Gradual introduction of feeding versus normal feeding in children with gastroenteritis
| Citation, country | Study group | Study type (level of evidence) | Outcome | Key results | Study weaknesses |
|---|---|---|---|---|---|
| Dugdale et al (1982), Australia | 59 inpatients older than 6 months (average 22 months) with acute gastroenteritis were given clear fluids and then allocated either to half strength milk for 24 h and then full strength milk and food or immediate normal milk and food | RCT | Hospital stay (days) | Immediate group 4.7; graduated group 5.4, p>0.5 | Small numbers ? length of clear fluids |
| Weight | During first 24 h of refeeding immediate group lost 0.02 (0.25) kg and the graduated group lost 0.14 (0.21), p> 0.05 | ||||
| Haque et al (1983), Saudi Arabia | 150 inpatients, all stages of dehydration between 1 month and 2 years of age randomised to three different feeding regimens: (1) clear fluids (6–24h) then gradual 1/4 strength milk reintroduction (2) clear fluids (6–24h) then full strength milk (3) continuing full strength milk | RCT | Increase in weight at discharge | (1) 0.4 (0.1) (2) 0.8 (0.2) (3) 1.2 (0.7) Not stat significant | Large proportion malnourished |
| Diarrhoea length (days) | (1) 3.0 (1.4) (2) 3.0 (1.3) (3) 3.8 (1.2) Not stat significant | ||||
| Vomiting length (days) | (1) 1.0 (1.1) (2) 1.8 ( 1.3) (3) 1.6 (1.2) Not stat significant | ||||
| Length in hospital (days) | (1) 3.1 (1.4) (2) 3.6 (1.2) (3) 3.8 (1.2) Not stat significant | ||||
| Placzek and Walker-Smith (1984), UK | 48 inpatients less than 18 months of age with gastro enteritis, >5% dehydration were after 24 h of GEM allocated to immediately full strength milk or gradual reintroduction | RCT | Complicated clinical course = recurrence of ether severe vomiting or watery diarrhoea with 2% or more reducing substances | 70% (16 ) of full strength group uncomplicated; 96% (24) of gradual group uncomplicated | Small numbers Alternate allocation = randomisation 20% not thriving |
| Rajah et al (1988), South Africa | 72 male black inpatients between 6 weeks and 2 years with prolonged dehydrating gastroenteritis (needing more than 72 h IV fluids) assigned to 4 different feeds; partially modified cows’ milk formula, a lactose free casein containing formula, a lactose free soy protein formula, a lactose free whey- hydrolysate formula | RCT | Stool weights in 3 days following formula change | Significant drop in stool weight AL110 p<0.01 Alfare p<0.05 Alsoy p<0.05 No change with Lactogen | Only male black children |
| Bhan et al (1988), India | 60 outpatients <5% dehydration between 3 and 24 months were fed either cereal based formula(A) or cows’ milk (B) | RCT | Duration of diarrhoea post intervention (days) | Gr A 11.0 (10.0) > gr B 7.6 (10.8) NS p>0.05 | Small numbers Difficulty comparing two preparations Selection criteria (close to hospital) ? compliance to treatment at home |
| Mean weight gain (g/kg/24h) | GrA 2.0 (4.2) < grB 5.8(7.8) significant p<0.05 | ||||
| Conway and Ireson (1989), Leeds | 200 well hydrated inpatients, formula fed, ages 6 weeks to 12 months, acute gastroenteritis Gr1: 24h dextrolyte and gradual reintroduction of SMA gold Gr2: special full strength HN25 untill stools normal, gradual substitution by SMA gold Gr3: continued full strength SMA gold cap Gr4: continued formula S | RCT | Time to discharge | Gr1 6.9 (3.2); Gr2 6.9 (1.9); Gr3 6.9 (2.2); Gr4 7.1 (3.6); NS | 117 had ORS before treatment, so is this immediate or delayed full strength feeding |
| Duration of diarrhoea (h) | Gr1 64 (53.7); Gr2 47 (53.7); Gr3 68 (43.6); Gr4 51 (41.5) NS | ||||
| Severity of diarrhoea | Gr2 0.8 (1.7) < Gr3 1.8 (1.5), p=0.05; group1 1.6 (1.7), gr4 1.4 (1.9) intermediate positions | ||||
| Weight gain | Day 2 Gr2,3,4 > Gr1 p=0.01; remains significant on day 5 p=0.05 | ||||
| Ooi et al (1989), Singapore | 70 inpatients mild/ moderate dehydration, age 1 week to 50 months, either graduated milk feeds or full strength soy feed | CT | Duration of hospitalisation (days) | Soy 2.8; milk group 2.5, not statistically different | Small numbers ?randomised ?effect on symptoms ?received clear fluids |
| Armitstead et al (1989), UK | 68 children, admitted or gastroenterology casualty, bottle fed, mild acute gastroenteritis dioralyte 24h plus: (1) gradual milk reintroduction (2) full strength milk (3) rapid regrade to whey hydrolysate formula | RCT | Hospital stay (days) | Gr1 4 (0.2); gr2 3.6 (0.6); gr3 3.5 (0.4) NS | ? sufficient number Bottlefed only (sponsored by Nestlé) Most mild dehydration |
| Reducing substances | None in all three groups | ||||
| Weight gain | Day 1–4: gr1 −0.35 (0.5); gr2 +0.65 (0.6); gr3 +0.15(0.2) | ||||
| Stool frequency | Day 1–4: grp1 4–2.2; grp2 3.7–1.6; grp3 4.3–2.5 | ||||
| Haffejee (1990), South Africa | 309 hospital patients age 3days to 28 months, acute diarrhoea, all stages of dehydration Formula fed children were randomised to their formula or soy based formula; breast fed children continued this and were divided in breast feeding only and breast feeding plus supplement | RCT | Recovery time (hrs) when hydration, weight and nature of stools were normal | Formula 70.5 (60.3); breast 60.9 (44.8); breast plus supplement 64.8 (43.3); soya 61.4 (43.5) p>0.05 NS | ?blinded No patient chracteristics (race, % dehydration) |
| Lifschitz et al (1991), USA | 8 children <5 months, mild to moderate dehydration, addition of 13C labelled rice at 6–22h and repeat at 14–17d later. Breath test measurement | CT | 13C in breath when ill and after recovery | Apparent absorption not different, 13 C diarrhoea 86.6%- recovery 94%. NS | Small numbers Boys only Mild/moderate dehydration only |
| Hoghton et al (1996), UK | 59 outpatient children <3 years old, <7 d gastroenteritis, <5% dehydrated; either immediate modified feeding + ORT (2) or ORT only for 24–48h after which modified food (no milk/wheat) (1) | PRCT, single blind | Median duration of diarrhoea | Grp1 66.5 h; grp2 56h p=0.4 not significant | Small numbers Mild dehydration only Parents assessed and charted symptoms (bias) |
| Median % weight change | Grp 1 0.005- grp 2 0.96 p=0.24 NS | ||||
| Complication rate | Similar, NS | ||||
| Sandhu et al (1997), Europe | 230 weaned European children under the age of 3 admitted to hospital; rehydrated with ORS for 4 hours, then Group A: immediate normal diet, Group B 20h of ORS then normal diet, breast feeding continued throughout | RCT | Weight gain | After rehydration weight gain grA 95g, grB 2g p=0.01; during hospitalisation grA> 200g, grB < 100g p=0.001; weight gain similar by day 5 and 14 | No severely dehydrated children |
| Complications | No significant diffences re complications |