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All Journal Sari Pediatri Paediatrica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia World Nutrition Journal Narra J Archives of Pediatric Gastroenterology, Hepatology, and Nutrition The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Muzal Kadim
Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Indonesia - RS Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Cholestasis as Primary Manifestation of Cytomegalovirus Infection: A Case Report Handayani, Dyah Suci; Kadim, Muzal
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 3 No. 4 (2024): APGHN Vol. 3 No. 4 November 2024
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.3.4.2024.33-42

Abstract

Background: Jaundice, marked by yellow discoloration of the sclera, skin, and mucous membranes due to bilirubin accumulation, can be physiological in neonates but may also signal pathological conditions like cholestasis. Cholestasis is commonly associated with biliary atresia; however, it can arise from various causes such as cytomegalovirus (CMV) infection. Thus, this study aims to discuss the diagnostic approach on neonatal cholestasis as the main manifestation in CMV infection. Case: A 2-years-old boy referred to the hospital with chief complaint of jaundice in both eyes and skin since 4 days of age and persisted until the age of 40 days old. Abdominal ultrasound in prior hospital revealed obstruction of bile duct which indicative for biliary atresia. However, subsequent abdominal and ARFI ultrasound showed no showed results inconsistent with biliary atresia. Furthermore, other examinations indicating infection, which were confirmed as CMV infection through serological and PCR test. Patient was then treated using valganciclovir treatment. Discussion: The diagnostic approach for cholestasis includes comprehensive anamnesis and physical examination, laboratory tests including complete blood count, bilirubin levels, liver function analysis, and coagulation factors, as well as ultrasound. CMV infection should be considered a potential cause of neonatal cholestasis, even in the absence of specific manifestations beyond jaundice and gastrointestinal symptoms. Conclusion: CMV infection can present solely with cholestasis and gastrointestinal symptoms, without other typical CMV manifestations. Thus, comprehensive evaluation, CMV screening, and careful assessment of the patient’s condition are essential for accurate management.
Perbandingan Efektivitas dan Keamanan Ligasi dengan atau Tanpa Propranolol pada Anak dengan Hipertensi Portal Kadim, Muzal; Rasyada, Amrina
Sari Pediatri Vol 26, No 6 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp26.6.2025.389-98

Abstract

Latar belakang. Hipertensi portal (HP) didefinisikan sebagai peningkatan tekanan portal >5 mmHg, jika >12 mmHg dapat terjadi perdarahan saluran cerna. Tindakan ligasi menjadi pilihan utama untuk eradikasi varises, tetapi penggunaan propranolol masih menjadi kontroversial mengingat efek samping yang timbul.Tujuan. Mengetahui efektivitas dan keamanan propranolol untuk mencegah perdarahan varises pada hipertensi portal.Metode. Penelusuran pustaka database elektronik, yaitu Pubmed, Cochrane, dan Embase dengan kata kunci keywords “pediatric” OR “child”, “AND” ‘portal hypertension”, “AND” “ligation” OR “endoscopy”, AND “propranolol” OR “beta blocker”, AND “gastrointestinal bleeding” OR “esophageal varices rupture” OR “variceal bleeding”.Hasil. Penelusuran literatur diperoleh 3 artikel yang kemudian dilakukan telaah kritis. Studi oleh Santos dkk didapatkan tidak ada perbedaan bermakna antara kelompok ligasi dengan atau tanpa propranolol terhadap kejadian perdarahan saluran cerna. Studi Pimenta dkk menunjukkan tidak ada perdarahan saluran cerna yang terjadi pada kelompok ligasi dan propranolol. Sementara studi Quintero dkk menyatakan bahwa ligasi saja cukup aman dan efektif dalam mencegah perdarahan saluran cerna, dengan Hazard Ratio (HR) kelompok propranolol 2.6 (IK 1.53-3.67). Efek samping propranolol terjadi pada ketiga penelitian, secara berurutan sebanyak 16%, 41% dan 21.8%, berupa bronkospasme, hipotensi, dan penurunan kesadaran.Kesimpulan. Berdasarkan penelitian ilmiah yang telah dipaparkan dapat disimpulkan bahwa pemberian propranolol belum direkomendasikan karena efek samping yang ditimbulkan. Efektivitas ligasi dengan atau tanpa propranolol tidak memiliki perbedaan bermakna.
Early enteral nutrition administration and time to achieve resting energy expenditure in critically ill children Yulman, Annisa Rahmania; Pudjiadi, Antonius Hocky; Tridjaja, Bambang; Kadim, Muzal; Prawitasari, Titis
Paediatrica Indonesiana Vol. 65 No. 5 (2025): September 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.5.2025.390-8

