PROGNOSTIC FACTORS IN HOSPITALIZED CHILDREN WITH PERSISTENT DIARRHEA - IMPLICATIONS FOR DIET THERAPY

A dietary algorithm for management of persistent diarrhea in developin g countries, using locally available foods, is yet to be standardized. We identified factors related to poor outcome among 75 malnourished h ospitalized male patients aged 348 months with persistent diarrhea (gr eater than or equal to 14 days) treated on soy and cereal-based diet ( Diet 1). The 28 patients with stool output >60 g/k body weight on the sixth or the seventh treatment day were considered diarrhea treatment failures on Diet I. In the univariate analysis, breast feeding (p < 0. 001), carbohydrate malabsorption based on low stool pH or reducing sub stances >0.5% (p = 0.03), initial 24-h purge rate (p = 0.001), pneumon ia (p = 0.003), or probable septicemia (p = 0.03) were associated with diarrhea treatment failures. Although 16 of these 28 patients respond ed to systemic antibiotics without dietary modification, all but one o f the remaining recovered on a chicken puree, glucose, and oil formula tion. Twenty-six children had weight loss after 7 days on Diet I as co mpared with the postrehydration weight. These children had lower mean age (p = 0.05), lower food intake in the first 24 h (p = 0.05) and dur ing the initial 7 days (p < 0.01), and a higher initial excretion of e nteroaggregative Escher?chia coil (32 vs. 8%; p = 0.01). In the logist ic regression model, significant risk factors for diarrhea treatment f ailures were initial purge rates, carbohydrate malabsorption, and inte rcurrent systemic infection; only low food intake was associated with significant risk for weight loss. The significant association of diarr hea treatment failures with carbohydrate malabsorption suggests that i n the initial diet itself, part of polysaccharide be substituted with sucrose or glucose to obtain the right balance between osmolarity and energy density. Our data suggest that prompt identification and treatm ent of systemic infection is critical, as its eradication achieved rec overy in more than half of the treatment failures without a dietary ch ange.