Severe Acute Malnutrition In Infants Research Articles

Clinical Profile and Risk Factors for Severe Acute Malnutrition in Infants Under 6 Months of Age Admitted to Tertiary Care Centre

Clinical Profile and Risk Factors for Severe Acute Malnutrition in Infants Under 6 Months of Age Admitted to Tertiary Care Centre

A Study of Reliability of Mid Upper Arm Circumference for Detection of Severe Acute Malnutrition in Infants Between 1-<6months of Age

Introduction: Severe Acute Malnutrition (SAM) in children below 6months of age is diagnosed in presence of either of (1) weight for height/length <-3 standard deviations (SD) of median WHO growth reference (in infants >45cm); (2) visible severe wasting; (3) presence of bipedal edema. Simple measuring tape with reorientation of health workers can detect beginning of childhood malnutrition. This study aims to study reliability of mid upper arm circumference (MUAC) for detection of SAM in infants aged 1-6 months of age.

Severe acute malnutrition among infants under 6 months of age in the teaching hospital of Borgou / Alibori in Northen Benin

Background: Acute malnutrition in infants under six months is a scourge that is little studied in relation to the global problem of child malnutrition. This paper aims to describe the sociodemographic, clinical, therapeutic, and outcome features of this phenomenon in the Teaching Hospital of Borgou /Alibori based in Parakou in northern Benin. Patients and methods: This was a two years case-control retrospective and descriptive study carried out in the pediatric care unit of the said hospital from January 1, 2016, to December 31, 2018. It included infants aged 1 to 6 months presenting with severe acute malnutrition defined according to the WHO criteria. Variables investigated were sociodemographic, clinical, therapeutic, and outcome-related. Results: Total of 78 out of 508 infants less than 6 months of age were severely malnourished (5.35%). Their mean age was 4.65 months±1.28. Contributory factors were early dietary diversification (69.2%), and maternal death (14.1%). Marasmus and kwashiorkor were their clinical expressions. Associated complications were gastrointestinal infections (38.5%), septicemia (17.9%), and HIV infection (5.1%). Diluted F-100 was the most used therapeutic food (46.1%) with a recovery rate estimated at 41% and mortality at 19.3%. Conclusion: Severe acute malnutrition in infants under six months of age is real and it involves three out of twenty infants admitted to the hospital. In-hospital mortality is significant. It is urgent to review the policies related to exclusive breast feeding promotion.

A narrative review of efficacy of antibiotics in treatment of children with severe acute malnutrition in community based out-patient treatment.

The World Health Organisation (WHO) updated guidelines on the management of severe acute malnutrition in infants and children (2013) recommends antibiotic treatment of uncomplicated severe acute malnutrition (SAM) in the community setting. As community-based treatment is gaining ground, this evidence review looks at the emerging data to improve the decision-making process. The databases of Pubmed, Google Scholar, Cochrane Database of Systematic Review were searched for experimental and observational studies in the English literature for the period of 2011-2021. The search identified seven studies: two interventional and five observational. Six of these studies showed significant improvement in recovery rates using weight for height Z-score-2. Emerging evidence supports the continuation of antibiotic treatment for uncomplicated SAM in out-patient settings, as recommended in the WHO guideline of 2013.

Therapeutic Food Development from Maize Grains, Pulses, and Cooking Banana Fruits for the Prevention of Severe Acute Malnutrition.

In children under five years of age, severe acute malnutrition is a complex and challenging problem, especially those living in poor communities. Therefore, this study aimed to formulate ready-to-use therapeutic foods from affordable, locally available cereals, pulses, and banana fruits to overcome the problem of severe acute malnutrition. Maize grains, pulses (soybeans), and cooking banana fruits were ingredients used in formulations of ready-to-use therapeutic foods (RUTF). A completely randomized design was done with two replicates. Data were analyzed using analysis of variance. A significant difference existed in the appearance and consistency for RUTF1, RUTF2, and RUTF3 samples (P < 0.05). The study findings revealed that the moisture content varied from 6.7 to 13.4%, energy from 513.2 to 642.41 kcal/100 g, protein from 13.9 to 19.34%%, and crude fat from 24.12 to 35.54%. The calcium content ranged from 225 to 302 g/100 mg, iron from 10.34 to 12.26 g/100 mg, and zinc from 10 to 20 g/100 mg. In this study, the phytate content varied from 314.74 to 369.3 μg/g and crude tannin, from 101.36 to 153.25 μg/g. This study concluded that the ingredients used in the RUTF1, RUTF2, and RUTF3 formulations met the standard ready-to-use therapeutic foods. Therefore, it is important to prescribe ready-to-use dietary supplements made from inexpensive, locally available, and culturally acceptable foods to prevent severe acute malnutrition in infants.

