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Introduction: Diarrhoeal disease is the second-leading cause of death in young children. Current guidelines recommend treating children with acute non-bloody diarrhea with oral rehydration solutions and zinc, but not antimicrobials. However, in many resource-limited settings, infections with treatable enteric bacterial and protozoan pathogens are common. Probiotics have shown promise as an adjunct treatment for diarrhoea but have not been studied in sub-Saharan Africa. Methods: We conducted a pilot, factorial, randomized, placebo-controlled trial of children aged 2–60 months hospitalized in Botswana for acute non-bloody diarrhoea. A rapid test-and-treat intervention, consisting of multiplex PCR testing of rectal swabs taken at enrolment, accompanied by targeted antimicrobial therapy if treatable pathogens were detected, was compared to the reference standard of no stool testing. Additionally, Lactobacillus reuteri DSM 17938 x 60 days was compared to placebo treatment. The main objective of this pilot study was to assess feasibility. The primary clinical outcome was the increase in age-standardized height (HAZ) at 60 days adjusted for baseline HAZ. Results: Seventy-six patients were enrolled over a seven-month study period. We judged that the recruitment rate, lab processing times, communication protocols, provision of specific antimicrobials, and follow-up rates were acceptable. Compared to the reference arm (no stool testing and placebo treatment), the combination of the rapid test-and-treat strategy plus L. reuteri DSM 17938 was associated with an increase of 0.61 HAZ (95% CI 0.09–1.13) and 93% lower odds of recurrent diarrhoea (OR 0.07, 95%CI 0.01–0.61) at 60 days. Discussion: We demonstrated that it was feasible to evaluate the study interventions in Botswana. Despite the small sample size, we observed a statistically significant increase in HAZ at 60 days and significantly lower odds of recurrent diarrhoea in children receiving both rapid test-and-treat and L. reuteri. There is sufficient evidence to warrant proceeding with a larger follow-up trial in a similar setting. [ABSTRACT FROM AUTHOR]

Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012). Outcome included (1) feasibility, measured by compliance of the nurses, and (2) length of stay (LOS) at the ED, the number of diagnostic tests, treatment, follow-up, and costs. Due to failure of post-ED weight measurement, we could not evaluate weight difference as measure for dehydration. Patient characteristics were comparable between the intervention (N = 113) and the usual care group (N = 109). Implementation of the clinical decision support system proved a high compliance rate. The standardized use of oral ORS (oral rehydration solution) significantly increased from 52 to 65%(RR2.2, 95%CI 1.09-4.31 p < 0.05). We observed no differences in other outcome measures.Conclusion: Implementation of nurse-guided clinical decision support system on rehydration treatment in children with AGE showed high compliance and increase standardized use of ORS, without differences in other outcome measures. What is Known: • Acute gastroenteritis is one of the most frequently encountered problems in pediatric emergency departments. • Guidelines advocate standardized oral treatment in children with mild to moderate dehydration, but appear to be applied infrequently in clinical practice. What is New: • Implementation of a nurse-guided clinical decision support system on treatment of AGE in young children showed good feasibility, resulting in a more standardized ORS use in children with mild to moderate dehydration, compared to usual care. • Given the challenges to perform research in emergency care setting, the ED should be experienced and adequately equipped, especially during peak times. [ABSTRACT FROM AUTHOR]

To demonstrate safety and efficacy of using normal saline (NS) for initial volume expansion (IVE) and rehydration in children with diarrhea-related hypernatremic dehydration (DR-HD), forty eight patients with DR-HD were retrospectively studied. NS was used as needed for IVE and for initial rehydration. Fluid deficit was given over 48 h. Median Na level on admission was 162.9 mEq/L (IQR 160.8-165.8). The median average hourly drop at 6 and 24 h was 0.53 mEq/L/h (0.48-0.59) and 0.52 mEq/L/h (0.47-0.57), respectively. Compared to children not needing IVE, receiving ≥40 ml/kg IVE was associated with a higher average hourly drop of Na at 6 h (0.51 vs. 0.58 mEq/L/h, p = 0.013) but not at 24 h ( p = 0.663). The three patients (6.3%) with seizures had a higher average hourly drop of Na at 6 and 24 h ( p = 0.084 and 0.021, respectively). Mortality (4/48, 8.3%) was not related to Na on admission or to its average hourly drop at 6 or 24 h. Children receiving ≥40 ml/kg IVE were more likely to die (OR 3.3; CI, 1.5-7.2). Conclusion: In children with DR-HD, NS is a safe rehydration fluid with a satisfactory rate of Na drop and relatively low incidence of morbidity and mortality. Judicious use of IVE should be exerted and closer monitoring should be guaranteed for children requiring large volumes for IVE and for those showing rapid initial drop of serum Na to avoid neurological complications and poor outcome. [ABSTRACT FROM AUTHOR]

