“…These include management by restoration of circulation, respiration, maintenance of temperature and blood glucose level, appropriate antimicrobial therapy to cover the possible causative organism, appropriate feeding; and provision of micronutrients, viatamins and minerals as required. The hospital follows the protocolized guidelines for the management of children with severe protein-energy malnutrition [11,12]. …”
In the logistic regression analysis, after adjusting for potential confounders, such as abnormal WBC count, use of intravenous fluid, patient with fatal outcome more often presented with hypernatremia (odds ratio = 16.48, 95% confidence interval = 2.21 -123.12; p = 0.006), lobar consolidation (odds ratio = 19.9, 95% confidence interval = 2.99 -132.80; p = 0.002), hypoxemia (odds ratio = 14.78, 95% confidence interval = 1.38 -157.90; p = 0.026) and severe under-nutrition (odds ratio = 7.57, 95% confidence interval = 1. 24 -46.11; p = 0.028). CONCLUSIONS: Our data suggest that children under-five with clinical sepsis who present with lobar pneumonia, hypoxaemia, severe acute malnutrition and hyperntaemia are at higher risk of death and identification of these simple factors may help clinicians to take prompt initiative for the aggressive management of such children especially in a resource-limited setting like Bangladesh.
“…These include management by restoration of circulation, respiration, maintenance of temperature and blood glucose level, appropriate antimicrobial therapy to cover the possible causative organism, appropriate feeding; and provision of micronutrients, viatamins and minerals as required. The hospital follows the protocolized guidelines for the management of children with severe protein-energy malnutrition [11,12]. …”
In the logistic regression analysis, after adjusting for potential confounders, such as abnormal WBC count, use of intravenous fluid, patient with fatal outcome more often presented with hypernatremia (odds ratio = 16.48, 95% confidence interval = 2.21 -123.12; p = 0.006), lobar consolidation (odds ratio = 19.9, 95% confidence interval = 2.99 -132.80; p = 0.002), hypoxemia (odds ratio = 14.78, 95% confidence interval = 1.38 -157.90; p = 0.026) and severe under-nutrition (odds ratio = 7.57, 95% confidence interval = 1. 24 -46.11; p = 0.028). CONCLUSIONS: Our data suggest that children under-five with clinical sepsis who present with lobar pneumonia, hypoxaemia, severe acute malnutrition and hyperntaemia are at higher risk of death and identification of these simple factors may help clinicians to take prompt initiative for the aggressive management of such children especially in a resource-limited setting like Bangladesh.
“…• Manter o esquema por 48 horas ou mais protocolo baseado no manual da OMS e atribuíram a redução do número de episódios de hipoglicemia ao início precoce da alimentação na admissão hospitalar no primeiro protocolo (14) . Quanto à hiperglicemia, com a redução dos estoques de glicose e utilização de outras vias para produção desse suprimento, há diminuição na síntese de insulina e aumento de glucagon, epinefrina e cortisol.…”
RESUMOObjetivos: Apresentar a conduta para o tratamento da desnutrição energético-proteica grave e os principais aspectos fisiopatológicos da doença.Fontes de dados: Tomando como base o Manual da Organização Mundial da Saúde (OMS, 1999), realizou-se uma busca por trabalhos publicados em inglês, espanhol e português sobre o tratamento hospitalar de crianças com desnutrição grave, nas bases de dados Lilacs, Medline e SciELO, publicados nos últimos dez anos, utilizando-se as palavras-chave: desnutrição, criança, hospitalização, terapia nutricional, diretrizes, OMS.Síntese dos dados: Foram abordadas as principais características fisiopatológicas da desnutrição grave e a conduta recomendada para o tratamento. Identificaram-se as principais complicações clínico-metabólicas, como a hipotermia, a hipoglicemia, a desidratação e as infecções recorrentes, além da má absorção e a fase de estabilização ou de recuperação do desnutrido grave. A compreensão de todos esses conceitos relacionados à fisiopatologia da desnutrição energético-proteica, associada ao adequado planejamento e execução da terapia nutricional, pode reduzir o risco de morbimortalidade em crianças com idade inferior a cinco anos.Conclusões: As diretrizes da OMS devem ser implantadas levando-se em consideração a realidade de cada região e a capacitação do profissional da saúde quanto ao conhecimento da complexidade e fisiopatologia da desnutrição energético-proteica grave, para adequado diagnóstico e tratamento. O sucesso do tratamento está associado ao cuidado e à atenção ao paciente.Palavras-chave: desnutrição; criança; hospitalização; terapia nutricional; Organização Mundial da Saúde.
