# Consequences of post-discharge hospitalisation on the growth of young Bangladeshi children hospitalised with diarrhoea: a secondary case-control analysis of Antibiotics for Children with Diarrhea (ABCD) trial

## TL;DR

Children in Bangladesh who were readmitted to the hospital after being discharged for diarrhea showed worse growth compared to those not readmitted.

## Contribution

This study is the first to show that post-discharge readmission in young children with diarrhea is linked to significant growth deterioration.

## Key findings

- Readmitted children had lower height-for-age, weight-for-age, and weight-for-height scores after 90 days.
- Mid-upper arm circumference also decreased significantly in readmitted children.
- These findings highlight the need for post-discharge interventions to prevent growth faltering.

## Abstract

Due to the scarcity of published data on growth among children with severe diarrhoea requiring readmission during post-discharge follow-up, we aimed to investigate the potential impact of post-discharge readmission at day-90 follow-up on growth in diarrheal children aged 2–23 months.

We performed a secondary analysis using Bangladesh site data from the Antibiotic for Children with Diarrhea (ABCD) trial, a multi-country, randomised, double-blind, placebo-controlled study conducted from July 2017 to July 2019. Children aged 2–23 months who had severe diarrhoea defined as having acute diarrhoea with some/severe dehydration, or severe stunting, or moderate wasting, were admitted to the facility. In this analysis, we classified children who were re-hospitalised within a 90-day post-discharge follow-up period as cases and randomly selected controls who did not require re-hospitalisation, matching them by similar ages and sexes in a 1:3 ratio. We gathered anthropometric data on enrolment and day 90 follow-up. The outcome variables were changes in nutritional indicators height-for-age (ΔHAZ), weight-for-age (ΔWAZ), weight-for-height (ΔWHZ), and mid-upper arm circumference (ΔMUAC). We assessed for growth changes at day 90 post-discharge follow-up using multivariate linear regression.

Among 1431 diarrhoeal children enrolled, we identified 145 cases and 435 controls. In terms of the baseline admission characteristics, the cases were less likely to be immunised (81% vs. 72%; P = 0.031), vomit (11% vs. 22%; P = 0.001), and have dehydrating diarrhoea (26% vs. 36%; P = 0.026) than the controls. After adjusting for potential covariates, the cases had a significant reduction in growth than the controls at 90 days of post-discharge follow-up, according to anthropometric indices: ΔHAZ (β = −0.11; 95% confidence interval (CI) = −0.21, −0.01; P = 0.029), ΔWAZ (β = −0.24; 95% CI = −0.35, −0.14; P < 0.001), ΔWHZ (β = −0.25; 95% CI = −0.39, −0.12; P < 0.001), and ΔMUAC (for children 6–23 months, β = −0.17; 95% CI = −0.29, −0.04; P = 0.011).

Diarrhoeal children aged 2–23 months requiring readmission during the 90-day post-discharge follow-up period had a significant deterioration of ponderal and linear growth, compared with those who did not require readmission. This finding underscores the importance of early identification of children with risks of post-discharge readmission and designing a package of post-discharge trials, including social and nutritional interventions that may help to reduce post-discharge readmissions as well as subsequent growth faltering.