• Nutrition Research and Practice
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• 제13권3호
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• pp.247-255
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• 2019

BACKGROUND/OBJECTIVES: Accurate, early identification of acutely malnourished children has the potential to reduce related child morbidity and mortality. The current World Health Organisation (WHO) guidelines classify non-oedematous acute malnutrition among children under five using Mid-Upper Arm Circumference (MUAC) or Weight-for-Height Z-score (WHZ). However, there is ongoing debate regarding the use of current MUAC cut-offs. This study investigates the diagnostic performance of MUAC to identify children aged 6-24 months with global (GAM) or severe acute malnutrition (SAM). SUBJECTS/METHODS: Cross-sectional, secondary data from a community sample of children aged 6-24 months in Niger were used for this study. Children with complete weight, height and MUAC data and without clinical oedema were included. Using WHO guidelines for GAM (WHZ < -2, MUAC < 12.5 cm) and SAM (WHZ < -3, MUAC < 11.5 cm), the sensitivity (Se), specificity (Sp), predictive values, Youden Index and Receiver Operating Characteristic (ROC) curves were calculated for MUAC when compared with the WHZ reference criterion. RESULTS: Of 1161 children, 23.3% were diagnosed with GAM using WHZ, and 4.4% with SAM. Using current WHO cut-offs, the Se of MUAC to identify GAM was greater than for SAM (79 vs. 57%), yet the Sp was lower (84 vs. 97%). From inspection of the ROC curve and Youden Index, Se and Sp were maximised for MUAC < 12.5 cm to identify GAM (Se 79%, Sp 84%), and MUAC < 12.0 cm to identify SAM (Se 88%, Sp 81%). CONCLUSIONS: The current MUAC cut-off to identify GAM should continue to be used, but when screening for SAM, a higher cut-off could improve case identification. Community screening for SAM could use MUAC < 12.0 cm followed by appropriate treatment based on either MUAC < 11.5 cm or WHZ < -3, as in current practice. While the practicalities of implementation must be considered, the higher SAM MUAC cut-off would maximise early case-finding of high-risk acutely malnourished children.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권3호
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• pp.242-248
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• 2019

Purpose: Severe acute malnutrition (SAM) is an important public health problem which contributes to significant number of under five deaths. Protocol based management significantly decreases risk of deaths in children with medical complications. Methods: Outcome of children aged 2 months-5 years admitted and fulfilling definition of SAM having diarrhea (group A) was compared to children with SAM having medical complications other than diarrhea (group B). Both groups were managed according to standard recommended protocols and monitored and followed up for 12 weeks after discharge. Results: The average weight gain, defaulter rate, primary failure, secondary relapse rate and readmission rate were similar in both groups. Length of stay in group A was three days longer (p-value=0.039). Discharge rate was comparable with overall 68% of children successfully discharged and 50% of children reaching weight/height > -2 standard deviation at follow-up of 12 weeks. Conclusion: The current management protocol is equally effective for managing children with SAM having diarrhea. Good adherence to management protocol of dehydration and timely modification of therapeutic feeds in children with persistent diarrhea results in satisfactory weight gain.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권sup1호
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• pp.53-61
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• 2009

The mainstay in the management of mild to moderately dehydrated children is fast rehydration by using hypotonic ORS (oral rehydration solution) and complete resumption of normal diet, including lactose-containing formula after 4 hours rehydration. Since the majority of young children with uncomplicated acute diarrhea will tolerate large amounts of undiluted non-human milk, withholding food and milk from children during diarrhea is not recommended anymore, regarding time to resolution and diarrhea control. In addition, routine dilution of milk and routine use of lactose-free formula are not necessary after fast ORS therapy. Breastfed infants and children fed with solid foods may safely continue receiving their usual diets during diarrhea instead of gradual reintroduction of feeding. However, young infants or children with severe diarrhea or malnutrition should be carefully treated under supervision if fed with lactose containing, non-human milk exclusively.

• 대한한의학회지
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• 제22권3호
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• pp.42-50
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• 2001

