Dear Anon,
You highlight a gap in guidance (one of the many) around managing acute malnutrition in infants < 6 months. As part of the MAMI Project completed late last year, we reviewed what guidance was used to manage this age group. Many lacked an anthropometric discharge criteria, partly because many infants of this age group were admitted under non anthropometric criteria (either for clinical reasons, poor feeding, or as you point out, length less than 45cm). Non-breastfed infant management and follow up was noted as especially lacking in key informant interviews. Rather than an 'adequate weight gain' discharge criterion as often used in breastfed infants, the guidelines reviewed reflected that non-breastfed infant was typically expected to reach the same anthropometric targets as older children prior to discharge (>80% or >85% weight-for-length). Many aspects of older child management are applied to infants <6m, but this is based on assumptions rather than strong evidence. So the suggestion in Module 2 remains valid and in keeping with other agencies guidance, but bearing in mind that that Module 2 content was based on a peer reviewed judgement to 'stop gap' in the absence of a strong evidence base. As the MAMI project found, this weak evidence base remains and is significant. You can download the MAMI report (Chapter 4 is the guidelines review) at:
http://www.ennonline.net/resources/741 Two notable guidance that are valuable with regard to infants<6m were:
ACF Assessment and Treatment of Malnutrition in Emergency Situations, Claudine Prudhon, 2000 (Book available for purchase via http://www.aahuk.org/publications.htm) MSF Nutrition Guidelines (2006) http://www.msf.org.uk/books.aspx Other key resources are listed in the appendices of the MAMI Report, http://www.ennonline.net/pool/files/ife/mami-appendices.pdf Best regards, Marie |