Oral rehydration solution therapy in the management of children with rotavirus diarrhea

Case fatality risk of diarrhoeal pathogens: a systematic review and meta-analysis

BACKGROUND

Estimates of the relative contribution of different pathogens to all-cause diarrhoea mortality are needed to inform global diarrhoea burden models and prioritize interventions. We aimed to investigate and estimate heterogeneity in the case fatality risk (CFR) of different diarrhoeal pathogens.

METHODS

We conducted a systematic review and meta-analysis of studies that reported cases and deaths for 15 enteric pathogens published between 1990 and 2019. The primary outcome was the pathogen-specific CFR stratified by age group, country-specific under-5 mortality rate, setting, study year and rotavirus vaccine introduction status. We developed fixed-effects and multilevel mixed-effects logistic regression models to estimate the pooled CFR overall and for each pathogen, controlling for potential predictors of heterogeneity.

RESULTS

A total of 416 studies met review criteria and were included in the analysis. The overall crude CFR for all pathogens was 0.65%, but there was considerable heterogeneity between and within studies. The overall CFR estimated from a random-effects model was 0.04% (95% CI: 0.026%-0.062%), whereas the pathogen-specific CFR estimates ranged from 0% to 2.7%. When pathogens were included as predictors of the CFR in the overall model, the highest and lowest odds ratios were found for enteropathogenic Escherichia coli (EPEC) [odds ratio (OR) = 3.0, 95% CI: 1.28-7.07] and rotavirus (OR = 0.23, 95% CI: 0.13-0.39), respectively.

CONCLUSION

We provide comprehensive estimates of the CFR across different diarrhoeal pathogens and highlight pathogens for which more studies are needed. The results motivate the need for diarrhoeal interventions and could help prioritize pathogens for vaccine development.

Probiotic, zinc and lactose-free formula in children with rotavirus diarrhea: are they effective?

BACKGROUND

The aim of the present study was to evaluate the effectiveness of zinc, probiotic bacteria, and lactose-free formula and their different combinations in the treatment of rotavirus diarrhea in young children.

METHODS

Eight different treatment groups were formed: group 1, 60 patients receiving Saccharomyces boulardii; group 2, 60 patients receiving zinc; group 3, 60 patients receiving lactose-free formula; group 4, 60 patients receiving S. boulardii plus zinc; group 5, 60 patients receiving S. boulardii plus lactose-free formula; group 6, 60 patients receiving zinc plus lactose-free formula; group 7, 60 patients receiving S. boulardii plus zinc plus lactose-free formula; group 8, 60 patients receiving only oral and/or parenteral rehydration solutions.

RESULTS

No statistically significant differences were found in the time to resolution of fever after intervention between the treatment groups and the control group. The time to resolution of vomiting was significantly lower in group 4 compared with groups 1 and 5. The duration of diarrhea was significantly reduced in groups 2 and 4 compared to control. A statistically significant difference in the duration of hospitalization was observed for the groups 2 and 4 in comparison to the control group.

CONCLUSIONS

A different combination of adjunct therapies did not seem to bring additional value to rehydration therapy in children with rotavirus diarrhea except for in those receiving only zinc and zinc plus S. boulardii. Further studies are required to determine the optimal protocol of adjunct therapy use in children with rotavirus diarrhea.

Treatment of mild to moderate dehydration in children with oral rehydration therapy

PURPOSE

To review current literature on the effectiveness of oral rehydration therapy (ORT) in the treatment of mild to moderate dehydration in children.

DATA SOURCES

Recommendations from American Academy of Pediatrics (AAP), World Health Organization (WHO), selected research articles (2000-2006), and Internet sources.

CONCLUSIONS

Dehydration is a common diagnosis in pediatric primary care. The literature indicates that dehydration is more often treated with intravenous (IV) therapy when ORT would be equally effective. ORT is an effective treatment for children with mild to moderate dehydration. ORT could be used more frequently rather than IV rehydration therapy. The use of ORT versus traditional methods of IV hydration matches the nursing philosophy of holistic care by enhancing client comfort and autonomy.

