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Using of WHO guidelines for the management of severe malnutrition to cases of marasmus and kwashiorkor in a Colombia children's hospital Aplicación del protocolo de la OMS de malnutrición marasmo-kwashiorkor en un hospital de Colombia

Keywords: Marasmo , Kwashiorkor , Desnutrición infantil , Patología nutricional , Marasmus , Kwashiorkor , Child malnutrition , Nutrition disorders

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Background: In 2007, the Hospital Infantil Los ángeles (HILA) in Colombia implemented a slightly-modified version of the WHO guidelines for the diagnosis and management of malnutrition during childhood. Objective: To evaluate the efficacy of the WHO-HILA protocol in children hospitalized with severe, chronic marasmus and kwashiorkor malnutrition (MS-KWK) in 2007 and 2008. Material and methods: In this descriptive retrospective study the records of 100 children hospitalized with MSKWK were initially evaluated. Of these, 30 fulfilled the inclusion criteria: children of both sexes with a primary diagnosis of MS-KWK. Patients with any chronic disease liable to cause malnutrition were excluded. Anthropometric parameters, clinical signs and biochemical indicators of malnutrition were assessed upon admission and again at discharge following application of the WHO guidelines. Univariate analysis was performed for each study variable; serum hemoglobin and albumin levels on admission and at discharge were compared, and data were subjected to bivariate analysis. Results: Marasmus was diagnosed in 23.3% of children, kwashiorkor in 73.3% and marasmic kwashiorkor in 3.3%. The major clinical findings were: edema (70%), emaciation (40%), "flag sign" hair (42.86%), low serum albumin (93%) and anemia (80%). Thirteen children following the WHO-HILA protocol showed a significant nutritional status improvement (p < 0.05), whereas no improvement was noted in the 17 children not treated according to the protocol. Conclusions: Application of the WHO-HILA protocol was associated with reduced morbimortality in children with marasmus-kwashiorkor malnutrition. Implementation of this protocol should therefore be considered in all children′s hospitals in countries where this disease is prevalent. Introducción: En 2007, el Hospital Infantil de Los ángeles (HILA) en Colombia implementó una versión del protocolo-OMS para el diagnóstico y tratamiento de la malnutrición en la infancia. Objetivo: Evaluar la aplicación del protocolo de la OMS-HILA en ni os hospitalizados con marasmo y/o kwashiorkor (MS-KWK) durante 2007-2008. Material y métodos: En este estudio retrospectivo, se evaluaron 100 ni os hospitalizados con MS-KWK; 30 cumplieron los criterios de inclusión: ni os de ambos sexos con MS-KWK primario. Los pacientes con enfermedades crónicas que pudieran causar desnutrición fueron excluidos. Se evaluaron determinados parámetros antropométricos, y signos clínicos y bioquímicos de desnutrición según el protocolo de la OMS, al ingreso y al alta. Se realizó un análisis univariante; los niv

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