45 Causes of Chronic Diarrhoea in Infants Admitted to Hospital in the First 6 Months of Life
Notice bibliographique
Résumé
In young infants, chronic diarrhoea can result in admission to hospital. The differential diagnosis is broad and there is no uniform approach to the workup of these patients, particularly as there is no definitive test for a number of the most common causes of chronic diarrhoea. Our objective was to determine the causes of chronic diarrhoea, defined as diarrhoea persisting for more than two weeks, in otherwise healthy infants less than six months of age, requiring admission to a tertiary care hospital for this problem. A second objective was to describe the specific features found on history, physical exam and investigations for the most common causes of chronic diarrhoea. This was a retrospective chart review of infants less than six months of age, admitted to the Hospital for Sick Children with a diagnosis of chronic diarrhoea from December 1995 to November 2001. Infants were excluded if the duration of diarrhoea was less than two weeks, or if they had a documented immunodeficiency, history of necrotizing enterocolitis, surgical/anatomical reasons for diarrhoea, or complex systemic disease. Data from the history, physical exam, and investigations were collected from the charts. Data analysis was descriptive. Forty-one patients were eligible for inclusion in the review. The most common discharge diagnoses were post-infectious enteritis in 29%, cow's milk protein allergy in 22%, and diarrhoea “not yet diagnosed” in 17%. The average age of onset of the diarrhoea in cow's milk protein allergy was 29 days in contrast to 57 days in post-infectious enteritis and 12 days in the four cases of rare congenital causes of diarrhoea. Infants with cow's milk protein allergy tended to look “sicker” than those with post-infectious enteritis; they presented more frequently with irritability, vomiting, and dehydration. They were more likely to have bloody stools, metabolic acidosis and hypoalbuminemia. Fewer infants with post-infectious enteritis were ever breastfed and none of these infants were anaemic. Radiological investigations were unhelpful in distinguishing between the two most common causes, whereas the haemoglobin and albumin were helpful. We concluded that post-infectious enteritis and cow's milk protein allergy are the most common diagnoses made in infants less than six months of age admitted with chronic diarrhoea. Age of onset, history of breastfeeding, and the presence of vomiting, bloody stool, irritability, and dehydration help determine the diagnosis. Haemoglobin, venous blood gas, and albumin are often helpful, whereas radiological investigations are generally not helpful.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,004 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».