15
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          The World Health Organization (WHO) recommends rapid intravenous rehydration, using fluid volumes of 70-100mls/kg over 3–6 h, with some of the initial volume given rapidly as initial fluid boluses to treat hypovolaemic shock for children with acute gastroenteritis (AGE) and severe dehydration. The evidence supporting the safety and efficacy of rapid versus slower rehydration remains uncertain.

          Methods

          We conducted a systematic review of randomised controlled trials (RCTs) on 11th of May 2017 comparing different rates of intravenous fluid therapy in children with AGE and moderate or severe dehydration, using standard search terms. Two authors independently assessed trial quality and extracted data. Non-RCTs and non-English articles were excluded. The primary endpoint was mortality and secondary endpoints included adverse events (safety) and treatment efficacy.

          Main results

          Of the 1390 studies initially identified, 18 were assessed for eligibility. Of these, 3 studies ( n = 464) fulfilled a priori criteria for inclusion; most studied children with moderate dehydration and none were conducted in resource-poor settings. Volumes and rates of fluid replacement varied from 20 to 60 ml/kg given over 1-2 h (fast) versus 2-4 h (slow). There was substantial heterogeneity in methodology between the studies with only one adjudicated to be of high quality. There were no deaths in any study. Safety endpoints only identified oedema ( n = 6) and dysnatraemia ( n = 2). Pooled analysis showed no significant difference between the rapid and slow intravenous rehydration groups for the proportion of treatment failures ( N = 468): pooled RR 1.30 (95% CI: 0.87, 1.93) and the readmission rates ( N = 439): pooled RR 1.39 (95% CI: 0.68, 2.85).

          Conclusions

          Despite wide implementation of WHO Plan C guideline for severe AGE, we found no clinical evaluation in resource-limited settings, and only limited evaluation of the rate and volume of rehydration in other parts of the world. Recent concerns over aggressive fluid expansion warrants further research to inform guidelines on rates of intravenous rehydration therapy for severe AGE.

          Electronic supplementary material

          The online version of this article (10.1186/s12887-018-1006-1) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references8

          • Record: found
          • Abstract: found
          • Article: not found

          European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014.

          These guidelines update and extend evidence-based indications for the management of children with acute gastroenteritis in Europe. The guideline development group formulated questions, identified data, and formulated recommendations. The latter were graded with the Muir Gray system and, in parallel, with the Grading of Recommendations, Assessment, Development and Evaluations system. Gastroenteritis severity is linked to etiology, and rotavirus is the most severe infectious agent and is frequently associated with dehydration. Dehydration reflects severity and should be monitored by established score systems. Investigations are generally not needed. Oral rehydration with hypoosmolar solution is the major treatment and should start as soon as possible. Breast-feeding should not be interrupted. Regular feeding should continue with no dietary changes including milk. Data suggest that in the hospital setting, in non-breast-fed infants and young children, lactose-free feeds can be considered in the management of gastroenteritis. Active therapy may reduce the duration and severity of diarrhea. Effective interventions include administration of specific probiotics such as Lactobacillus GG or Saccharomyces boulardii, diosmectite or racecadotril. Anti-infectious drugs should be given in exceptional cases. Ondansetron is effective against vomiting, but its routine use requires safety clearance given the warning about severe cardiac effects. Hospitalization should generally be reserved for children requiring enteral/parenteral rehydration; most cases may be managed in an outpatients setting. Enteral rehydration is superior to intravenous rehydration. Ultrarapid schemes of intravenous rehydration are not superior to standard schemes and may be associated with higher readmission rates. Acute gastroenteritis is best managed using a few simple, well-defined medical interventions.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Is this child dehydrated?

