• David W Brossier, Lyvonne N Tume, Anais R Briant, Jotterand ChaparroCorinneC0000-0002-1538-7127Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.Bureau d'Echange des Savoirs pour des praTiques E, Clémence Moullet, Shancy Rooze, VerbruggenSascha C A TSCAT0000-0003-4866-9865Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands., Luise V Marino, Fahad Alsohime, Sophie Beldjilali, Fabrizio Chiusolo, Leonardo Costa, Capucine Didier, Stavroula Ilia, Nyandat L Joram, KneyberMartin C JMCJ0000-0002-6008-3376Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, Critical Care, Anaesthesiology, Peri-Operative and Emergency Medicine (CAPE), University of Groningen, Groningen,, Eva Kühlwein, Jorge Lopez, Jesus López-Herce, Huw F Mayberry, Fortesa Mehmeti, Magdalena Mierzewska-Schmidt, Maria Miñambres Rodríguez, Claire Morice, John V Pappachan, Florence Porcheret, Leonor Reis Boto, Luregn J Schlapbach, Hakan Tekguc, Konstantinos Tziouvas, Jean-Jacques Parienti, Isabelle Goyer, Frederic V Valla, and Metabolism Endocrinology and Nutrition section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC).
• Pediatric Intensive Care, Medical School, Université Caen Normandie, CHU de Caen, Caen, France.
• Intensive Care Med. 2022 Dec 1; 48 (12): 169117081691-1708.

PurposeIntravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid.MethodsA multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds.Results56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. "Strong consensus" was reached for 11/16 (69%) and "consensus" for 5/16 (31%) of the recommendations.ConclusionsKey recommendations are to use isotonic balanced solutions providing glucose to restrict IV-MFT infusion volumes in most hospitalized children and to regularly monitor plasma electrolyte levels, serum glucose and fluid balance.© 2022. The Author(s).

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