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Management of acute gastroenteritis in children in Israel
R Shamir1, I Zahavi, T Abramowich
1Division of Gastroenterology and Nutrition, Schneider Children's Medical Center of Israel, Tel-Aviv University, Sackler School of Medicine, Petah Tikva, Israel.
Insights
Israeli pediatricians know about oral rehydration solutions (ORS) but don't fully follow updated American Academy of Pediatrics (AAP) dietary guidelines for gastroenteritis (GE). Implementation strategies are needed globally.
Area of Science:
- Pediatrics
- Gastroenterology
- Public Health
Background:
- Diarrheal diseases pose significant global health risks.
- The American Academy of Pediatrics (AAP) revised guidelines for managing acute gastroenteritis (GE), focusing on oral rehydration solutions (ORS) and diet.
- Understanding current pediatrician practices is crucial for effective guideline implementation.
Purpose of the Study:
- To assess Israeli pediatricians' knowledge and adherence to revised AAP guidelines for GE management.
- To investigate the influence of medical school origin and practice setting on GE management.
- To identify gaps in the implementation of updated pediatric gastroenteritis treatment protocols.
Main Methods:
- A cross-sectional study utilizing a written, multiple-choice questionnaire.
- Data collected from 87 pediatricians at two annual pediatrics meetings in Israel.
- Analysis of knowledge and reported practices regarding ORS and dietary management in GE.
Main Results:
- Pediatricians demonstrated 73% awareness of AAP guidelines and followed 60% of them.
- While 83% use ORS for dehydration, a majority (60-67%) incorrectly believe full-strength feeds are inappropriate during GE.
- 37% of pediatricians temporarily stop feeding, contrary to current recommendations; no significant differences were found based on medical school or practice type.
Conclusions:
- Israeli pediatricians are knowledgeable about ORS but lag in adopting recommended nutritional practices for GE.
- Current practices deviate from updated AAP guidelines, indicating a need for targeted implementation strategies.
- These findings highlight potential worldwide challenges in translating evidence-based guidelines into clinical practice.
Objective:
Diarrheal diseases are a major cause of morbidity and mortality worldwide. Guidelines about the use of oral rehydration solutions (ORS) and dietary management of acute gastroenteritis (GE) were recently revised and published by the American Academy of Pediatrics (AAP). Study aims were to examine Israeli pediatricians' knowledge and implementation of the revised AAP guidelines, the effect of medical school (Israeli versus foreign medical graduates) on the physicians' practice, and the effect of the type of practice (community vs hospital-based) on the management of gastroenteritis.
Methods:
A multiple-choice, written questionnaire was distributed at two pediatrics annual meetings.
Results:
A total of 87 pediatricians completed the questionnaire. They were aware of 73% of the current AAP guidelines and followed 60% of the guidelines. Most pediatricians (83%) use ORS for treatment of dehydration in GE, but 60% of pediatricians believe that full-strength feeds are inappropriate in the presence of GE, and 67% of them do not recommend full-strength formulas. In addition, 37% of the pediatricians stop feeding temporarily in the presence of GE, in contrast to the 1996 AAP guidelines. There were no differences in knowledge and management practices among pediatricians graduating in Israel, Europe, or the United States, and no differences between pediatricians working in an ambulatory setting or in a hospital.
Conclusions:
Pediatricians in Israel, regardless of country of origin, medical school, or place of practice, are aware of the correct use of ORS but do not follow nutritional practices recommended recently by the AAP. These findings suggest that steps for implementing the guidelines are needed in Israel and most probably worldwide.