{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:56:00Z","timestamp":1791482160514,"version":"4.3.4"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Congenital heart disease contributes substantially to chronic morbidity, growth impairment, and repeated healthcare utilization among children. Evidence regarding nutritional burden and outpatient healthcare patterns among pediatric patients with congenital heart disease in Indonesia remains limited. This study aimed to evaluate clinical characteristics, nutritional status, healthcare utilization, and factors associated with malnutrition among pediatric outpatients with congenital heart disease at Adam Malik General Hospital, Indonesia. A retrospective observational study was conducted using medical records of pediatric outpatients treated between January and December 2024. Demographic characteristics, cardiac diagnoses, nutritional status, complications, and outpatient visit history were analyzed. Logistic regression analysis was performed to identify factors associated with malnutrition. A total of 606 pediatric outpatients were included. Non cyanotic congenital heart disease predominated the cohort, with ventricular septal defect representing the most common diagnosis followed by patent ductus arteriosus and atrial septal defect. Nearly half of all patients demonstrated underweight or severe underweight nutritional status, while pulmonary hypertension emerged as the most frequent complication. Younger pediatric age groups and higher cumulative clinical burden were independently associated with greater odds of malnutrition. Children with congenital heart disease at this tertiary referral center carried a substantial nutritional and clinical burden. Routine nutritional screening, particularly among younger children and those with greater clinical burden may help identify patients who warrant closer nutritional assessment and multidisciplinary follow-up.<\/jats:p>","DOI":"10.1371\/journal.pone.0351014","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:28:27Z","timestamp":1791480507000},"page":"e0351014","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutritional status, clinical burden, and healthcare utilization among pediatric outpatients with congenital heart disease: A retrospective cross-sectional study from Indonesia"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9941-2555","authenticated-orcid":true,"given":"Putri","family":"Amelia","sequence":"first","affiliation":[{"name":"Universitas Sumatera Utara","place":["Medan, Indonesia"],"department":["Department of Pediatrics, Faculty of Medicine"]},{"name":"Adam Malik Hospital","place":["Medan, Indonesia"],"department":["Department of Pediatrics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lourents Christian Dika","family":"Sahertian","sequence":"additional","affiliation":[{"name":"Universitas Sumatera Utara","place":["Medan, Indonesia"],"department":["Center of Evidence-Based Cardiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rizky","family":"Adriansyah","sequence":"additional","affiliation":[{"name":"Universitas Sumatera Utara","place":["Medan, Indonesia"],"department":["Department of Pediatrics, Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnson","family":"Kannady","sequence":"additional","affiliation":[{"name":"Universitas Sumatera Utara","place":["Medan, Indonesia"],"department":["Center of Evidence-Based Cardiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"issue":"2","key":"pone.0351014.ref001","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1093\/ije\/dyz009","article-title":"Global birth prevalence of congenital heart defects 1970\u20132017: Updated systematic review and meta-analysis of 260 studies","volume":"48","author":"Y Liu","year":"2019","journal-title":"Int J Epidemiol"},{"key":"pone.0351014.ref002","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jpeds.2018.08.040","article-title":"Prevalence of congenital heart disease at live birth in China","volume":"204","author":"Q-M Zhao","year":"2019","journal-title":"J Pediatr"},{"issue":"5","key":"pone.0351014.ref003","first-page":"616","article-title":"Growth failure in children with congenital heart disease","volume":"12","author":"J Lee","year":"2025","journal-title":"Children (Basel)"},{"key":"pone.0351014.ref004","doi-asserted-by":"crossref","first-page":"1463998","DOI":"10.3389\/fped.2025.1463998","article-title":"Growth pattern of children with congenital heart disease before and after open heart surgery","volume":"13","author":"A Jamei Khosroshahi","year":"2025","journal-title":"Front Pediatr"},{"issue":"10","key":"pone.0351014.ref005","doi-asserted-by":"crossref","first-page":"936","DOI":"10.4070\/kcj.2025.0139","article-title":"Growth in children with congenital heart disease: Filling the gap with nationwide evidence","volume":"55","author":"SY Jung","year":"2025","journal-title":"Korean Circ J"},{"issue":"10","key":"pone.0351014.ref006","doi-asserted-by":"crossref","first-page":"923","DOI":"10.4070\/kcj.2025.0020","article-title":"Physical growth trajectories in children with congenital heart disease: A nationwide study","volume":"55","author":"JH Cha","year":"2025","journal-title":"Korean Circ J"},{"issue":"2","key":"pone.0351014.ref007","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.018037","article-title":"Israeli Adult Congenital Heart Disease Research Group. 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