title: Diagnosis and treatment of severely malnourished children with diarrhoea.
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.
authors.affiliation: Institute for Public Health, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Lora L
authors.initials: LL
authors.lastname: Iannotti
authors.forename: Indi
authors.initials: I
authors.lastname: Trehan
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Clitheroe
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
mesh_terms: D002648:Child; D003131:Combined Modality Therapy; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D018529:Nutritional Support / Q000379:methods; D012720:Severity of Illness Index
keywords: Cryptosporidium; GRADE review; diarrhoea; ready-to-use therapeutic food; severely malnourished children; zinc