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Batte A, Shahrin L, Claure-Del Granado R, Luyckx VA, Conroy AL. Infections and Acute Kidney Injury: A Global Perspective. Semin Nephrol 2023; 43:151466. [PMID: 38158245 DOI: 10.1016/j.semnephrol.2023.151466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Globally, there are an estimated 13.3 million cases of acute kidney injury (AKI) annually. Although infections are a common cause of AKI globally, most infection-associated AKI occurs in low- and lower-middle-income countries. There are marked differences in the etiology of infection-associated AKI across age groups, populations at risk, and geographic location. This article provides a global overview of different infections that are associated commonly with AKI, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus, malaria, dengue, leptospirosis, tick-borne illnesses, and viral hemorrhagic fevers. Further discussion focuses on infectious conditions associated with AKI including sepsis, diarrheal diseases and pregnancy, peripartum and neonatal AKI. This article also discusses the future of infection-associated AKI in the framework of climate change. It explores how increased investment in achieving the sustainable development goals may contribute to the International Society of Nephrology's 0 by 25 objective to curtail avoidable AKI-related fatalities by 2025.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Global Health Uganda, Kampala, Uganda.
| | - Lubaba Shahrin
- Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rolando Claure-Del Granado
- Division of Nephrology, Hospital Obrero No 2, Caja Nacional de Salud, Cochabamba, Bolivia; Instituto de Investigaciones Biomédicas e Investigación Social (IIBISMED), Facultad de Medicina, Universidad Mayor de San Simon, Cochabamba, Bolivia
| | - Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Andrea L Conroy
- Ryan White Center for Pediatric Infectious Diseases, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; Center for Global Health, Indiana University School of Medicine, Indianapolis, IN
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2
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Al-Nattah M, Abdullah A, Alkhateeb N, Abu Qaoud H, Al Ali A, Alzakeebeh O. Navigating a Complex Presentation: Management of Hypernatremic Dehydration, Acute Kidney Injury, Hyperkalemia, and Metabolic Acidosis in a Patient With Down Syndrome: A Case Report. Cureus 2023; 15:e46053. [PMID: 37900476 PMCID: PMC10604586 DOI: 10.7759/cureus.46053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Worldwide, gastroenteritis is a well-known cause of dehydration in pediatric patients and can be life-threatening due to subsequent electrolyte disturbance or dehydration itself. In this case, we present an infant with Down syndrome (karyotype: 21 trisomy) who presented to us with moderate hypernatremic dehydration associated with severe hyperkalemia, moderate metabolic acidosis (pH: 7.1, random blood glucose: 80-110 mg/dL), and elevated kidney function tests secondary to the gastroenteritis caused by Entamoeba histolytica infection. The patient is being followed up by the pediatrics genetics clinic for growth and development, with regular screening for thyroid and celiac diseases, and he has no major heart, gastrointestinal, or renal anomalies. This unique and complex presentation of electrolyte disturbance and dehydration associated with a susceptible condition of Down syndrome deserves special attention with precise management which can be challenging. We managed the patient as a case of hypernatremic dehydration with gradual correction of serum sodium and dehydration, while concurrently managing hyperkalemia by routine methods (beta agonist inhalers, insulin, dextrose 10%) with close laboratory and clinical monitoring at the pediatric intensive care unit. The pediatric nephrology team was also consulted while delineating the management plan. As the patient's condition eventually resolved with normal kidney function and electrolytes, metabolic acidosis also resolved, with good oral intake and urine output, stable vitals, and was discharged after 72 hours. In conclusion, this case showed that pediatric patients with susceptible conditions such as Down syndrome with gastroenteritis can present with a lethal combination of dehydration and/or electrolyte disturbance, making close monitoring and prompt management paramount in such cases.
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Affiliation(s)
- Mahmoud Al-Nattah
- Pediatrics and Neonatology, Royal Medical Services, Jordan Armed Forces, Amman, JOR
| | - Ahmad Abdullah
- Pediatric Medicine, Royal Medical Services, Jordan Armed Forces, Amman, JOR
| | - Nehal Alkhateeb
- Nursing, Royal Medical Services, Jordan Armed Forces, Amman, JOR
| | - Hedaya Abu Qaoud
- Pediatrics and Neonatology, Royal Medical Services, Jordan Armed Forces, Amman, JOR
| | - Alaeddin Al Ali
- Neonatology, Royal Medical Services, Jordan Armed Forces, Amman, JOR
| | - Ola Alzakeebeh
- Pediatric Medicine, Royal Medical Services, Jordan Armed Forces, Amman, JOR
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3
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Sarmin M, Shaly NJ, Sultana T, Tariqujjaman M, Shikha SS, Mariam N, Jeorge DH, Tabassum M, Nahar B, Afroze F, Shahrin L, Hossain MI, Alam B, Faruque ASG, Islam MM, Osmany DEMMF, Ahmed CM, Manji K, Kissoon N, Chisti MJ, Ahmed T. Efficacy of dopamine, epinephrine and blood transfusion for treatment of fluid refractory shock in children with severe acute malnutrition or severe underweight and cholera or other dehydrating diarrhoeas: protocol for a randomised controlled clinical trial. BMJ Open 2023; 13:e068660. [PMID: 37045565 PMCID: PMC10106066 DOI: 10.1136/bmjopen-2022-068660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION Diarrhoea is one of the leading causes of under-5 childhood mortality and accounts for 8% of 5.4 million global under-5 deaths. In severely malnourished children, diarrhoea progresses to shock, where the risk of mortality is even higher. At icddr,b Dhaka Hospital, the fatality rate is as high as 69% in children with severe malnutrition and fluid refractory septic shock. To date, no study has evaluated systematically the effects of inotrope or vasopressor or blood transfusion in children with dehydrating diarrhoea (eg, in cholera) and severe acute malnutrition (SAM) or severe underweight who are in shock and unresponsive to WHO-recommended fluid therapy. To reduce the mortality of severely malnourished children presenting with diarrhoea and fluid refractory shock, we aim to compare the efficacy of blood transfusion, dopamine and epinephrine in fluid refractory shock in children who do not respond to WHO-recommended fluid resuscitation. METHODS AND ANALYSIS In this randomised, three-arm, controlled, non-masked clinical trial in children 1-59 months old with SAM or severe underweight and fluid refractory shock, we will compare the efficacy of dopamine or epinephrine administration versus blood transfusion in children who failed to respond to WHO-recommended fluid resuscitation. The primary outcome variable is the case fatality rate. The effect of the intervention will be assessed by performing an intention-to-treat analysis. Recruitment and data collection began in July 2021 and are now ongoing. Results are expected by May 2023. ETHICS AND DISSEMINATION This study has been approved by the icddr,b Institutional Review Board. We adhere to the 'Declaration of Helsinki' (2000), guidelines for Good Clinical Practice. Before enrolment, we collect signed informed consent from the parents or caregivers of the children. We will publish the results in a peer-reviewed journal and will arrange a dissemination seminar. TRIAL REGISTRATION NUMBER NCT04750070.
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Affiliation(s)
- Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nusrat Jahan Shaly
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tania Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tariqujjaman
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shamima Sharmin Shikha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nafisa Mariam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Didarul Haque Jeorge
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mosharrat Tabassum
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Baharul Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Syed Golam Faruque
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Karim Manji
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
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Diagnostic, Management, and Research Considerations for Pediatric Acute Respiratory Distress Syndrome in Resource-Limited Settings: From the Second Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2023; 24:S148-S159. [PMID: 36661443 DOI: 10.1097/pcc.0000000000003166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Diagnosis of pediatric acute respiratory distress syndrome (PARDS) in resource-limited settings (RLS) is challenging and remains poorly described. We conducted a review of the literature to optimize recognition of PARDS in RLS and to provide recommendations/statements for clinical practice and future research in these settings as part of the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2). DATA SOURCES MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost). STUDY SELECTION We included studies related to precipitating factors for PARDS, mechanical ventilation (MV), pulmonary and nonpulmonary ancillary treatments, and long-term outcomes in children who survive PARDS in RLS. DATA EXTRACTION Title/abstract review, full-text review, and data extraction using a standardized data collection form. DATA SYNTHESIS The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Seventy-seven studies were identified for full-text extraction. We were unable to identify any literature on which to base recommendations. We gained consensus on six clinical statements (good practice, definition, and policy) and five research statements. Clinicians should be aware of diseases and comorbidities, uncommon in most high-income settings, that predispose to the development of PARDS in RLS. Because of difficulties in recognizing PARDS and to avoid underdiagnosis, the PALICC-2 possible PARDS definition allows exclusion of imaging criteria when all other criteria are met, including noninvasive metrics of hypoxemia. The availability of MV support, regular MV training and education, as well as accessibility and costs of pulmonary and nonpulmonary ancillary therapies are other concerns related to management of PARDS in RLS. Data on long-term outcomes and feasibility of follow-up in PARDS survivors from RLS are also lacking. CONCLUSIONS To date, PARDS remains poorly described in RLS. Clinicians working in these settings should be aware of common precipitating factors for PARDS in their patients. Future studies utilizing the PALICC-2 definitions are urgently needed to describe the epidemiology, management, and outcomes of PARDS in RLS.
