P0554 SEVERITY OF INFECTIOUS GASTROENTERITIS IS RELATED TO THE ETIOLOGY RATHER THAN TO THE AGE OF CHILDREN

Abstract

Introduction: Infants and younger children are generally considered to be at higher risk of acute diarrhea. Rotavirus (RV) is the most common and dangerous agent of diarrhea. Aim of the study was to assess whether etiology or age was the major determinant of diarrhea severity in children up to 4 years. Methods: Children of 1 month to 4 years of age admitted to 8 Italian hospitals with acute diarrhea were enrolled. All stool specimens were tested for RV. Clinical assessment was performed on admission and every day during the hospital stay. Body weight, number and characteristics of stools, vomiting, body temperature and hydration status were recorded daily. A score system was used to determine the severity of diarrhea. The severity of diarrhea was evaluated in RV positive(+) and RV negative(−) children into age groups of 0–6, 7–12, 13–24 and >24 months. Results: 911 children (480 males; mean age 17.9 m) were enrolled. RV was the most prevalent agent, found in 41% (372/911) of tested specimens. No statistical difference between rotaviral and non-rotaviral diarrhea group was observed in relation to sex, age, duration of diarrhea prior to admission. No statistical difference was observed in relation to breast-feeding for children under 1 year of age.The mean total duration of diarrhea and of hospital stay were significantly increased in RV+ compared to RV- children (6±0.2 days vs 5.4±0.2 p<0.05 and 5.1±0.2 days vs 4.5±0.2 p<0.01 respectively). At admission, the incidence of dehydration >5% was significantly higher in children RV+ than in RV- (30% vs 19% p<0.01). The need for parenteral rehydration and the duration of rehydration were increased in children with rotaviral gastroenteritis (74/222 vs 93/367 p<0.05 and 1.1±0.1 days versus 0.7±0.1 p<0.01 respectively). Overall, according to the score system, diarrhea was more severe in RV infection (11.7±2.9 vs 9.7±2.8 p<0.01). This pattern remained stable when the same parameters were analysed in RV+ and RV-matched for age. Mean durations of diarrhea and hospital stays, the need for parenteral rehydration, duration of rehydration and score were also analysed in relation to age. Irrespective to the etiology none of these parameters was statistically different in the different age groups. Conclusion: Etiology and not age is a major determinant of diarrheal severity. RV is the most common and aggressive enteric agent among those commonly responsible for acute diarrhea. Effective and safe antiRV-vaccine is strongly needed to reduce the morbidity of RV diarrhea.