Safety queries as treatment of common illnesses kills infants

A team of researchers say that the use of a large amount of fluids to restore levels of water in the body lost after dehydration in sick infants could lead to their deaths. FILE | NATION

What you need to know:

  • Medical experts from Kenya, Uganda and Tanzania took part in the study Fluid Expansion as Supportive Therapy, (Feast). They were led by Kathryn Maitland, a global expert on the use of rehydrating fluids.
  • The bolus, the experts said, were responsible for deaths.
  • The results of Feast, which were published in the New England Journal of Medicine, showed that among children who did not receive the bolus, 92.7 per cent survived.

Thousands of infants suffering from common infections, including malaria, are losing their lives as a result of a treatment approved by the Health ministry, despite a warning by some researchers.

In a study on restoring levels of water in the body after dehydration, the experts found out that injecting children with large amounts of fluids leads to death.

Medical experts from Kenya, Uganda and Tanzania took part in the study Fluid Expansion as Supportive Therapy, (Feast). They were led by Kathryn Maitland, a global expert on the use of rehydrating fluids.

Thousands of children are taken to hospital unconscious or weak from diseases such as malaria, infections that have fever as a symptom and septicaemia, also known as sepsis, where the blood is overloaded with disease causing organisms.

When the body is under siege and the disease causing microorganisms overload the blood, a child slips into a state of unconsciousness called septic shock.

When the child is taken to hospital with the shock, the ministry requires health staff to inject the patient with large amounts of fluids quickly to keep the child alive long enough to enable the medicine given to fight the disease to work.

The fluids injected are called fluid boluses and the procedure is called fluid resuscitation.

Calls and text messages to the Director of Medical Services Nicholas Muraguri regarding the safety of the bolus procedure in public hospitals went unanswered.

Dr Maitland’s Feast trial suggests that children who are treated by the boluses are more likely to die than those who were not.

During the study, the health expert and her team observed the care of 3,141 critically ill children in six hospitals that included Kilifi District Hospital.

RESPONSIBLE FOR DEATHS

With the parents’ permission, the children were divided into three groups, two of which were given emergency boluses of 20 to 40 millilitres of fluid per kilogramme of body weight.

Children given the bolus showed signs of quick recovery but went back into lethal shock within hours after the administration of the fluids, according to the research.

The bolus, the experts said, were responsible for deaths.

The results of Feast, which were published in the New England Journal of Medicine, showed that among children who did not receive the bolus, 92.7 per cent survived.
The survival rate for the children who received the bolus treatment was 3.3 per cent lower at 89.4.

When calculated, it means that in every 100 children given boluses, three will die, mainly as a result of cardiovascular collapse, the experts say.

The trial was stopped early when the excessive number of deaths became apparent.

Feast, funded by the UK’s Medical Research Council, caused global controversy as it suggests that doctors would have to rethink the treatment of shock all over the world.
Notably, the paper won the prestigious British Medical Journal Research Paper of the Year in 2012 for its methodology.

The Nation knew of this study during presentations at Kenya Medical Research’s Institute’s fifth scientific and health conference held in February this year the headquarters in Nairobi.

Dr Obonyo Nchafatso, who also participated in the trial, made the presentation. He explained at length why the bolus was implicated as the cause of death.

This evidence pushed scientists such as the Kenya Paediatric Association Chairman, Mr David Githanga, to ask the World Health Organisation, which announced the directive of using the treatment method, to revise its guidelines.

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