A Comprehensive Systematic Review of The Relationship between Fluid Restriction Management and The Prevention of Complications in Dengue Hemorrhagic Fever in Children

Introduction: Dengue Hemorrhagic Fever (DHF) in children remains a significant global health challenge, with fluid management being a cornerstone of treatment. However, the optimal fluid strategy—restrictive versus liberal—remains controversial, particularly in preventing complications such as shock, organ dysfunction, and mortality (Wills et al., 2005). Methods: A systematic review was conducted following PRISMA guidelines. Studies were screened based on predefined criteria including pediatric population (0–18 years), restrictive fluid intervention, comparison groups, and outcomes related to DHF complications. Data extraction covered study characteristics, fluid protocols, complication outcomes, and clinical context.Results: A total of 53 studies were included, predominantly from dengue-endemic regions. Restrictive or protocol-driven fluid management was consistently associated with reduced mortality, shorter ICU and hospital stays, and lower incidence of respiratory complications and fluid overload compared to liberal strategies (Ranjit et al., 2005; Tang, 2017; Naorungroj et al., 2025).Discussion: The effectiveness of fluid management depends on clinical setting, disease phase, and resource availability. In well-monitored ICU settings, aggressive early resuscitation followed by de-escalation is beneficial, whereas in resource-limited settings, minimal or restrictive approaches may be safer (Ford et al., 2012; Liyanarachchi et al., 2022). Conclusion: A tailored, context-sensitive fluid management strategy—incorporating adequate initial resuscitation, vigilant monitoring, and timely de-escalation—is essential to optimize outcomes in pediatric DHF. Future studies should standardize definitions and protocols across diverse healthcare settings.