From the Guidelines
Subcutaneous fluid resuscitation is not recommended for infants as the primary method of fluid resuscitation, and instead, intravenous fluid administration is preferred, with a recommended bolus of 10-20 mL/kg, up to 40-60 mL/kg in the first hour, as suggested by the most recent guidelines 1. The goal of fluid resuscitation in infants is to attain normal perfusion and blood pressure, while monitoring for signs of fluid overload, such as increased work of breathing, hepatomegaly, or pulmonary edema.
- The choice of fluid should be an isotonic crystalloid, such as normal saline (0.9%) or Ringer's lactate, rather than albumin or starches, due to the lower cost and similar outcomes 1.
- The administration of fluids should be guided by frequent reassessment of clinical markers of cardiac output, including heart rate, blood pressure, capillary refill time, level of consciousness, and urine output.
- In healthcare systems with no availability of intensive care, bolus fluid administration is not recommended in the absence of hypotension, and instead, maintenance fluids should be started 1.
- It is essential to monitor for complications, including local irritation, pain, edema, or infection, and discontinue fluid administration if these occur.
- Hyaluronidase (150 units/L) can be added to enhance fluid absorption, but its use is not routinely recommended in the provided guidelines.
- The procedure for subcutaneous fluid resuscitation involves cleaning the site, inserting a small-gauge needle (23-25G) at a 30-45° angle, securing with transparent dressing, and monitoring for complications, but this method is not preferred for infants due to the availability of more effective and safer alternatives, such as intravenous fluid administration.
From the Research
Subcutaneous Fluid Resuscitation for Infants
- There is limited information available on subcutaneous fluid resuscitation for infants in the provided studies.
- However, a study on calves with diarrhea compared oral, intravenous, and subcutaneous fluid therapy for resuscitation 2.
- The study found that subcutaneous fluids by themselves are a poor treatment option and should only be used as supportive therapy following the initial correction of hypovolemia and metabolic acidosis 2.
- In pediatric patients, intravenous and enteral fluid resuscitation are frequently used therapies in emergency departments and critical care settings 3.
- Rapid fluid resuscitation has gained increased recognition since the most recent pediatric shock management guidelines, and studies have proven the modality to be safe and efficacious and to reduce morbidity and mortality 3.
- The choice of fluid for resuscitation is also important, with some studies suggesting that lactated Ringer's solution may be superior to normal saline in certain situations 4.
- In newborn infants, rational parenteral fluid therapy must take into account large insensible fluid losses, adaptive changes of renal function in the first days of life, and the fact that neonates do not tolerate prolonged periods of fasting 5.
Key Considerations
- The provided studies do not directly address subcutaneous fluid resuscitation for infants, but rather focus on other aspects of fluid resuscitation in pediatric patients.
- The use of subcutaneous fluids in infants is not well-supported by the available evidence, and more research is needed to determine its safety and efficacy in this population.
- Intravenous and enteral fluid resuscitation remain the most commonly used and well-studied methods for fluid resuscitation in pediatric patients 3, 5.