Decision
Is child maintaining hydration?
Background
Fluid Administration
Infants with respiratory difficulty who develop nasal flaring, increased work of breathing, and prolonged expiratory wheezing may have difficulty maintaining hydration and adequate nutrition intake. Historically, clinicians worried that respiratory effort may increase risk of aspiration. However, more recent studies have demonstrated that aspiration events with enteral feeding in patients with bronchiolitis are rare regardless of the type of respiratory support provided. Children who are at risk for dehydration due to respiratory distress should be transferred to a higher level of care for further evaluation. Discussion with the accepting clinician on preferred method of hydration should be discussed. Because enteral feeds allow patients to receive nutrition in addition to hydration, nasogastric feeds are now preferred over intravenous (IV) hydration.
When using IV fluids for hydration, isotonic fluids appear to be safer in general than hypotonic solutions. A 2014 meta-analysis showed that, among hospitalized children who required maintenance fluids, the use of hypotonic fluids was associated with significant hyponatremia compared to the use of isotonic fluids.
