Nutritional Rehabilitation Centre (NRC)

Definition And Purpose

Facility-based care units established under the National Health Mission (NHM) for the comprehensive clinical and nutritional management of children with Severe Acute Malnutrition (SAM) complicated by medical illnesses.
Core Goal: To reduce case fatality rates in SAM, promote catch-up growth, and build maternal/caregiver capacity for appropriate home-based care and feeding.

Admissions target children who fail the appetite test or have associated medical complications.

Age 6 to 59 months:
- Anthropometry: Weight-for-Height (WFH) < -3 SD, OR Mid-Upper Arm Circumference (MUAC) < 11.5 cm, OR presence of bilateral pitting pedal edema.
- PLUS any one medical complication: Anorexia (fails appetite test), severe pneumonia, severe dehydration/cholera, persistent diarrhea, severe anemia (Hb < 5 g/dL or < 7 g/dL with respiratory distress), hypoglycemia, hypothermia, or systemic sepsis.
Infants < 6 months:
- WFH < -3 SD or visible severe wasting.
- Presence of edema.
- Ineffective feeding or breastfeeding failure.

Beds: Usually 10 to 20 beds per unit, located at District Hospitals (DH), Sub-District Hospitals (SDH), or Community Health Centres (CHC).
Staffing: Pediatrician/Medical Officer (Nodal Officer), Nutritionist/Feeding Demonstrator, trained Nursing Staff, and a Medical Social Worker.
Facilities: A specialized dietary kitchen for the preparation of F-75 and F-100 therapeutic diets, a dedicated play therapy area, and counseling space.

Management at the NRC is strictly protocol-driven and divided into Stabilization, Transition, and Rehabilitation phases.

Axillary temperature < 35.0°C (95°F).
Ensure "warm chain" (Kangaroo Mother Care, radiant warmers, wrapping, avoiding exposure).
Monitor temperature 2-hourly until stable.

Do not use standard ORS due to high sodium and low potassium.
Use ReSoMal (Rehydration Solution for Malnutrition): 5 ml/kg every 30 minutes for 2 hours, then 5-10 ml/kg/hour for the next 4-10 hours.
IV fluids (Ringer's Lactate with 5% Dextrose) are strictly reserved for severe dehydration with shock.

All SAM children have excess body sodium and deficient intracellular potassium and magnesium.
Supplement Potassium (3-4 mEq/kg/day) and Magnesium (0.4-0.6 mEq/kg/day). Usually premixed in F-75/F-100 diets.

Assume systemic infection even without clinical signs.
Uncomplicated/mild sickness: Oral Amoxicillin (15 mg/kg 8-hourly for 5 days).
Complicated/severe sickness: IV Ampicillin (50 mg/kg 6-hourly) + IV Gentamicin (7.5 mg/kg once daily) for 7 days. Add Ceftriaxone if no response in 48 hours.

Vitamin A: Administer on Day 1, Day 2, and Day 14 (Dose based on age).
Folic acid (5 mg on Day 1, then 1 mg/day), Zinc (2 mg/kg/day), and Copper (0.3 mg/kg/day).
Strict Rule: Withhold Iron supplementation during the stabilization phase; start only when the child enters the rehabilitation phase and is gaining weight.

Use F-75 therapeutic diet (75 kcal and 0.9g protein per 100 ml).
Target: 100 kcal/kg/day and 1-1.5 g protein/kg/day. Fluid: 130 ml/kg/day.
Frequent, small feeds (every 2-3 hours) to prevent heart failure and refeeding syndrome.

Use F-100 therapeutic diet (100 kcal and 2.9g protein per 100 ml) or Ready-to-Use Therapeutic Food (RUTF).
Target: 150-220 kcal/kg/day and 4-6 g protein/kg/day.
Indicates return of appetite and resolution of major medical complications.

Scheduled visits at the nearest health facility or community tracking.
1st follow-up at 15 days, followed by monthly visits for 6 months to monitor anthropometry and prevent relapse.