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Research Project: Pediatric Clinical Nutrition

Location: Children's Nutrition Research Center

Title: Diagnosis and treatment of severely malnourished children with diarrhea

item IANNOTTI, LORA - Washington University
item TREHAN, INDI - Washington University
item CLITHEROE, KATHRYN - Washington University
item MANARY, MARK - Children'S Nutrition Research Center (CNRC)

Submitted to: Journal of Paediatrics and Child Health
Publication Type: Review Article
Publication Acceptance Date: 7/11/2014
Publication Date: 4/1/2015
Citation: Iannotti, L.L., Trehan, I., Clitheroe, K.L., Manary, M.J. 2015. Diagnosis and treatment of severely malnourished children with diarrhea. Journal of Paediatrics and Child Health. 51(4):387-395.

Interpretive Summary:

Technical Abstract: Children with severe acute malnutrition complicated by diarrhoea require special care due to their unique physiological vulnerability and increased mortality risks. A systematic literature review (1950-2013) was conducted to identify the most effective diagnostic and therapeutic measures for the community-based management of severely malnourished children with diarrhoea. No studies directly addressed this question, so the search was broadened to include inpatient care. Of the 129 studies identified, 32 were selected for full review and found to contain varying degrees of indirectness, inconsistency and bias. Evidence from diagnostic studies point to the use of both prolonged and persistent diarrhoea as morbidity markers, rapid hypoglycaemia diagnosis and the frequent aetiological role of Cryptosporidium. Therapeutic studies suggest benefits from routine antiparasitic medication and feeding regimens with ready-to-use-therapeutic foods, lactose-free diets and zinc supplementation. Existing rehydration treatment guidelines were affirmed, but the utility of glutamine and low osmolarity feeds were inconclusive.