| Abstract | Uvod: Cilj ovog istraživanja bio je prikupiti podatke o etiologiji akutnih infekcijskih proljeva u djece mlađe od 5 godina zbrinute na Hitnom prijemu (HP) Klinike za Infektivne bolesti Kliničkog bolničkog centra Split; prikupiti podatke o težini bolesti, stupnju dehidracije i komplikacijama te ih usporediti s podacima o etiologiji i dojenju; utvrditi koja je procjena, težina bolesti ili stvarni stupanj dehidracije bio odlučujući za liječenje u dnevnoj bolnici ili stacionarno liječene zbog parenteralne dehidracije; prikupiti laboratorijske podatke upale i dehidracije djece liječene u dnevnoj bolnici i stacionaru.
Metode: Retrospektivno smo prikupili podatke o dobi pacijenata, načinu liječenja, etiologiji bolesti, dojenju, epidemiološkoj situaciji u obitelji i okruženju, trajanju i broju stolica, trajanju i broju epizoda povraćanja, temperature, dehidraciji, načinu rehidracije, C-reaktivnom proteinu (CRP), leukocitima, ureji, kreatininu, elektorlitima i acidobaznom statusu 1367 djece u dobi od 1-60 mjeseci od 1. siječnja 2012. do 31. prosinca 2013. koja su došla na HP Klinike za infektologiju Kliničkog bolničkog centra Split. Težina bolesti temeljila se na Vesikari skoru u kojem je zbroj ispod 7 vrednovan kao blaga oboljenje, 7-10 kao umjereno i 11 i više kao teško oboljenje. Podaci su prikupljeni u programu Microsoft Excell, a obrađeni su metodama deskriptivne statistike i χ2 testom.
Rezultati: Na HP pregledano je značajno su više djece u dobnim skupinama 13-24 mjeseca i 24-36 mjeseci nego drugih dobnih skupina. Većina djece su bila rehidrirana u dnevnoj bolnici. Rotavisni proljev bio je najčešći razlog za hospitalizaciju (≈44%) i za liječenje u dnevnoj bolnici. Većina hospitaliziranih, kao i onih koji su liječeni u dnevnoj bolnici, imala je tešku bolest, ali većina njih imala je blagi stupanj dehidracije. Ipak, broj hospitalizirane djece s teškom bolesti bio je veći nego u djece koja su liječena u dnevnoj bolnici. Također, broj hospitalizirane djece koji je imao umjereni stupanj dehidracije bio je 4.5 puta viši nego u djece liječene u dnevnoj bolnici. Nije bilo djece s teškim stupnjem dehidracije. Nije bilo razlike u virusnim i bakterijskim proljevima s obirom na težinu bolesti. Nije bilo razlike između virusne i bakterijske bolesti s obzirom na stupanj dehidracije. Dojenje nije se nije pokazalo kao zaštitni faktor što se tiče trajanja bolesti ili blažeg stupnja dehidracije. Srednje vrijednosti CRP-a bile su više u bakterijskoj nego u virusnoj bolesti. Srednje vrijednosti CRP-a bile su blago više u djece s teškom bolesti (21.9 mg/L) nego u djece s umjerenom bolesti (17.1 mg/L). U djece s bakterijskim proljevima srednje vrijednosti CRP-a bile su 3.1 puta više u pacijenata s teškom bolesti nego u pacijenata s umjereno teškom bolesti. S obzirom na dehidraciju, nije bilo razlike u srednjim vrijenostima CRP-a u virusnoj ili bakterijskoj bolesti. Bez obzira na etiologiju, većina djece imala je vrijednosti leukocita od 10x109/L ili niže. Nije bilo razlike u srednjim vrijednostima leukocita između virusne i bakterijske bolesti, s obzirom na težinu bolesti ili stupanje dehidracije. Nije bilo razlike u srednjim vrijenostima ureje ili kreatinina s obzirom na težinu bolesti i etiologiju bolesti. Normalne vrijednosti natrija pronađene su 53.5% djece, hiponatrijemija je pronađena u 45%, a hipernatrijemija u 1,5% djece. Nije bilo razlike u raspodjeli izo-, hipo i hipernatrijemije među djecom s blagim i umjerenim stupnjem dehidracije. Samo 16.4 % pacijenata imalo je snižene vrijednosti kalija. Hipokalijemija je češće pronađena u djece s umjerenim stupnjem dehidracije nego u djece s blagim stupnjem dehidracije. Većina djece (96.25%) imala je pH >7.3. Samo dva pacijenta imala su pH <7.25. Nije bilo razlike u raspodjeli pH vrijednosti s obzirom na stupanj dehidracije.
