Infantile Gastroenteritis Relationship Between Cause, Clinical Course. And Outcome

Areas of special risk and difficulty with management in children admitted to hospital for gastroenteritis have been prospectively investigated in 168 admissions to a major gastroenteritis unit. Children admitted to hospital for gastroenteritis were of young age (peak, six to 18 months), significantly underweight for age (P$lt0.01), and had a high incidence of previous medical disorder. Dehydration (40%), failed outpatient management (40%), and social reasons (11%) were the main indications for hospital admission. Most cases had a viral aetiology (59%), 12.3% had bacterial, and no pathogen was detected in 28%. Severe disease with dehydration (10.1% of total) was associated with young age (less than six months, P$lt0.05), female sex (P$lt0.05), a history of previous illness (P$lt0.01), a delay of more than 48 hours from onset to referral (P$lt0.05), and inappropriate preadmission management with antidiarrhoeals, antiemetics, and antibiotics rather than with oral rehydration (P$lt0.05). On a routine rehydration and refeeding routine, there were no deaths, no serious sequelae, with 80% of children recovering within four to seven days, although 30% of children temporarily had lactose-free diet for lactose intolerance. Persistent diarrhoea (lasting longer than seven days) occurred in 19% of children, predominantly in young infants (less than six months of age), in bacterial diarrhoea, and in the presence of lactose intolerance. It was concluded that early appropriate measures to prevent dehydration, identification of at-risk infants, and early detection of causes of delayed recovery may help further reduce morbidity from this potentially serious and common disorder. At-risk patients may require early admission to a unit suitably experienced in managing sick, dehydrated infants. Continuing medical supervision of the child in whom gastroenteritis seems merely one event in a series would appear appropriate.