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[Lethality in hospitalized infants with acute diarrhea: risk factors associated with death]
J A de Andrade1, J O de Oliveira, U Fagundes Neto
1Escola Paulista de Medicina-Universidade Federal de São Paulo-UNIFESP.
Insights
Infants under six months, severe malnutrition, food intolerance, and enteropathogenic Escherichia coli (EPEC) infections significantly increase the risk of death in children hospitalized with severe acute diarrhea. Early identification of these factors is crucial for improving infant survival rates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Context:
- Acute diarrhea is a leading cause of infant mortality in developing nations.
- Severe acute diarrhea poses a significant threat to infants under two years of age.
Purpose:
- To identify clinical and epidemiological factors associated with mortality in infants hospitalized with severe acute diarrhea.
- To evaluate risk factors contributing to death in a cohort of 511 infants.
Summary:
- Infants under six months (RR=4.0), severe malnutrition (RR=4.5), food intolerance (RR=2.7), and enteropathogenic Escherichia coli (EPEC) infection (RR=3.3) were significantly associated with increased mortality.
- Enteropathogenic agents were identified in 75% of deceased infants, with EPEC being the most common (56.3%).
- A total of 17 out of 511 infants hospitalized between 1989 and 1995 died.
Impact:
- Identifies critical risk factors for high-risk infant populations.
- Informs targeted interventions and clinical management strategies for severe acute diarrhea.
- Highlights the importance of nutritional status and pathogen identification in pediatric mortality.
Objectives:
Acute diarrhea is a very frequent disease in developing countries and is the first cause of death in infants under 2 years of age. This study was designed to evaluate the clinical and epidemiological factors associated to the death of 17 out of 511 infants hospitalized owing to severe acute diarrhea, between January 1989 and December 1995.
Patients And Methods:
The patients were divided into two groups according to their clinical evolution: Group I--Death and Group II--Survival. The following parameters were evaluated: birth weight, sex, age, duration of diarrhea (days) prior to admission, nutritional status, hydration, presence of an enteropathogenic agent in the stools, food intolerance and duration of hospitalization.
Results:
The analyzed factors have shown a significant association with death for the following variables: age, relative risk (RR) = 4.0 for infants less than 6 months of age, identification of an enteropathogenic Escherichia coli (EPEC) strain in the stools (RR = 3.3), severe malnutrition at admission to the hospital (RR = 4.5), Occurrence of food intolerance during hospitalization (RR = 2.7). Some enteropathogenic agent was identified in the stools of 253 (54.9%) infants, among the 461 (90.2%) studied. Group I revealed the presence of an enteropathogenic agent in 75% of the cases. The most frequent agents identified in Group I was: EPEC (56.3%) and Shigella (12.5%), while in Group II EPEC was identified in 26.5% of the patients.
Conclusions:
The association of some factors such as age less than 6 months, severe malnutrition, food intolerance and the identification of EPEC strains in the stool culture are indicators of high risk of death in infants hospitalized due to severe acute diarrhea.