Changing Clinical Presentation of Severe Protein Malnutrition (PEM) in Infants

Abstract

The hospital based clinical cross-sectional study was designed to investigate the prevalence
of oedematous malnutrition in early infancy.The study was undertaken among 65 infants
who were suffering front severe malnutrition and admitted consecutively in the
nutrition rehabilitation unit of Dhaka Shishu Hospital during 2004-2005. Nutritional
status was determined anthropometrically. Anthropometric measurements were
compared with that of NCHS standard. Clinical variables were recorded and analyzed
according to WHO & Welcome classification. The study reflected majority )63%) of
severely malnourished patients developed oedema before 6 months of age which
meant that there was no age specificity regarding development of oedema in severe
PEM. The study also showed that phase of wasting was not inevitable in oedematous
malnutrition. Only 75% of kwashiorkor and 5.7% of patients with marasmic
kwashiorkor developed oedema without passing through the phase of wasting
(P>0.05). There was no significant (p>0.05) difference in the prevalence of hair and
skm change between oedematous and non-oedematous patients. Some 31% of
oedematous malnutrition and marasmic patient also shown hepatomegaly in 7 %
cases. All these findings showed a changing trend in the clinical presentation of
severe PEM in comparison to classical presentation. Among the common associated
illnesses, diarrhoea and pneumonia were most frequently observed. There was no age
specificity regarding development of severe PEM in infancy. Contrary to classical
view, a trend of oedematous malnutrition can occur at an earlier age without being
prior passing through a state of wasting and without inevitably being associated with
skin changes and mental abnormalities.