
Copyright (c) 2026 Assyifa Gita Firdaus, Dhio Pratama Putra https://creativecommons.org/licenses/by-nc/4.0
Infantile Liver Failure as the Initial Manifestation of SCYL1-Related CALFAN Syndrome: A Case Report and Literature Review
Background: CALFAN (Cholestasis, Acute Liver Failure, and Neurodegeneration) syndrome is a rare autosomal recessive disorder caused by biallelic pathogenic variants in SCYL1 (SCY1-like pseudo-kinase 1). It is classically associated with low or normal gamma-glutamyl transpeptidase (GGT) cholestasis, infection-triggered acute liver failure (ALF), and progressive neurodegeneration. Because neurological and skeletal manifestations may be absent during the first hepatic presentation, early diagnosis can be missed unless the hepatic phenotype is recognized. Case: We describe a 9-month-old female infant born to third-degree consanguineous parents who developed fever-triggered cholestatic jaundice and ALF. Structural biliary disease, viral hepatitis, and common metabolic disorders were excluded. Whole-exome sequencing revealed a homozygous pathogenic nonsense variant in SCYL1 (c.1567C>T; p.Arg523*), consistent with autosomal recessive CALFAN syndrome. No neurological, neuroimaging, or skeletal abnormalities were present at initial presentation. The clinical course was notable for persistent hyperbilirubinemia and a family history of sibling death from infantile liver failure. Discussion: This case adds to the SCYL1 spectrum by demonstrating isolated infantile ALF without neurological features at presentation, a severe hepatic phenotype with persistent cholestasis, and a novel homozygous null variant in a consanguineous family. Conclusion: SCYL1 deficiency should be considered in infants with fever-triggered ALF and low/normal-GGT cholestasis, even when neurological and skeletal signs are absent. Early genomic testing, systematic exclusion of low-GGT cholestasis mimics, longitudinal neurological surveillance, timely transplant referral, and recurrence-risk counselling are essential.
Copyright (c) 2026 Deepika Yadav, Nishant Wadhwa, Megha Sharma https://creativecommons.org/licenses/by-nc/4.0
Gut Endocrine Regulation of Pediatric Growth and Weight: Integrating Intestinal Hormones, Inflammation, and the GH–IGF-1 Axis in Health and Disease
Background: The intestine is increasingly recognized as an endocrine organ through enteroendocrine cells, gut-derived peptides, mucosal trophic factors, and microbiota–host signaling. In children, these pathways influence appetite, nutrient handling, body composition, and growth, including the growth hormone–insulin-like growth factor-1 (GH–IGF-1) axis. This review summarizes how intestinal endocrine function affects linear growth, weight gain, and GH–IGF-1 regulation in children with celiac disease, inflammatory bowel disease, environmental enteric dysfunction, and obesity. Discussion: Evidence supports a convergent model linking gut function to growth via gut hormone signaling (GLP-1, PYY, CCK, GLP-2, ghrelin), inflammation-driven GH resistance, and microbiota-mediated IGF-1 modulation. Celiac disease can cause growth failure reversible with a gluten-free diet; Crohn's disease impairs growth through inflammation and malabsorption; environmental enteric dysfunction drives population-level stunting; and in obesity, altered incretin responses highlight the intestine as a therapeutic target. Gut-endocrine pathways remain underutilized in pediatric practice. IGF-1 is frequently interpreted without accounting for mucosal inflammation or malabsorption, and cross-specialty fragmentation limits holistic growth assessment. Emerging therapies including GLP-2 analogues and incretin-based agents offer promise, though pediatric data remain limited. Standardizing gut-endocrine biomarkers and integrating intestinal health into growth frameworks are key research priorities. Conclusion: The intestine is a clinically important endocrine organ in pediatric growth medicine. Integrating gut-endocrine biology into endocrine assessment improves the interpretation of IGF-1 and growth patterns and guides management across undernutrition, chronic intestinal disease, and obesity.
Copyright (c) 2026 Ashraf T. Soliman, Fawzia Alyafei, Nada Alaaraj, Shayma Mohamed, Noor Hamed, Sohair Elsiddig https://creativecommons.org/licenses/by-nc/4.0
Successful Diagnosis and Management in 28-week Preterm Infant with Gastrointestinal Perforation - A Case Report
Background: Gastrointestinal perforation (GIP) appears as an important reason for mortality during neonatal period, with reported high prevalence ranging from 15 - 70%. The perforation may be related to a variety of caused such as necrotizing enterocolitis (NEC), iatrogenic caused, obstruction of intestinal or spontaneous. The current standard treatment is surgery. Despite surgical intervention, the mortality rate remains significantly high about 49% in very low birth weight and low birth weight infants. Objective: The aim of this study was to report our hospital’s intensive care and surgical experience in managing gastrointestinal perforation among very preterm and very low birth weight infant. Case: A female baby, 980 gr of birth weight, was delivered by caesarean section at 28-weeks of gestation due to maternal severe pre-eclampsia and premature ruptured of membrane (>12 hours). Antenatal corticosteroid was completed before birth. The baby had respiratory distress syndrome and required immediate to NICU admission. Early oral care with breast milk had been given < 24 hours life. Unfortunately, at third days of age, she had an abdominal distention and diagnosed with acute abdomen. Free air in the abdomen seen on an X-ray indicated a pneumoperitoneum. An emergency surgery was performed immediately with pediatric surgeon, rupture of gaster was found. Primary repair gastric and omental patch were performed. She passed the critical period after surgery and improved, she was extubated on the seventh day after the operation. A trial feed was well tolerated. The baby was discharged and doing well on follow-up.
