Archives of disease in childhood
September 18, 2026 · via Europe PMC
Intravenous rehydration in children with severe malnutrition and severe dehydration: a systematic review and meta-analysis.
Dewez JE, Ouattara SM, Sunyoto T, +5 more, Maitland K.
AI summary — for doctors, generated from the abstract only
In children with severe acute malnutrition and severe dehydration, intravenous versus oral rehydration showed no clear mortality difference, with confidence intervals spanning benefit and harm.
What was studied
A systematic review and meta-analysis of 3 RCTs (484 children) in lower-to-middle-income countries comparing intravenous and oral rehydration in children with SAM hospitalised with severe dehydration.
Key findings
- In-hospital mortality RR 0.71 (95% CI 0.46-1.10), moderate certainty
- No fluid overload events reported (RR 0.99, 95% CI 0.10-9.35)
- Electrolyte abnormalities and 28-day mortality differences not significant (wide CIs)
Clinical relevance
This raises the question of whether traditional caution about IV rehydration in SAM is warranted, but evidence is insufficient to change practice.
Who should care
Limitations
Only three small trials with imprecise estimates and some risk of bias; the results text is partly garbled.
IV rehydration in severely malnourished children may not be as dangerous as assumed, but the evidence is thin.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
To compare the efficacy and safety of intravenous rehydration (IVR) versus oral rehydration (OR) strategies in children with severe acute malnutrition (SAM) and severe dehydration.
Design
Systematic review and meta-analysis.
Setting
Lower-to-middle-income countries.
Patients
Children with SAM are hospitalised with severe dehydration secondary to gastroenteritis.
Interventions
Randomised trials of IVR and OR (standard of care) MAIN OUTCOME MEASURES: Primary: in-hospital mortality. Secondary: fluid overload events, development of shock requiring intravenous boluses, severe electrolyte abnormalities at 24 hours and day 28 mortality.
Results
We identified three RCTs comprising 484 participants with severe malnutrition (72 had kwashiorkor, two had some risk of bias, and one had low risk of bias). The pooled risk ratio (RR) for in-hospital mortality for IVR versus OR is 0.71 (95% CI 0.46 to 1.10; I2=0.0%) with moderate certainty of evidence. No fluid overload events were reported, pooled RR 0.99 (95% CI 0.10 to 9.35). The pooled RR of severe hyponatraemia (sodium 145 mmol/L) or 28-day mortality with IVR versus OR (RRs 0.56, 95% CI 0.21 to 1.48; RR 2.05, 95% CI 0.50 to 8.58 and RR 0.85, 95% CI 0.44 to 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.
Conclusions
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 registration number
CRD42025637956.
DOI
10.1136/archdischild-2026-330358
PMID
42161576
PMCID
PMC7619270
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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