May 18, 2011

Inpatient management of severe malnutrition: time for a change in protocol and practice

Annals of Tropical Paediatrics
D R Brewster

Abstract

This review focuses on how to reduce the high mortality of severe acute malnutrition (SAM) in African hospitals. The World Health Organization's 1999 manual for physicians (protocol) has not resulted in case-fatality rates of under 5%, even in published research studies from Africa, far less in district and central hospitals which do not record case-fatality rates. It is suggested that the following eight changes to the protocol need to be considered if we are serious about reducing case-fatality rates in African hospitals: (1) use of low lactose, low osmolality milk feeds during the early stage of treatment, especially for HIV-exposed infants and diarrhoeal cases; (2) more cautious use of high carbohydrate loads (ORS, ReSoMal, sucrose and 10% dextrose) during initial stabilisation; (3) more careful grading up and down of feed volumes according the child's responses during the early rehabilitation phase; (4) rapid rehydration of children in shock with Ringer's lactate, as for well-nourished children, with closer monitoring for heart failure; (5) greater use of 3rd-generation cephalosporin and fluoroquinolone antibiotics (e.g. ceftriaxone, ciprofloxacin) to treat sepsis owing to resistant organisms; (6) consider adding glutamine...Continue Reading

  • References43
  • Citations10

References

  • References43
  • Citations10

Citations

Mentioned in this Paper

Septicemia
Vitamin A
Magnesium supplement
Diet
Fluoroquinolones
Ceftriaxone
Tuberculosis
Antibiotic throat preparations
Tuberculosis, Meningeal
Ciprofloxacin

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