Abstract

Background Malnutrition in critically ill children remains a significant concern, as a standardized nutritional support protocol has yet to be developed. Resting energy expenditure (REE) is recommended as a parameter for determining the fulfillment of energy needs in critically ill children, which should ideally be achieved within 72 hours. To achieve these energy needs, enteral nutrition (EN) is believed to have a lower mortality rate and a shorter length of stay compared to parenteral nutrition (PN). Objective  To evaluate the factors associated with delayed EN initiation and late achievement of REE.  Methods Data consisting of age, sex, nutritional status, timing of EN initiation, time required to achieve REE targets, PELOD-2 score, use of ventilators, duration of ventilation, hemodynamic status, use of inotropes and inotropic score, use of sedation, gastrointestinal symptoms, procedures performed during treatment, and technical issues were collected retrospectively from medical records from 2017 – 2018 in the Pediatric Intensive Care Unit (PICU) at Dr. Cipto Mangunkusumo Hospital. The REE was calculated using Schofield formula based on age and sex. These data were used to compare the proportion of the subjects receiving early EN (<48 hours) and delayed EN (>48 hours) and those who achieved REE <72 hours and delayed REE (>72 hours). Multivariate analysis was performed to determine which factors affecting late EN initiation and delayed REE achievement using logistic regression analysis. Results Of 203 subjects, 63.1% received early EN and 67.5% achieved REE at ≤72 hours. Delayed EN was associated with post-abdominal surgery (OR 10.89; 95%CI 4.31 to 27.50; P<0.001), ventilator use (OR 4.60; 95%CI 1.78 to 11.90; P=0.004), inotrope use (OR 4.18; 95%CI 1.56 to 11.17; P=0.002), gastrointestinal symptoms (OR 3.41; 95%CI 1.59 to 7.29; P=0.002), and abnormal nutritional status (OR 2.49; 95%CI 1.09 to 5.72; P=0.031). The REE >72 hours was associated with late EN (OR 20.62; 95%CI 6.48 to 65.65; P<0.001), enteral intolerance after receiving EN (OR 14.77; 95%CI 4.40 to 49.6; P<0.001), and PELOD-2 score ≥7 (OR 3.98; 95%CI 1.01 to 15.66; P=0.048). Conclusion The prevalence of EN and REE within 72 hours in the PICU is quite encouraging. Factors contributing to delayed EN administration include post-abdominal surgery, ventilator use, inotrope use, gastrointestinal symptoms, and abnormal nutritional status.  Delayed EN >48 hours, enteral intolerance after receiving EN, and PELOD-2 score >7 were the factors contributing to delayed REE achievement. However, these delays can be reduced by developing a comprehensive enteral feeding protocol. The factors influencing delayed EN and late REE achievement are an important basis for designing enteral feeding protocols to improve the clinical outcomes of critically ill children in the PICU.
Recurrent Esophageal Stricture in a Child Post Steven-Johnson Syndrome: A Case Report Rahman, Himawan Aulia; Astuti, Sri Kesuma; Kadim, Muzal
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 3 No. 1 (2024): APGHN Vol. 3 No. 1 February 2024
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.3.1.2024.33-40