Objectives : Dysphagia is common and severe problems of acute stroke determining the prognosis of stroke only second to mental change, and results in secondary fatal complications such as aspiration pneumonia, malnutrition, dehydration, etc. Therefore, we were to investigate the clinical characteristics of dysphagia accompanied by acute ischemic stroke. Methods : We selected subjects through clinical notes retrospectively, whose main problems included dysphagia resulted from acute stroke within 72 hours from onset who were admitted to the Internal Medicine Department of Wonkwang Oriental Medicine Hospital from Jan. 2000 to Apr. 2001. We assessed the severity of dysphagia from admission to discharge using a staging method : stage 0 is normal without dysphagia, stage 1 is nearly normal except for intermittent dysphagia, stage 2 is compensated abnormal swallowing requiring adjusted diets or delayed feeding time, stage 3 is uncompensated abnormal swallowing resulted in weight loss down to 10% of initial and daily aspiration, coughing, and vomiting, stage 4 is uncompensated abnormal swallowing resulting in weight loss beyond 10% and recommended for non-oral feeding, and stage 5 is 100% non-oral feeding by L-tube, or gastrostomy or NPO state. Results : Dysphagia was improved statistically significantly from the mean stage of $3.6{\pm}0.29$ on admission to $1.88{\pm}0.32$ on discharge (P<0.05). On average $7.1{\pm}1.48$ days were required for improving more than one stage level. As patients were older and the stage of dysphagia was worse on admission, severity of dysphagia was more difficult to improve (correlation coefficiency was 0.55 and 0.77 respectively, P<0.05). Aspiration pneumonia was complicated in 13 patients of the total 25 at mean dysphagia stage of $3.36{\pm}0.37$. However, any specific values such as lesion size, lesion site, sex, age, past history and NIH Stroke Scale on admission did not affect it (P>0.05). Conclusion : Clinical course of dysphagia was determined about I week from the onset. Aspiration pneumonia was mainly complicated during oral feeding periods. If there were no improvement of dysphagia over 2-3 weeks, then non-oral feeding such as Levin tube or gastrostomy must be considered.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제26권5호
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• pp.284-289
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• 2023

A 14-year-old girl was admitted to the emergency department for excessive bile-containing vomiting and severe abdominal pain. She had been healthy until she intentionally lost 25 kg over a 6-month period. Thick, bloody bile-mixed food particles were drained from the stomach through a nasogastric tube. Abdominal computed tomography revealed huge stomach dilatation with extensive gastric pneumatosis, possible near rupture, acute pancreatitis, and a very narrow third of the duodenum, indicating superior mesenteric syndrome. Gastrofibroscopy revealed multiple hemorrhagic ulcers and numerous beadlike cystic lesions in the stomach. Laboratory examination results were notable for severe deficiencies in critical nutrients, including iron, zinc, proteins, and prealbumin, as well as undernutrition-associated endocrine complications such as hypothyroidism and hypogonadotropic hypogonadism. Excessive vomiting ceased after the endoscopic removal of stagnant gastric contents. Gastric pneumatosis improved after 3 days of supportive care.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제4권1호
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• pp.83-91
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• 2001

목 적: 입원 환아의 영양결핍에 대한 통계가 국내에는 미비하여 영양평가의 지표를 삼기가 어렵다. 입원 환아의 영양상태를 평가하여 입원 환아 영양관리의 필요성을 강조하고 향후 영양평가의 기초자료로 삼고자 본 연구를 하였다. 대상 및 방법: 1994년 2월부터 7월까지(200명)와 1999년 2월부터 7월까지(233명) 조선대학교 부속병원 소아과에 입원한 환아를 대상으로 연령에 대한 체중비, 연령에 대한 신장비, 신장에 대한 체중비를 구하여 급성 및 만성 단백질-에너지 영양결핍의 유병률과 질환별 및 연령군에 따른 유병률의 차이 그리고 영양결핍의 질환별 분포를 비교 분석하였다. 영양상태의 평가는 Waterlow 분류기준에 의해 분석하였고, 생화학적 지표로는 혈색소, 혈청알부민, 총 임파구 수를 조사하여 영양결핍과의 관련성을 알아보았다. 결 과: 1) 급성 PEM은 신장에 대한 체중비로 산출하였는데 1994년에는 중증 0.5%, 중등도 7%, 경도 18%로서 입원 환아 200명 중 총 51명이었고, 1999년에는 중증 2.0%, 중등도 3.6%, 경도 20.0%로서 입원환아 223명 중 총 58명으로 나타나 두 연도에서 영양결핍에 대한 높은 빈도의 유병률을 보였다. 만성PEM에서도 1994년에는 중증 5%, 중등도 5.5%, 경도 25.5%로서 총 72명이었고, 1999년에는 중증2.24%, 중등도 4.04%, 경도 22.87%로서 총 62명으로 나타나 두 연도간의 유의한 차이는 없으나 각각 높은 빈도의 PEM을 보이고 있다(p=0.287). 급성과 만성 PEM 양쪽에 해당되는 환아는 1994년에 25명, 1999년에는 20명이어서 두 연도에서 PEM의 유병률은 1994년에 49.0%, 1999년에는 44.8%로 나타났다. 2) 연령군별로 영양결핍의 정도를 볼 때 급성 영양결핍에서는 경도의 PEM이 전반적으로 높게 나타났으며, 심한 만성 PEM의 유병률은 2세 이전의 영아에서 10.8%로서 높게 나타나고 있으나 이들은 통계학적으로 의미가 없었다(p=0.511). 3) 급.만성 PEM의 질환별 분류를 볼 때 1994년에는 급성 혹은 만성 PEM을 보였던 환아 98명 중 호흡기 질환이 43명으로 52%를 차지하여 가장 많았고, 소화기, 일반 내과, 신경계, 순환기 질환 순이었으며, 1999년에는 99명 중 호흡기 질환이 38명, 소화기, 일반내과, 신경계, 내분비, 순환기 질환순 이었다. 4) 각 질환에 대해 급.만성 PEM의 유병률을 볼때 1994년에는 혈액종양, 내분비, 신경계, 호흡기, 순환기, 소화기, 비뇨기계통의 질환 순으로 높았으며, 1999년에는 내분비, 순환기, 소화기, 호흡기, 혈액종양, 신경계, 비뇨기계통의 질환 순이었다. 5) 1999년에 측정한 신체계측에서 PEM을 보인 환아에서 생화학적 기준에 따라 혈청 알부민치, 혈색소 및 총 임파구 수를 분류해 볼 때 혈색소 및 혈청 알부민 수치가 총임파구의 수치보다 낮게 나타났다. 결 론: 입원 환아 단백질-에너지 영양결핍의 빈도는 1994년에 49%, 1999년에는 44.8%로 높게 나타나고 있음을 알 수 있었다. 따라서 질병의 예방과 효과적인 치료 및 환아에게 적합한 영양처방을 결정하기 위해서는 영양관리의 중요성을 인식하고 포괄적인 영양평가와 함께 올바른 식 습관 형성에 대한 지도를 비롯한 적극적인 영양관리가 이루어져야 한다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제4권2호
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• pp.243-248
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• 2001