            The ability to assess the degree of dehydration quickly and accurately in infants and young children often determines patient treatment and disposition. To systematically review the precision and accuracy of symptoms, signs, and basic laboratory tests for evaluating dehydration in infants and children. We identified 1561 potential articles by multiple search strategies of the MEDLINE database through PubMed. Searches of bibliographies of retrieved articles, the Cochrane Library, textbooks, and private collections of experts in the field yielded an additional 42 articles. Twenty-six of 1603 reviewed studies contained original data on the precision or accuracy of findings for the diagnosis of dehydration in young children (1 month to 5 years). Two of the 3 authors independently reviewed and abstracted data for estimating the likelihood ratios (LRs) of diagnostic tests. We eliminated 13 of the 26 studies because of the lack of an accepted diagnostic standard or other limitation in study design. The other 13 studies were included in the review. The most useful individual signs for predicting 5% dehydration in children are an abnormal capillary refill time (LR, 4.1; 95% confidence interval [CI], 1.7-9.8), abnormal skin turgor (LR, 2.5; 95% CI, 1.5-4.2), and abnormal respiratory pattern (LR, 2.0; 95% CI, 1.5-2.7). Combinations of examination signs perform markedly better than any individual sign in predicting dehydration. Historical points and laboratory tests have only modest utility for assessing dehydration. The initial assessment of dehydration in young children should focus on estimating capillary refill time, skin turgor, and respiratory pattern and using combinations of other signs. The relative imprecision and inaccuracy of available tests limit the ability of clinicians to estimate the exact degree of dehydration.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The management of acute diarrhea in children in developed and developing areas: from evidence base to clinical practice.

              Acute diarrhea remains a major problem in children and is associated with substantial morbidity, mortality and costs. While vaccination against rotavirus could reduce the burden of the disease, the persistent impact of intestinal infections requires effective treatment in adjunct to oral rehydration solutions, to reduce the severity and duration of diarrhea. Several therapeutic options have been proposed for acute diarrhea, but proof of efficacy is available for few of them, including zinc, diosmectite, selected probiotics and racecadotril. However, at present there is no universal drug, and therapeutic efficacy has only been shown for selected drugs in selected settings, such as: outpatients/inpatients, developed/developing countries and viral/bacterial etiology. This narrative review reports the opinions of experts from different countries of the world who have discussed strategies to improve the management of diarrhea. More data are needed to optimize the management of diarrhea and highlight the research priorities at a global level; such priorities include improved recommendations on oral rehydration solution composition, and the reevaluation of therapeutic options in the light of new trials. Therapeutic strategies need to be assessed in different settings, and pharmacoeconomic analyses based on country-specific data are needed. Transfer to clinical practice should result from the implementation of guidelines tailored at a local level, with an eye on costs.
                Bookmark

                Author and article information

                Contributors
                mildred.iro@paediatrics.ox.ac.uk
                timotheus@doctors.org.uk
                nickjwbrown@gmail.com
                K.maitland@imperial.ac.uk
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central (London )
                1471-2431
                9 February 2018
                9 February 2018
                2018
                : 18
                : 44
                Affiliations
                [1 ]ISNI 0000 0004 1936 8948, GRID grid.4991.5, Oxford Vaccine Group, Department of Paediatrics and the NIHR Biomedical Research Centre, , University of Oxford, ; Headington, Oxford, OX3 7LE UK
                [2 ]ISNI 0000 0004 0417 0779, GRID grid.416642.3, Department of Paediatrics, , Salisbury District Hospital, ; Salisbury, SP2 8BJ UK
                [3 ]ISNI 0000 0001 0633 6224, GRID grid.7147.5, Department of Child Health, , Aga Khan University, ; Karachi, Pakistan
                [4 ]ISNI 0000 0001 2113 8111, GRID grid.7445.2, Department of Paediatrics, Faculty of Medicine, Wellcome Trust Centre for Clinical Tropical Medicine, , Imperial College, ; W2 1PG, London, UK
                [5 ]ISNI 0000 0001 0155 5938, GRID grid.33058.3d, Clinical Trials Facility, , KEMRI Wellcome Trust Research Programme, ; PO Box 230, Kilifi, Kenya
                Author information
                http://orcid.org/0000-0002-0007-0645
                Article
                1006
                10.1186/s12887-018-1006-1
                5807758
                29426307
                f29d00c4-9e07-44c9-8b29-2c1e3b10f6f3
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 May 2016
                : 23 January 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Pediatrics
                acute gastroenteritis,dehydration,intravenous rehydration,systematic review,emergency care,africa,asia

                Comments

                Comment on this article