MEDICINE : U.S. Resists Inexpensive Cure for Diarrheal Dehydration

American doctors who pioneered the use of a low-tech method of saving the lives of babies dehydrated from diarrhea in developing countries have launched a vigorous campaign for use of the cost-effective technique in the United States.

Oral rehydration therapy, or ORT, is said to work well in the great majority of cases and be far less expensive than the intravenous therapy commonly used in the United States.

In developing countries, mothers mix water with packets of glucose and salts provided by international aid agencies and feed the mixture by mouth to their ailing babies. The glucose and salts provide the baby’s intestines with the proper chemical environment to halt the loss of fluids, which can be fatal.

In the United States, bottled preparations are available. Although diarrheal dehydration is a far less deadly problem here than in developing countries--where it kills 5 million children annually--figures compiled by the Centers for Disease Control show that 500 babies a year die and 200,000 are hospitalized at a cost of $500 million.

The hospitalizations represent 10% of all pediatric emergency room visits. In an effort to make the public and health professionals more aware of the technique’s usefulness, U.S. doctors who have seen its success in developing countries have become organizers of the National Oral Rehydration Therapy Program.

Participants include professional groups such as the American Academy of Pediatrics and the National Commission to Prevent Infant Mortality. The program is a kind of “reverse transfer of technology” from the developing world to the industrial world, according to Dr. William Greenough, chairman of the International Child Health Foundation and former director of the research center in Bangladesh where the basis for the therapy was worked out in the 1960s to treat cholera patients.

Teaching programs at centers such as Boston’s Children’s Hospital, Massachusetts General Hospital and Johns Hopkins Medical Center in Baltimore are being developed to instruct emergency room doctors and mothers on the benefits of oral rehydration therapy.

Mothers are told how to judge the severity of diarrhea and how to use the therapy at home to avoid taking sick babies to the emergency room.

Nevertheless, despite the proven simplicity, effectiveness and low cost, doctors say the therapy is not a popular form of treatment in U.S. hospitals and clinics. The reasons range from concern that it imparts an image of second-class medicine to nursing shortages that make it difficult to find someone to hold the baby while the therapy is administered. Attaching an intravenous tube is much quicker.

Dr. John Nelson, a family practitioner resident at Hartford’s St. Francis Hospital, said he would like to see families become more involved in health care through use of the therapy, but he has reservations. “It’s much easier to feel comfortable by admitting a dehydrated child and treating him intravenously than to send him home and have to worry whether the caretaker there will do things right.”

Dr. John Snyder, a pediatrician at Boston’s Children’s Hospital, said education is the big stumbling block in the way of wider use of the therapy. When doctors see the results of giving oral rehydration therapy to a lethargic dehydrated child, they will become as excited as they are with the results of intravenous therapy, he said.

Dr. Ronald Kleinman, head of the nutrition committee of the American Academy of Pediatrics, said that hospitalization to treat dehydration of a 1-year-old costs about $800 a day, but the same results can be obtained with oral therapy given by the mother at home for $6 to $8 a day. A drawback, he said, is that, although Medicaid (Medi-Cal in California) and private health insurance often pay for hospitalization, they do not cover home treatment.

“We try to get people to think oral,” said Dr. Thomas DeWitt of the University of Massachusetts Medical Center. “And it’s not good just for youngsters. (It) is effective for any age person.”