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Archives of Pediatric Gastroenterology, Hepatology, and Nutrition
Published by Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition
ISSN : -     EISSN : 28305442     DOI : -
Core Subject : Health,
Medicine & Pharmacology
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). APGHN is issued four times in a year and published in English. Previously published in print form as Jurnal Gastrohepatologi Anak Indonesia (JGAI), APGHN is committed to promote scientific development in child’s health through high-quality publication and provides recent updates on pediatric gastroenterology, hepatology, and nutrition for health practitioners and scholars. APGHN accepts original articles, case reports, review articles, medical illustrations and clinical practice guidelines, all of which have been peer-reviewed carefully by our selected experts.
Arjuna Subject : Kedokteran - Pediatrics, Perinatology, and Child Health
Articles 74 Documents
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Risk Factors of Stunted Children Aged 0-23 Months at Jatibaru Public Health Center Bima, West Nusa Tenggara: A Case Control Study Atmalia, Khafifah Puja; Balfas, Rania Reiza Faris; Aryana, Nurfathonah; Wulandari Hidaya; Putri, Nina Dwi
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 2 (2025): APGHN Vol. 4 No. 2 May 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.2.2025.51-61

Abstract

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.
Silent Splenic Infarction Following Infectious Mononucleosis Associated with Antiphospholipid Antibodies in a Pediatric Patient: A Case Report Scarponi, Davide; Cosic, Branislava; Fiorilli, Costanza; Di Biase, Anna Rita; Iughetti, Lorenzo
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 2 (2025): APGHN Vol. 4 No. 2 May 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.2.2025.78-82

Abstract

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.
The Effect of Giving One Egg Per Day on Stunted Children Aged 2-5 Years in Buton Regency on Zinc Levels Saputro, Alvreyna Cherienda Laviashna; Gunarti, Dwirini Retno
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 2 (2025): APGHN Vol. 4 No. 2 May 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.2.2025.62-72

Abstract

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.
CMV-Positive Biliary Atresia in Infants: A Review of Prognosis and Therapeutic Impact Rahmadiena, Qonita; Rahmah, Nailah; Karyanti, Mulya Rahma; Rahman, Himawan Aulia
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 2 (2025): APGHN Vol. 4 No. 2 May 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.2.2025.83-96

Abstract

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.
Syphilitic Hepatitis in Infancy Presenting with Cholestatic Jaundice and Inguinal Hernia: A Case Report Diva Putra, Agus Indra Yudhistira; Putu, Pradnyanita Mustika; Anak Agung, Made Sucipta
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 3 (2025): APGHN Vol. 4 No. 3 August 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.3.2025.141-150

Abstract

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.
Climate Change and Its Emerging Impact on Pediatric Gastrointestinal Infections in Indonesia – A Review Article Yanni, Daffa Arkananta Putra; Rafiqa Rais Akbar
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 3 (2025): APGHN Vol. 4 No. 3 August 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.3.2025.151-157

Abstract

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.
The Role of Green Banana in The Dietary Management of Children with Diarrhea: A Systematic Review and Meta Analysis Ghitha, Nida; Larasati, Anjani; Satari, Heidi; Indira, Fiona Maharani; Devaera, Yoga; Gayatri, Pramita
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 3 (2025): APGHN Vol. 4 No. 3 August 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.3.2025.98-110

Abstract

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.
Unlocking The Efficacy of Tetrahydrobiopterin (BH4) Towards Metabolic Profile and Growth Status in Children with Phenylketonuria: A Meta Analysis Rafi Alfian Razan; Nur Aisiyah Widjaja; Anggie Lorenza; Vianca Samara Andhary; Naoval Diza Ananda
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 3 (2025): APGHN Vol. 4 No. 3 August 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.3.2025.111-128

Abstract

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.
Diagnostic and Management Approach of Obesity with Multiple Complications in a Child: A Case Report Siti Azura Putri Dilla Sari; Cut Nurul Hafifah
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 3 (2025): APGHN Vol. 4 No. 3 August 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.3.2025.129-140

Abstract

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.
The Role of Gut Microbiota in Pediatric Obesity: A Systematic Review and Meta Analysis of Microbiota Profiles in Obese versus Normal Weight Children Alhaq, Karina Fitria; Fayyaza Faiz Adams; Athifah Nur Azizah Arif; Pricilia Laurenza Salsabila; Filla Reviyani Suryaningrat
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 4 (2025): APGHN Vol. 4 No. 4 November 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.4.2025.158-173

Abstract

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.

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