Page 107 - 15Diarrhoeaandvomiting

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

mean percentage weight gain and the mean duration of hospital stay were also similar in the two
groups. [EL = 1−]
In another RCT from UK, 46 children admitted to a hospital were recruited for the study if they
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were aged between 6 weeks and 4 years, had diarrhoea with or without vomiting (duration less
than 5 days), had less than 5% dehydration, and gastroenteritis was the only disease present. The
children were randomly allocated to one of the three feeding regimens:
• re-feeding with full-strength cow’s milk (n = 16)
• clear fluids until diarrhoea settled followed by introduction of full-strength milk (n = 16)
• clear fluids until diarrhoea settled, followed by graded re-feeding in increasing
concentrations by a one-quarter-strength every 8 hours till full-strength achieved (n = 14).

Exclusion criteria were not defined and no details were provided about the process of
randomisation, concealment allocation or blinding. The study only assessed length of hospital
stay as an outcome, and there was no statistically significant difference between the three groups
for this outcome. [EL = 1−]
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In an RCT conducted in a hospital in Australia, 62 infants aged above 6 months with
gastroenteritis for less than 7 days but no other major illness were enrolled for the study. The
initial method of rehydration was not standardised but all children were taken off their normal
diet and given clear fluids either by mouth or intravenously. Following rehydration, infants were
randomly allocated to the graduated re-feeding group (half-strength milk for 24 hours and then
normal feeds, n = 31) or to immediate resumption of full-strength milk and normal food (n = 28).
The authors did not specify the randomisation process, concealment of allocation or blinding.
At the time of admission, the two groups of children were comparable regarding demographic
characteristics and severity of disease. The mean weight loss during the first 24 hours was lower in
the group of children receiving full-strength feeding compared with graded re-feeding group but
this difference was not statistically significant (−0.02 ± 0.25 kg versus −0.14 ± 0.21 kg; P > 0.05).
The full-strength feeding group also had a shorter stay in hospital but again the difference was not
statistically significant. [EL = 1−]

Another RCT, from South Africa, recruited 74 children aged between 3 and 36 months who
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were admitted to a hospital with acute gastroenteritis requiring IVT and who did not have
severe malnutrition or lactose intolerance at the time of admission. After rehydration with IVT,
the children were randomised to receive either immediate full-strength cow’s milk formula re-
feeding (n = 29) or graded re-feeding of half-strength for 24 hours, two-thirds-strength for the next
48 hours, and then full-strength cow’s milk (n = 32). The authors did not give details about the
exclusion criteria, process of randomisation, allocation concealment or blinding. About 18% of
the children (13/74) dropped out of the trial owing to lactose malabsorption. The main outcome
measure was duration of diarrhoea in days and there was no statistically significant difference
between the two groups (2.62 versus 2.46 days; P < 0.05). [EL = 1−]
In an RCT in the UK, 125 68 infants who were admitted in a hospital with acute gastroenteritis (of
less than 7 days’ duration) and mild or moderate dehydration were randomised to one of three re-
feeding groups. Following appropriate assessment and rehydration, the infants were randomised
to either immediate full-strength re-feeding with cow’s milk formula, graded re-feeding (in
quarter measures per 24 hours) with cow’s milk formula or immediate full-strength hydrolysed
whey protein formula. There were no statistically significant differences in the mean duration of
hospital stay or the incidence of vomiting between all three groups. However, there was better
weight gain in both the cow’s milk formula groups compared with the whey formula (P = 0.01)
and the best weight gain was in the immediate full-strength milk formula group. One-quarter of
the infants randomised to the whey formula refused to feed with it. [EL = 1−]
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An RCT conducted in Brazil evaluated the effect of juice intake during acute diarrhoea. The
trial included 90 male infants aged 4–18 months with an episode of acute diarrhoea (duration
less than 3 days prior to admission) and moderate dehydration. Children presenting with severe
dehydration or other conditions or concurrent serious illness, with history of chronic diarrhoea
and those exclusively breastfed were excluded from the study. After treating rehydration orally
with ORS solution over 6 hours, maintenance rehydration therapy was continued and infants
started on their usual diet of age-appropriate milk formulas/feedings and complementary foods.
As part of the usual diet, 30 infants were randomised to receive apple juice (AJ) twice daily, 30

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