B Rébeillé-Borgella1, C Barbier2, R Moussaoui1, A Faisant1, A-P Michard-Lenoir1, A Rubio3. 1. Service d'accueil des urgences pédiatriques, clinique universitaire de pédiatrie, hôpital couple enfants, CHU de Grenoble Alpes, 38000 Grenoble, France. 2. Service d'accueil des urgences pédiatriques, clinique universitaire de pédiatrie, hôpital couple enfants, CHU de Grenoble Alpes, 38000 Grenoble, France. Electronic address: CBarbier1@chu-grenoble.fr. 3. Service d'accueil des urgences pédiatriques, clinique universitaire de pédiatrie, hôpital couple enfants, CHU de Grenoble Alpes, 38000 Grenoble, France; Université Grenoble Alpes, 38000 Grenoble, France.
Abstract
INTRODUCTION: When oral rehydration is not feasible, enteral rehydration via the nasogastric route has been the ESPGHAN recommended method of rehydration since 2008, rather than intravenous rehydration (IVR), for children with acute gastroenteritis. However, these recommendations are rarely followed in France. Since 2011, in case of failure of oral rehydration, enteral rehydration has been used as a first-line therapy in the Children's Emergency Department at the Grenoble-Alpes University Hospital. PURPOSE: The aims of the study were to compare the length of the hospital stay, the duration of initial rehydration, and the incidence of complications and failure with the use of enteral nasogastric versus intravenous rehydration. METHODS: This study compared two cohorts of children (<3 years of age) with mild-to-moderate dehydration caused by acute gastroenteritis and failure of rehydration via the oral route. The first group (winter 2010-2011) was managed according to the previous protocol (intravenous rehydration). The second group (winter 2011-2012) was managed according the new protocol (nasogastric tube rehydration [NGR]). The rest of the gastroenteritis management was identical in both groups. RESULTS: A total of 132 children were included, 65 were treated with nasogastric tube rehydration (NGR) and 67 with intravenous rehydration. There was a significant reduction in the duration of hospitalization in the post-emergency unit in the NGR group: 23.6h vs 40.1h (P<0.05). The duration of initial rehydration was also significantly reduced (10.5h vs 22.0h). There was no significant difference regarding serious adverse events. However, the NGR group presented more mild adverse events (22 vs 7, P<0.05) and more treatment failures (15.3% vs 3%, P=0.013). CONCLUSION: Nasogastric rehydration reduces the duration of rehydration and the length of the hospital stay without increasing the incidence of serious adverse events for dehydrated children hospitalized for acute gastroenteritis.
INTRODUCTION: When oral rehydration is not feasible, enteral rehydration via the nasogastric route has been the ESPGHAN recommended method of rehydration since 2008, rather than intravenous rehydration (IVR), for children with acute gastroenteritis. However, these recommendations are rarely followed in France. Since 2011, in case of failure of oral rehydration, enteral rehydration has been used as a first-line therapy in the Children's Emergency Department at the Grenoble-Alpes University Hospital. PURPOSE: The aims of the study were to compare the length of the hospital stay, the duration of initial rehydration, and the incidence of complications and failure with the use of enteral nasogastric versus intravenous rehydration. METHODS: This study compared two cohorts of children (<3 years of age) with mild-to-moderate dehydration caused by acute gastroenteritis and failure of rehydration via the oral route. The first group (winter 2010-2011) was managed according to the previous protocol (intravenous rehydration). The second group (winter 2011-2012) was managed according the new protocol (nasogastric tube rehydration [NGR]). The rest of the gastroenteritis management was identical in both groups. RESULTS: A total of 132 children were included, 65 were treated with nasogastric tube rehydration (NGR) and 67 with intravenous rehydration. There was a significant reduction in the duration of hospitalization in the post-emergency unit in the NGR group: 23.6h vs 40.1h (P<0.05). The duration of initial rehydration was also significantly reduced (10.5h vs 22.0h). There was no significant difference regarding serious adverse events. However, the NGR group presented more mild adverse events (22 vs 7, P<0.05) and more treatment failures (15.3% vs 3%, P=0.013). CONCLUSION: Nasogastric rehydration reduces the duration of rehydration and the length of the hospital stay without increasing the incidence of serious adverse events for dehydrated children hospitalized for acute gastroenteritis.