وصف
Severe acute malnutrition is described as having an incredibly low weight for height (below -3z scores of the median WHO growth criteria), noticeable severe wasting, or nutritional oedema. Children who are severely undernourished lack the growth nutrients needed to regenerate tissues. These nutrients promote weight gain after sickness, aid in tissue healing, and speed up cell turnover (intestine and immune cells). Recovery from malnutrition depends on the proper restoration of nutrients including vital amino acids (protein), potassium, magnesium, and zinc (among other minerals).
ملخص
- Children are more susceptible to protein-energy malnutrition (PEM) due to their high calorie and protein needs for growth and activity. Subclinical undernutrition can lead to long-term growth and development problems. WHO defines PEM as a range of pathological conditions resulting from varying deficiencies in protein and calories, often associated with infections like pneumonia and diarrhea.
- Severe acute malnutrition (SAM) is characterized by severe wasting, edema, and a low weight-for-height ratio. Mid-upper arm circumference (MUAC) measurement is a useful community-based screening tool, with a cutoff of less than 11.5 cm indicating severe wasting in children 6-59 months. WHO criteria for SAM include weight-for-height below -3 standard deviations, visible severe wasting, MUAC below 11.5 cm, or bilateral pitting edema.
- Inpatient care for SAM involves a stabilization phase followed by community-based management. Children with complications like edema, vomiting, fever, or respiratory distress should be admitted to a nutritional rehabilitation center. SAM carries a high risk of death from hypoglycemia, hypothermia, fluid overload, and infections. Initial management focuses on identifying and addressing emergency signs like airway obstruction, respiratory distress, and shock.
- History taking includes recent food and fluid intake, diet, breastfeeding practices, and symptoms of diarrhea and vomiting. Examination involves anthropometry, assessing edema, vital signs, signs of dehydration and shock, and indicators of anemia and vitamin deficiencies. Laboratory investigations include hemoglobin, blood glucose, electrolytes, WBC count, urine analysis, and chest X-ray.
- Management of SAM involves treating hypoglycemia and hypothermia, addressing dehydration and electrolyte imbalances, treating infections, and correcting micronutrient deficiencies. Initial feeding involves frequent small amounts of starter formula. As the child stabilizes, a transition to ketchup diet is initiated.
- A clinical case illustrates a situation of an 8-month-old female baby admitted for poor feeding, cough, and oral thrush with multiple deprivation and lacking maternal love and care and improper nutrition. Diagnosis was malnutrition, failure to thrive, pneumonia, and several deficiencies, highlighting the importance of proper nutrition, breast feeding and immunization to avoid acute malnutrition in children.
نموذج شهادة
حول المتحدثين
Dr.Bharat Parmar
Consultant Radiation Oncologist and Pain and Palliative Care PhysicianYashoda Hospitals
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