TITLE OF CASE
Severe Eczema with Protein-Energy Malnutrition (Marasmus), Failure-to-Thrive (FTT) and Global Developmental Delay (GDD)
BACKGROUND
Nutrition in the early years of life is a major determinant of growth and development and it influences future adult health.
CLIENT HISTORY
A seven-month-old Malay boy was admitted to Institute Peadiatrik Hospital Kuala Lumpur due to severe eczema and was diagnosed with marasmus, FTT and GDD.
ASSESSMENT
Both weight-for-age (4.3kg) and height-for-age (57cm) were below 5th percentile of CDC growth chart. His weight-for-length was on 3rd percentile. He was a full term baby with normal birth weight (3.01kg). He experienced weight loss at 4th month and later followed with poor weight gain. Liver function test showed low albumin (30g/L) and total protein (45g/L) level, indicating poor nutritional status. Renal profile showed low urea (2.51mmol/L) and sodium (127mmol/L) level which due to chronic diarrhea. He was exclusively breastfed for the first 6 months. Mother tried giving complementary food at 6th month but stopped due to flare up after consuming every food. He was continued been breastfed on demand.
NUTRITION DIAGNOSIS
Growth rate below expected (NC-3.5) related to inadequate protein-energy intake and increased energy and protein needs due to severe eczema as evidenced by weight-for-age and height-for-age were below 5th percentile, weight-for-age decreases in 2 percentiles lines and inconsistent intake from breastfeeding.
OBJECTIVE OF MANAGEMENT & NUTRITION PRESCRIPTION
Nutrition intervention aimed to provide adequate energy and protein for catch-up growth. Patient was prescribed perfusion feeding with extensively hydrolysed formula (eHF) and complementary diet was re-challenged.
OUTCOME AND FOLLOW-UP
He tolerated perfusor feeding however oral intake was minimal. Upon discharge, feeding was changed to bolus feeding. Patient gained 1.3kg in 18 days (72g/day) which is 5 times higher than normal growth rate.The skin condition was improved by medications. He was discharged with bolus feeding at 100ml/3H with the same eHF product.
DISCUSSION
Caloric supplementation is the major contributor to the management of FTT.
LEARNING POINTS/TAKE HOME MESSAGES
1. Provision of adequate energy, protein and other nutrients are important for accelerating the growth.
2. Enteral feeding is useful to supplement the infant with poor oral intake and to meet the increased nutrients need.
3. It is important to acknowledge parental over-concern and food restriction and provide nutritional counseling.
