Skip to main content
×
Home
    • Aa
    • Aa

Symposium 5: Joint BAPEN and Nutrition Society Symposium on ‘Feeding size 0: the science of starvation’ Severe malnutrition: therapeutic challenges and treatment of hypovolaemic shock: Conference on ‘Malnutrition matters’

  • Kathryn Maitland (a1)
Abstract

The systematic failure to recognise and appropriately treat children with severe malnutrition has been attributed to the elevated case-fatality rates, often as high as 50%, that still prevail in many hospitals in Africa. Children admitted to Kilifi District Hospital, on the coast of Kenya, with severe malnutrition frequently have life-threatening features and complications, many of which are not adequately identified or treated by WHO guidelines. Four main areas have been identified for research: early identification and better supportive care of sepsis; evidence-based fluid management strategies; improved antimicrobial treatment; rational use of nutritional strategies. The present paper focuses on the identification of children with sepsis and on fluid management strategies.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Symposium 5: Joint BAPEN and Nutrition Society Symposium on ‘Feeding size 0: the science of starvation’ Severe malnutrition: therapeutic challenges and treatment of hypovolaemic shock
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Symposium 5: Joint BAPEN and Nutrition Society Symposium on ‘Feeding size 0: the science of starvation’ Severe malnutrition: therapeutic challenges and treatment of hypovolaemic shock
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Symposium 5: Joint BAPEN and Nutrition Society Symposium on ‘Feeding size 0: the science of starvation’ Severe malnutrition: therapeutic challenges and treatment of hypovolaemic shock
      Available formats
      ×
Copyright
Corresponding author
Corresponding author: Dr Kathryn Maitland, fax +254 415 22390, email kmaitland@kilifi.kemri-wellcome.org
References
Hide All
1. Schofield C & Ashworth A (1996) Why have mortality rates for severe malnutrition remained so high? Bull World Health Organ 74, 223229.
2. Ashworth A, Khanum S, Jackson A et al. (2003) Guidelines for the Inpatient Treatment of Severely Malnourished Children. New Delhi, India: WHO Regional Office for South-East Asia.
3. Heikens GT (2007) How can we improve the care of severely malnourished children in Africa? PLoS Med 4, e45.
4. Heikens GT, Bunn J, Amadi B et al. (2008) Case management of HIV-infected severely malnourished children: challenges in the area of highest prevalence. Lancet 371, 13051307.
5. Cartmell E, Natalal H, Francois I et al. (2005) Nutritional and clinical status of children admitted to the malnutrition ward, Maputo central hospital: a comparison of data from 2001 and 1983. J Trop Pediatr 51, 102105.
6. Ashworth A, Chopra M, McCoy D et al. (2004) WHO guidelines for management of severe malnutrition in rural South African hospitals: effect on case fatality and the influence of operational factors. Lancet 363, 11101115.
7. Puoane T, Sanders D, Chopra M et al. (2001) Evaluating the clinical management of severely malnourished children – a study of two rural district hospitals. S Afr Med J 91, 137141.
8. Nathoo KJ, Bannerman CH & Pirie DJ (1999) Pattern of admissions to the paediatric medical wards (1995 to 1996) at Harare Hospital, Zimbabwe. Cent Afr J Med 45, 258263.
9. Deen JL, Funk M, Guevara VC et al. (2003) Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa. Bull World Health Organ 81, 237243.
10. Manary MJ & Brewster DR (2000) Intensive nursing care of kwashiorkor in Malawi. Acta Paediatr 89, 203207.
11. Karaolis N, Jackson D, Ashworth A et al. (2007) WHO guidelines for severe malnutrition: are they feasible in rural African hospitals? Arch Dis Child 92, 198204.
12. Briend A (2003) Management of severe malnutrition in children in tropical climates. Med Trop (Mars) 63, 527532.
13. Ahmed T, Ali M, Ullah MM et al. (1999) Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol. Lancet 353, 19191922.
14. Collins S & Sadler K (2002) Outpatient care for severely malnourished children in emergency relief programmes: a retrospective cohort study. Lancet 360, 18241830.
