{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T19:05:40Z","timestamp":1789931140122,"version":"4.0.1"},"reference-count":20,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["MR\/R018502\/1"],"award-info":[{"award-number":["MR\/R018502\/1"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R018502\/1"],"award-info":[{"award-number":["MR\/R018502\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child"],"accepted":{"date-parts":[[2026,4,27]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the efficacy and safety of intravenous rehydration (IVR) versus oral rehydration (OR) strategies in children with severe acute malnutrition (SAM) and severe dehydration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Lower-to-middle-income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Children with SAM are hospitalised with severe dehydration secondary to gastroenteritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Randomised trials of IVR and OR (standard of care)<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Primary: in-hospital mortality. Secondary: fluid overload events, development of shock requiring intravenous boluses, severe electrolyte abnormalities at 24 hours and day 28 mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified three RCTs comprising 484 participants with severe malnutrition (72 had kwashiorkor, two had some risk of bias, and one had low risk of bias). The pooled risk ratio (RR) for in-hospital mortality for IVR versus OR is 0.71 (95% CI 0.46 to 1.10; I\n                      <jats:sup>2<\/jats:sup>\n                      =0.0%) with moderate certainty of evidence. No fluid overload events were reported, pooled RR 0.99 (95% CI 0.10 to 9.35). The pooled RR of severe hyponatraemia (sodium &lt;125\u2009or &lt;130\u2009mmol\/L) at 24 hours was 0.66 (95% CI 0.44 to 0.99). Only one trial reported RR for shock development, hypernatraemia (sodium &gt;145\u2009mmol\/L) or 28-day mortality with IVR versus OR (RRs 0.56, 95% CI 0.21 to 1.48; RR 2.05, 95% CI 0.50 to 8.58\u2009and RR 0.85, 95% CI 0.44 to 1.65,\u2009respectively). Subgroup analyses for in-hospital mortality were carried out for region and risk of bias rating, giving p=0.85\u2009and p=0.54 for heterogeneity, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The estimated effect of using IVR versus OR in children with SAM with severe dehydration ranges from a 54% relative reduction to a 10% relative increase in the risk of death, with IVR resulting in fewer adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42025637956.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/archdischild-2026-330358","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T17:20:18Z","timestamp":1779297618000},"page":"866-872","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Intravenous rehydration in children with severe malnutrition and severe dehydration: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"111","author":[{"given":"Juan Emmanuel","family":"Dewez","sequence":"first","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"San Maurice","family":"Ouattara","sequence":"additional","affiliation":[{"name":"Epicentre Niger, Magaria, Niger"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0369-8830","authenticated-orcid":false,"given":"Temmy","family":"Sunyoto","sequence":"additional","affiliation":[{"name":"Medecins Sans Frontieres, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9181-3050","authenticated-orcid":false,"given":"Christabel Kemunto","family":"Mogaka","sequence":"additional","affiliation":[{"name":"KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3345-5971","authenticated-orcid":false,"given":"Matthew E.","family":"Coldiron","sequence":"additional","affiliation":[{"name":"Epicentre, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0615-7543","authenticated-orcid":false,"given":"Hadiza Alhaji","family":"Sainna","sequence":"additional","affiliation":[{"name":"Medecins Sans Frontieres, Maiduguri, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9751-2608","authenticated-orcid":false,"given":"Roberta","family":"Petrucci","sequence":"additional","affiliation":[{"name":"Paediatric Emergency Unit, Department of Paediatrics, Medecins Sans Frontieres, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2928-3580","authenticated-orcid":false,"given":"Elizabeth C","family":"George","sequence":"additional","affiliation":[{"name":"Medical Research Council Clinical Trials Unit at University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0007-0645","authenticated-orcid":false,"given":"Kathryn","family":"Maitland","sequence":"additional","affiliation":[{"name":"Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"2026091802150972000_111.10.866.1","unstructured":"Pocket book of hospital care for children 2nd edition. 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Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach, 2013. 2013:15."},{"key":"2026091802150972000_111.10.866.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)07499-6"},{"key":"2026091802150972000_111.10.866.16","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e318180af27"},{"key":"2026091802150972000_111.10.866.17","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-017-1679-0","article-title":"Myocardial and haemodynamic responses to two fluid regimens in African children with severe malnutrition and hypovolaemic shock (AFRIM study)","volume":"21","author":"Obonyo","year":"2017","journal-title":"Crit Care"},{"key":"2026091802150972000_111.10.866.18","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2431-10-71","article-title":"Phase II trial of isotonic fluid resuscitation in Kenyan children with severe malnutrition and hypovolaemia","volume":"10","author":"Akech","year":"2010","journal-title":"BMC Pediatr"},{"key":"2026091802150972000_111.10.866.19","doi-asserted-by":"publisher","DOI":"10.1111\/apa.15134"},{"key":"2026091802150972000_111.10.866.20","doi-asserted-by":"crossref","DOI":"10.1186\/1475-2891-10-92","article-title":"Are diagnostic criteria for acute malnutrition affected by hydration status in hospitalized children? 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