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Etiology and risk factors of severe and protracted diarrhea
A Guarino1, M I Spagnuolo, S Russo
1Department of Pediatrics, University Federico II, Naples, Italy.
Insights
Severe and protracted diarrhea (SPD) in infants often stems from enteric infections. Risk factors like low birth weight and early onset significantly increase severity, though specific causes are identifiable in most cases.
Area of Science:
- Pediatric Gastroenterology
- Infant Nutrition
- Infectious Diseases
Background:
- Severe and protracted diarrhea (SPD), also known as intractable diarrhea, is a critical condition in infants with poorly understood causes.
- Understanding the etiology and risk factors of SPD is crucial for improving infant health outcomes.
Purpose of the Study:
- To retrospectively evaluate the etiology, outcomes, and risk factors of SPD in 38 infants requiring total parenteral nutrition (TPN).
- To identify common causes and contributing factors for severe infant diarrhea.
Main Methods:
- Retrospective analysis of 38 infants with SPD needing TPN (1977-1993), excluding those with anatomical abnormalities or immunodeficiency.
- Comparison of risk factors between SPD patients and a control group with less severe diarrhea.
Main Results:
- Enteric infections were the most common cause (18 cases), followed by multiple alimentary intolerances (8 cases).
- Mortality was 12/38; 21 achieved full remission.
- Risk factors associated with SPD included low birth weight, lack of breastfeeding, family history of fatal diarrhea, and early onset.
Conclusions:
- A specific etiology for SPD can be identified in most cases, with enteric infection being the most frequent cause.
- The broad etiologic spectrum includes infections, intolerances, and rare genetic/autoimmune conditions.
- Established risk factors contribute significantly to the severity of SPD.
Abstract:
Severe and protracted diarrhea (SPD) is the most severe form of diarrhea in infancy and has also been defined as intractable diarrhea. Its etiology is poorly defined. We have retrospectively evaluated the etiology, the outcome, and the risk factors of 38 children, admitted with protracted diarrhea and need for total parenteral nutrition (TPN) from 1977 to 1993. Children with anatomic abnormalities and/or primary immunodeficiency were excluded. There was an inverse relationship between the number of patients and the age of diarrheal onset (mean age, 2.9 +/- 3.5 months). Etiology of SPD was an enteric infection in 18 cases (eight Salmonella, three Staphylococcus, five rotavirus, one adenovirus, one Cryptosporidium), multiple alimentary intolerance (eight cases), familial microvillous atrophy (two), autoimmune enteropathy (two), celiac disease, lymphangectasia, eosinophilic enteropathy, intestinal pseudoobstruction, and intestinal neurodysplasia (1 case each). Etiology was not detected in three cases. Overall, 12 children died, five are presently being treated, and 21 had full remission. Comparative evaluation of risk factors between children with SPD and a control population of children with diarrhea but without the need for TPN showed that low birth weight, no breast feeding, history of fatal diarrhea in a relative, and early onset of diarrhea had a significantly higher incidence in the former. Social background was similar in the two populations. We conclude that a specific etiology can be identified in the majority of cases of SPD. The etiologic spectrum of SPD is broad, but an enteric infection is the most common cause of SPD. The severity of this condition is related, at least in part, to established risk factors.