Diarrheal mortality in US infants. Influence of birth weight on risk factors for death.
Parashar UD. Kilgore PE. Holman RC. Clarke MJ. Bresee JS. Glass RI.
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga., USA.
OBJECTIVES: To examine diarrhea-associated deaths among very low-birth-weight (VLBW) (< 1500 g) infants and low- and normal-birth-weight (LNBW) (> or = 1500 g) infants at birth and to identify specific interventions to prevent these deaths. DESIGN: Retrospective analyses of linked infant and birth death data on diarrhea of all causes compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Ga. PATIENTS: Infants aged 27 days through 11 months who died with diarrhea. SETTING: United States, 1991. RESULTS: A majority (56%, n = 143) of the 257 diarrhea-associated deaths reported among US infants in 1991 occurred among VLBW infants. Compared with LNBW infants, VLBW infants had a 100-fold greater diarrheal mortality (269 deaths per 100,000 live births for VLBW infants vs 2.8 deaths per 100,000 live births for LNBW infants), died at a younger age, and more often died in the hospital. Diarrhea-associated deaths among VLBW infants were strongly associated with prematurity and a low 1-minute Apgar score whereas African American race, less maternal education, and a low 1-minute Apgar score were associated with increased diarrheal mortality among LNBW infants. CONCLUSIONS: Infants of VLBW are at an increased risk for diarrheal deaths and new efforts are required to understand and improve the diagnosis of and therapy for diarrhea among these infants. For LNBW infants, diarrheal deaths remain a social problem and efforts need to focus on improved education and home-based rehydration therapy for children whose mothers fit the high-risk profile and who may lack adequate access to health care.
Frozen oral hydration as an alternative to conventional enteral fluids.
Santucci KA. Anderson AC. Lewander WJ. Linakis JG.
Department of Pediatric Emergency Medicine, Rhode Island Hospital, Providence, USA.
BACKGROUND: Oral hydration therapy is effective in dehydration, but is often bypassed or may fail. OBJECTIVE: To compare the tolerance (amount accepted minus amount vomited) of a frozen solution (FS) (Revital-ICE, PTS Labs, Deerfield, Ill) with the conventional glucose electrolyte solution (CS). DESIGN: Prospective, controlled crossover trial. SETTING: Pediatric emergency department. PARTICIPANTS: A convenience sample of 91 children with enteritis, 6 months to 13 years of age, with mild or moderate dehydration. INTERVENTION: Children were offered either FS or CS. Each group was offered 10 mL/kg of either product during a 90-minute trial period, in 3 equal aliquots, and was monitored for the quantities consumed and vomited. Complete treatment failures (absolute refusal) were crossed over to the alternate product and intake was recorded. MAIN OUTCOME MEASURES: Tolerance of the full 10 mL/kg of the original product offered and, for treatment failures, the percentage who tolerated the alternate product. RESULTS: Of the patients who initially received FS, 23 (55%) tolerated the full amount offered, compared with 5 (11%) in the CS group (P < .001). Of the 57% who completely refused CS, after crossover, 20% tolerated the full amount of FS and 33% tolerated between 5 and 9 mL/kg of FS and were discharged from the hospital. The original treatment failures for FS (12%) were crossed over to CS; none tolerated more than 5 mL/kg CONCLUSIONS: Children with mild or moderate dehydration are more likely to tolerate FS than CS. Conventional solution failures crossed over to FS had a greater tolerance rate than the reverse.