Emergency Department Study Supports Benefits of Giving Dehydrated Children Fluids by Mouth; Therapy is Quicker, Less Invasive Than IV Therapy

02/7/2005

PHILADELPHIA, Feb. 7 /PRNewswire/ -- Oral rehydration therapy, or giving fluids by mouth, is equally effective as giving intravenous fluids to young children dehydrated by common stomach and intestinal inflammations, according to a new study by emergency medicine physicians. Because oral therapy can be
started more quickly and is less painful for the child than IV treatment, the
researchers say it should be the preferred treatment for children with moderate dehydration.

The research, performed in the emergency department of The Children's
Hospital of Philadelphia, supports previous recommendations by expert groups such as the American Association of Pediatrics and the World Health
Organization. The study appears in the February issue of "Pediatrics."

Gastroenteritis, an inflammation of the stomach and intestine, causes stomach pain, diarrhea, fever and vomiting in young children, especially during the winter months. The loss of fluids may cause a potentially dangerous dehydration, resulting in some 10 percent of hospitalizations in American children under age five.

Busy hospital emergency departments, such as The Children's Hospital of
Philadelphia, see hundreds of children each year with this condition, frequently caused by infection with rotavirus. "Our study shows that oral rehydration therapy is as effective as intravenous fluid therapy in rehydrating moderately dehydrated children," said Philip Spandorfer, M.D., a pediatric emergency physician at The Children's Hospital of Philadelphia and primary researcher on the study. "Currently, the majority of pediatric emergency physicians continue to use IV therapy for these children, both
because they believe parents and referring physicians expect it, and because they believe oral therapy is time-consuming."

There are many benefits to oral rehydration therapy (ORT) that make it
more desirable than compared to intravenous fluid therapy (IVF). Patients
treated with ORT do not require intravenous access, a potentially painful and difficult procedure in young children. Also, parents who learn to administer
ORT correctly have acquired a skill that can be used at home for ongoing and
future illnesses.

A randomized controlled clinical trial was performed in the emergency department at Children's Hospital from December 2001 through April 2003. Seventy-three children between 8 weeks and 3 years were enrolled in the study. Patients were randomized to receive either oral rehydration therapy (ORT) or intravenous fluid therapy (IVF). Of the 73 patients, 36 were randomized to ORT and 37 to IVF. Less than one third of the group that received ORT required Hospitalization, whereas almost half of the IVF group was hospitalized. Patients in the ORT group received small amounts of fluid (Pedialyte) over a period of 4 hours. After instruction, parents provided the fluid (Pedialyte) to their children.

Half of the participants in both groups were rehydrated successfully in four hours. The time required to start therapy was less in the ORT group, at just under 20 minutes compared to 41 minutes in the IVF group. Physicians also obtained 72-hour post-ED visit information through a follow-up phone call to all participants. Researchers used sham IVs so that treating physicians did not know which children were in each group.

"By the end of the study, we realized that most families prefer to start with the oral rehydration therapy for treatment of moderate dehydration," said Dr. Spandorfer. "It is our hope that this study may support greater adoption of ORT by emergency physicians."

Dr. Spandorfer's co-authors were Evaline Alessandrini, M.D., M.S.C.E.; Mark D. Joffe, M.D.; Russell Localio, M.S.; and Kathy N. Shaw, M.D. All are from the Division of Emergency Medicine at The Children's Hospital of Philadelphia.

The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.

Contact:
Joey Marie McCool
Phone: (267) 426.6070
McCool@email.chop.edu