Prevalence and Biochemical Risk Factors of Severe Acute Malnutrition in Infants Under 6 Months Old in Single Tertiary Referral Hospital

Severe acute malnutrition remains to be a burden in developing countries, including Indonesia. Recent studies and researches started to highlight the importance of recognizing severe acute malnutrition in infants under 6 months old. This is a cross-sectional study aims to know the prevalence and biochemical risk factors of severe acute malnutrition in infants under 6 months old in our single tertiary referral hospital, Sanglah General Hospital, Denpasar, Bali, Indonesia. From January 2017 to December 2018, there were 138 children with severe acute malnutrition admitted to Sanglah General Hospital, Denpasar. From 138 subjects, 19 were below 6 months old of age (13,8%) and 119 were older than 6 months old (86,2%). Majority of our study samples were males with ratio of 1,5:1, had length of stay of more than 15 days (60,9%) and were marasmic (96,4%). Death occurred in 44,9% of study samples. Bivariate analysis including gender, length of stay, death, comorbidities, anemia, hypoalbuminemia, hypokalemia, hyponatremia and hypocalcemia. Of all the variables analyzed, only hypocalcemia yielded significant result with prevalence ratio between below and older than 6 months old age group was 0,432 (<i>p value </i>0,045). The prevalence of hypocalcemia in infants under 6 months old with acute severe malnutrition is lower than children above 6 months old of age.

Mid-upper arm circumference cut-off for detection of severe acute malnutrition in infants aged between one and six months

Objective: To find the MUAC cut-off for detection of severe acute malnutrition in infants between 1to 6 months of age. Material and Methods: A prospective observational study at IPD and OPD of atertiary care hospital. 303 infants between one and six months of age above the length of 45cmswere included in the study. In infants between one and six months of age, the length, weight, andMUAC were measured. SAM infants were identified using the WHO definition. Sensitivity, specificity,and Youden index for a particular MUAC was calculated in SAM infants. Results: 11cms was found tohave a sensitivity of 85.1% and specificity of 65.9%. It had the maximum Youden index of 0.55 witha positive likelihood ratio of 2.79 and a negative likelihood ratio of 0.21. Conclusions: MUAC of11cms can be used as a cut-off for SAM infants between 1 to 6 months of age. MUAC does not varywith gender. Weight and MUAC are significantly lower in SAM infants. But there is no difference whenit comes to length as in acute malnutrition, the weight and MUAC are affected but length is not.

A novel RET gene mutation in a neonate with total colonic aganglionosis and renal agenesis: a case report

Objective: To find the MUAC cut-off for detection of severe acute malnutrition in infants between 1to 6 months of age. Material and Methods: A prospective observational study at IPD and OPD of atertiary care hospital. 303 infants between one and six months of age above the length of 45cmswere included in the study. In infants between one and six months of age, the length, weight, andMUAC were measured. SAM infants were identified using the WHO definition. Sensitivity, specificity,and Youden index for a particular MUAC was calculated in SAM infants. Results: 11cms was found tohave a sensitivity of 85.1% and specificity of 65.9%. It had the maximum Youden index of 0.55 witha positive likelihood ratio of 2.79 and a negative likelihood ratio of 0.21. Conclusions: MUAC of11cms can be used as a cut-off for SAM infants between 1 to 6 months of age. MUAC does not varywith gender. Weight and MUAC are significantly lower in SAM infants. But there is no difference whenit comes to length as in acute malnutrition, the weight and MUAC are affected but length is not.

Infant and maternal risk factors of severe acute malnutrition under 6 months of age

Aims: This study aims to analyze and focus on the factors associated with the risk of severe acute malnutrition (SAM) under 6 months infants. Materials and Methods: This hospital-based prospective study was conducted in the Department of Pediatrics of a Medical College in Central India from March 2019 to March 2020. Infant under 6 months of age admitted for SAM and related complications were observed during their stay in the hospital. After obtaining informed consent and detailed history including contributing factors, complete physical examination, anthropometry, comorbidities, and outcome were also recorded. SAM was classified according to the WHO criteria. Results: A total of 126 infants, 1–6 months of age, were enrolled in the study with a male-to-female ratio of 2.3:1. Birth weight (p=0.037), prematurity (p=0.0021), birth spacing (p=0.001), infant feeding characteristics as giving prelacteal feed (p=0.001), initiation of breastfeed after 1 h (p=0.003), exclusive breastfeeding (p=0.037), deprivation of colostrum (p=0.002), maternal characteristics age at first conception (p&lt;0.014), maternal BMI &lt;18.5 (p=0.0004), maternal literacy status (p=0.007), infant characteristics like sepsis (p=0.003), incomplete immunization (p=0.006), bilateral pedal edema (p=0.017), visible severe wasting (p=0.0001), and delayed milestone (p=0.0001) were found to affect the recovery of an infant. Conclusion: The present study identifies the maternal and sociodemographic factors associated with SAM in infants under 6 months of age. The risk factors insights identified in this study should provide a good basis to explore the modification of the existing approach as a starting point to strengthen the community-based management of uncomplicated SAM in infants under 6 months

Antimicrobial and micronutrient interventions for the management of infants under 6 months of age identified with severe malnutrition: a literature review.