ABSTRACTObjective: To identify the main physiopathological aspects of severe protein-energy malnutrition and its treatment.Data sources: Based on the World Health Organization guidelines (WHO, 1999), an electronic search for papers on hospital treatment of children with severe malnutrition was performed on Lilacs, Medline and SciELO databases. Studies in English, Spanish and Portuguese published in the last ten years were searched by the following key-words: malnutrition, child, hospitalization, nutrition therapy, practice guidelines, WHO.Data synthesis: The main pathological aspects of severe malnutrition and its specific treatment were reviewed. The main clinical and metabolic complications of severe malnutrition were identified such as hypothermia, hypoglycemia, dehydration, usual infections, intestinal malabsorption, as well as stabilization and recovery phases, were defined. Understanding the main concepts of the physiopathology of this condition, associated with appropriate nutrition support planning, can decrease morbidity and mortality risks of children younger than five years old.Conclusions: The implementation of the 1999 WHO guidelines should take into consideration local economic and cultural aspects, as well as the professional health care training. Due to the complexity of severe malnutrition, adequate knowledge about basic aspects of this condition helps provid...
“…Evidence shows that WHO guidelines have led to improved survival and mortality of children admitted to inpatient facilities for SAM [2] and that case fatality may be reduced with strict compliance to treatment recommendations [3,4]. 10.1080/16549716.2018.1503785-F0001Figure 1.Scoring system for assessment of adherence to an inpatient malnutrition checklist (MLNC).
…”
In low-resource settings, inpatient case fatality for severe acute malnutrition (SAM) remains high despite evidenced-based protocols and resources to treat SAM. Key reasons include a combination of insufficiently trained staff, poor teamwork and inadequate compliance to WHO treatment guidelines which are proven to reduce mortality. Checklists have been used in surgery and obstetrics to ameliorate similarly complicated yet repetitive work processes and may be a key strategy to improving inpatient SAM protocol adherence and reducing unnecessary death. Here, we share our experience developing and piloting an inpatient malnutrition checklist (MLNC) for children 6 to 59 months and associated scoring system to coordinate care delivery, improve team documentation, strengthen WHO malnutrition protocol adherence and facilitate quality improvement in a district hospital in rural Rwanda. MLNC was developed after careful review of the 2009 Rwandan National Nutrition Protocol and 2013 WHO malnutrition guidelines. Critical steps were harmonized, extracted and designed into an initial MLNC with input from pediatric ward nurses, doctors, a locally based pediatrician and a registered dietitian. A scoring system was developed to facilitate quality improvement. Using the standard Plan-Do-Study-Act cycle, MLNC was modified and progress assessed on a monthly to bimonthly basis. Significant modifications occurred in the first 6 months of piloting including incorporation of treatment reminders and formatting improvements, as well as initiation of the MLNC from the emergency department. The MLNC is the first checklist to be developed that unifies WHO 10 steps of treatment of inpatient SAM with local standards. Anecdotally, MLNC was observed to identify gaps in key malnutrition care, promote protocol adherence and facilitate quality improvement. Data gathering on the MLNC local facility impact is underway. Collaborative international efforts are needed to create an inpatient malnutrition checklist for wider use to improve quality and reduce unnecessary, facility-based child mortality.
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