Child shock guidelines 'are deadly'

Child with severe malarial infection

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Thousands of children could be dying each year because the World Health Organization has not updated guidelines for treating those going into shock, UK researchers warn.

They say the advice to give large quantities of fluid is deadly.

The updated guidelines in 2013 did not recommend a change, which the researchers described as "disappointing and puzzling".

The WHO said it had to be "very vigilant" when changing guidelines.

And that it aimed to publish a new set of interim guidelines by early 2015.

Start Quote

We're very concerned that two and a half years later the guidelines have not changed”

End Quote Prof Kathryn Maitland Imperial College London
Disagreement

Critically ill patients can go into shock as a result of severe infections, such as malaria, or fluid loss. It changes the way blood flows around the body leaving patients looking pale.

The recommended treatment is "rapid fluid resuscitation" - a large injection of fluid via a drip.

This brings children out of shock, but a large study on children in Africa in 2011 suggested it was also deadly.

Three more children out of every 100 treated would die with fluid resuscitation when compared with those slowly given small quantities of fluid, the study indicated.

In those with the most severe shock, 48% died with the resuscitation compared with 20% given the low fluid doses, it suggested.

Prof Kathryn Maitland, a paediatrician with the Medical Research Council and Imperial College London, criticised the WHO for not changing guidelines in its latest update.

She told the BBC: "We're very concerned that two and a half years later the guidelines have not changed."

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We have to be very vigilant in making recommendations”

End Quote Dr Elizabeth Mason World Health Organization
Thousands dying

She said there was a lack of data on the precise number children being diagnosed with shock.

But she added: "We can be confident that if hospitals follow the guidelines, there will be excess mortality... it is likely to run into thousands."

The WHO said the study came three-quarters of the way through the last update and that systematically assessing all the evidence on managing shock would have delayed the other guidelines.

Dr Elizabeth Mason, the WHO's director of maternal, newborn, child and adolescent health, told the BBC: "It was a fairly difficult decision, but we don't make decisions based on one study alone, even if it is fairly groundbreaking.

"As an organisation we have to be very vigilant in making recommendations, we need a systematic review of the evidence otherwise with every new study we could be changing WHO guidelines."

She said new interim guidelines were "anticipated by the end of the year or the beginning of next year".

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