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Bhowmick R. Normal Anion Gap Metabolic Acidosis in Pediatric Acute Diarrhea: A Menace or an Innocent Bystander? Indian J Crit Care Med 2022; 26:1235-1236. [PMID: 36755625 PMCID: PMC9886017 DOI: 10.5005/jp-journals-10071-24371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
How to cite this article: Bhowmick R. Normal Anion Gap Metabolic Acidosis in Pediatric Acute Diarrhea: A Menace or an Innocent Bystander? Indian J Crit Care Med 2022;26(12):1235-1236.
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Affiliation(s)
- Rohit Bhowmick
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Kalyani, West Bengal, India,Rohit Bhowmick, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Kalyani, West Bengal, India, Phone: +91 9629135875, e-mail:
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6
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Physical Quality of Life of Sepsis Survivor Severely Malnourished Children after Hospital Discharge: Findings from a Retrospective Chart Analysis. Life (Basel) 2022; 12:life12030379. [PMID: 35330130 PMCID: PMC8954014 DOI: 10.3390/life12030379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Quality of life (QoL) among pediatric sepsis survivors in resource-limited countries is poorly understood. We aimed to evaluate the QoL among sepsis survivors, by comparing them with non-sepsis survivors three months after hospital discharge. Methodology: In this retrospective chart analysis with a case–control design, we compared children having sepsis and non-sepsis at hospital admission and during their post-hospitalization life, where the study population was derived from a hospital cohort of 405 severely malnourished children having pneumonia. Results: The median age (months, inter-quartile range) of the children having sepsis and non-sepsis was 10 (5, 17) and 9 (5, 18), respectively. Approximately half of the children among the sepsis survivors had new episodes of respiratory symptoms at home. Though death was significantly higher (15.8% vs. 2.7%, p ≤ 0.001) at admission among the sepsis group, deaths during post-hospitalization life (7.8% vs. 8.8%, p = 0.878) were comparable. A verbal autopsy revealed that before death, most of the children from the sepsis group had respiratory complaints, whereas gastrointestinal complaints were more common among the non-sepsis group. Conclusions: Pediatric sepsis is life-threatening both during hospitalization and post-discharge. The QoL after sepsis is compromised, including re-hospitalization and the development of new episodes of respiratory symptoms especially before death.
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7
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Afroze F, Faruk MT, Kamal M, Kabir F, Sarmin M, Chakraborty M, Hossain MR, Shikha SS, Chowdhury VP, Islam MZ, Ahmed T, Chisti MJ. The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh. Antibiotics (Basel) 2021; 10:antibiotics10101255. [PMID: 34680835 PMCID: PMC8532929 DOI: 10.3390/antibiotics10101255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Antibiotic exposure in the pediatric intensive care unit (PICU) is very high, although 50% of all antibiotics may be unnecessary. We aimed to determine the utility of simple bedside screening tools and predicting factors to avoid antibiotic overuse in the ICU among children with diarrhea and critical illness. METHODS We conducted a retrospective, single-center, case-control study that included children aged 2-59 months who were admitted to PICU with diarrhea and critical illness between 2017 and 2020. RESULTS We compared young children who did not receive antibiotics (cases, n = 164) during ICU stay to those treated with antibiotics (controls, n = 346). For predicting the 'no antibiotic approach', the sensitivity of a negative quick Sequential Organ Failure Assessment (qSOFA) was similar to quick Pediatric Logistic Organ Dysfunction-2 (qPELOD-2) and higher than Systemic Inflammatory Response Syndrome (SIRS). A negative qSOFA or qPELOD-2 score calculated during PICU admission is superior to SIRS to avoid antibiotic overuse in under-five children. The logistic regression analysis revealed that cases were more often older and independently associated with hypernatremia. Cases less often had severe underweight, altered mentation, age-specific fast breathing, lower chest wall in-drawing, adventitious sound on lung auscultation, abdominal distension, developmental delay, hyponatremia, hypocalcemia, and microscopic evidence of invasive diarrhea (for all, p < 0.05). CONCLUSION Antibiotic overuse could be evaded in PICU using simple bedside screening tools and clinical characteristics, particularly in poor resource settings among children with diarrhea.
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Affiliation(s)
- Farzana Afroze
- Correspondence: (F.A.); (M.J.C.); Tel.: +880-(0)2-2222-77001-10 (ext. 2187) (F.A.); +880-(0)2-2222-77001-10 (ext. 2334) (M.J.C.)
| | | | | | | | | | | | | | | | | | | | | | - Mohammod Jobayer Chisti
- Correspondence: (F.A.); (M.J.C.); Tel.: +880-(0)2-2222-77001-10 (ext. 2187) (F.A.); +880-(0)2-2222-77001-10 (ext. 2334) (M.J.C.)
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8
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Nalin D. Issues and Controversies in the Evolution of Oral Rehydration Therapy (ORT). Trop Med Infect Dis 2021; 6:tropicalmed6010034. [PMID: 33809275 PMCID: PMC8005945 DOI: 10.3390/tropicalmed6010034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
The original studies demonstrating the efficacy of oral glucose-electrolytes solutions in reducing or eliminating the need for intravenous therapy to correct dehydration caused by acute watery diarrheas (AWD) were focused chiefly on cholera patients. Later research adapted the oral therapy (ORT) methodology for treatment of non-cholera AWDs including for pediatric patients. These adaptations included the 2:1 regimen using 2 parts of the original WHO oral rehydration solution (ORS) formulation followed by 1 part additional plain water, and a “low sodium” packet formulation with similar average electrolyte and glucose concentrations when dissolved in the recommended volume of water. The programmatic desire for a single ORS packet formulation has led to controversy over use of the “low sodium” formulations to treat cholera patients. This is the subject of the current review, with the conclusion that use of the low-sodium ORS to treat cholera patients leads to negative sodium balance, leading to hyponatremia and, in severe cases, particularly in pediatric cholera, to seizures and other complications of sodium depletion. Therefore it is recommended that two separate ORS packet formulations be used, one for cholera therapy and the other for non-cholera pediatric AWD.
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Affiliation(s)
- David Nalin
- Albany Medical College, Albany, NY 12208-3478, USA
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9
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Shahrin L, Sarmin M, Rahman AS, Hasnat W, Mamun GM, Shaima SN, Shahid AS, Ahmed T, Chisti MJ. Clinical and laboratory characteristics of acute kidney injury in infants with diarrhea: a cross-sectional study in Bangladesh. J Int Med Res 2020; 48:300060519896913. [PMID: 31937164 PMCID: PMC7113812 DOI: 10.1177/0300060519896913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Lubaba Shahrin
- Associate Scientist & Head, Acute Respiratory Infection Unit, Dhaka Hospital, Nutrition and Clinical Services Division (NCSD), International Centre for Diarrheal Disease Research Bangladesh (icddr,b)
| | - Monira Sarmin
- Senior Medical Officer, ICU, Dhaka Hospital, NCSD, icddr,b
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10
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Tan R, Kagoro F, Levine GA, Masimba J, Samaka J, Sangu W, Genton B, D'Acremont V, Keitel K. Clinical Outcome of Febrile Tanzanian Children with Severe Malnutrition Using Anthropometry in Comparison to Clinical Signs. Am J Trop Med Hyg 2020; 102:427-435. [PMID: 31802732 DOI: 10.4269/ajtmh.19-0553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Children with malnutrition compared with those without are at higher risk of infection, with more severe outcomes. How clinicians assess nutritional risk factors in febrile children in primary care varies. We conducted a post hoc subgroup analysis of febrile children with severe malnutrition enrolled in a randomized, controlled trial in primary care centers in Tanzania. The clinical outcome of children with severe malnutrition defined by anthropometric measures and clinical signs was compared between two electronic clinical diagnostic algorithms: ePOCT, which uses weight-for-age and mid-upper arm circumference to identify and manage severe malnutrition, and ALMANACH, which uses the clinical signs of edema of both feet and visible severe wasting. Those identified as having severe malnutrition by the algorithms in each arm were prescribed antibiotics and referred to the hospital. From December 2014 to February 2016, 106 febrile children were enrolled and randomized in the parent study, and met the criteria to be included in the present analysis. ePOCT identified 56/57 children with severe malnutrition using anthropometric measures, whereas ALMANACH identified 2/49 children with severe malnutrition using clinical signs. The proportion of clinical failure, defined as the development of severe symptoms by day 7 or persisting symptoms at day 7 (per-protocol), was 1.8% (1/56) in the ePOCT arm versus 16.7% (8/48) in the Algorithm for the MANagement of Childhood illnesses arm (risk difference -14.9%, 95% CI -26.0%, -3.8%; risk ratio 0.11, 95% CI 0.01, 0.83). Using anthropometric measures to identify and manage febrile children with severe malnutrition may have resulted in better clinical outcomes than by using clinical signs alone.
