Randomized Clinical Trial of Rapid Versus 24-Hour Rehydration for Children With Acute Gastroenteritis

Colin V. E. Powell, MD, FRACP, FRCPCH, Stephen J. Priestley, FACEM 3. Simon Young, ACEM,  4. Ralf G. Heine, MD, FRACP

Departments of aEmergency Medicine and Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia;

Department of Emergency Medicine, Sunshine Hospital, Melbourne, Australia;

Department of Pediatrics, School of Medicine, University of Cardiff, Cardiff, United Kingdom;

Department of Emergency Medicine, Nambour Hospital, Queensland, Australia;

Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia; and

Murdoch Childrens Research Institute, Melbourne, Australia

This local study adds to the body of literature showing that rapid nasogastric rehydration RNR  (over 4 hours) is as effective as more standard rehydration over 24 hours. The sample size wasn’t large enough to state this with a high degree of confidence for non-inferiority but the findings are still useful.

The article is available at:

http://pediatrics.aappublications.org/content/early/2011/09/21/peds.2010-2483.abstract

Our (RCH) regimen for RNR is at:

http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=12364#5

Mike

Objective: To compare the efficacy of 2 nasogastric rehydration regimens for children with acute viral gastroenteritis.

Methods: Children 6 to 72 months of age with acute viral gastroenteritis and moderate dehydration were recruited from emergency departments (EDs) at 2 metropolitan, pediatric, teaching hospitals. After clinical assessment of the degree of dehydration, patients were assigned randomly to receive either standard nasogastric rehydration (SNR) over 24 hours in the hospital ward or rapid nasogastric rehydration (RNR) over 4 hours in the ED. Primary (>2% weight loss, compared with the admission weight) and secondary treatment failures were assessed.

Results: Of 9331 children with acute gastroenteritis who were screened, 254 children were assigned randomly to receive either RNR (n = 132 [52.0%]) or SNR (n = 122 [48.0%]). Baseline characteristics for the 2 groups were similar. All patients made a full recovery without severe adverse events. The primary failure rates were similar for RNR (11.8% [95% confidence interval [CI]: 6.0%–17.6%]) and SNR (9.2% [95% CI: 3.7%–14.7%]; P = .52). Secondary treatment failure was more common in the SNR group (44% [95% CI: 34.6%–53.4%]) than in the RNR group (30.3% [95% CI: 22.5%–38.8%]; P = .03). Discharge from the ED after RNR failed for 27 patients (22.7%), and another 9 (7.6%) were readmitted to the hospital within 24 hours.

Conclusions: Primary treatment failure and clinical outcomes were similar for RNR and SNR. Although RNR generally reduced the need for hospitalization, discharge home from the ED failed for approximately one-fourth of the patients.

Mike
Prof Mike South,
Royal Children's Hospital, Parkville, Victoria 3052, Australia

www.mikesouth.org.au