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PEDIATRICS Vol. 101 No. 5 May 1998, pp. 892-894

Management of Acute Gastroenteritis in Children in Israel

Received Apr 21, 1997; accepted Sep 5, 1997.

Raanan Shamir*, Ilan Zahavi*, Tova Abramowich*, Irit PorazDagger , Dalia Tal§, Shlomo Pollakparallel , and Gabriel Dinari*

From the * Division of Gastroenterology and Nutrition and Dagger  Dietetic Services, Schneider Children's Medical Center of Israel, Tel-Aviv University, Sackler School of Medicine, Petah Tikva, Israel; and § Dietetic Services and the parallel  Department of Pediatrics, Barzilai Medical Center, Ashkelon, Israel.

Objective.  Diarrheal diseases are a major cause of morbidity and mortality worldwide. Guidelines about the use of oral rehydration solutions (ORS) and dietary management of acute gastroenteritis (GE) were recently revised and published by the American Academy of Pediatrics (AAP). Study aims were to examine Israeli pediatricians' knowledge and implementation of the revised AAP guidelines, the effect of medical school (Israeli versus foreign medical graduates) on the physicians' practice, and the effect of the type of practice (community vs hospital-based) on the management of gastroenteritis.

Methods.  A multiple-choice, written questionnaire was distributed at two pediatrics annual meetings.

Results.  A total of 87 pediatricians completed the questionnaire. They were aware of 73% of the current AAP guidelines and followed 60% of the guidelines. Most pediatricians (83%) use ORS for treatment of dehydration in GE, but 60% of pediatricians believe that full-strength feeds are inappropriate in the presence of GE, and 67% of them do not recommend full-strength formulas. In addition, 37% of the pediatricians stop feeding temporarily in the presence of GE, in contrast to the 1996 AAP guidelines. There were no differences in knowledge and management practices among pediatricians graduating in Israel, Europe, or the United States, and no differences between pediatricians working in an ambulatory setting or in a hospital.

Conclusions.  Pediatricians in Israel, regardless of country of origin, medical school, or place of practice, are aware of the correct use of ORS but do not follow nutritional practices recommended recently by the AAP. These findings suggest that steps for implementing the guidelines are needed in Israel and most probably worldwide.

Key words: acute gastroenteritis, children, diarrhea, infant, dietary management, oral rehydration solutions.




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