Abstract
Introduction
Current practice for major pediatric burns includes fluid resuscitation using formulas that estimate fluid requirements based on weight and/or body surface area (BSA) along with percent total burn surface area (TBSA). Adult studies have shown that these formulas can cause fluid overload in obese patients and increase risk of complications. These findings have not been validated in pediatric patients. This study aims to evaluate whether a weight-based resuscitation formula increases the risk of complications in obese children following burn injuries and compares fluid estimates to those that incorporate BSA.
Methods
A retrospective review was conducted on 110 children (≤ 18 years old) admitted to an ABA-verified urban pediatric burn center from October 2008 to May 2020. Patients had ≥15% TBSA, were resuscitated with the weight-based Parkland formula, and had fluids titrated to urine output every two hours (1 ml/kg/hr if ≤ 30kg; 0.5 ml/kg/hr if > 30kg). Demographics, burn type, and TBSA were collected on admission. BSA-based Galveston and BSA-incorporated Cincinnati formula resuscitation predictions were also calculated. Output and input volumes were collected at 8h and 24h post-injury. Complications were collected throughout the hospital stay. Patients were classified into CDC-defined weight groups based on percentile ranges. Statistical analysis was conducted using SPSS Statistics version 10.0.
Results
This study included 11 underweight, 60 normal weight, 18 overweight, and 21 obese children. Our patients had a mean age-based weight CDC percentile of 62.2%, and mean TBSA of 25.4%. Predicted resuscitation volumes increased as CDC percentile increased for all three formulas (p=0.033, 0.092, 0.038), however there were no significant differences between overweight and obese children. Total fluid administered was higher as CDC percentile increased (p=0.023). However, overweight children received more total fluid than obese children. The difference between total fluids given and Galveston predicted resuscitation volumes were significant across all groups (p=0.042); however, the difference using the Parkland and Cincinnati formulas were not statistically significant. There were more children in the normal weight group who developed complications compared to other groups, but these findings were not significant.
Conclusions
The Parkland formula tended to underpredict fluid needs in the underweight, normal weight, and overweight children, and it overpredicted fluid needs for the obese. Further research is needed to determine the value of weight-based vs BSA-based or incorporated formulas in terms of their risk of complications.
Nutrition treatment in pediatric burns patients
