Abstract
BackgroundIn developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM) children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children.MethodsIn this retrospective case-control study SAM children aged 0–59 months, admitted to the Intensive Care Unit (ICU) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50) with those without severe sepsis (controls = 354). Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline.ResultsThe case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001). In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons).Conclusion and SignificanceWe noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.
Highlights
Severe sepsis is associated with very high case-fatality; it’s appropriate management remains a challenge both in the developing and developed countries [1,2,3]
Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children
Pneumonic severely acute malnourished (SAM) children lack in the clinical signs for severe sepsis [12,13,14], despite being very sick, and aggressive fluid management in such children may lead to undesirable effects [15], especially heart failure, cardiac arrest, and deaths [16]
Summary
Severe sepsis is associated with very high case-fatality; it’s appropriate management remains a challenge both in the developing and developed countries [1,2,3]. Early identification and treatment of severe sepsis in pneumonic severely acute malnourished (SAM) children is a clinical challenge. The World Health Organization (WHO) recommends relatively slower, less aggressive fluid resuscitation in the management of severely malnourished children with severe sepsis aiming to reduce these adverse effects [16]. There is lack of data on the predicting factors and outcome of the severe sepsis in pneumonic SAM children. There is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM) children having pneumonia and impact of fluid resuscitation in such children. We aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children
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