Understanding the Phases of Severe Acute Malnutrition (SAM) Treatment
Severe acute malnutrition is a life-threatening condition that requires a carefully managed, two-phase treatment approach, as outlined by the World Health Organization (WHO). The first stage is the stabilization phase, which focuses on correcting metabolic disturbances and managing critical medical complications like hypoglycemia, hypothermia, and infection. The second is the rehabilitation phase, which promotes rapid catch-up growth once the patient is stable. The therapeutic milk formula F-75 is a cornerstone of the stabilization phase.
The Critical Role of F-75 in Stabilization
F-75 therapeutic milk is specifically formulated for use during the initial, high-risk stabilization phase. A severely malnourished child has a fragile physiological state and a reduced homeostatic capacity, making them susceptible to life-threatening complications, particularly refeeding syndrome.
Key functions of F-75 during stabilization:
- Prevents Refeeding Syndrome: The formula is low in protein, sodium, and fat but rich in carbohydrates to prevent the sudden metabolic shift that triggers refeeding syndrome when food is reintroduced too quickly. This syndrome is characterized by severe electrolyte shifts that can lead to cardiac failure.
- Restores Metabolic Balance: F-75 helps to restore the child's metabolic functions and correct severe electrolyte imbalances, particularly deficiencies in potassium and magnesium.
- Addresses Medical Complications: It is used for children with complications such as infections, anorexia (no appetite), and bilateral pitting edema. The gentle nutritional profile supports the body while other medical issues are addressed.
- Hydrates and Replaces Electrolytes: Along with special oral rehydration solutions like ReSoMal, F-75 helps rehydrate the child while providing necessary electrolytes, but it is not intended for initial rehydration in shock cases.
- Does Not Promote Weight Gain: Unlike subsequent therapeutic foods, F-75's low energy density is not designed for rapid weight gain, which could overload the compromised system.
Indications for Giving F-75
F-75 is administered under medical supervision in a hospital or therapeutic feeding center. A child is a candidate for F-75 when they are diagnosed with severe acute malnutrition (SAM) and present with one or more medical complications. These include:
- Anorexia (poor or absent appetite)
- Persistent vomiting
- Bilateral pitting edema extending to the face
- Hypoglycemia or hypothermia
- Shock, dehydration, or altered mental status
- Severe anemia or infection
The duration of F-75 feeding typically lasts for 2 to 7 days, depending on the child's clinical condition and the resolution of complications.
Transitioning from F-75 to Rehabilitation
Once a child has been stabilized, the transition to the next phase of nutritional support begins. The switch from F-75 occurs when the child's appetite returns, edema has reduced, and their medical complications are under control.
After successfully passing an appetite test, the child is moved to a higher energy-dense formula, such as F-100 or Ready-to-Use Therapeutic Food (RUTF) like Plumpy'Nut®. The transition is gradual over 2–3 days, with RUTF or F-100 gradually replacing F-75, ensuring the child tolerates the increased protein and fat intake.
Comparison of Therapeutic Formulas
To understand the different roles of these nutritional aids, here is a comparison table outlining the key differences between F-75 and F-100/RUTF.
| Feature | F-75 Therapeutic Milk | F-100 Therapeutic Milk / RUTF |
|---|---|---|
| Treatment Phase | Stabilization (Phase 1) | Rehabilitation (Phase 2) |
| Primary Goal | Restore metabolic function, correct electrolyte imbalance, treat complications, prevent refeeding syndrome | Achieve rapid catch-up weight gain and growth |
| Energy Density | Lower (~75 kcal per 100ml) | Higher (~100 kcal per 100ml or more) |
| Protein Content | Lower (approx. 0.9g per 100ml) | Higher (approx. 2.9g per 100ml) |
| Fat and Sodium | Lower levels | Higher levels |
| Target Population | Severely malnourished children with medical complications or anorexia | Stabilized children who are clinically well and have good appetite |
| Administration | Strictly inpatient under medical supervision | Inpatient and outpatient therapeutic care (for RUTF) |
Important Considerations for Administration
For the safe and effective administration of F-75, strict medical supervision is mandatory. The formula should never be given to well-nourished children or distributed directly to families without a clinical assessment. Proper preparation is also critical to ensure a sterile and correctly formulated feed. Following the manufacturer's and WHO's instructions for mixing with boiled, cooled water is essential. Incorrect preparation can lead to complications such as diarrhea or excessive fluid intake.
F-75 contains a low level of iron, and iron supplementation is deliberately delayed in the stabilization phase to avoid worsening potential infections. Iron is typically added later in the rehabilitation phase via F-100 or RUTF, which contain higher levels.
Conclusion
In summary, F-75 is a specialized therapeutic milk given during the initial, inpatient stabilization phase for severely malnourished children with complications. It is a critical tool for safely correcting metabolic and electrolyte imbalances and preventing refeeding syndrome, rather than for promoting weight gain. Its use is guided by strict medical protocols established by the WHO, mandating careful supervision and proper preparation. Only once a child is medically stable and has regained their appetite can the transition from F-75 to higher-energy feeds like F-100 or RUTF safely begin. By understanding the precise role and timing of F-75, healthcare providers can navigate the high-risk initial stages of malnutrition treatment and improve recovery outcomes for vulnerable children.
For more in-depth guidance on managing severe acute malnutrition, healthcare professionals can consult the World Health Organization's training course materials on the subject.