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Affiliation(s)
- Rainer Tan
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland
| | - Frank Kagoro
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Gillian A Levine
- Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland
| | - John Masimba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Josephine Samaka
- Amana Hospital, Dar es Salaam, Tanzania.,Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Willy Sangu
- Dar es Salaam City Council, Dar es Salaam, Tanzania
| | - Blaise Genton
- Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Kristina Keitel
- Department of Pediatric Emergency Medicine, University Hospital Bern, Bern, Switzerland.,Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland
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11
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Singh M, Sankar J, Kumar A, Kumar UV, Lodha R, Kabra SK. Predictors of Mortality in Children Admitted to the Pediatric Intensive Care Unit with Acute Gastroenteritis with Severe Dehydration. Indian J Pediatr 2019; 86:1142-1145. [PMID: 31701427 DOI: 10.1007/s12098-019-03094-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 09/30/2019] [Indexed: 12/20/2022]
Abstract
The objective of the present study was to identify risk factors for mortality at admission in children admitted to the Pediatric Intensive Care Unit (PICU) with acute gastroenteritis (AGE) with severe dehydration and shock. This was a retrospective chart review of all cases of AGE with severe dehydration and shock admitted to the PICU from 2012 to 2017. Children who died during hospital stay were compared with those who survived. A total of 62 children were admitted with AGE to the PICU during this period. Twenty-four children (39%) died. The following variables were found to be significantly associated with death on univariate analysis: clinical pallor (p = 0.01), thrombocytopenia (p = 0.018), elevated leucocyte count (p = 0.02), hypoalbuminemia (p = 0.02) and severe acute malnutrition (SAM) (p = 0.04). On multivariate analysis, only hypoalbuminemia {RR [95% CI: 2.6 (1.27 to 9.21)]; 0.039} and SAM {RR [95% CI: 4.9 (1.12 to 10)]; 0.045} remained statistically significant. Children admitted with severe dehydration and shock had high mortality rates. These children were a sicker subset with probable sepsis. Severe acute malnutrition and hypoalbuminemia were associated with increased risk of death in these patients.
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Affiliation(s)
- Man Singh
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Arvind Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - U Vijay Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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12
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Sarmin M, Afroze F, Sharifuzzaman, Alam T, Shaly NJ, Ahmed T, Chisti MJ. Predictor of Death in Diarrheal Children Under 5 Years of Age Having Severe Sepsis in an Urban Critical Care Ward in Bangladesh. Glob Pediatr Health 2019; 6:2333794X19862716. [PMID: 31384628 PMCID: PMC6647208 DOI: 10.1177/2333794x19862716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/23/2019] [Accepted: 06/03/2019] [Indexed: 01/20/2023] Open
Abstract
We aimed to identify clinical predictors of fatal outcome in children under 5
years of age having diarrhea and severe sepsis and treated in the Intensive Care
Unit of the Dhaka Hospital of icddr,b from October 2010 through September 2011.
Among 191 enrolled children, 70 (37%) died and were considered to be cases,
while the remaining 121 (63%) who survived constituted the controls. The cases
more often had shortness of breath (SOB), septic shock, dehydrating diarrhea
compared with the controls (for all, P < .05). After
adjusting for potential confounders using logistic regression analysis, the
likelihood of death was higher in children who had septic shock and SOB and
lower in children having dehydrating diarrhea (for all, P <
.05). Thus, SOB can trigger an early alarm for sepsis recognition; otherwise,
these children can end up with fatality from septic shock. In resource-poor
settings, early identification of these predictors can alleviate death.
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Affiliation(s)
- Monira Sarmin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sharifuzzaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nusrat Jahan Shaly
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Akech S, Ayieko P, Gathara D, Agweyu A, Irimu G, Stepniewska K, English M. Risk factors for mortality and effect of correct fluid prescription in children with diarrhoea and dehydration without severe acute malnutrition admitted to Kenyan hospitals: an observational, association study. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:516-524. [PMID: 29971245 PMCID: PMC6004535 DOI: 10.1016/s2352-4642(18)30130-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diarrhoea causes many deaths in children younger than 5 years and identification of risk factors for death is considered a global priority. The effectiveness of currently recommended fluid management for dehydration in routine settings has also not been examined. METHODS For this observational, association study, we analysed prospective clinical data on admission, immediate treatment, and discharge of children age 1-59 months with diarrhoea and dehydration, which were routinely collected from 13 Kenyan hospitals. We analysed participants with full datasets using multivariable mixed-effects logistic regression to assess risk factors for in-hospital death and effect of correct rehydration on early mortality (within 2 days). FINDINGS Between Oct 1, 2013, and Dec 1, 2016, 8562 children with diarrhoea and dehydration were admitted to hospital and eligible for inclusion in this analysis. Overall mortality was 9% (759 of 8562 participants) and case fatality was directly correlated with severity. Most children (7184 [84%] of 8562) with diarrhoea and dehydration had at least one additional diagnosis (comorbidity). Age of 12 months or younger (adjusted odds ratio [AOR] 1·71, 95% CI 1·42-2·06), female sex (1·41, 1·19-1·66), diarrhoea duration of more than 14 days (2·10, 1·42-3·12), abnormal respiratory signs (3·62, 2·95-4·44), abnormal circulatory signs (2·29, 1·89-2·77), pallor (2·15, 1·76-2·62), use of intravenous fluid (proxy for severity; 1·68, 1·41-2·00), and abnormal neurological signs (3·07, 2·54-3·70) were independently associated with in-hospital mortality across hospitals. Signs of dehydration alone were not associated with in-hospital deaths (AOR 1·08, 0·87-1·35). Correct fluid prescription significantly reduced the risk of early mortality (within 2 days) in all subgroups: abnormal respiratory signs (AOR 1·23, 0·68-2·24), abnormal circulatory signs (0·95, 0·53-1·73), pallor (1·70, 0·95-3·02), dehydration signs only (1·50, 0·79-2·88), and abnormal neurological signs (0·86, 0·51-1·48). INTERPRETATION Children at risk of in-hospital death are those with complex presentations rather than uncomplicated dehydration, and the prescription of recommended rehydration guidelines reduces risk of death. Strategies to optimise the delivery of recommended guidance should be accompanied by studies on the management of dehydration in children with comorbidities, the vulnerability of young girls, and the delivery of immediate care. FUNDING The Wellcome Trust.
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Affiliation(s)
- Samuel Akech
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Philip Ayieko
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Gathara
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ambrose Agweyu
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Irimu
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi Kenya
| | - Kasia Stepniewska
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Worldwide Antimalarial Resistance Network, Oxford, UK
| | - Mike English
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Chowdhury F, Ghosh PK, Shahunja KM, Shahid ASMSB, Shahrin L, Sarmin M, Sharifuzzaman, Afroze F, Chisti MJ. Hyperkalemia Was an Independent Risk Factor for Death While Under Mechanical Ventilation Among Children Hospitalized With Diarrhea in Bangladesh. Glob Pediatr Health 2018; 5:2333794X17754005. [PMID: 29399602 PMCID: PMC5788088 DOI: 10.1177/2333794x17754005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/17/2017] [Indexed: 12/04/2022] Open
Abstract
Objectives. We sought to evaluate the admission and hospital risk factors for death in children with diarrhea requiring mechanical ventilation (MV). Methods. This was a retrospective study. We enrolled children aged 0 to 59 months admitted with diarrhea to the intensive care unit of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between August 2009 and July 2013 and required MV. To evaluate the risk factors for death in MV, we compared the clinical and laboratory characteristics of the children requiring MV. We matched up to the clinical characteristics presented on admission and subsequently developed before MV during hospital stay with the survivors and deaths of children having MV. Results. Among 73 enrolled children, 58 (80%) died. Incidence of death in MV was higher among children having hyperkalemia (P ≤ .001), hypoglycemia (P ≤ .001), and metabolic acidosis (P = .06) on admission and lower in children having tracheal isolates (P ≤ .001) during hospitalization. After adjusting for covariates by using multivariate robust Poisson regression, children with hyperkalemia (incidence ratio = 1.34; P = .03; confidence interval = 1.02-1.76) on admission was the only independent risk factor for death of children with MV. Conclusion. Children with hyperkalemia on admission and subsequently requiring MV were more likely to die compared with those without hyperkalemia.