Abstract

Background: Esophageal stricture is an abnormal narrowing of the esophageal lumen, resulting in dysphagia. Despite its rarity, this condition could be caused by various etiologies, including Steven-Johnson Syndrome (SJS). In some cases, stricture could recur, which complicates the management. This case report presented a rare case of refractory esophageal stricture in children with Steven-Johnson Syndrome. Case: A 5-years-old boy with a prior history of SJS presented with dysphagia for one month. The patient experienced choking, blood vomiting, stomatitis, swelling on the lips, and difficulty in swallowing solid food. Barium meal and EGD test confirmed the diagnosis of esophageal strictures. The patient then underwent dilation using bougie dilator. However, he continued to experience dysphagia, resulting in a total of 15 serial dilation sessions. Discussion: Esophageal dysphagia is observed in patients who experience difficulty swallowing solid food. SJS can contribute to the development of esophageal dysphagia by causing inflammation of the esophageal mucosa, resulting in lesions and strictures. In patients with esophageal strictures, two types of dilation methods are available: bougie dilator with wire guidance (Savary-Gilliard) and balloon dilator, with the current consensus for dilation procedures supporting the rule of three. For patients with refractory strictures, other modalities such as mitomycin-C injection and stent placement are also available. Esophageal replacement surgery is considered as the last resort for refractory stricture patients who have not responded to previous treatments. Conclusion: Steven-Johnson Syndrome is a rare cause of esophageal strictures. The management of refractory esophageal stricture requires a comprehensive subspecialty care and long-term monitoring.
The importance of gut health in early life for long term health Kadim, Muzal; Masita, Bertri Maulidya
World Nutrition Journal Vol. 5 No. S2 (2022): Special Issue : critical aspects of early life nutrition, gut health, and deve
Publisher : Indonesian Nutrition Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25220/WNJ.V05.S2.0001

Abstract

Introduction. The gut microbiota plays an important role in the normal functioning of the host organism. The microbiota of healthy newborn affected by many factors such as prenatal exposures, maternal nutrition, mode of delivery, type of feeding, introduction to solid food and its type, geography, and antibiotics consumption; and its composition continues to mature until reaching 3 years of age. Normal gut microbiota is essential in gut health, and play an important role in our homeostasis. Therefore, gut microbiota is considered a crucial factor for proper early life development and lifelong health. Prebiotics, along with probiotics, may alter gut microbiota composition thus play a role in the prevention of various diseases associated with dysbiosis condition. Methods. Advanced search for relevant literatures in PubMed, Cochrane, and Willey was conducted. After assessing the relevancy and eligibility, articles were selected and critically appraised. Conclusions. Accumulating evidence from different studies has shown that the occurrence of a disease is often preceded by early alterations of the microbiota. Many studies established correlation between gut microbiota dysbiosis with diseases pathogenesis i.e obesity and other metabolic syndrome, asthma and allergies, also stress-related disorder. Prebiotic supplementation has proven to be effective in obesity, asthma and allergies management, also beneficial for immune system.
Konstipasi Fungsional pada Anak Muzal Kadim
Majalah Kedokteran Indonesia Vol 71 No 4 (2021): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.71.4-2021-371

