PECARN-Supported Study Delivers Answer on IV Fluid Choice in Pediatric Sepsis

FOR IMMEDIATE RELEASE April 27, 2026

Media Contact: Emily Lemiska 860-748-1349 communications@emscimprovement.center

Sepsis sends tens of thousands of children to U.S. emergency departments every year, and IV fluids are among the first treatments they receive. Until now, clinicians have not had definitive guidance on which fluid to reach for first. According to a major study published today in The New England Journal of Medicine, children treated for septic shock can be effectively managed with either of the two most commonly used IV fluids — 0.9% saline or balanced fluids such as lactated Ringer's solution.

The study enrolled a huge number of participants: more than 9,000 children across 47 emergency departments in five countries. In the United States, it was conducted through the Pediatric Emergency Care Applied Research Network (PECARN), part of the federal Emergency Medical Services for Children (EMSC) Program of the Health Resources and Services Administration. The trial was led by researchers at Children's Hospital of Philadelphia (CHOP), Nemours Children's Health, and Children's National Hospital, in collaboration with networks in Canada, Australia, New Zealand, and Costa Rica.

In the study, researchers tracked whether children with suspected septic shock experienced serious complications, including kidney injury and death, within 30 days of treatment. The rates were nearly identical regardless of which fluid was used: 3.4% in the balanced fluid group and 3.0% in the saline group. There were no meaningful differences in mortality, hospital length of stay, hospital-free days, and safety events such as thrombosis or cerebral edema. The investigators did confirm biochemical differences in children treated with these fluids, with a higher frequency of elevated blood chloride levels in the 0.9% saline group, and higher lactate levels in the balanced fluid group.

“This trial confirms that either balanced fluid or 0.9% saline are effective and safe for the initial resuscitation of children with suspected septic shock, and that a fluid strategy that reduces hyperchloremia does not necessarily translate to improved patient outcomes,” said Scott Weiss, MD, an attending physician and Division Chief of Critical Care at Nemours Children’s Hospital, Delaware, and co-lead author of the study. “We also did not identify differences across subgroups. However, despite the large number of participants, it is important to note that we cannot exclude the possibility of benefit of one fluid or the other in a subset of children with the most severe illness.”

"A large trial like this definitively answers a question we’ve had in our field for many years — and gives an actionable answer,” said Fran Balamuth, MD, PhD, attending physician and Division Chief of Emergency Medicine at CHOP and co-lead author of the study. “In an emergency department with a child with suspected sepsis, you can treat the child with whichever fluid is readily available for their initial therapy. And we think that’s great news for children around the world.”

For emergency physicians, nurses, and EMS clinicians, particularly those working in community settings where supplies and logistics vary, the results mean one less thing to worry about. Their focus can remain on rapid recognition and management of sepsis, not on which bag of fluid to choose.

"No single hospital, or even several hospitals, could have answered this question on their own,” said Nathan Kuppermann, MD, MPH, Executive Vice President and Chief Academic Officer of Children's National Hospital and senior author of the study. “That's exactly why PECARN exists, and why other similar networks around the globe exist — and why the EMSC Program's investment in PECARN matters so much for children's health.”

This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and

Human Development grant R01HD101528, the National Institute of Diabetes and Digestive and Kidney Diseases grant P50DK114786, Commonwealth of Pennsylvania Department of Health SAP #4100085749, the Medical Research Future Fund International Clinical Trial Collaboration grant GNT1190814, Canberra, Australia and the Canadian Institutes of Health Research grant 173498. Additional support was provided by the CHOP Research Institute and Alberta Children’s Hospital Research Institute. PECARN is funded through the EMSC Program of the Maternal and Child Health Bureau, Health Resources and Services Administration, under cooperative agreement awards U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, andU03MC22685. The Paediatric Research in Emergency departments International Collaborative (PREDICT) network was part funded by a National Health and Medical Research Council Centre of Research Excellence grant GNT2024601, Canberra, Australia, the Murdoch Children's Research Institute, Parkville, Australia, and the Victorian Government’s Operational Infrastructure Support program, Melbourne, Australia.

About PECARN

Now in its 25th year, the Pediatric Emergency Care Applied Research Network (PECARN) – part of the Health Resources and Services Administration’s Emergency Medical Services for Children Program – is the first and only federally funded research network dedicated to advancing clinical knowledge in pediatric emergency care. PECARN leverages the power of investigators across 18 emergency departments and 9 EMS agencies nationwide to conduct high-quality research into acute illnesses and injuries affecting children across the emergency care continuum. Learn more at https://pecarn.org/.

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