From the Guidelines
Crystalloids, specifically balanced/buffered crystalloids, are the most appropriate type of intravenous (IV) fluid for a bolus in a 4-month-old infant, as they are recommended for the initial resuscitation of children with septic shock or other sepsis-associated organ dysfunction 1.
Key Points
- The suggested bolus fluid dose is 10–20 mL/kg per bolus, with a total of up to 40–60 mL/kg over the first hour, titrated to clinical markers of cardiac output 1.
- Crystalloids are preferred over albumin due to considerations of cost and other barriers 1.
- Balanced/buffered crystalloids are suggested over 0.9% saline for the initial resuscitation of children with septic shock or other sepsis-associated organ dysfunction, although the quality of evidence is very low 1.
- The following IV fluids are not recommended for the acute resuscitation of children with septic shock or other sepsis-associated organ dysfunction:
From the Research
Appropriate IV Fluid for Bolus in Infants
- The choice of IV fluid for a bolus in a 4-month-old infant is crucial, and the current evidence suggests that isotonic fluids such as 0.9% sodium chloride (NaCl) are preferred 2.
- A study published in 2010 recommended the use of 0.9% NaCl for rehydration in patients with gastroenteritis, as it is a safer and more effective approach than using hypotonic fluids 2.
- Another study published in 2022 found that fluid boluses increase arterial blood pressure or cardiac output by 10% in approximately 56% of pediatric patients, but did not specify the type of fluid used 3.
- There is limited evidence on the specific type of IV fluid to use in infants, but it is generally recommended to avoid hypotonic fluids due to the risk of hyponatremia 2.
- The use of fluid boluses in infants has been associated with potential harms, such as increased incidence of need for home oxygen and higher prevalence of patent ductus arteriosus (PDA) and intraventricular hemorrhage (IVH) in very low birth weight infants 4.
- A systematic review and meta-analysis published in 2022 found that baseline characteristics such as greater age, lower cardiac index, and lower stroke volume were associated with increased likelihood of response to fluid boluses, but did not specify the type of fluid used 3.
Key Considerations
- The choice of IV fluid for a bolus in infants should be based on the individual patient's needs and clinical condition.
- Isotonic fluids such as 0.9% NaCl are generally preferred due to their ability to expand extracellular volume and correct volume deficits without increasing the risk of hyponatremia 2.
- Further research is needed to determine the optimal type and volume of IV fluid for bolus administration in infants 5, 4, 6.