Rytter et al tried to identify risk factors for mortality in pediatric patients with severe malnutrition who were undergoing inpatient refeeding. The authors are from the University of Copenhagen, Mulago Tertiary Teaching Hospital (Kampala, Uganda) and Makerere University in Uganda.
Patient selection: child age 6 to 59 months, severe acute malnutrition with mid-upper arm circumference < 11.5 cm OR bilateral pitting edema OR a weight-for-height z score < -3.
Risk factors for inpatient mortality:
(1) oral thrush (which may be a marker of immunosuppression)
(2) greater caretaker-reported severity of illness on 10 cm VAS
(3) impaired consciousness
(4) capillary refill time > 2 seconds
(5) C-reactive protein concentration > 15 mg/L on admission
(6) low plasma phosphate concentration on day 2 of hospital stay and/or drop in plasma phosphate after admission
(7) use of unfortified rice porridge to reduce diarrhea (vs use of F-75)
(8) age >= 24 months
(9) lower mid-upper arm circumference (MUAC)
where:
• F-75 contains phosphorus
