PediatricSevere MalnutritionHospital Management Chart Review GUIDE

Based on Libera MOHSW 2012 Quick Reference Booklet for the Integrated Management of Acute Malnutrition Inpatient Treatment (IPT)

Initial Evaluation Malnutrition/Nutritional Status

MUAC Score
Absence/presence edema (grade +, ++, +++)
Weight
Height
Weight/Height Score
Child’s BF status recorded if < 2 years (Note: NA if child > 2 years)
Child’s food intake recorded before ill (BF, fluids and other)
Child’s food intake recorded last 24 hours
Initial Evaluation Clinical Status/ Assessment for complications
Presence/absence diarrhea recorded (caretaker report)
Presence/absence cough recorded (caretaker report)
Presence/absence vomiting recorded (caretaker report)
Presence/absence fever (caretaker report)
Temperature recorded
Respiratory Rate recorded
Heart Rate recorded
Clinical exam recorded(minimum: level of conscioulsness, skin/hair, lung, cardiovascular, Ear Nose Throat; presence/absence edema, abdominal, capillary refill, eyelids retracted or not)
Hydration status recorded: normal, dehydrated, shock, uncertain
Admission Criteria
Children 6 mos to 8 yrs):
W/H < -3 Z score (WHO 2006) OR MUAC < 11.5 cm OR presence bilateral oedema (+++) OR Any Medical Complication OR No suitable willing caretaker
Infants < 6 mos or any infant < 3kgw/female caretaker capable of BF: too weak to suckle effectively (irrespective of H/W score) OR infant not gaining weight at home (by serial measuremnt) OR W/L < -3 z score OR bilateral edema
Treatment of Dehydration
--If conscious, Resomal 10 mg/kg/hr first 24 hours then re-assess and follow algorithm p.22 of reference guide (Note: No use of regular SRO in dehydrated child with acute malnutrition)
--If unconcious, IVF hydration 15mg/kh first hour then reassess per algorithm p. 22 reference guide (½ Saline & 5% glucose or Ringer Lactate & 5% glucose)
Systematic Treatment (all children admitted for IPT for SAM)
Amoxicillin (100 mg/kg/day in two doses) or IM cefotaxime (50mg/kg)/day (Check only if dosing correct per weight; do not check if weight not recorded)
Nystatin 100,000 UI orally 4x/day if oral candidiasis or if geographic area with > 20% prevalence HIV or candidiasis
Malaria treatment:
If > 5 kg, Artesunate 4 mg/kg + Amodiaquine 10/kg x 3 days (If complicated malaria see checklist for treatment of severe malaria)
For patients < 5 mg, Paracheck at admission and treatment if + result
Folic Acid 2.5 mg at admission only if clinical signs of anemia
Measles vaccine (from 9 months) if no documentation of prior vaccination (2nd vaccine 4 weeks later after transitions to OTP)
If hospitalized 4 weeks: Vitamin A in 4th week (100,000IU if 6-11 mos; 200,000 IU if > 12 mos)
If hospitalized 4 weeks: Albendazole 400 mg OR Mebendazole 500 mg in 4th week
Inpatient Monitoring (at least once daily)
Weight
Degree of oedema (0 to +++)
Temperature
Respiratory Rate
Feeding status documented (including BF status if BF at admission) (presence/absence NGT, etc.)
Hydration status (presence/absence dehydration)
Presence/absence diarrhea
Presence/absence vomiting
Food/RUTF/F75-F100 intake (or non intake)
General clinical status
Weekly MUAC recorded
Nutritional Recuperation
ACUTE PHASE/PHASE I:
F-75: Daily quantity per weight chart p. 13 of Liberia IPF SAM Reference Guide
--graduate to transition phase when return of appetite, oedema decreasing to at least ++, appears to be clinically recovering
TRANSITION PHASE:
RUTF/F100: Daily quantity per weight chart p. 16 IPF reference guide
Discharge
Successful appetite test recorded (see p.17 Reference Guide)
MUAC recorded
Weight Recorded
Height Recorded
Discharge Criteria Met: MUAC > 11.5 cm OR W/H >-1.5z score OR No oedema for 14 days
Discharge counseling and transition to OTP (outpatient treatment) documented

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