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Affiliation(s)
- Fahmida Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Probir Kumar Ghosh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K M Shahunja
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu S M S B Shahid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sharifuzzaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Sharifuzzaman, Sarmin M, Ahmed T, Alam T, Islam SB, Islam MM, Chisti MJ. Determinants and Outcome of Metabolic Acidosis in Diarrheal Children Under 5 Years of Age in an Urban Critical Care Ward in Bangladesh. Glob Pediatr Health 2017; 4:2333794X17740223. [PMID: 29152544 PMCID: PMC5680939 DOI: 10.1177/2333794x17740223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/05/2017] [Indexed: 12/02/2022] Open
Abstract
We evaluated the independent determinants and outcome of metabolic acidosis in diarrheal children. Children under 5 years of age admitted with diarrhea and severe respiratory distress in the critical care ward at Dhaka Hospital of icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh) from April 2010 to April 2014 who had their reports of arterial blood gas analyses were enrolled in the study. We compared clinical and laboratory characteristics between the study children with (cases = 74) and without metabolic acidosis (controls = 65). Metabolic acidosis was defined if pH < 7.35 and HCO3 < 22 mmol/L in ABG. Cases had higher mortality (53% vs 29%, P = .01) compared to controls. After adjustment of potential confounders, for instance, hypokalemia and dehydration, the cases were independently associated with severe sepsis and raised serum creatinine (for both P < .05). Thus, early identification of these features of metabolic acidosis in diarrheal children may help clinicians to have prompt management that may further help reduce mortality in such children especially in resource-limited settings.
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Affiliation(s)
- Sharifuzzaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shoeb Bin Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Munirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Houston KA, Gibb JG, Maitland K. Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review. Wellcome Open Res 2017; 2:66. [PMID: 29090271 PMCID: PMC5657219 DOI: 10.12688/wellcomeopenres.12357.3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols/l) and higher potassium (40mmols/l) content than old WHO ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM. Methods: We conducted a systematic review of randomised controlled trials (RCTs) on 18
th July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration. Results: Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including old WHO ORS, standard hypo-osmolar WHO ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities. Conclusions: Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines
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Affiliation(s)
- Kirsty A Houston
- Department of Paediatrics, Faculty of Medicine, Imperial College, London, W2 1PG, UK.,KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Jack G Gibb
- Department of Paediatrics, Faculty of Medicine, Imperial College, London, W2 1PG, UK.,KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Kathryn Maitland
- Department of Paediatrics, Faculty of Medicine, Imperial College, London, W2 1PG, UK.,KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
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Clinical signs, profound acidemia, hypoglycemia, and hypernatremia are predictive of mortality in 1,400 critically ill neonatal calves with diarrhea. PLoS One 2017; 12:e0182938. [PMID: 28817693 PMCID: PMC5560544 DOI: 10.1371/journal.pone.0182938] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/26/2017] [Indexed: 01/09/2023] Open
Abstract
Profound acidemia impairs cellular and organ function and consequently should be associated with an increased risk of mortality in critically ill humans and animals. Neonatal diarrhea in calves can result in potentially serious metabolic derangements including profound acidemia due to strong ion (metabolic) acidosis, hyper-D-lactatemia, hyper-L-lactatemia, azotemia, hypoglycemia, hyperkalemia and hyponatremia. The aim of this retrospective study was to assess the prognostic relevance of clinical and laboratory findings in 1,400 critically ill neonatal calves with diarrhea admitted to a veterinary teaching hospital. The mortality rate was 22%. Classification tree analysis indicated that mortality was associated with clinical signs of neurologic disease, abdominal emergencies, cachexia, orthopedic problems such as septic arthritis, and profound acidemia (jugular venous blood pH < 6.85). When exclusively considering laboratory parameters, classification tree analysis identified plasma glucose concentrations < 3.2 mmol/L, plasma sodium concentrations ≥ 151 mmol/L, serum GGT activity < 31 U/L and a thrombocyte count < 535 G/L as predictors of mortality. However, multivariable logistic regression models based on these laboratory parameters did not have a sufficiently high enough sensitivity (59%) and specificity (79%) to reliably predict treatment outcome. The sensitivity and specificity of jugular venous blood pH < 6.85 were 11% and 97%, respectively, for predicting non-survival in this study population. We conclude that laboratory values (except jugular venous blood pH < 6.85) are of limited value for predicting outcome in critically ill neonatal calves with diarrhea. In contrast, the presence of specific clinical abnormalities provides valuable prognostic information.
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Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: A retrospective cohort study in Bangladesh. PLoS One 2017; 12:e0181160. [PMID: 28753618 PMCID: PMC5533322 DOI: 10.1371/journal.pone.0181160] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/26/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pediatric sepsis has a high mortality rate in limited resource settings. Sepsis protocols have been shown to be a cost-effective strategy to improve morbidity and mortality in a variety of populations and settings. At Dhaka Hospital in Bangladesh, mortality from pediatric sepsis in high-risk children previously approached 60%, which prompted the implementation of an evidenced-based protocol in 2010. The clinical effectiveness of this protocol had not been measured. We hypothesized that implementation of a pediatric sepsis protocol improved clinical outcomes, including reducing mortality and length of hospital stay. MATERIALS AND METHODS This was a retrospective cohort study of children 1-59 months old with a diagnosis of sepsis, severe sepsis or septic shock admitted to Dhaka Hospital from 10/25/2009-10/25/2011. The primary outcome was inpatient mortality pre- and post-protocol implementation. Secondary outcomes included fluid overload, heart failure, respiratory insufficiency, length of hospital stay, and protocol compliance, as measured by antibiotic and fluid bolus administration within 60 minutes of hospital presentation. RESULTS 404 patients were identified by a key-word search of the electronic medical record; 328 patients with a primary diagnosis of sepsis, severe sepsis, or septic shock were included (143 pre- and185 post-protocol) in the analysis. Pre- and post-protocol mortality were similar and not statistically significant (32.17% vs. 34.59%, p = 0.72). The adjusted odds ratio (AOR) for post-protocol mortality was 1.55 (95% CI, 0.88-2.71). The odds for developing fluid overload were significantly higher post-protocol (AOR 3.45, 95% CI, 2.04-5.85), as were the odds of developing heart failure (AOR 4.52, 95% CI, 1.43-14.29) and having a longer median length of stay (AOR 1.81, 95% CI 1.10-2.96). There was no statistically significant difference in respiratory insufficiency (pre- 65.7% vs. post- 70.3%, p = 0.4) or antibiotic administration between the cohorts (pre- 16.08% vs. post- 12.43%, p = 0.42). CONCLUSIONS Implementation of a pediatric sepsis protocol did not improve all-cause mortality or length of stay and may have been associated with increased fluid overload and heart failure during the study period in a large, non-governmental hospital in Bangladesh. Similar rates of early antibiotic administration may indicate poor protocol compliance. Though evidenced-based protocols are a potential cost-effective strategy to improve outcomes, future studies should focus on optimal implementation of context-relevant sepsis protocols in limited resource settings.
