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Background: Hyponatremia is the most common electrolyte imbalance encountered in the management of diarrheal children. Common ramifications include cerebral edema and fatal outcomes. However, pediatric data remain lacking, particularly in developmental contexts where resources are limited and associated conditions like malnutrition and pneumonia are common. Aim: This study aimed to evaluate predicting factors associated with hyponatremia in children under five years of age with severe acute malnutrition (SAM) in Bangladesh. Methods: Using a nested case-control design, we compared clinical and laboratory characteristics of children with (n = 61) and without hyponatremia (n = 183) taken from a parent population of all children under five with SAM and clinical or radiological pneumonia admitted to Dhaka Hospital of icddr,b between April 2011 and June 2012 (n = 407). Results: Logistic regression analysis adjusting for potential confounders such as lack of breast feeding, duration of vomiting (days), and severe wasting revealed that older age (OR 1.05, 95%CI 1.02 - 1.07, p = 0.001) (5% increase in the relative odds of hyponatremia for each additional month of age), presence of diarrhea (OR 2.43, 95%CI 1.0 - 6.0, p = 0.05), and difficulty breathing (OR 1.52, 95%CI 1.0 - 2.05, p = 0.05) were significantly associated with hyponatremia. Conclusion: Our data suggest that older age, presence of diarrhea, and difficulty breathing in under-five children with SAM is independent predictors of hyponatremia. These findings underscore the importance of detecting simple clinical predictors early in order to facilitate appropriate management and to prevent potential ramifications of hyponatremia in SAM children, especially in resource-poor settings.
There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score < ?3.00 SD) children in rural and urban Bangladesh. From the database (2000-2011) of Diarrheal Disease Surveillance Systems (DDSS) at rural Matlab and urban Dhaka hospitals of icddr,b, 2234 and 3109 under-5 children were found severely malnourished (underweight, stunted or wasted) respectively. Two comparison groups [moderately malnourished (MM) and well-nourished (WN)] were randomly selected in a ratio of 1:1:1. Children with all categories of SM were more likely to be infected with Vibrio cholerae (rural—11%; urban—15%), Shigella (16%; 9%), Salmonella (1%; 2%) and Campylobacter (3%; 4%); and less likely to have rotavirus (25%; 20%) compared to only one SM category. Isolation rate of Vibrio cholerae was significantly higher among SM both in rural and urban children (7%; 13%) than those of MM (5%; 10%) and WN (2%; 8%) and lower for rotavirus (30%; 31%), (34%; 43%), (35%; 47%) respectively (p < 0.01). However, for Shigella it was only higher among rural SM children (11%) [MM (9%), and WN (8%) (p < 0.01)]. The isolation rate of Salmonella in SM (2%) was similar to that in MM (2%; p = 0.72) but significantly higher than that in WN (1%; p < 0.01) among urban children. Isolation rates of bacterial enteric pathogens were higher but rotavirus was lower in SM children in both rural and urban area with geographical heterogeneity.
Background: Data are lack on predicting features
of meningitis in diarrheal children although the great
clinical importance. Objective: To evaluate clinical and laboratory features in
predicting meningitis in under-fifteen children having diarrheal illnesses.
Methods: Children aged 1 month to 15 years, admitted in the ICU of the Dhaka
Hospital of icddr, b between
March 2011 and February 2012 with fever and seizure or altered consciousness
and having LP done were enrolled
into this analysis. Those children who had abnormal CSF findings [pleocytosis
(normal range of leukocyte, 0 - 10/mm3) and/or elevated protein (normal
range, 0.10 - 0.45 mg/dl) and low
glucose (normal value, 60% of corresponding blood glucose)] were defined as meningitis. Comparison was made between
children with (cases = 17) and without meningitis (controls = 66) from our
study children. Data were retrospectively collected from SHEBA, an online
database system of the Dhaka Hospital of icddr, b. Results: Death was
significantly higher among the cases compared to the controls (29% vs. 3%, p =
0.003). In logistic regression analysis, after
adjusting for potential confounders, cases frequently had hypoxemia (95% CI
1.55 - 21.93), absent peripheral pulse (95% CI 1.95 - 27.13) and
neutrophilia (95% CI 1.13 - 17.00). Conclusion: Our data suggest that children
with meningitis had higher case fatality rate. Simple independent predictors of
meningitis such as hypoxemia, absent peripheral pulse, and neutrophilia may
help clinicians to initiate early and prompt management in order to curve
lifelong sequel due to meningitis and death in such patient population
especially those in resource poor settings.
SETTING: Special Care Ward (SCW) of the Dhaka Hospital of icddr,b, Bangladesh. OBJECTIVE: To evaluate the clinical and laboratory predictors of death in under-five children with clinically defined sepsis presenting with diarrhea. METHODS: We prospectively enrolled all the diarrheal children (n = 151) aged 0 to 59 months with clinical sepsis admitted in the SCW during September’2007 through December’2007. Comparison was made between deaths (n = 23) and survivors (n = 128). Sepsis is defined as presence of inflammation [abnormal WBC count (>11 × 109/L or, <4 × 109/L or, band and neutrophil ratio ≤0.10] plus presence or presumed presence of infection with thermo-instability [hypo (≤35.0℃) or hyperthermia (≥38.5℃)], tachycardia, tachypnea, and/or the indications of altered organ function (altered mental status and bounding pulse) in the absence of clinical dehydration or after correction of dehydration. RESULTS: The median (inter-quartile range) age (months) of the children who survived and died was comparable [4.0 (2.0, 12.0) vs. 1.5 (0.8, 10.0); p = 0.703]. In the logistic regression analysis, after adjusting for potential confounders, such as abnormal WBC count, use of intravenous fluid, patient with fatal outcome more often presented with hypernatremia (odds ratio = 16.48, 95% confidence interval = 2.21 - 123.12; p = 0.006), lobar consolidation (odds ratio = 19.9, 95% confidence interval = 2.99 - 132.80; p = 0.002), hypoxemia (odds ratio = 14.78, 95% confidence interval = 1.38 157.90; p = 0.026) and severe under-nutrition (odds ratio = 7.57, 95% confidence interval = 1.24 - 46.11; p = 0.028). CONCLUSIONS: Our data suggest that children under-five with clinical sepsis who present with lobar pneumonia, hypoxaemia, severe acute malnutrition and hyperntaemia are at higher risk of death and identification of these simple factors may help clinicians to take prompt initiative for the aggressive management of such children especially in a resource-limited setting like Bangladesh.