Nutritional rehabilitation centre
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Nutritional rehabilitation centre psm mbbs
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Nutritional Rehabilitation Centre (NRC)
(Park's Textbook of PSM)
Definition
An NRC is a facility-based inpatient unit that provides medical and nutritional care to children under 5 years of age with Severe Acute Malnutrition (SAM) who have medical complications.
SAM is a major contributing factor to deaths from common childhood illnesses (diarrhoea, pneumonia). Deaths are preventable with timely, appropriate care - which NRCs provide.
Services Provided at an NRC
| # | Service |
|---|---|
| a | 24-hour care and monitoring of the child |
| b | Treatment of medical complications |
| c | Therapeutic feeding |
| d | Sensory stimulation and emotional care |
| e | Counselling on appropriate feed, care, and hygiene |
| f | Demonstration and practice-by-doing on preparation of energy-dense food using locally available, culturally acceptable, and affordable food items |
| g | Social assessment of the family to identify and address contributory factors |
| h | Follow-up of children discharged from the facility |
Special focus is on improving the skills of mothers on child care and feeding practices so the child continues to get adequate care at home.
Management of SAM at NRC - 3 Phases
Phase 1: Stabilization Phase (Days 1-2)
- For SAM children without adequate appetite and/or a major medical complication
- Feeding formula: Starter Diet - promotes recovery of normal metabolic function and nutrition-electrolytic balance
- Duration: 1-2 days
- Careful monitoring for signs of overfeeding or overhydration
Phase 2: Transition Phase (Days 3-5)
- Bridge from stabilization to rehabilitation
- Duration: 2-3 days
- Diet: Gradual transition from Starter Diet to Catch-Up Diet (same quantity as stabilization phase)
- Child moves from Stabilization to Transition phase when ALL of the following are met:
- At least beginning of loss of oedema
- Return of appetite
- No nasogastric tube, infusions, no severe medical problems
- Alert and active
Phase 3: Rehabilitation Phase
- Goal: Promote rapid weight gain, stimulate emotional and physical development, prepare child for normal feeding at home
- Child progresses to rehabilitation when:
- Good appetite: finishes >90% of feed given without significant pause
- Major reduction or loss of oedema
- No other medical problem
Assessment at Admission (Triage)
ABCD steps: Airway, Breathing, Circulation, Coma/Convulsion, Dehydration
History includes: Recent food/fluid intake, usual diet, breastfeeding, diarrhoea/vomiting duration, cough, loss of appetite, family circumstances, contact with TB/measles, HIV status, immunizations.
Examination includes: Anthropometry (weight, height, MUAC), oedema, pulse/heart rate/respiratory rate, dehydration signs, shock signs, palmar pallor, eye signs of Vitamin A deficiency (Bitot's spots, corneal ulceration, keratomalacia), skin changes of kwashiorkor (hypo/hyperpigmentation, desquamation, ulceration).
Micronutrient Supplementation
| Micronutrient | Dose |
|---|---|
| Vitamin A | Age <6 months: 50,000 IU; 6-12 months or wt <8 kg: 1,00,000 IU; >12 months: 2,00,000 IU (single dose; same dose on Day 1, 2, and 14 if clinical deficiency) |
| Folic acid | 5 mg on Day 1, then 1 mg/day |
| Elemental Zinc | 2 mg/kg/day |
| Copper | 0.3 mg/kg/day |
| Iron | 3 mg/kg/day in two divided doses - start ONLY after 2 days on catch-up diet; DO NOT give iron in stabilization phase |
Follow-Up After Discharge from NRC
- NRC shares list of discharged SAM children with the area ANM and ICDS supervisors
- Children enrolled at Anganwadi Centre (AWC) for supplementary food
- AWW home visits: weekly for first 4 weeks, then once in 2 weeks till discharged from programme
- Children weighed every week at AWC
- ASHA incentive: Rs. 50 for accompanying child to NRC and motivating mother to stay at least 7 days; additional Rs. 50 per follow-up visit (max 3 visits)
Current Status (India)
1,075 NRCs are functional across 17 States/UTs (as per Park's edition data).
Key Points for Exam
- NRC = facility-based, for SAM children under 5 with medical complications
- Three phases: Stabilization (1-2 days) → Transition (2-3 days) → Rehabilitation
- Starter diet in stabilization; Catch-up diet in rehabilitation
- NO iron in stabilization phase - give iron only after 2 days on catch-up diet
- ASHA incentive = Rs. 50 + up to 3 follow-up visits x Rs. 50
- Linkage with AWC, ANM, ICDS for community follow-up
(Source: Park's Textbook of Preventive and Social Medicine)
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