Intensive Care Medicine

, Volume 32, Issue 7, pp 995–1003

Fluid resuscitation in neonatal and pediatric hypovolemic shock: a Dutch Pediatric Society evidence-based clinical practice guideline

  • Nicole Boluyt
  • Casper W. Bollen
  • Albert P. Bos
  • Joke H. Kok
  • Martin Offringa
Special Article

DOI: 10.1007/s00134-006-0188-4

Cite this article as:
Boluyt, N., Bollen, C.W., Bos, A.P. et al. Intensive Care Med (2006) 32: 995. doi:10.1007/s00134-006-0188-4

Abstract

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.

Keywords

Practice guidelineSystematic reviewShockFluid therapyCrystalloidColloidAlbuminChild

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Nicole Boluyt
    • 1
  • Casper W. Bollen
    • 2
  • Albert P. Bos
    • 4
  • Joke H. Kok
    • 3
  • Martin Offringa
    • 1
    • 3
  1. 1.Department of Pediatric Clinical Epidemiology, Emma Children's HospitalAcademic Medical CentreAmsterdamThe Netherlands
  2. 2.Department of Pediatric Intensive Care, Wilhelmina Children's HospitalUniversity Medical Centre UtrechtUtrechtThe Netherlands
  3. 3.Department of NeonatologyEmma Children's Hospital, Academic Medical CentreAmsterdamThe Netherlands
  4. 4.Department of Pediatric Intensive CareEmma Children's Hospital, Academic Medical CentreAmsterdamThe Netherlands