Since the 1960s oral rehydration of children suffering acute diarrhoea with specifically manufactured solutions containing salt and sugar has become more frequent globally and prevented millions of deaths from acute dehydration. This strategy was hailed as one of the major medical advances of the last century as it was estimated to prevent 90% of deaths secondary to diarrhoea in those under five years of age. Oral rehydration solutions (ORS) continue to evolve, alongside understanding of the mechanisms of enterocyte damage and recovery. Futher, the application of ORS is now linked by all health professionals to preventative measures directed at limiting the spread of diarrhoeal diseases. [ABSTRACT FROM AUTHOR]

Objective: To describe the management of acute diarrhea in emergency departments with emphasis on the type of hydration and exploring factors associated with prescription of oral rehydration therapy vs. intravenous rehydration therapy for children with dehydration that is not severe. Methods: This was a descriptive study conducted from January to May of 2008 observing case management of children with non-severe dehydration due to acute diarrhea at two emergency units (A and B) in Recife, Brazil. Emergency unit B is affiliated to a teaching hospital. The primary variables were: 1) type of hydration prescribed, 2) associations with the characteristics of the children and emergency department (A or B). Results: A total of 166 children took part in the study. The rates of prescription of oral rehydration therapy were similar at both services (32.2 vs. 31.6% for A and B, respectively, p = 0.93) and were lower for cases with moderate dehydration (17.6%) compared with mild dehydration (35.6%) (p = 0.07). Neither service had a dedicated oral rehydration room. Conclusions: Most children were given intravenous rehydration therapy, especially those with moderate dehydration, without differences according type of service: whether a teaching institution or healthcare provider only. [ABSTRACT FROM AUTHOR]

Abstract: Background: Acute gastroenteritis is characterized by diarrhea, which may be accompanied by nausea, vomiting, fever, and abdominal pain. Objective: To review the evidence on the assessment of dehydration, methods of rehydration, and the utility of antiemetics in the child presenting with acute gastroenteritis. Discussion: The evidence suggests that the three most useful predictors of 5% or more dehydration are abnormal capillary refill, abnormal skin turgor, and abnormal respiratory pattern. Studies are conflicting on whether blood urea nitrogen (BUN) or BUN/creatinine ratio correlates with dehydration, but several studies found that low serum bicarbonate combined with certain clinical parameters predicts dehydration. In most studies, oral or nasogastric rehydration with an oral rehydration solution was equally efficacious as intravenous (i.v.) rehydration. Many experts discourage the routine use of antiemetics in young children. However, children receiving ondensetron are less likely to vomit, have greater oral intake, and are less likely to be treated by intravenous rehydration. Mean length of Emergency Department (ED) stay is also less, and very few serious side effects have been reported. Conclusions: In the ED, dehydration is evaluated by synthesizing the historical and physical examination, and obtaining laboratory data points in select patients. No single laboratory value has been found to be accurate in predicting the degree of dehydration and this is not routinely recommended. The evidence suggests that the majority of children with mild to moderate dehydration can be treated successfully with oral rehydration therapy. Ondansetron (orally or intravenously) may be effective in decreasing the rate of vomiting, improving the success rate of oral hydration, preventing the need for i.v. hydration, and preventing the need for hospital admission in those receiving i.v. hydration. [Copyright &y& Elsevier]

