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ReSoMaL (Rehydration Solution for Malnutrition) for children under 6 months with severe acute malnutrition

This question was posted the Management of At Risk Mothers and Infants forum area and has 6 replies.

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Boukary SORGHO

Field Coordinator at Médicos Del Mundo

Normal user

22 Aug 2016, 11:06

Dear all, is ReSoMal forbidden for children under 6 months suffering from severe acute malnutrition with severe dehydration? If yes , what is your experience about it?

Dr Sylvia Garry

Public Health Doctor / NHS

Technical expert

24 Aug 2016, 10:16

This is an interesting question, with limited information in the literature about using ReSoMal specifically in this age group. A few points from my previous clinical practice:

1. I generally avoid giving oral non-milk fluids to to infants. If they can tolerate anything orally I would prefer the usual - breast milk, or breast milk substitute if this is not possible.

2. If an infant is severely dehydrated and cannot tolerate oral fuids, I would start off with very gentle i.v. fluids (keeping an eye on that blood sugar) and re-establish feeds as soon as possible.

3. I would be very carefully about thinking of giving anything with lower sodium content (such as ReSomal) to an infant <6 months due to the risks of hyponatraemia / fitting.

So generally, the focus is on getting milk into the infant as soon as possible, following the usual guidelines, and adapting this according to vomiting / tolerance of feeds.

This is based on my experience, as I only found limited research on this!

Namesius

Sub County Nutrition Coordinator

Normal user

24 Aug 2016, 11:37

Very nice question i usually withhold managing this age group with resamol.
1)We advocate for exclusive breastfeeding,in case where mother has enough breast milk I advice her to breastfeed the baby as many times as possible to capture dehydration and baby should be having a good breastfeeding reflexes.
2)of late have not yet seen the guidelines for managing this age group with resomal,the dehydration in this case is captured through I.V fluids

Boukary SORGHO

Field Coordinator at Médicos Del Mundo

Normal user

24 Aug 2016, 13:24

Thanks to all of you for your suggestions. In my work context, most cases of severe malnourished children less than 6 months with dehydration are maternal orphan. What is recommended to treat these cases (malnutrition<6 months) is the using of diluted therapeutic milk (F-100).
As Dr Sylvia Garry said, we don't have enougth information in the literature about using ReSoMal specifically in this age group.
In nutriset website, we can read that ReSoMal is forbidden for malnourished children under 6 months. Here is the link: http://www.nutriset.fr/fr/nos-produits/malnutrition-aigue-severe/resomal.html.
Thanks again for your help.

Geraldine Fitzgerald

ILCA UN Liaison

Normal user

24 Aug 2016, 15:31

How is Resomol used in infants >6 months?

Boukary SORGHO

Field Coordinator at Médicos Del Mundo

Normal user

24 Aug 2016, 16:24

Dear Geraldine Fitzgerald ,
ReSoMal (Rehydration Solution for Malnutrition) is used to treat severe dehydraton in children with severe acute malnutrition through oral route. The first condition is to establish a correct diagnosis of the severe state of dehydration.
After preparing the solution (powder in a water), it may take 2 to 12 hours to rehydrate the patient.
For the first 2 hours start with 5ml x weight (kg) of the child every 30 minutes during the first 2 hours. After that it's important to evaluate the state of the child before continuing. For the 2nde phase , ReSoMal should be alternated every two hours with therapeutic milk F-75. At this stage, the quantity of ReSoMal is 10ml x weight of the child. In practice, patient monitoring is important because it is very easy to fluid overload in the malnourished.
There lot of guidelines about it though WHO website.

Nina Berry

IFE Consultant

Normal user

29 Aug 2016, 10:33

In orphaned children less than six months old, the priority would be to find breastmilk from another mother (donor milk or a wet nurse), if that is socially and culturally acceptable.
If all efforts to find a milk donor are fruitless, the option of last resort would be a breastmilk substitute (following IV rehydration, as suggested above), until a wet-nurse or carer willing to relactate can be found.
An artificially fed infant is in a very precarious position; likely to be readmitted soon after discharge.

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