Consenso Internacional de Gastroenteritis Aguda en Urgencias. Comité de Emergencias SLACIP (Sociedad Latino Americana de Cuidados Intensivos Pediátricos)
Palabras clave:
deshidratación, manejo gastroenteritis aguda, rehidrataciónResumen
Este documento pretende poner al alcance de todo profesional de salud una guía actualizada en el diagnóstico y manejo de la gastroenteritis aguda en pediatría, ya que esta enfermedad es una de las principales causas de consultas y hospitalizaciones. Se realizó una revisión exhaustiva de la literatura proponiendo una herramienta útil con el objetivo de reducir el impacto de la enfermedad en términos de incidencia, morbilidad y mortalidad. El tratamiento de la gastroenteritis debe ir dirigido a la prevención de la deshidratación y el desequilibrio electrolítico que produce, con líquidos adecuados, sales de rehidratación oral y el mantenimiento de la alimentación oral. La causa de esta enfermedad es principalmente viral y los criterios para el uso de antibióticos es controversial. Los coadyuvantes para disminuir el tiempo de enfermedad así como la frecuencia de la diarrea, en muchos de los casos están en estudio; por lo tanto el manejo guiado, estructurado y sistematizado garantizará en muchos casos el éxito del tratamiento de la gastroenteritis en los niños.
Conflicto de intereses: Los autores declaran no poseer conflicto de interés
Recibido: 22/08/2017. Aprobado: 28/12/2017.
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2. Karas J et al. Developing a core outcome measurement set for clinical trials in acute diarrhea. ActaPaediatrica 2016. 105, pp. e176-e180.
3. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H, European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; European Society for Pediatric Infectious Diseases.European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J PediatrGastroenterolNutr. 2014 Jul;59(1):132-52.
4. O Ryan M, Rierra Montes M, et al. Norovirus in Latin America Systematic Review and meta-analysis. Pediatr Infect Dis J. 2017;36:127-134
5. Grupo Ibero-Latinoamericano sobre el Manejo de la Diarrea Aguda (GILA). Guía de práctica clínica ibero-latinoamericana sobre el manejo de la gastroenteritis aguda en menores de 5 años. AnPediatr (Barc) 2014;80(Supl 1):1-57.
6. Acute Gastroenteritis Guideline Team, Cincinnati Children's Hospital Medical Center: Evidence-based care guideline for prevention and management of Acute Gastroenteritis (AGE) in children age 2 months to 18 years. http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/gastroenteritis/ Guideline 5, pages 1-20, Dec 21, 2011.
7. Lo Vecchio A, Vandenplas Y, Benninga M, Broekaert I, Falconer J, Gottrand F, et al. An international consensus report on a new algorithm for the management of infant diarrhoea. Actapaediatrica 2016 Aug;105(8):e384-9.
8. Goldman RD, Friedman JN, Parkin PC. Validation of the clinical dehydration scale for children with acute gastroenteritis. 2008 Sep;122(3):545-9.
9. Gorelick MH, Shaw KN, Murphy KO. Validityvand reliability clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997;99:e6.
10. Gravel J, Manzano S, Guimont C, Lacroix L, Gervaix A, Bailey B. Multicenter validation of the clinical dehydration scale for children. Arch Pediatr 2010;17:1645-51.
11. Schnadower D et al. Validation of the Modified Vesikari Score in Children with Gastroenteritis in 5 U.S. Emergency Departments. J PediatrGastroenterolNutr. 2013 October ; 57(4): 514-519.
12. Lewis K. Vesikari clinical severity scoring manual. PATH. 2011. http://www.path.org/publications/files/VAD_vesikari_scoring_manual.pdf
13. Guarino A et al. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases Evidence-based Guidelines for the Management of Acute Gastroenteritis in Children in Europe. Journal of Pediatric Gastroenterology and Nutrition 2008. 46:S81-S184
14. Lee G et al. A Comparison of Diarrheal Severity Scores in the MAL-ED Multisite Community-Based Cohort Study. JPGN 2016;63: 466-473
15. Dalby-Payne JR, Elliott EJ. Gastroenteritis in children. ClinEvid. 2011 Jul 26;2011. pii:0314.
16. Fonseca BK, Holdgate A, Craig JC. Enteral vs. intravenous rehydration therapy for children with gastroenteritis: a meta-analysis of randomized controlled trials. Arch PediatrAdolesc Med. 2004;158:483-90.
