Trial reportAnnals of the Royal College of Surgeons of England2026
Chloride-guided bolus vs conventional fluid therapy for preoperative optimisation in infantile hypertrophic pyloric stenosis.
Trial report in Annals of the Royal College of Surgeons of England, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
introductionInfantile hypertrophic pyloric stenosis (IHPS) often presents with significant metabolic derangement requiring preoperative fluid resuscitation. Conventional fluid therapy (CFT) is widely used, but bolus fluid therapy (BFT), guided by serum chloride levels, may allow faster correction and improved outcomes. This study compared the safety and efficiency of BFT vs CFT in infants with IHPS.
methodsA single-centre randomised controlled trial was conducted over 30 months at a tertiary paediatric surgical unit in Pakistan. Infants aged 2-12 weeks with confirmed IHPS were randomly assigned to receive either CFT or BFT. CFT involved maintenance fluids with potassium supplementation and 6-hourly monitoring. BFT comprised 20ml/kg saline boluses tailored by initial chloride and bicarbonate levels, based on the Dalton algorithm, with monitoring before and after each bolus. Primary outcomes included time to biochemical optimisation, hospital stay, and number of laboratory tests.
resultsOne hundred infants were enrolled (
conclusionsChloride-guided BFT is a safe, efficient alternative to CFT for IHPS. It reduces time to correction, length of stay and investigation burden. Early discharge may also reduce nosocomial risk, offering particular benefit in resource-limited settings.
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