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Chisti MJ, Shahunja KM, Afroze F, Shahid AS, Sharifuzzaman, Ahmed T. Hypoxaemia and septic shock were independent risk factors for mechanical ventilation in Bangladeshi children hospitalised for diarrhoea. Acta Paediatr 2017; 106:1159-1164. [PMID: 28316105 DOI: 10.1111/apa.13836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/24/2017] [Accepted: 03/14/2017] [Indexed: 01/20/2023]
Abstract
AIM In Bangladesh, approximately 6% of children under five years of age die due to diarrhoea. We evaluated the admission and hospitalisation risk factors for mechanical ventilation and outcomes in children with diarrhoea. METHODS This retrospective case-control chart analysis was conducted in the intensive care unit of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh. We enrolled 219 children with diarrhoea aged 0-59 months between August 2009 and July 2013. The 73 cases were children who were initially identified as requiring mechanical ventilation during the study period, and the 146 controls were randomly selected from those who did not require mechanical ventilation. We compared the groups to determine the risk factors for mechanical ventilation. RESULTS Mortality was significantly higher among the cases than the controls (p < 0.001). In the logistic regression analysis carried out for two separate time points, the independent risk factors for mechanical ventilation on admission were hypoxaemia (p < 0.001) and septic shock (p = 0.004) and during hospitalisation, they were intake of intravenous fluid (p = 0.015), hypokalaemia (p = 0.018), hyperkalaemia (p = 0.005) and septic shock (p = 0.001). CONCLUSION Children under five with diarrhoea who required mechanical ventilation frequently had hypoxaemia and septic shock and were more likely to die than unventilated controls.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
| | - KM Shahunja
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
| | - Farzana Afroze
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
| | - Abu S.M.S.B. Shahid
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
| | - Sharifuzzaman
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
| | - Tahmeed Ahmed
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
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Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU. Crit Care Med 2017; 44:1530-7. [PMID: 26985636 DOI: 10.1097/ccm.0000000000001713] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU. DESIGN Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis. SETTING Ninety PICUs from 16 countries with eight or more beds. PATIENTS Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours. MEASUREMENTS AND MAIN RESULTS Data from 1,622 eligible patients, 54.8% men and mean (SD) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively. CONCLUSIONS Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.
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Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review. PLoS Negl Trop Dis 2017; 11:e0005603. [PMID: 28493871 PMCID: PMC5441652 DOI: 10.1371/journal.pntd.0005603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 05/23/2017] [Accepted: 04/26/2017] [Indexed: 12/29/2022] Open
Abstract
Background Severely malnourished children aged under five years requiring hospital admission for diarrheal illness frequently develop ileus during hospitalization with often fatal outcomes. However, there is no data on risk factors and outcome of ileus in such children. We intended to evaluate predictive factors for ileus during hospitalization and their outcomes. Methodology/Principal findings This was a retrospective chart review that enrolled severely malnourished children under five years old with diarrhea, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh between April 2011 and August 2012. We used electronic database to have our chart abstraction from previously admitted children in the hospital. The clinical and laboratory characteristics of children with (cases = 45), and without ileus (controls = 261) were compared. Cases were first identified by observation of abnormal bowel sounds on physical examination and confirmed with abdominal radiographs. For this comparison, Chi-square test was used to measure the difference in proportion, Student’s t-test to calculate the difference in mean for normally distributed data and Mann-Whitney test for data that were not normally distributed. Finally, in identifying independent risk factors for ileus, logistical regression analysis was performed. Ileus was defined if a child developed abdominal distension and had hyperactive or sluggish or absent bowel sound and a radiologic evidence of abdominal gas-fluid level during hospitalization. Logistic regression analysis adjusting for potential confounders revealed that the independent risk factors for admission for ileus were reluctance to feed (odds ratio [OR] = 3.22, 95% confidence interval [CI] = 1.24–8.39, p = 0.02), septic shock (OR = 3.62, 95% CI = 1.247–8.95, p<0.01), and hypokalemia (OR = 1.99, 95% CI = 1.03–3.86, p = 0.04). Mortality was significantly higher in cases compared to controls (22% vs. 8%, p<0.01) in univariate analysis; however, in multivariable regression analysis, after adjusting for potential confounders such as septic shock, no association was found between ileus and death (OR = 2.05, 95% CI = 0.68–6.14, p = 0.20). In a separate regression analysis model, after adjusting for potential confounders such as ileus, reluctance to feed, hypokalemia, hypocalcemia, and blood transfusion, septic shock (OR = 168.84, 95% CI = 19.27–1479.17, p<0.01) emerged as the only independent predictor of death in severely malnourished diarrheal children. Conclusions/Significance This study suggests that the identification of simple independent admission risk factors for ileus and risk factors for death in hospitalized severely malnourished diarrheal children may prompt clinicians to be more vigilant in managing these conditions, especially in resource-limited settings in order to decrease ileus and ileus-related fatal outcomes in such children. Childhood malnutrition and diarrhea are important problems in lower and middle-income countries, including Bangladesh. Severe acute malnutrition (SAM) and diarrhea are responsible for more than one third of all deaths in children below five years old globally. Most of these deaths occur because of complications of SAM and/or diarrhea. SAM and diarrhea may simultaneously present in a child, often with serious complications. Ileus is a common fatal complication in such hospitalized children, and is accompanied by abdominal distension and hyperactive, sluggish, or absent bowel sounds heard using a stethoscope. Ileus is confirmed by radiologic evidence of multiple gas-fluid levels in the abdomen. However, the underlying factors contributing to ileus and its management in diarrheal children with severe acute malnutrition is unknown. Our study aimed to ascertain these risk factors and the outcome of ileus in such children by reviewing the data of previously admitted children between April 2011 and August 2012. Of 306 severely malnourished Bangladeshi under-five-year-old children with diarrhea enrolled for 17 months, 45 had ileus. Ileus was independently associated with a reluctance to feed, septic shock, and hypokalemia and had a higher case-fatality rate compared to those without ileus.
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Alam T, Ahmed T, Sarmin M, Shahrin L, Afroze F, Sharifuzzaman, Akhter S, Shahunja KM, Shahid ASMSB, Bardhan PK, Chisti MJ. Risk Factors for Death in Bangladeshi Children Under 5 Years of Age Hospitalized for Diarrhea and Severe Respiratory Distress in an Urban Critical Care Ward. Glob Pediatr Health 2017; 4:2333794X17696685. [PMID: 28491923 PMCID: PMC5406149 DOI: 10.1177/2333794x17696685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 11/15/2022] Open
Abstract
Children with diarrhea hospitalized for respiratory distress often have fatal outcome in resource-limited settings, although data are lacking on risk factors for death in such children. We sought to evaluate clinical predictors for death in such children. In this prospective cohort study, we enrolled under-5 children with diarrhea admitted with severe respiratory distress to the intensive care unit of Dhaka Hospital of International Centre for Diarhoeal Disease Research, Bangladesh, from September 2014 through September 2015. We compared clinical and laboratory characteristics between study children those who died (n = 29) and those who survived (n = 62). In logistic regression analysis, after adjusting for potential confounders, the independent predictors for death in children hospitalized for diarrhea and severe respiratory distress were severe sepsis and hypoglycemia (P < .05 for all). Thus, recognition of these simple parameters may help clinicians identify children with diarrhea at risk of deaths in order to initiate prompt management for the better outcome, especially in resource-poor settings.
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Affiliation(s)
- Tahmina Alam
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sharifuzzaman
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shamima Akhter
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K M Shahunja
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Pradip Kumar Bardhan
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Jung WJ, Park SM, Park JM, Rhee H, Kim IY, Lee DW, Lee SB, Seong EY, Kwak IS, Song SH. Severe Hypernatremia Caused by Acute Exogenous Salt Intake Combined with Primary Hypothyroidism. Electrolyte Blood Press 2016; 14:27-30. [PMID: 28275385 PMCID: PMC5337430 DOI: 10.5049/ebp.2016.14.2.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/30/2016] [Indexed: 11/05/2022] Open
Abstract
This report describes a case of severe hypernatremia with a serum sodium concentration of 188.1mmol/L caused by exogenous salt intake. A 26-year-old man diagnosed with Crohn's disease 5 years previously visited our clinic due to generalized edema and personality changes, with aggressive behavior. He had compulsively consumed salts, ingesting approximately 154 g of salt over the last 4 days. Despite careful fluid management that included not only hypotonic fluid therapy for 8 hours but also hypertonic saline administration, his serum sodium level decreased sharply at 40.6 mmol/L; however, it returned to normal within 72-hour of treatment without any neurological deficits. Primary hypothyroidism was also diagnosed. He was discharged after 9 days from admission, with a stable serum sodium level. We have described the possibility of successful treatment in a patient with hypernatremia caused by acute salt intoxication without sustained hypotonic fluid therapy.
