Professor Maitland and colleagues recently published the results of a large international study to examine the role of fluid boluses in the management of seriously ill febrile children in Africa.1 While the study was extremely well conducted, we are seriously concerned about the conclusions and implications of the paper, which states: The results of this study challenge the importance of bolus resuscitation as a life-saving intervention in resource-limited settings for children with shock who do not have hypotension and raise questions regarding fluid-resuscitation guidelines in other settings as well.

Already in the UK, the media has responded with alarming headlines, such as ‘a trial in Africa has raised major questions about the safety of the routine treatment given to children suffering from shock in the UK and other developed countries’.2 The consequences of responding positively to this message and not treating hypovolaemic shock with intravenous fluid boluses could be extremely serious for children in both poorly resourced and developed countries.

In our opinion, the study was inappropriately designed with respect to patient selection and as a result was probably treating children with serious febrile illnesses due to the most common of medical problems, namely pneumonia and malaria, but …