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Parenteral versus enteral fluids for infants hospitalized with bronchiolitis: The PREFER shared decision-making
Peter J Gill1,2,3,4, Francine Buchanan1,3,4, Christine Fahim5
1Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
This study explores shared decision-making (SDM) for fluid choices in hospitalized infants with bronchiolitis. It investigates how parents participate in selecting intravenous (IV) or nasogastric (NG) fluids and the outcomes of these treatments.
Area of Science:
- Pediatric Hospital Medicine
- Shared Decision-Making
- Clinical Practice Guidelines
Background:
- Shared decision-making (SDM) is a priority in pediatric hospital care.
- Bronchiolitis management involves differing fluid recommendations (intravenous vs. nasogastric).
- Parental involvement in SDM for fluid selection in bronchiolitis is not well understood.
Purpose of the Study:
- To assess the extent of SDM between parents and clinicians when choosing between intravenous (IV) or nasogastric (NG) fluids for infants with bronchiolitis.
- To evaluate parent knowledge, treatment outcomes, and complications associated with IV vs. NG fluid selection.
Main Methods:
- A multicenter, prospective, observational study involving infants under 12 months with bronchiolitis requiring IV or NG fluids.
- Utilized the CollaboRATE tool to measure the primary outcome: the extent of SDM.
- Secondary outcomes included parent choice, knowledge, fluid rates, length of stay, and complications.
Main Results:
- This section is to be filled once the study is completed and results are available.
Conclusions:
- The study aims to provide crucial insights into SDM for fluid therapy in hospitalized infants with bronchiolitis.
- Findings will inform clinical practice by evaluating patient-centered and clinical outcomes relevant to fluid selection.
Introduction:
Incorporating shared decision-making (SDM) with children and families in hospitals was a top priority identified by patients, caregivers, and clinicians. Bronchiolitis, a common and costly reason for hospitalization in children, is an exemplar condition to study SDM in hospitals. Internationally, clinical practice guidelines differ when recommending intravenous (IV or parenteral) or nasogastric (NG or enteral) fluids for hospitalized infants with bronchiolitis who are unsafe to be fed orally. While evidence indicates that either IV or NG fluids are safe and effective, parent involvement in SDM in selecting IV or NG fluids is unknown. Our aim is to generate knowledge of SDM with parents in choosing between IV or NG fluids and the benefits and harms of these two treatment options for hospitalized children with bronchiolitis.
Method:
This is a multicenter, prospective, observational study, including children aged <12 months admitted to hospital with bronchiolitis requiring supplemental IV or NG fluids. The primary outcome will evaluate the extent of SDM in choosing IV versus NG fluids using the validated CollaboRATE tool. Secondary outcomes include the proportion of parents provided a choice of IV versus NG fluids; parent knowledge of fluid therapy; rate of fluids; length of hospital stay; and complications.
Discussion:
This study will evaluate the extent of SDM in hospitalized infants with bronchiolitis who require IV or NG fluids and will evaluate both patient-centered and clinical outcomes that are relevant to clinical practice.
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