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Intravenous fluid therapy in children and young people in hospital N29
  1. Jessica Green,
  2. Jonathan Lillie
  1. Paediatric Intensive Care, Evelina Children’s Hospital, Guy’s and St Thomas’ Hospital, London, UK
  1. Correspondence to Dr Jessica Green, Paediatric Intensive Care, Evelina children’s hospital, Guy’s and St Thomas’ Hospital, London SE1 7EH, UK; jg2846{at}gmail.com

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Information about the current guideline

The prescription of intravenous fluids requires an understanding of fluid homeostasis and should be tailored to the individual, the disease and the intended therapeutic goal. Errors in prescribing or administration can increase morbidity, with inadequate provision causing hypovolaemia and poor organ perfusion, and excessive fluids leading to overload and cardiac failure. Failing to correct electrolyte imbalances can result in neurological sequelae and even death.

In December 2015, the National Institute for Care Excellence (NICE) addressed the lack of guidance by publishing ‘Intravenous fluid therapy in children and young people in hospital NG29’1. Endorsed by the Royal College of Paediatrics and Child Health, its aim was to offer a ‘standardised approach to assessing patient’s fluid and electrolyte status and prescribing IV fluid therapy in term neonates, children and young people’.

Previous guidelines

Although there is no previous national consensus for intravenous fluid prescription in children, some guidance in certain paediatric scenarios is embedded in other NICE guidelines (see  box 1).

Box 1

Resources

  1. Intravenous fluid therapy in children and young people in hospital NICE guideline, December 2015 N29, https://www.nice.org.uk/guidance/ng29/resources/intravenous-fluid-therapy-in-children-and-young-people-in-hospital-1837340295109

  2. Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management NICE guideline CG84, April 2009, https://www.nice.org.uk/guidance/cg84

  3. Diabetes (type 1 and type 2) in children and young people: diagnosis and management NICE clinical guideline NG18, August 2015, https://www.nice.org.uk/guidance/ng18

  4. Fever in under 5s: assessment and in children NICE clinical guideline CG160, https://www.nice.org.uk/guidance/cg160

  • NICE, National Institute for Care Excellence.

Key issues that the guideline addresses

  1. provides a standardised approach for the initial prescription of intravenous fluid in children for maintenance, fluid resuscitation and replacement/redistribution

  2. offers standards for monitoring children who are receiving intravenous fluids

  3. presents algorithms for the management of hypernatraemia and hyponatraemia that may develop during fluid administration.

Box 2

Factors to consider prior to prescription of intravenous fluids

  • Age

  • Weight

  • Prematurity

  • Risk of increased antidiuretic hormone secretion (see box 4)

  • Burns

  • Diabetic ketoacidosis

  • Fever

  • Mechanical ventilation (decreases insensible …

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