ABC
La gestione del bambino con gastroenterite acuta
Management of acute gastroenteritis in children
Marta Massaro1, Claudio Germani1, Lorenzo Calligaris1, Silvana Schreiber1, Rosamaria Bortoluzzi2, Luca Ronfani3, Egidio Barbi1, Federico Marchetti4
1SC di Pediatria d’Urgenza e Pronto Soccorso Pediatrico, 2Direzione Professioni Sanitarie, 3Servizio di Epidemiologia e Biostatistica,
Istituto Materno-Infantile, IRCCS Pediatrico “Burlo Garofolo”, Trieste
4UOC di Pediatria e Neonatologia, Azienda Ospedaliera di Ravenna
Novembre 2012 - pagg. 570 -577
Abstract
Acute gastroenteritis (AG) is a very common disease in children. It causes significant mortality
in developing countries and significant economic burden to developed countries. Viruses
are responsible for approximately 70% of episodes of acute gastroenteritis in children
and rotavirus is one of the best studied of these viruses. Although guidelines exist to
assist clinicians, there is evidence that the treatment of paediatric AG varies considerably
from place to place, that Oral Rehydration Solution (ORS) is still underused and that children
frequently receive intravenous rehydration. In this paper the literature and international
guidelines on the epidemiology, diagnosis, management and prevention of AG and
its major complication, dehydration are reviewed; in particular a scale to evaluate the level
of dehydration and a detailed protocol for oral and intravenous rehydration are provided.
The correct approach to diet and the role of antiemetic drugs are also discussed.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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576 Medico e Bambino 9/2012
ABC
! La GA è il principale motivo di ricovero
ospedaliero in età pediatrica. Nel
70% dei casi la causa è virale (rotavirus
e norovirus in particolare).
! Il gold standard per stimare il livello
di disidratazione è il calcolo della percentuale
di peso corporeo. La perdita di
peso deve essere valutata sempre rispetto
alle condizioni cliniche del bambino.
! Alcuni segni hanno una buona correlazione
con il grado di disidratazione
(in particolare l’aumento del tempo di
riempimento capillare; l’aumento del
tempo di retrazione della plica cutanea;
la frequenza respiratoria aumentata).
! Nella maggioranza dei casi non è
raccomandata la raccolta delle feci per
effettuare indagini microbiologiche e
non vanno eseguiti esami ematici, consigliati
solo nel caso in cui si renda necessaria
una reidratazione per via endovenosa
(IVT). La presenza di chetonuria
nelle urine per valutare lo stato di
disidratazione è un segno del tutto
aspecifico e non andrebbe ricercata.
! Le linee guida supportano l’utilizzo
precoce della soluzione reidratante orale
(ORS). I bambini vanno reidratati secondo
protocolli ben definiti. In ambiente
ospedaliero per i bambini che rifiutano
di assumere la ORS è possibile utilizzare
la soluzione tramite il sondino naso-
gastrico.
! Le indicazioni per la IVT (con soluzioni
isotoniche per tutti i tipi di disidratazione)
sono molto ristrette: disidratazione
severa o non ripristino delle perdite
di liquidi nonostante assunzione
adeguata di ORS.
! La rialimentazione deve essere precoce
e non deve essere sospeso l’allattamento
al seno. Di regola non sono
necessarie formule prive di lattosio, né
è utile somministrare formule diluite.
! L’ondansetron è l’unico antiemetico
che presenta evidenze a favore dell’impiego
nella GA (0,15-0,20 mg/kg).
Andrebbe previsto nei casi in cui si sia
verificato un fallimento con il primo tentativo
di ORS.
MESSAGGI CHIAVE
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Corrispondenza: massaro.marta@gmail.com