17. Hartling L, Bellemare S, Wiebe N, et al. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD004390. D
18. Bellemare S, Hartling L, Wiebe N, et al. Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials. BMC Med. 2004;2:11.
19. Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database Syst Rev (online) 2009;CD002847.
20. Florez I et al. The effectiveness and safety of treatments used for acute diarrhea and acute gastroenteritis in children: protocol for a systematic review and network meta-analysis. Systematic Reviews (2016) 5:14 DOI 10.1186/s13643-016-0186-8.
21. Gregorio GV, Dans LF, Silvestre MA. Early versus delayed refeeding for children with acute diarrhoea. Cochrane Database Syst Rev 2011;7:CD007296.
22. Suárez L, Cano B. Current management of acute gastroenteritis (AGE) with oral rehydration solutions. NutrClin Diet Hosp. 2009;29:6-14.
23. Gutiérrez-Castrellón P, Polanco I, Salazar E. An evidence based Iberic-Latin American guideline for acute gastroenteritis management in infants and prescholars. An Pediatr (Barc). 2010;72:e1-220.
24. Lehert P, Cheron G, Calatayud GA, et al. Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis. Dig Liver Dis. 2011;43:707-13.
25. Gutiérrez-Castrellón P, Polanco Allué I, Salazar Lindo E. AnevidencebasedIberic-Latin American guidelineforacute gastroenteritis management in infants and prescholars [Manejo de la gastroenteritis aguda en menores de 5 años: un enfoque basado en la evidencia. Guía de práctica clínica ibero-latinoamericana]. AnPediatr (Barc) 2010;71:e1-220.e20. Disponible en: http://xa.yimg.com/kq/groups/23751477/1015766879/name/Gastroenteritis.pdf.
26. Hao R, De Vera M, Resurrección E. Racecadoril in the treatment of acute diarrhoea in children: a meta-analysis. PIDSP Journal. 2010;11(2):19-32.
27. Chacón J. Analysis of factors influencing the overall effect of racecadotril on childhood acute diarrhoea. Results from a real-word and post-authorization surveillance study in Venezuela. TherClinRiskManag. 2010;6:293-299.
28. Gutiérrez-Castrellón P, Acosta-Bastidas M, Llamosas Gallardo B, et al. Ensayo clínico aleatorizado y análisis farmacoeconómico del impacto de racecadotrilo como coadyuvante en el tratamiento de la gastroenteritis aguda sobre la reducción de los gastos hospitalarios relacionados en lactantes menores de 24 meses en México. Rev Invest Clin. 2011.
29. Rautenberg TA, Zerwes U, Foerster D, et al. Evaluating the cost utility of racecadotril for the treatment of acute watery diarrhoea in children: the RAWD model. Clinicoecon Outcomes Res. 2012;4:109-16.
30. Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. The Cochrane library 2012. CD005436)
31. Patel A, Mamtani M, Dibley MJ, et al. Therapeutic Value of Zinc Supplementation in Acute and Persistent Diarrhea: A Systematic Review. PLoS ONE 2010;5(4):e10386.
32. Patro B, Golicki D, Szajewska H. Meta-analysis: zinc supplementation for acute gastroenteritis in children. Aliment PharmacolTher. 2008;28:713-23.
33. Lukacik M, Thomas RL, Aranda JV. Metaanalysis of the effects of oral zinc in the treatment of acute and persistent diarrhoea. Pediatrics. 2008;121(2):326-36.
34. Brown KH, Peerson JM, Baker SK, et al. Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food Nutr Bull. 2009 Mar;30(1 Suppl):S12-40.