15. Brewster DR (2006) Critical appraisal of the management of severe malnutrition: 1. Epidemiology and treatment guidelines. J Paediatr Child Health 42, 568574.
16. Brewster DR (2006) Critical appraisal of the management of severe malnutrition: 3. Complications. J Paediatr Child Health 42, 583593.
17. Maitland K, Berkley JA, Shebbe M et al. (2006) Children with severe malnutrition: can those at highest risk of death be identified with the WHO protocol? PLoS Med 3, e500.
18. Collins S & Myatt M (2000) Short-term prognosis in severe adult and adolescent malnutrition during famine: use of a simple prognostic model based on counting clinical signs. JAMA 284, 621626.
19. Collins S & Yates R (2003) The need to update the classification of acute malnutrition. Lancet 362, 249.
20. World Health Organization (1999) Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. Geneva: WHO.
21. Mbori-Ngacha DA, Otieno JA, Njeru EK et al. (1995) Prevalence of persistent diarrhoea in children aged 3–36 months at the Kenyatta National Hospital, Nairobi, Kenya. East Afr Med J 72, 711714.
22. Brewster DR, Manary MJ, Menzies IS et al. (1997) Comparison of milk and maize based diets in kwashiorkor. Arch Dis Child 76, 242248.
23. Alam NH, Hamadani JD, Dewan N et al. (2003) Efficacy and safety of a modified oral rehydration solution (ReSoMaL) in the treatment of severely malnourished children with watery diarrhea. J Pediatr 143, 614619.
24. World Health Organization/UNICEF (2001) Reduced osmolarity oral rehydration salts (ORS) formulation. http://whqlibdoc.who.int/hq/2001/WHO_FCH_CAH_01.22.pdf.
25. Hahn S, Kim S & Garner P (2002) Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database of Systematic Reviews, issue 1, CD002847. Chichester, West Sussex: John Wiley and Sons Ltd.
26. English M, Ahmed M, Ngando C et al. (2002) Blood transfusion for severe anaemia in children in a Kenyan hospital. Lancet 359, 494495.
27. Bojang KA, Van Hensbroek MB, Palmer A et al. (1997) Predictors of mortality in Gambian children with severe malaria anaemia. Ann Trop Paediatr 17, 355359.
28. Han YY, Carcillo JA, Dragotta MA et al. (2003) Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 112, 793799.
29. Carcillo JA, Davis AL & Zaritsky A (1991) Role of early fluid resuscitation in pediatric septic shock. JAMA 266, 12421245.
30. Merx MW & Weber C (2007) Sepsis and the heart. Circulation 116, 793802.
31. Goldstein B, Giroir B & Randolph A (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6, 28.
32. Alleyne GA (1966) Cardiac function in severely malnourished Jamaican children. Clin Sci 30, 553562.
33. Viart P (1977) Blood volume changes during treatment of protein-calorie malnutrition. Am J Clin Nutr 30, 349354.
34. Viart P (1977) Hemodynamic findings in servere protein-calorie malnutrition. Am J Clin Nutr 30, 334348.
35. Phornphatkul C, Pongprot Y, Suskind R et al. (1994) Cardiac function in malnourished children. Clin Pediatr (Phila) 33, 147154.
36. Kothari SS, Patel TM, Shetalwad AN et al. (1992) Left ventricular mass and function in children with severe protein energy malnutrition. Int J Cardiol 35, 1925.
37. Viart P (1978) Hemodynamic findings during treatment of protein-calorie malnutrition. Am J Clin Nutr 31, 911926.
38. Parker MM, Hazelzet JA & Carcillo JA (2004) Pediatric considerations. Crit Care Med 32, Suppl., S591S594.
39. Cockfield A & Philpot U (2009) Managing anorexia from a dietitian's perspective. Proc Nutr Soc 68 (In the Press; doi: 10.1017/S0029665109000).
40. Stanga Z, Brunner A, Leuenberger M et al. (2008) Nutrition in clinical practice – the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Eur J Clin Nutr 62, 687694.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Proceedings of the Nutrition Society
  • ISSN: 0029-6651
  • EISSN: 1475-2719
  • URL: /core/journals/proceedings-of-the-nutrition-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 5
Total number of PDF views: 38 *
Loading metrics...

Abstract views

Total abstract views: 96 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st October 2017. This data will be updated every 24 hours.