Principles of Managing Severe acute malnutrition

8/18/2019 Principles of Managing Severe acute malnutrition

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PRINCIPLES OF MANAGING A CHILDWITH SAM.


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OBJECTIVES

• At the end of this session !o" sho"#d$e %$#e to&

'. De(ne SAM

). *no+ P,in-i#es of M%n%/e0ent ofSAM


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De(nition of SAM

Fe%t",es&

1i2 P,esen-e of ede0% of $oth feet

1ii2 se3e,e +%stin/ 1+t fo, hei/ht 4 56SD o, M7AC 4 ''.8 -02


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Co0#i-%ted 3s 7n-o0#i-%ted SAM

COMPLICATED SAM UNCOMPLICATED SAMH%3e oo, %etite H%3e % /ood %etite

Not %#e,t C#ini-%##! +e## %nd %#e,t

H%3e Se3e,e Ede0% 19992 No ede0%

M%! h%3e one o, 0o,e0edi-%# complications1sho-: h!o/#!-%e0i%h!othe,0i% ,esi,%to,! o,",in%,! t,%-t infe-tionsde,0%tosis 1;%:! %int

de,0%tosis2

H%3e no %n! 0edi-%#-o0#i-%tions.


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P,in-i#es of the 0%n%/e0ent ofSAM.

• Gene,%# t,e%t0ent in3o#3es '< stesdi3ided into h%ses&

the initi%# st%$i#i=%tion h%se

the Reh%$i#it%tion h%se %ndfo##o+5"


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Adapted from Nelson Textbook of pediatrics 19th Ed


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Ph%se one & st%$i#i=%tionh%se.

• Co,,e-t h!o/#!-e0i% deh!d,%tion0%n%/e h!othe,0i% -ont,o#infe-tions initi%te feedin/ -o,,e-t

e#e-t,o#!te i0$%#%n-e s"#!0i-,on"t,ients +itho"t i,on senso,!sti0"#%tion.


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M%n%/e0ent ofH!o/#!-e0i%

• Gi3e 8< 0# of s"/%, +%te, 1' te%soon s"/%, in8


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M%n%/e0ent of h!o/#!-%e0i%

-ontd..

• Monito, RBG e3e,! 6< 0ins %nd St%,tAnti$ioti-s


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H!othe,0i%.

• Co00on in 0%#no",ished -hi#d,en%nd 0%! indi-%te infe-tion o,h!o/#!-e0i%.

• A$illar% temp < 35&C or rectaltemp < 35'5&C'

• M%n%/e0ent & Feed /i3e %nti$ioti-s,e+%,0 the -hi#d 1-#othin/ s:in tos:in -ont%-t +ith 0othe,2.


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Deh!d,%tion

• Ass"0e th%t %## -hi#d,en +ith +%te,!di%,,he% o, ,ed"-ed ",ine o"t"th%3e so0e deh!d,%tion.

• M%n%/e0ent& Gi3e 80# :/ ofeSoMal e3e,! 6


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Infe-tions

• Chi#d,en +ith SAM 0%! h%3einfe-tions +itho"t si/ns #i:e fe3e,.Ass"0e th%t %## h%3e %n infe-tion

%nd t,e%t +ith %nti$ioti-si00edi%te#!.

• Fo, )ncomplicate" SAM /i3e o,%#

A0oi-i##in )85@< 0/ :/ h,#! fo, 8?• Fo, complicate" SAM /i3e

%,ente,%# %nti$ioti-s&


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Infe-tions -td

• Ben=!#eni-i##in o, %0i-i##in IMIV fo,) d%!s then o,%# %0oi-i##in fo, 8d%!s PL7S Gent%0i-in od fo, ?d%!s.

• If %n! e3iden-e of othe, infe-tionst,e%t %,o,i%te#!.


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Mi-,on"t,ient de(-ien-ies.

• If -hi#d is ,e-ei3in/ ,e5 0iedthe,%e"ti- foods -ont%inin/3it%0ins %nd 0ine,%#s the,e is no

need of %ddition%# doses.

• If not /i3e &

FA 8 0/ on d%! ' then ' 0/

d%i#!.

0"#ti3it%0in s!," 80#

=in- ) 0/ :/ d%! %nd

-o e,


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)nd h%se& ,eh%$i#it%tionh%se

• Contin"e +ith %nti$ioti- the,%!-%t-h 5 " feedin/ i,on the,%!senso,! sti0"#%tion.


