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Master Thesis

Étude des facteurs de risque d’échec de réhydratation par sonde naso-gastrique lors des gastro-entérites aiguës virales de l’enfant

Abstract : Introduction: When oral rehydration fails, nasogastric (NG) rehydration is the second-line recommended therapy in pediatric acute gastroenteritis (AGE), since it has been shown to be as effective as intravenous (IV) rehydration. However, NG rehydration is underused in France due to parental and physician's reluctance. We aimed to identify risk factors for NG rehydration failure, namely the presence of intractable vomiting. Methods: A prospective case-control study was performed at the pediatric emergency department of the Grenoble Alpes University Hospital between 2014 and 2018. 477 children with mild-to-moderate dehydration due to viral AGE and requiring NG rehydration were included. Cases were defined as children with NG rehydration failure and therefore requirement for IV rehydration. Anamnestic and clinical data of cases and controls were compared. Results: The NG rehydration failure rate is 18%. 60% of children had intractable vomiting and 47% had intractable diarrhoea. Intractable vomiting were significantly more frequent in children with a NG rehydration failure: OR=2.92; [1.8-4.73], p=0.001 with more than a doubling of failure rate (22% versus 12%). Other observed risks factors were more than 5 vomiting episodes in the last 24 hours (p <0.0001) and a shorter duration of AGE (p 0.007) and vomiting (p 0.001). Intractable diarrhoea were significantly more frequent in children with a successful NG rehydration: OR of failure: 0.6 [0.37-0.97], p 0.037.Conclusion: Intractable vomiting was the only significant risk factor of NG rehydration failure in our population. These findings should encourage research on the indication of ondansetron in this context.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02418316
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Submitted on : Wednesday, December 18, 2019 - 4:46:24 PM
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Magali Marxgut. Étude des facteurs de risque d’échec de réhydratation par sonde naso-gastrique lors des gastro-entérites aiguës virales de l’enfant. Médecine humaine et pathologie. 2019. ⟨dumas-02418316⟩

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