Mapping the Evidence Gap in Pediatric Perioperative IV Fluid Management

Perioperative intravenous fluid therapy is a cornerstone of surgical care, yet the evidence guiding its use in children remains fragmented, sparse, and heavily extrapolated from adult populations. Children—particularly neonates and infants—have fundamentally different physiology, including immature neurohormonal systems, greater susceptibility to hypoglycemia and hyperglycemia, and distinct acid-base regulation. These differences make direct application of adult protocols potentially unsafe, yet most clinical guidelines lack robust pediatric-specific evidence to replace them.

This publication describes the protocol for a scoping review designed to comprehensively map the existing literature on perioperative intravenous fluid management in pediatric patients under 18 years of age undergoing elective non-cardiac surgery. The review will cover all three perioperative phases: the preoperative fasting and fluid replacement period, the intraoperative period, and the early postoperative period (up to 24 hours post-surgery). Researchers will examine the types of fluids studied—including balanced and unbalanced crystalloids, natural and synthetic colloids, and dextrose-containing solutions—along with their reported physiological effects and clinical outcomes.

The review will follow Joanna Briggs Institute (JBI) guidance for scoping reviews and will be reported using the PRISMA-ScR checklist. A comprehensive search will span MEDLINE (PubMed), Ovid, Embase, Web of Science, Cochrane CENTRAL, Google Scholar, and ClinicalTrials.gov, with no publication date restrictions and coverage of English, Spanish, and German literature. Eligible study designs include randomized controlled trials, observational studies (cohort, case-control, cross-sectional), and systematic reviews. Animal studies, case reports, and studies involving cardiac surgery, critical care settings, or emergency resuscitation will be excluded.

Primary outcomes of interest include perioperative fluid balance, hemodynamic stability, electrolyte disturbances, acid-base status, coagulation alterations (especially with synthetic colloids), and postoperative complications. Secondary outcomes include comparative efficacy between fluid types, adverse effects such as hyperchloremic acidosis and acute kidney injury, length of hospital stay, and postoperative morbidity. Neonates will be analyzed separately given their unique metabolic profile.

Because the available pediatric literature is too heterogeneous for a formal systematic review or meta-analysis at this stage, the scoping methodology is deliberately chosen to characterize the breadth and nature of existing evidence rather than evaluate effectiveness. Three independent reviewers will screen studies, extract data using a piloted template, and resolve discrepancies by consensus. Results will be presented descriptively in narrative and tabular formats. This protocol represents a necessary foundational step toward future evidence-based guidelines for pediatric perioperative fluid therapy.