Enteral Nutrition Support in Management of a Pediatric Patient with Secondary Acute Malnutrition and SARS-CoV-2 Infection : A Case Report

Abstract

Severe acute malnutrition (SAM) contributes to about one million deaths annually in children under the age of 5 years. Secondary acute malnutrition is common in children with underlying medical conditions. It may pose a great risk in developing severe illness during SARS-CoV-2 infection among children. Proper implementation of nutrition care process is critical in management of secondary acute malnutrition among children in clinical settings. Eight months old male admitted with meningoencephalitis; septic shock, anemia, rickets, osteomyelitis, severe malnutrition and severe SARS-CoV-2 pneumonia complications. On admission, body temperature was 370C, random blood sugars were 17.5mmol/L and with saturation of 98% on room air. He had a body weight of 5.5kg on admission with a z-score of -3sd. Nutrition focused physical examination revealed severe loss of muscle mass and adipose tissue. Nutrition prescription of high calorie high protein diet providing 846 calories and 22.3 g of protein per day was prescribed. The feed of choice was fortified blended flour (FBF) porridge which was administered via nasogastric feeding tube. After fourteen days of nutrition care in the unit, the patient had a weight gain of 100g. The average weight gain rate was 1.29g/kg/day. This case report documents challenges in nutrition management of secondary acute malnutrition with SARS-CoV-2 pneumonia in resource limited clinical settings. The review of existing guidelines and disease specific nutrition commodities in the management of secondary acute malnutrition in clinical settings is recommended. Keywords: Enteral nutrition, Nutrition care process, Secondary acute malnutrition, SARS CoV2 infection, Covid19