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Affiliation(s)
- Woo Jin Jung
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Su Min Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jong Man Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Harin Rhee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Il Young Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Dong Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Soo Bong Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ihm Soo Kwak
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Brennhofer S, Reifsnider E, Bruening M. Malnutrition coupled with diarrheal and respiratory infections among children in Asia: A systematic review. Public Health Nurs 2016; 34:401-409. [PMID: 27354205 DOI: 10.1111/phn.12273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this systematic literature review was to assess the relationship between malnutrition and respiratory and diarrheal infections among children aged five and under living in Asian countries. DESIGN AND SAMPLE The design was adapted from the PRISMA method to include case-control, cross-sectional, ecological, and experimental studies. A review of electronic databases identified 144 articles of which 20 met the inclusion criteria. The inclusion criteria were studies of malnourished children under the age of five with respiratory and/or diarrheal infections, admitted to hospitals or residing in villages throughout countries in Asia, and published between 2005 and 2015. MEASURES Infection was defined as the presence of a respiratory or diarrheal illness. Malnutrition was predominantly measured by WHO standards. RESULTS Malnutrition is associated with respiratory and diarrheal infections. Children have higher rates of mortality when both malnourished and experiencing a respiratory infection. CONCLUSION Further research needs to examine the synergetic effect of diarrheal and respiratory infections in malnourished children and rates of mortality. Public health nurses (PHNs) play a critical role in the prevention and treatment of malnutrition and infections in community and national systems. Obtaining better data will allow PHNs to provide critical care in the most underserved areas throughout Asia.
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Affiliation(s)
- Stephanie Brennhofer
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Elizabeth Reifsnider
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Meg Bruening
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
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25
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Chisti MJ, Ahmed T, Ahmed AMS, Sarker SA, Faruque ASG, Islam MM, Huq S, Shahrin L, Bardhan PK, Salam MA. Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death. Clin Pediatr (Phila) 2016; 55:654-63. [PMID: 26810623 DOI: 10.1177/0009922815627346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We sought to investigate the magnitude, clinical features, treatment, and outcome of children suffering from hypernatremic diarrhea and to identify risk factors for fatal outcome among them. We reviewed 2 data sets of children <15 years admitted to the in-patient ward of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) with diarrhea and hypernatremia (serum sodium ≥150 mmol/L): (a) March 2001 to March 2002 (n = 371) and (b) March 2009 to August 2011 (n = 360). We reviewed their records and collected relevant information for analyses. The prevalence of hypernatremia was 5.1% (371/7212) and 2.4% (360/15 219), case fatality rate was 15% and 19%, respectively. In logistic regression analysis, the risk for death significantly increased in association with serum sodium ≥170 mmol/L, nutritional edema, hypoglycemia, respiratory distress, and absent peripheral pulses and reduced with the sole use of oral rehydration salts (ORS) or ORS following intravenous fluid, if indicated (for all, P < .05). Thus, managing children with hypernatremia using only ORS or ORS following intravenous fluid may help reduce the number of deaths.
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Affiliation(s)
- Mohammad Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - A M Shamshir Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shafiqul Alam Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Syed Golam Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Munirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayeeda Huq
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Abdus Salam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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26
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Shahrin L, Chisti MJ, Huq S, Nishath T, Christy MD, Hannan A, Ahmed T. Clinical Manifestations of Hyponatremia and Hypernatremia in Under-Five Diarrheal Children in a Diarrhea Hospital. J Trop Pediatr 2016; 62:206-12. [PMID: 26851435 DOI: 10.1093/tropej/fmv100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To study clinical manifestations and outcome of hyponatremia and hypernatremia in children with diarrhea. METHOD We compared children aged 0-59 months hospitalized from 1 January to 31 December 2013 with hyponatremia (serum sodium <130 mmol/l), hypernatremia (serum sodium >150 mmol/l) and normonatremia (serum sodium 135-145 mmol/l). RESULTS The case fatality was significantly higher among the children with hypernatremia and hyponatremia than normonatremia. A logistic regression analysis adjusting for potential confounders revealed that children with hyponatremia are more likely to have convulsions, have severe acute malnutrition and be of older age compared with children with normal serum sodium. Children with hypernatremia are more likely to have convulsions and dehydration than normonatremic children (for all p < 0.05). CONCLUSION Early diagnosis and prompt management of hypo- and hypernatremia by identifying simple clinical predicting factors of these two conditions in diarrheal children <5 years of age is critically important to prevent deaths in such children, especially in resource-limited settings.
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Affiliation(s)
- Lubaba Shahrin
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, 1212 Bangladesh
| | - Mohammad Jobayer Chisti
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, 1212 Bangladesh
| | - Sayeeda Huq
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, 1212 Bangladesh
| | - Thamanna Nishath
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, 22908 USA
| | - Maria D Christy
- School of Nutrition and Health Promotion, Arizona State University, Tempe, AZ, 85004 USA
| | - Anika Hannan
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 28303 USA
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, 1212 Bangladesh
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Bado AR, Susuman AS, Nebie EI. Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990-2013): assessing the neighborhood inequalities. Glob Health Action 2016; 9:30166. [PMID: 27174860 PMCID: PMC4865764 DOI: 10.3402/gha.v9.30166] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Diarrheal diseases are a major cause of child mortality and one of the main causes of medical consultation for children in sub-Saharan countries. This paper attempts to determine the risk factors and neighborhood inequalities of diarrheal morbidity among under-5 children in selected countries in sub-Saharan Africa over the period 1990-2013. DESIGN Data used come from the Demographic and Health Survey (DHS) waves conducted in Burkina Faso (1992-93, 1998-99, 2003, and 2010), Mali (1995, 2001, 2016, and 2012), Nigeria (1990, 1999, 2003, 2008, and 2013), and Niger (1992, 1998, 2006, and 2012). Bivariate analysis was performed to assess the association between the dependent variable and each of the independent variables. Multilevel logistic regression modelling was used to determine the fixed and random effects of the risk factors associated with diarrheal morbidity. RESULTS The findings showed that the proportion of diarrheal morbidity among under-5 children varied considerably across the cohorts of birth from 10 to 35%. There were large variations in the proportion of diarrheal morbidity across countries. The proportions of diarrheal morbidity were higher in Niger compared with Burkina Faso, Mali, and Nigeria. The risk factors of diarrheal morbidity varied from one country to another, but the main factors included the child's age, size of the child at birth, the quality of the main floor material, mother's education and her occupation, type of toilet, and place of residence. The analysis shows an increasing trend of diarrheal inequalities according to DHS rounds. In Burkina Faso, the value of the intraclass correlation coefficient (ICC) was 0.04 for 1993 DHS and 0.09 in 2010 DHS; in Mali, the ICC increased from 0.04 in 1995 to 0.16 in 2012; in Nigeria, the ICC increased from 0.13 in 1990 to 0.19 in 2013; and in Niger, the ICC increased from 0.07 in 1992 to 0.11 in 2012. CONCLUSIONS This suggests the need to fight against diarrheal diseases on both the local and community levels across villages.
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Affiliation(s)
- Aristide R Bado
- Department of Statistics and Population Studies, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - A Sathiya Susuman
- Department of Statistics and Population Studies, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa;
| | - Eric I Nebie
- Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
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28
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Yoshimatsu S, Sugaya T, Hossain MI, Islam MM, Chisti MJ, Kamoda T, Fukushima T, Wagatsuma Y, Sumazaki R, Ahmed T. Urinary L-FABP as a mortality predictor in <5-year-old children with sepsis in Bangladesh. Pediatr Int 2016. [PMID: 26214495 DOI: 10.1111/ped.12765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although sepsis is often associated with high mortality in severely malnourished children, data are very limited on appropriate diagnostic tools to predict mortality. We examined the role of urinary liver-type fatty acid-binding protein (L-FABP) in children <5 years old with sepsis who died. METHODS This prospective observational study was conducted at the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. Children aged 6-59 months admitted with sepsis from April 2010 to December 2011 were enrolled. Comparison of clinical and laboratory characteristics was made between children who survived (n = 83) and those who did not survive (n = 22). RESULTS On multiple Poisson regression analysis, after adjusting for potential confounders such as mid-upper arm circumference < 115 mm, plasma albumin < 2.5 g/dL, potassium > 5.0 mmol/L, and blood urea nitrogen > 20 mg/dL on admission, first urine L-FABP ≥ 370 ng/mL (relative risk [RR], 2.76; 95%CI: 1.22-6.25), weight-for-length/height z score < -3 (RR, 2.54; 95%CI: 1.26-5.09), capillary refilling time > 2.0 s (RR, 5.16; 95%CI: 1.46-18.3), and sodium > 160 mmol/L (RR, 2.72; 95%CI: 1.07-6.90) were identified as significant risk factors of mortality in children with sepsis. Diagnostic performance of first urine L-FABP was analyzed using receiver operating characteristic curve, and the area under the curve was 0.647 (95%CI: 0.500-0.795). CONCLUSION Urinary L-FABP may be a useful predictor of mortality in septic children. Urinary examination is non-invasive and easy to apply at the bedside.
