Journal Club: Subcutaneous rehydration trial has promising results for dehydrated children

The first pediatric study of recombinant human hyaluronidase (rHuPH20)-facilitated subcutaneous hydration demonstrated that the procedure is safe, well tolerated, and effective in children with mild-to-moderate dehydration. The study was conducted in 51 children from 2 months to 10 years of age (mean age, 1.9 years) who presented to emergency departments (EDs) of 9 US hospitals with symptoms of dehydration during a 10-month period. Using a 24-gauge angiocatheter or needle inserted into the midanterior thigh or interscapular area, investigators injected one 1-mL dose of rHuPH20 subcutaneously followed by a continuous, pump-facilitated, subcutaneous infusion of 20 mL/kg isotonic fluid over 1 hour. Infusion was continued with or without electrolytes up to 72 hours as needed. The rHuPH20 injections were repeated every 24 hours if continued subcutaneous hydration was required to a maximum of 3 injections.

In 90.2% of patients, initial subcutaneous catheter placement was achieved with 1 attempt in the ED, where rehydration was successful for 84.3% of patients. In addition, hydration was completed during hospitalization in another 9.8%, bringing the total of successful subcutaneous rehydrations to 94.1%. No treatment-related systemic adverse events were reported. Although all the children experienced infusion site reactions, the severity of these reactions varied widely, and none were severe enough to require site changes. Finally, investigators found the procedure easy to perform in almost all children, and 90% of parents were "satisfied" or "very satisfied" with it (Allen CH, et al. Pediatrics. 2009;124[5]:e858-e867).

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