Predictors of mortality in infants with sclerema presenting to the Centre for Diarrhoeal Disease, Dhaka

Background: Sclerema is an uncommon, life-threatening condition, usually of newborns, with a case-fatality rate ranging from 50 to 100%. Very little is known about factors influencing outcome. Aim: To identify clinical and biochemical predictors associated with fatal outcome of sclerema in infants with diarrhoea. Methods: Thirty infants with sclerema admitted to the Special Care Unit of the Dhaka Hospital of ICDDR, B with diarrhoea from May 2005 to end April 2006 were studied prospectively. Nine infants who died (30%) were considered to be cases while the 21 who survived constituted the comparison group. Hypothermia, severe malnutrition, septic shock, serum ammonia and CRP levels were considered to be predictors of death. Differences in proportions were compared by the chi(2) test and mean differences were compared using Student's t-test or the Mann-Whitney test, as appropriate. Results: The mean age of the 30 infants was 2.1 months ( range 12 d to 8 m). Fatal cases were more likely than survivors to be associated with severe underweight, a positive blood culture and higher serum ammonia and serum CRP levels. After adjusting for possible confounders in logistic regression analysis, the likelihood of death was higher in infants admitted with septic shock or who developed it soon after admission (OR 17.96, 95% CI 1.5-220.4, p=0.024). Conclusions: Sclerema is associated with a high fatality rate and scleremic infants with diarrhoea who present with septic shock are at a greater risk of death.