Recovery of children following hospitalisation for complicated severe acute malnutrition.
Recovery of children following hospitalisation for complicated severe acute malnutrition.
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DOI：
10.1111/mcn.13302
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发表时间：
2022-04
影响因子：
3.4
通讯作者：
Prendergast AJ
中科院分区：
文献类型：
--
作者：
Bwakura-Dangarembizi M;Dumbura C;Amadi B;Chasekwa B;Ngosa D;Majo FD;Sturgeon JP;Chandwe K;Kapoma C;Bourke CD;Robertson RC;Nathoo KJ;Ntozini R;Norris SA;Kelly P;Prendergast AJ
复杂性严重急性营养不良（SAM）住院治疗后的营养恢复和再入院特征不明显。我们的目的是确定在赞比亚和津巴布韦，在住院后52周内管理复杂SAM后出院的儿童中，与再入院、营养恢复和发病率相关的模式和因素。使用多变量Fine-Gray子分布风险模型（死亡和失访作为竞争风险）识别与再入院相关的因素;负二项回归评估住院时间，有序logistic回归建模与营养恢复相关的因素。共有649名儿童（53%为男性，中位年龄18.2个月）出院，继续社区营养康复。52周内全因再入院率为15.4%（95% CI 12.7，18.6）。至再入院时间的独立风险因素为脑瘫（调整的亚危险比（aSHR）：2.96，95%CI 1.56，5.61）和非水肿性SAM（aSHR：1.64，95%CI 1.03，2.64）。年龄别身高Z评分（HAZ）（aSHR：0.82，95% CI 0.71，0.95）和赞比亚入组率（aSHR：0.52，95% CI 0.28，0.97）的单位增加与再入院时间的亚危险降低相关。年轻、出院时SAM、非水肿性SAM和脑瘫与整个随访期间营养恢复不良相关。总的来说，非水肿性SAM、出院时持续SAM、脑瘫和低HAZ是复杂SAM后再入院和营养恢复不良的独立风险因素。具有这些高风险特征的儿童应优先接受额外的康复护理，以改善长期结局。复杂性严重急性营养不良（SAM）住院治疗后的营养恢复和再入院特征不明显。我们的目的是确定在赞比亚和津巴布韦，在住院后52周内管理复杂SAM后出院的儿童中，与再入院、营养恢复和发病率相关的模式和因素。发现非水肿性SAM、出院时持续SAM、脑瘫和年龄别身高Z评分低是复杂SAM后再入院和恢复不良的独立风险因素。 六分之一接受SAM治疗的儿童在出院后的第一年内再次入院，八分之一在52周随访时仍然营养不良。非水肿性SAM、出院时持续SAM和基础脑性瘫痪是再入院和营养恢复不良的独立危险因素。低HAZ是再入院和营养恢复不良的危险因素。出院后护理应侧重于残疾儿童、初次住院时的非水肿性SAM以及出院时的持续SAM。在SAM儿童的管理中应考虑发育迟缓。
Nutritional recovery and hospital readmission following inpatient management of complicated severe acute malnutrition (SAM) are poorly characterised. We aimed to ascertain patterns and factors associated with hospital readmission, nutritional recovery and morbidity, in children discharged from hospital following management of complicated SAM in Zambia and Zimbabwe over 52‐weeks posthospitalization. Multivariable Fine‐Gray subdistribution hazard models, with death and loss to follow‐up as competing risks, were used to identify factors associated with hospital readmission; negative binomial regression to assess time to hospitalisation and ordinal logistic regression to model factors associated with nutritional recovery. A total of 649 children (53% male, median age 18.2 months) were discharged to continue community nutritional rehabilitation. All‐cause hospital readmission was 15.4% (95% CI 12.7, 18.6) over 52 weeks. Independent risk factors for time to readmission were cerebral palsy (adjusted subhazard ratio (aSHR): 2.96, 95% CI 1.56, 5.61) and nonoedematous SAM (aSHR: 1.64, 95%CI 1.03, 2.64). Unit increases in height‐for‐age Z‐score (HAZ) (aSHR: 0.82, 95% CI 0.71, 0.95) and enrolment in Zambia (aSHR: 0.52, 95% CI 0.28, 0.97) were associated with reduced subhazard of time to readmission. Young age, SAM at discharge, nonoedematous SAM and cerebral palsy were associated with poor nutritional recovery throughout follow‐up. Collectively, nonoedematous SAM, ongoing SAM at discharge, cerebral palsy and low HAZ are independent risk factors for readmission and poor nutritional recovery following complicated SAM. Children with these high‐risk features should be prioritised for additional convalescent care to improve long‐term outcomes. Nutritional recovery and hospital readmission following inpatient management of complicated severe acute malnutrition (SAM) are poorly characterised. We aimed to ascertain patterns and factors associated with hospital readmission, nutritional recovery and morbidity, in children discharged from hospital following management of complicated SAM in Zambia and Zimbabwe over 52‐weeks posthospitalization. Nonoedematous SAM, ongoing SAM at discharge, cerebral palsy and low height‐for‐age Z‐score were found to be independent risk factors for readmission and poor recovery following complicated SAM. One‐in‐six children managed for SAM were readmitted into hospital over the first year after discharge and one‐in‐eight remained undernourished by 52 weeks of follow‐up. Nonoedematous SAM, ongoing SAM at the time of discharge and underlying cerebral palsy were independent risk factors for hospital readmission and poor nutritional recovery. Low HAZ was a risk factor for hospital readmission and poor nutritional recovery. Postdischarge care should focus on children with disability, nonoedematous SAM at initial hospitalisation and have ongoing SAM at the time of discharge. Stunting should be considered in the management of children with SAM.
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DOI：
10.1038/nrdp.2017.67
发表时间：
2017-09-21
期刊：
Nature reviews. Disease primers
影响因子：
--
作者：
Bhutta ZA;Berkley JA;Bandsma RHJ;Kerac M;Trehan I;Briend A
通讯作者：
Briend A
影响因子：
3.4
作者：
Isanaka, Sheila;Hitchings, Matt D. T.;Grais, Rebecca F.
通讯作者：
Grais, Rebecca F.
影响因子：
7.1
作者：
Ngari, Moses M.;Mwalekwa, Laura;Berkley, James A.
通讯作者：
Berkley, James A.
影响因子：
3.4
作者：
Somasse, Yassinme Elysee;Dramaix, Michele;Donnen, Philippe
通讯作者：
Donnen, Philippe
影响因子：
11.8
作者：
Katona, Peter;Katona-Apte, Judit
通讯作者：
Katona-Apte, Judit