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Shorter duration of rehydration may be effective for pediatric patients with gastroenteritis
Powell C. Pediatrics. 2011;doi:10.1542/peds.2010-2483.
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A technique that employed 4 hours of rehydration during a 24-hour period may offer an alternative for children with gastroenteritis, according to a study published online this week.
Colin V.E. Powell, MD, of Royal Children’s Hospital in Melbourne, Australia, and colleagues screened 9,331 children with acute gastroenteritis and randomly assigned 254 of them to either the standard 24 hours of care or treatment with the more rapid nasogastric rehydration during the course of 4 hours in the ED (n=132).
Powell and colleagues said primary failure rates, defined as more than 2% weight loss during the rehydration period, were similar for the 4-hour treatment and the standard of care; however, readmission was more common in the more rapid form, with 7.6% readmitted within 24 hours. According to the researchers, secondary treatment failure, defined as the inability to tolerate a nasogastric tube, frequent or persistent vomiting, and need for IV rehydration, and other symptoms were more common in the standard treatment group.
They said there are some study limitations, including a lack of blinding, but this technique may offer an alternative to the 24-hour treatment.
Future studies should look at “antiemetic medications as an adjunct” to the shorter therapy they propose, the researchers said.
Disclosure: The researchers report no relevant financial disclosures.
The management of infants and young children with moderate dehydration continues to be a challenge to clinicians. The uptake of rotavirus vaccines has greatly decreased the burden of disease associated with dehydration. However, guidelines for management of children with moderate dehydration provide varying recommendations. While the AAP Clinical Guidelines recommend rapid nasogastric rehydration over 4 hours for children with moderate dehydration, clinician practices vary widely.
A regimen involving a 24-hour hospitalization with fluid deficit replacement over 6 hours and maintenance over the subsequent 18 hours is the standard of care at two metropolitan hospitals in Melbourne, Australia. Powell and colleagues conducted a prospective, randomized, noninferiority clinical trial comparing a rapid nasogastric rehydration regimen provided in an outpatient setting over 6 hours to their standard regimen in children aged 6 months to 6 years with moderate dehydration at two metropolitan pediatric teaching hospitals over an 18-month period.
Although the findings suggested that there were no differences in the efficacy and safety outcomes that were assessed, an inability to enroll the projected number of subjects during the study period weakens the noninferiority conclusion. The absence of blinding of subjects and investigators to the duration of intervention may have biased outcome assessment. Despite these study design limitations, this study provides evidence that rapid nasogastric rehydration in the outpatient setting may be as suitable as prolonged rehydration delivered during a hospitalization. Outpatient management may be beneficial to the child, family, and the health care system and may reduce the tendency to resort to intravenous hydration and other diagnostic procedures. In many resource poor settings, rapid nasogastric rehydration is successfully achieved, as it is often the only option for management of children with moderate dehydration.
Andi L. Shane, MD, MPH
Emory University, Atlanta
Disclosure: Dr. Shane reports no relevant financial disclosures.
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