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Feedin/

The,e %,e t+o +%!s of feedin/&

'.Initi%# Refeedin/ 1D%! '5 ?2

St%$i#i=%tion Ph%se

).C%t-h " Feedin/ 1F,o0 ) +ee:s2Reh%$i#it%tion Ph%se


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Initi%# ,e5feedin/.

• Sho"#d $e f,e"ent1 e3e,! )56h,s 2

• The st%,te, fo,0"#% -o00on#! "sed is F5 ?8.th%t $e/in %s soon %nd -ontin"in/ fo, )5? d%!s

• T,e%t0ent in the initi%# h%se %i0ed %t,o3idin/ -%#o,ies %t '


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DA*S +E,UENC* -OL/./+EED -OL/./DA*

'5) ) ho",#! ''0# '6


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CONTENTS per4mls

+015 (cerealase"#

+015(starter#

+04 (Catc6)p#

Ener!% (7cal# 15 15 4Protein (!# 4'4 '8 9'8

Lactose (!# 4'3 4'3 '9

Pot%ssi"0 100o#2 @.) @.6 .6

Sodi"0 100o#2 ene,/! f,o0 f%t 6) 6) 86

Osmolalit%(mOsm/l#

33 43 48


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C%t-h5" /,o+th feedin/

• In3o#3es T,%nsition f,o0 F5?8 to F5'


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C%t-h 7 /,o+th feedin/

• Re#%-e st%,te, F5?8 +ith e"%# %0o"ntof F5'


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Wei/ht /%in

• Is -%#-"#%ted e3e,! 6 d%!s %s /:/e, d%!

5Poo, if 48/:/d

5Mode,%te if 85'


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Senso,! sti0"#%tion.

• P,e3ent e,0%nent s!-hoso-i%#ee-ts of st%,3%tion +iths!-ho0oto, sti0"#%tion.

• P,o3ide the -hi#d +ith tende, #o3in/-%,e % -hee,f"# sti0"#%tin/en3i,on0ent h!si-%# %-ti3it! %s

soon %s the -hi#d is +e## eno"/h.• P,o3ide to!s %nd #%! %-ti3ities fo,

the -hi#d.


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Co00on Asso-i%ted-onditions

'. E!e P,o$#e0s& 0%in#! d"e to 3it%0in Ade(-ien-!.

). Se3e,e An%e0i%.

6. S:in #esions in *+%shio,:o,& H!o5 o,h!e,i/0ent%tion 7#-e,%tionE"d%ti3e #esions Des"%0%tion of s:in.

@. Contin"in/ Di%,,hoe%& Che-: stoo#L%-tose into#e,%n-e Os0oti- di%,,he%.

8. T"$e,-"#osis.


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Dis-h%,/e %nd fo##o+5".

• The -hi#d sho"#d $e dis-h%,/ed f,o0hosit%# to o"t%tient o, n"t,ition%#,o/,%0 +hen&

5the! h%3e -o0#eted %,ente,%#%nti$ioti- the,%! %nd %,e -#ini-%##!+e## %nd %#e,t

50edi-%# -o0#i-%tions %,e,eso#3ed

5thei, %etite h%s f"##!

,e-o3e,ed %nd the! %,e e%tin/ +e##


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Dis-h%,/e %nd fo##o+5"

• The -hi#d sho"#d $e dis-h%,/ed f,o0the n"t,ition%# t,e%t0ent ,o/,%0+hen on#! +hen&

5+t fo, hei/ht 5) SD s-o,e%nd the! h%3e h%d no ede0% fo, %t#e%st ) +ee:s

o, M7AC ').8-0 %nd the!h%3e h%d no ede0% fo, %t #e%st )+ee:s.


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Fo##o+5"

• Afte, the -hi#d h%s $een dis-h%,/ed too"t%tient % #%n sho"#d 0%de fo##o+5""nti# f"## ,e-o3e,!.

• The -hi#d sho"#d $e +ei/hed +ee:#! %fte,dis-h%,/e

• If the! f%i# to /%in +ei/ht o3e, % ) +ee:e,iod o, #oses +ei/ht $tn )

0e%s",e0ents o, de3e#os #oss of %etiteo, ede0% sho"#d $e ,efe,,ed $%-: tohosit%# fo, f",the, %ssess0ent.


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Refe,en-es

'. Po-:et $oo: of hosit%# -%,e fo,-hi#d,en WHO

). Ne#son Tet$oo: of edi%t,i-s 'th Ed

6. N%tion%# /"ide#ine fo, theM%n%/e0ent of A-"te 0%#n"t,ition in

T%n=%ni%.

Principles of Managing Severe acute malnutrition

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