| What is the treatment for hypothermia in infants? | Skin to skin care with mother (infants) Warming under warmer, incandescent lamp or warmer | HYPOTHERMIA (<35.5 ºC or 96 ºF) Facilities for supportive monitoring, investigations and IVF. Plus warmer Skin to skin care with mother (infants) Warming under warmer, incandescent lamp or warmer Intensive care facility to manage shock NO IMPROVEMENT treat as shock Unconscious: 5 ml/kg of 10% Dextrose IV NO IMPROVEMENT treat as shock SEVERE DEHYDRATION Facilities for supportive monitoring, investigations and IVF Conscious: 50 ml of 10% Dextrose or 1 tsf sugar in 3 tsf water orally Transfer to intensive care facility to manage shock Unconscious: 5 ml/kg of 10% Dextrose IV NO IMPROVEMENT treat as shock PRIMARY FAILURE OF TREATMENT: (a.) Failure to regain appetite by day 4 (b.) Failure to lose oedema by day 4 (c.) Oedema still present Day 10 (d.) Failure to gain at least 5g/Kg/day for 3 consecutive days on catchup diet. | 106 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952337_paediatrics_severe_acute_malnutrition.pdf | Plus warmer Skin to skin care with mother (infants) Warming under warmer, incandescent lamp or warmer Intensive care facility to manage shock NO IMPROVEMENT treat as shock Unconscious: 5 ml/kg of 10% Dextrose IV NO IMPROVEMENT treat as shock SEVERE DEHYDRATION Facilities for supportive monitoring, investigations and IVF Conscious: 50 ml of 10% Dextrose or 1 tsf sugar in 3 tsf water orally Transfer to intensive care facility to manage shock Unconscious: 5 ml/kg of 10% Dextrose IV NO IMPROVEMENT treat as shock PRIMARY FAILURE OF TREATMENT: (a.) Failure to regain appetite by day 4 (b.) Failure | 1 | page=1,block=49 | 0.700 | valid |
| What condition is indicated by bilateral pitting oedema in children aged 6-59 months? | SAM | 0-6 months • Consider SAM if MUAC <11.0 cm 6-59 months • Consider SAM if MUAC <11.5 cm or WHZ <-3 SD or bilateral pitting oedema • Consider MAM if MUAC is between 11.5- 12.4 cm or WHZ is between -2 to -3 SD >5 years • Consider SAM if BMI ≤ 3SD (severe thinness) • Consider MAM if BMI ≤ 2 SD (thinness) | 22 | definition | 0.940 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952337_paediatrics_severe_acute_malnutrition.pdf | 0-6 months • Consider SAM if MUAC <11.0 cm 6-59 months • Consider SAM if MUAC <11.5 cm or WHZ <-3 SD or bilateral pitting oedema • Consider MAM if MUAC is between 11.5- 12.4 cm or WHZ is between -2 to -3 SD >5 years • Consider SAM if BMI ≤ 3SD (severe thinness) • Consider MAM if BMI ≤ 2 SD (thinness) | 1 | page=1,block=67 | 0.700 | valid |
| What are some common signs of faulty feeding in infants? | Not exclusively breastfed for 6 months • Bottle feeding • Delayed/Inadequate complementary feeding | Additional symptoms of complications • Loose motions • Jaundice • Seizures Inter-current infections: • Pneumonia • Diarrhea • Sepsis • Skin infections • Severe dehydration • Untreated tuberculosis • HIV • Social challenges WHEN TO SUSPECT? COMMON PRESENTATION • Faulty feeding • Not exclusively breastfed for 6 months • Bottle feeding • Delayed/Inadequate complementary feeding • Poor appetite • Not gaining weight • Lethargic • Disinterested in surroundings • Delayed development EXAMINE FOR • Vital signs: PR, RR, CRT • Lethargy/ irritability • Loss of subcutaneous fat • Muscle wasting • Pallor • Signs of Vitamin B, K and A deficiencies • Respiratory distress • Dehydration | 279 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952337_paediatrics_severe_acute_malnutrition.pdf | Additional symptoms of complications • Loose motions • Jaundice • Seizures Inter-current infections: • Pneumonia • Diarrhea • Sepsis • Skin infections • Severe dehydration • Untreated tuberculosis • HIV • Social challenges WHEN TO SUSPECT? COMMON PRESENTATION • Faulty feeding • Not exclusively breastfed for 6 months • Bottle feeding • Delayed/Inadequate complementary feeding • Poor appetite • Not gaining weight • Lethargic • Disinterested in surroundings • Delayed development EXAMINE FOR • Vital signs: PR, RR, CRT • Lethargy/ irritability • Loss of subcutaneous fat • Muscle wasting • Pallor • |
