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A Predictive Model for Thiamine Responsive Disorders Among Infants and Young Children: Results from a Prospective
Taryn J Smith1, Charles D Arnold1, Philip R Fischer2
1Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, CA.
Insights
Infants and young children with suspected thiamine deficiency disorders (TDDs) often respond well to thiamine treatment. A predictive model identified key signs, but high prevalence suggests empirical thiamine use in high-risk areas.
Area of Science:
- Pediatrics
- Nutritional Science
- Infectious Disease Epidemiology
Background:
- Thiamine deficiency disorders (TDDs) pose a significant health risk to infants and young children.
- Early diagnosis and treatment are crucial for favorable outcomes.
- Identifying predictive factors for thiamine responsiveness can aid clinical decision-making.
Purpose of the Study:
- To develop a predictive model for identifying thiamine responsive disorders (TRDs) in hospitalized infants and young children.
- To assess the response to therapeutic thiamine in a high-risk population.
Main Methods:
- A cohort of 449 children (21 days to <18 months) in Lao People's Democratic Republic with suspected TDDs received parenteral thiamine.
- Clinical assessments and recovery were monitored for 72 hours post-thiamine initiation.
- Logistic regression models identified predictors of TRD, with model performance evaluated by AUC.
Main Results:
- 60.8% of enrolled children had a confirmed TRD.
- Key predictors of TRD included exclusive/predominant breastfeeding, hoarse voice, cyanosis, lack of eye contact, and absence of recent diarrhea.
- The predictive model achieved an AUC of 0.82 (95% CI: 0.78, 0.86).
Conclusions:
- The majority of children with suspected TDDs showed a positive response to thiamine.
- Five clinical features effectively predicted TRD, but the high prevalence supports empirical thiamine administration for all suspected cases in similar settings.
- Further research is needed to refine and validate the predictive model for broader application.
Objective:
To develop a predictive model for thiamine responsive disorders (TRDs) among infants and young children hospitalized with signs or symptoms suggestive of thiamine deficiency disorders (TDDs) based on response to therapeutic thiamine in a high-risk setting.
Study Design:
Children aged 21 days to <18 months hospitalized with signs or symptoms suggestive of TDD in northern Lao People's Democratic Republic were treated with parenteral thiamine (100 mg daily) for ≥3 days in addition to routine care. Physical examinations and recovery assessments were conducted frequently for 72 hours after thiamine was initiated. Individual case reports were independently reviewed by three pediatricians who assigned a TRD status (TRD or non-TRD), which served as the dependent variable in logistic regression models to identify predictors of TRD. Model performance was quantified by empirical area under the receiver operating characteristic curve.
Results:
A total of 449 children (median [Q1, Q3] 2.9 [1.7, 5.7] months old; 70.3% exclusively/predominantly breastfed) were enrolled; 60.8% had a TRD. Among 52 candidate variables, those most predictive of TRD were exclusive/predominant breastfeeding, hoarse voice/loss of voice, cyanosis, no eye contact, and no diarrhea in the previous 2 weeks. The area under the receiver operating characteristic curve (95% CI) was 0.82 (0.78, 0.86).
Conclusions:
In this study, the majority of children with signs or symptoms of TDD responded favorably to thiamine. While five specific features were predictive of TRD, the high prevalence of TRD suggests that thiamine should be administered to all infants and children presenting with any signs or symptoms consistent with TDD in similar high-risk settings. The usefulness of the predictive model in other contexts warrants further exploration and refinement.
Trial Registration:
Clinicaltrials.gov NCT03626337.
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