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[Mortality in breast-fed infants with persistent diarrhea: risk factors associated with death]
J A de Andrade1, T A Gomes, U Fagundes-Neto
1Escola Paulista de Medicina, Universidade Federal de São Paulo EPM-UNIFESP.
Insights
Infants under six months with persistent diarrhea face higher mortality risks, especially when infected with enteropathogenic Escherichia coli (EPEC). Sepsis is a leading cause of death in these vulnerable hospitalized children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Context:
- Persistent diarrhea is a significant health challenge in developing nations.
- This study analyzed 189 hospitalized patients with persistent diarrhea between 1985 and 1992.
Purpose:
- To identify risk factors associated with mortality in hospitalized patients with persistent diarrhea.
- To investigate the etiological agents and their correlation with patient outcomes.
Summary:
- Younger age (under 6 months), transfer from other hospitals, third-degree dehydration, and isolation of enteropathogenic Escherichia coli (EPEC) were significantly associated with increased mortality.
- EPEC, particularly the O111 serogroup, was the most frequently isolated enteropathogen in deceased patients.
- Sepsis was identified as the primary cause of death among hospitalized infants with persistent diarrhea.
Impact:
- Findings highlight critical risk factors for mortality in persistent diarrhea, informing clinical management and public health interventions.
- Emphasizes the need for targeted interventions for high-risk infants, including early diagnosis and treatment of EPEC infections and sepsis.
Objects:
Persistent diarrhea is a frequent disease in developing countries. In this research, we studied 21 patients that passed away among 189 that were hospitalized with persistent diarrhea at the "Hospital Italo Brasileiro Umberto I Foundation", from January of 1985 until December of 1992.
Patients And Methods:
The patients were distributed into two groups: survival and dead, in accord of the clinical evolution at the end of the internment. The analyzed parameters were: birth weight, sex, age, provenance, diarrhea period before the admission, nutritional status, hydration status, coprologic results, occurrence of food intolerance, internment period and the age of ending breast-feeding.
Results:
The parameters that showed significantly association with the death were: age, with relative risk = 3 for children with age below 6 months old; provenance, with relative risk = 3.4 for patients who were arrived from other hospitals; third grade dehydration at the admission (relative risk = 2.9); enteropathogenic Escherichia coli (EPEC) isolated in feces (relative risk = 3.3), and use of total parenteral nutrition. The etiologic research was positive in 57.1% of the cases. The enteropathogen more frequently isolated in dead group, was EPEC (42.9%), followed by Shigella (9.5%) and Salmonella (5.9%). From the isolated EPEC (35/189), 26 (74.3%) were belonged to the OIII sorogroup (6/26). From these children, 23.1% died. From the 35 patients with EPEC isolated in feces, 25 were below 6 months old, and from these one, eight died. The relative risk to die for lactents with less than 6 months old and EPEC in feces was equal 3.2. Sepsis was considered the most important cause of death for hospitalized lactents with persistent diarrhea.