Dear CHIFA colleagues,
We have previously discussed the role of intravenous rehydration for children with severe acute malnutrition and severe dehydration. This new systematic review suggests that current guidelines should be reconsidered.
Below is the citation and summary of key points.
CITATION: Dewez JE, Ouattara SM, Sunyoto T, et al. Intravenous rehydration in children with severe malnutrition and severe dehydration: a systematic review and meta-analysis. Archives of Disease in Childhood 2026;111:866-872.
WHAT IS ALREADY KNOWN ON THIS TOPIC
International guidelines advise against giving intravenous rehydration to children with severe acute malnutrition and severe dehydration, unless the child is in shock, due to concerns about fluid overload.
Evidence to support this recommendation is weak, specifically in children in Africa with severe dehydration due to diarrhoea.
WHAT THIS STUDY ADDS
We systematically reviewed evidence from 484 children in three randomised trials and estimated that intravenous rehydration resulted in a 54% relative reduction to a 10% relative increase in the risk of death.
No evidence of fluid overload or cardiac failure was reported in any trial.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
The guidance on intravenous rehydration should be reconsidered in light of the findings of this review, considering the safety of intravenous rehydration.
Simplification of the rehydration guidelines for severe dehydration to remove the distinction between malnourished and non-malnourished children would facilitate ease of implementation.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org