Survey of current maintenance intravenous fluids prescribing practices among Egyptian pediatricians

Abstract

Abstract Background Recent research has firmly linked the administration of hypotonic fluids with the incidence of hospital-acquired hyponatremia in pediatric patients. Objective This study examined the prevailing practices in prescribing maintenance intravenous fluids (mIVFs) among Egyptian pediatricians, assessed the compliance of current prescribing practices with the American Academy of Pediatrics Clinical Practice Guidelines (AAP-CPG), and emphasized the urgency for revised educational initiatives. Materials and methods To recruit pediatricians for this study, a convenience and snowballing sampling methods were used. The questionnaire was created in Google Forms and then distributed in English to Egyptian Facebook groups devoted to pediatric education. The data collection phase started on January 1, and ended on February 28, 2022. Different case scenarios with increased antidiuretic hormone were introduced, and respondents were asked to choose the optimum mIVFs in each case scenario. Finally, respondents were directly asked how often they use isotonic fluids as their primary mIVFs and what caused them to not use isotonic fluids. Results For this study, a total of 513 participatants were included. The survey revealed that Egyptian pediatricians did not not fully comply with AAP-CPG regarding the mIVFs in pediatrics. Hypotonic fluids are still preferred, but there is a shift towards 0.45% sodium chloride (NaCl) from the previously favored 0.2% NaCl. Isotonic fluids are more common in older age groups and conditions that involve potential excessive antidiuretic hormone secretion, while 0.2% NaCl remains popular in neonatal care. Balanced solutions are underused, indicating practice variation. Conclusions The utilization of isotonic fluids in the treatment of neurologic conditions has experienced a notable increase, propelled by heightened awareness and a growing demand for continuous medical education. To comprehensively address concerns related to fluid management beyond the scope of AAP-CPG, it is imperative to conduct multicenter studies across governmental, private, and educational pediatric healthcare settings to assess and improve pediatracians' clinical practice.

Keywords

• Pediatrics
• Maintenance intravenous fluids
• Hypotonic fluids
• Pediatrics clinical practice guideline