Related Experiment Video
Updated: Jul 20, 2026
A Neonatal BALB/c Mouse Model of Necrotizing Enterocolitis
Published on: November 30, 2021
Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol
1Clinical Sciences Division, ICDDR, B: Centre for Health and Population Research, Dhaka, Bangladesh.
Insights
A new standardized protocol for treating severely malnourished children with diarrhea significantly reduced mortality by 47%. This approach emphasizes oral rehydration, leading to fewer complications like hypoglycemia and less need for intravenous fluids.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- High mortality rates in severely malnourished children, particularly within 48 hours of hospital admission.
- Existing case-management strategies have been linked to increased mortality.
- Development of a standardized protocol to improve acute-phase treatment outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a standardized protocol for treating severe malnutrition and diarrhea in children.
- To compare mortality rates between children managed with the standardized protocol versus conventional treatment.
- To assess the impact of the protocol on rehydration success, complications, and resource utilization.
Main Methods:
- Comparative study of children aged 0-5 years with severe malnutrition and diarrhea.
- Two groups: standardized protocol (oral rehydration emphasis) and non-protocol (conventional treatment).
- Data collected from ICDDR,B Hospital, Dhaka, comparing 1997 (protocol) and 1996 (non-protocol) admission periods.
Main Results:
- The standardized protocol group (n=334) showed significantly higher oral rehydration success (59.9% vs 29%, p<0.0001).
- Fewer episodes of hypoglycemia (15 vs 30, p=0.005) and less frequent use of expensive antibiotics were observed with the protocol.
- Mortality was reduced by 47% in the standardized protocol group (9% vs 17%, p=0.003).
Conclusions:
- The standardized protocol significantly reduced mortality, hypoglycemia, and the need for intravenous fluids in severely malnourished children with diarrhea.
- This protocol offers a more effective and potentially less resource-intensive approach to managing this vulnerable population.
- Implementation of this standardized protocol is recommended for all children presenting with diarrhea and severe malnutrition.
Background:
Severely malnourished children have high mortality rates. Death commonly occurs during the first 48 h after hospital admission, and has been attributed to faulty case-management. We developed a standardised protocol for acute-phase treatment of children with severe malnutrition and diarrhoea, with the aim of reducing mortality.
Methods:
We compared severely malnourished children with diarrhoea aged 0-5 years managed by non-protocol conventional treatment, and those treated by our standardised protocol that included slow rehydration with an emphasis on oral rehydration. The standardised-protocol group included children admitted to the ICDDR,B Hospital, Dhaka between Jan 1, 1997, and June 30, 1997, while those admitted between Jan 1, 1996, and June 30, 1996, before the protocol was implemented, were the non-protocol group.
Findings:
Characteristics on admission of children on standardised protocol (n=334) and non-protocol children (n=293) were similar except that more children on standardised protocol had oedema, acidosis, and Vibrio cholerae isolated from stools. 199 (59.9%) of children on standardised protocol were successfully rehydrated with oral rehydration solution, compared with 85 (29%) in the non-protocol group (p<0.0001). Use of expensive antibiotics was less frequent in children on standardised protocol than in the other group (p<0.0001). Children on standardised protocol had fewer episodes of hypoglycaemia than non-protocol children (15 vs 30, p=0.005). 49 (17%) of children on non-protocol treatment died, compared with 30 (9%) children on standardised protocol (odds ratio for mortality, 0.49, 95% CI 0.3-0.8, p=0.003).
Interpretation:
Compared with non-protocol management, our standardised protocol resulted in fewer episodes of hypoglycaemia, less need for intravenous fluids, and a 47% reduction in mortality. This standardised protocol should be considered in all children with diarrhoea and severe malnutrition.
More Related Videos
09:36Effect of Hyaluronic Acid 35 kDa on an In Vitro Model of Preterm Small Intestinal Injury and Healing Using Enteroid-Derived Monolayers
Published on: July 28, 2022
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Related Concept Videos
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:26Pharmaceutical Poisoning: Potential Scenarios