No Mortality Difference Found Between Oral and IV Rehydration in Malnourished Children: NEJM
Researchers discovered that intravenous (IV) rehydration therapy did not decrease mortality rates as compared to oral rehydration therapy in children with severe acute malnutrition (SAM) and dehydration from gastroenteritis. The study was published in The New England Journal of Medicine by Kathryn and colleagues. The results contradict conventional clinical practices and raise the possibility that well-managed IV rehydration is safe in this high-risk group.
This open-label, factorial superiority trial was completed in four African nations and included 272 children between 6 months and 12 years of age with SAM and dehydration caused by gastroenteritis. Participants were randomly assigned in a 2:1:1 ratio to one of three treatment arms:
Oral rehydration strategy, IV boluses reserved for shock (138 children)
Rapid IV rehydration, lactated Ringer's solution at 100 ml/kg over 3–6 hours with boluses for shock (67 children)
Slow IV rehydration, same solution over 8 hours without boluses (67 children)
The main outcome was 96-hour mortality, and follow-up was extended to 28 days.
Key Findings
At 96 hours, deaths were 8% (11 of 138) for the oral and 7% (9 of 134) for the IV groups (5 rapid, 4 slow)
Risk ratio for 96-hour death: 1.02 (95% CI: 0.41–2.52; P=0.69)
At 28 days, 12% (17 of 138) in the oral and 10% (14 of 134) in the IV groups had died
Hazard ratio for 28-day death: 0.85 (95% CI: 0.41–1.78)
Nasogastric tubes were needed in 93% (126/135) of oral and 65% (82/126) of IV groups
Bolus IV fluids on admission were utilized in 9% (12/138) of oral, 10% (7/67) of rapid IV, and 0% of slow IV groups
Serious adverse events in 23% of oral, 21% of rapid IV, and 15% of slow IV groups
Notably, no pulmonary edema, heart failure, or fluid overload cases were observed
The research reported no divergence in mortality from oral versus intravenous rehydration regimens among malnourished children with dehydration due to gastroenteritis. With no fluid overload or complication evidence, these results concur with a reconsideration of treatment protocols to most likely enhance outcomes in this at-risk population.
Reference:
Maitland, K., Ouattara, S. M., Sainna, H., Chara, A., Ogundipe, O. F., Sunyoto, T., Hamaluba, M., Olupot-Olupot, P., Alaroker, F., Connon, R., Saidou Maguina, A., Okiror, W., Amorut, D., Mwajombo, E., Oguda, E., Mogaka, C., Langendorf, C., Dewez, J. E., Ciglenecki, I., … GASTROSAM Trial Group. (2025). Intravenous rehydration for severe acute malnutrition with gastroenteritis. The New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2505752
