Gastroenteritis is one of the illnesses most frequently seen in infants and children, and its effects can be devastating, especially in developing countries. And while clinicians agree that the rehydration of infants and children with gastroenteritis is crucial, there is significant disagreement on how to accomplish it. Despite the recommendations of many professional bodies, including a practice guideline issued by the American Academy of Pediatrics in 1996 in favor of enteral (oral or nasogastric) rather than parenteral rehydration, clinicians in many developed and developing countries continue to insist on IV rehydration. In an attempt to settle the argument, Fonseca and colleagues conducted a metaanalysis of 16 randomized, controlled trials involving 1,545 children from 11 different countries or regions, comparing IV and enteral administration.
The most noteworthy findings were that in developing countries enteral rehydration was associated with fewer seizures and fewer deaths from rehydration-related complications, findings that argue against the practice of IV rehydration in children. Even though the authors were not able to look specifically at age, nutritional status, or degree of hydration because of the varied designs of the studies, they did find that enteral rehydration led to shorter hospital stays and fewer adverse events than parenteral rehydration. The rates of weight gain and diarrhea were comparable. And although nasogastric rehydration was associated with a shorter course of diarrhea than IV rehydration, stool volume tended to be lower among children rehydrated intravenously (which may be because those children were eating less).
The authors conclude that there is "no evidence to support the ongoing use of IV therapy" in most cases of childhood gastroenteritis and voice their hope that enteral therapy will gain acceptance among clinicians worldwide. -Doug Brandt
Fonseca BK, et al. Arch Pediatr Adolesc Med 2004;158(5):483-90.