By ULY CLINIC Staff,
Management of Heart failure in children with malutrition
Heart failure is usually a complication of over-hydration. It can also be caused by very severe anaemia.
Clinical signs
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Difficulty in breathing
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Grunting respiration
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An acute increase in RR more than 5 breaths per minute or PR of more
than 25 beats per minute (during rehydration). -
Basal lung crepitations
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Gallop rhythm
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Prominent superficial and neck veins.
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A sudden increase in liver size with tenderness
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Engorgement of the neck veins when the abdomen (liver) is pressed.
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Physical deterioration with a gain in weight.
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Increasing oedema or reappearance of oedema during treatment.
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An acute fall in haemoglobin concentration.
Treatment of heart failure:
Stop all oral intakes or IV fluids.
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Administer frusemide IV 1 mg/kg as a single dose.
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Do not give fluid or food until the heart failure has improved (i.e. RR and PR are slower).
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Avoid giving digoxin to severely malnourished children
Feeding infants under 6 months
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For breastfeeding infant, assist mother to breastfeed or express breast milk.
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Give the prescribed amount of feeding in addition to the breast milk.
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Give expressed breast milk, F-75 or F-100 diluted for children with or without oedema in that order of preference.
Last updated on 14.09.2020
References
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Tanzanian Standard treatment guideline for children 2017 edition page 85