Initial intravenous fluid prescription in general paediatric in-patients aged >28 days and <18 years: Consensus statements

Abstract

Intravenous fluid (IVF) prescription has often been an ‘assumed’ skill in hospital-based paediatric practice, with little evidence-based guidance. Traditionally prescribed hypotonic fluids were responsible for many iatrogenic, hyponatraemia-related morbidity and mortality. Robust evidence is available to support recent guidelines that isotonic fluids are the most appropriate maintenance IVF for most hospitalised children. However, many other aspects of IVF prescription still lack evidence. Thus, an IVF Working Group was formed in 2016 under the Hospital Authority Paediatric Coordinating Committee to review IVF guidelines for local application, with the aim to provide guidance for initial IVF prescription and subsequent monitoring of paediatric in-patients in Hong Kong. Published randomised controlled trials, IVF guidelines, and practices of reputable children’s hospitals up to December 2019 were reviewed. Local survey findings and practical realities were considered. Extracted evidence and draft recommendations were presented to the group, using a consensus approach in areas where evidence was unavailable. After further input from designated reviewers, an IVF clinical pathway was finalised in November 2019 and endorsed by the Paediatric Clinical Coordinating Committee. This article represents an explanatory discussion of the pathway, with consensus statements established by Working Group members at the final meeting in June 2020. The consensus statements emphasise that IVF should be prescribed with the same care and consideration as medications, based on each patient’s pathophysiology. Evidence is presented regarding the use of isotonic maintenance fluid, comparing 0.9% sodium chloride with balanced solutions. These eight statements provide localised guidance for paediatricians in initial IVF prescription but do not replace clinical judgement.