Gregorio Germana V, Dans Leonila F, Silvestre Maria Asuncion
Department of Pediatrics, University of the Philippines College of Medicine, Philippine General Hospital, Taft Avenue, Manila, National Capital Region, Philippines, 1000.
Cochrane Database Syst Rev. 2011 Jul 6;2011(7):CD007296. doi: 10.1002/14651858.CD007296.pub2.
Acute diarrhoea is one of the principal causes of morbidity and mortality among children in low-income countries. The cornerstone of treatment is oral rehydration therapy and dietary management. However, there is a lack of data and studies on both the timing and type of feeding that should be adopted during the course of the illness.
To compare the efficacy and safety of early and late reintroduction of feeding in children with acute diarrhoea.
In May 2011, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE, EMBASE, LILACS, and mRCT. We also contacted researchers and organizations, and searched reference lists.
Randomized controlled trials of early versus late refeeding among children less than 10 years old with acute diarrhoea. Early refeeding was defined as within 12 hours of start of rehydration and late refeeding was defined as more than 12 hours after start of rehydration.
Two authors independently assessed the search results and the risk of bias, and extracted data. We present risk ratios for dichotomous outcomes and mean differences for continuous outcomes. We combined the results of the trials using meta-analysis when heterogeneity was not substantial.
Twelve trials involving 1283 participants wereincluded; 1226 participants were used in the analysis (724 in the early refeeding group and 502 in the late refeeding group). Nine trials described their allocation sequence, but only two used concealed allocation. One trial reported single-blinding but did not clearly identify the person who was blinded. Early refeeding meant intake during or immediately after start of rehydration, while late refeeding meant intake only 20 hours to 48 hours after start of rehydration. Significant heterogeneity was noted in the data for the duration of diarrhoea. There was no significant difference between the two refeeding groups in the number of participants who needed unscheduled intravenous fluids (six trials with 813 participants), who experienced episodes of vomiting (five trials with 466 participants), and who developed persistent diarrhoea (four trials with 522 participants). The mean length of hospital stay was also similar (two trials with 246 participants).
AUTHORS' CONCLUSIONS: There was no evidence that early refeeding increases the risk of unscheduled intravenous fluid use, episodes of vomiting, and development of persistent diarrhoea. No conclusion could be made regarding the duration of diarrhoea.
急性腹泻是低收入国家儿童发病和死亡的主要原因之一。治疗的基石是口服补液疗法和饮食管理。然而，对于疾病过程中应采用的喂养时间和类型，缺乏数据和研究。
比较急性腹泻患儿早期和晚期重新引入喂养的疗效和安全性。
2011年5月，我们检索了Cochrane传染病小组专业注册库、CENTRAL（Cochrane图书馆2011年第1期）、MEDLINE、EMBASE、LILACS和mRCT。我们还联系了研究人员和组织，并检索了参考文献列表。
对10岁以下急性腹泻儿童进行早期与晚期重新喂养的随机对照试验。早期重新喂养定义为在补液开始后12小时内，晚期重新喂养定义为在补液开始后12小时以上。
两位作者独立评估检索结果和偏倚风险，并提取数据。我们给出二分结果的风险比和连续结果的均值差。当异质性不显著时，我们使用荟萃分析合并试验结果。
纳入了12项试验，涉及1283名参与者；1226名参与者用于分析（早期重新喂养组724名，晚期重新喂养组502名）。9项试验描述了其分配序列，但只有2项采用了隐藏分配。1项试验报告了单盲，但未明确指出被盲法的对象。早期重新喂养意味着在补液开始期间或之后立即摄入，而晚期重新喂养意味着仅在补液开始后20小时至48小时摄入。腹泻持续时间的数据存在显著异质性。在需要非计划静脉补液的参与者数量（6项试验，813名参与者）、经历呕吐发作的参与者数量（5项试验，466名参与者）以及出现持续性腹泻的参与者数量（4项试验，522名参与者）方面，两个重新喂养组之间没有显著差异。住院时间的均值也相似（2项试验，246名参与者）。
没有证据表明早期重新喂养会增加非计划静脉补液使用、呕吐发作和持续性腹泻发生的风险。关于腹泻持续时间无法得出结论。