저자들은 생후 2개월부터 지속되는 만성 설사를 주소로 내원한 환아에서 면역글로불린 정량 검사상 IgA의 결핍과 함께 $IgG_2$ 및 $IgG_4$ 결핍이 동반되어 있고 영아기에 빈번한 설사와 감염을 동반한 증례를 경험하였기에 보고하는 바이다.

• Journal of Preventive Medicine and Public Health
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• 제53권4호
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• pp.289-292
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• 2020

Yemen has been faced with the worst cholera epidemic of modern times, with more than 1 million suspected cases and 3000 deaths at the time of writing. This problem is largely due to the longstanding civil war between pro-government forces and the Houthi armed movement, which has severely damaged already vulnerable sanitation and healthcare facilities and systems in the country. It is further compounded by a dire lack of basic amenities, chronic malnutrition, and unfavourable weather conditions. Another contributory component may be aerial transfer by cholera-infected chironomid insects. To contain the spread of cholera in Yemen, a nation-wide armistice should be negotiated, and national and local committees must be convened to coordinate efforts on the ground. Community isolation facilities with proper sanitation, reliable disposal systems, and a clean water supply should be set up to isolate and treat sick patients. The continuity of vaccination programmes should be ensured. Public health campaigns to educate local communities about good hygiene practices and nutrition are also necessary. The One Health paradigm emphasizes a multi-sectoral and transdisciplinary understanding and approach to prevent and mitigate the threat of communicable diseases. This paradigm is highly applicable to the ongoing cholera crisis in Yemen, as it demands a holistic and whole-of-society approach at the local, regional, and national levels. The key stakeholders and warring parties in Yemen must work towards a lasting ceasefire during these trying times, especially given the extra burden from the mounting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak worldwide.

• Clinical and Experimental Pediatrics
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• 제64권11호
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• pp.588-595
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• 2021

Background: Acute respiratory infections (ARIs), especially pneumonia, remain a major cause of infant mortality worldwide. In Indonesia, pneumonia is the second most common cause of infant and toddler deaths. Exclusive breastfeeding and basic immunization can protect infants and children from contracting pneumonia. Purpose: Our goal was to assess the risk factors for childhood pneumonia in regions with a high prevalence of pneumonia in Indonesia. Methods: This case-control study was conducted between March and April 2019. A total of 176 infants and toddlers aged 10-59 months were enrolled and selected from among patients who visited the community health center. Cases of pneumonia were diagnosed clinically based on the World Health Organization guidelines, and the control was nonpneumonia. Results: The risk factors for the diagnosis of pneumonia included no or nonexclusive breastfeeding (odds ratio [OR], 7.95; 95% confidence interval [CI], 3.52-17.94), incomplete basic immunizations (OR, 4.47; 95% CI, 2.22-8.99), indoor air pollution (OR, 7.12; 95% CI, 3.03-16.70), low birth weight (OR, 3.27; 95% CI, 1.19-8.92), and a high degree of wasting (OR, 2.77; 95% CI, 1.06-7.17). Other variables such as nutritional status (height-for-age z score), age, sex, and educational status of the mother were not risk factors for pneumonia. Conclusion: No or nonexclusive breastfeeding, incomplete basic immunizations, indoor air pollution, a history of low birth weight, and severe malnutrition were risk factors for childhood pneumonia. Breastfeeding was the dominant factor, while sex modified the relationship between exclusive breastfeeding and the incidence of pneumonia.