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Acute diarrhea and malnutrition: lethality risk in hospitalized infants
U Fagundes-Neto1, J A de Andrade
1Department of Pediatric Gastroenterology, Umberto I Hospital, São Paulo Federal University/Escola Paulista de Medicina, São Paulo, Brazil.
Insights
Infants under six months, severe malnutrition, food intolerance, and enteropathogenic Escherichia coli (EPEC) infections significantly increase the risk of death from severe acute diarrhea. These factors are crucial for identifying high-risk infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Acute diarrhea is a leading cause of infant mortality in developing nations.
- Severe acute diarrhea necessitates hospitalization for infants under two years old.
Purpose of the Study:
- To identify clinical and epidemiological factors associated with mortality in hospitalized infants with severe acute diarrhea.
Main Methods:
- A retrospective study comparing infants who died (Group I) versus survived (Group II).
- Evaluated parameters included birth weight, age, nutritional status, hydration, enteropathogenic agents, food intolerance, and hospitalization duration.
Main Results:
- Factors significantly associated with death included younger age (under six months), severe malnutrition, and food intolerance during hospitalization.
- Enteropathogenic Escherichia coli (EPEC) was identified in 75% of deceased infants compared to 26.5% of survivors.
- Severe malnutrition (RFD=4.5) and age under six months (RFD=4.0) were major risk factors.
Conclusions:
- Age under six months, severe malnutrition, food intolerance, and EPEC infection are critical indicators of high mortality risk in infants with severe acute diarrhea.
- Early identification and management of these factors are essential for improving outcomes.
Objectives:
Acute diarrhea is a very frequent disease in developing countries and is the first cause of death in infants under two 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 due 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, gender, 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 factor of death (RFD)=4.0 for infants less than six months of age, identification of an enteropathogenic Escherichia coli (EPEC) strain in the stools (RFD=3.3), severe malnutrition at admission to the hospital (RFD=4.5), occurrence of food intolerance during hospitalization (RFD=2.7). Some enteropathogenic agent was identified in the stools of 253 infants (54.9%), 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 were: 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 six months, severe malnutrition, food intolerance and the identification of EPEC strains in the stool culture, indicate a high risk of death in infants hospitalized due to severe acute diarrhea.