| What are some conditions to look for when identifying potential health issues in a patient? | unrecognized congenital abnormality, inborn errors of metabolism, immune deficiency, other major organ dysfunction, and malignancy. | Look for unrecognized congenital abnormality, inborn errors of metabolism, immune deficiency, other major organ dysfunction, and malignancy. *CRITERIA FOR DISCHARGE FROM HOSPITAL TO OUTPATIENT CARE: Clinically well and alert; no or resolving medical complications; no or resolving oedema (if present); satisfactory oral intake has a good appetite (taking at least 75% of target calorie intake of 150- 200 kcal/kg/day & 0-6 months old have weight gain of 3-5 gm/kg/day for three days). | 9 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952337_paediatrics_severe_acute_malnutrition.pdf | Look for unrecognized congenital abnormality, inborn errors of metabolism, immune deficiency, other major organ dysfunction, and malignancy. *CRITERIA FOR DISCHARGE FROM HOSPITAL TO OUTPATIENT CARE: Clinically well and alert; no or resolving medical complications; no or resolving oedema (if present); satisfactory oral intake has a good appetite (taking at least 75% of target calorie intake of 150- 200 kcal/kg/day & 0-6 months old have weight gain of 3-5 gm/kg/day for three days). |
| What are the suggested antibiotics for treatment in the stabilization phase? | Inj.. Ampicillin – 50 mg/kg/iv or im X 6hrly Plus inj. Gentamicin- 7.5 mg/kg iv or im, OD for 7-10 days | Serum electrolytes (Na, K, Cal), Serum B12, Serum Folate levels OPTIONAL Blood Culture, Blood gases, Ultrasound (inferior vena cava to ascending aorta ratio) A. STABILISATION PHASE: Monitor vitals, urine frequency, stool/vomitus volumes INTAKE: IVF (DNS) 4 ml/kg/hr for 2-3 days with early/concomitant initiation of oral feeds (130 ml/kg/day) CONDITION PLACE OF TREATMENT TREATMENT • Inj.. Ampicillin – 50 mg/kg/iv or im X 6hrly Plus inj. Gentamicin- 7.5 mg/kg iv or im, OD for 7-10 days • If no response within 48 hrs or critically ill give inj. Ceftriaxone 50 mg/kg, OD for 7-10 days • When accepting orally, switch to oral amoxicillin 40-45 mg/kg/dose twice a day for 7 days • If prolonged diarrhea (>7 days): Metronidazole 10-12 mg/kg, 8 hrly for 7-10 days (inj.ectable or oral) | 384 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952337_paediatrics_severe_acute_malnutrition.pdf | STABILISATION PHASE: Monitor vitals, urine frequency, stool/vomitus volumes INTAKE: IVF (DNS) 4 ml/kg/hr for 2-3 days with early/concomitant initiation of oral feeds (130 ml/kg/day) CONDITION PLACE OF TREATMENT TREATMENT • Inj.. Ampicillin – 50 mg/kg/iv or im X 6hrly Plus inj. Gentamicin- 7.5 mg/kg iv or im, OD for 7-10 days • If no response within 48 hrs or critically ill give inj. |
| What is the composition of the mixture that should be refrigerated for not more than 1 week? | Mixture of Roasted groundnut 1000 gm , Milk powder 1200 gms, Sugar 1120 gms, Coconut oil 600 gms. | APPETITE TEST: Passed if, a child not fed for last 2 hours, when fed by mother in a quiet place consumes in 1 hour: • 7-12 months: of ≥ 25 ml/kg of F100 • > 12 months: of locally prepared ready to eat food ** AMOUNT TO BE GIVEN: 15 gms or more if < 4 kg; 25 gms or more if 4 – 7 kg; 35 gms or more if 7-10 kg **[ Mixture of Roasted groundnut 1000 gm , Milk powder 1200 gms, Sugar 1120 gms, Coconut oil 600 gms. To be kept refrigerated for not more than 1 week.] | 313 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952337_paediatrics_severe_acute_malnutrition.pdf | APPETITE TEST: Passed if, a child not fed for last 2 hours, when fed by mother in a quiet place consumes in 1 hour: • 7-12 months: of ≥ 25 ml/kg of F100 • > 12 months: of locally prepared ready to eat food ** AMOUNT TO BE GIVEN: 15 gms or more if < 4 kg; 25 gms or more if 4 – 7 kg; 35 gms or more if 7-10 kg **[ Mixture of Roasted groundnut 1000 gm , Milk powder 1200 gms, Sugar 1120 gms, Coconut oil 600 gms. To be kept refrigerated for not more than 1 week.] | 1 |
| What are some examples of inter-current infections? | Pneumonia • Diarrhea • Sepsis • Skin infections • Severe dehydration • Untreated tuberculosis • HIV • Social challenges | Additional symptoms of complications • Loose motions • Jaundice • Seizures Inter-current infections: • Pneumonia • Diarrhea • Sepsis • Skin infections • Severe dehydration • Untreated tuberculosis • HIV • Social challenges WHEN TO SUSPECT? COMMON PRESENTATION • Faulty feeding • Not exclusively breastfed for 6 months • Bottle feeding • Delayed/Inadequate complementary feeding • Poor appetite • Not gaining weight • Lethargic • Disinterested in surroundings • Delayed development EXAMINE FOR • Vital signs: PR, RR, CRT • Lethargy/ irritability • Loss of subcutaneous fat • Muscle wasting • Pallor • Signs of Vitamin B, K and A deficiencies • Respiratory distress • Dehydration | 103 | list | 0.780 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952337_paediatrics_severe_acute_malnutrition.pdf | Additional symptoms of complications • Loose motions • Jaundice • Seizures Inter-current infections: • Pneumonia • Diarrhea • Sepsis • Skin infections • Severe dehydration • Untreated tuberculosis • HIV • Social challenges WHEN TO SUSPECT? COMMON PRESENTATION • Faulty feeding • Not exclusively breastfed for 6 months • Bottle feeding • Delayed/Inadequate complementary feeding • Poor appetite • Not gaining weight • Lethargic • Disinterested in surroundings • Delayed development EXAMINE FOR • Vital signs: PR, RR, CRT • Lethargy/ irritability • Loss of subcutaneous fat • Muscle wasting • Pallor • |
| What are some symptoms associated with complications? | Loose motions • Jaundice • Seizures | Additional symptoms of complications • Loose motions • Jaundice • Seizures Inter-current infections: • Pneumonia • Diarrhea • Sepsis • Skin infections • Severe dehydration • Untreated tuberculosis • HIV • Social challenges WHEN TO SUSPECT? COMMON PRESENTATION • Faulty feeding • Not exclusively breastfed for 6 months • Bottle feeding • Delayed/Inadequate complementary feeding • Poor appetite • Not gaining weight • Lethargic • Disinterested in surroundings • Delayed development EXAMINE FOR • Vital signs: PR, RR, CRT • Lethargy/ irritability • Loss of subcutaneous fat • Muscle wasting • Pallor • Signs of Vitamin B, K and A deficiencies • Respiratory distress • Dehydration | 39 | list | 0.780 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952337_paediatrics_severe_acute_malnutrition.pdf | Additional symptoms of complications • Loose motions • Jaundice • Seizures Inter-current infections: • Pneumonia • Diarrhea • Sepsis • Skin infections • Severe dehydration • Untreated tuberculosis • HIV • Social challenges WHEN TO SUSPECT? COMMON PRESENTATION • Faulty feeding • Not exclusively breastfed for 6 months • Bottle feeding • Delayed/Inadequate complementary feeding • Poor appetite • Not gaining weight • Lethargic • Disinterested in surroundings • Delayed development EXAMINE FOR • Vital signs: PR, RR, CRT • Lethargy/ irritability • Loss of subcutaneous fat • Muscle wasting • Pallor • |
| What calorie intake percentage is considered satisfactory for discharge from hospital to outpatient care? | at least 75% of target calorie intake of 150- 200 kcal/kg/day | Look for unrecognized congenital abnormality, inborn errors of metabolism, immune deficiency, other major organ dysfunction, and malignancy. *CRITERIA FOR DISCHARGE FROM HOSPITAL TO OUTPATIENT CARE: Clinically well and alert; no or resolving medical complications; no or resolving oedema (if present); satisfactory oral intake has a good appetite (taking at least 75% of target calorie intake of 150- 200 kcal/kg/day & 0-6 months old have weight gain of 3-5 gm/kg/day for three days). | 355 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952337_paediatrics_severe_acute_malnutrition.pdf | *CRITERIA FOR DISCHARGE FROM HOSPITAL TO OUTPATIENT CARE: Clinically well and alert; no or resolving medical complications; no or resolving oedema (if present); satisfactory oral intake has a good appetite (taking at least 75% of target calorie intake of 150- 200 kcal/kg/day & 0-6 months old have weight gain of 3-5 gm/kg/day for three days). | 1 | page=1,block=49 | 0.700 | valid |
| What is the minimum amount of food to be given to a child weighing less than 4 kg? | 15 gms or more if < 4 kg | APPETITE TEST: Passed if, a child not fed for last 2 hours, when fed by mother in a quiet place consumes in 1 hour: • 7-12 months: of ≥ 25 ml/kg of F100 • > 12 months: of locally prepared ready to eat food ** AMOUNT TO BE GIVEN: 15 gms or more if < 4 kg; 25 gms or more if 4 – 7 kg; 35 gms or more if 7-10 kg **[ Mixture of Roasted groundnut 1000 gm , Milk powder 1200 gms, Sugar 1120 gms, Coconut oil 600 gms. To be kept refrigerated for not more than 1 week.] | 229 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952337_paediatrics_severe_acute_malnutrition.pdf | APPETITE TEST: Passed if, a child not fed for last 2 hours, when fed by mother in a quiet place consumes in 1 hour: • 7-12 months: of ≥ 25 ml/kg of F100 • > 12 months: of locally prepared ready to eat food ** AMOUNT TO BE GIVEN: 15 gms or more if < 4 kg; 25 gms or more if 4 – 7 kg; 35 gms or more if 7-10 kg **[ Mixture of Roasted groundnut 1000 gm , Milk powder 1200 gms, Sugar 1120 gms, Coconut oil 600 gms. | 1 | page=1,block=97 | 0.700 | valid |