Oral Rehydration Therapy in Well-Nourished Ambulatory Children *

Santosham, Mathuram; Carrera, Eduardo da Frota; Rb, Sack

doi:10.4269/ajtmh.1983.32.804

Cited by 6 publications

(6 citation statements)

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“…Or > 10% weight loss during follow up. Powered for combined outcome of negative nutritional outcome vii Low ϑ, Ψ Oral Rehydration Solution Formulations Santosham 1983 [ 39 ] Panama Inpatient 3 mo - 2 y/o who were well nourished, with acute diarrhea (more than 3 watery stools per day) High potassium and chloride ORS, or standard WHO-ORS Standard diet for diarrhea management (aerated beverages, bananas, cereals, and apple sauce) 93 14 days Weight at day 14, weight gain at day 14 as percent of enrollment weight (power/sample size calculations not reported) Very low Ω, Φ, Ψ Ribeiro 1991 [ 40 ] Brazil Inpatient male infants less than 12 mo, with acute diarrhea and dehydration Standard WHO-ORS with 30 mmol/L alanine Standard WHO-ORS 18 7 days Weight gain at day 7 (power/sample size calculations not reported) Moderate Ω Faruque 1997 [ 21 ] Bangladesh Inpatient children 3–35 mo with acute non-dysenteric diarrhea Glucose based ORS Rice-powder based ORS 471 16 days Proportion with diarrhea at day 14, weight gain at day 16 (powered for outcomes of stool output, diarrhea duration and weight gain [70 g]) Low Φ, Ψ Alam 2009 [ 55 ] Bangladesh Severely malnourished (< 70% NCHS standard), inpatient infants 6–60 mo with acute diarrhea and culture-confirmed V. cholerae Glucose-based ORS, or Glucose-based ORS plus amylase resistant starch Rice-based ORS 137 6 weeks Time to attain 80% of median WLZ from enrollment; proportion with diarrhea at or after day 7 (power/sample size calculations not reported) Low Ω, Ψ Probiotics Boudraa 2001 [ 47 ] Algeria Inpatient children 3–24 mo with acute watery diarrhea (> 3 loose stools in the previous 24 h) Standard formula fermented with L. bulgaricus and S. thermophilus (lactose and calorically equivalent) Standard milk-based formula 97 7 days Weight gain at day 7 (power/sample size calculations not reported) Very low Ω, Φ, ϑ, Ψ …”

Section: Resultsmentioning

confidence: 99%

“…Three of the 6 high protein trials found a statistically significant improvement in weight associated with the intervention group, [ 10 , 43 , 44 ] as did 3 of the 6 zinc trials, [ 22 , 25 , 48 ] 1 of which also assessed vitamin A which did not appear to have a weight benefit [ 22 ]. Two of the 4 lactose-free diets [ 16 , 50 ] and 1 of 2 ORS trials demonstrated a significant benefit in weight [ 39 ]. This trial found a greater percent improvement in weight 14 days after presentation in the groups of children treated with ORS (90 mmol/l or 50 mmol/l of sodium) vs. no ORS but did not find a statistically significant difference when measured as absolute difference in weight.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to reduce post-acute consequences of diarrheal disease in children: a systematic review

