Nine studies (n=1,189 reported and 1,231 calculated, range 27 to 512) were included in the review: six RCTs and three quasi-randomised trials. Three studies in children with dengue shock syndrome were of low risk of bias and one was at high risk of bias; all studies in children with severe malaria and the one study in children with sepsis were at high risk of bias. None of the studies were specifically designed or adequately powered to assess mortality as a primary outcome.
There was no evidence of statistical heterogeneity, but due to clinical heterogeneity odds ratios and 95% CIs were not pooled. The authors stated that three out of six studies that reported at least one death showed greater survival in children resuscitated with colloids compared to crystalloids (Peto OR ranged between 0.18, 95% CI 0.02 to 1.42 and 0.48, 0.06 to 3.99). However, the forest plots suggested that only one study showed a statistically significant difference in favour of colloids and the remaining five showed no statistically significant differences. Three studies that assessed the effect of human albumin solution on survival in children with severe malaria showed conflicting results. One study of children with sepsis found no statistically significant difference in the risk of mortality with fluids used (saline versus gelatin polymer).
There were no statistically significant differences in recovery from shock in children with sepsis or malaria who were resuscitated with different fluids. Studies in children with dengue shock reported greater efficacy of colloids compared to crystalloids for resolution of severe shock.
There was no evidence of publication bias using a funnel plot (data not presented).