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This trial addresses a very common bedside question: When a child with suspected septic shock needs crystalloid fluid, should we preferentially use Ringer's lactate/Plasma-Lyte-type balanced fluids rather than 0.9% saline?The biological argument is attractive: Saline has supraphysiologic chloride and may worsen hyperchloraemic acidosis and renal perfusion, while balanced fluids more closely resemble plasma.However, the real clinical question is not whether chloride falls; it is whether children survive more often, avoid dialysis, preserve kidney function and leave the hospital earlier.This was a large pragmatic, open-label, randomised trial conducted in 47 emergency departments (EDs) across the United States, Canada, Australia, New Zealand and Costa Rica.Children aged 2 months to under 18 years being treated in the ED for suspected septic shock with abnormal perfusion were eligible if they had received no more than 40 mL/kg crystalloid before enrolment.Patients were randomised to a balanced crystalloid strategy or 0.9% saline for bolus and maintenance fluids until 11:59 PM the next day, giving roughly 24-48 h of assignedfluid exposure.Balanced fluid could be lactated Ringer's, Plasma-Lyte or Hartmann's depending on site availability and clinician preference.Other care, including volume, rate, timing of fluids, vasoactives, ventilation and antibiotics, remained at the clinician's discretion.The primary outcome was major adverse kidney event within 30 days (MAKE30), defined as death, new renal replacement therapy or persistent kidney dysfunction.The trial was planned to detect a reduction from 6.0% to 4.3%, but the observed event rate was much lower.Of 9041 enrolled children, 559 withdrew permission for data use, leaving 4235 assigned to balanced fluid and 4247 to saline.Median age was 6.8 years; respiratory infection was the most common source; 14.2% received vasoactive drugs and 9.7% required invasive mechanical ventilation.Baseline acute kidney injury (AKI) was present in a meaningful minority: KDIGO stage 1 in 13.8%, stage 2 in 4.9% and stage 3 in 5.1%.The result was clinically straightforward.MAKE30 occurred in 137 of 4073 children, or 3.4%, in the balanced-fluid group and 124 of 4068, or 3.0%, in the saline group: Absolute difference 0.4 percentage points, 95% confidence interval (CI) -0.5-1.3;risk ratio 1.10, 95% CI 0.88-1.40;p = 0.85.Death within 30 days was almost identical: 0.97% versus 0.92%.New renal replacement therapy occurred in 0.62% versus 0.73%.Persistent kidney dysfunction at discharge occurred