Published online June 1, 2005
PEDIATRICS Vol. 115 No. 6 June 2005, pp. 1788 (doi:10.1542/peds.2005-0459)
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Oral Versus Intravenous Rehydration of Moderately Dehydrated Children

Samuel Reid, MD
Pediatric Emergency Medicine
Children's Hospitals and Clinics
St Paul, MN 55102

To the Editor

I read with interest the study by Spandorfer et al,1 who are to be commended for their use of a rigorous methodology and a simplified scheme for oral rehydration therapy (ORT).

However, I believe that their conclusion that "ORT is as good as IVF [intravenous fluid] in rehydration of moderately dehydrated children due to gastroenteritis" is not supported by their data. The fact that 15.2% of their patients randomized to receive ORT were unable to perform ORT and required intravenous (IV) rehydration suggests that ORT is not as predictably useful as IV rehydration. Had they enrolled patients after 8 PM, one might guess that more patients would have been too tired to perform ORT and more parents would have been too tired to administer it.

I also feel that it is misleading to state that "patients treated with ORT had fewer hospitalizations" based on a treatment-received analysis. What matters to the physician trying to decide between the 2 therapies (and to his or her patients) is the intention-to-treat analysis. Based on the data set presented and the authors' intention-to-treat analysis, there was no difference in the hospitalization rates between patients receiving ORT and those receiving IV rehydration.

REFERENCE

  1. Spandorfer PR, Alessandrini EA, Joffe MD, Localio R, Shaw KN. Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial. Pediatrics. 2005;115 :295 –301[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics




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