From the Guidelines
For a 12-month-old infant with respiratory distress, isotonic crystalloid fluids such as normal saline (0.9% sodium chloride) or Ringer's lactate should be administered, as recommended by the most recent and highest quality study 1.
Key Considerations
- Initial fluid resuscitation typically involves a bolus of 10-20 mL/kg given over 5-20 minutes, which can be repeated based on clinical response.
- Maintenance fluids should be calculated using the 4-2-1 rule (4 mL/kg/hr for the first 10 kg, 2 mL/kg/hr for 10-20 kg, and 1 mL/kg/hr for each kg above 20), with careful consideration of the child's overall clinical status and risk of fluid overload.
- It's crucial to monitor for signs of fluid overload, especially in respiratory distress, as excessive fluids can worsen respiratory symptoms.
- Careful assessment of vital signs, urine output, and respiratory status should guide ongoing fluid management, with adjustments made to fluid composition as needed based on laboratory results.
Rationale
The use of isotonic fluids is supported by strong consensus and high-quality evidence 1, which reduces the risk of hyponatremia and is consistent with other guidelines and recent publications.
Additional Recommendations
- In critically ill children, balanced solutions should be favored when prescribing intravenous maintenance fluid therapy to slightly reduce length of stay 1.
- Glucose provision in intravenous maintenance fluid therapy should be considered in sufficient amount and guided by blood glucose monitoring (at least daily) to prevent hypoglycaemia 1.
- The total daily amount of maintenance fluid therapy should be considered, including all IV fluids, blood products, and enteral intake, to prevent fluid creep and reduce fluid intake 1.
- Avoidance of fluid overload and cumulative positive fluid balance should be considered to avoid prolonged mechanical ventilation and length of stay 1.
From the Research
Fluid Management for 12-Month-Old Infant with Respiratory Distress
The management of fluids in a 12-month-old infant with respiratory distress involves careful consideration of the underlying cause of the distress and the infant's hydration status.
- For infants with mild to moderate dehydration caused by acute diarrhea, oral rehydration solutions such as Pedialyte or Infalyte can be effective 2.
- In cases of hypernatremic dehydration, oral rehydration solutions containing 90 or 75 mEq/L of sodium have been shown to be safe and effective 3, 4.
- However, for infants with respiratory distress due to acute bronchiolitis, the use of nebulized racemic epinephrine or albuterol may be beneficial in relieving symptoms 5.
- It is essential to note that the choice of fluid and treatment approach should be individualized based on the infant's specific needs and clinical condition.
Key Considerations
- The infant's hydration status and electrolyte balance should be closely monitored.
- Oral rehydration solutions should be administered slowly and in sufficient volume to replace lost fluids and electrolytes.
- In cases of severe respiratory distress or dehydration, intravenous fluids may be necessary.
- The use of supplemental oxygen and moistening of inspired air can help relieve symptoms of acute bronchiolitis.
Relevant Fluids
- Oral rehydration solutions (e.g., Pedialyte, Infalyte)
- Intravenous fluids (e.g., lactated Ringer's solution, hypertonic saline) in severe cases
- Nebulized racemic epinephrine or albuterol for acute bronchiolitis 5