Fluid resuscitation in neonatal and pediatric hypovolemic shock: a Dutch Pediatric Society evidence-based clinical practice guideline.
OBJECTIVE
To develop a clinical practice guideline that provides recommendations for the fluid, i.e. colloid or crystalloid, used for resuscitation in critically ill neonates and children up to the age of 18 years with hypovolemia.


METHODS
The guideline was developed through a comprehensive search and analysis of the pediatric literature. Recommendations were formulated by a national multidisciplinary committee involving all stakeholders in neonatal and pediatric intensive care and were based on research evidence from the literature and, in areas where the evidence was insufficient or lacking, on consensus after discussions in the committee.


RESULTS
Because of the lack of evidence in neonates and children, trials conducted in adults were considered. We found several recent meta-analyses that show excess mortality in albumin-treated groups, compared with crystalloid-treated groups, and one recent large randomized controlled trial that found evidence of no mortality difference. We found no evidence that synthetic colloids are superior to crystalloid solutions.


CONCLUSIONS
Given the state of the evidence and taking all other considerations into account, the guideline-developing group and the multidisciplinary committee recommend that in neonates and children with hypovolemia the first-choice fluid for resuscitation should be isotonic saline.
Boluyt
Nicole
N
Department of Pediatric Clinical Epidemiology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands. n.boluyt@amc.uva.nl
Bollen
Casper W
CW
Bos
Albert P
AP
Kok
Joke H
JH
Offringa
Martin
M
D002648:Child; D002675:Child, Preschool; D000077324:Crystalloid Solutions; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D020896:Hypovolemia / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D007552:Isotonic Solutions / Q000627:therapeutic use; D009426:Netherlands; D010372:Pediatrics / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015532:Rehydration Solutions; D012151:Resuscitation / Q000379:methods*; D012769:Shock / Q000628:therapy*
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D015532:Rehydration Solutions