Failure to respond to treatment
A child that is not improving clinically, gaining or not losing oedema, or is deteriorating clinically. Re-consider your diagnosis, discuss with a senior. Realise that malnourished children might show no signs of systemic infection.
No weight gain during Moyo admission?
Keep in mind that F 75 is a stabilization feed; a child is not expected to gain weight on it.
The most common causes for not reaching the expected weight gains are:
- Inadequate dietary intake (insufficient amount of F75, F100 or Chiponde, the prescribed (night-) feeds are not given as prescribed, spillage [easily 10% of prescribed volume], vomiting, anorexia or the amount prescribed is wrong. CONSIDER NGT.
- Chronic diarrhoea, and malabsorption
- Lack of supervisory staff, exhausted guardians
- Inaccurate or faulty recording and weighing
- Your diagnosis is wrong, make a new differential diagnosis. Do physical examination!
Manage treatment failure by
- Review the exact amount of food that the child is taking and calculate the caloric intake per day (should be > 150 kcal/kg/d).
- Treating HIV infection (the decision to start HAART should be discussed with senior staff)
- Look for underlying occult infection (TB, HIV, bacteraemia, UTI, Otitis, Thrush)
- TB infection should be suspected in any child who does not gain weight for more than 7 days on AB, who has a TB contact, or symptoms or signs suggestive of TB.
Consider re-admission as a type of treatment failure. Involve Umodzi.