BackgroundInfants under 6 months (U6M) contribute a significant proportion of the burden and mortality of severe malnutrition globally. Evidence of underlying aetiology in this population is sparse, but it is known that the group includes ex-preterm and low birthweight (LBW) infants. They represent a unique population given their dependence on breastmilk or a safe, secure alternative. Nutrition agencies and health providers struggle to make programming decisions on which interventions should be provided to this group based upon the 2013 WHO Guidelines for the ‘Management of Severe Acute Malnutrition in Infants and Young Children’ since there are no published interventional trial data focussed on this population. Interim guidance for this group might be informed by evidence of safety and efficacy in adjacent population groups.MethodologyA narrative literature review was performed of systematic reviews, meta-analyses and randomised controlled trials of antimicrobial and micronutrient interventions (antibiotics, deworming, vitamin A, vitamin D, iron, zinc, folic acid and oral rehydration solution (ORS) for malnutrition) across the population groups of low birthweight/preterm infants, infants under 6 months, infants and children over 6 months with acute malnutrition or through supplementation to breastfeeding mothers. Outcomes of interest were safety and efficacy, in terms of mortality and morbidity.ResultsNinety-four articles were identified for inclusion within this review. None of these studied interventions exclusively in severely malnourished infants U6M. 64% reported on the safety of studied interventions. Significant heterogeneity was identified in definitions of study populations, interventions provided, and outcomes studied. The evidence for efficacy and safety across population groups is reviewed and presented for the interventions listed.ConclusionsThe direct evidence base for medical interventions for severely malnourished infants U6M is sparse. Our review identifies a specific need for accurate micronutrient profiling and interventional studies of micronutrients and oral fluid management of diarrhoea amongst infants U6M meeting anthropometric criteria for severe malnutrition. Indirect evidence presented in this review may help shape interim policy and programming decisions as well as the future research agenda for the management of infants U6M identified as malnourished.

Are innovative ready to use therapeutic foods more effective, accessible and cost-efficient than conventional formulations? A review

Ready to Use Therapeutic Foods (RUTFs) are used in international food assistance strategies as a safe and effective way of treating children suffering from severe acute malnutrition (SAM). Though the peanut-based formulation has a proven track record in terms of efficacy in treating SAM around the world, the conventional formulation is not without challenges. Concerns regarding cost, the availability of local ingredients, the presence of aflatoxin, shifting global supply patterns, and dietary appropriateness of the peanut-based RUTF have encouraged researchers to experiment with other lipid sources in formulations. This shift requires not only changes to RUTF formulations, but also changes to supply chain activities. The goal of this review is to first, provide an update on the efficacy of recently trialed non-peanut RUTF formulations in treating SAM in infants and children and second, to review recent UN agency led interventions into local/regional RUTF supply chains and programmatic capacity. Based on published documents (2017–2019), this review flags three significant issues requiring further attention from the international food assistance community: the need for follow-up studies of children treated for SAM with RUTFs in programmatic countries, a regional customization of Community-Based Management of Acute Malnutrition (CMAM) protocols to maximize cost effectiveness and programmatic coverage, and an increase in the number of studies focusing on the acceptability of non-peanut RUTF formulations by the infants and children in low and medium income countries.

BUN and creatinine in Severe Acute Malnutrition in Infants and Children

BUN and creatinine in Severe Acute Malnutrition in Infants and Children

Managing acute malnutrition in infants aged less than six months: A qualitative assessment in niger public hospitals

