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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 1 Death.
Figuras y tablas -
Analysis 1.1

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 1 Death.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 2 Severe neurological sequelae.
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Analysis 1.2

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 2 Severe neurological sequelae.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 3 Mild to moderate neurological sequelae.
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Analysis 1.3

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 3 Mild to moderate neurological sequelae.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 4 Hemiparesis/hemiplegia.
Figuras y tablas -
Analysis 1.4

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 4 Hemiparesis/hemiplegia.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 5 Spasticity.
Figuras y tablas -
Analysis 1.5

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 5 Spasticity.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 6 Seizures.
Figuras y tablas -
Analysis 1.6

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 6 Seizures.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 7 Visual impairment.
Figuras y tablas -
Analysis 1.7

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 7 Visual impairment.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 8 No response to sound.
Figuras y tablas -
Analysis 1.8

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 8 No response to sound.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 9 Oedema.
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Analysis 1.9

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 9 Oedema.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 10 Total body water ‐ fall after 48 hours.
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Analysis 1.10

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 10 Total body water ‐ fall after 48 hours.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 11 Extracellular water ‐ fall after 48 hours.
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Analysis 1.11

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 11 Extracellular water ‐ fall after 48 hours.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 12 Serum sodium.
Figuras y tablas -
Analysis 1.12

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 12 Serum sodium.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 13 Urinary sodium.
Figuras y tablas -
Analysis 1.13

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 13 Urinary sodium.

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Comparison 1 Maintenance fluids versus restricted fluids, Outcome 14 Plasma osmolality ‐ change after 48 hours.
Figuras y tablas -
Analysis 1.14

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 14 Plasma osmolality ‐ change after 48 hours.

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Summary of findings for the main comparison. Maintenance fluids versus restricted fluids for acute bacterial meningitis

Maintenance fluids versus restricted fluids for acute bacterial meningitis

Patient or population: paediatric patients with acute bacterial meningitis

Settings: hospital inpatient department

Intervention: maintenance fluids

Comparison: restricted fluids

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Restricted fluids

Maintenance fluids

Death ‐ all participants

Study population

RR 0.82

(0.53 to 1.27)

407
(2 studies)

⊕⊕⊝⊝
low1,2

186 per 1000

153 per 1000

(99 to 237)

Moderate risk population

213 per 1000

175 per 1000

(113 to 271)

Severe neurological sequelae ‐ acute (within the first 4 weeks)

Study population

RR 0.67
(0.41 to 1.08)

407
(2 studies)

⊕⊕⊝⊝
low1,2

176 per 1000

118 per 1000

(72 to 191)

Moderate risk population

252 per 1000

169 per 1000

(103 to 272)

Severe neurological sequelae ‐ chronic (after the first 4 weeks)

Study population

RR 0.42
(0.20 to 0.89)

351
(1 study)

⊕⊝⊝⊝
very low3,4

121 per 1000

51 per 1000

(24 to 108)

Moderate risk population

121 per 1000

51 per 1000

(24 to 108)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Total number of events is small and 95% CI around pooled estimate includes both appreciable benefit and harms.
2Duke 2002 and Singhi 1995 both were deemed to have high risk of bias for blinding. However, this would not have any effect on outcome assessment for the outcome of death and acute severe neurological sequelae. Singhi 1995 was deemed at high risk for reporting bias but we did not downgrade for risk of bias because sensitivity analyses did not change effect estimates significantly.
3Duke 2002 ‐ high risk of bias due to improper blinding would affect outcome assessment for chronic severe neurological sequelae.
4 Total number of events is not large enough for precision.

Figuras y tablas -
Summary of findings for the main comparison. Maintenance fluids versus restricted fluids for acute bacterial meningitis
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Comparison 1. Maintenance fluids versus restricted fluids

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 All participants

2

407

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.53, 1.27]

1.2 Participants with hyponatraemia

1

26

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 2.50]

1.3 Participants without hyponatraemia

1

24

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.16, 3.90]

2 Severe neurological sequelae Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Acute (within the first 4 weeks)

2

407

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.41, 1.08]

2.2 Chronic (after the first 4 weeks)

1

351

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.20, 0.89]

2.3 Participants without hyponatraemia

1

24

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.13, 2.64]

2.4 Participants with hyponatraemia

1

26

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.34, 2.47]

3 Mild to moderate neurological sequelae Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Hemiparesis/hemiplegia Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Spasticity Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5.1 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Seizures Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 Within the first 72 hours

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Visual impairment Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

7.1 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 No response to sound Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

8.1 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Oedema Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

9.1 Acute facial oedema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.2 Acute pulmonary oedema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.3 Acute hydrocephalus

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Total body water ‐ fall after 48 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

10.1 Participants without hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.2 Participants with hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Extracellular water ‐ fall after 48 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

11.1 Participants without hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 Participants with hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Serum sodium Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

12.1 All participants (24 hours)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.2 Participants with hyponatraemia (48 hours)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.3 Participants without hyponatraemia (48 hours)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.4 Change from baseline at 48 hours ‐ without hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.5 Change from baseline at 48 hours ‐ with hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

13 Urinary sodium Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

13.1 Participants without hyponatraemia (48 hours)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

13.2 Participants with hyponatraemia (48 hours)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

13.3 Change from baseline at 48 hours ‐ without hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

13.4 Change from baseline at 48 hours ‐ with hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Plasma osmolality ‐ change after 48 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

14.1 Participants without hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.2 Participants with hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 1. Maintenance fluids versus restricted fluids
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