Adherence to who severe acute malnutrition guidelines and mortality in critically ill children ‒ A cohort study in a pediatric intensive care unit.

BACKGROUND

this study aims to characterize clinical adherence in a pediatric intensive care unit (PICU) and to analyze its association with 28-day in-hospital mortality.

METHODS

retrospective cohort study in a Bolivian PICU between 2022 and 2024. Children aged 1 month to 15 years diagnosed with SAM were included. Adherence to the WHO 10-step protocol and its association with mortality were evaluated.

RESULTS

sixty-nine patients were analyzed; median age 12 months (IQR 8-24). In-hospital mortality was 42 % in SAM patients admitted in PICU. Adherence to WHO guidelines during the first 7 days was 62 %, four interventions showed a significant association with survival (p < 0.001): prevention and treatment of hypoglycemia, management of hypothermia, appropriate rehydration, and early enteral feeding. In survival analysis, early adherence to these steps demonstrated a significant reduction in risk of death (HR 0.45; 95 % CI 0.22-0.91).

CONCLUSION

adherence to WHO guidelines for the management of children with SAM in PICU settings was low. Improving adherence to these interventions, especially during the first 3 days, might reduce mortality, and strategies adapted to the PICU context are required.