To review the relative efficacy and safety of enteral vs intravenous (IV) rehydration therapy in treating childhood gastroenteritis. MEDLINE, EMBASE, and the Cochrane Controlled Trials Register databases were searched. Known investigators and expert bodies were contacted to locate unpublished and ongoing studies. Studies were selected based on the following criteria: randomized or quasi-randomized trials; children younger than 15 years with a clinical diagnosis of gastroenteritis of less than 1-week duration; interventions comprising enteral and IV treatment arms; and at least 1 of the following: major adverse event rates, treatment failure rates, weight gain with treatment, measurement of ongoing losses, length of hospital stay, costs of treatment, and satisfaction with treatment. Data were extracted from eligible studies, which were then combined using a random-effects model. Sixteen trials involving 1545 children and conducted in 11 countries were identified. Compared with children treated with IV rehydration, children treated with oral rehydration had significantly fewer major adverse events, including death or seizures (relative risk, 0.36; 95% confidence interval [CI], 0.14–0.89), and a significant reduction in length of hospital stay (mean, 21 hours; 95% CI, 8–35 hours). There was no difference in weight gain between the 2 groups (mean, -26 g; 95% CI, -61 to 10 g). The over-all failure rate of enteral therapy was 4.0% (95% CI, 3.0%-5.0%). For childhood gastroenteritis, enteral rehydration is as effective if not better than IV rehydration. Enteral rehydration by the oral or nasogastric route is associated with significantly fewer major adverse events and a shorter hospital stay compared with IV therapy and is successful in most children. [ABSTRACT FROM AUTHOR]

In South Africa there has been an unenthusiastic response to oral rehydration therapy. Parents and patients still demand hospital therapy for gastro-enteritis, even in cases that can be successfully managed at home using oral rehydration solution (ORS). The aims of this study were to assess whether a period of contact with health workers (doctors, nurses and medical students) had an effect on the carers' knowledge of gastro-enteritis. Fifty carers of children aged 2 years and less with gastro-enteritis were interviewed on admission and on discharge from the paediatric short-stay facility. Eighty-eight per cent of the babies had had acute gastro-enteritis (for less than 7 days). According to the carers (44% on admission and 52% on discharge), teething was the commonest cause of gastro-enteritis. On discharge, 50% of carers did not know any of the signs and symptoms of dehydration. Sixty-seven per cent of carers had first tried ORS at home, but of these only 49% could prepare an acceptable solution. Clinics are the commonest source of information about ORS (according to 78% of carers). All the carers said they had received no health education in the hospital. On discharge only one carer knew that she had been given a follow-up date and why she had to bring the child for follow-up. Contact with health workers during a period of admission to the paediatric short-stay facility had no impact on caretakers' knowledge of gastro-enteritis and its management. [ABSTRACT FROM AUTHOR]

The article investigates whether ultrarapid intravenous rehydration is an effective intervention in children who are dehydrated from viral gastroenteritis compared to other methods of rehydration. Results of randomized studies are discussed including the different methods for administering ultrarapid intravenous rehydration in the outpatient setting, the primary outcome of clinical rehydration, and the number and proportion of children who were rehydrated, and the safety of the intervention.

Aim To evaluate changes in glomerular filtration rate in acute gastroenteritis. Methods The correlation between two clinical diagnostic scales and glomerular filtration rate has been investigated in 113 children with acute gastroenteritis in a paediatric emergency setting. Results A significant reduction of GFR was found in 10% children less than, and 5% children higher than, 2 years of age with acute gastroenteritis. Conclusion The differences observed as for risk of renal hypoperfusion suggests to consider the age of children as an important determinant to consider the dehydration status in acute gastroenteritis. [ABSTRACT FROM AUTHOR]

Reports on the findings of the 2003 National Sentinel Surveillance System on the increase of severe rotavirus gastroenteritis cases among children in Jamaica. Discussion on the need for additional education of caregivers regarding the treatment for gastroenteritis; Investigation on the number of diarrheal deaths among children in the country; Recommendation for oral rehydration therapy for the treatment of the disease.

Examines the use of honey in oral rehydration solution in infants and children with gastroenteritis. Influence of honey on the duration of acute diarrhea; Importance of honey as glucose substitute in oral rehydration; Presence of electrolytes in oral rehydration.