Hospital management of children with acute gastroenteritis.

Eugenia Bruzzese, Andrea Lo Vecchio, Alfredo Guarino

Department of Pediatrics, University of Naples Federico II, Naples, Italy.

Current opinion in gastroenterology 2013 Jan

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Acute gastroenteritis (AGE) is a major cause of ED visits, hospitalizations, and prescription of investigations, drugs, and changes in diet. Several guidelines on management have been produced. There is new information on different rehydration protocols, use of antiemetics, and antidiarrheal drugs that could reduce the burden of AGE. The need of intravenous (i.v.) rehydration is the main cause of hospital admission yet a standardized rehydration scheme is not available. Rehydration therapy through nasogastric tube is better than i.v. rehydration, in children with moderate-severe dehydration. Ultrarapid rehydration has been proposed by enteric or i.v. route to reduce the time in hospital and costs. However, reduced rehydration times are associated with high readmission rates and side effects. Antiemetics may reduce the need of i.v. rehydration because of vomiting and the number of hospital admissions. However, the main antiemetic, ondansetron, has been loaded with a warning for potentially severe side effects. Selected antidiarrheal drugs could reduce the length of stay, but data on their use in inpatients are still not conclusive. Inappropriate medical interventions are still common in the hospital setting and have a high impact on costs. A validated management is still needed in inpatients.

Citation

Eugenia Bruzzese, Andrea Lo Vecchio, Alfredo Guarino. Hospital management of children with acute gastroenteritis. Current opinion in gastroenterology. 2013 Jan;29(1):23-30