Oral rehydration of infants in a large urban U.S. medical center

Tamer, Akram; Friedman, Lawrence B.; Maxwell, Stefan R.W.; Cynamon, Harry A.; Perez, Hugo N.; Cleveland, William W.

doi:10.1016/s0022-3476(85)80606-5

Cited by 55 publications

(19 citation statements)

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“…Sample sizes ranged from 24 to 111 (median 47, inter-quartile range 35 to 91). Five studies did not report dehydration severity; the remainder, with one exception,[35] included primarily children with mild dehydration.…”

Section: Resultsmentioning

confidence: 99%

Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis

et al. 2015

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ContextGastroenteritis remains a leading cause of childhood morbidity.ObjectiveBecause prior reviews have focused on isolated symptoms and studies conducted in developing countries, this study focused on interventions commonly considered for use in developed countries. Intervention specific, patient-centered outcomes were selected.Data SourcesMEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, trial registries, grey literature, and scientific meetings.Study SelectionRandomized controlled trials, conducted in developed countries, of children aged <18 years, with gastroenteritis, performed in emergency department or outpatient settings which evaluated oral rehydration therapy (ORT), antiemetics, probiotics or intravenous fluid administration rate.Data ExtractionThe study was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. Data were independently extracted by multiple investigators. Analyses employed random effects models.Results31 trials (4,444 patients) were included. ORT: Compared with intravenous rehydration, hospitalization (RR 0.80, 95%CI 0.24, 2.71) and emergency department return visits (RR 0.86, 95%CI 0.39, 1.89) were similar. Antiemetics: Fewer children administered an antiemetic required intravenous rehydration (RR 0.40, 95%CI 0.26, 0.60) While the data could not be meta-analyzed, three studies reported that ondansetron administration does increase the frequency of diarrhea. Probiotics: No studies reported on the primary outcome, three studies evaluated hospitalization within 7 days (RR 0.87, 95%CI 0.25, 2.98). Rehydration: No difference in length of stay was identified for rapid vs. standard intravenous or nasogastric rehydration. A single study found that 5% dextrose in normal saline reduced hospitalizations compared with normal saline alone (RR 0.70, 95% CI 0.53, 0.92).ConclusionsThere is a paucity of patient-centered outcome evidence to support many interventions. Since ORT is a low-cost, non-invasive intervention, it should continue to be used. Routine probiotic use cannot be endorsed at this time in outpatient children with gastroenteritis. Despite some evidence that ondansetron administration increases diarrhea frequency, emergency department use leads to reductions in intravenous rehydration and hospitalization. No benefits were associated with ondansetron use following emergency department discharge.

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Section: Resultsmentioning

confidence: 99%

Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis

et al. 2015

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“…Source of funding was not mentioned in the published version of the remaining studies. Though three studies [33,36,38] had incomplete follow up and one other [32] counted a withdrawal as a failure, none of the studies reported doing an intention-to-treat (ITT) analysis.…”

Section: Resultsmentioning

confidence: 99%

Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials

Bellemare

Hartling

Wiebe

et al. 2004

BMC Med

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“…Not surprisingly, deaths in study patients were exceedingly rare and were reported exclusively in low-middle-income countries, and these deaths could not be directly attributed to the mode of rehydration therapy (45). In one trial, 1 patient developed a seizure 17 h after the onset of ORT, thought to be related to a rapid decrease in total osmolality (57). Other relatively minor complications (i.e., complications with nasogastric tube placement and multiple attempts at i.v.…”

Section: Oral Vs Intravenous Rehydration In the Emergency Departmentmentioning

confidence: 97%

The Management of Children with Gastroenteritis and Dehydration in the Emergency Department

Colletti

Brown

Sharieff

et al. 2010

The Journal of Emergency Medicine

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Oral rehydration of infants in a large urban U.S. medical center

Cited by 55 publications

References 10 publications

Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis

Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis

Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials

The Management of Children with Gastroenteritis and Dehydration in the Emergency Department

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