Abstract

Constipation has a negative impact, both for the child and their family, because it can reduce the quality of life, as well as impact on health care costs. The diagnosis of functional constipation is based on Rome IV criteria. The prevalence of functional constipation is related to geography, dietary habits and types, and exposure to stressful life events for children. Although most constipation in children is functional, an organic disorder must be excluded by looking for any alarm signs.
Prevalence and associated factors of infantile colic in infants of mothers in medical residency program Muzal Kadim; Wira Febrisandi Irsan; Tjhin Wiguna; Dina Muktiarti; Sulaiman Yusuf; Ade Rachmat Yudianto; Yusri Dianne Jurnalis; Yudith Setiati Ermaya; Wahyu Damayanti; Andy Darma; Christy Venada
Paediatrica Indonesiana Vol. 66 No. 1 (2026): January 2026
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background  Infantile colic, defined according to the Rome IV criteria as excessive crying in otherwise healthy infants without signs of illness or failure to thrive, could be linked to inadequate mother–infant bonding. The risk of infantile colic is increased in mothers with depression and insufficient family support. Infantile colic could lead to recurrent emergency department admissions, unnecessary treatments, and child abuse. Mothers in medical residency programs who often face long working hours, reduced bonding time with their infants, burnout, and depression, may be at an increased risk of having infants with colic. However, data on the prevalence and associated factors of infantile colic in infants of mothers in this specific population are lacking. Objective To determine the prevalence of infantile colic and its associated factors among infants of mothers participating in medical residency programs. Methods We conducted a cross-sectional study involving 67 infants of mothers in medical residency programs across seven centers in Java and Sumatra. We used the Indonesian-translated Parent Report Questionnaire for Children Aged 0-3 Years from the Rome Foundation to obtain information on infantile colic based on Rome IV criteria and the Indonesian version of the Mother-Infant Bonding Scale Questionnaire to assess the risk level of mother-infant bonding problems. An online questionnaire was distributed to subjects’ mothers via WhatsApp© application. Results  Of 67 subjects, 18 (26.8%) experienced infantile colic. High risk of mother–infant bonding problems, as indicated by elevated Mother-Infant Bonding Scale-Indonesian version (MIBS-I) scores, were significantly associated with infantile colic (OR 2.922; 95%CI 1.07 to 4.87; P=0.046). The type of nutrition, whether breast milk or a combination of formula and breast milk, did not significantly differ between infants with and without colic (OR 1.333; 95%CI 0.451 to 3.940; P=0.602). Conclusion Elevated MIBS-I scores, reflecting impaired mother–infant bonding, are ssociated with an increased risk of infantile colic in infants born to mothers in medical residency training programs.
Co-Authors Ade Rachmat Yudianto Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Amrina Rasyada Andini Striratnaputri Andy Darma Anjar Setiani Annisa Rahmania Yulman Antonius H. Pudjiadi Aryono Hendarto Astuti Giantiti Astuti, Sri Kesuma Aswitha Boediarso Aswitha Boediharso Aswitha Boediharso Aswitha D Boediarso Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Bambang Madiyono Bambang Supriyatno Bambang Tridjaja AAP, Bambang Tridjaja Berlian Hasibuan Bernie Endyarni Medise Chozie, Novie A. Christy Venada Cindy Gisella Zahrany Deddy S Putra Deddy S Putra Dina Muktiarti, Dina Evita Bermansyah Ifran Ezy Barnita Farahdina Shahnaz Handayani, Dyah Suci Hartono Gunardi Haryanti F. Wulandari Hasri Salwan Hikari Ambara Sjakti, Hikari Ambara I Gusti Ngurah Sanjaya Putra Idha Yulandari Idham Amir Irawan Mangunatmadja Jennie Dianita Sutantio Jeshika Febi Kusumawati Kholisah Nasution Laila, Dewi S. Lily Rundjan Lukito Ongko Mardjanis Said Mardjanis Said Masita, Bertri Maulidya Muhammad Indera Ramadani Mulyadi M. Djer Najib Advani Nina Dwi Putri Nur Hayati Partini P. Trihono Perdana, Andri Permatasari, Ruth K. Pramita G D Pramita GD Pustika Amalia Rahman, Himawan Aulia Ratno Juniarto Marulitua Sidauruk Setia Budi Setyo Handryastuti Simanjuntak, Sumardi F. Soedjatmiko Soedjatmiko Soepardi Soedibyo Sudung Oloan Pardede Sulaiman Yusuf Sulaiman Yusuf Syafruddin Haris Tantri, Aida Rosita Taralan Tambunan Teny Tjitra Sari, Teny Tjitra Titi Sunarwati Sularyo Titis Prawitasari, Titis Tjhin Wiguna Vera Irawani Wahyu Damayanti Wahyu Ika Wardhani William Cheng Wira Febrisandi Irsan Yati Soenarto Yudith Setiati Ermaya Yuli Kumalawati Yusri Dianne Jurnalis Yvan Vandenplas