Acute Infectious Gastroenteritis in Infancy and Childhood

Abstract

Background: Despite the introduction of vaccination against rotavirus, and even though it can often be treated on an outpatient basis, acute infectious gastroenteritis is nevertheless the second most common non-traumatic cause of emergency hospitaliza - tion in children aged 1 to 5 years, accounting for approximately 9% of cases (39 410 cases in 2017). The most common path - ogens are viruses (47% rotavirus, 29% norovirus, and 14% adenovirus).

Methods: This review is based on publications retrieved by a selective search in PubMed employing the terms "acute gastro - enteritis children" AND "dehydration" OR "rehydration" OR "prevention," and by manual searching (based, for example, on reference lists and expert knowledge), with subsequent evaluation including consideration of the relevant guidelines.

Results: The degree of dehydration can be judged from weight loss and other clinical findings. In 17 randomized controlled trials conducted on a total of 1811 children with mild or moderate dehydration, oral rehydration with oral rehydration solution was just as effective as intravenous rehydration with respect to weight gain, duration of diarrhea, and fluid administration, and was associated with shorter hospital stays (weighted mean difference, -1.2 days; 95% confidence interval [-2.38; -0.02]). Oral rehydration therapy failed in 4% of patients [1; 7]. In children who are vomiting or who refuse oral rehydration solution, continuous nasogastric application is just as effective as intravenous rehydration and is the treatment of first choice.

Conclusion: In Germany, children with mild or moderate dehydration are often hospitalized for intravenous rehydration therapy, despite the good evidence supporting ambulatory oral rehydration. Obstacles to intersectoral care, the nursing shortage, and inadequate reimbursement must all be overcome in order to reduce unnecessary hospitalizations and thereby lessen the risk of nosocomial infection.

Figure

Treatment algorithm for acute infectious gastroenteritis depending on the severity of clinical dehydration, according to (e61). Attention: the threshold values for percentage weight loss as an index of the degree of dehydration differ in infants and young children. ABS, acid–base status; BUN, blood urea nitrogen; CBC, complete blood count; CDS, Clinical Dehydration Score; CRT, capillary refilling time; Cl^-, chloride; Cr, creatinine; i. v., intravenous; K⁺, potassium; Na⁺, sodium; ORS, oral rehydration solution; ORT, oral rehydration therapy. * Heterogeneous evidence base—no general recommendation.

eFigure

Numbers of cases reported to the Robert Koch Institute (RKI): Campylobacter, norovirus, and rotavirus enteritis and salmonellosis, classified by age, in 5-year intervals. Source: Robert Koch Institute: survStat@RKI2.0, https://survstat.rki.de, accessed on 11.04.2020