Early versus Delayed Refeeding for Children with Acute Diarrhoea

Background 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. Objectives To compare the efficacy and safety of early and late reintroduction of feeding in children with acute diarrhoea. Search strategy 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. Selection criteria 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. Data collection and analysis 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. Main results Twelve trials involving 1283 participants were included; 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.