Intravenous rehydration in children with severe malnutrition: a systematic review and meta-analysis
Rattachement africain : gb, ch, lu, be, Kenya, Afrique du Sud, Ouganda, Nigéria, Niger. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
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 randomized clinical trials (RCTs) comparing the use of IVR and oral rehydration (standard of care) in children with SAM hospitalized 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; I 2 =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 hyponatremia at 24 hours (grouped by threshold (sodium < 125 or <130mmol/L)) was 0.66 (95% CI 0.44-0.99). Only one trial reported RR for shock development; hypernatremia (sodium >145mmol/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 using IVR versus OR in children with SAM with severe dehydration ranges from a 54% relative reduction to a 10% relative increase in the risk of death with IVR resulting in fewer adverse events. (PROSPERO number, CRD42025637956.) Key Questions What is already known on this topic International guidelines advise against giving intravenous rehydration to children with severe acute malnutrition due to concerns about fluid overload. Evidence to support this recommendation is weak, specifically in children in African with severe dehydration due to diarrhoea What this study adds We systematically reviewed evidence comprising of 484 children in 3 randomised trials, and estimated that intravenous rehydration resulted in a 54% relative reduction to a 10% relative increase in the risk of death No evidence of fluid overload or cardiac failure was reported in any trial How might this study affect research, practice or policy The guidance on intravenous rehydration should be reconsidered in light of the findings of this review and considering the safety of intravenous rehydration Simplification of the rehydration guidelines for severe dehydration to remove the distinction between malnourished and non-malnourished children would facilitate ease of implementation.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Intravenous rehydration in children with severe malnutrition: a systematic review and meta-analysis
- Date Crossref
- 21/08/2025
- Éditeur
- openRxiv
- Type
- posted-content
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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London School of Hygiene & Tropical Medicine pays non établi dans la noticeUniversité ou école supérieure
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Médecins Sans Frontières Maiduguri, Nigéria (pays nommé en fin d’affiliation)Organisation à but non lucratif
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University of Luxembourg pays non établi dans la noticeUniversité ou école supérieure
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Kenya Medical Research Institute Kilifi, Kenya (code pays fourni par la source)Structure de recherche
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Epicentre (South Africa) Afrique du Sud (code pays fourni par la source)Entreprise
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Médecins Sans Frontières Ouganda (code pays fourni par la source)Organisation à but non lucratif
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University of Maiduguri University of Maiduguri, Nigéria (code pays fourni par la source)Université ou école supérieure
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United Nations Children's Fund Niger Niger (code pays fourni par la source)Institution
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University College London pays non établi dans la noticeUniversité ou école supérieure
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Medical Research Council pays non établi dans la noticeOrganisme public
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Imperial College London Institute of Global Health and Innovation pays non établi dans la noticeUniversité ou école supérieure
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London School of Hygiene and Tropical Medicine pays non établi dans la noticeUniversité ou école supérieure
London School of Hygiene & Tropical Medicine, Médecins Sans Frontières (Maiduguri, Nigéria) et University of Luxembourg, avec 9 autres affiliations. Pays d’affiliation : Nigéria, Kenya, Afrique du Sud, Ouganda, Niger.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.