35. Haider BA, Bhutta ZA. The effect of therapeutic zinc supplementation among young children with selected infections: a review of the evidence. Food Nutr Bull. 2009;30:S41-59.
36. DuPont C, Foo JL, Garnier P, et al. Peru and MalasiaDiosmectite study. Oral diosmestite reduces stool output and diarrhoea duration in children with acute watery diarrhoea. ClinGastroenterolHepatol 2009;7:456-62.
37. Dupont C, Vernisse B. Anti-diarrheal effect of diosmectite in the treatment of acute diarrhoea in children. A review. Paediatric Drugs. 2009;11(2):89-99.
38. Mujawr QM, Naganoor R, Ali MD, et al. Efficacy of dioctahedralsmectite in acute watery diarrhoea in Indian children: a randomized clinical trial. J Trop Pediatr 2012;58:63-7.
39. Szajewska H, Dziechciarz P, Mrukowicz J. Meta-analysis: Smectite in the treatment of acute infectious diarrhoea in children. Aliment PharmacolTher. 2006;23:217-27
40. Carter B, Fedorowicz Z. Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework. BMJ Open 2012;2.
41. Dalby-Payne JR, Elliot EJ. Gastroenteritis in children. ClinEvid (online). 2009;PMCID: PMC2907797.
42. DeCamp LR, Byerley JS, Doshi N, et al. Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis. ArchiPediatAdolesc Med. 2008;162(9):858-65.
43. Brenner S, Boucher J. Fatal Cardiac Arrest in 2 Children. Possible Role of Ondansetron. PediatrEmer Care 2016;32: 779-784.
44. AImdad A, Herzer K, Mayo-Wilson E, et al. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. The Cochrane library. 2010;DOI:10.1002/ 14651858.CD008524. b
45. Long KZ, Santos JI, Rosado JL, et al. Vitamin A supplementation modifies the association between mucosal innate and adaptive immune responses and resolution of enteric pathogen infections.Am J ClinNutr. 2011 Mar;93(3):578-85.
46. Long KZ, Garcia C, Ko G, et al. Vitamin A modifies the intestinal chemokine and cytokine responses to norovirus infection in Mexican children. J Nutr. 2011 May;141(5):957-63. doi: 10.3945/jn.110.132134. Epub 2011 Mar 16.
47. Urbariska M, Gieruszczak-Bialek D, Szajewska H. Systematic review with meta-analysis: Lactobacillus reuteri DSM 17938 for diarrhoeal diseases in children . Aliment PharmacolTher. 2016 May;43(10):1025-34.
48. Allen SJ, Martinez EG, Gregorio GV, et al. Probiotics for treating acute infectious diarrhea. Cochrane Database Syst Rev. 2010;11:CD003048.
49. Guandalini S. Probiotics for prevention and treatment of diarrhoea. J ClinGastroenterol. 2011;45(suppl):S149-53.
50. Correa NBO, Penna FJ, Lima FM, et al. Treatment of acute diarrhoea with Saccharomyces boulardii in infants. J PediatrGastroenterolNutr. 2011;53:497-501.
51. Chmielewska A, Ruszczynski M, Szajewska H. Lactobacillus reuteri strain ATCC 55730 for the treatment of acute infectious diarrhoea in children: a meta-analysis of randomized controlled trials. PediatriaWspolczesna. 2008;10(1):32-6.
52. Szajewska H, Wanke M, Patro B. Meta-analysis: the effects of Lactobacillus rhamnosus GG supplementation for the prevention of healthcare-associated diarrhoea in children. Aliment PharmacolTher. 2011;34(9):1079-87.
53. Vandenplas Y. PROBIOTICAL-study group. Randomised clinical trial: the synbiotic food supplement Probiotical vs. placebo for acute gastroenteritis in children. Aliment PharmacolTher. 2011;34:862-7.
