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Diagnosis and treatment of severely malnourished children with diarrhoea

Lora L Iannotti1, Indi Trehan, Kathryn L Clitheroe

  • 1Institute for Public Health, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri.

Journal of Paediatrics and Child Health
|September 9, 2014
PubMed

Insights

Effective management of severe acute malnutrition in children with diarrhea involves specific diagnostic and therapeutic strategies. Key findings include using diarrhea duration as a marker, rapid hypoglycemia diagnosis, and benefits from antiparasitic medication and specialized diets.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Nutritional Science

Background:

  • Children with severe acute malnutrition (SAM) and diarrhea face heightened mortality risks.
  • Effective community-based management strategies for SAM with diarrhea are critical but under-researched.
  • Physiological vulnerability in this population necessitates specialized care approaches.

Purpose of the Study:

  • To systematically review diagnostic and therapeutic measures for community-based management of SAM in children with diarrhea.
  • To identify evidence-based interventions, broadening the search to include inpatient care due to limited direct studies.

Main Methods:

  • Systematic literature review conducted from 1950 to 2013.
  • Initial search focused on community-based management, expanded to inpatient settings.
  • 129 studies were identified, with 32 selected for full review, noting limitations like indirectness, inconsistency, and bias.

Main Results:

  • Diagnostic indicators include prolonged/persistent diarrhea, rapid hypoglycemia detection, and the role of Cryptosporidium.
  • Therapeutic benefits suggested for routine antiparasitic medication, ready-to-use therapeutic foods, lactose-free diets, and zinc supplementation.
  • Existing rehydration guidelines were supported; glutamine and low osmolarity feeds showed inconclusive utility.

Conclusions:

  • Evidence supports specific diagnostic markers and therapeutic interventions for SAM children with diarrhea.
  • Routine antiparasitic medication, specialized feeding (RUTFs, lactose-free, zinc), and established rehydration are recommended.
  • Further research is needed to clarify the role of glutamine and low osmolarity feeds in this vulnerable population.

Keywords:
CryptosporidiumGRADE reviewdiarrhoeaready-to-use therapeutic foodseverely malnourished childrenzinc

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