P0929 NEONATAL DIARRHEA: A MULTICENTER STUDY

Abstract

Introduction: Many aspects on epidemiology, etiology, treatment and nutrition of newborns with diarrhea are largely undefined. In addition, several chronic diarrheal diseases start in neonatal age and a prompt diagnosis to prevent severe dehydration and poor outcomes is advocated. The aims of the study were to investigate hospital admission rate, etiology, and management strategies in newborns with diarrhea. Methods: Clinical charts of all hospital admissions (from December 1999 to December 2002)of six neonatal care units were reviewed in a multicenter, retrospective study. Results: Diarrhea was the main cause of admission in 34 (24 term, 12 male, median birth weight 2.800 g, 12 breast fed; 10 preterm, 1 male, median birth weight 1.540 g; 2 breast fed) out of 5764 newborns admitted to neonatal units (hospital admission rate: 5.8/1 000/yr, without significant differences during 3 yrs study period). Median duration of hospital stay was 13 days (range 7–22). A definitive etiologic diagnosis was achieved in 24 cases (70.5%): 7 gastrointestinal infections (20.5%) (4 Rotavirus, 1 Salmonella, 1 ETEC, 1 Shigella), 6 cow’s milk allergy (CMA)(17.6%), and 5 antibiotic-associated diarrhea (14.7%), 1 parenteral diarrhea, 1 cystic fibrosis, 1 Hirschsprung’s disease, 1 SCID, 1 urea cycle disorder, 1 glucose-galactose transport defect (2.9%). Diarrhea was acute in 29, protracted in 3, and chronic in 2 patients. Parenteral re-hydration alone or in combination with ORS was adopted in 15 out of 34 newborns(44.1%), remaining cases were re-hydrated by ORS alone (55.9%). Excluding CMA-affected subjects (6/34), breast-feeding was continuated in all cases, and a hydrolysed formula was used in 9 out of the remaining 14 newborns (64%) as re-feeding strategy. Antibiotics were used in all cases of bacterial infections. The clinical outcomes, including diarrhea duration, weight gain and length of hospitalisation were not influenced by different re-hydration and re-feeding approaches. Conclusion: Diarrhea is an infrequent cause of hospital admission in neonatal age. Gastrointestinal infections and CMA are the most common etiologies. Practical guidelines for the optimal management of this condition are needed.