Problemi correnti
Il trattamento della malnutrizione severa
CASE-MANAGEMENT OF SEVERE MALNUTRITION
MARA BALDISSERA
Clinica Pediatrica dell’Università e Unità per la Ricerca sui Servizi Sanitari e la Cooperazione Internazionale, IRCCS “Burlo Garofolo”, Trieste
Marzo 2002 - pagg. 163 -168
Abstract
Malnutrition contributes to almost 60% of deaths in under 5 children. Severe malnutrition can
lead to death in over a third of affected children, while appropriate case-management can
reduce the mortality to less than 10%. The main steps for effective case-management include:
prevention, prompt recognition and treatment of hypoglycemia, hypothermia and electrolyte
disturbances; cautious, preferably enteral rehydration with low-sodium high-potassium
solutions when necessary; broad spectrum antibiotic therapy, micronutrient supplementation,
frequent feeding with high calorie re-feeding formulas and psychosocial stimulation. The
Author describes the main problems in the implementation of such a protocol in a tertiary care
paediatric hospital in North-East Brazil.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. United Nations. Report of the Secretary-General.
We the Children: End-decade rewiew to
the follow-up to the World Summit for Children.
A/S-27/3, United Nations, New York, 4
May 2001 (http://www.unicef.org).
2. Pelletier DL, Frongillo EA, Schroeder DG, et al. The effects of malnutrition on child mortality in developing countries. Bull World Health Org 1995;73:443.
3. Unicef, State of the World Children 1998.
4. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr 1999;129(8):1555-62.
5. Schofield C, Ashworth A. Why have mortality rates for severe malnutrition remained so high? Bull World Health Org 1996;74(2).
6. Nolan T, Angos P, Cunha AJLA, et al. Quality of hospital care for seriously ill children in less-developed countries. Lancet 2001;357:106-10.
7. Cavalcante AAM, Pinheiro LMP, Monte C, et al. Treatment of malnutrition in Brazil: simple solution to common problems. Tropical Doctor 1998;28:140-4.
8. Ahmed T, Ali M, Ullah MA, Choudhury IA, et al. Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol. Lancet 1999;353:1919- 22.
9. World Health Organization. Management of the child with a serious infection or severe malnutrition. Geneva, WHO, 2000
10. Tamburlini G, Di Mario S, Schindler Maggi R, et al. Evaluation of guidelines for emergency triage assessment and treatment in developing countries. Arch Dis Child 1999;81: 478-82.
11. Golden MHN. Severe malnutrition. Oxford Textbook of Medicine, 3th edition, 1996, vol 1:1278-94.
12. Unicef, Statistical Data 2000. http://www.unicef.org/statis
13. Batista Filho M, Costa MJC. Desnutrição energètico-protèica: experiencia do hospital universitàrio de João Pessoa, PB. Revista do IMIP 1988;2:90-3.
14. Khanum S, Ashworth A, Huttly SRA. Growth, morbidity, and mortality of children in Dhaka after treatment for severe malnutrition: a prospective study. Am J Clin Nutr 1998; 67:940-5.
15. Heikens GT, Schofield WN, Dawson SM, Waterlow JC. Long-stay versus short-stay hospital treatment of children suffering from severe protein-energy malnutrition. Eur J Clin Nutr 1994;48:873-82.
2. Pelletier DL, Frongillo EA, Schroeder DG, et al. The effects of malnutrition on child mortality in developing countries. Bull World Health Org 1995;73:443.
3. Unicef, State of the World Children 1998.
4. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr 1999;129(8):1555-62.
5. Schofield C, Ashworth A. Why have mortality rates for severe malnutrition remained so high? Bull World Health Org 1996;74(2).
6. Nolan T, Angos P, Cunha AJLA, et al. Quality of hospital care for seriously ill children in less-developed countries. Lancet 2001;357:106-10.
7. Cavalcante AAM, Pinheiro LMP, Monte C, et al. Treatment of malnutrition in Brazil: simple solution to common problems. Tropical Doctor 1998;28:140-4.
8. Ahmed T, Ali M, Ullah MA, Choudhury IA, et al. Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol. Lancet 1999;353:1919- 22.
9. World Health Organization. Management of the child with a serious infection or severe malnutrition. Geneva, WHO, 2000
10. Tamburlini G, Di Mario S, Schindler Maggi R, et al. Evaluation of guidelines for emergency triage assessment and treatment in developing countries. Arch Dis Child 1999;81: 478-82.
11. Golden MHN. Severe malnutrition. Oxford Textbook of Medicine, 3th edition, 1996, vol 1:1278-94.
12. Unicef, Statistical Data 2000. http://www.unicef.org/statis
13. Batista Filho M, Costa MJC. Desnutrição energètico-protèica: experiencia do hospital universitàrio de João Pessoa, PB. Revista do IMIP 1988;2:90-3.
14. Khanum S, Ashworth A, Huttly SRA. Growth, morbidity, and mortality of children in Dhaka after treatment for severe malnutrition: a prospective study. Am J Clin Nutr 1998; 67:940-5.
15. Heikens GT, Schofield WN, Dawson SM, Waterlow JC. Long-stay versus short-stay hospital treatment of children suffering from severe protein-energy malnutrition. Eur J Clin Nutr 1994;48:873-82.