Quality management of severe acute malnutrition (SAM) in infants < 6 months of age is a key strategy within the “1000 days window of opportunity”. It prevents early child death, secures optimal growth and forms a foundation for full adulthood potentials. Most studies to date on management of SAM in infants relied on informants from Non-Governmental Organizations staff or government public health officials but little is known from hospital practitioners. From June to August 2013, a qualitative appraisal of hospital practitioners’ views on the current quality of care for malnourished infants was conducted in the eight main hospitals of Niger. These eight hospitals included two National Referral Hospitals (Lamorde and Zinder) and six Regional Referral Hospitals (Poudriere, Dosso, Tahoua, Maradi, Diffa and Agadez). Authorization for the review was given by the Ministry of Health of Niger. Health workers (HW) present during surveyors’ visits were included in the study. Two (2) specific objectives were considered: 1) Determine HW perceptions and current use of the Supplemental Suckling Technique (SST) and 2) Collect HW propositions on feasibility to organize outpatient treatment of SAM in infants less than six months. Self-designed interview guide was used. Data were analysed manually and saturation in the occurrence of responses were the criteria used to retain items. The Supplemental Suckling Technique (SST), though firmly recommended by national guidelines to ensure continuation of breastfeeding and adequate nutrients intake from supplemental milks especially in a small infant, was rarely used. Main reasons advanced by staff were work overload, inadequate training, and lack of compliance from mothers. Before being discharged from hospital, mothers were counseled on continuation of treatment, follow up visits at peripheral health center (PHC) and feeding options at home. However, hospital staff had no indication whether mothers were seen at the referred PHC, nor if counseling was practiced at home. The proposed outpatient treatment model for selected cases without medical complications should relieve hospital caseloads, strengthen referral and improve breastfeeding support to mothers after discharge from hospital. Keywords: Malnutrition, infant feeding, inpatient treatment, qualitative assessment, Niger

Mid upper Arm Circumference for Detection of Severe Acute Malnutrition in Infants Aged Between One and Six Months.

This study conducted among 302 infants aimed to determine the most suitable mid upper arm circumference cutoff to diagnose severe acute malnutrition (weight-for-length <-3 SD) in infants aged between 1 and 6 months. The cut off of 11.0 cm had the best performance (Youden index 0.63, sensitivity 82.5%, specificity 80.3%).

G246 Management of acute malnutrition in infants aged &lt;6 months (mami) in malawi: prevalence and risk factors in an observational study

Aims Severe Acute Malnutrition (SAM) underlies some 500,000 young child deaths per year. For the first time, new (December 2013) World Health Organisation Guidelines recognise SAM in infants In this study we aimed to address a key question highlighted by WHO: how best to identify high risk infants u6m. We did this by: - Comparing prevalence of infant SAM as defined by current weight-for-length (WFL)-based definitions with proposed new definitions based on mid-upper-arm circumference (MUAC). - Identifying risk factors for use in future clinical assessment tools. Methods A cross sectional prevalence survey conducted in two referral hospitals and three community health centres in Malawi. All infants u6m excluding twins attending for either medical attention or routine immunizations were measured and asked about potential malnutrition risk factors. Results From October 2013–January 2014 we measured 6,787 infants u6m. After data cleaning, we analysed a total of 5,717 infants u6m: 582 from hospitals; 5,135 from health centres. Defined by WFL There were no male/female sex differences. Infants with low birth weight ( Conclusion Infant u6m SAM is an important problem, especially in hospital settings, but even in otherwise stable infants attending for immunizations. MUAC identifies more infants as having SAM than does WFL – these differences matter for calculating sample sizes for future intervention studies. MUAC, though not currently used for infants u6m is being actively researched in this age-group; MUAC is well established in older children in identfying those high risk of death. Risk factors identified here are also important towards future studies in this age group.

Treatment of Severe Acute Malnutrition in Infants Aged

To report a nutritional rehabilitation program in Niger for the management of severe acute malnutrition in infants aged <6 months. This is a presentation of a case series (n=632) of young infants who were admitted to a nutrition rehabilitation program in 2010-2011. The main characteristics of the inpatient treatment protocol where the use of diluted F-100 milk via a supplementary suckling technique until exclusive breastfeeding was reinitialized, coaching of mothers on infant feeding, and intensive antibiotic therapy as indicated during the stabilization phase. Semistructured interviews were conducted with 103 mothers. Rates of recovery, mortality, and default were 85% (537 of 632), 6% (37 of 632), and 9% (55 of 632), respectively. The majority of infants had an infectious disease at study entry (81%), particularly acute watery diarrhea and respiratory tract infections. Infection on admission was a predictor of death during treatment (OR, 3.9; 95% CI, 1.6-9.2). Anorexia at entry was a risk factor for treatment failure (OR, 4.4; 95% CI, 1.71-11.1). Interviews revealed a very low rate of exclusive breastfeeding (3%), with delayed initiation in 68% of cases. Traditional beliefs, perceived insufficiency of breast milk, and psychological problems played important roles in feeding choices. Severe acute malnutrition in infants aged <6 months can be successfully treated by managing cases as inpatients with an adapted protocol, intensive clinical supervision, and intensive drug treatment if indicated. Whether similar outcomes are achievable in community-based programs remains to be verified. Effective interventions for improving breastfeeding practices are needed.