Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding).
A Cochrane review [Abstract] 1 included 12 studies with a total of 1 283 children. All trials included children less than five years old with acute diarrhoea of 14 days or less in duration. Early refeeding was defined as within 12 hours of start of rehydration and late refeeding was defined as more than 12 hours after start of rehydration. For those in the early refeeding group, the feeding consisted of either half- or full-strength cow's milk formula (4 studies); boiled rice or the child's usual diet (3 studies); soy-based milk formula (2 studies); or breast milk or cow's milk formula (1 study). One study randomized the patients into either a soy- or rice-based formula or pre-cooked rice. Another trial allocated patients to receive either oral rehydration solution and breastfeeding during the rehydration phase or oral rehydration alone for 24 hours.
Overall, the late refeeding group showed longer duration compared with the early refeeding group, although the mean difference was not significant (MD -6.90 hrs, 95% CI -18.70 to 4.91; 7 studies, n=685). Considerable heterogeneity was observed (I2 = 82%). There was no significant difference between the early and late refeeding groups in the number of participants who needed unscheduled intravenous fluids (RR 0.87, 95% CI 0.48 to -1.59; 6 studies, n= 813), who experienced episodes of vomiting (RR 1.16, 95% CI 0.72 to 1.86; 5 studies, n=456), and who developed persistent diarrhoea (RR 0.57, 95% CI 0.18 to 1.85; 4 studies, n=522). The mean length of hospital stay was also similar (2 studies, n=246).
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