For children with mild gastroenteritis and minimal dehydration, initiating diluted apple juice followed by their preferred fluids led to fewer treatment failures vs. electrolyte maintenance solution, according to findings from a study published in JAMA.

Electrolyte maintenance solution is recommended to treat and prevent dehydration in cases of gastroenteritis, a common pediatric condition. Its benefits, however, have not been demonstrated in minimally dehydrated children. Researchers from the University of Calgary and the University of Toronto conducted a randomized, single-blind noninferiority trial to assess whether oral hydration with dilute apple juice/preferred fluids was noninferior to electrolyte maintenance solution in children with mild gastroenteritis. 

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Between October and April during 2010–2015, 647 study patients aged 6–60 months with gastroenteritis and minimal dehydration were enrolled. They were randomized to receive either color-matched half-strength apple juice/preferred fluids (n=323) or apple-flavored electrolyte maintenance solution (n=324). Following discharge, the half-strength apple juice/preferred fluids group was given fluids as desired, and the electrolyte maintenance solution group replaced losses with additional solution. The primary outcome was a composite of treatment failure defined by any of the following events occurring within 7 days of enrollment: IV rehydration, hospitalization, subsequent unscheduled physician encounter, protracted symptoms, crossover, and ≥3% weight loss or significant dehydration at in-person follow-up. 

A total of 644 children (99.5%) completed follow-up. Researchers found that the children given diluted apple juice experienced less treatment failures than children given electrolyte maintenance solution (16.7% vs. 25.0%; difference –8.3%; P<0.001 for inferiority; P=0.006 for superiority). Also, there were fewer children receiving IV rehydration in the diluted apple juice/preferred fluids group vs. the electrolyte maintenance solution group (2.5% vs. 9.0%; difference -6.5%). Rates of hospitalization and diarrhea and vomiting frequency did not significantly differ between the groups. 

Use of diluted apple juice and preferred fluids as desired may be a suitable alternative to electrolyte maintenance fluids in children with mild gastroenteritis and minimal dehydration in many high-income countries, study authors concluded. 

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