IMPLICATIONS FOR PRACTICE

Current practice in the treatment of mild to moderate dehydration in children does not match both AAP and WHO guidelines, which are based on evidence supporting ORT effectiveness. Treatment with ORT allows children more flexibility to be treated at home and thus decreases hospital stay. Evidence shows that the time required to initiate ORT is actually quicker than IV therapy and allows for a less stressful therapy that can be performed in the home.

Effects of nucleotide supplementation in milk replacer on small intestinal absorptive capacity in dairy calves

Milk replacer was supplemented with nucleotides and fed to dairy calves from birth through weaning to examine the potential for enhancing recovery of small intestinal function after enteric infection. Three treatments of 23 calves each were fed milk replacer (10% body weight/d) supplemented with no nucleotides (C), purified nucleotides (N), or nucleotides from an extract of Saccharomyces cerevisiae (S). Average daily gain, health scores, fecal dry matter, and fecal bacteria were monitored, and blood was analyzed for packed cell volume, glucose, blood urea nitrogen (BUN), and creatinine. Calves were monitored twice daily for fecal score, and 48 h after increased fecal fluidity was recorded, intestinal function was evaluated by measuring absorption of orally administered xylose (0.5 g/kg of body weight). Packed cell volume of blood was greater for treatment N for wk 2 and 5 compared with other treatment groups. Four calves per treatment were killed, and intestinal tissue was evaluated for morphology, enzyme activities, and nucleoside transporter mRNA expression. Treatment S calves had increased abundance of nucleoside transporter mRNA, numerically longer villi, and lower alkaline phosphatase than other groups. Growth measurements and plasma concentrations of glucose, BUN, creatinine, and IgG were not different between treatments; however, BUN-to-creatinine ratio was higher for treatment N, possibly indicating decreased kidney function. There were also no treatment effects on fecal dry matter and fecal bacteria population. However, N-treated calves had the highest detrimental and lowest beneficial bacteria overall, indicating an unfavorable intestinal environment. Supplementation of purified nucleotides did not improve intestinal morphology or function and resulted in higher fecal water loss and calf dehydration. Supplementation of nucleotides derived from yeast tended to increase calf intestinal function, provide a more beneficial intestinal environment, and improve intestinal morphology.

The use of oral rehydration solutions in children and adults

The observation that the intestinal Na(+)-glucose cotransporter remains intact in most diarrheal illnesses led to development of the life-saving, low-cost technology of oral rehydration salt (ORS) solutions. The primary therapeutic role of ORS solutions is in prevention and treatment of dehydration during management of acute gastroenteritis. Successful oral rehydration therapy involves early use of ORS with maintenance or timely resumption of regular feeding. Since the inception of the oral rehydration approach more than three decades ago, the widespread use of ORS solutions has revolutionized the management and outcomes of acute gastroenteritis in children and adults. The efficacy of the World Health Organization ORS solution and of commercial ORS formulations has been enhanced by reducing osmolarity. Newer formulations of ORS are under active investigation, with promise of added benefits, including promotion of intestinal healing. This article reviews fluid and electrolyte transport in the gastrointestinal tract, the pathophysiologic mechanisms of acute diarrhea, and the basis and formulation of current and newer ORS solutions. Guidelines for efficacious use of ORS in the management of acute gastroenteritis and short gut syndrome are also provided.

Glucose and electrolyte supplementation of drinking water improve the immune responses of poults with inanition

Enteric disorders predispose poultry to malnutrition. The objectives of this paper were 1) to simulate the inanition of poult enteritis mortality syndrome by restricting feed intake and 2) to develop a drinking water supplement that supports the immune functions of poults with inanition.

