Background: Functional constipation affects 0.7–29.6% of children worldwide. Dietary factors, including carbohydrate, protein, fat, fiber and fluid intake, are known factors associated with constipation. Constipation impacts children's growth and psychosocial functioning. This study aims to assess macronutrients and fluid intake in children with functional constipation. Methods: A descriptive study was conducted at the Gastrohepatology Outpatient Clinic, Harapan Kita Mother & Children Hospital, from November to December 2025. Age, sex, nutritional status, and intake of carbohydrate, protein, fat, fiber, and fluid were assessed. Results: Thirty-one subjects were included. The majority were female (58.1%), aged 1–3 years (45.2%), with normal nutritional status (61.3%). Most subjects had lower energy intake than recommended (90.3%), while 12.9% had inadequate protein intake. More than half had adequate fat intake (58.1%) while only 32.3% met the carbohydrate target. Using the “age + 5” rule, the majority had fiber intakes below recommended values. Additionally, 90.3% had fluid intake below recommended levels. Conclusion: Children with functional constipation were predominantly young and female, and more than half had normal nutritional status; however, most did not meet recommended energy, carbohydrate, fiber, and fluid intake levels. These findings indicate that dietary intakes were frequently below recommended levels in this sample and underscore the need to strengthen public education regarding appropriate nutrition to support the prevention and management of constipation.
Background Eosinophilic gastritis (EoG) is an uncommon form of eosinophilic gastrointestinal disease (EGID) characterized by dense eosinophilic infiltration of the gastric wall, most often involving the antrum and fundus. Although EoG can mimic other causes of gastric outlet obstruction (GOO), including infantile hypertrophic pyloric stenosis (IHPS), such presentations are rare. Diagnosis requires histological confirmation, and management typically involves dietary modification with elimination diets, corticosteroids, and proton pump inhibitors. Case: We report the case of a 3-year-old girl presenting with recurrent non-bilious, non-bloody projectile vomiting and abdominal pain over 15 days, with a 3 kg weight loss. Imaging revealed pyloric canal hypertrophy not meeting IHPS criteria, and upper gastrointestinal endoscopy showed an erythematous, edematous antrum with pinpoint pylorus. Pyloric biopsy demonstrated dense eosinophilic infiltration (>30 eosinophils/HPF in 5 fields), confirming EoG. The child was treated with oral prednisolone (2 mg/kg/day) and lansoprazole (1 mg/kg/dose twice a day), resulting in marked clinical improvement and weight gain within two weeks Discussion: EoG represents a spectrum of EGIDs, with clinical manifestations depending on the gastric layer involved. It may occur with or without peripheral eosinophilia and is frequently associated with atopic conditions. Diagnosis rests on gastrointestinal symptoms, tissue eosinophilia, and exclusion of secondary causes. Corticosteroids remain the cornerstone of treatment, though dietary elimination and PPIs also contribute to remission. Conclusion: EoG should be considered in children presenting with unexplained GOO. Early endoscopic biopsy and corticosteroid-based therapy can lead to rapid symptom resolution and prevent long-term morbidity.
Background: Neonatal Dubin-Johnson syndrome (DJS) is an unusual presentation of a rare autosomal recessive disease that typically manifests in adolescents. Methods: A thorough literature review was conducted, examining clinical, radiologic, morphological, and genetic features, as well as diagnostic pathways and long-term outcomes in neonatal-onset disease. The review adhered to the 2020 PRISMA guidelines, with study quality evaluated using the JBI checklist and influence assessed through leave- one-out analysis. Result: 141 cases were identified, most presenting within the first week as neonatal cholestatic liver disease. Males are affected twice as often as females. The condition is characterized by hyperbilirubinemia, elevated ALP, GGT, and bile acid levels, with normal transaminases. Common signs include hepatomegaly and acholic stools. Liver scintigraphy typically shows a bimodal pattern with excellent uptake but absent or delayed intestinal excretion, which may mimic biliary atresia (BA). Unlike BA, cholangiography appears normal. Liver biopsy reveals intrahepatic cholestasis (62%), paucity of interlobular bile ducts (22%), hepatopathy (33%), and steatosis (26%); the characteristic dark brown pigment is absent in 80% of cases. Fifty-five ABCC2 variants are associated with neonatal DJS. Additional risk factors include male sex, biliary immaturity, hepatitis, steatosis, bile acid retention, and maternally induced drug cholestasis. Urinary coproporphyrin I excretion, cholangiography, and genetic analysis are highly sensitive and specific diagnostic tools. Neonatal onset does not alter the disease's benign long-term course. Conclusion: Neonatal DJS should be considered in the differential diagnosis of neonatal cholestatic disease. Low transaminase levels and abnormal scintigraphy should prompt suspicion, with confirmation via cholangiography, coproporphyrin analysis, or genetic testing.
Background: Inflammatory Bowel Disease (IBD) and Juvenile Idiopathic Arthritis (JIA) are chronic diseases characterized by persistent inflammation. The incidence of IBD in patients with JIA is higher than in the general pediatric population. The clinical manifestations of these diseases sometimes overlap or may even be absent, making early detection more difficult. This review aims to explore the pathophysiological interplay between IBD and JIA, highlighting their potential mutual influence and clinical implications. Discussion: Both IBD and JIA share a similar mechanism involving the interplay between immunological processes and environmental influences. A key common factor in both diseases is the involvement of gut microbiota. Alterations in gut microbiota can lead to gut dysfunction and immunological abnormalities. The involvement of intestinal factors in JIA pathophysiology is gaining more attention, as emerging evidence indicates a connection with the gastrointestinal system. Additionally, the use of specific medications in JIA patients has been recognized as a potential risk factor for developing IBD. Conclusion: Multiple underlying mechanisms suggest a connection between the IBD and JIA. However, additional research is needed to gain a more comprehensive understanding of this connection.
Background: Esophagitis dissecans superficialis (EDS) is an uncommon disorder characterized by sloughing of the esophageal mucosa. Paediatric cases are infrequent and esophageal involvement due to mucous membrane pemphigoid (MMP) is exceptionally rare. We report a young child presenting with recurrent hematemesis secondary to EDS caused by MMP Case: A previously healthy three-year-old girl presented with hematemesis. Upper gastrointestinal endoscopy revealed severe desquamative esophagitis. Initial treatment with proton pump inhibitors resulted in temporary resolution, however symptoms recurred three months later. Careful examination identified intermittent blistering skin lesions. Skin biopsy and direct immunofluorescence demonstrating linear IgG deposition along the basement membrane zone confirmed MMP. Treatment with systemic corticosteroids and azathioprine resulted in sustained remission over 52 months of follow-up. Discussion: The absence of obvious mucocutaneous manifestations initially delayed diagnosis. Recurrent EDS should prompt evaluation for autoimmune blistering disorders. Multidisciplinary assessment and direct immunofluorescence were crucial for establishing the diagnosis and guiding treatment. Conclusion: Mucous membrane pemphigoid should be considered in children with recurrent desquamative esophagitis or unexplained hematemesis. Early diagnosis and immunosuppressive therapy may prevent long-term oesophageal complications and achieve durable remission.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
