Rinawi Firas, Ashkenazi Shai, Wilschanski Michael, Somekh Eli, Shamir Raanan
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center.
Department of Pediatrics A and Unit of Infectious Diseases, Schneider Children's Medical Center.
Harefuah. 2017 Mar;156(3):189-193.
The aim of these guidelines is to update and extend evidence-based recommendations for the diagnosis and management of children with acute gastroenteritis (AGE) in Israel, based on new data and the recently published European update.
The recommendations, which are based on a systematic review of the literature, were graded by the level of evidence. The guidelines were endorsed by the Israeli societies for Pediatric Gastroenterology, Pediatric Infectious Diseases and the Israeli Association of Pediatrics.
Gastroenteritis severity is mainly linked to etiology, and rotavirus is most frequently associated with dehydration. Dehydration reflects severity and should be monitored by established score systems. Laboratory tests are generally not needed. Oral rehydration with hypo-osmolar solution is the major treatment and should start as soon as possible. Breast-feeding should not be interrupted; regular feeding should usually be continued with no dietary changes including milk. Data suggest that in the hospital setting, in non-breast-fed infants and young children, lactose-free feeds can be considered in the management of gastroenteritis. Antimicrobial therapy should be given in exceptional cases. Hospitalization should generally be reserved for children requiring enteral/parenteral rehydration, and most cases may be managed in an outpatients setting. Enteral rehydration is superior to intravenous rehydration.
Implementation of the scientifically-based guidelines in clinical practice may improve the standard of care of pediatric AGE in Israel.
这些指南的目的是根据新数据和最近发布的欧洲更新内容，更新并扩展以色列儿童急性胃肠炎（AGE）诊断和管理的循证建议。
基于对文献的系统评价得出的建议，根据证据水平进行分级。这些指南得到了以色列儿科学会、儿科传染病学会和以色列儿科学会的认可。
胃肠炎的严重程度主要与病因有关，轮状病毒最常与脱水相关。脱水反映了疾病的严重程度，应通过既定的评分系统进行监测。一般不需要实验室检查。使用低渗溶液进行口服补液是主要治疗方法，应尽快开始。不应中断母乳喂养；通常应继续正常喂养，饮食无需改变，包括牛奶。数据表明，在医院环境中，对于非母乳喂养的婴幼儿，在胃肠炎管理中可考虑使用无乳糖喂养。抗菌治疗仅在特殊情况下使用。一般应将住院治疗留给需要肠内/肠外补液的儿童，大多数病例可在门诊处理。肠内补液优于静脉补液。
在临床实践中实施基于科学的指南可能会提高以色列儿科AGE的护理标准。
