Intravenous rehydration in children with severe malnutrition: a systematic review and meta-analysis
Abstract
Background The comparative efficacy and safety of intravenous rehydration (IVR) and oral rehydration (OR) strategies in children with severe acute malnutrition (SAM) remains uncertain. Methods We systematically reviewed randomised clinical trials (RCTs) comparing the use of IVR and oral rehydration (standard of care) in children with SAM hospitalised with severe dehydration secondary to gastroenteritis. The primary outcome was in-hospital mortality. Secondary outcomes included fluid overload events, development of shock requiring intravenous boluses, development of neurological complications; severe electrolyte abnormalities at 24 hours and day 28 mortality. Findings We identified 3 RCTs, comprising 484 participants with severe malnutrition including 72 children with the kwashiorkor phenotype: (2 some risk of bias; 1 low risk of bias). The risk ratio (RR) for in-hospital mortality with IVR versus OR was 0.71 (95% confidence interval [CI], 0.46-1.10; I2=0.0%) with moderate certainty of evidence. No fluid overload events were reported, pooled RR 0.99 (95% CI 0.10-9.35). Pooled RR of severe hyponatraemia at 24 hours (grouped by threshold (sodium 145 mmol/l) and 28-day mortality with IVR versus OR RRs of 0.56 (95% CI 0.21-1.48); 2.05 (95% CI 0.50-8.58) and 0.85 (95% CI 0.44-1.65) respectively. Subgroup analyses for in-hospital mortality were carried out for region and risk of bias rating giving p=0.85 and p=0.54 for heterogeneity respectively. Conclusion The estimated effect of…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 484 participants or records.
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