54. Passariello A, Terrin G, Cecere G, et al. Randomised clinical trial: efficacy of a new synbiotic formulation containing Lactobacillus paracasei B21060 plus arabinogalactan and xilooligosaccharides in children with acute diarrhoea. Aliment PharmacolTher. 2012;35:782-8.
55. Hobson M, Ranjit S.Pediatric Hypovolemic Shock.The Open Pediatric Medicine Journal, 2013, 7, (Suppl 1: M3) 10-15
56. Davis A, et al. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med 2017; 45:1061-1093
2. Karas J et al. Developing a core outcome measurement set for clinical trials in acute diarrhea. ActaPaediatrica 2016. 105, pp. e176-e180.
3. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H, European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; European Society for Pediatric Infectious Diseases.European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J PediatrGastroenterolNutr. 2014 Jul;59(1):132-52.
4. O Ryan M, Rierra Montes M, et al. Norovirus in Latin America Systematic Review and meta-analysis. Pediatr Infect Dis J. 2017;36:127-134
5. Grupo Ibero-Latinoamericano sobre el Manejo de la Diarrea Aguda (GILA). Guía de práctica clínica ibero-latinoamericana sobre el manejo de la gastroenteritis aguda en menores de 5 años. AnPediatr (Barc) 2014;80(Supl 1):1-57.
6. Acute Gastroenteritis Guideline Team, Cincinnati Children's Hospital Medical Center: Evidence-based care guideline for prevention and management of Acute Gastroenteritis (AGE) in children age 2 months to 18 years. http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/gastroenteritis/ Guideline 5, pages 1-20, Dec 21, 2011.
7. Lo Vecchio A, Vandenplas Y, Benninga M, Broekaert I, Falconer J, Gottrand F, et al. An international consensus report on a new algorithm for the management of infant diarrhoea. Actapaediatrica 2016 Aug;105(8):e384-9.
8. Goldman RD, Friedman JN, Parkin PC. Validation of the clinical dehydration scale for children with acute gastroenteritis. 2008 Sep;122(3):545-9.
9. Gorelick MH, Shaw KN, Murphy KO. Validityvand reliability clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997;99:e6.
10. Gravel J, Manzano S, Guimont C, Lacroix L, Gervaix A, Bailey B. Multicenter validation of the clinical dehydration scale for children. Arch Pediatr 2010;17:1645-51.
11. Schnadower D et al. Validation of the Modified Vesikari Score in Children with Gastroenteritis in 5 U.S. Emergency Departments. J PediatrGastroenterolNutr. 2013 October ; 57(4): 514-519.
12. Lewis K. Vesikari clinical severity scoring manual. PATH. 2011. http://www.path.org/publications/files/VAD_vesikari_scoring_manual.pdf
13. Guarino A et al. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases Evidence-based Guidelines for the Management of Acute Gastroenteritis in Children in Europe. Journal of Pediatric Gastroenterology and Nutrition 2008. 46:S81-S184
14. Lee G et al. A Comparison of Diarrheal Severity Scores in the MAL-ED Multisite Community-Based Cohort Study. JPGN 2016;63: 466-473
15. Dalby-Payne JR, Elliott EJ. Gastroenteritis in children. ClinEvid. 2011 Jul 26;2011. pii:0314.
16. Fonseca BK, Holdgate A, Craig JC. Enteral vs. intravenous rehydration therapy for children with gastroenteritis: a meta-analysis of randomized controlled trials. Arch PediatrAdolesc Med. 2004;158:483-90.
17. Hartling L, Bellemare S, Wiebe N, et al. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD004390. D
18. Bellemare S, Hartling L, Wiebe N, et al. Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials. BMC Med. 2004;2:11.
19. Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database Syst Rev (online) 2009;CD002847.
20. Florez I et al. The effectiveness and safety of treatments used for acute diarrhea and acute gastroenteritis in children: protocol for a systematic review and network meta-analysis. Systematic Reviews (2016) 5:14 DOI 10.1186/s13643-016-0186-8.
