Abstract
INTRODUCTION: Infantile hypertrophic pyloric stenosis (IHPS) often presents with significant metabolic derangement requiring preoperative fluid resuscitation. Conventional fluid therapy (CFT) is widely used, but bolus fluid therapy (BFT), guided by serum chloride levels, may allow faster correction and improved outcomes. This study compared the safety and efficiency of BFT vs CFT in infants with IHPS. METHODS: A single-centre randomised controlled trial was conducted over 30 months at a tertiary paediatric surgical unit in Pakistan. Infants aged 2-12 weeks with confirmed IHPS were randomly assigned to receive either CFT or BFT. CFT involved maintenance fluids with potassium supplementation and 6-hourly monitoring. BFT comprised 20ml/kg saline boluses tailored by initial chloride and bicarbonate levels, based on the Dalton algorithm, with monitoring before and after each bolus. Primary outcomes included time to biochemical optimisation, hospital stay, and number of laboratory tests. RESULTS: One hundred infants were enrolled (n = 50 per group). The BFT group achieved faster correction (7.1 ± 2.2h vs 71.5 ± 10.3h; p = 0.001), shorter hospital stay (118.6 ± 29.9h vs 154.5 ± 37.3h; p = 0.001), and fewer laboratory tests (3.2 ± 0.9 vs 4.8 ± 1.1; p = 0.02). No complications occurred. CONCLUSIONS: Chloride-guided BFT is a safe, efficient alternative to CFT for IHPS. It reduces time to correction, length of stay and investigation burden. Early discharge may also reduce nosocomial risk, offering particular benefit in resource-limited settings.