NEW YORK (Reuters Health) – When oral rehydration is problematic, nasogastric administration of fluids is a good alternative for treating dehydrated children in resource-scarce settings, according to a review published in the March issue of Pediatrics.

The report notes that life-threatening dehydration affects at least 2 million children annually. “The effectiveness of oral and IV rehydration has been well established, although at times neither is available, effective, or possible,” write Dr. Shada Rouhani, with Massachusetts General Hospital in Boston, and colleagues.

The team examined the data on alternative nonoral and nonintravenous methods of pediatric rehydration. These included intraosseous rehydration (16 articles), nasogastric administration (12 articles), intraperitoneal rehydration (7 articles), subcutaneous delivery (3 articles) and rectal rehydration (no articles found).

Nasogastric rehydration was as effective as IV rehydration for moderate-to-severe dehydration, the researchers report. “Despite this fact, it is not as widely used as it could be,” they point out. “It is important to note that, unlike IV infusion, nasogastric infusion does not require sterile fluids but can rely on standard oral rehydration solutions, which makes it a more accessible technique in low-resource environments.”

The quality of evidence for other methods of rehydration is relatively poor, Dr. Rouhani and colleagues found. Nonetheless, intraosseous infusion is effective and easy to obtain, and is recommended by several guidelines when IV access cannot be obtained quickly.

Reliable evidence on the effectiveness of intraperitoneal rehydration is scarce, so the researchers say it can only be recommended if oral, nasogastric, IV and intraosseous rehydration fail. Similar advice applies to subcutaneous rehydration, and for rectal administration of fluids.

“Oral rehydration remains the preferred route for rehydration,” the authors advise in their conclusion. “When oral rehydration is not possible, our review suggests that nasogastric and IV rehydration have similar outcomes.”

However, other methods may have advantages in different circumstances, Dr. Rouhani and colleagues add, and “clinicians who work in resource-limited settings may wish to also consider these alternative methods when all other options fail or are not feasible.”

Reference:

Alternative Rehydration Methods: A Systematic Literature Review and Lessons for Resource-Limited Care


Pediatrics 2011;127.