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Edema is infants <6 months and PLW

This question was posted the Management of At Risk Mothers and Infants forum area and has 5 replies.

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Tina Lloren

Technical Advisor, Nutrition

Normal user

20 Mar 2015, 15:53

In the context of developing training materials and deciding which topics to include, the question has come up about bilateral pitting edema in infants <6 months and in pregnant women. How common is bilateral pitting edema in infants <6 months? And in pregnant women? Thank you for your help.

Mark Manary

Washington University School o

Frequent user

20 Mar 2015, 16:17

Edema in pregnancy is very common, and unrelated to malnutrition. I would use arm circumference to assess pregnant women for malnutrition. Edema in younger infants is rare and should be taken as serious sign of illness, including severe malnutrition. This finding is rare. If it happens in the context of cessation of breast feeding or mother becoming ill and unable to breast I would be very suspicious that it is severe acute malnutrition.

Bernadette Paul

Independent Nutrition/Health Promotion Consultant

Normal user

20 Mar 2015, 17:15

Maybe this document could provide some more information. WHO child growth standards and the identification of severe acute malnutrition in infants and children. Retrieved from the link below: http://www.who.int/nutrition/publications/severemalnutrition/9789241598163_eng.pdf

Mahaman Elhadji Hallarou

Nutrition Consultant

Normal user

21 Mar 2015, 12:17

Hi Yes edema in infants in rare but depends on the context. I am currently analyzing from a 2 years review ( 2011-2012) of SAM management in infants less than six month of age in 8 main hospitals in Niger. edema accounts for about 6-7% of total admissions of these children. however prevalence in community should be much lower.

Dr Sylvia Garry

Public Health Doctor / NHS

Technical expert

22 Mar 2015, 22:36

There are a few of causes of bilateral pitting oedema in children, and they should be considered according to the context. Since fluid collection is gravity dependent and infants < 6 months will not be able to sit up unaided the fluid may collect in other places, but may be most obvious in the lower limbs. Causes other than malnutrition that may be seen are: 1) Heart failure e.g. congenital heart disease 2) Anaemia 3) Nephrotic syndrome These can be differentiated using clinical examination / haemocue / urine dipstick. Although they can co-exist with malnutrition. In premature neonates there can also be a benign bilateral pitting oedema, once other causes have been excluded. However, generally speaking, bilateral pitting oedema in children should never be considered 'benign' or a normal finding, and all the possible causes should be considered. In addition, if the cause is nutritional, then monitoring the oedema is a good clinical marker of progress. The child's weight is not reliable since the water of the oedema will add artificial weight to the child.

Martha

Technical expert

23 Mar 2015, 09:07

I am currently analysis admission anthropometric/ clinical data for infants aged below 6 months admitted to our local district hospital between January 2003 and December 2012 (admissions for a period of 10 years n=4,700). Our results show that 10% infants had SAM (WFLz<-3), 12% had MAM (WFLz between -3 to -2)while 23% had a MUAC<11.0cm; but none had bilateral pitting edema. This goes to show that edema in infants under 6 months is very rare, however, it may also be that because clinicians do not expect edema in infants, they don't look for neither do they record it.

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