Poults were restricted to 14 g of feed/d for 7 d beginning at 14 d of age then fed ad libitum until 36 d (recovery). The control was fed ad libitum. During the feed-restriction period, duplicate groups of 6 poults received 1 of 5 drinking water treatments: 1) restricted feed, unsupplemented water; 2) restricted feed + electrolytes (RE); 3) RE + glucose + citric acid (REGC); 4) REGC + betaine (REGCB); or 5) REGCB + zinc-methionine (REGCBZ). Immunological functions were assessed by inoculating poults with SRBC and B. abortus (BA) antigen at 15, 22, and 29 d of age. Antibody (Ab) titers were determined 7 d later for primary, secondary, and recovery responses. The primary and secondary total Ab titers to SRBC for restricted feed were 4.71 and 6.16 log₃, which where lower (P < 0.05) than for controls (8.00 and 9.66 log₃) and the other treatments. The recovery Ab titer for controls was 10.7, significantly higher than restricted feed (8.71) and RE (8.10) groups but not different from other treatments. The primary total Ab responses to BA were significantly lower in the restricted feed and RE groups as compared with the control and other treatments. Although feed restriction of poults to maintenance reduces the humoral immune responses, these responses can be significantly improved by drinking water containing electrolytes and especially sources of energy such as glucose and citric acid.

Effect of oral administration of tormentil root extract (Potentilla tormentilla) on rotavirus diarrhea in children: a randomized, double blind, controlled trial

OBJECTIVES

To determine the effectiveness of tormentil root extract (TRE) for treatment of rotavirus diarrhea in children.

BACKGROUND

Rotavirus, one of the most widely spread pathogens of acute, dehydrating diarrhea in children, is estimated to cause >800 000 annual deaths of young children in developing countries. Currently no rotavirus vaccine is available. Management involves rehydration therapy. Available antiperistaltic or antisecretory drugs to reduce the severity of diarrhea can cause serious side effects in children.

METHODS

A randomized, double blinded, placebo-controlled trial was conducted at Children's Hospital for Infectious Diseases #3, St. Petersburg, Russia in 40 children ranging in age from 3 months to 7 years with rotavirus diarrhea. We constructed 2 groups for comparison: a treatment group that consisted of 20 children treated with tormentil root extract; and a control group of 20 children who received a placebo. All patients received 3 drops of tormentil root extract or placebo per year of life, three times daily until discontinuation of diarrhea, or a maximum of 5 days. An objective method was used to evaluate diarrhea, and physical examination was used to assess degree of dehydration in children.

RESULTS

The duration of diarrhea in the tormentil root extract treatment group was 3 days, compared with 5 days in the control group (P < 0.0001). In the treatment group 8 of 20 (40%) children were diarrhea-free 48 h after admission to the hospital, compared with 1 of 20 (5%) in the control group (P < 0.0001). Subjects in the treatment group received smaller volumes of parenteral fluids than subjects in the control group.

CONCLUSIONS

The administration of tormentil root extract in controlled doses shortened the duration of rotavirus diarrhea and decreased the requirement for rehydration solutions. Tormentil root extract appears to be an effective measure to treat rotavirus diarrhea in children.

Detection of pediatric respiratory and diarrheal outbreaks from sales of over-the-counter electrolyte products

OBJECTIVE

To determine whether sales of electrolyte products contain a signal of outbreaks of respiratory and diarrheal disease in children and, if so, how much earlier a signal relative to hospital diagnoses.

DESIGN

Retrospective analysis was conducted of sales of electrolyte products and hospital diagnoses for six urban regions in three states for the period 1998 through 2001.

MEASUREMENTS

Presence of signal was ascertained by measuring correlation between electrolyte sales and hospital diagnoses and the temporal relationship that maximized correlation. Earliness was the difference between the date that the exponentially weighted moving average (EWMA) method first detected an outbreak from sales and the date it first detected the outbreak from diagnoses. The coefficient of determination (r2) measured how much variance in earliness resulted from differences in sales' and diagnoses' signal strengths.

RESULTS

The correlation between electrolyte sales and hospital diagnoses was 0.90 (95% CI, 0.87-0.93) at a time offset of 1.7 weeks (95% CI, 0.50-2.9), meaning that sales preceded diagnoses by 1.7 weeks. EWMA with a nine-sigma threshold detected the 18 outbreaks on average 2.4 weeks (95% CI, 0.1-4.8 weeks) earlier from sales than from diagnoses. Twelve outbreaks were first detected from sales, four were first detected from diagnoses, and two were detected simultaneously. Only 26% of variance in earliness was explained by the relative strength of the sales and diagnoses signals (r2 = 0.26).

CONCLUSION

Sales of electrolyte products contain a signal of outbreaks of respiratory and diarrheal diseases in children and usually are an earlier signal than hospital diagnoses.