Gernaat H B, Dechering W H, Voorhoeve H W
Regional Institute of Community Mental Health Care, Division Meppel, The Netherlands.
J Trop Pediatr. 1998 Aug;44(4):211-7. doi: 10.1093/tropej/44.4.211.
At St Paul's Hospital, Nchelenge district, north-eastern Zambia, routine clinical management of 299 children up to 5 years of age with severe and/or complicated protein-energy malnutrition (PEM) was monitored and predictors of outcome analysed. PEM was typed according to a modified Wellcome classification. Overall mortality was 25.8 per cent with 13.4 per cent for kwashiorkor, 17.8 per cent for marasmus, 28.0 per cent for marasmic kwashiorkor, and 48.3 per cent for untyped cases of PEM. Mortality up to 18 months of age was related to the presence of dehydration, pneumonia or another infectious disorder, severe stunting, and a mid-upper arm circumference < or = 104 mm, suggesting that these children may have been born pre- and/or dysmaturely. At ages 19-60 months, the main predictor of mortality was pneumonia, with other infectious disorders and dehydration showing less impact. Routine administration of broad-spectrum antibiotics, irrespective of clinical signs of infection, is most probably the single most effective measure to reduce the high case-fatality rate due to PEM in developing countries.
在赞比亚东北部恩泽伦格区的圣保罗医院，对299名5岁及以下患有严重和/或复杂蛋白质-能量营养不良（PEM）的儿童的常规临床管理进行了监测，并分析了预后的预测因素。PEM根据改良的韦尔科姆分类法进行分型。总体死亡率为25.8%，其中夸希奥科病为13.4%，消瘦症为17.8%，消瘦型夸希奥科病为28.0%，未分型PEM病例为48.3%。18个月龄以内的死亡率与脱水、肺炎或其他感染性疾病、严重发育迟缓以及上臂中部周长≤104毫米有关，这表明这些儿童可能早产和/或发育不成熟。在19至60个月龄时，死亡的主要预测因素是肺炎，其他感染性疾病和脱水的影响较小。在发展中国家，无论有无感染的临床体征，常规使用广谱抗生素很可能是降低因PEM导致的高病死率的最有效单一措施。
