OBJECTIVE: Cholestasis is a common manifestation of liver disease in children due to impairment of bile flow to intestinal tract. More than 60% of children already experienced neonatal jaundice and one of 2500 to 5000 children develop cholestasis. Cholestasis in children can leads to impairment of nutritional status, and is associated with higher morbidity and mortality. This study aims to describe and evaluate nutritional status of children with cholestasis.
METHOD: A cross sectional study was conducted from January to December 2018 in pediatric ward Saiful Anwar General Hospital. All children aged more than 3 month with cholestasis were included in this study. The measurement of cholestasis included clinical manifestation, bilirubin level, AST/ALT level, and albumin level. All children fulfilling the diagnostic criteria of cholestasis were analyzed for each anthropometric index to describe the relation of cholestasis and children nutritional status.
RESULT: A total of 31 cholestatic patients were included in this study, with mean age of 7.13 months old. Jaundice developed in 14 of them (45,16%) and various clinical manifestations also found such as edema, ascites, and hepatosplenomegali. All of the patients developed the increase of bilirubin level, while lower albumin level found in 8 patients and increase of AST/ALTwas found in 6 & 3 patient respectively. From the nutritional status, malnutrition found in 19 patients (61,29%) and 12 of them (38,71%) fulfil the criteria of severe malnutrition (<-3SD). 3 patients with edema and organomegali developed normal anthropometric index, which was actually classified to severe malnutrition through upper arm circumference measurement.
CONCLUSION: Cholestasis in children can cause alteration in nutritional status, detected by anthropometric index. In patients who develop clinical manifestation such as edema, ascites, or organomegali, anthropometric index could perform false negative result, which can be corrected by upper arm circumference measurement.