An international consensus report on a new algorithm for the management of infant diarrhoea.
OBJECTIVE
Implementing international guidelines guarantees high standards of clinical care. A group of experts developed an algorithm to drive the management of common gastrointestinal symptoms in infancy by paediatricians and general practitioners.


METHODS
The algorithm started from the evidence-based recommendations of the European Society of Gastroenterology, Hepatology and Nutrition and the European Society of Pediatric Infectious Diseases and an updated review of the literature. We used the structured quantitative method of nominal group technique to reach a consensus.


RESULTS
A practical algorithm for the management of infants with acute diarrhoea was designed based on the consensus reached for each statement. The management of an infant with acute diarrhoea should include a sequence of actions: (i) a semiquantitative estimate of infant dehydration through validated clinical scores, (ii) rehydration therapy and early refeeding with breast milk or regular formula and (iii) effective agents to reduce the severity and duration of the diarrhoea. Finally, in children with prolonged diarrhoea, the search for aetiology should include persistent infections or reinfections, cows' milk protein allergy and coeliac diseases. Lactose should always be withdrawn.


CONCLUSIONS
This algorithm provides an evidence-based sequence of interventions to optimise the management of infants with acute diarrhoea.
Department of Translational Medical Science, Section of Paediatrics, University of Naples Federico II, Naples, Italy.
Andrea
A
Lo Vecchio
Department of Paediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Yvan
Y
Vandenplas
Department of Paediatrics, Emma Children's Hospital/AMC, Amsterdam, the Netherlands.
Marc
M
Benninga
Department of Paediatrics, University Hospital Cologne, Cologne, Germany.
Ilse
I
Broekaert
Nutrition and Dietetics Department, Chelsea and Westmister NHS Healthcare Foundation, London, UK.
Jackie
J
Falconer
Department of Paediatrics, Faculty of medicine, Jeanne de Flandre University Hospital, CHRU Lille, Lille, France.
Frederic
F
Gottrand
Department of Pediatrics, Section of Gastroenterology, Hepatology and Transplantation, Hospital Italiano, Buenos Aires, Argentina.
Carlos
C
Lifschitz
Department of Neuroscience, Pharmacology and Child Health, University of Florence-Meyer children's Hospital, Florence, Italy.
Paolo
P
Lionetti
Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia.
Rok
R
Orel
Gastroenterology Unit, First Department of Paediatrics, University of Athens, Children's Hospital "Agia Sofia", Thivon, Greece.
Alexandra
A
Papadopoulou
Paediatric Gastroenterology and Hepatology Unit, La Fe University Hospital, Valencia, Spain.
Carmen
C
Ribes-Koninckx
Paediatric Department, University of Insubria, Varese, Italy.
Silvia
S
Salvatore
Schneider Children's Medical Centre of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Raanan
R
Shamir
Paediatric Center, Clinique des Grangettes and Centre Médical Universitaire, Geneva, Switzerland.
Michela
M
Schäppi
Department of Translational Medical Science, Section of Paediatrics, University of Naples Federico II, Naples, Italy.
Annamaria
A
Staiano
Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
Hania
H
Szajewska
Gastroenterology Unit, Great Ormond Street Hospital and UCL Institute of Child Health, London, UK.
Nikhil
N
Thapar
Paediatric Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Michael
M
Wilschanski
Department of Translational Medical Science, Section of Paediatrics, University of Naples Federico II, Naples, Italy.
Alfredo
A
Guarino
D000208:Acute Disease; D000465:Algorithms; D002675:Child, Preschool; D003681:Dehydration / Q000175:diagnosis; D003967:Diarrhea / Q000175:diagnosis / Q000628:therapy*; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007223:Infant
Algorithm; Dehydration; Gastroenteritis; Infant diarrhoea; Prolonged diarrhoea