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Intractable diarrhoea of infancy and its management: modified cost effective treatment
1Division of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research Chandigarh, India.
Insights
This study investigated intractable infant diarrhea, finding common issues like malnutrition, infections, and various food intolerances. Early interventions often failed, highlighting the complexity of these severe pediatric cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Intractable diarrhea in infants under 1 year is a severe condition.
- Affected infants often present with malnutrition and significant illness.
- Previous treatments, including antimicrobials and IV fluids, were frequently unsuccessful.
Purpose of the Study:
- To characterize the clinical presentation, comorbidities, and etiological agents of intractable diarrhea in infants.
- To identify factors contributing to treatment failure in severe pediatric diarrhea cases.
Main Methods:
- A cohort of 120 infants with intractable diarrhea (duration > 2 weeks) was studied.
- Clinical data, including symptoms, malnutrition, and prior treatments, were collected.
- Stool cultures and other diagnostic tests were performed to identify infections and intolerances.
Main Results:
- Common symptoms included vomiting (44%), dehydration (23%), and perianal excoriation (47%).
- High prevalence of anemia (70%) and secondary lactose intolerance (53%) was observed.
- Identified pathogens included E. coli (18%), Candida albicans (18%), and various other bacteria and parasites.
Conclusions:
- Intractable infant diarrhea is associated with severe malnutrition, multiple infections, and significant feeding intolerances.
- The study underscores the need for comprehensive diagnostic approaches to manage these complex pediatric cases.
- Understanding the diverse etiological agents is crucial for effective treatment strategies.
Abstract:
One-hundred-twenty infants under 1 year of age suffering from intractable diarrhoea were studied. They had received prior treatment in the form of antimicrobials (100 per cent), stool binding substance (50 percent), antimotility agents (50 per cent), and intravenous (IV) fluids (33 per cent). One-third of them had been hospitalised in peripheral hospitals. All of them had diarrhoea of more than 2 weeks' duration, protein energy malnutrition and were very ill. In addition vomiting, dehydration, fever, paralytic ileus, perianal excoriation and rectal prolapse were present in 44, 23, 33, 9, 47, and 3 per cent of the infants, respectively. Anaemia, multiple vitamin deficiencies, and pedal oedema were seen in 70, 10, and 3 per cent of infants, respectively. The infections documented were septicaemia (22 per cent), bronchopneumonia (6 per cent), meningitis (4 per cent), urinary tract infection (3 per cent) and acute supporative otitis media in 2 per cent of infants. Fifty-three per cent of infants had secondary lactose intolerance. Intolerance to milk protein, milk protein and soyabean and milk protein, as well as soyabean and chicken was seen in 4, 2, and 1 per cent cases, respectively. Aetiological agents isolated from stool culture were E. coli, (18 per cent), Klebsiella species (9 per cent), Shigella species (6 per cent), Salmonella typhimurium (2 per cent), Cholera mitschikom (1 per cent), Giardia lamblia (6 per cent), cryptosporidium (1 per cent), and E. histolytica (1 per cent). Candida albicans was grown in 18 per cent of infants. Pseudomembranous colitis was documented in 2 per cent cases.(ABSTRACT TRUNCATED AT 250 WORDS)