© 1994 by Oxford University Press
research-article |
Intractable Diarrhoea of Infancy and its Management: Modified Cost Effective Treatment
Division of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research Chandigarh 160012, India
Dr B. R. Thapa, Pediatric Gastroenterology, Post Graduate Institute of Medical Education and Research Chandigarh, 160012, India
One-hundred-twenty infants under 1 year of age suffering from intractable diarrhoea were studied. They had received prior treatment in the form of antimicrobials (100 per cent), stool binding substance (50 per cent), antimotility agents (50 per cent), and intravenous (IV) fluids (33 per cent). One-third of them had been hospitalised in peripheral hospitals. All of them had diarrhoea of more than 2 weeks' duration, protein energy malnutrition and were very ill. In addition vomiting, dehydration, fever, paralytic ileus, perianal excoriation and rectal prolapse were present in 44, 23, 33, 9, 47, and 3 per cent of the infants, respectively. Anaemia, multiple vitamin deficiencies, and pedal oedema were seen in 70, 10, and 3 per centof infants, respectively. The infections documented were septicaemia (22 per cent), bronchopneumonia (6 per cent), meningitis (4 per cent), urinary tract infection (3 per cent) and acute supporative otitb media in 2 per cent of infants. Fifty-three per cent of infants had secondary lactose intolerance. Intolerance to milk protein, milk protein and soyabean and milk protein, as well as soyabean and chicken was seen in 4, 2, and 1 per cent cases, respectively. Aetiological agents isolated from stool culture were E. coli, (18 per cent), Klebsiella species (9 per cent), Shigella species (6 per cent), Salmonella typhimurium (2 per cent), Cholera mitschikom (1 per cent), Giardia lamblia (6 per cent), cryptosporidium (1 per cent), and E. histolylica (1 per cent). Candida albicans was grown in 18 per cent of infants. Pseudomembranous colitis was documented in 2 per cent cases. All the infants were managed with locally made rice gruel. Very sick and dehydrated patients received IV fluids. Thirteen infants (11 per cent) received modified parenteral nutrition through IV cannula in the peripheral vein. After initial stabilization cereal diets were instituted. The septicaemia was responsible for 5 per cent mortality. The remainder improved and showed weight gain. The enteral and modified parenteral nutrition are very effective in the management of intractable diarrhoea in developing countries.