Évaluation du Risque de Choc chez l’Enfant Souffrant de Malnutrition Aigüe Sévère à l’Institut de Nutrition et de Santé de l’Enfant au CHU de Donka (Conakry)

RESUMEObjectif. Le choc est une complication determinante dans la letalite de la malnutrition chez l’enfant; notre objectif etait d’analyser les facteurs de risque de sa survenue a l’admission dans notre service. Methodologie. Etude retrospective transversale, descriptive et analytique, des dossiers et registres d’hospitalisation a l’Institut de Nutrition et de Sante de l’Enfant au CHU de Donka (Conakry). Les parametres suivants ont ete etudies en rapport avec la survenue du choc: le type d’admission, la presentation clinique, les donnees biologiques, les complications et l’issue. Resultats. Nous avons inclus 1053 enfants (553 garcons et 500 filles) dont 98.5% de nouvelles admissions. Parmi eux, 845 (80%) avaient moins de 24 mois. Tous avaient au moins un antecedent pathologique. L’evaluation anthropometrique selon les indices nutritionnels exprimes en Z score montrait que le tiers avaient un retard de croissance severe, pres de 9/10 enfants une insuffisance ponderale severe et 2/3 une emaciation severe; la proportion d’œdeme etait de 1/10. Le risque de survenue d’un etat de choc etait associe aux parametres suivants : nouvelle admission (x3)(p=0.034; vomissements (p=0.017); diarrhee (p<0.0001); presence d’œdeme (x2)(p=0.002); trie comme etat d’urgence (p=0.0000; insuffisance ponderale severe ou severe retard de croissance (x2) (p=0.001); pâleur (p=0.04); desaturation (x3)(p=0.0001); infection respiratoire basse (x2)(p= 0.00001); adenopathie peripherique (p=0.034); deshydratation severe (p=0.0001); tuberculose (p=0.032); polypnee(X7)(p=0.017). Conclusion. Le choc chez le malnutri est grave, son risque de survenue depend des etats anthropometriques, cliniques et biologiques a l’admission dont il faut en tenir compte pour une prise en charge precoce.ABSTRACTObjective. Shock is a key determinant of the risk of death among children with malnutrition. The goal of our work was to assess its risk factors at admission in our setting. Population and methods. This was a cross sectional descriptive and analytical, retrospective study based on hospitalization records from the Institute of Nutrition and Child Health of the Donka Hospital (Conakry). Our study variables in relation with the occurrence of shock were: modality of admission, clinical presentation, biological data, type of complications et outcome. Results We included 1053 children. Among them, 1134 (98.5%) were new admissions and 845 (80%) had less than 24 months. All had and a positive medical history. Anthropometric data (Z score) showed that one third had severe growth retardation, 9/10 were underweight and 2/3 had severe emaciation, and 1/10 had edema. Le risk o shock was associated to the following parameters: new admission (x3)(p=0.034; vomiting (p=0.017); diarrhea (p<0.0001); edema (x2)(p=0.002); emergency state on admission (p=0.0000; severely underweight or severe growth retardation (x2) (p=0.001); pallor (p=0.04); desaturation (x3)(p=0.0001); low respiratory infection (x2)(p= 0.00001); peripheral adenopathy (p=0.034); severe dehydration (p=0.0001); tuberculosis (p=0.032); polypnea (x7)(p=0.017). Conclusion. Shock state is severe in the malnourished. The risk of occurrence is related on anthropometric, clinical and biological conditions at admission, which must be taken into account for proper management.