FLUID MANAGEMENT IN NEONATES

Fluid management in neonates

Fluid Management in Neonates

Physiology: aInsensible aWater aLoss a(IWL)

Weight a<1000 agrams: a52 aml/kg/day

Weight a<1250 agrams: a56 aml/kg/day

Weight a<1500 agrams: a46 aml/kg/day

Weight a>1500 agrams: a26 aml/kg/day

Physiology: aNewborn aRenal alimits

Limits aare amore asevere ain ayounger agestation

Limited aability ato aconcentrate aor adilute aurine

Decreased aGlomerular aFiltration aRate

Decreased arenal ablood aflow

Decreased aresorption aof aGlucose, asodium, abicarbonate

Inability ato aexcrete aacid aand aphosphate aload

Physiology: aDecreased afluid arequirements

Renal aFailure aor acardiac afailure

Lower ainsensible awater aloss

High aAnti-Diuretic ahormone alevel

Physiology: aIncreased afluid arequirements

Excess aInsensible awater aloss

Fever

High aActivity

High arenal aloss

Monitoring aOf aFluid aand aElectrolyte aStatus

Body aweight

Serial aweight ameasurements acan abe aused aas aa aguide ato aestimate athe afluid adeficit ain anewborns. aTerm aneonates aloose a1-3% aof atheir abirth aweight adaily awith aa acumulative aloss aof a5-10% ain athe afirst aweek aof alife. aPreterm aneonates aloose a2-3% aof atheir abirth aweight adaily awith aa acumulative aloss aof a15-20% ain athe afirst aweek aof alife. aFailure ato aloose aweight ain athe afirst aweek aof alife ashould abe aan aindicator afor afluid arestriction. aHowever, aexcessive aweight aloss ain athe afirst a7 adays aor alater awould abe anon-physiological aand awould amerit acorrection awith afluid atherapy. a

Clinical aexamination

The ausual aphysical asigns aof adehydration aare aunreliable ain aneonates. aInfants awith a10% a(100 aml/kg) adehydration amay ahave asunken aeyes aand afontanel, acold aand aclammy askin, apoor askin aturgor aand aoliguria. aInfants awith a15% a(150ml/kg) aor amore adehydration awould ahave asigns aof ashock a(hypotension, atachycardia aand aweak apulses) ain aaddition ato athe aabove afeatures. aDehydration awould amerit acorrection aof afluid aand aelectrolyte astatus agradually aover athe anext a24 ahours.

Serum abiochemistry

Serum asodium aand aplasma aosmolarity awould abe ahelpful ain athe aassessment aof athe ahydration astatus ain aan ainfant. aSerum asodium avalues ashould abe amaintained abetween a135-145 ameq/L. aHyponatremia awith aweight aloss asuggests asodium adepletion aand awould amerit asodium areplacement. aHyponatremia awith aweight again asuggests awater aexcess ...