title: Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial.
abstract: BACKGROUND
  Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospital admission. Hydration is a mainstay of treatment, but insufficient evidence exists to guide clinical practice. We aimed to assess whether intravenous hydration or nasogastric hydration is better for treatment of infants.
  
  
  METHODS
  In this multicentre, open, randomised trial, we enrolled infants aged 2-12 months admitted to hospitals in Australia and New Zealand with a clinical diagnosis of bronchiolitis during three bronchiolitis seasons (April 1-Oct 31, in 2009, 2010, and 2011). We randomly allocated infants to nasogastric hydration or intravenous hydration by use of a computer-generated sequence and opaque sealed envelopes, with three randomly assigned block sizes and stratified by hospital site and age group (2-<6 months vs 6-12 months). The primary outcome was length of hospital stay, assessed in all randomly assigned infants. Secondary outcomes included rates of intensive-care unit admission, adverse events, and success of insertion. This trial is registered with the Australian and New Zealand clinical trials registry, ACTRN12605000033640.
  
  
  RESULTS
  Mean length of stay for 381 infants assigned nasogastric hydration was 86·6 h (SD 58·9) compared with 82·2 h (58·8) for 378 infants assigned intravenous hydration (absolute difference 4·5 h [95% CI -3·9 to 12·9]; p=0·30). Rates of admission to intensive-care units, need for ventilatory support, and adverse events did not differ between groups. At randomisation, seven infants assigned nasogastric hydration were switched to intravenous hydration and 56 infants assigned intravenous hydration were switched to nasogastric hydration because the study-assigned method was unable to be inserted. For those infants who had data available for successful insertion, 275 (85%) of 323 infants in the nasogastric hydration group and 165 (56%) of 294 infants in the intravenous hydration group required only one attempt for successful insertion.
  
  
  CONCLUSIONS
  Intravenous hydration and nasogastric hydration are appropriate means to hydrate infants with bronchiolitis. Nasogastric insertion might require fewer attempts and have a higher success rate of insertion than intravenous hydration.
  
  
  BACKGROUND
  Australian National Health and Medical Research Council, Samuel Nissen Charitable Foundation (Perpetual), Murdoch Children's Research Institute, Victorian Government.
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Emergency Medicine, Monash Medical Centre, Melbourne, VIC, Australia; Southern Clinical School Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. Electronic address: ed.oakley@rch.org.au.
authors.forename: Ed
authors.initials: E
authors.lastname: Oakley
authors.affiliation: Department of Emergency Medicine, Princess Margaret Hospital, Perth, WA, Australia; School of Paediatrics and Child Health and School of Primary, Rural and Aboriginal Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Meredith
authors.initials: M
authors.lastname: Borland
authors.affiliation: Department of Emergency Medicine, Kidz First Hospital, Middlemore, Auckland, New Zealand.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Neutze
authors.affiliation: Department of Emergency Medicine, Royal Children's Hospital, Brisbane, QLD, Australia; Queensland Children's Medical Research Institute, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Acworth
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Emergency Medicine, Sunshine Hospital, Melbourne, VIC, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Krieser
authors.affiliation: Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Stuart
authors.initials: S
authors.lastname: Dalziel
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia, Royal Children's Hospital, Melbourne, VIC, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davidson
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Donath
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Jachno
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.
authors.forename: Mike
authors.initials: M
authors.lastname: South
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Emergency Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.
authors.forename: Theane
authors.initials: T
authors.lastname: Theophilos
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Emergency Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
mesh_terms: D061605:Administration, Intravenous / Q000009:adverse effects / Q000379:methods; D001315:Australia; D001988:Bronchiolitis / Q000628:therapy*; D057186:Comparative Effectiveness Research; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D015532:Rehydration Solutions / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D015532:Rehydration Solutions