21. Gregorio GV, Dans LF, Silvestre MA. Early versus delayed refeeding for children with acute diarrhoea. Cochrane Database Syst Rev 2011;7:CD007296.
22. Suárez L, Cano B. Current management of acute gastroenteritis (AGE) with oral rehydration solutions. NutrClin Diet Hosp. 2009;29:6-14.
23. Gutiérrez-Castrellón P, Polanco I, Salazar E. An evidence based Iberic-Latin American guideline for acute gastroenteritis management in infants and prescholars. An Pediatr (Barc). 2010;72:e1-220.
24. Lehert P, Cheron G, Calatayud GA, et al. Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis. Dig Liver Dis. 2011;43:707-13.
25. Gutiérrez-Castrellón P, Polanco Allué I, Salazar Lindo E. AnevidencebasedIberic-Latin American guidelineforacute gastroenteritis management in infants and prescholars [Manejo de la gastroenteritis aguda en menores de 5 años: un enfoque basado en la evidencia. Guía de práctica clínica ibero-latinoamericana]. AnPediatr (Barc) 2010;71:e1-220.e20. Disponible en: http://xa.yimg.com/kq/groups/23751477/1015766879/name/Gastroenteritis.pdf.
26. Hao R, De Vera M, Resurrección E. Racecadoril in the treatment of acute diarrhoea in children: a meta-analysis. PIDSP Journal. 2010;11(2):19-32.
27. Chacón J. Analysis of factors influencing the overall effect of racecadotril on childhood acute diarrhoea. Results from a real-word and post-authorization surveillance study in Venezuela. TherClinRiskManag. 2010;6:293-299.
28. Gutiérrez-Castrellón P, Acosta-Bastidas M, Llamosas Gallardo B, et al. Ensayo clínico aleatorizado y análisis farmacoeconómico del impacto de racecadotrilo como coadyuvante en el tratamiento de la gastroenteritis aguda sobre la reducción de los gastos hospitalarios relacionados en lactantes menores de 24 meses en México. Rev Invest Clin. 2011.
29. Rautenberg TA, Zerwes U, Foerster D, et al. Evaluating the cost utility of racecadotril for the treatment of acute watery diarrhoea in children: the RAWD model. Clinicoecon Outcomes Res. 2012;4:109-16.
30. Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. The Cochrane library 2012. CD005436)
31. Patel A, Mamtani M, Dibley MJ, et al. Therapeutic Value of Zinc Supplementation in Acute and Persistent Diarrhea: A Systematic Review. PLoS ONE 2010;5(4):e10386.
32. Patro B, Golicki D, Szajewska H. Meta-analysis: zinc supplementation for acute gastroenteritis in children. Aliment PharmacolTher. 2008;28:713-23.
33. Lukacik M, Thomas RL, Aranda JV. Metaanalysis of the effects of oral zinc in the treatment of acute and persistent diarrhoea. Pediatrics. 2008;121(2):326-36.
34. Brown KH, Peerson JM, Baker SK, et al. Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food Nutr Bull. 2009 Mar;30(1 Suppl):S12-40.
35. Haider BA, Bhutta ZA. The effect of therapeutic zinc supplementation among young children with selected infections: a review of the evidence. Food Nutr Bull. 2009;30:S41-59.
36. DuPont C, Foo JL, Garnier P, et al. Peru and MalasiaDiosmectite study. Oral diosmestite reduces stool output and diarrhoea duration in children with acute watery diarrhoea. ClinGastroenterolHepatol 2009;7:456-62.
37. Dupont C, Vernisse B. Anti-diarrheal effect of diosmectite in the treatment of acute diarrhoea in children. A review. Paediatric Drugs. 2009;11(2):89-99.
38. Mujawr QM, Naganoor R, Ali MD, et al. Efficacy of dioctahedralsmectite in acute watery diarrhoea in Indian children: a randomized clinical trial. J Trop Pediatr 2012;58:63-7.