Copyright (c) 2026 Fadhilah Hana, Dito Desdwianto, Cherie Nurul Farid Lubis https://creativecommons.org/licenses/by-nc/4.0
Chronotype and Chrononutrition Profiles in Adolescents Obesity
Background: Adolescent obesity remains a major global public health challenge. Modern lifestyle factors that disrupt circadian rhythms may exacerbate metabolic dysregulation in adolescents. Chronotype, reflecting innate circadian preferences for sleep-wake and activity timing, and chrononutrition, which emphasizes the alignment of meal timing with circadian rhythms, have gained attention as potential determinants of obesity. However, evidence integrating chronotype and chrononutrition profiles with adolescent obesity remains limited. Therefore, this review aims to synthesize the current evidence on the roles of chronotype and chrononutrition in adolescents obesity. Discussion: Circadian rhythm regulates metabolic, hormonal, and behavioral processes through coordinated central and peripheral clocks. Variations in chronotype and disruptions in circadian alignment influence sleep patterns, meal timing, and metabolic regulation in adolescents. Evidence indicates that chronotype alone does not directly determine obesity risk; rather, its interaction with eating timing, sleep quality, and lifestyle behaviors plays a crucial role. Chrononutrition emphasizes aligning food intake with the biologically active phase, which is associated with improved insulin sensitivity, glycemic control, lipid metabolism, and blood pressure regulation. Determining chronotype and chrononutrition profiles remains challenging. The assessment is predominantly performed using standardized and validated questionnaires. Conclusion: Chronotype and chrononutrition profiles may contribute to the risk of obesity in adolescents. They might be a potential strategy for obesity prevention and management. Nevertheless, current evidence remains limited, and further longitudinal and interventional studies are required to confirm these findings and inform future recommendations.
Copyright (c) 2026 Danindra Andri Hidayat, Mifta Khudin, Titis Prawitasari https://creativecommons.org/licenses/by-nc/4.0
Impact of Biliary Atresia on Neurodevelopment in Children: A Systematic Review
Background: Survival in children with biliary atresia (BA) has improved substantially, shifting clinical focus toward long-term morbidity, including neurodevelopmental outcomes. However, existing evidence remains fragmented, and prior reviews have not comprehensively addressed motor, behavioral, and autism-related domains. This study aimed to synthesize current evidence on neurodevelopmental outcomes in children with BA across cognitive, motor, and behavioral domains, and to identify clinical factors associated with adverse developmental trajectories. Methods: A systematic search of PubMed, Scopus, and Wiley was conducted from database inception to October 17, 2025, following PRISMA 2020 guidelines. Observational studies reporting neurodevelopmental outcomes in children (≤18 years) with BA were included. Risk of bias was assessed using the Newcastle–Ottawa Scale and the Joanna Briggs Institute checklist. Due to substantial heterogeneity, a narrative synthesis was performed. Result: Seven studies involving infants to adolescents with BA were included. Motor impairment was the most consistent finding, detectable from early infancy and persisting into later childhood. Cognitive outcomes were heterogeneous, ranging from significant impairment to age-appropriate or above-normative performance in selected cohorts. Behavioral and adaptive difficulties, including attention problems and autism spectrum–related traits, were frequently reported. Markers of disease severity such as unsuccessful Kasai portoenterostomy (KPE), delayed jaundice clearance, growth failure, ascites, and portal hypertension were consistently associated with poorer neurodevelopmental outcomes. Conclusion: Children with BA are at increased risk of multidimensional neurodevelopmental impairment, particularly affecting motor and behavioral domains. Early identification and longitudinal neurodevelopmental surveillance are essential to optimize long-term functional outcomes in this vulnerable population.
