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Pericardial effusions in children with severe protein energy malnutrition resolve with therapeutic feeding: a
1Department of Paediatrics, College of Medicine, University of Malawi, Malawi. Shafique.Ahmad@nuh.nhs.uk
Insights
Pericardial effusions are common in malnourished children and larger in those with peripheral edema. Nutritional therapy alone significantly reduced effusion size, indicating it
Area of Science:
- Pediatric Cardiology
- Nutritional Sciences
- Infectious Diseases
Background:
- Malnutrition is a major cause of child mortality in sub-Saharan Africa.
- Clinicians often suspect tuberculosis (TB) in malnourished children with pericardial effusions.
- The relationship between malnutrition, pericardial effusions, and TB requires further investigation.
Purpose of the Study:
- To determine the prevalence and characteristics of pericardial effusions in malnourished children.
- To assess the association between pericardial effusion size and peripheral edema, malnutrition type, and HIV status.
- To evaluate the impact of nutritional therapy on pericardial effusion size.
Main Methods:
- Prospective study of 89 children at a nutritional rehabilitation unit in Malawi.
- Echocardiography performed at admission and 4-week follow-up.
- Children classified into marasmus, marasmic kwashiorkor, and kwashiorkor groups, with and without TB.
Main Results:
- Pericardial effusions were common in severely malnourished children.
- Effusion size decreased significantly (2.9 mm) after 4 weeks of nutritional therapy (p=0.002).
- Larger effusions were observed in children with peripheral edema.
Conclusions:
- Pericardial effusions are a frequent finding in severely malnourished children.
- Effusion size correlates with peripheral edema and improves with nutritional therapy.
- Nutritional therapy alone is effective in resolving pericardial effusions in this population.
Background:
Malnutrition underlies 50% of paediatric morbidity and mortality in sub-Saharan Africa. It is important to look for the underlying causes of the malnutrition, and some clinicians have assumed that the presence of a pericardial effusion indicates underlying tuberculosis (TB). We wished to see how common pericardial effusions are in malnourished children and how their presence or size is related to peripheral oedema or the type of malnutrition of the child, HIV status or to underlying TB.
Methods:
We prospectively studied a cohort of children at a regional nutritional rehabilitation unit in Malawi. Echocardiography on admission and follow-up 4 weeks later was performed. During this interval children received therapeutic feeding and any other required medical care. The children were grouped into group 1 (marasmus), group 2 (marasmus with TB), group 3 (marasmic kwashiorkor), group 4 (marasmic kwashiorkor with TB), group 5 (kwashiorkor) and group 6 (kwashiorkor with TB).
Results:
Of the 89 children who were enrolled, 28 were marasmic (eight also had TB), 29 had marasmic kwashiorkor (six with TB) and 32 had kwashiorkor (four with TB). In all the children who had a pericardial effusion, its size was greatest at presentation. The overall reduction in pericardial effusion size after 4 weeks of nutritional therapy was significant (2.9 mm change, range 0 to 8.4 mm, p = 0.002). The greatest change in pericardial effusion size was in the children with most peripheral oedema compared with those with no oedema (2.7 mm versus 1.0 mm, p = 0.017).
Conclusions:
In severely malnourished children pericardial effusions are common, larger in children with peripheral oedema and respond to nutritional therapy alone.
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