39. Szajewska H, Dziechciarz P, Mrukowicz J. Meta-analysis: Smectite in the treatment of acute infectious diarrhoea in children. Aliment PharmacolTher. 2006;23:217-27
40. Carter B, Fedorowicz Z. Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework. BMJ Open 2012;2.
41. Dalby-Payne JR, Elliot EJ. Gastroenteritis in children. ClinEvid (online). 2009;PMCID: PMC2907797.
42. DeCamp LR, Byerley JS, Doshi N, et al. Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis. ArchiPediatAdolesc Med. 2008;162(9):858-65.
43. Brenner S, Boucher J. Fatal Cardiac Arrest in 2 Children. Possible Role of Ondansetron. PediatrEmer Care 2016;32: 779-784.
44. AImdad A, Herzer K, Mayo-Wilson E, et al. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. The Cochrane library. 2010;DOI:10.1002/ 14651858.CD008524. b
45. Long KZ, Santos JI, Rosado JL, et al. Vitamin A supplementation modifies the association between mucosal innate and adaptive immune responses and resolution of enteric pathogen infections.Am J ClinNutr. 2011 Mar;93(3):578-85.
46. Long KZ, Garcia C, Ko G, et al. Vitamin A modifies the intestinal chemokine and cytokine responses to norovirus infection in Mexican children. J Nutr. 2011 May;141(5):957-63. doi: 10.3945/jn.110.132134. Epub 2011 Mar 16.
47. Urbariska M, Gieruszczak-Bialek D, Szajewska H. Systematic review with meta-analysis: Lactobacillus reuteri DSM 17938 for diarrhoeal diseases in children . Aliment PharmacolTher. 2016 May;43(10):1025-34.
48. Allen SJ, Martinez EG, Gregorio GV, et al. Probiotics for treating acute infectious diarrhea. Cochrane Database Syst Rev. 2010;11:CD003048.
49. Guandalini S. Probiotics for prevention and treatment of diarrhoea. J ClinGastroenterol. 2011;45(suppl):S149-53.
50. Correa NBO, Penna FJ, Lima FM, et al. Treatment of acute diarrhoea with Saccharomyces boulardii in infants. J PediatrGastroenterolNutr. 2011;53:497-501.
51. Chmielewska A, Ruszczynski M, Szajewska H. Lactobacillus reuteri strain ATCC 55730 for the treatment of acute infectious diarrhoea in children: a meta-analysis of randomized controlled trials. PediatriaWspolczesna. 2008;10(1):32-6.
52. Szajewska H, Wanke M, Patro B. Meta-analysis: the effects of Lactobacillus rhamnosus GG supplementation for the prevention of healthcare-associated diarrhoea in children. Aliment PharmacolTher. 2011;34(9):1079-87.
53. Vandenplas Y. PROBIOTICAL-study group. Randomised clinical trial: the synbiotic food supplement Probiotical vs. placebo for acute gastroenteritis in children. Aliment PharmacolTher. 2011;34:862-7.
54. Passariello A, Terrin G, Cecere G, et al. Randomised clinical trial: efficacy of a new synbiotic formulation containing Lactobacillus paracasei B21060 plus arabinogalactan and xilooligosaccharides in children with acute diarrhoea. Aliment PharmacolTher. 2012;35:782-8.
55. Hobson M, Ranjit S.Pediatric Hypovolemic Shock.The Open Pediatric Medicine Journal, 2013, 7, (Suppl 1: M3) 10-15
56. Davis A, et al. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med 2017; 45:1061-1093
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2018-07-09
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Iramain, R., Jara, A., Martinez Tovilla, Y., Cardozo, L., Morinigo, R., Rojas, P., Bogado, N., Rolon, P., Flecha, C., Amado, A., Lasso, R., Solis, K., & Galvis, L. (2018). Consenso Internacional de Gastroenteritis Aguda en Urgencias. Comité de Emergencias SLACIP (Sociedad Latino Americana de Cuidados Intensivos Pediátricos). Pediatría (Asunción), 44(3), 249-258. Recuperado a partir de https://revistaspp.org/index.php/pediatria/article/view/432
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