342 - Change in Practice of Maintenance Intravenous fluid therapy in Pediatric Population before versus after October 2015: A Population based Cohort Study.

Poster Number: 342
Publication Number: 342.1318

Background: Hypotonic maintenance intravenous (IV) fluid has been associated with high rates of hyponatremia and complications in hospitalized children. In 2015 isotonic fluid was recommended for maintenance fluids in a New England Journal of Medicine (NEJM) article in response to this growing concern, and in 2018 isotonic fluid was recommended by the American Academy of Pediatrics (AAP). Little is known about how these recommendations were adopted.

Objective: Determine the change in rate of use of hypotonic and isotonic intravenous solutions in hospitalized children during the 10-year span surrounding the 2015 NEJM article, the exposure. The hypothesis is that new guidelines led to a change in clinical practice, and widespread adoption of the new fluid management guidelines. The change will be detected by using real world data to compare the proportions of hospitalized children who receive isotonic fluids for maintenance therapy as stored in the Epic Electronic Medical Records.

Design/Methods: We used data from Epic database and Integrated Data Repository (IDR) over a 10-year period, which also includes age, race, details of Intravenous fluids, diagnosis, medications, and laboratory test results.

Inclusion criteria:
-Age: 2 months to 18 years
-IV fluids in the hospital 24 hours after admission, thus avoiding resuscitation, replacement and restoration fluids.
-Jan. 2012 to Jan. 2022

Exclusion Criteria:
-Abnormal sodium levels at admission
-Patients with head trauma or stroke for whom hypernatremia is induced.

Results: We completed preliminary analysis on the data on IV fluid therapy. Out of the total 107,000 maintenance fluid encounters, 42% received isotonic fluids, 0.5% received fluids with tonicity in the range of 120-129 milliequivalents per liter (meq/l) and 57% received hypotonic fluids with tonicity less than 120 meq/l. The incidence of isotonic fluid therapy was 36% from 2012 to 2016, and 47% from 2017 to 2021, with the highest incidence in 2021. A Chi-square test indicated a significant change in practice, with Chi square statistic of 1474, p= <.00001.

Conclusion(s): A change in practice is noted after 2017, although to our knowledge there was no unified, concerted effort to change the practice of IV fluid management. Analysis of the remaining data can be used to evaluate for changes in the complication rate of IV fluid management using real world data.