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

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!

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

How is Resomol used in infants >6 months?

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.

Not posting a reply, rather revisiting the same question. There is nothing in the WHO or our country guidelines about not giving resomal to babies under 6 months. If it is to be avoided as suggested and the mother not having breastmilk due to her own poor nutrition (which is the commonest cause of malnutrition under 6 months in our setting) are our only options for rehydration substitute milk (F75 or dilute F100) or IV? When we are told so often to avoid IV in malnutrition and the substitute milk seems sometimes to worsen diarrhea what options do we have?

Using the IV route to rehydrate a child with severe acute malnutrition is dangerous, with a risk of haemodilution. The oral route through a nasogastric tube should be the prefered option especially if the child is vomiting everything or is too weak to feed orally.

Please, could you let me ask at the same context, What about the manufacture of Resomal in Therapeutic Feeding Centers? and What is the commercial alternative you recommend?