Risk factors of prolonged diarrhea in children under 2 years old
Dedy Rahmat1, Agus Firmansyah2, Ina S Timan3
1Department of Child Health, Fatmawati General Hospital, Jakarta, Indonesia.
Insights
Antibiotic use, zinc deficiency, and elevated fecal alpha-1 antitrypsin (AAT) levels are key risk factors for prolonged diarrhea in young children. Early identification and proper antibiotic management are crucial for prevention.
Area of Science:
- Pediatrics
- Gastroenterology
- Infectious Diseases
Background:
- Prolonged diarrhea (lasting >7 days) significantly hinders child growth and development.
- Limited research exists on the specific risk factors contributing to prolonged diarrhea in pediatric populations.
Purpose of the Study:
- To identify and analyze the primary risk factors associated with prolonged diarrhea in children under two years old presenting with acute diarrhea.
Main Methods:
- A nested case-control study was conducted involving children under two years with acute diarrhea.
- Data collected included clinical information and laboratory tests such as complete blood count, zinc levels, and fecal alpha-1 antitrypsin (AAT).
- Prolonged diarrhea was defined as lasting 7 days; children with comorbidities were excluded.
Main Results:
- Antibiotic use history (OR, 15.860), zinc deficiency (OR, 4.758), and elevated fecal AAT levels (OR, 2.677) were identified as significant risk factors.
- These factors were strongly correlated with the development of prolonged diarrhea in the study cohort.
- The study involved 62 subjects in total, with a median age of 12 months.
Conclusions:
- Antibiotic use, zinc deficiency, and elevated fecal AAT levels are the primary risk factors for prolonged diarrhea in young children.
- Recommendations include thorough diagnostic testing and judicious antibiotic use to prevent prolonged diarrhea.
- These findings underscore the importance of addressing nutritional status and prior antibiotic exposure in managing pediatric diarrhea.
Background:
Prolonged diarrhea, defined as diarrhea lasting longer than 7 days, is known to negatively impact children's growth and development. However, studies of the risk factors of prolonged diarrhea remain limited.
Purpose:
This study aimed to analyze the risk factors for prolonged diarrhea in children under 2 years of age with acute diarrhea.
Methods:
This 1-year nested case-control study was conducted at Fatmawati General Hospital in 2021-2022. Participants were selected using a consecutive sampling method from among children under 2 years of age with acute diarrhea within the previous 2-4 days. Children with diarrhea that lasted 7 days were considered positive for prolonged diarrhea, whereas those with acute diarrhea were considered negative. Children with comorbidities such as malnutrition were excluded. Clinical information including age, breastfeeding history, antibiotic exposure history, and nutritional status was recorded. Complete blood count, blood zinc levels, Rotavirus, adenovirus, and norovirus serology, alpha-1 antitrypsin (AAT) levels, and stool analysis were acquired as laboratory data.
Results:
There were 62 subjects in the study and control groups. Overall, the median age was 12 months (6-24 months); most patients were boys. A history of antibiotic use (odds ratio [OR], 15.860; 95% confidence interval [CI], 5.286-47.591; P<0.001), zinc deficiency (OR, 4.758; 95% CI, 1.711-13.229; P=0.003), and elevated fecal AAT levels (OR, 2.677; 95% CI, 1.046-6.850; P=0.040) were the main risk factors for prolonged diarrhea in children under 2 years of age with acute diarrhea.
Conclusion:
A history of antibiotic use, zinc deficiency, and elevated fecal AAT levels were the main risk factors for prolonged diarrhea in children under 2 years of age with acute diarrhea. Thorough testing and appropriate antibiotic use are required to prevent prolonged diarrhea in children under 2 years of age.
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