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8/18/2019 Principles of Managing Severe acute malnutrition
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PRINCIPLES OF MANAGING A CHILDWITH SAM.
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OBJECTIVES
• At the end of this session !o" sho"#d$e %$#e to&
'. De(ne SAM
). *no+ P,in-i#es of M%n%/e0ent ofSAM
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De(nition of SAM
Fe%t",es&
1i2 P,esen-e of ede0% of $oth feet
1ii2 se3e,e +%stin/ 1+t fo, hei/ht 4 56SD o, M7AC 4 ''.8 -02
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Co0#i-%ted 3s 7n-o0#i-%ted SAM
COMPLICATED SAM UNCOMPLICATED SAMH%3e oo, %etite H%3e % /ood %etite
Not %#e,t C#ini-%##! +e## %nd %#e,t
H%3e Se3e,e Ede0% 19992 No ede0%
M%! h%3e one o, 0o,e0edi-%# complications1sho-: h!o/#!-%e0i%h!othe,0i% ,esi,%to,! o,",in%,! t,%-t infe-tionsde,0%tosis 1;%:! %int
de,0%tosis2
H%3e no %n! 0edi-%#-o0#i-%tions.
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P,in-i#es of the 0%n%/e0ent ofSAM.
• Gene,%# t,e%t0ent in3o#3es '< stesdi3ided into h%ses&
the initi%# st%$i#i=%tion h%se
the Reh%$i#it%tion h%se %ndfo##o+5"
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Adapted from Nelson Textbook of pediatrics 19th Ed
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Ph%se one & st%$i#i=%tionh%se.
• Co,,e-t h!o/#!-e0i% deh!d,%tion0%n%/e h!othe,0i% -ont,o#infe-tions initi%te feedin/ -o,,e-t
e#e-t,o#!te i0$%#%n-e s"#!0i-,on"t,ients +itho"t i,on senso,!sti0"#%tion.
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8/18/2019 Principles of Managing Severe acute malnutrition
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M%n%/e0ent ofH!o/#!-e0i%
• Gi3e 8< 0# of s"/%, +%te, 1' te%soon s"/%, in8
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M%n%/e0ent of h!o/#!-%e0i%
-ontd..
• Monito, RBG e3e,! 6< 0ins %nd St%,tAnti$ioti-s
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H!othe,0i%.
• Co00on in 0%#no",ished -hi#d,en%nd 0%! indi-%te infe-tion o,h!o/#!-e0i%.
• A$illar% temp < 35&C or rectaltemp < 35'5&C'
• M%n%/e0ent & Feed /i3e %nti$ioti-s,e+%,0 the -hi#d 1-#othin/ s:in tos:in -ont%-t +ith 0othe,2.
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Deh!d,%tion
• Ass"0e th%t %## -hi#d,en +ith +%te,!di%,,he% o, ,ed"-ed ",ine o"t"th%3e so0e deh!d,%tion.
• M%n%/e0ent& Gi3e 80# :/ ofeSoMal e3e,! 6
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8/18/2019 Principles of Managing Severe acute malnutrition
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Infe-tions
• Chi#d,en +ith SAM 0%! h%3einfe-tions +itho"t si/ns #i:e fe3e,.Ass"0e th%t %## h%3e %n infe-tion
%nd t,e%t +ith %nti$ioti-si00edi%te#!.
• Fo, )ncomplicate" SAM /i3e o,%#
A0oi-i##in )85@< 0/ :/ h,#! fo, 8?• Fo, complicate" SAM /i3e
%,ente,%# %nti$ioti-s&
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Infe-tions -td
• Ben=!#eni-i##in o, %0i-i##in IMIV fo,) d%!s then o,%# %0oi-i##in fo, 8d%!s PL7S Gent%0i-in od fo, ?d%!s.
• If %n! e3iden-e of othe, infe-tionst,e%t %,o,i%te#!.
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Mi-,on"t,ient de(-ien-ies.
• If -hi#d is ,e-ei3in/ ,e5 0iedthe,%e"ti- foods -ont%inin/3it%0ins %nd 0ine,%#s the,e is no
need of %ddition%# doses.
• If not /i3e &
FA 8 0/ on d%! ' then ' 0/
d%i#!.
0"#ti3it%0in s!," 80#
=in- ) 0/ :/ d%! %nd
-o e,
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8/18/2019 Principles of Managing Severe acute malnutrition
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)nd h%se& ,eh%$i#it%tionh%se
• Contin"e +ith %nti$ioti- the,%!-%t-h 5 " feedin/ i,on the,%!senso,! sti0"#%tion.
