Post-Discharge Mortality in Children with Severe Malnutrition and Pneumonia in Bangladesh

Chisti, Mohammod Jobayer; Graham, Stephen M.; Duke, Trevor; Ahmed, Tahmeed; Faruque, Abu Syed Golam; Ashraf, Hasan; Bardhan, Pradip Kumar; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Salam, Mohammed Abdus

doi:10.1371/journal.pone.0107663

Cited by 81 publications

(100 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings are consistent with that of a smaller study focused on children admitted to an intermediate care unit at the icddr,b, where those with pneumonia coinfection were found to have a two times higher mortality rate than those without pneumonia. 2 More recently, we have shown that children admitted with severe malnutrition and pneumonia to our diarrheal hospital have a 9% in-hospital death rate, 12 with an additional 9% children dying within 3 months of hospital discharge, even after inpatient nutritional rehabilitation was given. All of these data underline the potentially severe consequences of respiratory and gastrointestinal coinfection.…”

Section: Discussionmentioning

confidence: 94%

Concurrent Pneumonia in Children Under 5 Years of Age Presenting to a Diarrheal Hospital in Dhaka, Bangladesh

Leung

Das

Malek

et al. 2015

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 94%

Concurrent Pneumonia in Children Under 5 Years of Age Presenting to a Diarrheal Hospital in Dhaka, Bangladesh

Leung

Das

Malek

et al. 2015

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

show abstract

“…Even in nutritional rehabilitation centers that follow WHO-established treatment protocols, in-hospital mortality remains high, ranging from 10% to 30% of all treated cases (2). Postdischarge mortality is also significant, with studies reporting mortality rates of 8.7% within 3 mo of discharge (3), or ≤18% of all treated cases dying within 1 y of discharge (4). Furthermore, even if the children survive, they suffer from long-term adverse effects, showing patterns of thrifty growth and functional deficits such as weak hand grip and impaired cardiovascular capacity (5).…”

Section: Introductionmentioning

confidence: 99%

Metabolomic Changes in Serum of Children with Different Clinical Diagnoses of Malnutrition

Giovanni¹,

Bourdon²,

Wang³

et al. 2016

The Journal of Nutrition

View full text Add to dashboard Cite

Background: Mortality in children with severe acute malnutrition (SAM) remains high despite standardized rehabilitation protocols. Two forms of SAM are classically distinguished: kwashiorkor and marasmus. Children with kwashiorkor have nutritional edema and metabolic disturbances, including hypoalbuminemia and hepatic steatosis, whereas marasmus is characterized by severe wasting. The metabolic changes underlying these phenotypes have been poorly characterized, and whether homeostasis is achieved during hospital stay is unclear.Objectives: We aimed to characterize metabolic differences between children with marasmus and kwashiorkor at hospital admission and after clinical stabilization and to compare them with stunted and nonstunted community controls.Methods: We studied children aged 9–59 mo from Malawi who were hospitalized with SAM (n = 40; 21 with kwashiorkor and 19 with marasmus) or living in the community (n = 157; 78 stunted and 79 nonstunted). Serum from patients with SAM was obtained at hospital admission and 3 d after nutritional stabilization and from community controls. With the use of targeted metabolomics, 141 metabolites, including amino acids, biogenic amines, acylcarnitines, sphingomyelins, and phosphatidylcholines, were measured.Results: At admission, most metabolites (128 of 141; 91%) were lower in children with kwashiorkor than in those with marasmus, with significant differences in several amino acids and biogenic amines, including those of the kynurenine-tryptophan pathway. Several phosphatidylcholines and some acylcarnitines also differed. Patients with SAM had profiles that were profoundly different from those of stunted and nonstunted controls, even after clinical stabilization. Amino acids and biogenic amines generally improved with nutritional rehabilitation, but most sphingomyelins and phosphatidylcholines did not.Conclusions: Children with kwashiorkor were metabolically distinct from those with marasmus, and were more prone to severe metabolic disruptions. Children with SAM showed metabolic profiles that were profoundly different from stunted and nonstunted controls, even after clinical stabilization. Therefore, metabolic recovery in children with SAM likely extends beyond discharge, which may explain the poor long-term outcomes in these children. This trial was registered at isrctn.org as ISRCTN13916953.

show abstract

“…The goal of SAM treatment also includes the reduction of susceptibility to life‐threatening infections, restoration of a healthy body composition, and improvement in neurocognitive status (Ngari et al, a). However, children with SAM remain at risk of developing severe illness and/or infections after treatment of clinical complications and discharged from hospital (Berkley et al, ; Chisti et al, ; Kerac et al, ; Ngari et al, a). A study by Kerac et al () that followed 1,024 children 1 year post‐discharge reported 5% hospital readmissions but 42% deaths, whereas Khanum et al () reported 1.2% emergency hospital readmissions.…”

Section: Discussionmentioning

confidence: 99%

Phenotype is sustained during hospital readmissions following treatment for complicated severe malnutrition among Kenyan children: A retrospective cohort study

Gonzales

Ngari

Njunge

et al. 2019

Maternal & Child Nutrition

View full text Add to dashboard Cite

Hospital readmission is common among children with complicated severe acute malnutrition (cSAM) but not well‐characterised. Two distinct cSAM phenotypes, marasmus and kwashiorkor, exist, but their pathophysiology and whether the same phenotype persists at relapse are unclear. We aimed to test the association between cSAM phenotype at index admission and readmission following recovery. We performed secondary data analysis from a multicentre randomised trial in Kenya with 1‐year active follow‐up. The main outcome was cSAM phenotype upon hospital readmission. Among 1,704 HIV‐negative children with cSAM discharged in the trial, 177 children contributed a total of 246 readmissions with cSAM. cSAM readmission was associated with age<12 months (p = .005), but not site, sex, season, nor cSAM phenotype. Of these, 42 children contributed 44 readmissions with cSAM that occurred after a monthly visit when SAM was confirmed absent (cSAM relapse). cSAM phenotype was sustained during cSAM relapse. The adjusted odds ratio for presenting with kwashiorkor during readmission after kwashiorkor at index admission was 39.3 [95% confidence interval (95% CI) [2.69, 1,326]; p = .01); and for presenting with marasmus during readmission after kwashiorkor at index admission was 0.02 (95% CI [0.001, 0.037]; p = .01). To validate this finding, we examined readmissions to Kilifi County Hospital, Kenya occurring at least 2 months after an admission with cSAM. Among 2,412 children with cSAM discharged alive, there were 206 readmissions with cSAM. Their phenotype at readmission was significantly influenced by their phenotype at index admission (p < .001). This is the first report describing the phenotype and rate of cSAM recurrence.

show abstract

Post-Discharge Mortality in Children with Severe Malnutrition and Pneumonia in Bangladesh

Cited by 81 publications

References 24 publications

Concurrent Pneumonia in Children Under 5 Years of Age Presenting to a Diarrheal Hospital in Dhaka, Bangladesh

Concurrent Pneumonia in Children Under 5 Years of Age Presenting to a Diarrheal Hospital in Dhaka, Bangladesh

Metabolomic Changes in Serum of Children with Different Clinical Diagnoses of Malnutrition

Phenotype is sustained during hospital readmissions following treatment for complicated severe malnutrition among Kenyan children: A retrospective cohort study

Contact Info

Product

Resources

About