Peer-reviewed article
Intravenous rehydration in children with severe malnutrition and severe dehydration: a systematic review and meta-analysis.
Dewez JE, Ouattara SM, Sunyoto T, Mogaka CK, Coldiron ME et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review and meta-analysis compared intravenous rehydration versus oral rehydration in children with severe acute malnutrition and severe dehydration from gastroenteritis. The review included three randomised trials with 484 participants. Intravenous rehydration showed a trend toward lower in-hospital mortality and fewer electrolyte abnormalities, though results were not statistically significant. The evidence suggests intravenous rehydration may be safer with fewer adverse events, but definitive conclusions require larger studies.
Key points
- Pooled in-hospital mortality risk ratio for intravenous versus oral rehydration was 0.71 (95% CI 0.46-1.10), suggesting a potential 29% relative reduction in mortality risk but with wide confidence intervals
- Severe hyponatraemia at 24 hours was significantly lower with intravenous rehydration (RR 0.66, 95% CI 0.44-0.99)
- No fluid overload events were reported in either treatment group across the trials
- Only three randomised trials met inclusion criteria, with most studies having some risk of bias
- Results show moderate certainty of evidence but range from 54% relative reduction to 10% relative increase in death risk
Limitations
The analysis is based on only three trials with relatively small sample sizes and varying risk of bias ratings, limiting the certainty of conclusions. The wide confidence intervals and lack of statistical significance for the primary outcome mean definitive recommendations about clinical practice cannot be made from this evidence.
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 <125 or <130 mmol/L) at 24 hours was 0.66 (95% CI 0.44 to 0.99). Only one trial reported RR for shock development, hypernatraemia (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.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Intravenous rehydration versus oral rehydration (standard of care)
- Population
- Children with severe acute malnutrition (including 72 with kwashiorkor) hospitalised with severe dehydration secondary to gastroenteritis
Key finding
Pooled in-hospital mortality: RR 0.71 (95% CI 0.46-1.10) for intravenous versus oral rehydration
JE et al. · Europe PMC · 18 Sept 2026