Evaluation of simple laboratory investigations to predict fatal outcome in infants with severe malnutrition presenting in an urban diarrhoea treatment centre in Bangladesh

Abstract

Summaryobjective To evaluate rapid and simple laboratory investigations to predict fatal outcome in infants presenting with diarrhoea and severe malnutrition. results In logistic regression analyses, after adjusting for all available potential confounders (abnormal WBC count, higher CRP level, hyponatraemia, hypokalaemia, hypocalcaemia, and hypomagnesaemia), cases (n = 10) were significantly associated only with hypoglycaemia (measured using a portable bedside finger blood glucose test) (odds ratio 5.0, CI 1.1-23.0, P = 0.039) on admission.conclusion A simple rapid bedside glucose test may be used to predict the outcome of diarrhoeal infants presenting with severe malnutrition.

Childhood Deaths with a Co-Morbidity of Diarrhea and Severe Malnutrition: A Brief Insight in an Urban Critical Care Ward in Dhaka, Bangladesh

“…The observation of association of less intake of ORS at home with deaths in these children is also understandable. Lack of replacement of purging by taking ORS is often associated with a number of ramifications such as dehydration, shock, hypoglycemia, electrolyte imbalance especially hyponatremia and hypokalemia following convulsion 7,11 which are highly associated with deaths in such children 7,15,16 . Observation of association of pneumonia with respiratory distress with deaths in such children has also been reported earlier 17 .…”

Hypoglycemia in Children Attending the Critical Care Medicine in Developing Countries

“…The study revealed that to predict death, the sensitivity, specificity, and positive predictive value of hypoglycemia with their 95% confidence intervals were 40% (14-73%), 88% (75-95%), and 40% (14-73%), respectively (Chisti et al, 2010). The study concluded that most of the laboratory markers used to predict fatal outcome in diarrheal infants with SAM take several hours to become available, except a bedside glucose test, which takes less than a minute but is inexpensive.…”

“…The study concluded that most of the laboratory markers used to predict fatal outcome in diarrheal infants with SAM take several hours to become available, except a bedside glucose test, which takes less than a minute but is inexpensive. The study suggested that presence of hypoglycemia, measured by a portable bedside glucose test, is significantly associated with fatal outcome with high specificity in infants presenting with diarrhea and SAM (Chisti et al, 2010). It may be a useful rapid diagnostic test allowing prompt detection followed by comprehensive management of such infants according to WHO guidelines, which would help in reducing deaths even in resource poor settings (WHO, 2005).…”

“…Furthermore, data on simple, less time-consuming and inexpensive laboratory diagnostic tool(s) that can predict the outcome of such infants are scarce. However, limited data for predicting factors of fatal outcome in severely malnourished children in pediatric critical care medicine revealed that hypoglycemia, measured by a simple portable bedside glucose test, is significantly associated with fatal outcome especially in children presenting with SAM (Chisti et al, 2010, Huq et al, 2007. It may be a useful rapid diagnostic test, allowing prompt comprehensive management of such children following WHO guidelines (WHO, 2005), thus reducing deaths even in resource poor settings.…”

“…Health professionals in developing countries often rely on clinical signs to predict the severity of disease in hospitals with limited facilities, which is often reliable in children with better nutritional status (WHO, 2005, Chisti et al, 2009c but severely malnourished children often have severe infection (Chisti et al, 2010) and die without any prior overt clinical signs, which may prevent their appropriate and timely management (Suskind andSuskind, 1990, Morgan, 1997). Laboratory investigation, an essential alternative measure of suppressed clinical signs, often involves many efforts, time and cost, as in blood culture.…”