Two babies. Infants really, but they are so tiny I think of them am newborns. I've been taking care of them all week.
Baby S. Is 8 months old. He weighs 5 kilograms (11 Lbs). Pathetic is the word that best describes him. He came in with vomiting, diarrhea, having been given some muti (spelling?)- or traditional meds. He is the definition of a marasmic kwash. He is wasted in size, and also edematous. He has strep viridians growing in his blood culture, and e coli in his urine culture. His lips are cracked and peeling, his perineum (the part that sits in a bike seat) is also excoriated, and raw. It's painful to look at. He usually stares off into space. He makes an attempts at a cry when examined. Again, he is 8 months old. He doesn't sit up. He doesn't roll over. His mom is HIV +.
Baby T is 4 months old. He weighs 5 kilograms (11 Lbs). He came in with one week of gastro (vomiting, diarrhea). He was acidotic and ill appearing on admission, required aggressive fluids. He doesn't have anything growing in his cultures. He isn't marasmic, or kwashiorkor. His mom is HIV +
Baby S should weight 8 kg/17 lbs
Baby T should weight 6.5 kg/15 lbs
Both have gotten better as the week has gone on, both are off of IV fluids, taking in formula, and even have gained some weights. Both have been tested for HIV. It's been tough to think of HIV status as another label for all of these kids. I sometimes just think that all of the kids are HIV positive, they look so small and sick, it's hard for me to grasp that this can be the sole result of not getting enough nutrition.
Enough nutrition. This hasn't really been a problem in my training thus far. And, in fact, we deal with TOO much nutrition. We have a "chunky" baby who looks like a normal baby to me. But this kid looks chunky here. The other day as we were doing bloods and IVs, I tried to explain how we have to counsel parents on LIMITING junk food, eating veggies etc.
So there are all these new factors to deal with. HIV status. Nutrition status. I've been trying to link HIV status with overall appearance. Like, if an infant has TB, then that kid must have HIV as well??
And this week I learned that you can't tell.
Baby S is HIV negative.
Baby T is HIV positive.
The only way to tell is to test.
