Age-related patterns of intravenous infusion volume during severe burn toxemia in children

Abstract

Introduction. Severe thermal injury in children requires prolonged intensive care, including intravenous fluid administration beyond the initial resuscitation phase. During burn toxemia, the volume administered may vary with body size, burn characteristics, nutritional support, surgical interventions, and the evolving clinical condition. Assessment confined to the early postinjury period does not describe subsequent infusion exposure in children requiring prolonged treatment. Age-specific analysis of daily intravenous volumes may help characterize these treatment trajectories. However, absolute infusion volume must be distinguished from weight-adjusted fluid exposure, cumulative fluid balance, and fluid overload. Objective. To describe age-related differences and temporal patterns in daily intravenous infusion volume during the first 21 days of observation in children with severe burn toxemia requiring prolonged intensive care. Materials and Methods. A secondary descriptive analysis of aggregate data from a clinical dissertation study was performed. The analysis included 21 children who received treatment in the intensive care unit for 21–50 days. Patients were distributed across three age groups: 6 months–3 years (n = 8), 3.1–7 years (n = 7), and 7.1–18 years (n = 6). Daily group values of intravenous infusion volume were analyzed over a common 21-day observation interval. For each age group, arithmetic means of the daily group values were calculated for days 1–7, 8–14, and 15–21. Relative changes between the first and third intervals were determined. Burn depth and the extent of affected body surface were considered as descriptive clinical characteristics. Individual patient-level trajectories, body-weight-adjusted volumes, and complete fluid input and output data were unavailable. Consequently, hypothesis testing, multivariable analysis, and assessment of cumulative fluid balance or fluid overload were not performed. Results and Discussion. Mean daily group infusion volumes decreased across the three consecutive intervals in all age groups. In children aged 6 months–3 years, the corresponding values were 931.5, 788.3, and 760.1 mL/day. In those aged 3.1–7 years, they were 1548.2, 1423.9, and 1338.8 mL/day; in children aged 7.1–18 years, they were 1953.8, 1640.7, and 1585.8 mL/day. Relative decreases between days 1–7 and 15–21 were 18.4%, 13.5%, and 18.8%, respectively. Despite decreasing interval means, day-to-day fluctuations persisted, and intravenous administration continued throughout the observation period. The oldest age group received the largest absolute volumes, whereas the largest mean area of deep burns was recorded in children aged 3.1–7 years. The middle age group also showed the smallest numerical decrease in infusion volume. These group-level observations do not establish an individual association between burn depth and infusion requirements. Differences in body size, treatment composition, clinical complications, and the daily number of contributing patients may have influenced the observed trajectories. The findings therefore characterize administered treatment rather than its physiological necessity or effectiveness. Conclusion. Children with severe burn toxemia and prolonged intensive care demonstrated continuing intravenous infusion exposure over 21 observation days, with progressively lower interval means and persistent daily variability. Absolute infusion volumes and the magnitude of their decrease differed numerically across age groups. These findings support longitudinal documentation of intravenous administration alongside body weight, all sources of fluid intake, measured losses, perfusion indicators, and clinical events. The reported volumes should not be interpreted as age-specific prescribing targets, evidence of fluid overload, or proof of benefit from a restrictive infusion strategy. Patient-level analysis is required to determine whether the observed differences persist after adjustment for body weight, burn severity, and treatment-related factors.