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Feedin/
The,e %,e t+o +%!s of feedin/&
'.Initi%# Refeedin/ 1D%! '5 ?2
St%$i#i=%tion Ph%se
).C%t-h " Feedin/ 1F,o0 ) +ee:s2Reh%$i#it%tion Ph%se
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Initi%# ,e5feedin/.
• Sho"#d $e f,e"ent1 e3e,! )56h,s 2
• The st%,te, fo,0"#% -o00on#! "sed is F5 ?8.th%t $e/in %s soon %nd -ontin"in/ fo, )5? d%!s
• T,e%t0ent in the initi%# h%se %i0ed %t,o3idin/ -%#o,ies %t '
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DA*S +E,UENC* -OL/./+EED -OL/./DA*
'5) ) ho",#! ''0# '6
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CONTENTS per4mls
+015 (cerealase"#
+015(starter#
+04 (Catc6)p#
Ener!% (7cal# 15 15 4Protein (!# 4'4 '8 9'8
Lactose (!# 4'3 4'3 '9
Pot%ssi"0 100o#2 @.) @.6 .6
Sodi"0 100o#2 ene,/! f,o0 f%t 6) 6) 86
Osmolalit%(mOsm/l#
33 43 48
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C%t-h5" /,o+th feedin/
• In3o#3es T,%nsition f,o0 F5?8 to F5'
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C%t-h 7 /,o+th feedin/
• Re#%-e st%,te, F5?8 +ith e"%# %0o"ntof F5'
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Wei/ht /%in
• Is -%#-"#%ted e3e,! 6 d%!s %s /:/e, d%!
5Poo, if 48/:/d
5Mode,%te if 85'
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Senso,! sti0"#%tion.
• P,e3ent e,0%nent s!-hoso-i%#ee-ts of st%,3%tion +iths!-ho0oto, sti0"#%tion.
• P,o3ide the -hi#d +ith tende, #o3in/-%,e % -hee,f"# sti0"#%tin/en3i,on0ent h!si-%# %-ti3it! %s
soon %s the -hi#d is +e## eno"/h.• P,o3ide to!s %nd #%! %-ti3ities fo,
the -hi#d.
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Co00on Asso-i%ted-onditions
'. E!e P,o$#e0s& 0%in#! d"e to 3it%0in Ade(-ien-!.
). Se3e,e An%e0i%.
6. S:in #esions in *+%shio,:o,& H!o5 o,h!e,i/0ent%tion 7#-e,%tionE"d%ti3e #esions Des"%0%tion of s:in.
@. Contin"in/ Di%,,hoe%& Che-: stoo#L%-tose into#e,%n-e Os0oti- di%,,he%.
8. T"$e,-"#osis.
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Dis-h%,/e %nd fo##o+5".
• The -hi#d sho"#d $e dis-h%,/ed f,o0hosit%# to o"t%tient o, n"t,ition%#,o/,%0 +hen&
5the! h%3e -o0#eted %,ente,%#%nti$ioti- the,%! %nd %,e -#ini-%##!+e## %nd %#e,t
50edi-%# -o0#i-%tions %,e,eso#3ed
5thei, %etite h%s f"##!
,e-o3e,ed %nd the! %,e e%tin/ +e##
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Dis-h%,/e %nd fo##o+5"
• The -hi#d sho"#d $e dis-h%,/ed f,o0the n"t,ition%# t,e%t0ent ,o/,%0+hen on#! +hen&
5+t fo, hei/ht 5) SD s-o,e%nd the! h%3e h%d no ede0% fo, %t#e%st ) +ee:s
o, M7AC ').8-0 %nd the!h%3e h%d no ede0% fo, %t #e%st )+ee:s.
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Fo##o+5"
• Afte, the -hi#d h%s $een dis-h%,/ed too"t%tient % #%n sho"#d 0%de fo##o+5""nti# f"## ,e-o3e,!.
• The -hi#d sho"#d $e +ei/hed +ee:#! %fte,dis-h%,/e
• If the! f%i# to /%in +ei/ht o3e, % ) +ee:e,iod o, #oses +ei/ht $tn )
0e%s",e0ents o, de3e#os #oss of %etiteo, ede0% sho"#d $e ,efe,,ed $%-: tohosit%# fo, f",the, %ssess0ent.
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Refe,en-es
'. Po-:et $oo: of hosit%# -%,e fo,-hi#d,en WHO
). Ne#son Tet$oo: of edi%t,i-s 'th Ed
6. N%tion%# /"ide#ine fo, theM%n%/e0ent of A-"te 0%#n"t,ition in
T%n=%ni%.