et al. 2018

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BackgroundAlthough acute diarrhea often leads to acute dehydration and electrolyte imbalance, children with diarrhea also suffer long term morbidity, including recurrent or prolonged diarrhea, loss of weight, and linear growth faltering. They are also at increased risk of post-acute mortality. The objective of this systematic review was to identify interventions that address these longer term consequences of diarrhea.MethodsWe searched Medline for randomized controlled trials (RCTs) of interventions conducted in low- and middle-income countries, published between 1980 and 2016 that included children under 15 years of age with diarrhea and follow-up of at least 7 days. Effect measures were summarized by intervention. PRISMA guidelines were followed.ResultsAmong 314 otherwise eligible RCTs, 65% were excluded because follow-up did not extend beyond 7 days. Forty-six trials were included, the majority of which (59%) were conducted in Southeast Asia (41% in Bangladesh alone). Most studies were small, 76% included less than 200 participants. Interventions included: therapeutic zinc alone (28.3%) or in combination with vitamin A (4.3%), high protein diets (19.6%), probiotics (10.9%), lactose free diets (10.9%), oral rehydration solution (ORS) formulations (8.7%), dietary supplements (6.5%), other dietary interventions (6.5%), and antimicrobials (4.3%). Prolonged or recurrent diarrhea was the most commonly reported outcome, and was assessed in ORS, probiotic, vitamin A, and zinc trials with no consistent benefit observed. Seven trials evaluated mortality, with follow-up times ranging from 8 days to 2 years. Only a single trial found a mortality benefit (therapeutic zinc). There were mixed results for dietary interventions affecting growth and diarrhea outcomes in the post-acute period.ConclusionDespite the significant post-acute mortality and morbidity associated with diarrheal episodes, there is sparse evidence evaluating the effects of interventions to decrease these sequelae. Adequately powered trials with extended follow-up are needed to identify effective interventions to prevent post-acute diarrhea outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5092-7) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Interventions to reduce post-acute consequences of diarrheal disease in children: a systematic review

et al. 2018

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“…The patients of our study who received ORS also showed a significantly higher weight gain than those in the control group in the first few days after the treatment was initiated. This weight change probably reflects better rehydration of those patients in the ORS group and/or the effects of an increase in appetite (6,(11)(12)(13)19). Nevertheless, this comparative nutritional advantage of the use of ORS was not evident after the first week of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…There have also been several reports that have shown the many advantages of ORS when used in ambulatory children either in outpatient clinics or in community-based programs (11)(12)(13)(14). Solutions that contain 90 mmol/L of sodium (as recommended by WHO/UNICEF) as well as lesser concentrations of this ion (30-60 mmol/L) have proven effective and safe for the hydration of am-bulatory patients with minimal (subclinical) dehydrations (6,13,14).…”

mentioning

confidence: 99%

“…A number of clinical experiences, carried out in different countries, have clearly demonstrated that oral rehydration therapy is a highly successful technique for rehydration of patients hospitalized with diarrhea (7-10). There have also been several reports that have shown the many advantages of ORS when used in ambulatory children either in outpatient clinics or in community-based programs (11)(12)(13)(14). Solutions that contain 90 mmol/L of sodium (as recommended by WHO/UNICEF) as well as lesser concentrations of this ion (30-60 mmol/L) have proven effective and safe for the hydration of am-bulatory patients with minimal (subclinical) dehydrations (6,13,14).…”

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confidence: 99%

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The Use of Oral Hydration in the Treatment of Children with Acute Diarrhea in Primary Care

Delucchi,

Guiraldes,

Hirsch

et al. 1989

J. pediatr. gastroenterol. nutr.

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The use of oral rehydration solutions (ORSs) for treating children with diarrhea is spreading in hospitals in Chile, but it has not yet been incorporated into routine primary care programs. We sequentially compared the effectiveness of an ORS, with 60 mmol/L of Na+, with the standard treatment for diarrhea used in primary care centers, in a study with 285 diarrheal children under 2 years of age who consulted a health center in a low‐income periurban neighborhood of Santiago. When compared with the control group, the patients treated with ORS showed a significantly higher percentage weight gain in the first few days after treatment was begun, required fewer medical visits for follow‐up treatment at other facilities (8.4 vs. 15.5%; p < 0.05), and experienced fewer episodes of subsequent clinical dehydration that needed rehydration (oral or intravenous) in emergency services (2.8 vs. 10.6%; p < 0.01). In addition, there were no metabolic complications in either group. Our results reinforce the feasibility, efficaciousness, and safety of programs that use ORS at the primary care level and indicate that this is an effective method of preventing metabolic complications and reducing hospitalizations of children with acute diarrhea.

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