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Affiliation(s)
- Shoji Yoshimatsu
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis, Tokyo, Japan
| | | | - Md Iqbal Hossain
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Munirul Islam
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tomohiro Kamoda
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Fukushima
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukiko Wagatsuma
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryo Sumazaki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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29
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Chisti MJ, Salam MA, Bardhan PK, Faruque ASG, Shahid ASMSB, Shahunja KM, Das SK, Hossain MI, Ahmed T. Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study. PLoS One 2015; 10:e0139966. [PMID: 26440279 PMCID: PMC4595075 DOI: 10.1371/journal.pone.0139966] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/18/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM) children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children. METHODS In this retrospective case-control study SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50) with those without severe sepsis (controls = 354). Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline. RESULTS The case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001). In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons). CONCLUSION AND SIGNIFICANCE We noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Mohammed Abdus Salam
- Research & Clinical Administration and Strategy (RCAS), icddr,b, Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Abu S. G. Faruque
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu S. M. S. B. Shahid
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K. M. Shahunja
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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30
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Leung DT, Das SK, Malek MA, Qadri F, Faruque ASG, Chisti MJ, Ryan ET. Concurrent Pneumonia in Children Under 5 Years of Age Presenting to a Diarrheal Hospital in Dhaka, Bangladesh. Am J Trop Med Hyg 2015; 93:831-5. [PMID: 26149863 DOI: 10.4269/ajtmh.15-0074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/12/2015] [Indexed: 11/07/2022] Open
Abstract
Respiratory and gastrointestinal infections are the top killers of children worldwide, and their co-occurrence is reported but not well understood. Our aim was to determine the risk factors for concurrent presentation of diarrhea and pneumonia (DP) in a resource-limited setting in Bangladesh. We used data from the Diarrheal Disease Surveillance System of the icddr,b Dhaka Hospital to identify children < 60 months of age with diarrhea and concurrent pneumonia, defined as a history of cough, an abnormal lung examination, and tachypnea. For the years 1996-2007, out of total 14,628 diarrheal patients surveyed, there were 607 (4%) patients who satisfied criteria for pneumonia. Those with DP had a higher mortality rate (4% versus 0.05%, odds ratio [OR] = 86, 95% confidence interval [CI] = 26-286) and a longer hospital stay (mean 84 versus 26 hours, difference 58 hours, 95% CI = 52-64 hours) than those with diarrhea (D) only. In multivariable logistic regression comparing cases (N = 607) with controls matched for month and year of admission at a ratio of 1:3 (N = 1,808), we found that DP was associated with younger age, male gender, severe acute malnutrition (SAM), less maternal education, lower family income, and lack of current breast-feeding history.
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Affiliation(s)
- Daniel T Leung
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Sumon K Das
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - M A Malek
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Firdausi Qadri
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - A S G Faruque
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Mohammod J Chisti
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Edward T Ryan
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
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31
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Das SK, Afroze F, Ahmed T, Faruque ASG, Sarker SA, Huq S, Islam MM, Shahrin L, Matin FB, Chisti MJ. Extreme hypernatremic dehydration due to potential sodium intoxication: consequences and management for an infant with diarrhea at an urban intensive care unit in Bangladesh: a case report. J Med Case Rep 2015; 9:124. [PMID: 26031517 PMCID: PMC4460769 DOI: 10.1186/s13256-015-0611-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/28/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Hypernatremia (serum sodium ≥150mmol/L) is one of the most life-threatening complications of childhood diarrhea, and its management remains challenging, even in a highly advanced critical care setting. This case report describes the acute clinical course and 3-month neurological follow-up after discharge of an infant with extreme hypernatremia in an intensive care unit in Dhaka, Bangladesh. Case presentation A 6-month-old Asian Bangladeshi girl of middle-class socioeconomic status was admitted to the intensive care unit of our institution in 2012 with acute watery diarrhea, lethargy and hypernatremia (208mmol/L serum sodium). She had a history of taking excess oral rehydration salt: five packets each, inappropriately prepared, rice-based, properly diluted, glucose-based oral rehydration salt. Her hypernatremia was treated exclusively with oral rehydration salt solution. She experienced seizures on the third day of her hospitalization and was treated with anticonvulsant drugs. Later in the course of her hospitalization, Enterobacter spp bacteremia was detected and successfully treated with ciprofloxacin. Although magnetic resonance imaging of her brain at discharge showed cerebral edema, brain magnetic resonance imaging appeared normal at a follow-up examination 3 months after discharge. Electroencephalograms taken at discharge and at her 3-month follow-up examination also appeared normal. Conclusions Successful management of extreme hypernatremia with only oral rehydration salt did not result in observable neurological consequences, which emphasizes the importance of the use of oral rehydration salt for the clinical management of childhood hypernatremia.
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Affiliation(s)
- Sumon Kumar Das
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. .,School of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.
| | - Farzana Afroze
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. .,Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Abu Syed Golam Faruque
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Shafiqul Alam Sarker
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. .,Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Sayeeda Huq
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. .,Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - M Munirul Islam
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. .,Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Lubaba Shahrin
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. .,Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Fariha Bushra Matin
- Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Mohammod Jobayer Chisti
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. .,Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
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Kissoon N, Carapetis J. Pediatric sepsis in the developing world. J Infect 2015; 71 Suppl 1:S21-6. [DOI: 10.1016/j.jinf.2015.04.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
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Chisti MJ, Salam MA, Ashraf H, Faruque ASG, Bardhan PK, Hossain MI, Shahid ASMSB, Shahunja KM, Das SK, Imran G, Ahmed T. Clinical risk factors of death from pneumonia in children with severe acute malnutrition in an urban critical care ward of Bangladesh. PLoS One 2013; 8:e73728. [PMID: 24040043 PMCID: PMC3767805 DOI: 10.1371/journal.pone.0073728] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 07/22/2013] [Indexed: 01/08/2023] Open
Abstract
Background Risks of death are high when children with pneumonia also have severe acute malnutrition (SAM) as a co-morbidity. However, there is limited published information on risk factors of death from pneumonia in SAM children. We evaluated clinically identifiable factors associated with death in under-five children who were hospitalized for the management of pneumonia and SAM. Methods For this unmatched case-control design, SAM children of either sex, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during April 2011 to July 2012 with radiological pneumonia were studied. The SAM children with pneumonia who had fatal outcome constituted the cases (n = 35), and randomly selected SAM children with pneumonia who survived constituted controls (n = 105). Results The median (inter-quartile range) age (months) was comparable among the cases and the controls [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p = 0.210)]. In logistic regression analysis, after adjusting for potential confounders, such as vomiting, abnormal mental status, and systolic hypotension (<70 mm of Hg) in absence of dehydration, fatal cases of severely malnourished under-five children with pneumonia were more often hypoxemic (OR = 23.15, 95% CI = 4.38–122.42), had clinical dehydration (some/severe) (OR = 9.48, 95% CI = 2.42–37.19), abdominal distension at admission (OR = 4.41, 95% CI = 1.12–16.52), and received blood transfusion (OR = 5.50, 95% CI = 1.21–24.99) for the management of crystalloid resistant systolic hypotension. Conclusion and Significance We identified hypoxemia, clinical dehydration, and abdominal distension as the independent predictors of death in SAM children with pneumonia. SAM children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk for death. Thus, early identification and prompt management of these simple clinically recognizable predictors of death and discourage the use of blood transfusion for the management of crystalloid resistant systolic hypotension may help reduce deaths in such population.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | | | - Hasan Ashraf
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Abu S. G. Faruque
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Abu S. M. S. B. Shahid
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K. M. Shahunja
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Gazi Imran
- Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Dey SK, Chisti MJ, Das SK, Shaha CK, Ferdous F, Farzana FD, Ahmed S, Malek MA, Faruque ASG, Ahmed T, Salam MA. Characteristics of diarrheal illnesses in non-breast fed infants attending a large urban diarrheal disease hospital in Bangladesh. PLoS One 2013; 8:e58228. [PMID: 23520496 PMCID: PMC3592889 DOI: 10.1371/journal.pone.0058228] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 02/01/2013] [Indexed: 01/15/2023] Open
Abstract
Background Lack of breast feeding is associated with higher morbidity and case-fatality from both bacterial and viral etiologic diarrheas. However, there is very limited data on the characteristics of non–breastfed infants attending hospital with diarrheal illnesses caused by common bacterial and viral pathogens. Our objective was to assess the impact of lack of breast feeding on diarrheal illnesses in infants living in urban Bangladesh. Methods We extracted data of infants (0–11 months) for analyses from the data archive of Diarrheal Disease Surveillance System (DDSS) of the Dhaka Hospital of icddr,b for the period 2008–2011. Results The prevalence of breastfeeding in infants attending the hospital with diarrhea reduced from 31% in 2008 to 17% in 2011, with corresponding increase in the prevalence of non-breastfed (chi square for trend <0.001). Among breastfed infants, the incidence of rotavirus infections was higher (43%) among the 0–5 months age group than infants aged 9–11 months (18%). On the other hand, among non-breastfed infants, the incidence of rotavirus infections was much higher (82%) among 9–11 months old infants compared to those in 0–5 months age group (57%) (chi square for trend <0.001). Very similar trends were also observed in the incidence of cholera and ETEC diarrheas among different age groups of breastfed and non-breastfed infants (chi square for trend 0.020 and 0.001 respectively). However, for shigellosis, the statistical difference remained unchanged among both the groups (chi square for trend 0.240). Conclusion and Significance We observed protective role of breastfeeding in infantile diarrhea caused by the major viral and common bacterial agents. These findings underscore the importance of promotion and expansion of breastfeeding campaigns in Bangladesh and elsewhere.
