Matt Silver

Half-strength apple juice followed by usual liquids is at least as good as electrolyte maintenance solution (EMS) in preventing treatment failures in children with gastroenteritis and minimal dehydration, according to results from a single-blinded, non-inferiority study, presented here on April 30 at the 2016 Annual Meeting of the Pediatric Academic Societies/American Society of Pediatric Nephrology (PAS/ASPN).

Although oral rehydration via EMS is the standard therapy for children in high-income countries with gastroenteritis, its advantage over other options in minimally dehydrated children has yet to be proven.

Stephen B. Freedman, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada and colleagues compared EMS to dilute/half-strength apple juice in 647 minimally dehydrated children aged 6 to 60 months of age seeking emergency-department care for gastroenteritis with ≥3 episodes of vomiting or diarrhoea in the preceding 24 hours and over 96 hours of symptoms.

Dr. Freedman and colleagues randomised the children to receive either colour-matched EMS or half-strength apple juice dispensed in opaque bottles. Caregivers were informed of the allocation assignment at discharge, and children were followed up with by telephone. Children in the EMS groups were instructed to replace all fluids with EMS, while children in the apple-juice group were told to use diluted apple juice followed by the usual fluids they would normally drink.

Children given diluted apple juice experienced treatment failure less often than those given EMS (16.7% vs 25.0%; P < .001 for inferiority), with children who were at least 12 months old benefitting the most.

Fewer children in the apple-juice group required intravenous rehydration, and hospitalisation rates were 2.8% versus 0.9% in the EMS and apple-juice groups, respectively. The frequency of diarrhoea and vomiting was similar between groups.

The 2016 Pediatric Academic Societies Annual Meeting is organised and sponsored entirely by the Pediatric Academic Societies: the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association, and the American Academy of Pediatrics.

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