Every year, over a million children in sub-Saharan Africa die in hospital from severe infections, often within hours of arrival. Doctors have antimalarial and antimicrobial drugs, but these treatments take time to work—and most children die from complications before the drugs can take effect. Supportive care, such as giving fluids intravenously, could buy that time, but no one knows whether rapid fluid infusion (volume expansion) actually saves lives or causes harm. As a result, most children currently receive little or no extra fluid. The FEAST trial is a multi-centre study designed to settle this question definitively. It will test whether giving saline or albumin—a safe by-product of blood transfusion—improves disability-free survival in children with severe febrile illness and signs of poor blood flow. If either fluid proves beneficial, the approach is cheap and could be adopted immediately into international treatment guidelines. That would mean thousands of children’s lives saved each year, using a simple intervention that costs pennies per dose. This is not fundamental science; it is a direct test of a practical, life-or-death question that has gone unanswered for too long.
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In hospitals throughout sub-Saharan Africa case fatality rates for severe infections in childhood remains at 15-30%. In this region well over a million children die of severe infection in hospital each year. Currently, antimalarial and antimicrobial drugs are the mainstay of treatment, however most deaths occur early, due to the complications of severe illness, and before definitive treatments have time to act. In this situation doctors have to rely upon supportive therapies to treat complications and try to improve outcome. Defining which are the best life saving treatments has been frustrated by the lack of clinical trials addressing this issue. Correction of fluid deficits by rapid infusion (volume expansion) is practised routinely for sick children presenting for emergency care and would be a logical supportive treatment for African children with severe illness and signs of impaired perfusion. Currently, reticence to adopt this approach remains and so most children are managed with little or no additional fluid. In these circumstances the method resolving uncertainty is though in a clinical trial. FEAST is a multi centre study which aims to address this question and to definitively establish whether volume expansion with saline or albumin improves disability-free survival and whether this is best achieved by saline, a cheap a widely used solution or the more expensive colloid, albumin (a safe bi-product of a blood transfusion). If benefit were shown it could potentially save thousands of lives of young children annually. Preliminary analysis suggest that this represents a highly cost effective method for improving child survival and which could be easily adopted within future international guidelines for treating children with severe illness and signs of impaired perfusion.
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