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MESH Headings
- Bangladesh/epidemiology
- Bottle Feeding/adverse effects
- Breast Feeding
- Cholera/epidemiology
- Cholera/etiology
- Cholera/therapy
- Diarrhea, Infantile/epidemiology
- Diarrhea, Infantile/etiology
- Escherichia coli Infections/epidemiology
- Escherichia coli Infections/etiology
- Escherichia coli Infections/therapy
- Female
- Hospitals, Urban
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/therapy
- Male
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Affiliation(s)
- Sanjoy Kumer Dey
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Chandan Kumar Shaha
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Farzana Ferdous
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Dil Farzana
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahnawaz Ahmed
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Abdul Malek
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Syed Golam Faruque
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Predictors and outcome of hypoxemia in severely malnourished children under five with pneumonia: a case control design. PLoS One 2013; 8:e51376. [PMID: 23320066 PMCID: PMC3540031 DOI: 10.1371/journal.pone.0051376] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/05/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is lack of information in the medical literature on predictors of hypoxemia in severely malnourished children with pneumonia, although hypoxemia is common and is often associated with fatal outcome in this population. We explored the predictors of hypoxemia in under-five children who were hospitalized for the management of pneumonia and severe acute malnutrition (SAM). METHODS In this unmatched case-control design, SAM children of both sexes, aged 0-59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) with radiological pneumonia and hypoxemia during April 2011 to April 2012 were studied. SAM children with pneumonia and hypoxemia (SpO(2)<90%) constituted the cases (n = 37), and randomly selected SAM children with pneumonia but without hypoxemia constituted controls (n = 111). RESULTS The case-fatality was significantly higher among the cases than the controls (30% vs. 4%; p<0.001). In logistic regression analysis, after adjusting for potential confounders such as nasal flaring, head nodding, inability to drink, and crackles in lungs, fast breathing (95% CI = 1.09-13.55), lower chest wall in-drawing (95% CI = 2.48-43.41), and convulsion at admission (95% CI = 3.14-234.01) were identified as independent predictors of hypoxemia in this population. The sensitivity of fast breathing, lower chest wall in-drawing and convulsion at admission and their 95% confidence intervals (CI) to predict hypoxemia were 84 (67-93)%, 89 (74-96)%, and 19 (9-36)% respectively, and their specificity were 53 (43-63)%, 60 (51-69)% and 98 (93-100)% respectively. CONCLUSION AND SIGNIFICANCE Fast breathing and lower chest wall in-drawing were the best predictors of hypoxemia in SAM children with pneumonia. There thus, in resources poor settings where pulse oximetry is not available, identification of these simple clinical predictors of hypoxemia in such children could be reliably used for early O(2) supplementation in addition to other appropriate management to reduce morbidity and deaths.
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Chisti MJ, Ahmed T, Ashraf H, Faruque ASG, Bardhan PK, Dey SK, Huq S, Das SK, Salam MA. Clinical predictors and outcome of metabolic acidosis in under-five children admitted to an urban hospital in Bangladesh with diarrhea and pneumonia. PLoS One 2012; 7:e39164. [PMID: 22720060 PMCID: PMC3376101 DOI: 10.1371/journal.pone.0039164] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/17/2012] [Indexed: 12/01/2022] Open
Abstract
Background Clinical features of metabolic acidosis and pneumonia frequently overlap in young diarrheal children, resulting in differentiation from each other very difficult. However, there is no published data on the predictors of metabolic acidosis in diarrheal children also having pneumonia. Our objective was to evaluate clinical predictors of metabolic acidosis in under-five diarrheal children with radiological pneumonia, and their outcome. Methods We prospectively enrolled all under-five children (n = 164) admitted to the Special Care Ward (SCW) of the Dhaka Hospital of icddr, b between September and December 2007 with diarrhea and radiological pneumonia who also had their total serum carbon-dioxide estimated. We compared the clinical features and outcome of children with radiological pneumonia and diarrhea with (n = 98) and without metabolic acidosis (n = 66). Results Children with metabolic acidosis more often had higher case-fatality (16% vs. 5%, p = 0.039) compared to those without metabolic acidosis on admission. In logistic regression analysis, after adjusting for potential confounders such as age of the patient, fever on admission, and severe wasting, the independent predictors of metabolic acidosis in under-five diarrheal children having pneumonia were clinical dehydration (OR 3.57, 95% CI 1.62–7.89, p = 0.002), and low systolic blood pressure even after full rehydration (OR 1.02, 95% CI 1.01–1.04, p = 0.005). Proportions of children with cough, respiratory rate/minute, lower chest wall indrawing, nasal flaring, head nodding, grunting respiration, and cyanosis were comparable (p>0.05) among the groups. Conclusion and Significance Under-five diarrheal children with radiological pneumonia having metabolic acidosis had frequent fatal outcome than those without acidosis. Clinical dehydration and persistent systolic hypotension even after adequate rehydration were independent clinical predictors of metabolic acidosis among the children. However, metabolic acidosis in young diarrheal children had no impact on the diagnostic clinical features of radiological pneumonia which underscores the importance of early initiation of appropriate antibiotics to combat morbidity and deaths in such population.
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Affiliation(s)
- Mohammod J Chisti
- Clinical Services, International Centre for Diarhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
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El-Bayoumi MA, Abdelkader AM, El-Assmy MMA, Alwakeel AA, El-Tahan HM. Normal saline is a safe initial rehydration fluid in children with diarrhea-related hypernatremia. Eur J Pediatr 2012; 171:383-8. [PMID: 21909623 DOI: 10.1007/s00431-011-1559-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 08/15/2011] [Indexed: 12/01/2022]
Abstract
UNLABELLED To demonstrate safety and efficacy of using normal saline (NS) for initial volume expansion (IVE) and rehydration in children with diarrhea-related hypernatremic dehydration (DR-HD), forty eight patients with DR-HD were retrospectively studied. NS was used as needed for IVE and for initial rehydration. Fluid deficit was given over 48 h. Median Na(+) level on admission was 162.9 mEq/L (IQR 160.8-165.8). The median average hourly drop at 6 and 24 h was 0.53 mEq/L/h (0.48-0.59) and 0.52 mEq/L/h (0.47-0.57), respectively. Compared to children not needing IVE, receiving ≥40 ml/kg IVE was associated with a higher average hourly drop of Na(+) at 6 h (0.51 vs. 0.58 mEq/L/h, p = 0.013) but not at 24 h (p = 0.663). The three patients (6.3%) with seizures had a higher average hourly drop of Na(+) at 6 and 24 h (p = 0.084 and 0.021, respectively). Mortality (4/48, 8.3%) was not related to Na(+) on admission or to its average hourly drop at 6 or 24 h. Children receiving ≥40 ml/kg IVE were more likely to die (OR 3.3; CI, 1.5-7.2). CONCLUSION In children with DR-HD, NS is a safe rehydration fluid with a satisfactory rate of Na(+) drop and relatively low incidence of morbidity and mortality. Judicious use of IVE should be exerted and closer monitoring should be guaranteed for children requiring large volumes for IVE and for those showing rapid initial drop of serum Na(+) to avoid neurological complications and poor outcome.
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Affiliation(s)
- Mohammed A El-Bayoumi
- Pediatric Intensive Care Unit, Mansoura University Children Hospital, PO Box 63, Mansoura, Egypt.
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