Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children

 

Abstract

Background

Dehydration associated with gastroenteritis is a serious complication. Oral rehydration is an effective and inexpensive treatment, but some physicians prefer intravenous methods.

Objectives

To compare oral with intravenous therapy for treating dehydration due to acute gastroenteritis in children.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register (March 2006), CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to March 2006), EMBASE (1974 to March 2006), LILACS (1982 to March 2006), and reference lists. We also contacted researchers, pharmaceutical companies, and relevant organizations.

Selection criteria

Randomized and quasi-randomized controlled trials comparing intravenous rehydration therapy (IVT) with oral rehydration therapy (ORT) in children up to 18 years of age with acute gastroenteritis.

Data collection and analysis

Two authors independently extracted data and assessed quality using the Jadad score. We expressed dichotomous data as a risk difference (RD) and number needed to treat (NNT), and continuous data as a mean difference (MD). We used meta-regression for subgroup analyses.

Main results

Seventeen trials (1811 participants), of poor to moderate quality, were included. There were more treatment failures with ORT (RD 4%, 95% confidence interval (CI) 1 to 7, random-effects model; 1811 participants, 18 trials; NNT = 25). Six deaths occurred in the IVT group and two in the ORT groups (4 trials). There were no significant differences in weight gain (369 participants, 6 trials), hyponatremia (248 participants, 2 trials) or hypernatremia (1062 participants, 10 trials), duration of diarrhea (960 participants, 8 trials), or total fluid intake at six hours (985 participants, 8 trials) and 24 hours (835 participants, 7 trials). Shorter hospital stays were reported for the ORT group (WMD -1.20 days, 95% CI -2.38 to -0.02 days; 526 participants, 6 trials). Phlebitis occurred more often in the IVT group (NNT 50, 95% CI 25 to 100) and paralytic ileus more often in the ORT group (NNT 33, 95% CI 20 to 100, fixed-effect model), but there was no significant difference between ORT using the low osmolarity solutions recommended by the World Health Organization and IVT (729 participants, 6 trials).

Authors' conclusions

Although no clinically important differences between ORT and IVT, the ORT group did have a higher risk of paralytic ileus, and the IVT group was exposed to risks of intravenous therapy. For every 25 children (95% CI 14 to 100) treated with ORT one would fail and require IVT.

 

Plain language summary

Children with dehydration due to gastroenteritis need to be rehydrated, and this review did not show any important differences between giving fluids orally or intravenously

Dehydration is when body water content is reduced causing dry skin, headaches, sunken eyes, dizziness, confusion, and sometimes death. Children with dehydration due to gastroenteritis need rehydrating either by liquids given by mouth or a tube through the nose, or intravenously. The review of 17 trials (some funded by drug companies) found that the trials were not of high quality; however the evidence suggested that there are no clinically important differences between giving fluids orally or intravenously. For every 25 children treated with fluids given orally, one child would fail and require intravenous rehydration. Further, the results for low osmolarity solutions, the currently recommended treatment by the World Health Organization, showed a lower failure rate for oral rehydration that was not significantly different from that of intravenous rehydration. Oral rehydration should be the first line of treatment in children with mild to moderate dehydration with intravenous therapy being used if the oral route fails. The evidence showed that there may be a higher risk of paralytic ileus with oral rehydration while intravenous therapy carries the risk of phlebitis (ie inflammation of the veins).

 

摘要

背景

口服與靜脈液體補充治療孩童因腸胃炎導致之脫水的比較

與腸胃炎相關的脫水是一嚴重的併發症。口服液體補充是一有效且花費不多的治療，但有些醫師喜歡採用靜脈給予的方式。

目標

比較在治療孩童因急性腸胃炎導致之脫水的口服與靜脈療法。

搜尋策略

我們在the Cochrane Infectious Diseases Group Specialized Register (March 2006), CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to March 2006), EMBASE (1974 to March 2006), LILACS (1982 to March 2006), 以及參考文獻清單中搜尋。我們亦連繫了研究者、藥品公司及相關機構。

選擇標準

以隨機及半隨機對照試驗對靜脈液體補充治療(intravenous rehydration therapy, IVT)與口服液體補充治療(oral rehydration therapy, ORT)做比較。對象為罹患急性腸胃炎，年紀不超過18歲的孩童。

資料收集與分析

兩位作者採用Jadad 計分法來獨立篩選數據及評估品質。我們的二分數據以risk difference (RD)與number needed to treat (NNT)來表示，而連續數據則為weighted mean difference (WMD)。我們使用了metaregression進行次群體分析。

主要結論

17個品質從不良到中等的試驗(1181位受試者)納入資料分析。使用ORT治療有較多的失敗(RD 4%, 95% confidence interval (CI) 1 to 7, randomeffects model；1811個受試者，18個試驗；NNT = 25)。在4個試驗中，IVT組有6人死亡，ORT組則有2人死亡。下列的比較並無顯著差異：體重增加(369個受試者，6個試驗)，低鈉血症(248個受試者，2個試驗)或是高鈉血症(1062個受試者，10個試驗)，腹瀉時間(960個受試者，8個試驗)，或是6小時內液體攝入總量(985個受試者，8個試驗)及24小時內液體攝入總量(835個受試者，7個試驗)。在ORT組有較短住院時間(WMD1.20天，95% CI −2.38 to −0.02 days；526個受試者，6個試驗)。IVT組發生較多靜脈炎案例(NNT 50, 95% CI 25 to 100)，而麻痹性腸阻塞則較常發生在ORT組(NNT 33, 95% CI 20 to 100, fixedeffect model)，但使用WHO建議的低滲透壓溶液的ORT與IVT之間則無顯著差異(729個受試者，6個試驗)。

作者結論

雖然ORT與IVT在臨床上並無重大差異，ORT組確實有較高的麻痺性腸阻塞風險，而IVT組則暴露於靜脈治療的風險中。每25個使用ORT治療的孩童(95% CI 14 to 100)中，會有1個因失敗而需使用IVT。

翻譯人

本摘要由三軍總醫院洪乃勻翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

因腸胃炎導致脫水的孩童需要補充液體，此回顧並未顯示口服及靜脈給予液體有任何重大差異。脫水是身體水含量減少而會導致皮膚乾燥、頭痛、眼睛凹陷、頭暈、意識混淆、甚至死亡。孩童因腸胃炎導致的脫水需要補充液體，可經口、或透過管子經過鼻子、或由靜脈給予液體。回顧17個試驗(有些是由藥品公司資助)發現這些試驗品質並不高；不管如何，證據顯示經口或經靜脈給予液體並無重大差異。每25個經口給予液體的孩童中，就有1個會因治療失敗而需使用靜脈液體補充。另外，以WHO目前所建議的低滲透壓溶液來治療時發現口服液體補充有較低失敗率，但與靜脈液體補充相較時並無顯著差異。口服液體補充應作為孩童輕度至中度脫水的第一線治療，只有在口服途徑失敗時才使用靜脈途徑療法。證據顯示口服液體補充有較高的麻痺性腸阻塞風險，而靜脈治療則有靜脈炎發生的危險(即靜脈發炎)。