Copyright (c) 2026 Hisyam Hartaman Putra, Vanessa Permata Putri, Sri Wahyuni Evi Nafisyah, Mishbakhul Luthfi, Rahmat Hidayat Nur Ilhami, Siswanto Basuki https://creativecommons.org/licenses/by-nc/4.0
The Correlation Between Low Milk Supply in Breastfeeding and The Severity of Neonatal Hyperbilirubinemia
Background: Inadequate breastfeeding can cause neonatal hyperbilirubinemia. Hyperbilirubinemia was the fifth leading cause of neonatal mortality in Indonesia with a prevalence of approximately 5.6%. The severe level of bilirubin concentration can cause life- threatening kernicterus. The study aimed to examine the correlation between low milk supply in breastfeeding and the severity of neonatal hyperbilirubinemia among newborns who were admitted to Assyifa Mother and Child Hospital in Tangerang, Banten. Methods: A cross-sectional study was conducted on 20 neonates diagnosed with unspecified hyperbilirubinemia who were referred to either Emergency Department or Pediatric Department in Assyifa Mother and Child Hospital. Data were obtained from electronic medical records, including information related to mothers and neonates. Data on breast milk supply in breastfeeding mothers were obtained from patient anamnesis records. Statistical analysis was performed using the Fisher’s test with SPSS version 30. Result: Hyperbilirubinemia severity was categorized into three severity levels: level 1 (12-18 mg/dL), level 2 (19-24 mg/dL), level 3 (25-30 mg/dL). There were 8 neonates with adequate breastmilk supply that categorized who were classified into level 2. In contrast, 12 neonates with inadequate breastmilk supply were classified into levels 2 and 3. A significant correlation was found between inadequate breastmilk supply and increased severity of neonatal hyperbilirubinemia (p = 0.042). Higher severity of hyperbilirubinemia was associated with lower quantities of breastfeeding. Conclusion: The study shows a significant correlation between inadequate breastmilk supply in breastfeeding and the severity of neonatal hyperbilirubinemia.
Copyright (c) 2026 Finanda Nisa Amani, Dianty Anjarsari https://creativecommons.org/licenses/by-nc/4.0
Symptomatic Cholelithiasis in a Male Infant: Two-Year Follow-Up and Surgical Management – A Case Report
Background: Infant cholelithiasis is an uncommon and often idiopathic condition, frequently detected incidentally due to nonspecific symptoms. Although spontaneous resolution is common during infancy, the lack of standardized management guidelines complicates decision-making, particularly in symptomatic patients. Long-term data describing the natural history and indications for surgical intervention remain limited. Case: We describe a male infant diagnosed with gallstones at four months of age following recurrent episodes of colicky abdominal pain. Extensive laboratory evaluation excluded hemolytic, metabolic, infectious, and anatomical causes. Serial ultrasonography confirmed persistent gallstones without inflammatory changes. Given the patient’s clinical stability, expectant management with close follow-up was initially chosen, including periodic clinical assessments, annual ultrasound examinations, and biochemical testing. Despite normal growth and normal biochemical results, the patient experienced intermittent recurrent localized abdominal pain over a two-year period. Because of persistent symptoms, definitive surgical management was indicated, and an open cholecystectomy was performed at two years of age. Intraoperative findings revealed two black pigment stones consisting of calcium bilirubinate, without anatomical abnormalities. Postoperative recovery was uneventful, and the patient remained asymptomatic during follow-up. Discussion: This case illustrates the challenges of managing idiopathic infant cholelithiasis, particularly regarding the timing of surgery. While conservative management is appropriate for asymptomatic patients, persistent or recurrent symptoms justify surgical intervention. This extended follow-up provides insight into the persistence of the disease beyond infancy. Conclusion: Individualized management is essential in infant cholelithiasis. This case supports surgical treatment in symptomatic patients with persistent gallstones, even in the absence of identifiable risk factors.
Copyright (c) 2026 Manuel Gonzalez-Plascencia, Antonio Ignacio del Rio-Robles https://creativecommons.org/licenses/by-nc/4.0
Choledochal Cyst Todani Classification Type IC and Choledocholithiasis Presenting as Recurrent Pancreatitis in a 7-Year-Old Girl – A Case Report
Background: Choledochal cyst is an uncommon but important cause of biliary pathology in the pediatric population which can lead to choledocholithiasis and recurrent pancreatitis. High clinical suspicion, comprehensive imaging, and multidisciplinary evaluation are essential for accurate diagnosis and treatment. Definitive management is achieved through surgical intervention. Case: A 7-year-old girl experienced recurrent postprandial right upper quadrant and epigastric pain for three years, with fluctuating pancreatic and hepatic enzymes. Initial ultrasound and magnetic resonance cholangiopancreatography (MRCP) revealed ductal dilatation with biliary sludge, while multislice computed tomography (MSCT) suggested autoimmune pancreatitis, leading to temporary steroid response. Symptoms persisted, and contrast-enhanced magnetic resonance imaging (MRI) demonstrated fusiform common bile duct dilatation with debris, confirming Todani type IC choledochal cyst and choledocholithiasis. She underwent laparoscopic cyst and gallbladder excision with Roux-en-Y hepaticojejunostomy. Intraoperative and histological findings verified sludge, gallstones, and chronic cholecystitis. Discussion: Choledochal cysts should be considered in pediatric recurrent pancreatitis, particularly with biliary obstruction. Advanced imaging and differential diagnosis are crucial. Surgical excision with biliary reconstruction is the treatment of choice. Conclusion: Early recognition and timely surgical intervention are essential to prevent long-term complications.
magnetic resonance cholangiopancreatography
Copyright (c) 2026 Della Sabrina Marta, I Putu Gede Karyana, I Gusti Ngurah Sanjaya Putra, Ni Nyoman Metriani Nesa, Ketut Dewi Kumara Wati, Kadek Deddy Ariyanta 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
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
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
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
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
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
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
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
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
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