45 Causes of Chronic Diarrhoea in Infants Admitted to Hospital in the First 6 Months of Life
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".