BACKGROUND AND OBJECTIVE:
Immunity is heavily impaired in children experiencing severe acute malnutrition (SAM), often resulting in sepsis and death. Knowledge of biochemical derangements during the early stage of sepsis among these children with SAM would help in their treatment and reduce fatality. The goal of this study was to describe and compare the features of sepsis in children with SAM and those without SAM, and the risks and associated factors of death in septic children.
Children aged 6 to 59 months with SAM (weight-for-height z score ≤3) or bipedal edema and non-SAM admitted with diarrhea plus sepsis at the icddr,b hospital from April 2010 to December 2011 were studied prospectively.
A total of 126 children (48 with SAM and 78 without SAM) were studied; all had diarrhea and sepsis. Their mean ± SD age was 19.1 ± 14.2 months; 52% were female; capillary refill time, neutrophil and band %, serum urea nitrogen, pH, hemoglobin, platelet, serum total CO2, phosphate, calcium, C-reactive protein, creatinine, and creatine kinase were similar between SAM and non-SAM children (P > .05). However, serum sodium and albumin levels were lower and leukocyte count, hypoglycemia, septic shock, and mortality rates were higher in SAM than in non-SAM children (P < .05). Logistic regression showed that septic children with SAM were 13 times more likely to have fever or hypothermia than septic children without SAM. Among these 126 children, 25 (19.8%) died. Weight-for-height z score (–3.0 ± 2.1 vs –2.7 ± 1.5), % band cell (5.2 ± 6.4 vs 2.6 ± 5.5), sodium (154 ± 29 vs 142 ± 21), serum urea nitrogen (25.7 ± 21.5 vs 17.8 ± 16.1), and septic shock (92% vs 9%) findings were significantly higher, and hemoglobin (9.2 ± 1.6 vs 10.3 ± 2.0) and albumin (2.9 ± 1.1 vs 3.4 ± 0.8) levels were significantly lower, among those who died than in the children who survived, respectively. Children who died were 4 times more likely to be severely wasted and 3 times more likely to have had moderate anemia.
The case fatality rate is significantly high in sepsis, particularly in septic shock and children with SAM. These features may assist in the better management of septic children with or without SAM and thus reduce fatality.
- Copyright © 2015 by the American Academy of Pediatrics