IV bolus, maintenance and medication carrier fluid in children with community-acquired sepsis: a multicentre cohort study

OBJECTIVES: We set out to describe the amount of fluid administered within the first 24 hours of sepsis treatment with an exploratory analysis of associations. DESIGN: This prospective observational study used data from the Sepsis Epidemiology in Australian and New Zealand Emergency Departments Study, collected from 2021 to 2023. PATIENTS: Participants were children aged 0 years to <18 years with suspected community-acquired sepsis admitted to the hospital through 11 emergency departments in Australia and New Zealand. MAIN OUTCOMES: We describe the volumes of fluid administered and mortality rates associated with different fluid volumes. RESULTS: A total of 5352 patients were included in the analysis, with a median age of 2.6 years (IQR 0.4-7.5 years), in-hospital mortality of 58 (1.1%), and 293 (5.5%) of whom met Phoenix sepsis criteria. The median total volume of fluid administered over the initial 24 hours of hospitalisation was 40.0 mL/kg (IQR 20.6-61.5 mL/kg), including: bolus fluid 10.0 mL/kg (IQR 9.4-19.9 mL/kg), maintenance fluid 27.1 mL/kg (IQR 10.2-47.3 mL/kg) and medication carrier fluid 0.0 mL/kg (IQR 0.0-0.9 mL/kg). In-hospital mortality increased with increasing volume of bolus fluid but not with increasing volume of total fluid (unadjusted OR for in-hospital mortality for >55 mL/kg vs <15 mL/kg bolus fluid: 20.5, 95% CI 8.0 to 52.5; p<0.001). CONCLUSION: Although maintenance fluids accounted for the largest proportion of total fluid volume, bolus fluids showed the strongest association with in-hospital mortality in unadjusted analyses.

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Journal
Archives of Disease in Childhood
Published
2026-05-22
DOI
https://doi.org/10.1136/archdischild-2025-330189
Primary Topic
Trauma, Hemostasis, Coagulopathy, Resuscitation
Type
article
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article

IV bolus, maintenance and medication carrier fluid in children with community-acquired sepsis: a multicentre cohort study

Fran Balamuth, Meredith Louise Borland, Emma Whyte, Amit Kochar et al.
Archives of Disease in Childhood
Trauma, Hemostasis, Coagulopathy, Resuscitation
article

IV bolus, maintenance and medication carrier fluid in children with community-acquired sepsis: a multicentre cohort study

Fran Balamuth, Meredith Louise Borland, Emma Whyte, Amit Kochar, Shane George, Ben Gelbart, Sarah McNab, Chris J Selman, NJ Phillips, Simon Craig, Stuart Dalziel, Amanda Williams, Anna Lithgow, Scott L Weiss, Nathan Kuppermann, Elliot Long, Shefali Jani, Franz E Babl, Eunicia Tan
article en

Abstract

OBJECTIVES: We set out to describe the amount of fluid administered within the first 24 hours of sepsis treatment with an exploratory analysis of associations. DESIGN: This prospective observational study used data from the Sepsis Epidemiology in Australian and New Zealand Emergency Departments Study, collected from 2021 to 2023. PATIENTS: Participants were children aged 0 years to <18 years with suspected community-acquired sepsis admitted to the hospital through 11 emergency departments in Australia and New Zealand. MAIN OUTCOMES: We describe the volumes of fluid administered and mortality rates associated with different fluid volumes. RESULTS: A total of 5352 patients were included in the analysis, with a median age of 2.6 years (IQR 0.4-7.5 years), in-hospital mortality of 58 (1.1%), and 293 (5.5%) of whom met Phoenix sepsis criteria. The median total volume of fluid administered over the initial 24 hours of hospitalisation was 40.0 mL/kg (IQR 20.6-61.5 mL/kg), including: bolus fluid 10.0 mL/kg (IQR 9.4-19.9 mL/kg), maintenance fluid 27.1 mL/kg (IQR 10.2-47.3 mL/kg) and medication carrier fluid 0.0 mL/kg (IQR 0.0-0.9 mL/kg). In-hospital mortality increased with increasing volume of bolus fluid but not with increasing volume of total fluid (unadjusted OR for in-hospital mortality for >55 mL/kg vs <15 mL/kg bolus fluid: 20.5, 95% CI 8.0 to 52.5; p<0.001). CONCLUSION: Although maintenance fluids accounted for the largest proportion of total fluid volume, bolus fluids showed the strongest association with in-hospital mortality in unadjusted analyses.

Archives of Disease in Childhood
Griffith University (AU), The University of Sydney (AU), Royal Children's Hospital (AU), Alfred I. duPont Hospital for Children (US), Children's Hospital of Philadelphia (US), University of Auckland (NZ), The University of Queensland (AU), The University of Melbourne (AU), The University of Western Australia (AU), George Washington University (US), Gold Coast Hospital (AU), Middlemore Hospital (NZ), Princess Margaret Hospital for Children (AU), Townsville Hospital (AU), Community Health Systems - Dupont Hospital (US), Monash Medical Centre (AU), Children's Hospital at Westmead (AU), Children’s Health Queensland Hospital and Health Service (AU), Women's and Children's Health Network (AU), Nemours Children's Health System (US), Auckland District Health Board (NZ), Royal Darwin Hospital (AU), Starship Children's Health (NZ), Murdoch Children's Research Institute (AU), Melbourne Health (AU)
Royal Children's Hospital Foundation, National Health and Medical Research Council
Good health and well-being
Openalex Percentile: Top 5%
Trauma, Hemostasis, Coagulopathy, Resuscitation
DOISourceOpenAlex
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