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Nutritional management




                           On day 1 there were no cases of recurrence in either group. On day 6 there was a significantly
                           greater number of recurrence cases in the lactose compared with the non-lactose group (52%
                           versus 21%; P < 0.05). [EL = 1−]

                           A pragmatic comparative trial recruited 316 children (age range 3 days to 28 months) admitted
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                           to a hospital in South Africa  with acute gastroenteritis (more than three liquid or watery stools
                           per day, and of less than 7 days’ duration) and dehydration. Exclusion criteria were diarrhoea
                           of  more  than  7  days’  duration,  ORS  solution  administration  for  5  days  prior  to  admission,
                           modifications to lactose consumed in the diet or withholding of food, inability to tolerate feeds,
                           and  not  having  a  milk/formula-based  diet  (older  children).  Children  were  randomised  (using
                           sealed envelopes) to one of four study groups. Following assessment and appropriate rehydration,
                           children were randomised to either cow’s milk formula (n = 120), breast milk (n = 79), breast
                           milk plus supplementation (n = 35) or soy formula (n = 75). The main outcome measures were
                           duration of diarrhoea and duration of diarrhoea corrected for age of child, duration of diarrhoea
                           prior to admission, and type of infective organism, all of which showed no statistically significant
                           differences between the four study groups. [EL = 1−]
                           Seventy-three infants (aged 2–12 months) with acute non-bloody diarrhoea (less than 7 days’
                           duration)  and  dehydration  (the  majority  were  mild)  were  enrolled  into  a  trial  in  a  Canadian
                           hospital. 136  Infants were excluded if they were breastfed, had been noted as intolerant to the
                           test formulas or were malnourished. Randomisation (using a random numbers table and coded
                           identically packaged formula) was to two treatment groups, to soy (n = 39) or cow’s milk (n = 44),
                           following appropriate rehydration within the first 24 hours. Parents were given a 14 day supply of
                           formula and kept a diary of observations of their child until clinical examination at day 14. There
                           were no statistically significant differences in weight gain between the two groups at 14 days or
                           in the median duration of hospital stay (not all infants were hospitalised). However, the mean
                           duration of diarrhoea was significantly less in the soy compared with the cow’s milk group (4.5
                           ± 3.6 days versus 6.6 ± 4.2 days; P < 0.01). [EL = 1−]

                           Soy formula in early and late re-feeding
                           Early versus late feeding with a soy formula was investigated in a trial involving 56 infants aged
                           between 2 and 12 months (mean 6 months) with acute diarrhoea (more than five watery stools in
                           the previous 24 hours, and of less than 7 days’ duration) and mild dehydration (>7% dehydration)
                           seen in a US hospital outpatient department or a private health clinic. 137  Exclusion criteria were
                           not presented. Following assessment, infants were randomised (using a random number tables;
                           no allocation or masking details were provided) to either ORS solution plus soy formula for
                           24 hours (n = 29) or ORS solution and water for the first 24 hours followed by half-strength soy
                           formula for next 24 hours and then full-strength soy formula (n = 27). They were then discharged
                           and seen daily in clinic or followed at home until resolution of diarrhoea. Outcome measures
                           were percentage resolved illness, duration of diarrhoea and percentage weight gain. The two
                           groups had similar characteristics at the start of the study. There was a statistically significantly
                           greater percentage of resolved illness in the early group versus the late group at the 48 hour time
                           point (72% versus 44%; P = 0.02) but at the post-48 hour time point the early group showed a
                           statistically significantly lower percentage of resolved illness compared with the late group (21%
                           versus 56%; P < 0.01). The mean duration of diarrhoea was also significantly shorter in the early
                           group compared with the late group (2.0 ± 0.2 days versus 2.7 ± 1.3 days; P = 0.02). However,
                           there were no statistically significant differences in the mean weight gain between the groups at
                           24 hours, at resolution of illness or at 2 weeks post therapy. [EL = 1−]

                           Cow’s milk formula versus a special formula
                           Sixty  infants  younger  than  2  years  (mean  age  9  months)  with  mild  acute  gastroenteritis  (no
                           definition given) and no dehydration presenting to a hospital outpatient department were enrolled
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                           in a trial in India.  Criteria for exclusion were prior antibiotic therapy, milk elimination during
                           current illness, concurrent non-gastrointestinal infections, gross blood in stools and moderate or
                           severe dehydration. Infants were randomised (using block randomisation and sealed envelopes)
                           to either milk-free formula (rice powder, mung bean powder, sugar, coconut oil) (n = 30) or cow’s
                           milk formula (n = 30) and followed up at home for at least 11 days. Trained observers visited the
                           children’s households every 3 days up until day 7 or until the child recovered. The two groups
                           had similar characteristics at the start of the study. There were three treatment failures, two in



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