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Overview of childhood acute diarrhoea in Europe: implications for oral rehydration therapy
1Department of Pediatrics, University of Naples, Italy.
Insights
European children need oral rehydration solutions (ORS) with lower sodium and glucose concentrations than standard formulations. Current ORS use is low, necessitating improved access and education for effective hydration management.
Area of Science:
- Pediatrics
- Gastroenterology
- Public Health
Background:
- Acute diarrhea remains common in European children despite reduced infant mortality.
- Rotavirus and Campylobacter are leading infectious agents causing diarrhea in this age group.
- Existing oral rehydration solutions (ORS) may not be optimal for European children's specific fluid and electrolyte loss patterns.
Purpose of the Study:
- To evaluate the suitability of current ORS formulations for European children.
- To determine optimal sodium and glucose concentrations for ORS in this population.
- To highlight the low utilization of commercially available ORS and propose strategies for improved implementation.
Main Methods:
- Analysis of fluid and electrolyte losses in pediatric diarrhea cases in Europe.
- Review of existing literature on rotavirus, Campylobacter, and secretory diarrheas in children.
- Assessment of current ORS composition and recommended guidelines.
Main Results:
- Diarrheal fluid loss in European children suggests a need for ORS with lower sodium concentration (<90 mmol/l).
- Higher glucose concentrations (>110 mmol/l) may exacerbate diarrhea and hypernatremia, particularly in rotaviral enteritis.
- Commercial ORS use is notably low, with many children receiving inadequate "clear fluids" for rehydration.
Conclusions:
- A tailored ORS formulation with reduced sodium and glucose is recommended for European children.
- There is a critical need to increase the use of appropriate ORS through better implementation strategies.
- Effective rehydration in pediatric diarrhea requires both optimal ORS composition and widespread accessibility.
Abstract:
Infant mortality from acute diarrhoea has sharply declined in the last few decades throughout Europe. However, acute diarrhoea is still a very common occurrence in European children, who experience, in their first 3 years of life, approximately 1 episode/year. The commonest agent responsible for infectious diarrhoeas appears to be rotavirus, followed by campylobacter. Although water loss may be high, the mean sodium loss is close to 40 mmol/l of stool in rotaviral diarrhoea, and to 60 mmol/l in diarrhoeas due to invasive pathogens such as campylobacter and salmonella. Larger fluid losses but a somewhat lower sodium loss accompanies non-cholera secretory diarrhoeas, which appear to be commoner in infants than in older children. This evidence indicates that an ORS for European children should have a sodium concentration lower than 90 mmol/l which was primarily intended for use in developing countries. Clearly, the glucose concentration is crucial, as it is now evident that concentrations higher than the recommended 110 mmol/l may lead, particularly in rotaviral enteritis, to worsening of diarrhoea and development of hypernatraemia. Finally, it appears that in Europe the use of commercially available ORS is strikingly low, so that infants and children are often given a variety of "clear fluids", generally inadequate to ensure proper rehydration or maintenance of hydration. Thus an effort should be made not only to devise the "ideal" solution, but also to effectively implement its use.