Zaključak: Većina djece imala je virusne proljeve, a Rotavirus bio je najčešći uzročnik. Nije bilo razlike između virusnih i bakterijskih proljeva ni u pogledu ozbiljnosti ni u pogledu stupnja dehidracije. Nije dokazano kako su dojena djeca češće imala ili blažu bolest ili niži stupanj dehidracije. S obzirom na vrlo dobru dostupnost zdravstvene skrbi većina pacijenata došla je na pregled zbog teže bolesti, a ne zbog teškog stupnja dehidracije. Unatoč većoj zastupljenosti teške kliničke slike bolesti, većina pacijenata nije imala većih odstupanja u laboratorijskim parametrima upale i dehidracije. |
| Abstract (english) | Objective: The aim of this study was to collect data on the etiology of acute infectious diarrhea in children under 5 years of age, treated at the Emergency Service (ES) of the Department of Infectious diseases at the Clinical Hospital Split; to collect data on the severity of the disease, the degree of dehydration and complications and to compare it with data on etiology and breastfeeding; to establish which assessment, either the severity of the disease or the actual degree of dehydration was decisive for treatment in the day-care hospital or infirmary treatment for parenteral rehydration; to collect laboratory data of the infection and dehydration of children treated in day hospital or in an infirmary.
Methods: We retrospectively collected data on 1367 children aged 1-60 months from 1st January 2012 to 31st December 2013 that attended the ES of Department of Infectious diseases at the Clinical Hospital Split. The age of the patients, treatment methods, etiology of the disease, breastfeeding, epidemiological situation in the family and environment, duration and number of stools, duration and number of vomiting episodes, temperature, dehydration, the way of rehydration, C-reactive protein (CRP), leukocytes, urea, creatinine, electrolytes and acid-base status of the children was recorded. The severity of the disease was based on the Vesikari score in which a score of less than 7 was evaluated as mild, 7-10 as moderate and 11 and more as severe disease. The data were collected in Microsoft Excel, and were analysed by descriptive statistics and χ2 test.
Results: Children aged 13-24 months and 24-36 months were significantly more frequently assessed in ES than the other age groups. Most of the children were rehydrated in day-care hospital. Rotavirus diarrhea was the most common reason for hospitalization (≈44%) and for therapy in the day-care hospital. Majority of hospitalized, as well as day-care hospital treated children had severe disease, but most of them had a mild degree of dehydration. However, the number of hospitalized children with severe disease was higher than the number of children which were treated in the day-care hospital. In addition, the number of hospitalized children that had a moderate degree of dehydration was 4.5 times higher than the number of children which were treated in the day hospital. There were no children with a severe degree of dehydration. There was no difference between viral and bacterial diarrhea according to severity of disease. There was no difference between viral and bacterial disease according to the degree of dehydration. Breastfeeding was not proven as a protective factor, nor in terms of disease severity or a milder degree of dehydration. The average value of CRP was higher in the bacterial than in the viral disease. The average value of CRP was a slightly higher in children with severe disease (21.9 mg/L) than in children with moderate disease (17.1 mg/L). In children with bacterial diarrhea the average values of CRP were 3.1 times higher in patients with severe disease than in patients with moderate disease. Considering the degree of dehydration, there was no difference in the average value of CRP in either the viral or bacterial disease. Irrespective of etiology, most children had leukocyte values of 10x109/L or lower. There was no difference in the averge value of leukocytes between viral and bacterial disease, according to the severity of the disease or the degree of dehydration. There was no difference in the average value of urea or creatinine according to the severity and the etiology of the disease. Normal values of natrium were found in 53.5% of the children, hyponatremia was found in 45% of the children, and hypernatremia in 1.5% of the children. There was no difference in distribution of iso-, hypo- and hypernatremia between children with mild and moderate degrees of dehydration. Only 16.4% patients had decreased values of potassium. Hypokalemia was found more frequetly in children with a moderate degree of dehydration than in children with a mild degree of dehydration. Most of the children (96,25%) had pH >7.3. Only two patients had pH <7.25. There was no difference in the distribution of pH values according to the degree of dehydration.
Conclusion: Most children had viral diarrhea, and Rotavirus was most common causative agent. There were no differences between viral and bacterial diarrhea either in terms of severity or in terms of the degree of dehydration. It was not found that breastfed children had either a milder disease or a lower degree of dehydration more often than children who were not breastfed. Considering a very good availability of medical care, most of the patients came to the ES because of severe disease and not for a severe degree of dehydration. Despite higher representation of severe disease, most of the patients did not have any major abnormalities in laboratory parameters of the infection and parameters of dehydration. |
